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An increasing number of studies exploit the occurrence of unexpected events during the fieldwork of public opinion surveys to estimate causal effects. In this paper, we discuss the use of this identification strategy based on unforeseen and salient events that split the sample of respondents into treatment and control groups: the Unexpected Event during Survey Design. In particular, we focus on the assumptions under which unexpected events can be exploited to estimate causal effects and we discuss potential threats to identification, paying especial attention to the observable and testable implications of these assumptions. We propose a series of best practices in the form of various estimation strategies and robustness checks that can be used to lend credibility to the causal estimates. Drawing on data from the European Social Survey, we illustrate the discussion of this method with an original study of the impact of the Charlie Hebdo terrorist attacks (Paris, 01/07/2015) on French citizens’ satisfaction with their national government.

PurposeTo report outcomes of autologous simple limbal epithelial transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) at multiple centres worldwide.MethodsIn this retrospective, multicentre, interventional case series, records of patients who had undergone autologous SLET for unilateral LSCD, with a minimum of 6 months of follow-up, were reviewed. The primary outcome measure was clinical success, defined as a completely epithelised, avascular corneal surface. Kaplan–Meier survival curves were constructed and survival probability was calculated. A Cox proportional hazards analysis was done to assess association of preoperative characteristics with risk of failure. Secondary outcome measures included the percentage of eyes achieving visual acuity of 20/200 or better, percentage of eyes gaining two or more Snellen lines and complications encountered.Results68 eyes of 68 patients underwent autologous SLET, performed across eight centres in three countries. Clinical success was achieved in 57 cases (83.8%). With a median follow-up of 12 months, survival probability exceeded 80%. Presence of symblepharon (HR 5.8) and simultaneous keratoplasty (HR 10.8) were found to be significantly associated with a risk of failure. 44 eyes (64.7%) achieved a visual acuity of 20/200 or better, and 44 eyes (64.7%) gained two or more Snellen lines. Focal recurrences of pannus were noted in 21 eyes (36.8%) with clinical success.ConclusionAutologous SLET is an effective and safe modality for treatment of unilateral LSCD. Clinical success rates and visual acuity improvement are equal to or better than those reported with earlier techniques.

There is a growing interest in analyzing what citizens think about democracy. However, gauging citizens’ opinions about a complex concept such as democracy might be hindered by the apparent low levels of political sophistication of mass publics. This paper contributes to the emerging literature on citizens’ views and evaluations of democracy by analyzing to what extent ordinary citizens are capable of developing structured opinions about democracy and its constitutive principles. For this purpose, the paper adapts Converse’s notion of political belief systems to analyze the articulation of individuals’ democracy belief systems (DBS). The first goal of this paper is to conceptualize and operationalize the main components of individuals’ DBS: cognitive availability, horizontal constraint, and vertical constraint. Drawing on data from the sixth round of the European Social Survey, the second goal is to describe the articulation of DBS in Europe. The third and final aim of this paper is to trace the most relevant individual- and country-level correlates of the articulation of the three components of DBS. In line with recent findings about political belief systems in other policy domains, the results indicate that most Europeans have coherently structured attitudes about democracy. However, even if the results imply that Europeans have a relatively articulated DBS, the empirical analysis also reveals some individual- and country-level variation in the articulation of specific components of DBS.

While elections are an instrument to hold politicians accountable, corrupt politicians are often re-elected. A potential explanation for this paradox is that citizens trade-off integrity for competence. Voters may forgive corruption if corrupt politicians manage to deliver desirable outcomes. While previous studies have examined whether politicians’ competence moderates the negative effect of corruption, this paper focuses on voters’ priorities and directly assesses what citizens value more: integrity or favourable outcomes. Using a survey experiment, we assess citizens’ support for politicians who violate the law in order to improve the welfare of their community and, in some cases, benefit personally from these violations. The results indicate that citizens prefer a politician who follows the law, even if this leads to a suboptimal outcome. However, voters are more likely to overlook violations of the law that benefit the community if these do not result in a personal gain for politicians (i.e., in the absence of corruption). These findings suggest that the mild electoral punishment of corruption may be due to the public’s unawareness of private gains from malfeasance, or to the delay in these private benefits becoming apparent by election day.

Introduction A multicountry monkeypox disease (MPX) outbreak began in May 2022 in Europe, leading to the assessment as a potential Public Health Emergency of International Concern (PHEIC) on June 23, 2022. Some observational studies have partially characterised clinical features, hospitalisations, and deaths. However, no systematic reviews of this MPX outbreak have been published. Methods We performed a systematic review with meta-analysis, using five databases to assess clinical features, hospitalisations, complications and deaths of MPX confirmed or probable cases. Observational studies, case reports and case series, were included. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In addition, we carried out a subgroup analysis according to the continents and a sensitivity analysis excluding studies classified as having a high risk of bias. Results A total of 19 articles were included, using only 12 articles in the quantitative synthesis (meta-analysis). For 1958 patients, rash (93%, 95% CI 80–100%), fever (72%, 95% CI 30–99%), pruritus (65%, 95% CI 47–81%), and lymphadenopathy (62%, 47–76%), were the most prevalent manifestations. Among the patients, 35% (95% CI 14–59%) were hospitalised. Some 4% (95% CI 1–9%) of hospitalised patients had fatal outcomes (case fatality rate, CFR). Conclusion MPX is spreading rapidly, with a third of hospitalised patients, but less than 5% with fatal outcomes. As this zoonotic virus spreads globally, countries must urgently prepare human resources, infrastructure and facilities to treat patients according to the emerging guidelines and the most reliable clinical information.

Purpose: To evaluate the long-term safety and efficacy of simultaneous total corneal wavefront-guided transepithelial photorefractive keratectomy (TCWG-TransPRK) with accelerated corneal cross-linking (CXL) in mild to moderate keratoconus, incorporating corneal biomechanics as objective markers of structural stability. Methods: This prospective, interventional, single-center study included patients with mild to moderate keratoconus. All underwent TCWG-TransPRK (maximum planned stromal ablation: 55 µm) followed by accelerated CXL (30 mW/cm2 for 3 minutes; total fluence: 5.4 J/cm2). Follow-up was conducted at 24 hours, 1 week, and 1, 3, 6, and 12 months. Primary outcomes were safety and efficacy, with stress-strain index version 2 (SSI v2) proposed as a key objective marker of biomechanical stability. Additionally, refractive accuracy, tomography, and epithelial remodeling were evaluated. Results: Thirty-eight eyes from 19 patients were analyzed. At 12 months, uncorrected distance visual acuity improved from 0.80 ± 0.36 to −0.03 ± 0.10 logarithm of the minimum angle of resolution (P < .0001), with 87% achieving 20/20 and all 20/40 or better. Corrected distance visual acuity improved (P < .0001), with no Snellen line loss. Refractive accuracy was high (89% within ±1.00 diopter). SSI v2 increased significantly (P < .0001), indicating enhanced intrinsic stiffness. No keratoconus progression was observed. Epithelial thickness increased nasally and temporally, correlating with changes in spherical aberration and vertical trefoil. Conclusions: Despite the use of accelerated CXL parameters, TCWG-TransPRK with CXL improved vision and enhanced biomechanical stability, as evidenced by a significant increase in SSI v2. This provides an objective structural marker for monitoring and customizing keratoconus care. These findings support the procedure as a safe and effective option for non-progressive mild to moderate keratoconus.

Plasmatic uric acid (UA) has been inconsistently associated with diabetic retinopathy (DR). Specific sight-threatening stages of DR have not been studied for their association with UA. Cross-sectional, comparative study. Between 2014 and 2018 we recruited 210 Mexican individuals > 18 years-old with type 2 diabetes (T2D). Clinical, ophthalmological and biochemical assessment was performed with standardized funduscopic examination. Certified readers classified DR stages. The association between DR and UA was assessed by multiple logistic regression analysis, calculating odds ratios (OR) and 95% CI, after adjustment for covariates. Two hundred and ten patients were included, 41 (19.5%) had referable DR. Subjects with referable (severe or worse) DR had longer diabetes duration, 22 (15–28) vs 15 (8–20) years ( P  < 0.01); higher levels of UA, 6.5 (5.8–8.1) vs 5.4 (4.5–6.6) mg/dL ( P  < 0.01); higher systolic blood pressure, 130 (120–140) vs 120 (110–130) mmHg ( P  < 0.01); higher diastolic blood pressure, 78.4 ± 9.7 vs 75.4 ± 9.2 mmHg ( P  = 0.03); and lower glomerular filtration rate , 54.1 (41.5–69.6) vs 87.3 (66.8–108.3) mL/min/1.73m 2 ( P  < 0.01) compared with those without referable DR. With multiple logistic regression, after adjustment, per each unit of change (mg/dL) in UA the probability of having referable DR increased 45% (OR = 1.45, 95% CI 1.12–1.87, P  < 0.01). When UA was evaluated as dichotomous variable, those with levels ≥ 7.8 mg/dL had almost two times (OR = 2.81, 95% CI 1.00–7.9., P  = 0.049) the probability of having referable DR compared with those with levels < 7.8 mg/dL. UA may contribute to the microvascular damage in retinal vessels and therefore hyperuricemia could be a therapeutic target to prevent DR progression.

SARS-CoV-2 is a novel β-coronavirus that caused the COVID-19 pandemic disease, which spread rapidly, infecting more than 134 million people, and killing almost 2.9 million thus far. Based on the urgent need for therapeutic and prophylactic strategies, the identification and characterization of antibodies has been accelerated, since they have been fundamental in treating other viral diseases. Here, we summarized in an integrative manner the present understanding of the immune response and physiopathology caused by SARS-CoV-2, including the activation of the humoral immune response in SARS-CoV-2 infection and therefore, the synthesis of antibodies. Furthermore, we also discussed about the antibodies that can be generated in COVID-19 convalescent sera and their associated clinical studies, including a detailed characterization of a variety of human antibodies and identification of antibodies from other sources, which have powerful neutralizing capacities. Accordingly, the development of effective treatments to mitigate COVID-19 is expected. Finally, we reviewed the challenges faced in producing potential therapeutic antibodies and nanobodies by cell factories at an industrial level while ensuring their quality, efficacy, and safety.

In this paper, we analyze the short-term impact of the Russian invasion of Ukraine on Europeans’ attitudes toward democracy. For this purpose, we leverage the coincidence of the Russian invasion of Ukraine on February 24, 2022 with the fieldwork of the European Social Survey in 10 countries. By means of an unexpected event during survey design, we analyze the impact of the invasion on 12 different attitudes toward democracy, including overt support for democracy, satisfaction with democracy, as well as the importance attributed to particular democratic principles. The results of this comprehensive analysis reveal that the invasion did not have a substantive impact on individuals’ attitudes toward democracy. The invasion of a neighboring democratic country by an autocratic power did not alter Europeans’ satisfaction with democracy, their support for this political regime, or the importance they attribute to different democratic principles.

The research trend in additive manufacturing (AM) has evolved over the past 30 years, from patents, advances in the design, and layer-by-layer materials, to technologies. However, this evolution is faced with some barriers, such as the implementation of additive manufacturing (AM) in operations, its productivity limitations, and economic and social sustainability. These barriers need to be overcome in order to realize the full potential of AM. The objective of this study is to analyze the bibliometric data on these barriers through a systematic review in two study areas: business model innovation and sustainability in AM from Industry 4.0 perspective. Using the most common keywords in these two study areas, we performed a search on the Web of Science (WoS) and Scopus databases and filtered the results using some inclusion and exclusion criteria. A bibliometric analysis was performed for authorship productivity, journals, the most common keywords, and the identified research clusters in the study areas. For the bibliometric analysis, the BIBEXCEL software was used to extract the relevant information, and Bibliometrix was used to determine the research trend over the past few years. Finally, a literature review was performed to identify future trends in the study areas. The analysis showed evidence of the relationship between the study areas from a bibliometric perspective and areas related to AM as an enabler for Industry 4.0.