The Balkanization of Politics: Crime and Corruption in Albania

In the last few years, Albania, as well as other South Eastern and Mediterranean countries, have shown increased growth in corruption affecting every level of political power. Organized crime is becoming more sophisticated as it consolidates links between Albanian clans and the wider criminal world. According to the EU, the FBI and other police organization reports, while the situation concerning organized crime and corruption is grave throughout the Balkans, it is especially so in Albania, even as its authorities are continuing to implement talks for future membership in the EU. Efforts to combat this problem have thus far been insufficient. Authorities appear to not admit the full extent of criminal links among individuals across state offices, the police and politics. In many areas the traffickers work with the complicity of police and customs officials and enjoy the protection of high-ranking politicians. Corruption remains endemic and is destined to seriously undermine efforts for democratization of the society. This is a sort of vicious cycle: every institution in Albania is affected by organized crime which hampers democracy and economic development; any attempts to change the situation, like the Stability Pact for South Eastern Europe seem to be ineffective. This paper aims to analyze the problem of corruption and illegality in the current period in Albania and to measure its infiltration, via local authorities, into every level of the political, economic and social life.EU-East-Central Europe; transparency; democratization; civil society; pre-negotiation

How a lasting settlement to the Russia-Ukraine war can be achieved

For Ukraine’s citizens to return to a normal way of life, it will be necessary to establish a sustainable peace between the country and Russia. Daniela Irrera argues a coherent debate on the future settlement in Ukraine should not wait for the end of hostilities – it should start now and involve the commitment of western powers

NGO-led rescue operations in the Mediterranean: saving people, alleviating EU responsibilities

Several EU governments have sent ships to the Mediterranean as part of efforts to tackle the ongoing migration crisis, but a number of non-governmental actors have also been involved in conducting operations. Daniela Irrera writes on the role of these actors and whether overreliance on NGOs could prove problematic if there is an upturn in attempted crossings in the central Mediterranean following the EU’s agreement with Turkey

Simulating conflict resolution dynamics and fostering negotiation skills

The article discusses the use of simulations as an active learning tool and explores their suitability in International Relations (IR) studies, involving different student populations. Previous negotiation experiences are used to describe Game of Peace, a negotiation model, developed by the author, for encompassing students in taking on the role of several factions involved in a civil war. By assessing students’ feedbacks, it is here sustained that simulations are extremely functional to IR courses, in improving learning abilities, encouraging skills and relational capacities, and in bringing theories and concepts to real life. The article consists of three parts. Firstly, the most recent literature on simulations is assessed in order to reflect on the suitability of simulations; secondly, the Game of Peace experience is presented in its major steps, roles and interactional features. Lastly, its main outcomes are used for assessing its pedagogical impact and envisaging further research.El artículo analiza el uso de simulaciones como una herramienta de aprendizaje activo y explora su idoneidad en los estudios de Relaciones Internacionales (RR. II.), que involucran a diferentes poblaciones de estudiantes. Las experiencias de negociación anteriores se utilizan para describir Game of Peace, un modelo de negociación, desarrollado por el autor, para abarcar a los estudiantes en el papel de varias facciones involucradas en una guerra civil. Al evaluar los comentarios de los estudiantes, aquí se sostiene que las simulaciones son extremadamente funcionales para los cursos de RR. II., para mejorar las habilidades de aprendizaje, fomentar las habilidades y capacidades relacionales, y para llevar las teorías y conceptos a la vida real. El artículo consta de tres partes. En primer lugar, se evalúa la literatura más reciente sobre simulaciones para reflexionar sobre la idoneidad de las simulaciones; en segundo lugar, la experiencia del Game of Peace se presenta en sus principales pasos, roles y características de interacción. Por último, sus principales resultados se utilizan para evaluar su impacto pedagógico y prever más investigaciones

NGOS AND THE EU REGARDING THE MANAGEMENT OF SYRIAN REFUGEES IN TURKEY

Based on the assumption that there are different approaches to the activities of non-governmental non-governmental organizations (NGOs) implementing migrant and refugee policies, the author attempts to answer the following questions: - What impact can NGOs have on EU Member States and on migrants and refugees ? - Can long-term and sustained experience in emergencies have such an impact? - Does the work of the NGO within the Fund, along with international agencies and the Red Cross, affect EU policy and relations withTurkeyin this policy area? The article is divided into three parts. In the first, non-state actors (NGOs) are analyzed within the framework of theoretical studies on migration and humanitarian strategy. The second one deals with the EU's relations withTurkeythrough the aforementioned lenses. Third, empirical funding data provided by ECHO to non-governmental organizations is used to evaluate arrangements and developments. The data is used to evaluate future prospects. The article notes that the events of the last decade have called into question the values and practices of the EU. It is shown that European NGOs seek to play an executive role in the implementation of EU humanitarian projects for Syrian refugee camps inTurkey. The author concludes that non-state actors remain important but controversial actors in the implementation of EU policy. NGOs have different approaches and their ideological and political differences are reflected in their relationship with political power. The author emphasizes the increasing critical attitude towards the lack of EU solidarity, especially in matters of emergency management interventions carried out by non-state SAR operations. Thirdly, the author points out that, in parallel with practices that typically replace states and the EU, NGOs support a consolidated partnership with ECHO. The growing role of non-state actors in managing sensitive global crises such as migration and refugees has been demonstrated. The risk for the EU is the loss of the chance to manage the crisis as a laboratory and a model of functional coordination that can be implemented and secured in the rest of the world system

Molecular and computational diagnostic approach identifies FOXP3, ICOS, CD52 and CASP1 as the most informative biomarkers in acute graft versus host disease.

BACKGROUND: Acute graft-versus-host disease is a severe complication of allogeneic stem cell transplantation in which the functional immune cells of the donor recognize the recipient as foreign and mount an immunological attack. There is an urgent need for better diagnostic instruments for the assessment of acute graft-versus-host disease. In the present study, a novel bioinformatics framework was used to identify gene expression patterns associated with acute graft-versushost disease in patients undergoing allogeneic hematopoietic stem cell transplantation. DESIGN AND METHODS: Peripheral blood cells were collected prospectively from patients who did develop acute graftversus-host disease (YES) and from those who did not (NO). Gene expression profiling was performed using a panel of 47 candidate genes potentially involved in alloreactive responses. The entire population of YES/NO acute graft-versus-host disease patients formed the experimental validation set. Personalized modeling based on a gene selection technique was applied to identify the most significant mRNA transcripts, which were then used to profile individual data samples for training and testing the classification/prediction framework. RESULTS: A leave-one-out cross-validation procedure was performed to investigate the robustness of the classification framework producing the following results: 100% on the training dataset and 97% on the testing dataset. According to our integrated methodology, transcripts for FOXP3, ICOS, CD52 and CASP1, genes involved in immune alloreactive responses and participating in immune cell interactions, were identified as the most informative biomarkers in allogeneic stem cell transplant recipients experiencing acute graft-versus-host disease. CONCLUSIONS: This study demonstrates that the integrated methodology proposed is useful for the selection of valid gene targets for the diagnosis of acute graft-versus-host disease, producing satisfactory accuracy over independent clinical features of the allogeneic transplanted population

Emerging Evidence and Treatment Perspectives from Randomized Clinical Trials in Systemic Sclerosis: Focus on Interstitial Lung Disease

Systemic sclerosis (SSc) is a complex rare autoimmune disease with heterogeneous clinical manifestations. Currently, interstitial lung disease (ILD) and cardiac involvement (including pulmonary arterial hypertension) are recognized as the leading causes of SSc-associated mortality. New molecular targets have been discovered and phase II and phase III clinical trials published in the last 5 years on SSc-ILD will be discussed in this review. Details on the study design; the drug tested and its dose; the inclusion and exclusion criteria of the study; the concomitant immunosuppression; the outcomes and the duration of the study were reviewed. The two most common drugs used for the treatment of SSc-ILD are cyclophosphamide and mycophenolate mofetil, both supported by randomized controlled trials. Additional drugs, such as nintedanib and tocilizumab, have been approved to slow pulmonary function decline in SSc-ILD. In this review, we discuss the therapeutic alternatives for SSc management, offering the option to customize the design of future studies to stratify SSc patients and provide a patient-specific treatment according to the new emerging pathogenic features of SSc-ILD

Autologous Haematopoietic Stem Cell Transplantation and Systemic Sclerosis: Focus on Interstitial Lung Disease

Autologous hematopoietic stem cells transplantation (AHSCT) has been employed as treatment for severe systemic sclerosis (SSc) with high risk of organ failure. In the last 25 years overall survival and treatment-related mortality have improved, in accordance with a better patient selection and mobilization and conditioning protocols. This review analyzes the evidence from the last 5 years for AHSCT-treated SSc patients, considering in particular the outcomes related to interstitial lung disease. There are increasing data supporting the use of AHSCT in selected patients with rapidly progressive SSc. However, some unmet needs remain, such as an accurate patient selection, pre-transplantation analysis to identify subclinical conditions precluding the transplantation, and the alternatives for post-transplant ILD recurrence

The COVID-19 Assessment for Survival at Admission (CASA) Index: A 12 Months Observational Study

Objective: Coronavirus disease 2019 (COVID-19) is a disease with a high rate of progression to critical illness. However, the stratification of patients at risk of mortality is not well defined. In this study, we aimed to define a mortality risk index to allocate patients to the appropriate intensity of care. Methods: This is a 12 months observational longitudinal study designed to develop and validate a pragmatic mortality risk score to stratify COVID-19 patients aged ≥18 years and admitted to hospital between March 2020 and March 2021. Main outcome was in-hospital mortality. Results: 244 patients were included in the study (mortality rate 29.9%). The Covid-19 Assessment for Survival at Admission (CASA) index included seven variables readily available at admission: respiratory rate, troponin, albumin, CKD-EPI, white blood cell count, D-dimer, Pa02/Fi02. The CASA index showed high discrimination for mortality with an AUC of 0.91 (sensitivity 98.6%; specificity 69%) and a better performance compared to SOFA (AUC = 0.76), age (AUC = 0.76) and 4C mortality (AUC = 0.82). The cut-off identified (11.994) for CASA index showed a negative predictive value of 99.16% and a positive predictive value of 57.58%. Conclusions: A quick and readily available index has been identified to help clinicians stratify COVID-19 patients according to the appropriate intensity of care and minimize hospital admission to patients at high risk of mortality

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations