Facebook profiles of leading media outlets in the United Kingdom, France, and Germany. In a combination of qualitative pragmalinguistic analysis and quantitative analysis, we examined their comment sections concerning the conceptual and linguistic repertoire of verbal antisemitism in these three languages as well as to the frequency of antisemitic utterances. The corpus comprises 4500 comments (1500 for each language) made in reaction to the media’s Facebook posts reporting on an escalation phase of the Arab–Israeli conflict in May 2021. Since in antisemitism studies, Israel—and issues related to it—are widely perceived as today’s main pretext for communicating antisemitic resentment, unsurprisingly, those events led to the emergence of antisemitic content online. This article contrasts the findings of antisemitism in the three countries’ comment sections and illustrates them by presenting a variety of linguistic realisations of various antisemitic concepts and illustrates the corresponding steps of interpretation.We conducted a cross-national study on antisemitic hate speech on the  Community Security Trust  but also on the phrase one . The comments we chose for this purpose are examples of the most frequent antisemitic concepts. However, they are not representative of certain types of comments but serve to illustrate linguistic realisations of which there are countless. At the same time, a certain phrase may appear several times in a similar way in our corpora. However, since the corpora are limited in size, we cannot highlight such similarities as recurring patterns, as it could be a coincidental accumulation.On the following pages, we present our corpus and methodology as well as a short description of those antisemitic concepts that appeared most prominently in the corpus and whose verbal realisations are discussed later on. After this, we give an overview of the distribution of antisemitic concepts—and comments in general—in the three-country subcorpora. Subsequently, in the section “Qualitative findings”, the linguistic characteristics of our corpus will be explored. Here, we will present the results of our qualitative content analysis of the threads examined, that is how antisemitic comments are verbalised by BBC, Daily Mail, The Guardian, The Independent, The Spectator, The Telegraph, The Times, Daily Express, Daily Mirror, Financial Times, Metro and The Sun, while the French corpus was collected from Le Monde, Libération, Le Figaro, Le Parisien, Le Point, L’Express, and 20 min As to the German corpus, the study was conducted on Bild, FAZ, Focus, n-tv, rp-online, Der Spiegel, Süddeutsche Zeitung, taz, Die Welt, and Die Zeit. The study focuses on threads on the Facebook profiles of these media. This allowed us to overcome the limits set by paywalls and the deactivated comment sections of certain media outlets and to collect a great number, and wide range, of users’ reactions. In order to make the datasets comparable and subject them to consistent qualitative corpus analysis, we applied a rule-based selection of Facebook threads and comments. For threads to be relevant for the corpus the corresponding Facebook post had to relate to Hamas rocket fire or the Israeli army’s retaliations. In the case of the German subcorpus they combined both. Depending on the number of threads available in each of the languages 100–150 comments were coded  in order to achieve an evenly distributed number of comments throughout the threads of a subcorpus.The goal of this analysis was to investigate antisemitic hate speech in comment sections of mainstream media. This choice shifts the focus away from radical fringes of the political spectrum and is in line with the fact that antisemitism is communicated throughout society—and stresses the necessity to understand patterns of antisemitism in those discourse spaces. Therefore, the leading British, French and German media outlets were selected to build our corpus. As far as the British corpus is concerned, the analysis was conducted on Due to its high level of acceptance, we use the working definition of the International Holocaust Remembrance Alliance (IHRA) as a basis for the identification of antisemitic posts.2evilpower, greed, child murderinstrumentalisation of the holocaust, nazi analogy, denial of israel’s right to exist)  form, it still requires additional complexity in order that it can be utilised as an analytical tool in web communications research. The extensive operationalisation resulted in a detailed list of 57 stereotypes and topoi—considering the main components of anti-Judaism of the Middle Ages, racial antisemitism of early modern times, secondary antisemitism after 1945 as well as Israel-related antisemitism—according to which antisemitic utterances can be precisely categorised on the content level. Therefore, the list consists of classical stereotypes In addition to the content-related phenomena covered by recourse to research on antisemitism, we drew on linguistic and discourse-analytical research in order to better understand the language and imagery through which antisemitic ideas are conveyed online today.Since antisemitism in the politically moderate web milieus we studied collides with culturally developed, collective self-images—resulting that web users who want to communicate antisemitic ideas run the risk of being sanctioned—it is all the more important to take implicit patterns of language use into account. That is, users rather do not communicate an antisemitic stereotype explicitly, but they choose communicative detours through which the same concept of devaluation and exclusion remains, but its presentation appears concealed  taboo of criticism asserts that freedom of expression would be curtailed when it comes to issues concerning Jews and/or Israel.The topos of a sole guilt of israel for the arab-israeli conflict assigns the general responsibility for the conflict—and for being attacked—to Israel. (It is an adaptation of blaming jews for antisemitism.) This blanket attribution combines the stereotype of Jews as troublemakers with ideas of an inherent aggressiveness.The idea of a denying jews the right to self-determination in their own state can for instance be expressed by targeting or denying Israel’s legitimacy or negating it altogether.apartheid analogy in reference to Israel alleges that a system of structural racist oppression would exist in Israel. A similar and more general concept is that of Israel being a racist state—without connecting it to a specific historic scenario.The colonialism analogy. By equating Israel to past colonising states or their actions it asserts that the state of Israel would be a colonialist enterprise itself or that it would occupy the West Bank for colonialist reasons – the former deligitimising the sovereignty of Israel.Closely related to those concepts is the Facebook pages of leading media outlets in the UK reveals a frequency of antisemitic statements twice as high as in the other two countries: 26.9% of 1504 analysed comments. 12.6% of 1500 comments on Facebook pages of French mainstream media were antisemitic—almost the same share as for leading German media outlets: 13.6% of 1520 comments.The recent escalation in the Arab–Israeli conflict triggered extensive coverage across all three countries and generated a consistent number of antisemitic responses in social media. However, the results of our analyses demonstrate that these vary greatly between countries. The analysis of There are various reasons for the high presence of antisemitism in the comment sections of British media. On the one hand, due to the prevalence of English around the world, posts in British media attract an international audience, which possibly contributes to the spread of antisemitism.israel’s sole guilt in the conflict (27.9%), child murder (8.1%), the denial of jewish self-determination (7.7%), apartheid (5.2%) and nazi (4.2%) analogies, as well as amorality (4%).For 38.7% of the antisemitic comments in the UK corpus, the thread’s context was decisive for inferring the hidden meaning. The most frequently communicated concepts were, in this order, evil (39.8%), evil stereotype (46.8%). Other antisemitic concepts French users evoke most often are denial of jewish self-determination (17.8%), colonialism (13.1%) and nazi analogies (7.8%), child murder (11%) and amorality (6.3%).The analysis conducted on the French corpus reveals that around 62% of the antisemitic comments required the wider context of the thread to be taken into account in order to determine their antisemitic character. Almost half of the antisemitic comments present the evil (41.0%), israel’s sole guilt in the conflict (10.1%), jewish/israeli influence on the media (8.2%), a taboo of criticism towards Israel (8.2%), the apartheid analogy (6.2%), child murder (5.8%), and denial of jewish self-determination (5.3%).For the German comments sections, 48.3% of the antisemitic meanings could only be inferred via the context. The most frequent antisemitic attributions were those of evil stereotype serves as the basis for further topoi, be it by means of the depiction of Israel as a nazi or apartheid state, or the sole culprit in the conflict. The conceptualisation of Israel as the last existing colonial state plays a greater role in the French corpus than in its British equivalent. Inversely, the accusation of an apartheid regime as well as the concept of israel’s sole guilt in the conflict is less present in the French debates.It is striking that attributions towards Israel of being essentially evil or committing major evil have been by far the most frequent in all three countries—that is to say that Israel is principally connected to a range of demonising evaluations that are regularly repeated and shared across the countries. The child murder and the denial of jewish self-determination. The former evidently continues to serve as a perennial mode of antisemitism. The latter ties in with the antisemitic conceptualisation of Israel as such: the end of Israel’s existence one way or the other, with the foreseeable catastrophic consequences for its Jewish population.Moreover, there are two shared dominant topoi in all three country discourses: taboo of criticism is far more prominent in Germany than France or the UK. This difference may be due to the centrality within German antisemitic discourses of the idea that German consciousness of guilt for the Holocaust has made Jews virtually untouchable, whether through social desirability or the influence of an (un)determined power, and that both this guilt and untouchability should be rejected. There is also relatively little appearance of the stereotype of jewish/israeli influence on the media in the UK and France. With regard to the UK, the majority of commenters who dismiss the image of Israel presented in the British media do so solely by accusing the latter of a pro-Israeli bias . This accusation is compatible with the notion of a jewish influence on the media—an interesting contrast to this more overt allegation found in the British corpus.The topos of Facebook users reacted to the escalation phase in the Arab–Israeli conflict in the three countries under investigation. However, a larger amount of data would have been necessary in order to conduct quantitative analyses and then provide statistically significant results. It is for this reason that for this study only a qualitative approach was adopted and whose findings will be presented in the following section.These numbers shed light on both the differences and similarities in the way Facebook profiles of The BBC, Daily Express, Daily Mail, The Financial Times, The Guardian, The Independent, The Mirror, The Spectator, The Telegraph, and The Times (cf. sources).The analysis of the British corpus focuses on the first 150 comments of ten threads that were taken from the evil stereotype stands out, especially when the articles focus directly on Israel’s reaction to the Hamas rocket fire.The UK media’s comment sections bring to light that commenters frequently direct various antisemitic stereotypes against Israelis (and Jews)—whether linguistically or via imagery (or both). Among the predominant ones, the evil of the world is expressed by a dichotomy between Israel and the world: “Th[is] country throw[s the] world into war” ; “Israe” (BBC-FB). In oth” .Regarding negative ascriptions of this kind, it may be argued that only Israel or the Israeli state is meant. The following example, however, illustrates that a line is not drawn between the state and its population: “Same old. Israelis using 21st-century technology supplied by the West to slaughter Palestinians and steal their homes” (BBC-FB)—nor do evil stereotype can also be expressed implicitly, e.g., via wordplay , demons”, Tel-FB).evil stereotype—like all other topoi of antisemitism – has adapted to new communicative conditions over time. Accordingly, web users may present Israel as a strikingly evil force by enriching it conceptually and framing the country as a criminal or even terrorist state: “built by brutal gangsters” (Gua-FB); “Zion is built on terrorism” ; “terrom” (FT-FB).nazi analogy occurs in various forms in the corpus. Explicit forms are direct equations  or overt references to the historical perpetrators  through which the classic construction of comparison, based on the scheme X is like Y, gets modified . Based Extermination plan is a term strongly linked to the plans of the Nazis to annihilate the Jewish population of Europe. The same holds true with regard to the word resistance in particular contexts in order to refer to Hamas, like in the following rhetorical question: “Terror groups? [Was] the French resistance a ‘terror group’? =” . In oth” (Spe-FB).Other commenters use references to the Nazi scenario, not to equate Israel with it, but again to allude to the evil character of Jews and by doing so, to justify Nazi crimes: “the big dùde of Germany (Hïtłèr) once saīd that “ he côuld’ve kįlléd em all, but hė left some so people can know why he did that” (Tel-FB).racist state and/or society: “Above all, Israel is an apartheid based country that has been occupying Palestine since 1948”  Israel per se.Next to references to Nazi Germany, commenters regularly equate Israel to apartheid South Africa or depict it more generally as a ” (Ind-FB). Next tMandela alluding to South Africa, Gandhi to colonised India).It is interesting to observe that even in comments that criticise the Palestinian side, the apartheid analogy  is used to argue for the renunciation of terror on the Palestinian side: “If I were being sanctimonious, then I’d say that the Palestinians have had multiple examples of successful non-violent self-determination movements to draw on—Gandhi, MLK, Mandela—but they’ve instead opted for a self-destructive policy of zero-sum eternal war with Israel. How’s that working out for them in a world where India and South Africa are independent sovereign nations?” (Spe-FB). Even tBlack Lives Matter movement, i.e., by means of a changed label, the Hamas–Israel conflict is subtly placed in the context of racism in Western societies. In this way Israel is accused of structural discrimination against Palestinians, ignoring the complex genesis of the conflict, as well as the role of Islamism: “This is the equivalent of […] blaming George Floyd that he stopped breathing under the knee of (yet another) militant police officer” , users r” (FT-FB); cf. alr” (FT-FB), or “Isr” (FT-FB).jews are to blame for antisemitism) becomes apparent. The following comment subtly expresses the idea that Jews themselves are to blame for the hatred they have been subjected to ever since: “I wonder why the British government sent the jews away to philistine and didn’t keep them in its own land >” ; “If I ” (BBC-FB).Other examples present comparisons that foreground a disproportionate, highly unjust relationship—closely linked to scenarios of violence , murderevil nature and sole guilt in the conflict is also presented in combination with slurs and the denial of the jewish state’s right to exist: “It’s not Israel Palestine until 1948 then these scums came begging for safety and bit the hand that fed them” .immoral, hypocritical and deceitful, which has already been echoed in the latter example, is further developed in many other comments. Here, users conceptualise Israel as a state that sees deceit and obfuscation as acceptable means for its own advancement. E.g., users accuse Israelis of presenting themselves as victims in order to generate political capital out of their deliberate continuation of the conflict, and suggest they are willing to accept civilian casualties on the Palestinian side in order to do so: “Israels government is doing this on purpose to try and boost the ailing election ratings of the evil man in power at the moment” .The antisemitic idea of Jews being t” (DE-FB) and “Nojewish-zionist influence on British media .Also, users complemented such imputations by the accusation of a secret arrangement between Israel and the British royal family, put forward to manipulate public opinion about the conflict —or theyLe Monde, Le Figaro, Libération, Le Parisien, Le Point, 20 min, and L’Express.The French corpus was composed of the first 100 comments posted in reaction to 15 different articles from 7 mainstream media outlets: devil stereotype tends to be associated with the Israeli government’s actions against Palestinians rather than with the old belief that Jews would adhere to the Anti-Christ.Focusing on Hamas rocket fire and IDF’s retaliation, these articles elicited hostility towards Israel and Israelis rather than Jews. Our analysis clearly shows that, nowadays, classical antisemitic stereotypes are adapted to the current situation. For instance, as we will see, the evil entities constitutes the most frequent stereotype. This representation is exaggerated and nuanced in different ways, according to the specific event it refers to. The more condemnable the action is to the eyes of the user, the more emphasised the evil attributions are. This is shown in a comment posted in reaction to an article from Le Monde: “it’s the only people in the world boasting of killing human beings” . The usterrorist state to Israel. Out of the 1500 comments analysed, 32 present and define Israel as a terrorist state, like in the following example: “A terrorist, racist, homophobic state that kills children, women and handicapped persons” . In thiOn the contrary, the interpretation of the following comment could be slightly different: “These are victims of the Israeli terrorism, civilians, children, women, elders… Israeli terrorism has no limit” . Contraterrorist state not through verbal expression but rather through visual elements made available by computer-mediated communication, in this case the symbol “=”.In 4 comments, the users resort to the means made available by computer-mediated communication: “Isra-Hell = terrorists” . In thiA discursive feature characterising these comments is the fact that through the argumentative maxim of the act Plantin, , the useterrorist state is a form of generalisation since the user transposes the actions undertaken by a certain government to the entire population.As stated before, considering and presenting Israel as a evil entities is through the analogy between Israel and the Nazi regime. Most of the time this nazi analogy is activated by comparing, more or less indirectly, the violence faced by the Palestinians in the current conflict and the Jews in the Nazi scenario. However, this analogy may be presented in different ways. In a thread from Le Parisien, a user describes Gaza as “a new open-air concentration camp” . Here, nazi analogy reveals the antisemitic character of this statement. More precisely, according to this user, Nazi and Israelis are implicitly presented as perpetrators who would justify and, as a consequence, legitimise, the murder of the respective victim group  by using the same argumentative strategy.On the contrary, in a thread taken from the Facebook page of Le Monde, another user refers to a previous comment stating: “The same discourse as Nazis’ when Jews killed German soldiers” . The prnazi analogy since, according to the user, two originally separate and distinct groups, that is Nazis and Zionists, form a single and merged entity.Furthermore, in some of the comments that we analysed, the analogy was operated through the process of the denomination. In these cases, by using compound words, the user designates their target  as Nazis like in the comment “the Nazi-Zionists” . This pcolonialism analogy. Here, Israelis are perceived and presented as colonisers and, more precisely, as foreign people who occupy the territory of Israel, as shown in the following comment: “A land that is being stolen by new settlers coming from Europe” . The fal, Par-FB). Howevel, Par-FB).Facebook. Web users thus had information on both events and the connection between them and they were able to incorporate them equally into their assessment and evaluation of this conflict phase. The dual focus of the reporting meant that online commentators were not influenced by one-sided coverage but responded to stories describing actions taken by both sides of the conflict. With this approach, we were able to investigate reactions that, in addition to possibly already established attitudes, are based on the reception of both events. A total of posts, 1520 user comments were analysed. Within these comments, the question of the blame for this escalation and attacks against the media for their alleged bias in favour of Israel cropped up with particular frequency. The antisemitic posts were mainly aimed at Israel and Israelis, though in some cases also at Jews. Selected antisemitic ideas are presented here with examples. One concept area revolves around the stereotype evil and includes the stereotype child murder as well as the nazi analogy.The two conflict events at the beginning of the Hamas–Israel conflict—the rocket fire on Israel from Gaza on 10 May and the subsequent bombing of Hamas targets by the IDF—were jointly discussed in one article by each of the observed leading German media outlets, each in a linked article posted on evil stereotype is expressed, Israel is often explicitly branded as a rogue or terrorist state: “Nothing more than a rogue state” [“Nichts weiter als ein Schurkenstaat”] (NTV-FB). Alongside the imputation of malicious activity, this attribution also delegitimises Israel’s statehood. As “the spawn of Europe”  (NTV-FB), Israel is portrayed as the embodiment of all that is negative in the world. However, key terms and explicit attributions are not usually present. The comment “I think when all Israelis come back to Europe and America then we’ll have peace in all Arab countries, no refugees will come to Europe and America”  (NTV-FB) makes the absence of Jews in Israel a condition for peace in the region. In so doing the comment also asserts, conversely, that Israel is allegedly responsible for all regional conflicts and thus all flights of refugees from the wider Middle East. In another aspect of the evil stereotype Israelis are accused several times of having an inherent tendency to violence—one at times said to have been temporarily hindered by the Covid-19 pandemic: “They have fought off covid and now they are gaily shooting all over the place again. >” [“Corona ist bei denen bekämpft und jetzt wird wieder lustig rumgeschossen. >”] (B-FB[When the >”] (B-FB).child murder appears—apart from that term—in other explicit ways: “Israelis deliberately kill children and dance while they’re doing it” [“Israelis töten gezielt Kinder und tanzen dabei”] . It invokes the stereotype by presenting the killing of children as an everyday feature of Israeli life. The rhetorical question “So shooting children in the head is legitimate?” [“Kopfschüsse bei Kindern ist also legitim?”] (SZ-FB[The stereotype ”] (SP-FB); “This ”] (SP-FB). In bot”] (SZ-FB) containnazi analogy is often verbalised below the line of direct equation of the actors. For expressing it the following comment uses comparison and allusions. The reference to crimes against humanity, a category of international law created in response to the Nazi atrocities, is an allusion to Nazism which brings Israel into conceptual proximity with it. It serves as a bracket both for a comparison on the level of action, with Israel said to be re-enacting these atrocities, and for the allusions deportation and ghetto which once again reinforce the analogy.“Israel’s policy has been a crime against humanity since the founding of Israel, although they should know what the Germans did to them, that is exactly what they are enacting. The Palestinians are forcibly deported into ghettos with no way out” (FAZ-FB).The like—implies that Israel would have similar characteristics as National Socialism and should therefore be countered.An even more indirect allusion evokes that analogy by reference to Sophie Scholl, a resistance activist against National Socialism: “Since its foundation, Israel has only been discriminating and oppressing. You have to fight back. Just like Sophie Scholl fought back then” [“Israel ist seit ihrer Gründung nur am benachteiligen und unterdrücken. Da muss man sich wehren. Genau wie sich Sophie Scholl damals gewehrt hat“] (SP-FB). This aevil, the second main conceptual area in the corpus relates to the idea of supposed Israeli influence on media reporting and public opinion. It includes the stereotype of jewish/israeli influence on the media and the topos of a taboo of criticism against (in this case) Israel. Conceptually similar to both is the frequent accusation of media bias (motivated either by the media themselves or some unknown cause) which we have not, however, categorised here as antisemitic. A variant of uttering the former stereotype explicitly is this comment: “Since the entire media landscape in Germany is dependent on the money supply by the Zionists, an objective reporting hardly exists.”  . But inTo A’s critical question, “Who controls the German media habibi” [“Wer kontrolliert den die deutschen Medien habibi”], B responds: “You already know, who? Not just the German media but all media. This is a known fact.”  (SP-FB). By empThe idea of a taboo of criticism against Israel is expressed very clearly throughout (“Scary and you can’t say anything about Israel=” [“Gruselig und man darf nix über Israel sagen =”] (B-FB)—hereaftisrael sole guilt for the entire Arab–Israeli conflict. For this, they withhold that the existence of antisemitism and claims to Israeli territory are among the drivers of the conflict within the Palestinian side. These phenomena obviously cannot be part of a reconciliation of interests between the two parties and will therefore continue to stoke the conflict as long as they persist. The range of linguistic realisations reaches from straightforward accusations The distorted portrayals of the conflict in the comments often went as far as giving ], FAZ-FB) to more], FAZ-FB). Whereadenying jews the right to self-determination. A very clear statement is: “Palestine under occupation for 73 years” [“Palästina seit 73 Jahren unter Besetzung”] The ideas in such comments are often accompanied by statements g”] (W-FB). Here, evil.It is used to undermine any claim to a historical connection between Jews and the territory of contemporary Israel. In addition, the image of a tyranny that is depicted here corresponds to a stereotypical attribution of Facebook profiles of leading British, French, and German media outlets on coverage of an escalation phase of the Arab–Israeli conflict. The findings are as varied as they are worrying. Quantitatively, we were able to confirm the observation coming from antisemitism studies that the conflict is a central facilitator for antisemitic communication. Further, it showed that antisemitism was surprisingly high and considerably higher in British comments sections than in French or German ones. In the comments of all three subcorpora, it was noticeable that—in spite of a high percentage of antisemitic contributions making use of linguistic means of implicitness—web users generally do not try to hide the antisemitic meanings behind implicit structures. Rather, antisemitic ideas were expressed openly or with a minimum of subtlety which stands in opposition to our expectations to predominantly find coded forms of antisemitism among the users of the quality media. It seems the users were not under the impression they needed to hide their attitudes. Given the high number of antisemitic comments found, it can be assumed that (with one possible exception) none of the media carried out moderation on their Facebook posts. So far, linguistically based research on antisemitism (online) had been mainly carried out for German corpora (cf. e.g., Schwarz-Friesel, We studied user comments on the The prominently circulated antisemitic concepts presented deny Israel any moral integrity, picture it as an aggressor—whose behaviour would be covered up by pro-Israeli biased reporting—and exclude it from the community of states for a number of alleged reasons.The qualitatively obtained material discussed here shows clearly how diverse variations of linguistic realisations of antisemitic concepts can occur. This poses a number of challenges when it comes to the identification of such content—first of all for the purpose of moderating it. Apart from the thorough understanding of the conceptual background and characteristics of antisemitism needed, a capability of making adequate inferences concerning the true nature of such content is indispensable—above all when it comes to implicit forms. Those two challenges have to be considered extensively for the implementation of automated moderation tools. Those would have to be trained on data acquired with such a qualitative approach that we presented in order to have the learning basis to recognise such content and to track antisemitic speech on a large scale.


Moominvalley in November, was published over fifty years ago, the Moomins’ and Jansson’s popularity is still rising, which testifies to the universality and timelessness of the books as well as the thoughtful marketing strategies of Moomin Characters Ltd, the company responsible for copyright supervision. In this article I discuss the Moomin characters’ representation in three events set in contemporary (2017–2021), extratextual societal contexts, both strategically planned and co-organized by Moomin Characters Ltd and spontaneously organized by ordinary people. The motifs and figures from Moominvalley which have been applied in (1) the Invisible Child campaign, (2) the #OURSEA campaign, and/ (3) the women’s strike protests in Poland are exemplified and juxtaposed with their literary images in the nine Moomin books by Jansson. My conclusion is that the references are based on a selective reading and focus on beneficial—in specific contexts—facets. On the one hand, it proves the Moomin books’ versatility and topicality, while on the other, it is not inclusive and disregards the holistic message of the saga, which is an evolving continuum. Furthermore, this way of reading reinforces a single address of the unequivocally double-addressed series.Tove Jansson (1914–2001) was an outstandingly talented Finnish-Swedish artist, recognized worldwide mostly as the creator of the Moomins. Although the last of the nine-volume series (1945–1970) about the internationally popular Finnish trolls,  The Moomins and the Great Flood, during the Winter War in 1939 to distract from the despair and fear, to escape the reality, and to shape her own private catharsis—an original, fairy-tale-like purgation of negative emotions. Six years later, in 1945, she decided to publish this book, which when reprinted in 1991 appeared with her personal preface—interestingly, the only one within the whole series: “One’s work stood still; it felt completely pointless to try to create pictures. Perhaps it was understandable that I suddenly felt an urge to write down something that was to begin with ‘Once upon a time.’ ” (Jansson The Moomins and the Great Flood was shortly followed by Comet in Moominland (1946) and The Hobgoblin’s Hat (1948), and the situation was to alter. As Westin notes, “In The Hobgoblin’s Hat Tove Jansson the writer enlarged her Moomin world, sharpened her aesthetic, honed her vocabulary and anchored the codes of her fictive world to a firm foundation. She worked on the personalities of her characters, refining their characteristics and use of language”  made not only a national but also an international breakthrough after the book was translated into English in 1950 as Finn Family Moomintroll. The volume was followed by six other Moomin volumesMoominvalley in November in 1970.While developing the fictional world of the Moominvalley, Jansson, a brilliant observer, drew on the images of her own family, friends and reality, and simultaneously, in a still escapist manner, structured a verbal and visual vision of a dreamlike community and a better future. Although her books have been traditionally labelled and marketed as children’s literature, already the first volumes were evidently double-addressed , of the third—the spectacular Moominvalley Park that opened in Tokyo in 2019 and its current exhibitions, 3D animation series (2019) or original seasonal mugs by Arabia, and of the fourth—the Invisible Child campaign (2017) and #OURSEA (2020) or the initiative launched in February 2021—Reading, Writing and the Moomins. Furthermore, another intriguing form of expansion is promoting “Moominous” values such as love, courage and equality, or a Moomin way of life, which seems to be creating an alternative to Finnish sisu. This seems to be building  a popular form of Nordic country branding with national, hypothetically existential concepts, like Danish hygge or Swedish lagom.In 1995, on the wings of success, the managing director of Moomin Characters Ltd announced that they were aiming “to establish the Moomins alongside Donald Duck and Asterix”  nation is commonly famous for its high-quality education, mobile phones, minimalist yet cosy design, and … the Moomins. And although Finland enjoys one of the best nation brands worldwide, it is still developing it, employing Moominvalley and its original dwellers.The country brand webpage thisisFINLAND (finland.fi), produced by the Ministry for Foreign Affairs of Finland and published by the Finland Promotion Board, includes extensive coverage related to the Moomins. The contributions overview the history of the book series and their creator, Tove Jansson, inform about new initiatives by Moomin Characters Ltd or refer to anniversaries such as the Moomin’s 75th birthday celebrated in 2020. Symptomatically, they emphasize, often in the headlines, both the importance of the figures and their national affiliation, labelling them “Finland’s Moomins”, “classics”, “semiofficial national symbols” or “a national treasure”.thisisFinland, there is also room for “exhibitions or activities on a nonprofit basis”  the significance of the sea in Jansson’s private life, enhanced by her two black and white photographs, and (3) the fact that this beloved sea is today affected by dangerous eutrophication. The simple syllogism led to the conclusion that Moomin fans should consider donation and “save the Baltic Sea and its cultural heritage for future generations”  a quotation from  Moomin, . Further Moomin, . The optMoominpappa at Sea:He came to the edge of the water and stood watching the breakers. There was the sea—his sea—going past, wave after wave, foaming recklessly, raging furiously, but, somehow, tranquil at the same time. All Moominpappa’s thoughts and speculations vanished. He felt completely alive from the tips of his ears to the tip of his tail. This was a moment to live to the full  and the Catholic Church supporting it. The protests were organized by All-Poland Women’s Strike, a social movement fighting for women’s rights, and participants displayed their anger using various symbols which have come to signify this social revolt. Among the most popular were a red lightning bolt, a meaningful yet vulgar slogan “F…k off!” directed at PiS, and a black umbrella. Interestingly, the Finnish trolls were also implemented in the imagery of the anti-government demonstrations.For Tove Jansson, who wrote and illustrated the Moomin stories, the freedom of choice in life and art was one of the most important values that guided her art and work—including her beloved Moomin stories. We, at Moomin Characters Oy Ltd, the company Jansson founded in the 1950s, do not accept the use of Moomin stories for political purposes Wprost, .On the same day that the tribunal announced its decision, Kaja Godek, a conservative Polish anti-abortion activist, released in social media a symbolical message to her Downs syndrome son, beginning with “Wojtek, you know? It is no longer possible to kill little moomins” Wprost, . Godek’sFrom that point Moomins became ingrained into protesters’ imagery, representing different levels of quality: from fumbling black and white drawings on a piece of cardboard to professionally printed, colourful images. They were generally based on a popular picture of the Moomin family and friends, available on the internet, and were adorned with the slogan “F…k off!” Sometimes the characters smiled, like in the original version, while sometimes their snouts frowned, expressing anger. The message was clear-cut—even the good-hearted Moomins lost their temper in the face of the government’s disrespectful policy.6The other recurringly employed figure was the Groke, portrayed either in her original shape, known in particular from cartoons, or merged with Godek’s face. In some cases, the figure was individualized with a red lightning bolt on her dark dress and an inscription, for example “Respect from Moomins!” It is noteworthy that this representative character from Jansson’s legendarium was again associated with her stereotyped role. The Groke occurs in four of nine Moomin booksFinn Family Moomintroll is preceded by the warning by the newcomers Thingummy and Bob in their own foreign language, “‘The Groke is coming!’ whispered Bob. ‘Groke? Who is that?’ asked the Hemulen, getting a bit frightened. ‘Tig and brim and gerrible!’ said Bob. ‘Lock the door against her’”  are absent. Already at the beginning Moominmamma expresses an opinion which corresponds with Too-ticky’s: “we are afraid of the Groke because she’s just cold all over. And because she doesn’t like anybody. But she’s never done any harm” (Jansson, Tove. (Importantly, the Groke is a character of the last book featuring the Moomin family, n, Tove. /1965. MoThe Little Prince involves observing at a distance and pretending not to see each other, and then sitting closer and closer every day.However, a direct confrontation with the Groke occurs only between her and the Moomintroll, who, in this volume, grows up, loosens the bonds with his beloved mother and becomes distinctly independent. One of the elements of his maturation is thinking about the Groke and trying to understand her, “If she was someone you mustn’t talk to or about, then she would gradually vanish and not even dare to believe in her own existence” (Jansson, Tove. /1965. MoSuddenly the Groke started to sing. Her skirts fluttered as she swayed to and fro, stamping on the sand and doing her best to show him that she was pleased to see him.Moomintroll moved forwards in amazement. There was no doubt about it, the Groke was pleased to see him. She didn’t mind about the hurricane lamp. She was delighted that he had come to meet her.He had stood quite still until she finished her dance. Then he watched her shuffle off down the beach and disappear. He went and felt the sand where she had stood. It wasn’t frozen hard at all but felt the same as it did (Jansson, Tove. /1965. MoMoomintroll’s relationship with the Groke is also silent and at first devoid of eye contact—words become dispensable, and the patience and curiosity of the other are of the highest significance. The Groke makes a ritual of the evening meetings, and even when paraffin is missing and the Moomin is unable to light the hurricane lamp, she comes ashore reacting to his sight:Thus, the Groke, viewed via a comprehensive reading of the Moomin saga, appears as a victim of groundless ostracism, but symptomatically, the abortion strike protestors in Poland used her one-sided image of a fright-evoking figure, based on her initial characterization, reinforced by the cartoons.9As I have tried to show, the presence of Moomins in societal campaigns has been discernible for over two years and thanks to largely social media, it has gained world-wide coverage. The analytical juxtaposition of relations between the images from Moominvalley employed in the three events and their literary sources suggests interesting conclusions. The motifs and characters used in these campaigns both by professionals and average readers reify a selective reading and cement the single address of the Moomin suite. The unique value of Jansson’s books is a combination of universality, diversity and avoidance of simplistic solutions. On the one hand, it is indisputably a fact that in Jansson’s saga Ninny is invisible, the sea is beautiful and the Groke is gruesome. On the other hand, the same Jansson, let us not forget, argues that the invisible can be male, the sea can be angry and the Groke can be vulnerable.


The understanding of what ethnography looks like, and its purpose, is continuously evolving. COVID-19 posed a significant challenge to ethnographers, particularly those working in health-related research. Researchers have developed alternative forms of ethnography to overcome some of these challenges; we developed the Mobile Instant Messaging Ethnography (MIME) adaptation to ethnography in 2021 to overcome restrictions to our own research with hospital doctors. However, for ethnographic innovations to make a substantial contribution to methodology, they should not simply be borne of necessity, but of a dedicated drive to expand paradigms of research, to empower participant groups and to produce change – in local systems, in participant-collaborators and in researchers and the research process itself. In this paper, we reflect on our experiences using MIME, involving collaborative remote observation and reflection with 28 hospital doctors in Ireland from June to December 2021. After reviewing literature on ethnography in COVID-19 and general epistemological developments in ethnography, we detail the MIME approach and illustrate how MIME presents an evolution of the ethnographic approach, not only practically but in terms of its reflexive shift, its connected and co-creative foundations, and its ability to drive change in research approaches, participant life-worlds and real-world improvement. The COVID-19 pandemic – in addition to unsettling the world along with health and societal systems – confounded the best laid research plans. New ethical paradigms, institutional policies and life pressures arose, challenging and often scuppering the work of scholars, ethnographers in particular . At the Two driving forces – COVID-19 and the push for evidence-informed healthcare improvement – are catalysing change for researchers aiming to improve healthcare practices and systems. Conducting ethnographic research in this setting is complex. The ‘ethics of care’ : 1089 ofIn discussing ethnography as a methodology, there is substantial debate around the nature of what makes something ‘ethnography’; legitimacy in ethnography has long been built on the value of data gathered through physical presence and observation . This paidea of being there represents an idealised and romantic view of how fieldwork should be conducted’ – that is, that the paradigm of traditional in-person participant observation as the only true form of ethnography discounts the validity of undertaking other research approaches, not involving physical co-presence, with the epistemologies of ethnography in mind.However, such observation is not always possible or suitable for answering questions about lived experiences. Sometimes observation is not safe, or not permitted, as during COVID-19. In other cases, it may not be appropriate for analysing the everyday experiences of people whose cultural or social practices do not take place in physical spaces, such as online communities, or people whose cultural or social experiences take place physically in their own local spaces but are ruled by larger non-physical social institutions . In thesThere are many well-established ethnographic approaches and methodologies, including institutional ethnography , digitalethnographic approaches that eschew physical participant observation yet maintain a commitment to the epistemological standpoints at the heart of ethnography. We draw our understandings of such an ethnographic approach from a commitment to make sense of people’s lives from their points of view; engagement with the field, however constructed by the researcher and through the project and not limited to a geographical area. . . flexible in the kinds of engagement involved in research. . .seek to place issues within wider context. . .[and] analysis that invokes working through descriptions even if these do not always feature as ‘thick descriptions’ in the various outputs produced by research. : 67–68Thus, mindful of the semantic meaning inherent within the terminology of ‘ethnography’ and its participant observation traditions, MIME joins a group of established The core features of this articulation are emic perspective, engagement, flexibility, contextualisation and description-based analysis. These are the foundations on which MIME was developed: to respond flexibly to the requirements and restrictions of research during COVID-19, but more than this, to describe, engage with and analyse participants’ lived experience in a way that empowers and explores their own experiential and emotional spaces within the broader social context of their professional worlds.The ethnographic method is always evolving. From the reflexive feminist turn of the 1970s to the development of digital ethnography in the 2000s, ‘as cultures and societies develop, so does ethnography, using its inherent adaptability and flexibility to try and find out “exactly what is going on”’ : 64. As Alongside the collaborative work of building the corpus of ethnographic research data, these new methodologies have often sought to involve participants in the processes of reflexivity, as ‘an embodied process of making ethnographies accountable’ : 78. SucCOVID-19 has greatly impacted on the work of ethnographers. In many places, work-from-home and stay-at-home orders governed the early pandemic. Even in locations where these were eased, many institutions discouraged or even outright banned face-to-face data collection . EthnogrYet, institutions, systems and scholars alike also realised the importance of gathering insights and lived experiences of the pandemic to inform policy and practice responses and prepare for the future . In respThe MIME method was developed as part of an Irish Health Research Board-funded study of the working conditions and emigration of hospital doctors in Ireland. After previously surveying and interviewing Irish hospital doctors at home and abroad , 2019b, However, it was important not only to document the day-to-day experiences and cumulative pressures of work in Irish hospitals, but also to understand the incremental effects these experiences and pressures had on doctors’ working lives and their physical, emotional and social wellbeing. Stress, burnout and vulnerability to ill health are common among doctors generally ; but in A traditional field-based hospital ethnography was planned to study the pressures and experiences of working in Irish hospitals. The arrival of COVID-19 made these plans unworkable. A new research approach was needed to gain a similar understanding of hospital doctors’ lived experiences over time, within the confines of hospital visitor inaccessibility and public health guidance . We therefore developed a remote research study, utilising common but secure smartphone communication applications to connect researchers and doctors on a regular basis, enabling us to communicate with them and discuss their experiences and feelings about work. We labelled this method Mobile Instant Messaging Ethnography MIME; . We sougThe MIME project sought participation from hospital-based doctors, of any grade or nationality, working in hospitals in Ireland at the time of the study. Twenty-eight hospital doctors elected to participate. Each was assigned to one of three project team members  and, after receiving substantial participant information and giving informed consent to participate, conducted a preliminary video interview with their researcher via Zoom or WhatsApp, establishing their work and life context, or ‘field’ Across 12 weeks, each participant and their researcher participated in WhatsApp text conversations at least three times a week, consisting of researchers’ questions and participants’ answers and unprompted comments or responses, on varied themes or about various events in their ‘field’. After the 12 weeks, participant and researcher met again via Zoom or WhatsApp for a final debriefing interview, where a reflexive discussion was held about key themes and elements arising across their MIME messages and about the processes of reflecting and observing themselves.We have reflected elsewhere on the design, operation and experience of conducting research using our novel MIME method from an operational point of view  this paper does not revisit these methodological practicalities. Rather, we aim here to reflect instead on how MIME has been a catalyst for change: in our conceptualisations as researchers of what it means to research ethnographically, in our participants’ conceptualisations of their ‘fields’ and their place within them, and potentially to inform improvement within the Irish health system.Here we outline our experiences of conducting research using MIME. First, we describe how interactions fostered descriptive insight into the context: a sense of participants’ ‘fields’. Next, we explore how collaboration and connection, on a personal and emotional level, developed between researchers and participants and shaped the study. Finally, we consider how the research exercise generated change, not only from findings but from the process itself, for both participants and researchers and their approaches to their respective work. In accordance with ethical clearance and principles, quotes are presented below using pseudonyms. Except where explicitly indicated, all participant quotes are drawn from follow-up reflexive interviews conducted after the 12-week period of MIME WhatsApp interactions was completed.One major concern of switching from traditional participant-observation fieldwork to participant-mediated MIME was whether the sort of rich contextual ‘thick description’ of ethnography could be accessed if the researcher did not experience the full sensory and affective immersion of ‘being there’. Thick description can be described as records of events and environments that go beyond surface appearances to interpret ‘how [people] shape and trim their actions to fit their principles’, and vice versa’ Inpatient service very busy.Reg on leave. . .so things a bit tight. . .going to be disaster.Your patience gets extremely thin at the end of a 72-hour shift,Really blunt, you don’t realize how far gone you are.No doctor’s office so every conversation takes place on the ward,Everyone can hear.No spare computers, nowhere to keep a coat.I’m a two-hour drive from my life.Ten years of your life or more, filled with stuff you have to endure.I’m very tired now,Buying takeaway chips and going to bed. (R22)The following two transcript poems , made upYour questions then gave an opportunity to reflect on where we were at and we’re a small hospital but I suppose we could be very demonstrative of the greater situation. (R28)It was weird to think about, kind of, the bigger picture, because you can get very caught up in the minutiae. [But] the bigger picture stuff is borne out of, you know, individual experiences. (R9)The themes here help build a picture of participants’ day-to-day activities in the context of their broader organisational, systemic and influences and pressures – as ‘thick’ a description of work-as-done as possible. MIME responses via WhatsApp captured the tasks of the day as participants had done them – and often the ‘extreme work’  this entLet’s just get the patients sorted and out of here, soWrite prescriptions, write blood forms on triplicate carbon paperDrop everything, run up to the department, perform the procedureSkip lunch, stay late, do whatever it takes to get it doneBecause that’s the right thing for the patient.ButDo your day job, hit by a cyber-attack, COVID thrown in on topI worked 10hrs on the floor and still huge waits to be seenTreating patients on 20-year-old machines, stretched between clinic and wardsNot only asked to do your job, you’re asked to do everyone else’s tooThree people were crying at handover, we were just shattered.And thenAll the messing around with being paid or being paid backEven things as basic as space for bags and lockers and coatsLittle pointless barriers caused by how things are doneI don’t think management listen, or even careI just feel we are heading for a cliff.This ‘bigger picture stuff’ formed the context in which participants’ own ‘fields’ were situated, bringing a rich interconnectedness across the data. While each participant’s experiences at work were their own, with their own backgrounds and frameworks, cross-cutting themes enabled the creation of broader insights into what work in Irish hospitals is like. This third transcript poem provides a composite of quotes drawn from the MIME WhatsApp transcripts of several participants to illustrate this composite ‘field’:As The participants, too, shared our feeling of connection, particularly the ability to talk through and about their emotional responses to work experiences, something which was difficult to do.I’m flat sharing with another [junior doctor]. . .you wouldn’t go into the same detail about the way that you’re thinking about [things], your hopes or the way that it’s affecting you. (R15)You’d have mates who you’d chat to now and then, but it’s not [the same]. . .I’ve never, in a consistent way like that, reflected on what work is like. (R23)It makes me so sad reading it [my messages]. . . I guess ‘cos you’re telling it to someone else you’re kind of formulating your own thoughts about it as well. (R5)I felt like almost on the week that I was the most busy was the week that I actually typed the most – because I was the most angry. (R24)Some also felt like the process of MIME participation gave them time and space and permission to share their feelings about work which made room for genuine emotions, unlike in the original situation or event that they were reflecting on, where they would have normally compartmentalised them:It was actually kind of therapeutic to say ‘this is the annoying things’. And to kind of hand it over to somebody else [and] move on with my life. (R7)It was kind of nice to get some of it off my chest. Nice to feel like there was possibly somebody out there listening, trying to get things to change. (R26)This ability to feel and share emotions about work itself, and about thinking about work, in a ‘space’ of psychological safety  was highI’d see it on my phone when I sat down in the evening, or once or twice even on my walk home. Just as I was thinking about stuff, you know? It was probably as close as we could get to you guys being here. (R2)You wouldn’t text back sometimes when you’re just kind of fed up, and just wrecked. . .[but whenever] you’ve time, you could answer them. . .in the mornings when you’re on [the ward or] you get home. . .it was good. (R10)The choice of WhatsApp texts, rather than being limiting for emotive communication and rapport, were a key factor for facilitating connectedness. Participants noted that they felt a connectedness by virtue of the consistent long-term presence of the researcher in the WhatsApp space, one in which they regularly conducted work and engaged in work discourse, and one noted to be ‘a highly socialized form of interaction’ : 1:I’d sThrough the medium of the mobile phone and WhatsApp instant messaging, the researcher was available to them whenever they wanted to interact with the research or reflect on work, both in terms of time and location, much more than they would have been in a traditional site-based ethnography, though this posed its own challenges for the researchers . Allowing participants to engage when they wanted to, may have also levelled the power balance between researcher and participant which is often problematic in ethnographic research, particularly with more junior doctors .You don’t really take that much time to reflect. It’s difficult to build it in. . . .We’re not really taught that, you know? (R4)You might rant to somebody, you know, or something like that, but you wouldn’t kind of stop and think quite as much. (R12)Key to building understanding of participants’ ‘fields’ through MIME was their understandings of and reflections on the context in which they worked, and combining this with researchers’ own understandings and reflections on hospital, system and professional structures and cultures. The cognitive exercise of reflection and reflexivity was not one that all participating doctors initially felt at ease doing. Some felt that the professional duties and logics of medicine did not encourage reflection or reflexivity:Do we get an opportunity to debrief? No, we don’t. (R8)Previously, the only time when people are able to fill in things about their attitudes to work, is when they have time. And if you’re in a really bad place at work, you don’t have time for any of that. (R22)Others felt that, even if they had wanted to reflect, the ‘extreme work’ of medicine left them little opportunity to do so as they struggled simply to get through their workload and pressures:Certainly the questions, especially the ones about well-being and how you feel, that’s not something I would normally think about during the day. (R1)It’s unusual to be asked so many questions about work. And it’s not an easy topic. . . you wouldn’t really discuss those things. (R19)Others felt that, while describing their working conditions and the impact on their daily work was easy, having to think about and articulate the impact on them on a psychological and personal level was more difficult, and required a significant shift of mindset:I don’t know that I reflected that frequently [before]. . . So, actually, it was kind of beneficial to think about those things, you know, week on week. (R3)There was no kind of time pressure to answer. I would see it, and then there would be things ruminating in my brain, and then I’d answer. . . I’d actually thought about it, I would be reflecting consciously. (R21)These reflections were not always easy for participants: two of the original twenty-eight formally withdrew from the study citing burnout, and another two dropped out informally. But, in the main, participants felt that MIME gave them an opportunity to convey their feelings about work into words in a reflexive way, perhaps more than would have been possible in an interview:By facilitating participant doctors to ‘reflect consciously’, we were able to elicit and collect their reflexive understandings of the system in which they worked and the things they experienced in it. Combining this with our understandings, as researchers, of the Irish health system from our own and others’ previous research enabled us to situate participants’ experiences and reflections within a greater body of knowledge, but also both reinforced and challenged what we felt we already knew about doctors’ working lives in the Irish health system with doctors’ own interpretations. This distributed reflexivity not only gave researchers a stronger emic foundation from which to help push for participant-informed change, but empowered participants to draw from their enriched understandings of their roles and experiences, honed by affect and emotion, to create change for themselves, at work and in their own lives.The goals of publicly-funded research align with policy and practice change and improvement ; this reFor researchers, MIME challenged and changed not only the way we conceive of ethnography, but the way we practice improvement research and who we engage to see improvement happen. Our ideas of what constitutes ‘ethnography’ have changed, with previous learning and experience from our various disciplines about what ethnography ‘looked like’ as a method. Instead, we learned through MIME to see ethnographic research not as a method to be used, but as an approach to be embraced: in Sometimes, even on busy days it’s nice to respond. . .to get your head out of whatever zone you’re in for a little while, because sometimes it brings balance to a situation when you go back to it. (R11)It was a good way for me to vent my frustrations. (R17)For participants, the process of being involved in MIME, and particularly in talking and thinking reflexively about the things they did and saw around them in their hospital workplaces day-to-day, also began to change the way they approached their working lives. In the short-term, receiving a MIME message from the research team gave participants an excuse to reflect on work-related thoughts, emotions and anxieties and on the health system and their place within it, and then return to work with a changed attitude:You forced me to think a little bit more in the abstract in what I’m doing and pull myself out of the day-to-day stuff, and really think about it and it, and maybe reframe what I’m doing in some ways (R6)To actually think about why, why was it awful day, and how might it have been better. I think actually, if we did more of that, we might be able to fix more things. (R20)Longer-term, the process of reflection and reflexivity across the 12 weeks of the MIME study led participants to adopt these processes as habit, and make changes of their own to their approaches and practices around work:I try and say, “Well, that wasn’t ideal. And how do we do that better?” There’s only a certain amount of things that I can actually meaningfully influence. [But] if I do things differently, then it will have a difference on the outcome. . .small local things. (R14)Initial findings from our MIME data have been used to convey to policy makers and the public the significance of improved working conditions for healthcare delivery . But at This ability to provide a framework for reflexively making small local changes – ‘doing that better’ – is the heart of collaborative ethnographic approaches: as Debates over the evolution of the ethnographic approach have long been a part of the discourse of qualitative social research. This is no less true in the context of a pandemic. While mindful of the need to safeguard both people and research itself, some commentators have challenged assertions that innovative forms born of the COVID-19 pandemic can be considered interchangeable with or equivalent to field-based participant observation . In reimAdditionally, while collaborative work in ethnography has become well-established practice, alongside other collaborative approaches like participatory action research, typical projects are discretely bounded; participant collaborators and researchers interact in scheduled meetings, and communicate through the course of their work days, towards their shared desired outputs in the form of policies, protocols and academic literature. However, the connected and intimate nature of MIME through the use of smartphones and WhatsApp completely removed such boundaries. The ethnographer whose ‘field’ was engaged through social media could be ‘suddenly thrown into fieldwork’ at any time, producing an experience equal parts ‘reassurance to fatigue and exhaustion’ : 12. WhiFurther to this, context in ethnographic research has long been considered ‘an interactional achievement’ : 57 builMore than building understanding, such an approach informs health system improvement. Initial summarised findings arising from our MIME have already been delivered and discussed with high-level stakeholders, just as previous project studies have engaged system-level policymakers, representative bodies and regulators in attempts to drive change. Yet as an exercise in collaborative ethnography and reflexivity, MIME is an approach which is ‘constantly push[ing] the conceptual boundaries of the participating disciplines and professions’ : 77 by eAs demographic, technological and climatic changes usher in a new era of infectious diseases , novel vHowever, beyond the confines of the COVID-19 pandemic, MIME presents an approach that may be a real catalyst for change, in the way we might do ethnography for health service impact and improvement. In drawing on contexts, findings and meanings from the day-to-day experiences of participants in collaboration with them, MIME provides grounds for change on multiple levels. First, it challenges and empowers participants to reflect on their work-life context, and make their own changes, about their work and systems. Second, it challenges and empowers researchers to change the way they see themselves and their research as part of the approach to system improvement. Finally, and most importantly, by the amplification of frontline voices through collaborative reflexive research, it has the capacity to challenge systems to change, to better meet the needs of those who spend their lives making the system ‘work’.


The representative personality of this new era certainly was Marcello Malpighi, seen as “founder of microscopic anatomy”. He studied, with a rudimentary compound microscope, numerous tissues and organs of several classes of animals, as well as plants. He described, for the first time, the microscopic structure of the nervous system, identifying in the gray matter of its various levels minute elements he took as “glands”. It should be reminded that the concept of “cell” (and “nerve cell”) was unknown at his time. Many researchers followed, performing microscopic studies, but without better results, and Malpighi’s view was maintained until the beginning of the 19th century, when new histological processing and staining techniques appeared, as well as improved microscopes.The longstanding study of gross anatomy experienced a considerable improvement with the advent of the microscope in the early 17 He was introduced to the microscope while in Pisa (1656), being apparently one of the first to use the compound instrument (objective plus ocular lenses), turning possible much of his research. He moved to Rome after accepting the invitation to be Pope Innocent XII personal physician (1691)De Cerebro Epistola (1665)De cerebri cortice (1666) a more detailed description of the microscopic structure of the nervous system, with emphasis on the “cortex of the cerebrum” (cerebri cortice) [cerebral cortex], apparently for the first time,,,Malpighi’s investigations on the nervous system were first published in ,,,,,,,His initial account was on the general anatomic aspects of the nervous system of “perfect animals” , as known at the timeDe cerebri cortice. A drawing of the cortex, according to Malpighi’s description, may be found only in Govard Bidloo’s Anatomia humani corporis (plates drawn by Gérard de Lairesse) (1685) , to a homology to other organs he identified as glandular ,,th century, mainly thanks to Jan Evangelista Purkinje, describing “ganglionic bodies” in the gray matter of the brain (1837),Malpighi provided the first microscopic description of the central nervous system of “perfect animals" . He focused on the gray matter, defined as “cortical”, in the various levels of the nervous system. There he identified microscopic discrete elements he denominated “glands” in the gray matter of the cerebral and cerebellar cortex, basal nuclei, brain stem, and spinal cord. The fibrous structures, he called “nerve fibers” , were constituents of the already known subcortical white matter and tracts. His interpretation of the cortical elements as “glands” may be related to his admiration for Hippocrates, who regarded the brain as a glandular organ  generated adverse arguments, frequent at his time, and more recently some authors claimed, mainly in relation to the nervous system, that they represented artefactsth century, when new histological processing and staining techniques appeared, as well as improved microscopes,It can be affirmed, without error, that Malpighi’s findings, identifying minute elements in the gray matter of the nervous system, an unshaped tissue until his time, was a large new step to elucidate its structure. Following Malpighi, many researchers performed microscopic examination of the nervous system. However, all their reports looked unremarkable compared to Malpighi's description. His view and the representation of the cerebral cortex were afterwards reproduced by many authors, until the beginning of the 19


A steadily increasing demand and decreasing number of rheumatologists push current rheumatology care to its limits. Long travel times and poor accessibility of rheumatologists present particular challenges for patients. Need-adapted, digitally supported, patient-centered and flexible models of care could contribute to maintaining high-quality patient care. This qualitative study was embedded in a randomized controlled trial (TELERA) investigating a new model of care consisting of the use of a medical app for ePRO (electronic patient-reported outcomes), a self-administered CRP (C-reactive protein) test, and joint self-examination in rheumatoid arthritis (RA) patients. The qualitative study aimed to explore experiences of RA patients and rheumatology staff regarding (1) current care and (2) the new care model.The study included qualitative interviews with RA patients (n = 15), a focus group with patient representatives (n = 1), rheumatology nurses (n = 2), ambulatory rheumatologists (n = 2) and hospital-based rheumatologists (n = 3). Data was analyzed by qualitative content analysis.Participants described current follow-up care as burdensome. Patients in remission have to travel long distances. Despite pre-scheduled visits physicians lack questionnaire results and laboratory results to make informed shared decisions during face-to-face visits. Patients reported that using all study components  was easy and helped them to better assess their disease condition. Parts of the validated questionnaire used in the trial  seemed outdated or not clear enough for many patients. Patients wanted to be automatically contacted in case of abnormalities or at least have an app feature to request a call-back or chat. Financial and psychological barriers were identified among rheumatologists preventing them to stop automatically scheduling new appointments for patients in remission. Rheumatology nurses pointed to the potential lack of personal contact, which may limit the holistic care of RA-patients.The new care model enables more patient autonomy, allowing patients more control and flexibility at the same time. All components were well accepted and easy to carry out for patients. To ensure success, the model needs to be more responsive and allow seamless integration of education material.The study was prospectively registered on 2021/04/09 at the German Registry for Clinical Trials (DRKS00024928).The online version contains supplementary material available at 10.1186/s12913-022-08619-6. Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that requires lifelong medical support . The disThe European Alliance of Associations for Rheumatology (EULAR) recently acknowledged the potential of remote care and patient self-management to improve rheumatology care, and published respective recommendations . SimilarTherefore, we were eager to explore the potential of a new decentralized digitally-supported patient-centered asynchronous RA care-model, and initiated the multicenter TELERA trial  Fig. 1)1). In thThe aim of this qualitative study was to explore experiences of RA patients and medical staff regarding challenges in current standard RA follow-up, the new care-model and their perspective towards its transferability to standard RA care. The study was designed in close cooperation with official patient research partners of the German League against Rheumatism (Deutsche Rheuma-Liga Bundesverband e.V.)To explore the user perspectives towards the new care-model, we conducted qualitative interviews with RA-patients (n = 15) that had participated at one clinical site in the TELERA trial and a multiperspective focus group discussion with patient-representatives (n = 1), rheumatologists (n = 5) and specialised rheumatology nurses (n = 2).Interview partners were identified using purposive sampling  with theThe focus group  was heldData collection and analysis were conducted simultaneously by three researchers , based on Kuckartz’s structured qualitative content analysis  using MAThe study has received ethical approval by the Ethical Committee of the University Clinic of Tuebingen (# 4442020BO) and was prospectively registered on 2021/04/09 at the German Registry for Clinical Trials (DRKS00024928). This manuscript has been compiled in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) . On March 21st, 2022, we conducted a focus group with patient representatives (n = 1), rheumatology nurses (n = 2) as well as ambulatory rheumatologists (n = 2) and hospital-based rheumatologists (n = 3). The focus group duration was 68 min. Mean age of the focus group participants was 44 (range: 30–57) years. 56% of participants were female (Table 2).From December 2021 to January 2022, we conducted qualitative interviews with RA-patients (n = 15), involved in the TELERA trial. The mean duration of the interviews was 17 (range: 8–30) minutes. Mean age of interviewed patients was 55 (range: 32–69) years. Most interviewed patients were female . Patients received their RA diagnosis on average 7 (range: 1–28) years ago. Patients reported diverse occupational and educational backgrounds The analysis revealed three key themes: (i) Standard RA follow-up care; (ii) TELERA trial user experiences; (iii) transfer to standard rheumatology care.Specifically, during the focus group, challenges in rheumatologic care were discussed extensively. The study participants homogeniously reported the enormous workforce shortage as the main challenge in rheumatology care. This applies to both rheumatologists and specialist nurses, respectively. The shortage is particularly evident in rural areas. There are too few appointments for too many patients, with patient and appointment management procedures not yet fully optimized. New patients have to face long waiting times before receiving an appointment, causing irreversible damage that could be avoided; while well-adjusted RA-patients might be over-served and patients suffering short-term episodes cannot be treated quickly enough.“We still have a situation where, depending on the region- In rural areas, two-thirds are under-served anyway, even according to the newly changed demand planning. In the urban area, perhaps only half is under-served - And the whole thing also in a not yet optimized patient management in such a way that well-adjusted rheumatism patients like me are so to speak over-served and not even necessarily all have to go to the rheumatologist once every quarter, which is why difficult cases somehow have to wait much, much too long for a first appointment. Then the first damage has already occurred, perhaps also as a result of this the first incapacities to work, somehow perpetuated.“ .According to the study participants, the current rheumatology care delivery is not need-driven, meaning that patients who need extra care should be prioritized. Moreover, the participants reported that too much HCP-time is spent on non-medical activities, simultaneously leaving too little time for patient education. Furthermore, workflows in rheumatology care are not structured efficiently, which leads to not having all relevant information available in the consultation:“The sequence of diagnostic findings, for example, that we see the patients, then do the laboratory and, if there are any abnormalities, contact the patient again and perhaps have to completely change what we discussed, because it would perhaps make more sense to take the laboratory beforehand, then use it to come to the appointment and also replace the paper questionnaires with electronic ones in order to be able to do something with the data more quickly, in order to perhaps also record them beforehand, to go into the appointment much more informed, to better record how the patients are doing in between appointments.” .Interviewed patients described predominantly the journeys to the rheumatologist as burdensome:“For me, that’s always 120 kilometers there and back. And now, with the fuel prices.” .“The distance wasn’t the problem either, but rather finding a parking space.“ .In the interviews, patients were asked about their experiences in the study. Most interviews initially reported their experiences with the app:Interviewer: And what did you do in the trial? Please describe. Interviewee: I answered questions weekly on this app about how I was doing and if I was having relapses. Yes, there were two blocks of questions, I answered them weekly. Whereas independent self-sampling and joint-examination were reported as relatively little change compared to standard routine.Interviewer: All right then. Another question: The palpation of your joints, how was that? Could you please describe it?Interviewee: Well, I’ve been doing that for several years now. You can tell for yourself where you have pain and where you don’t. Overall, participants reported easy and intuitive use of the app, even with self-perceived low digital- and language skills.“I didn’t have any difficulties with that, so that was easy also for me with my language level and my knowledge with these new things, with apps. I’m a little bit old-fashioned, not like my kids for example with the stuff, but I didn’t have to ask my kids for help or something.” .“It’s well operable, in any case. It’s self-explanatory. The questions appear and then you answer them and then there’s just “Submit” at the bottom and then the questionnaire is gone, so that wasn’t a problem.” .Patients reported that the app helps them to better assess their disease condition.“When I have seen that the curve has actually always been recurrent, so it has never gone beyond the red. I don’t know how to explain it. For me, it was actually like this: Gee, the last four months have actually been relatively stable, except for the one slip. That’s actually a self-confirmation that everything is actually going well.” .However, some of the questions asked (weekly routine assessment of patient index data 3 (RAPID3) questionnaire ) were di“So there were a few questions that I don’t have at home, for example, like turning a faucet. I don’t have that at home, but I answered it for example when I open a bottle.” (P1: 07:02).“I was a bit confused as to whether running was actually meant or the Franconian term for walking. Or just others, if they somehow go jogging or go running. Then they also say running. In this respect, it must be clarified what is meant there. Important point.” .The independent collection of capillary blood was also described by several interview partners as easy, painless and intuitive. In the trial, the blood collection was performed under the supervision of medical staff. Nevertheless, most interviewees reported that they could well imagine performing the blood collection independently at home:Interviewer: “Could you imagine doing that on your own at home without supervision?”Interviewee: “Yes, without any problems. It’s like a COVID test or like being a diabetic. It’s not different, thus I canreally imagine that.” While other interviewees described challenges in the sampling process:“But what I found difficult is getting those drops of blood in there into the container. That was totally hard because it kind of doesn’t soak in and there was always this bubble. So I was sort of in the wrong place. I don’t know if I’m the only one, but I found it really hard. Maybe there should be something else…” .Several patients reported no problems performing the joint self-examination, as for some this was already part of their disease-management routines (P4 - see above). Less experienced patients reported the provided instruction video to be helpful, while one patient felt confused by it:“So in the meantime on the surface of my hand I can also see it visually, that there are now some bulges, without somehow touching myself, but the elbow is difficult. For example, my hip joint, that hurts me then also, you can’t determine it somehow. And in this video, they even excluded this palm, yeah. My palm hurts sometimes.” .Users made various suggestions to improve the follow-up model, mainly to enhance patient-physician communication, see Table In the interviews, we identified a broad spectrum of opinions as to whether, and how, the investigated follow-up model should be transferred into patients’ routine rheumatology care, see Fig. Trial participants described that the monitoring approach enables them to monitor their disease progression and eventually assess whether medication needs to be adjusted. In addition, the progress curves allow users to relate their own disease state to individual health behavior and lifestyle. The interviewees associated this with increased knowledge on their disease and a more active, controlling role in their disease management:“So the differences are that I didn’t control myself before: ‘Yes, it hurt, I went to the doctor, the doctor gave me pills and that was it.’ Because of the fact that I participated in this study, I started doing something for myself. I didn’t let it slide, now I really had to check: Is there anything, do you see anything, is something changing? And if that had been the case - thank God it wasn’t - then I could have described it to the doctor during my next visit. If I hadn’t participated in the study, nothing would have changed: It’s just the way it is, it hurts. I would not have dealt with it so intensively. " .Trial participants reported the reduction of appointments and journeys to the rheumatology practice to be time- and money-saving. Furthermore, some interviewees reflected on the lack of rheumatology care resources in Germany.“Well, first of all, compared to the number of patients there is not enough rheumatology care in Germany. For instance, since I am well adjusted, I do not need a direct contact with the doctor since there is not much to talk about. In other words, if it worked by means of telemedicine, it would be completely sufficient and I think that this is the case for many patients who are not in an acute situation.” .Similarly, a rheumatologist highlighted the new care models’ potential to save resources in rheumatology care:“I believe that you can replace doctor’s appointments, if you leave aside the whole budgeting and all that, especially if travel distances are long and if patients have simply been in remission for a long time, who were previously seen once a quarter, that you can simply replace these appointments, of course.“ .A substantial boundary to the transfer of the investigated care model was the limited personal contact to health care professionals, specifically the treating rheumatologist.“But the visits to the clinic are very important to me, because then you have the personal conversation with the doctor. At least that is very important to me. Nevertheless, in the meantime, there could always be things like in the study, that you look at it more closely, now maybe weekly or biweekly do some test or palpate joints or whatever. But for me personally, the appointments in the clinic are very important after all.” .This was also discussed by a rheumatology nurse in the focus group.“I like to talk to people and they like to talk to me, and I think that’s also a very important point in everything we do. People also want to be talked to, they also want to maybe say something about it right and left, which is not just about their swollen wrist. And I believe that the specialist assistants, together with the rheumatologists, are also in a position to include this a little bit in all the progress and in all that we will certainly have to achieve in a few years. For me, it would be important to have a combination of real people and real presence, but of course also digitalization.” .Patients reported experience with the disease, respectively, a high level of knowledge and information on the diseases as essential prerequisites to effectively implement the new care model. For instance, patients have to know certain terms and vocabulary in order to use the medical app and perform joint self-examination. Additionally, the relatively small blood volume, limiting the number of laboratory tests and biomarker insights was described as limitation of the CRP self-sampling, requiring in-person visits in the medical practice. Some trial participants reported the possession of smartphone as well as technical skills to be a barrier:“It might be related to interest or education, but when you do not possess a smartphone, then you certainly cannot participate.” .In the focus group, rheumatologists reported concerns of ePRO monitoring causing additional demand on already scarce resources, accompanied by financial losses. Furthermore, the outpatient appointment and reimbursement system of ambulatory rheumatology care was addressed and discussed as a barrier that must be overcome in order to successfully implement the new follow-up model into standard care.“I certainly also see that this could mean significant financial losses for the practices, but here again the question: What would happen if, theoretically, digital monitoring, which is designed differently than it is now, were to provide us with at least as good or perhaps even better monitoring of patients? Would we actually have to change our system and not just say, okay, this doesn’t fit into our quarterly logic? Because that’s part of the study, to break up this quarterly logic in order to see if there aren’t alternatives?” .According to the trial participants, the investigated follow-up model is suitable for patients in remission with a stable course of the disease. Interviewees reported that the new follow-up requires certain experience with- and knowledge of one’s own disease. Patients need to possess a smartphone and have certain technical skills to participate. Blood collection could be impeded when patients suffer impaired vision. Additionally, interviewees surmised that younger patients might get along better with the investigated follow-up model than older patients.Regardless of the characteristics of the users, both in the interviews and in the focus group, participants highlighted the relevance of the patients’ freedom to choose the follow-up form.“But you still have to consider the patient’s right to wish and choose the form of medical treatment. There are people who don’t want to or who can’t monitor themselves in this way for very different reasons, psychological reasons or because they also have other intellectual prerequisites or are in a social situation where that’s not possible or where it’s just a matter of course - we are talking about a marathon - stop any events within the time frame where the patient or patients are no longer able to carry out this self-monitoring.“ .In this study, we explored RA patients’ experiences of a new care model, patients’ and HCP experiences regarding current challenges of rheumatology care, and barriers and opportunities of the new care model. There is a lack of studies examining asynchronous RA monitoring strategies . To our Reported patient experiences suggest high usability and acceptance among patients. Most suggested improvements targeted patient-physician communication. Patients wanted to be automatically contacted, have a feature to request a call-back or chat option. Similarly, patients reported the trouble reaching local staff, as during the study we had to use the traditional local communication options. Improving this access to HCP feedback should be a main goal of a new care model approach. Prior studies reported on the benefit of guidebooks  and an i(Table ).Rheumatologists are concerned about ePRO monitoring causing additional demand on already scarce resources. Even if ePRO results would only be used for physician visits they could help patients to legitimize their symptoms  and imprTable .In line with previous work , rheumatExperienced patients felt highly confident examining their joints, yet rheumatologists questioned the reliability of self-performed joint counts. Radner et al. demonstrated that self-performed joint counts are more reliable in patients in remission . A trainDue to the COVID-19 pandemic, patients were already used to perform POC tests. The value of at-home POC measurements has previously been demonstrated by fecal calprotectin in patients with inflammatory bowel disease. Recently, Riches et al. demonstrated that usage of an app and urate self-testing substantially improved attainment of urate targets compared with usual care . We beliThis study has some limitations to consider. All patients were recruited from one study site, so the results might not be generalisable. Secondly, participating rheumatologists did not have access to any preliminary results of the trial and did only describe their individual study experiences. Recall bias cannot be excluded, e.g. due to the time difference between self-sampling and the interview. In addition, results may be biased toward the benefits as participants agreed to participate in the study first hand. Further biases are possible due the data being collected via phone call or video conference: loss of non-verbal communication, distractions, lack of confidential atmosphere, and thus social-desiarability bias. Specifically, in the focus groups, originally intented to discursevely contrast opinions among professional groups, we observed a very homogenous opinion profile, which might also be due to hierarchy dynamics between the included professions and individuals. Futhermor, since this study essentially examines the implementation of complex health interventions, another limitation could be the inductive analysis approach and the absence of an implementation framework (such as Consolidated Framework for Implementation Research (CFIR)). A major strength of this study is the patient involvement, the diversity of the included patients  and staff .Our results highlight current challenges in rheumatology and the urgent need for a transformation of care enabling more flexibility and need-adapted visits. The investigated model was easy to use and well accepted among patients. Yet, many ways of improvement were suggested and multiple barriers could be identified.Below is the link to the electronic supplementary material.Supplementary Material 1Supplementary Material 2Supplementary Material 3


Explainable Artificial Intelligence (XAI) and Interpretable Machine Learning (IML) are both terms coined as a response to the proliferation of automated systems penetrating societal, economic, industrial, and scientific environments by concerned users. For instance, what is a These concerns, particularly in mission-critical or life-affecting systems, are fuelled by the increased complexity of such systems, which inevitably turn them into a “black box” when it comes to explaining and interpreting their decisions, outcomes, or behavior. Despite the fact that interesting algorithmic approaches and implementations, e.g., LIME, IBM Protodash, and SHAP (SHapley Additive exPlanations), have been taken to tackle this challenge to look through the “black box” and understand its behavior, these have been predominantly driven by ML developers, and are designed to improve the ML models rather than to provide some explanation or interpretation of the outcome for the consumer of the system.The answer to the question “what is a good explanation for lay users” becomes more challenging within a broader, multi-disciplinary context, as the one of our call, from philosophy to sociology, economics, and computer sciences. In this context, XAI should entail another level of discussion that need to be addressed: our relationship as humans, to AI systems, in general. Nonetheless, the term “explain” derives from the Latin verb “explanare”, which means, literally, “to make level”. Thus, the discussions and scientific endeavors into XAI could entail the notion of ourselves “making level” with AI systems, which again brings us to the old question as to our relationship to and with AI systems. More specifically, bringing in our multifaceted cultural notions of AI and human beings, for instance, in terms of master and servant, or who is and will be dominating whom .Arguably, the intertwined cultural perceptions and  ideas regarding AI and its potential ultimately also influence lay persons perceived needs for explanation when interacting with AI systems. For example, when interacting with a social robot, ideally, we should not have any perceived need for explanation—or only as much or little as we would have when interacting with any other social, human companion. Given that we are seeing a machine, however, brings up expectations and impressions formed by popular culture, and thus the need for explanation to, maybe, satisfy a need for safety, trust, etc.Therefore, answering the research question “what is a good explanation” is far from obvious. Seeking answers to this research question has been the main incentive for the launch of this Research Topic. Even though specific answers to this research question cannot be given, general research directions and perspectives for seeking answers have emerged from the seven contributing articles.In a nutshell, the key message has been that it is impossible to provide answers to this research question without consideration of at least the following aspects: (a) Philosophical foundations of what an explanation is ; (b) Social attribution: how people explain behavior ; (c) Cognitive processes underpinning how people explain and evaluate explanations ; (d) Social explanation, or how people communicate explanations .More specifically, the following key insights should be acknowledged.3Es for AI: Economics, Explanation, Epistemology” , we learn that there is a differentiation between ordinary and scientific meanings of explanation; while ordinary explanation replaces the unfamiliar by the familiar, scientific explanation replaces the familiar by the unfamiliar (Kaul). Hence, a “good explanation” may not be necessarily “comprehensible”, if it is true. Furthermore, the concept of explanation, as of the example of explanations in economics, may mutate and inflect, indicating the changing ways in what counts as knowledge and the terms of access to it have been understood.From the article “Explainable Model Fusion for Customer Journey Mapping” , we understand that, in lay terms, economics and business are often conflated, hence, the answer may lie with customer journey mapping as an approach to explaining and understanding behavior in a market-driven economy (Okazaki and Inoue).From the article “Self-Explaining Social Robots: An Explainable Behavior Generation Architecture for Human-Robot Interaction” , we take the message that before even asking ourselves “what is a good explanation?”, we should design and create systems capable of explaining themselves first .From the article “Prediction, Knowledge, and Explainability: Examining the Use of General Value Functions in Machine Knowledge” (Perspective Article), we learn that, perhaps the answer to this question may lie with the “agent self-assessing its learning environment by carrying out model estimates and calculating the certainty in those estimates during decision-making” .From the article “Benchmarking Perturbation-Based Saliency Maps for Explaining Atari Agents” , we learn how difficult it is for agents to explain their actions when they rely on highly complex ML models such as Deep Reinforcement Learning and Saliency Maps .From the article “GANterfactual—Counterfactual Explanations for Medical Non-experts Using Generative Adversarial Learning”  we may take the insight that despite the diversifying aspects in providing an answer to our research question, perhaps the creation of counterfactuals may the best approach to explain things to lay users .From the article “AI Technologies, Privacy, and Security” (Hypothesis and Theory Article), we may take the message that issues surrounding privacy and data protection may limit the depth and breadth of explanation (Elliott and Soifer).From the article “All authors have been listed in alphabetical order. All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.