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Peer reviewed: True, Acknowledgements: The authors thank the survey participants for their generous contribution of time and effort. We also thank our contact persons for their essential support in making the distribution of the survey possible., BACKGROUND: There is no clear guidance on how to implement opportunistic atrial fibrillation (AF) screening in daily clinical practice. OBJECTIVES: This study evaluated the perception of general practitioners (GPs) about value and practicalities of implementing screening for AF, focusing on opportunistic single-time point screening with a single-lead electrocardiogram (ECG) device. METHODS: A descriptive cross-sectional study was conducted with a survey developed to assess overall perception concerning AF screening, feasibility of opportunistic single-lead ECG screening and implementation requirements and barriers. RESULTS: A total of 659 responses were collected (36.1% Eastern, 33.4% Western, 12.1% Southern, 10.0% Northern Europe, 8.3% United Kingdom & Ireland). The perceived need for standardized AF screening was rated as 82.7 on a scale from 0 to 100. The vast majority (88.0%) indicated no AF screening program is established in their region. Three out of four GPs (72.1%, lowest in Eastern and Southern Europe) were equipped with a 12-lead ECG, while a single-lead ECG was less common (10.8%, highest in United Kingdom & Ireland). Three in five GPs (59.3%) feel confident ruling out AF on a single-lead ECG strip. Assistance through more education (28.7%) and a tele-healthcare service offering advice on ambiguous tracings (25.2%) would be helpful. Preferred strategies to overcome barriers like insufficient (qualified) staff, included integrating AF screening with other healthcare programs (24.9%) and algorithms to identify patients most suitable for AF screening (24.3%). CONCLUSION: GPs perceive a strong need for a standardized AF screening approach. Additional resources may be required to have it widely adopted into clinical practice.

To understand the extent to which individual preferences towards sustainable and especially climate-related investments vary across countries, we are going to conduct an incentivized framed field experiment in five European countries during May and June 2021. We also in-vestigate the importance of different motives for sustainable investments across countries. The experiment is part of a survey of households’ financial decision-makers in France, Germany, the Netherlands, Poland, and Spain, with about 1,000 respondents per country. Our experimental design enables us to calculate the amount of additional fees respondents are willing to pay in order to invest in exchange traded index funds based on the MSCI World ESG Screened Index and the MSCI World Climate Change Index. This allows us to compare not only preferences for sustainable investments across different countries, but also in terms of the thematic focus of sustainable funds. Following Riedl and Smeets (2017), we also analyze to what extent the relevance of pecuniary motives, social signaling, and social prefer-ences for sustainable investment decisions varies across countries. Thus, this study is the first to compare preferences for sustainable investments at the individual level across different countries, while providing identical information and choices to individuals.

We analyze the determinants of hypothetical bias in choice experiments for sustainable investments (SRI). To this end, we compare participants’ willingness to pay derived from incentivized and stated decisions in discrete choice experiments conducted among households’ financial decision makers in Germany. We further extend the set of potential determinants of differences between incentivized and hypothetical choices with the Big Five personality traits. In particular, we analyze the role of extraversion, conscientiousness, and openness to experience, as those traits have been shown to be related to how people react to (monetary) incentives. Our results allow us to shed light on the reliability of previous stated choice analyses in this field and to provide guidance for future experiments.

Objectives: Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios.Design: Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach.Setting: AF screening stakeholders in 11 European countries.Participants: Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation.Intervention: Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening.Primary outcome measures: Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system.Results: Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed.Conclusions: There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities.

Progressing digitalization and networking of systems and organizations representing Critical Infrastructures opens promising new potentials and opportunities, which on the downside, are accompanied by rising complexity and increasingly opaque interdependencies. The consequently increasing lack of knowledge leads to uncertainties affecting risk assessment and decision-making in case of adverse events. This trend motivated recent discussions and developments in risk science, emphasizing the need to handle such uncertainties. Complementarily, research in the resilience domain focuses on system capabilities to handle surprising hazardous situations. Several frameworks presented in the literature aim at combining both perspectives but either lack the focus on operational management, have a rather theoretical approach, or are designed for specific applications. Based on this observation, we propose an approach that integrates resilience management into the actual operation of Critical Infrastructure Systems and Organizations by providing an operational process that coordinates the fundamental resilience capabilities of responding, monitoring, anticipation, and learning. Furthermore, we tackle the challenge of uncertainties resulting from a lack of knowledge by aligning the concepts of digital twin and resilience management. The proposed framework is extensively discussed, and required processes are presented in detail. Eventually, its applicability and potential are reviewed by means of a complex hazardous situation at a Bavarian district heating power plant.

Based on the well-known observation that social norms can guide individual behavior, this paper empirically examines the causal effect of related information interventions on revealed climate protection activities, measured through incentivized donations. In our field-experi-mental setting, we differentiate between descriptive social norms by providing information about individual climate protection activities in Germany, injunctive social norms by provid-ing information about what people in Germany think about the need for climate protection activities, and a combination of both social norms. Based on representative survey data for more than 1,600 individuals in Germany, our econometric analysis shows some weak evi-dence that information about both descriptive and injunctive social norms increases donations for climate protection. The decomposition of this estimated average treatment effects reveals that the corresponding treatment particularly has a significantly positive effect at the extensive margin, i.e. on the probability to donate for climate protection. These results suggest that a combined information intervention referring to both descriptive and injunctive social norms is at least able to stimulate the general willingness for climate protection. In addition, our analysis of heterogeneous treatment effects reveals that strong social preferences (in terms of altruism and trust) and high environmental attitudes (in terms of environmental awareness and ecological policy identification) induce significantly positive information treatment effects on donations for climate protection. This result suggests that individuals in Germany with a strong environmental and social orientation do not only behave directly more climate-friendly, but can also be better stimulated by information about descriptive and/or injunctive social norms.

Voluntary CO2 offsetting by individuals, firms, and organizations is increasingly considered as a direction of climate policy that is complementary to traditional approaches such as sub-sidies or CO2 taxes. Based on data from a large-scale survey among corporate decision mak-ers, this paper empirically examines corporate CO2 offsetting and its determinants in small- and medium-sized firms in Germany. Our descriptive analysis shows both a rather limited engagement in corporate CO2 offsetting as well as a strong lack of knowledge about its mechanism. The econometric analysis reveals that some firm-specific characteristics like the average age of the employees, firm size, and firm age matter for CO2 offsetting. However, the main estimation results refer to the relevance of general environment-related variables like the implementation of environmental product and service innovations or the share of employees that carry out environment-related tasks and especially of climate-related factors and activities. In particular, the implementation of climate targets and the participation in the EU Emissions Trading System (EU ETS) are strongly significantly positively correlated with CO2 offsetting. In line with similar findings at the individual level, these estimation results imply that corporate CO2 offsetting also does not substitute or crowd out other climate pro-tection and further pro-environmental activities, but rather complements them.

Based on data from a representative survey among citizens in Germany during the peak of the COVID-19 crisis, this paper empirically examines the acceptance of climate-oriented economic stimulus programs and several further climate policy measures. Our descriptive analysis shows no general lower acceptance of climate policy measures compared to the time before the crisis. However, the econometric analysis reveals that individuals with higher negative emotions towards the crisis are significantly less supportive of at least some climate-oriented policy measures. Economic concerns are of particular relevance. For example, a perceived deterioration of the general economic situation due to the COVID-19 crisis has a significantly negative effect on the acceptance of climate-oriented economic stimulus programs. Concerns about the own personal economic and financial situation due to the crisis are significantly negatively correlated with the support of climate-oriented policy measures that directly lead to higher costs in daily life. Besides the relevance of this perceived self-interest, our estimation results also highlight the relevance of social aspects since individuals with a social policy identification are significantly more likely to agree with climate-oriented policy measures that are also financially beneficial for socially de-prived groups, but significantly less likely to support measures that are financially unfa-vorable for them. We discuss several climate policy implications. For example, our estima-tion results suggest that successful climate policy should, especially in times of the COVID-19 crisis, also be socially oriented and consider distribution effects, for example, through financial compensations for costly measures like taxes.

Using a stated choice experiment, we find that a prime that makes environmental identity salient makes people behave greener, whereas it does not if it makes religious identity salient. Further-more, we discover non-linear priming effects for environmental identity, which means that rais-ing the salience of highly environmentally oriented respondents or respondents without envi-ronmental identity does not change behavior while it does for respondents with a medium level strength of identity. Methodologically, our study combines for the first time a priming experi-ment with a stated choice (SC) experiment and uses a respondent specific status quo alternative in the empirical analysis with mixed logit models.

AimsDespite marked progress in the management of atrial fibrillation (AF), detecting AF remains difficult and AF-related complications cause unacceptable morbidity and mortality even on optimal current therapy.Methods and resultsThis document summarizes the key outcomes of the 8th AFNET/EHRA Consensus Conference of the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eighty-three international experts met in Hamburg for 2 days in October 2021. Results of the interdisciplinary, hybrid discussions in breakout groups and the plenary based on recently published and unpublished observations are summarized in this consensus paper to support improved care for patients with AF by guiding prevention, individualized management, and research strategies. The main outcomes are (i) new evidence supports a simple, scalable, and pragmatic population-based AF screening pathway; (ii) rhythm management is evolving from therapy aimed at improving symptoms to an integrated domain in the prevention of AF-related outcomes, especially in patients with recently diagnosed AF; (iii) improved characterization of atrial cardiomyopathy may help to identify patients in need for therapy; (iv) standardized assessment of cognitive function in patients with AF could lead to improvement in patient outcomes; and (v) artificial intelligence (AI) can support all of the above aims, but requires advanced interdisciplinary knowledge and collaboration as well as a better medico-legal framework.ConclusionsImplementation of new evidence-based approaches to AF screening and rhythm management can improve outcomes in patients with AF. Additional benefits are possible with further efforts to identify and target atrial cardiomyopathy and cognitive impairment, which can be facilitated by AI.

Objectives Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios. Design Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach. Setting AF screening stakeholders in 11 European countries. Participants Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation. Intervention Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening. Primary outcome measures Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system. Results Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed. Conclusions There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities. RS has received funding from the European Research Council under the European Union’s Horizon 2020 research and innovation program (grant agreement no. 648131); the German Center for Cardiovascular Research (DZHK) (81Z1710103); the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 847770, AFFECT-EU) and ERACoSysMed3 (031L0239). We thank the participants and dedicated study staff of the AFFECT-EU studies for their generous contribution of time and efforts.

Europace : the European journal of pacing, arrhythmias and cardiac electrophysiology euac062 (2022). doi:10.1093/europace/euac062, Published by Oxford Univ. Press, Oxford