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Cosmopolitanism, which is often defined as openness to other cultures and individuals, is significant for understanding processes of stratification in contemporary, globalised societies that are home to increasingly diverse populations. In this paper, we broaden the perspective on cosmopolitanism to include cultural, interpersonal, and political dimensions. We test the associations between these types of cosmopolitanism and three types of correlates: socio-demographic characteristics, personal exposure to other cultures, and exposure to other cultures via various media. We analyse data from nine European countries that differ in the characteristics of their population, cultural traditions, and political models. Results indicate that differences between respondents in the nine countries are better explained by individual characteristics than by country characteristics. Furthermore, it is mainly personal and mediated exposure to other cultures, rather than socio-demographic variables, that play a significant role in influencing respondents' cosmopolitan tendencies. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive approaches to the hip joint for total hip arthroplasty such as the DAA ("Direct Anterior Approach with bikini incision") are increasingly utilized. According to the literature, this approach is more muscle-sparing, results in less postoperative pain, and achieves higher patient satisfaction. The existence of postoperative lymphedema after hip arthroplasty is hardly considered. The aim of this paper is to contribute to the evaluation of the different access methods related to postoperative lymphedema and their functional outcomes. Methods: This is a prospective non-randomized study at an orthopedic specialist clinic in Northern Europe. The surgeons that performed the arthroplasties are high-volume surgeons in private practice affiliated to the clinic. The study included 188 patients with primary hip arthroplasty in a 1:1 ratio (DAA: standard accesses (posterior, transgluteal, and anterolateral access)). Epidemiologic data, Harris Hip Score, Oxford Hip Score, European Quality of Life 5, and Visual Analog Scale were collected preoperatively on admission day, 3rd and 5th postoperative day, and follow-up after 1 year. Furthermore, the range of motion, gait, and ability to climb stairs, as well as the presence of hypesthesia were assessed. To evaluate the edema situation, both legs were measured on the 3rd and 5th postoperative day. The prescription of manual lymphatic drainage and remaining swelling conditions 1 year postoperatively were recorded. Results: For each group, 94 patients with a mean age of 61.7 years (DAA 60.7 and standard access 62.6) were included. All but one patient in the DAA group showed postoperative lymphedema (n: 93/94; 98.9%). In the standard surgery group, only n: 37/94 (39.4%) showed swelling symptoms requiring treatment. After 1 year, lymphedema persisted in 20 patients in the DAA group and 0 patients in the standard-OR group. Hypesthesia at the ventral thigh persisted in 16/94 (= 17%) patients of the DAA group versus 0/94 patients of the standard group after 12 months. Of these 16 cases, 10 had concomitant edema (62.5%). The DAA showed better results than the standard accesses in terms of Oxford Hip Score (p < 0.05) and ability to climb stairs (p < 0.05). In contrast, the Visual Analog Scale and patient quality of life results showed no significant difference (p > 0.05). Conclusion: The present study demonstrated the increased incidence of postoperative lymphedema in patients operated on via DAA access using a Bikini-type skin incision. In the follow-up, significantly more hypesthesia of the ventral thigh occurred in the DAA group. Otherwise, the DAA proved to be superior to the standard approaches from a functional point of view at short-term follow-up. Future research is needed to compare the horizontally oblique to the longitudinal oblique skin incision technique in direct anterior hip surgery regarding the above-mentioned adverse effects found in this study. [ABSTRACT FROM AUTHOR]

Simple Summary: Patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor gene (EGFR) Exon 20 insertion mutations (Exon20ins) used to have poor outcomes after the failure of platinum-based therapies. Amivantamab, a drug that targets two proteins involved in NSCLC (EGFR/MET), was developed and studied in the CHRYSALIS clinical trial. This paper summarizes an analysis comparing outcomes for amivantamab from CHRYSALIS to the outcomes for a mix of treatments that were used in real-world clinical practice (real-world physician's choice [RWPC]). RWPC data were collected from hospitals across Europe in the CATERPILLAR real-world evidence (RWE) study. The outcomes of 114 patients from CHRYSALIS were compared to 55 lines of treatment (LOTs) from CATERPILLAR-RWE, accounting for differences in patient characteristics between the two populations. Overall, the results show that amivantamab was at least twice as good as RWPC for platinum pre-treated patients in terms of tumor response and survival rates. Patients with advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor gene (EGFR) Exon 20 insertions (Exon20ins) at the second line and beyond (2L+) have an unmet need for new treatment. Amivantamab, a bispecific EGFR- and MET-targeted antibody, demonstrated efficacy in this setting in the phase 1b, open-label CHRYSALIS trial (NCT02609776). The primary objective was to compare the efficacy of amivantamab to the choices made by real-world physicians (RWPC) using an external control cohort from the real-world evidence (RWE) chart review study, CATERPILLAR-RWE. Adjustment was conducted to address differences in prognostic variables between cohorts using inverse probability weighting (IPW) and covariate adjustments based on multivariable regression. In total, 114 patients from CHRYSALIS were compared for 55 lines of therapy from CATERPILLAR-RWE. Baseline characteristics were comparable between the amivantamab and IPW-weighted RWPC cohorts. For amivantamab versus RWPC using IPW adjustment, the response rate ratio for the overall response was 2.14 (p = 0.0181), and the progression-free survival (PFS), time-to-next-treatment (TTNT) and overall survival (OS) hazard ratios (HRs) were 0.42 (p < 0.0001), 0.47 (p = 0.0063) and 0.48 (p = 0.0207), respectively. These analyses provide evidence of clinical and statistical benefits across multiple outcomes and adjustment methods, of amivantamab in platinum pre-treated patients with advanced NSCLC harboring EGFR Exon20ins. These results confirm earlier comparisons versus pooled national registry data. [ABSTRACT FROM AUTHOR]

Objectives Research among older adults reveals that the loss of core network members is a risk factor for loneliness. Still, it is not clear whether all such losses induce similar levels of loneliness, particularly as network members are distributed at varied geographic distances. Neither is it clear whether tie addition—the other ubiquitous aspect of network turnover in later life—offsets the loneliness that arises from different network loss scenarios. Methods This paper scrutinized core network losses across multiple relationship–distance scenarios. We used the fourth and sixth waves of data from the Survey of Health, Ageing, and Retirement in Europe and estimated fixed-effect models. Results The loss of a child from a core network increases feelings of loneliness across variant distances, especially when not complemented by additional connections. Losing relatives or nonkin core connections in proximity (within 1 km and 5 km radius, respectively) is also associated with increased loneliness, yet such effects are also largely mitigated by the addition of new core network members. Discussion The relationship between core network member losses and loneliness can significantly differ based on the nature of the lost connection and its geographic distance. Active rebalancing of one's core network following losses and proactive network expansion can serve as pivotal strategies to prevent loneliness for the aging population. [ABSTRACT FROM AUTHOR]

The first European Union Survey on Violence against Women (EU-VAW) released in 2014 revealed the unexpected result indicating that the world's most egalitarian countries have relatively high rates of Intimate Partner Violence Against Women (IPVAW). This phenomenon, referred to as the "Nordic Paradox," revived a heated, intermittently ongoing discussion dating back four decades where several competing hypotheses about the relationship between gender inequality and IPVAW have been proposed, but no consensus has been reached. The main aim of this paper is to revisit the most important of such hypotheses proposed in the last four decades, while proposing a new one that could potentially throw some light on understanding the "Nordic Paradox." Multilevel linear regression models are estimated using data from the EU-VAW survey conducted in 2012, and an alternative operationalization of the Gender Equality Index (GEI) (our measure of gender equality). We did not find any significant effect of gender equality on IPVAW repetition. However, we found that higher country-level status of women and men go together with less IPVAW, with a larger effect of women's status in economic domains compared to the impact of men's economic status, and a larger effect of men's overall status. These findings support the Marxist feminist hypothesis, stating that women's absolute status in the economic and labor domain is critical in lessening IPVAW, as women's real and potential access to resources is key for leaving a violent relationship. At the same time, our results support the "male privilege protection" hypothesis, which states that gains in women's status in certain domains—such as in the economic sphere considering our results for the European Union—would not suppose a threat to men, allowing ameliorative effects. In contrast, if the overall status of men is threatened, backlash effects would be triggered. [ABSTRACT FROM AUTHOR]

The paper measures environmental efficiency and productivity change to then carry out a decomposition analysis of an environmental efficiency index and a productivity change index. The paper includes a novel comparative assessment to determine the drivers of environmental efficiency and the sources of productivity change of the manufacturing sector in Europe, Asia and the whole world. We explore the capability to convert in an environmentally efficient way, selected inputs into desirable and undesirable outputs. Our estimation results of environmental efficiency confirm that Europe is ahead the world's average. Our analysis shows, however, a slowdown of Europe compared with the productivity growth of Asia. The latter shows a better performance in management capabilities, optimal resource allocation, and economies of scale. The analysis carried out in a second stage using the dynamic effects of the generalized method of moments also shows that the annual growth rate of manufacturing value added and manufacturing exports positively influence the level of environmental efficiency in both Asia and Europe. Therefore, the internationalization and extroversion of manufacturing can be crucial for sustainable development in Europe and Asia. • Benchmarking the strategy for sustainable development in Asia and Europe. • Decomposition of environmental efficiency indices and productivity change. • Effect of manufacturing value added and exports on environmental efficiency. • Benchmarking the manufacturing sector in Asia and Europe. • Showing Asia's best practices and European pillar of industrial restructuring. [ABSTRACT FROM AUTHOR]

This paper presents a comparative analysis of various capacity mechanisms that are either in force or under approval in key countries/regions in Europe and the US. A detailed analysis on the necessities that led to the establishment of the capacity mechanisms, along with various fundamental technical and operational features associated with the design and operation of different capacity mechanisms, mainly in Europe (Italy, France, Germany, Belgium, Poland, Great Britain, Ireland, Cyprus) and complementarily in the US (PJM, New England), are presented. This analysis is complemented by a real-life application regarding the long-term capacity remuneration mechanism that is expected to be established in Greece in the near future. A detailed simulation of the envisaged capacity mechanism auctions under differentiated scenarios has been performed, regarding the future Greek power system operating conditions during the forthcoming decade (2022–2031). Test results illustrate that the outcome of the auctions is heavily dependent on the future energy generation mix and the market participants' bidding strategy. Whereas, the total cost that will have to be undertaken by the electricity supply companies and, ultimately, by the end-consumers for the financing of the proposed capacity mechanism lies in the range of 5.5–8.7 €/MWh for the entire study period. [ABSTRACT FROM AUTHOR]

There has been a strong degree of interest over the last 30 years towards immigrant segregation in Europe. This paper aims to contribute towards the existing body of research by extending the multi-scalar analysis of patterns of immigrant residential segregation into a coherent international comparative study of cities of different sizes. We investigate the patterns of immigrant-native segregation at different geographical scales, along with their correlates, in more than a hundred cities in 2011 across Germany, Spain, Sweden, the Netherlands, and the United Kingdom. Our findings suggest that cities in the UK are the most highly segregated in Europe. The positions of the other countries in the 'European segregation ranking' depend upon the considered immigrant group and spatial scale. The national context is consistently the most important factor in understanding segregation at multiple spatial scales. However, even while taking into account the national contexts, the structural-ecological factors remain important predictors of segregation patterns in Europe. [ABSTRACT FROM AUTHOR]

This paper investigates different uses of the Journal Impact Factor (JIF) in national journal rankings and discusses the merits of supplementing metrics with expert assessment. Our focus is national journal rankings used as evidence to support decisions about the distribution of institutional funding or career advancement. The seven countries under comparison are China, Denmark, Finland, Italy, Norway, Poland, and Turkey—and the region of Flanders in Belgium. With the exception of Italy, top‐tier journals used in national rankings include those classified at the highest level, or according to tier, or points implemented. A total of 3,565 (75.8%) out of 4,701 unique top‐tier journals were identified as having a JIF, with 55.7% belonging to the first Journal Impact Factor quartile. Journal rankings in China, Flanders, Poland, and Turkey classify journals with a JIF as being top‐tier, but only when they are in the first quartile of the Average Journal Impact Factor Percentile. Journal rankings that result from expert assessment in Denmark, Finland, and Norway regularly classify journals as top‐tier outside the first quartile, particularly in the social sciences and humanities. We conclude that experts, when tasked with metric‐informed journal rankings, take into account quality dimensions that are not covered by JIFs. [ABSTRACT FROM AUTHOR]

Background To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe. Methods SILNE-R school survey data, which was collected in 2016–17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N  = 5088, age 13–19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL. Results Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83–5.49], alcohol use (OR: 2.94, 95% CI: 2.34–3.68) and cannabis use (OR: 2.56, 95% CI: 1.89–3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89–1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL. Conclusions Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use. [ABSTRACT FROM AUTHOR]

Background: The aim of the study is to analyse the association between job stress and interpersonal relationships on and outside of the job in Europe. The main assumption of the paper is that since social relations at various levels enhance individual well-being, they may counteract stress created by an unfavourable work environment.Methods: The econometric analysis, based on a standard ordered probit model, employs data taken from the Sixth European Working Conditions Survey carried out in 2015 and released in 2017.Results: The results show significant correlations between interpersonal contacts on and outside of the job and job stress. Help and support provided by one's manager decreases the probability of being stressed at work, while receiving help and support from co-workers is likely to increase the probability of job stress occurrence. However, maintaining cooperation and getting on well with colleagues decrease the probability of experiencing stress, confirming the positive and gratifying features of contact with co-workers reported by the literature.Conclusions: While we were not able to establish the direction of causality between job stress and interpersonal relationships (a limitation of this paper), the present work contributes new evidence to the literature on occupational stress. Our results show that interpersonal relationships on and outside of the job can be considered valuable resources that, when available to an individual, are useful for managing stress created by workplace stressors. [ABSTRACT FROM AUTHOR]

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples' health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant-centric ePHR responses. This paper highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe. [ABSTRACT FROM AUTHOR]

Background: The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar.Methods: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support.Results: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention.Conclusions: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts. [ABSTRACT FROM AUTHOR]

This paper analyzes whether and how work values differ between European Welfare states and change over time. We proceed in three steps: First, we show that—despite EU harmonization endeavors, for example, via the Europe 2020 strategy—work values still vary substantially between European countries and welfare regimes. Second, by analyzing data from the European Social Survey 2004 and 2010, we show how labor market policies, such as active and passive labor market policies, are associated with work values and how overall levels of work values changed over this period. Third, we discuss potential implications of the heterogeneity of work values for national as well as European labor market policy making. Altogether we are able to show that work values are substantially driven by the economic structure of a country and its labor market policy making. Key Practitioner MessageWork values vary substantially between European countries and welfare regimes.The change of work values is substantially driven by welfare state structures (both labor market policies implemented and industry share).Both European and national labor market policy making has to account for these different work values to be successful. [ABSTRACT FROM AUTHOR]

In this paper we carried out a comparative analysis of three alliances, namely Quercion petraea, Betonico-Quercion and Lathyro-Quercion, which span Central and Eastern European thermophilous oak forests. The main goal was to find out floristic and ecological differences as well as to assess specificities in the phytosociological and layer structure across the syntaxa in different regions of Europe. Cluster analysis was performed based on the Bray-Curtis distance matrix and the flexible beta algorithm. A phytoindication method was applied to determine ecological relationships. Variability in the phytosociological structure was studied by shares of species of different classes of vegetation. The layer structure features were investigated by comparing species with the highest constancy value within each layer. Analysis of the distribution boundaries of differentiating species allowed the geographical boundaries of the three identified syntaxa clusters to be delineated. In the phytosociological structure, the greatest differences were found in the proportion of species of Quercetea pubescentis and Brachypodio-Betuletea classes. The Central and Eastern European syntaxa groups were shown to be significantly different in the constancy-ranked series of major layer-forming species. [ABSTRACT FROM AUTHOR]

Background: In Europe, knowledge about the social determinants of health among undocumented migrants is scarce. The canton of Geneva, Switzerland, implemented in 2017-2018 a pilot public policy aiming at regularizing undocumented migrants. We sought to test for associations between self-rated health, proven eligibility for residence status regularization and social and economic integration.Methods: This paper reports data from the first wave of the Parchemins Study, a prospective study whose aim is to investigate the effect of residence status regularization on undocumented migrants' living conditions and health. The convenience sample included undocumented migrants living in Geneva for at least 3 years. We categorized them into those who were in the process of receiving or had just been granted a residence permit (eligible or newly regularized) and those who had not applied or were ineligible for regularization (undocumented). We conducted multivariate regression analyses to determine factors associated with better self-rated health, i.e., with excellent/very good vs. good/fair/poor self-rated health. Among these factors, measures of integration, social support and economic resources were included.Results: Of the 437 participants, 202 (46%) belonged to the eligible or newly regularized group. This group reported better health more frequently than the undocumented group (44.6% versus 28.9%, p-value < .001), but the association was no longer significant after adjustment for social support and economic factors (odds ratio (OR): 1.12; 95% confidence interval (CI): 0.67-1.87). Overall, better health was associated with larger social networks (OR: 1.66; 95% CI: 1.04-2.64). This association remained significant even after adjusting for health-related variables.Conclusion: At the onset of the regularization program, access to regularization was not associated with better self-rated health. Policies aiming at favouring undocumented migrants' inclusion and engagement in social networks may promote better health. Future research should investigate long-term effects of residence status regularization on self-rated health. [ABSTRACT FROM AUTHOR]

Study Question: How many twins are born in human populations and how has this changed over recent decades?Summary Answer: Since the 1980s, the global twinning rate has increased by a third, from 9.1 to 12.0 twin deliveries per 1000 deliveries, to about 1.6 million twin pairs each year.What Is Known Already: It was already known that in the 1980s natural twinning rates were low in (East) Asia and South America, at an intermediate level in Europe and North America, and high in many African countries. It was also known that in recent decades, twinning rates have been increasing in the wealthier parts of our world as a result of the rise in medically assisted reproduction (MAR) and delayed childbearing.Study Design, Size, Duration: We have brought together all information on national twinning rates available from statistical offices, demographic research institutes, individual survey data and the medical literature for the 1980-1985 and the 2010-2015 periods.Participants/materials, Setting, Methods: For 165 countries, covering over 99% of the global population, we were able to collect or estimate twinning rates for the 2010-2015 period. For 112 countries, we were also able to obtain twinning rates for 1980-1985.Main Results and the Role Of Chance: Substantial increases in twinning rates were observed in many countries in Europe, North America and Asia. For 74 out of 112 countries the increase was more than 10%. Africa is still the continent with highest twinning rates, but Europe, North America and Oceania are catching up rapidly. Asia and Africa are currently home to 80% of all twin deliveries in the world.Limitations, Reasons For Caution: For some countries, data were derived from reports and papers based on hospital registrations which are less representative for the country as a whole than data based on public administrations and national surveys.Wider Implications Of the Findings: The absolute and relative number of twins for the world as a whole is peaking at an unprecedented level. An important reason for this is the tremendous increase in medically assisted reproduction in recent decades. This is highly relevant, as twin deliveries are associated with higher infant and child mortality rates and increased complications for mother and child during pregnancy and during and after delivery.Study Funding/competing Interest(s): The contribution of CM was partially supported by the European Research Council (ERC) under the European Union's Horizon 2020 Research and Innovation Programme (grant No 681546, FAMSIZEMATTERS), Nuffield College, and the Leverhulme Trust. The contribution of GP was partially supported by the French Agence Nationale de la Recherche (grant No ANR-18-CE36-0007-07). The authors declare no conflict of interest.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

The use of serious games to improve collaborative skill transfer and retention has received considerable attention from scholars, web marketing practitioners and business consultants. Team rankings and learning progress in game learning analytics, however, have yet to be empirically examined. Using fuzzy-set qualitative comparative analysis to study the performance of competing teams in a web marketing serious game (Simbound), we highlight a combination of causal conditions (engagement, reach and profitability) affecting team rankings. This paper proposes a conceptual architecture of the forces that influence learning progress within a collaborative learning environment. This learning environment is studied for web marketing boot camps powered by Simbound at three European universities: Grenoble Alpes University (France), University of Milano-Bicocca (Italy) and Dunarea de Jos University of Galati (Romania). Gaining knowledge of cases through game learning analytics is valuable for two reasons: It emphasises the instructor’s role in mobilising players’ engagement, and it tests variability across cases, offering precursors of team performance rankings. This approach to collective skill retention highlights the moderating factors of team performance rankings, whilst purposely calibrating a gameable learning environment. This paper enriches our knowledge of how active experimentation in learning analytics metrics can develop skills for real business competition. [ABSTRACT FROM AUTHOR]

Mistakes, printing defects, reused woodcuts and low-quality paper are often the result of strategies enabled by printers and publishers to offer printed material at a low price while balancing profit/loss in their daily activities. It was precisely due to these strategies that a wider class of population could read, sing, learn and enjoy life in early modern Europe. This essay illustrates the preliminary results of a comparative analysis aimed at investigating the production phase of cheap books and prints all over Europe. With a focus on editorial strategies, printing practices and materials commonly adopted and used in these publications, it demonstrates that European publishers and printers followed very similar patterns while producing cheap products. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores education-, income- and occupational class-related inequalities in risky health behaviours including into models all three factors together as well as their interactions, which has not been undertaken by previous studies analysing socioeconomic status (SES) related differences in risky health behaviours.Methods: Our data source is the special module "Social Inequalities in Health" included into the European Social Survey Round 7 (ESS R7) and conducted in 20 European countries. We run nine separate multilevel binomial logistic regression analyses for all the risky health behaviours with all our independent and control variables including country as the second level random intercept. Into all the models we also included interaction terms to consider possible moderating effects of separate independent variables.Results: Education and income emerged as factors most consistently related to risky health behaviours, but occupational class differences were also found to be significant: eating vegetables or salad less than once a day and being daily smoker is positively related to lower SES as measured by all three indicators; eating fruits less than once a day is related to lower income and occupational class, while drinking alcohol at least several times a week is positively related to higher education and higher income; being physically active for less than 3 days per week is positively related to lower education; patterns of heavy smoking and binge drinking are inconsistently related to SES variables. We also found considerable regional variation, especially in fruit and vegetable consumption, being physically active and alcohol consumption patterns.Conclusions: Without careful theoretical consideration linking SES and risky health behaviours, education, income and occupational class cannot substitute each other in the study of SES-related differences of health behaviours, as assumed in the larger part of research on the subject. [ABSTRACT FROM AUTHOR]

Migrant inclusion in a society is a process that ultimately succeeds or fails at the local level and cities have increasingly taken a proactive stance in delivering their own policies for integration. The literature on the topic has focused particularly on the cooperation between local political institutions and civil society organizations, underestimating the key role played by social partners. This paper demonstrates the participation of social partners in the local governance of migrant integration in three European cities: Barcelona, Lyon and Gothenburg. Drawing on process tracing analysis and qualitative interviews, the article illustrates the different responses of local unions and employers' organizations to immigration and the variety of approaches to supporting migrant integration into employment and society. The article argues that these approaches, which take place within different institutional and structural contexts, shape different patterns of migrant inclusion and allow us to explain the new and traditional ways in which social partners operate as social and political actors. [ABSTRACT FROM AUTHOR]

Background: Medical data from family doctors are of great importance to health care researchers but seem to be locked in German practices and, thus, are underused in research. The RADAR project (Routine Anonymized Data for Advanced Health Services Research) aims at designing, implementing and piloting a generic research architecture, technical software solutions as well as procedures and workflows to unlock data from family doctor's practices. A long-term medical data repository for research taking legal requirements into account is established. Thereby, RADAR helps closing the gap between the European countries and to contribute data from primary care in Germany.Methods: The RADAR project comprises three phases: (1) analysis phase, (2) design phase, and (3) pilot. First, interdisciplinary workshops were held to list prerequisites and requirements. Second, an architecture diagram with building blocks and functions, and an ordered list of process steps (workflow) for data capture and storage were designed. Third, technical components and workflows were piloted. The pilot was extended by a data integration workflow using patient-reported outcomes (paper-based questionnaires).Results: The analysis phase resulted in listing 17 essential prerequisites and guiding requirements for data management compliant with the General Data Protection Regulation (GDPR). Based on this list existing approaches to fulfil the RADAR tasks were evaluated-for example, re-using BDT interface for data exchange and Trusted Third Party-approach for consent management and record linkage. Consented data sets of 100 patients were successfully exported, separated into person-identifying and medical data, pseudonymised and saved. Record linkage and data integration workflows for patient-reported outcomes in the RADAR research database were successfully piloted for 63 responders.Conclusion: The RADAR project successfully developed a generic architecture together with a technical framework of tools, interfaces, and workflows for a complete infrastructure for practicable and secure processing of patient data from family doctors. All technical components and workflows can be reused for further research projects. Additionally, a Trusted Third Party-approach can be used as core element to implement data privacy protection in such heterogeneous family doctor's settings. Optimisations identified comprise a fully-electronic consent recording using tablet computers, which is part of the project's extension phase. [ABSTRACT FROM AUTHOR]

• Techno-economic comparative analysis is carried for parabolic trough collector and steam generating heat pumps with focus on industrial boundary conditions. • A novel comparative indicator based on solar fraction is introduced to compare the results to find economic strong hold of analysed technologies. • Parabolic trough collectors are an effective technology to reduce the emission in low to medium irradiation locations. • There is a significant potential of combining both technologies to leverage the advantages for fully decarbonised industrial systems. Industrial heat production is responsible for around 20% of total greenhouse gas emissions in Europe. To achieve the climate change goals defined in the Paris Climate Agreement, the EU commission has shifted its focus on sustainable means to generate heating. Moreover, global dependencies are leading to a re-organization of natural gas supplies. Therefore, there is a need for less vulnerable and less price-volatile solutions for heating. This paper focuses on two decarbonization technologies for industrial process heat supply: a) electricity-driven steam-generating high-temperature heat pumps (HTHP), a technology that is more efficient than fossil fuel boilers in generating steam, and b) solar parabolic trough collector (PTC), which can produce heat economically and at a minimal carbon footprint compared to other technologies. The main aim of this paper is to evaluate the levelized cost of heat (LCOH) of these technologies to fulfill a comparative techno-economic analysis. A maximum PTC collector's solar fraction limit (SF limit) is defined to indicate when the LCOH for these two technologies is equal. This allows for distinguishing between the economic stronghold of each technology. The evaluation is carried out through the annual energy simulations using TRNSYS and Excel spreadsheets for HTHPs, while TRNSED and OCTAVE are used for the solar thermal part. Boundary conditions for European geographical constraints have been applied to establish use cases for the analysis. The result shows that the design of a PTC system with optimal SF can reach cost parity with HTHP for most of the analyzed locations. The developed methodology serves as a valuable guide to quickly determine a preferred lower carbon heat solution, thus easing the decision-making for industries. [ABSTRACT FROM AUTHOR]

Population aging is exacerbating the loss of competences in the workforce and simultaneously young people neither in employment nor in education and training (NEETs) are struggling to be reengaged in employment. These issues, which are deemed priorities for the European policy agenda, could be addressed by triggering active aging dimensions, valuing and exploiting older adult entrepreneurs' knowledge for enhancing youngsters' entrepreneurial attitudes, through mentoring. This paper reports the results of a study based on an intergenerational learning program, carried out in 2018 in Germany, Italy and Slovenia. The study was aimed at developing and testing one training on mentoring addressing 41 older adult entrepreneurs (55 and over), and two intergenerational learning trainings aiming at boosting entrepreneurial competences of 33 NEETs (aged 18–29). The impact of the program on older adult entrepreneurs and NEETs was assessed through a pre and post-evaluation using qualitative and quantitative tools. Findings at country level were treated as national case-studies and then the latter were compared by considering them as a multiple embedded case-study. Results indicated that, to different extent in the study countries, mentors learned and enhanced mentoring competences, e.g. active listening and the capability of orienting, improved well-being and self-esteem, social inclusion and active aging attitude. Moreover, NEETs acquired entrepreneurial and socio-relational competences by benefiting from the full exploitation of mentors' know-how and the trust relationship with them. Companies, trade unions, educational and voluntary organizations should cooperate to adopt intergenerational learning programs as good practices for older adults and NEETs' lifelong learning promotion. [ABSTRACT FROM AUTHOR]

Purpose: The French academic libraries directors association (ADBU) launched and updated a European comparative study on Key Performance Indicators (KPI) in Academic Libraries over the 2013–2017 period. The purpose of this paper is to briefly present the ADBU initiative; its main focus is how to use these figures to ground decision making process, notably so as to better assess the contribution of libraries in student success or research performance. Design/methodology/approach: As universities and academic libraries are facing research evolutions and teaching/learning new models, a strong increase in students' number is observed everywhere in Europe. This trend will most probably continue in the coming years and the pressure on academic libraries will grow. That is why the French ADBU took the initiative to launch a European comparative study on key and performance indicators in Academic Libraries over the 2013–2016 period. Data were updated in 2019, covering 2017 figures and including additional countries. Findings: Thanks to the European partners and the help of a consultant firm, the first observations were updated with the 2017 figures and the country scope grew broader. Libraries buildings and equipment, space and seats per student, opening days and hours, frequentation rate, library services, users training, staff per student/documentary budgets/total expenditure, staff training, documentation loans/consultation/downloads: these KPI are gathered and can be compared in both relative and absolute value. Originality/value: The ADBU initiative is unique, results are widely shared. [ABSTRACT FROM AUTHOR]

Flood risks are managed differently across Europe. While a number of research studies aim to understand these differences, they tend to pay little attention to the social constructionist aspects of flood risk governance, i.e. the meaning that societies give to flood risk and governance. This paper aims to address this gap by understanding differences in flood risk management approaches (FRMA) from a discursive-institutional perspective. Based on this perspective, an analytical framework was developed to systematically analyse and compare discourses pertaining to flood risk and its governance in six European member states (England (the United Kingdom), Flanders (Belgium), France, the Netherlands, Poland and Sweden). Correspondingly, this paper demonstrates how the hegemonic discursive-institutional patterns of flood risk governance differ between the six European countries. These differences may influence the capability of countries to learn from each other, adopt new FRMAs or cooperate with each other. Moreover, the paper argues that differences in discourses partially account for the differences in FRMAs between countries, combined with other factors. Additionally, broader implications are discussed. For example, the research findings imply that some discourses tend to favour or disfavour other discourses, and that they additionally also tend to favour particular FRMAs; e.g. the flood risk discourse pertaining to high manageability of risks seems to favour a governance discourse of collectivity and central governance . The different insights imply that further research is necessary to understand the complex interaction of discourses and institutional arrangements. [ABSTRACT FROM AUTHOR]

Aims: Estimates of the prevalence of gestational diabetes vary widely. It is important to have a clear understanding of the prevalence of this condition to be able to plan interventions and health care provision. This paper describes a meta-analysis of primary research data reporting the prevalence of gestational diabetes mellitus in the general pregnant population of developed countries in Europe.Methods: Four electronic databases were systematically searched in May 2016. English language articles reporting gestational diabetes mellitus prevalence using universal screening in general pregnant population samples from developed countries in Europe were included. All papers identified by the search were screened by one author, and then half screened independently by a second author and half by a third author. Data were extracted by one author. Values for the measures of interest were combined using a random effects model and analysis of the effects of moderator variables was carried out.Results: A total of 3258 abstracts were screened, with 40 studies included in the review. Overall prevalence of gestational diabetes mellitus was 5.4% (3.8-7.8). Maternal age, year of data collection, country, area of Europe, week of gestation at testing, and diagnostic criteria were found to have a significant univariate effect on GDM prevalence, and area, week of gestation at testing and year of data collection remained statistically significant in multivariate analysis. Quality category was significant in multivariate but not univariate analysis.Conclusions: This meta-analysis shows prevalence of GDM that is at the upper end of previous estimates in Europe. [ABSTRACT FROM AUTHOR]

Background and Aim: Factors promoting family adaptation to child's disability are poorly studied together. The aim of the study was to describe the family adaptation to disability and to identify determinants associated with using a global theoretical model.Materials and Methods: 286 families of teenagers [13-17 years] with cerebral palsy (CP) from 4 European disability registers were included and visited at home. Face to face interviews were performed in order to measure parental distress, perceived impact in various dimensions of family life, family resources and stressors. Relationships were modelled with structural equations.Results: 31.8% of parents living with an adolescent with CP showed clinically significant high stress requiring professional assistance. The main stressors were the level of motor impairment and behavioural disorders in adolescent. A good family functioning was the best protective factor. Respite in care and a parents' positive attitude were significantly related to less parental distress. Material support, socioeconomical level, marital status or parental qualifications did not appear to be significant protector factors.Conclusions: Particular attention must be paid not only on physical condition but also on adolescent psychological problems to improve family adaptation. Families at risk of experiencing severe distress should be targeted early and proactive caregiver interventions on the whole family should be performed.What This Paper Adds: Family is a dynamic system: facing disability, it tries to recover its balance with available resources and its perception of the situation. Literature highlights potential stressors and protecting factors that could affect the disabled child's family adaptation but few papers study a global model including most of these factors. This study validated a global theoretical model of family adaptation to disability at adolescence. It identified behaviour disorders and motor impairment level as main stressors, family functioning as the largest protecting factors, and equipment and financial support as non significant protective factors. [ABSTRACT FROM AUTHOR]

ABSTRACT In the final decades of the twentieth century, the post-industrial regions of western Europe and the US were hot-spots of urban shrinkage, and this also affected large areas in post-socialist countries. Despite ongoing calls for a better integration of diverse global urban experiences into theorization, post-socialist cities and their trajectories, as well as their experiences with rapid urban change, have been largely disregarded in general theory development. At the same time, we face a somewhat inconsistent situation in the theoretical discourse on urban development. There are requests for 'new geographies of theory' or to regard all cities as 'ordinary', in order to include different types of narratives and experience into overall comparisons and/or theory building. Set against this background, this paper aims to deal with the case of shrinking post-socialist cities, that is, cities that are 'excluded' from hegemonic discourses for two reasons: they are post-socialist and they are shrinking. In contrast to this situation, we understand shrinking post-socialist cities as valuable examples for strengthening the debate on current and future forms of, and determining factors for, general urbanization. At the focus of our paper, therefore, are the questions about what we can learn from the analysis of shrinking post-socialist cities for the general discourse, as well as for theory building for cities, and how we can overcome the observed reluctance to integrate the post-socialist experience into general theory development. The paper draws on an EU 7 FP research project finished in 2012 that comparatively analysed urban shrinkage across several regions of Europe, with a particular focus on post-socialist countries. [ABSTRACT FROM AUTHOR]

Aim: Children born very preterm require additional specialist care because of the health and developmental risks associated with preterm birth, but information on their health service use is sparse. We sought to describe the use of specialist services by children born very preterm in Europe.Method: We analysed data from the multi-regional, population-based Effective Perinatal Intensive Care in Europe (EPICE) cohort of births before 32 weeks' gestation in 11 European countries. Perinatal data were abstracted from medical records and parents completed a questionnaire at 2 years corrected age (4322 children; 2026 females, 2296 males; median gestational age 29wks, interquartile range [IQR] 27-31wks; median birthweight 1230g, IQR 970-1511g). We compared parent-reported use of specialist services by country, perinatal risk (based on gestational age, small for gestational age, and neonatal morbidities), maternal education, and birthplace.Results: Seventy-six per cent of the children had consulted at least one specialist, ranging across countries from 53.7% to 100%. Ophthalmologists (53.4%) and physiotherapists (48.0%) were most frequently consulted, but individual specialists varied greatly by country. Perinatal risk was associated with specialist use, but the gradient differed across countries. Children with more educated mothers had higher proportions of specialist use in three countries.Interpretation: Large variations in the use of specialist services across Europe were not explained by perinatal risk and raise questions about the strengths and limits of existing models of care.What This Paper Adds: Use of specialist services by children born very preterm varied across Europe. This variation was observed for types and number of specialists consulted. Perinatal risk was associated with specialist care, but did not explain country-level differences. In some countries, mothers' educational level affected use of specialist services. [ABSTRACT FROM AUTHOR]

Background: The Anaesthesia PRactice In Children Observational Trial (APRICOT) in 261 European hospitals revealed a 5.2% incidence of severe critical events in the perioperative period and wide variability in practice.Methods: A sub-analysis of the Scandinavian data was undertaken to investigate differences from the rest of Europe in the incidence and nature of perioperative severe critical events and to attempt to identify areas for quality improvement.Findings: In the Scandinavian cohorts of 1520 paediatric patients out of 31 127 patients, the overall incidence of perioperative severe critical events was lower than the rest of Europe (4.4% (95% CI [3.5-5.6]) vs 5.2% (95% CI [5.0-5.5]); RR 0.57), albeit the incidence varied across countries. There was a lower rate of bronchospasm (0.9%), stridor (1.1%) and cardiovascular instability (0.9%) than the rest of Europe. The proportion of bronchospasm events occurring at induction was 0.13% in Scandinavian cohort which was less than the rest of Europe (1.2%). The proportion of sicker patients where less experienced teams were managing the care was notably lower in Scandinavia than in the rest of Europe (14.4% vs 20.4% of the American Society of Anesthesiologists Physical Status Classification System Score (ASA-PS III and 8.3% vs 12.8% of the ASA-PS IV. Cardiovascular instability was lower in Scandinavia (0.92%) compared to Europe (1.9%). The incidence of drug errors was low in both the overall APRICOT (0.2%) and in Scandinavia (0.3%). There were no deaths.Interpretation: This sub-analysis shows that current Scandinavia paediatric perioperative clinical practice compares favourably with the rest of Europe. The lower incidence of cardiovascular and respiratory complications could be partly attributed to more experienced dedicated paediatric anaesthesia providers managing the higher risk groups of patients in Scandinavia. Whether this cohort of anaesthetized children is truly representative of the entire Scandinavia countries is unknown. Areas for quality improvement include: standardisation of the definition of severe critical events, increased reporting, development of evidence-based protocols for the management of severe critical events, development and rational implementation of paediatric perioperative risk assessment scores, implementation of current best practice in the provision of competent paediatric anaesthesia service in Europe, development of specific training and ensuring maintenance skills in paediatric anaesthesia. Furthermore, based on data from the original Apricot paper children under the age of 3 years and ASA-PS III and IV patients should not be anaesthetised without direct supervision of a specialist in paediatric anaesthesia. Given the sample size of the Scandinavian cohort this conclusion cannot be investigated further. [ABSTRACT FROM AUTHOR]

Within Northern Europe, gendered roles and responsibilities within the family have been challenged through an emergence of different family forms, increasing cultural diversity, and progressive developments in welfare policies. To varying degrees, welfare policies in different countries support a dual‐earner model and encourage men to be more active as fathers by reinforcing statutory rights and responsibilities. In child welfare practice, there has traditionally been a strong emphasis on the mother as primary carer for the child; the father has been less visible. This paper explores, in four national welfare contexts, how child welfare social workers include fathers in practice decisions. Data were collected using focus group interviews with social workers from England, Ireland, Norway, and Sweden. Similarities and differences emerge in relation to services and the focus of social work assessments. However, overall, the research suggests that despite gains in policy and legislation that promote gender equality, fathers remain largely absent in child welfare practice decisions about the parenting of their children. From the research, we raise questions for social work practice and the development of welfare policies. [ABSTRACT FROM AUTHOR]

Abstract School leaders around the world are increasingly required to orchestrate their school's strategic planning in order to both meet external accountability requirements and create fostering learning environments for all students. To meet these objectives in the complex school ecosystem, leaders need to make decisions based on holistic collection and analysis of diverse educational data, coming from different school actors (such as students, teachers, infrastructure, curricula, legislations etc.). However, this task can be very cumbersome, especially since contemporary 'School Analytics' methods aiming to support decision making have mainly accommodated the aspect of collecting and visualizing data or utilized variance-based analyses, but have yet to explicitly address the aspect of deriving insights to inform strategic school planning. In this context, the contribution of this work is to present and evaluate a novel School Analytics approach that employs fuzzy-set qualitative comparative analysis (fsQCA) as the means to bridge the qualitative-quantitative divide in learning technology research methods and provide leaders with actionable insights on how to create school conditions for fostering students' outcomes, focusing on digital skills as a case study. By employing fsQCA on data from almost 3000 schools across Europe, the paper outlines eight distinct configurations of school factors, which describe how school leaders can potentially generate nurturing environments for enhancing students' digital skills. Finally, the quantitative results from a layered evaluation protocol argue for the promising potential of the fsQCA method as a tool to unravel the complex knot of processing school-wide educational data and generating insights to inform school leaders' decision making. Highlights • Existing School Analytics methods offer limited actionable decision support to leaders. • FsQCA can be used to process various school data and offer actionable insights. • FsQCA outlined 8 configurations of school factors nurturing to students' digital skills. • The fsQCA configurations can act as blueprints towards holistic school improvement. • FsQCA can bridge the qualitative-quantitative divide in learning technology research methods. [ABSTRACT FROM AUTHOR]

Context/problem: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. Objective: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. Methods: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. Results: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. Conclusions: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption. [ABSTRACT FROM AUTHOR]

In times of growing commercialisation and digitisation, it is often assumed that traditional mass media react to growing economic pressures by providing more entertaining, more trivial and oversimplified content. This supposed development—also known as tabloidisation—seems to be caused by media structures, particularly the competitive pressures of tabloid newspapers and commercial television. However, to date only very few studies have explored systematically how coverage (micro level) is shaped by media structures (macro level) and the strategies of the media companies (meso level). The present study investigates, based on the industrial economic Structure–Conduct–Performance (SCP) model, whether the degree of tabloidisation (performance) of German and Austrian national market-leading quality papers and tabloids can be explained by market structures and individual newspapers' self-images (conduct). A theoretical model of tabloidisation by Reinemann et al. is empirically tested for the first time, resulting in a categorisation of four dimensions of tabloidisation: topic, focus, visual style and verbal style. Altogether, the study shows a rather weak influence both of structure and conduct, explained by reverse “tabloidising effects” of a high market share of tabloids in Austria and of commercial television in Germany. Nevertheless, it finds some remarkable differences between the four newspapers. While both quality papers are rather weakly tabloidised and the GermanBildis quite strongly tabloidised, the AustrianKroneis surprisingly somewhat less tabloidised than the quality papers, presumably due to its “peoples' newspaper strategy”. [ABSTRACT FROM PUBLISHER]

Entrepreneurship is an important driver of development, employment and productivity. Economic system in modern and developped countries is founded on a dynamic "entrepreneurial system", where innovation plays the role of main driver of economy and society. First part of the paper intends to analyze the structure of REDI index elaborated by a team of experts for measuring entrepreneurship in 125 macro-regions of European Union. This index has the objective of capturing differences in the quality of entrepreneurial activity, taking in account the different environmental factors. Second part of the paper is dedicated to a comparative analysis of the REDI index calculated for Italian macro-regions and Romanian ones. Finally, several on field researches are utilized in order to analyze the characteristics of Italian entrepreneurial situation. [ABSTRACT FROM AUTHOR]

Background: Driven by climate change mitigation, EU countries are committed to improve energy efficiency of their building stock by implementing the energy performance of buildings directive (EPBD). Should higher energy efficiency result in better indoor environmental quality (IEQ), this policy could also be seen as an opportunity to improve public health across Europe.Objectives: This paper focuses on the assessment of the effects of energy retrofits on occupant satisfaction with IEQ and health in multifamily buildings.Methods: Data on occupant satisfaction with IEQ and health were collected from the occupants of 39 Finnish and 15 Lithuanian multifamily buildings (an average of five apartments per building, one adult per apartment) both before and after energy retrofits (such as improving thermal insulation, windows, heating and/or ventilation systems). Parallel to the data collected from the occupants, data on several IEQ parameters, including temperature, temperature factor, and air change rate, were collected from their apartments. Moreover, data from seven Finnish and five Lithuanian non-retrofitted control buildings were collected according to the same protocol.Results: Occupant satisfaction regarding indoor temperature was associated with both retrofit status (OR 5.3, 95% CI 2.6-11.0) and measured IEQ parameters (indoor temperature OR 1.4 per 1 °C increase, temperature factor OR 1.1 per 1% increase, and air change rate OR 5.6 per 1/h increase). Additional positive associations were found between retrofit status and occupants reporting absence of upper respiratory symptoms (OR 1.8, 95% CI 1.1-2.9) as well as not missing work or school due to respiratory infections (OR 4.1, 95% CI 1.2-13.8), however, these associations were independent of the measured IEQ parameters.Conclusions: There seems to be a strong subjective component related to the observed changes in occupant satisfaction with IEQ and health as a result of energy retrofitting in buildings. Further studies are needed to verify the actual mechanisms, as well as possible long term effects. [ABSTRACT FROM AUTHOR]

Background: Cryptomarkets, or illegal anonymizing online platforms that facilitate drug trade, have been analyzed in a rapidly growing body of research. Previous research has found that, despite increased risks, cryptomarket sellers are often willing to ship illegal drugs internationally. There is little to no information, however, about the extent to which uncertainty and risk related to geographic constraints shapes buyers' behavior and, in turn, the structure of the global online drug trade network. In this paper, we analyze the structure of a complete cryptomarket trade network with a focus on the role of geographic clustering of buyers and sellers.Methods: We use publicly available crawls of the cryptomarket Abraxas, encompassing market transactions between 463 sellers and 3542 buyers of drugs in 2015. We use descriptive social network analysis and Exponential Random Graph Models (ERGM) to analyze the structure of the trade network.Results: The structure of the online drug trade network is primarily shaped by geographical boundaries. Buyers are more likely to buy from multiple sellers within a single country, and avoid buying from sellers in different countries, which leads to strong geographic clustering. The effect is especially strong between continents and weaker for countries within Europe. A small fraction of buyers (10%) account for more than a half of all drug purchases, while most buyers only buy once.Conclusion: Online drug trade networks might still be heavily shaped by offline (geographic) constraints, despite their ability to provide access for end-users to large international supply. Cryptomarkets might be more "localized" and less international than thought before. We discuss potential explanations for such geographical clustering and implications of the findings. [ABSTRACT FROM AUTHOR]

Background: The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients.Main Body: This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources.Conclusion: Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level. [ABSTRACT FROM AUTHOR]

This paper evaluates the effects of migration on life satisfaction in later life. We compare the life satisfaction of older migrants with that of non-migrants and return migrants of a similar age and originating from the same regions in Turkey. Turks constitute one of the largest migrant groups in Europe, and the growing population of older Turkish migrants display greater risks of loneliness and material disadvantage compared to native-born populations in Europe. However, compared to their non-migrant peers from the country of origin, older migrants may experience gains from migration that are reflected in their life satisfaction. Using the 2000 Families Study, a large survey of Turkish migrants from the peak labour migration period and their non-migrant comparators, we investigate whether life satisfaction of migrants and stayers differs and the possible causes of any differences. We find that both migrants and return migrants experience higher life satisfaction in old age than stayers. However, the gap cannot be explained by the classical determinants of life satisfaction such as income, health, partner and friends, or religiosity, nor by the better outcomes of the migrants’ children. We discuss possible reasons for this migration satisfaction advantage. [ABSTRACT FROM AUTHOR]

Contemporary theories of the policy process typically assume that policy responses tend to go through long periods of stasis alternated with occasional bursts of intense activity. The concept of policy punctuations has been put forward to denote large-scale changes in public policies that take place in crisis moments. However, research on the dynamics of policy overreaction and underreaction is still in its infancy. It has mostly focused on either small-n cross-sectional analysis of government spending or case studies of single events. A comparative assessment of the extent of disproportionate responses in a crisis is still lacking. To fill this gap, in this paper we develop a framework to conceptualize, operationalize, and ultimately assess disproportionate policy responses systematically from a cross-sectional perspective. We create a series of indexes to measure policy over- and underreactions among the EU member states that experienced the 2007–2008 banking crisis. We found that a large majority of EU countries overreacted through public liability guarantee and budget commitment. On the other hand, regulatory responses are characterized by a greater variation. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that higher seizure burden in Dravet syndrome is associated with increased comorbidities and lower quality of life (QoL) in a large cohort of patients with Dravet syndrome and their caregivers in Europe.Method: An extensive survey of caregivers of patients with Dravet syndrome on experiences of diagnosis, seizure burden, management, social and financial impact, and health services use was administered online in 10 languages.Results: The survey received 584 unique responses from caregivers of paediatric (83%) and adult (17%) patients with Dravet syndrome (aged <1-48y). Despite broadly following current treatment guidance, less than 10% of patients were seizure free in the previous 3 months. Nearly all (99.6%) patients aged 5 years or older experienced at least one or more motor, speech, learning, or behavioural impairment. High seizure frequency was related to more reports of emergency treatment, comorbidities, and a lower QoL (as measured by the standardized instrument EQ-5D-5L). If not diagnosed at the first instance, the majority (83%) of adults, but less than 20% of 6- to 11-year-olds were diagnosed after 4 or more years.Interpretation: Patients with Dravet syndrome with the highest current seizure frequency suffer from more comorbidities and have a lower QoL. Therefore, more effective antiepileptic treatments are needed.What This Paper Adds: The survey captured about 15% of all patients with Dravet syndrome in Europe. Less than 10% of patients had current seizure freedom. Patients with a high current seizure burden have more comorbidities and lower quality of life. [ABSTRACT FROM AUTHOR]

Background: There is significant interest in comparing countries on many different indicators of social problems and policies. Cross-national comparisons of drug prevalence and policies are often hampered by differences in the approach used to reach respondents and the methods used to obtain information in national surveys. The paper explores how much these differences could affect cross-country comparisons.Methods: This study reports prevalence of drug use according to the most recent national household survey and then adjusts estimates as if all national surveys used the same methodology. The analysis focuses on European countries for which the European Monitoring Centre for Drugs and Drug Addiction reports data, the United States, Canada, and Australia. Adjustment factors are based on US data.Findings: Adjusting for modality differences appears likely to modestly affect the rankings of countries by prevalence, but to an extent that could be important for comparisons. For example, general population surveys suggest that the US had some of the highest cannabis and cocaine prevalence rates circa 2012, but this is partially driven by the use of a modality known to produce higher prevalence estimates. This analysis shows that country rankings are partly an artifact of the mode of interview used in national general population surveys.Conclusions: Our preliminary efforts suggest that cross-national prevalence comparisons, policy analyses and, other projects such as estimating the global burden of disease could be improved by adjusting estimates from drug use surveys for differences in modality. Research is needed to create more authoritative adjustment factors. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most frequent localization of malignant process in American women and women of European countries. To date it is not possible to control the morbidity growth due to lack of effective ways of primary prevention. Comparing the incidence of breast cancer in developed countries with the countries of Asia and Africa, there is the fact of population predominance lesion in more urbanized countries. This suggests that the environment along with other factors, occupies a significant place in the initiation and progression of breast neoplasia. The impressive rates of industrial development led to the pollution of soil, surface water and, as a consequence, food by heavy metal salts. The purposes of this paper are as follows: the chemical composition determination of neoplastic breast tissue, evaluation of the DNA methylation level, study of prognostic-important receptors expression in the breast cancer cells, establishing linkages between all the derived indicators. Methods: In our study we used the following methods: studying of the chemical composition of breast cancer tissue by atomic absorption spectrophotometry and energy-dispersion spectrometer; immunohistochemical study of ER, PR, HER2/neu, p53, Ki-67, E-cadherin and MGMT receptors; DNA extraction and investigation by oscillating infrared spectroscopy method. Results: The total amount of heavy metals in breast cancer tissue ranged from 51.21 x 10-3 to 84.86 x 10-3 µg/kg. We have got the following results: the growth of heavy metals in neoplastic tissue is accompanied with the increase of HER2/neu, p53, Ki-67, MGMT expression and decrease of ER and PR expression. The increment of pathological DNA methylation is accompanied with the increasing amount of heavy metals in tumor tissue. Conclusions: Heavy metals through different pathogenetic links stimulate the progression of breast cancer and reduce its sensitivity to treatment. DNA of tumor tissue has a different level of methylation which changes with the amount of heavy metals in cancer cells. This is displayed on the synthesis of prognostically important receptors in neoplastic tissue. [ABSTRACT FROM AUTHOR]

Background: Knowledge of HIV status can be important in reducing the risk of HIV exposure. In a European sample of men-who-have-sex-with-men (MSM), we aimed to identify factors associated with HIV serostatus disclosure to the most recent anal intercourse (AI) partner. We also aimed to describe the impact of HIV serostatus disclosure on HIV exposure risks.Methods: During 2013 and 2014, 4901 participants were recruited for the bio-behavioural Sialon-II study in 13 European cities. Behavioural data were collected with a self-administered paper questionnaire. Biological specimens were tested for HIV antibodies. Factors associated with HIV serostatus disclosure with the most recent AI partner were examined using bivariate and multilevel multivariate logistic regression analysis. We also describe the role of serostatus disclosure for HIV exposure of the most recent AI partner.Results: Thirty-five percent (n = 1450) of the study participants reported mutual serostatus disclosure with their most recent AI partner or disclosed having HIV to their partner. Most of these disclosures occurred between steady partners (74%, n = 1077). In addition to the type of partner and HIV diagnosis status, other factors positively associated with HIV serostatus disclosure in the multilevel multivariate logistic regression model were recent testing, no condom use, and outness regarding sexual orientation. Disclosure rates were lowest in three south-eastern European cities. Following condom use (51%, n = 2099), HIV serostatus disclosure (20%, n = 807) was the second most common prevention approach with the most recent AI partner, usually resulting in serosorting. A potential HIV exposure risk for the partner was reported by 26% (111/432) of HIV antibody positive study participants. In 18% (20/111) of exposure episodes, an incorrect HIV serostatus was unknowingly communicated. Partner exposures were equally distributed between steady and non-steady partners.Conclusions: The probability of HIV exposure through condomless AI is substantially lower after serostatus disclosure compared to non-disclosure. Incorrect knowledge of one's HIV status contributes to a large proportion of HIV exposures amongst European MSM. Maintaining or improving condom use for anal intercourse with non-steady partners, frequent testing to update HIV serostatus awareness, and increased serostatus disclosure particularly between steady partners are confirmed as key aspects for reducing HIV exposures amongst European MSM. [ABSTRACT FROM AUTHOR]

Background: Tier 1 exposure tools recommended for use under REACH are designed to easily identify situations that may pose a risk to health through conservative exposure predictions. However, no comprehensive evaluation of the performance of the lower tier tools has previously been carried out. The ETEAM project aimed to evaluate several lower tier exposure tools (ECETOC TRA, MEASE, and EMKG-EXPO-TOOL) as well as one higher tier tool (STOFFENMANAGER®). This paper describes the results of the external validation of tool estimates using measurement data. Methods: Measurement data were collected from a range of providers, both in Europe and United States, together with contextual information. Individual measurement and aggregated measurement data were obtained. The contextual information was coded into the tools to obtain exposure estimates. Results were expressed as percentage of measurements exceeding the tool estimates and presented by exposure category (non-volatile liquid, volatile liquid, metal abrasion, metal processing, and powder handling). We also explored tool performance for different process activities as well as different scenario conditions and exposure levels. Results: In total, results from nearly 4000 measurements were obtained, with the majority for the use of volatile liquids and powder handling. The comparisons of measurement results with tool estimates suggest that the tools are generally conservative. However, the tools were more conservative when estimating exposure from powder handling compared to volatile liquids and other exposure categories. In addition, results suggested that tool performance varies between process activities and scenario conditions. For example, tools were less conservative when estimating exposure during activities involving tabletting, compression, extrusion, pelletisation, granulation (common process activity PROC14) and transfer of substance or mixture (charging and discharging) at nondedicated facilities (PROC8a; powder handling only). With the exception of STOFFENMANAGER® (for estimating exposure during powder handling), the tools were less conservative for scenarios with lower estimated exposure levels. Conclusions: This is the most comprehensive evaluation of the performance of REACH exposure tools carried out to date. The results show that, although generally conservative, the tools may not always achieve the performance specified in the REACH guidance, i.e. using the 75th or 90th percentile of the exposure distribution for the risk characterisation. Ongoing development, adjustment, and recalibration of the tools with new measurement data are essential to ensure adequate characterisation and control of worker exposure to hazardous substances. [ABSTRACT FROM AUTHOR]

Despite that small and medium-sized towns (SMSTs) have been, and continue to be, a central part of the history of Europe, these places have largely been neglected by urban research. The ESPON TOWN project, on which this Special Issue builds, sought to redress this neglect performing a comparative analysis of their position and role across Europe. In this introductory paper we discuss some of the theoretical and methodological challenges when it came to identifying, studying and analysing SMSTs and the theoretical framework developed to inform our understanding of SMSTs. In particular, three themes are discussed. The first one is about the ontological problem of defining a town. Administrative, morphological and functional perspectives are considered. The second one reflects on a wide array of interpretative approaches about the relationship between towns and their regional context. The third one is about the thematic and multi-scalar perspectives that can characterise the policy approach to towns. [ABSTRACT FROM AUTHOR]

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making. [ABSTRACT FROM AUTHOR]

Abstract: Coastal floodplains are complex regions that form the interface between human, physical and natural systems. This paper describes the development, application and evaluation of a conceptual foundation for quantitative integrated floodplain risk assessments using the recently-developed SPR systems model. The SPR systems model is a conceptual model that combines the well-established Source–Pathway–Receptor (SPR) approach with the concept of system diagrams. In comparison to the conventional approach, the systems model provides spatially explicit quasi-2D descriptions of the floodplain in terms of constituent elements and possible element linkages. The quasi-2D SPR, as it will henceforth be referred to in this paper, is not the final product of this work, but is an important intermediate stage which has been pursued as part of a wider European flood risk project THESEUS (www.theseusproject.eu). Further research is currently on-going to provide full quantification of the quasi-2D SPR, and to add further refinements such that hydraulic assessments could follow on easily and rapidly from the results of these appraisals. The first part of the paper synthesises current conceptual treatment of coastal floodplains and identifies areas for improvement in describing coastal floodplains as complex systems. The synthesis demonstrates that the conceptual foundation of a ‘typical’ flood risk study often achieves a less comprehensive and integrated description of the floodplain than the quantitative models which it informs. From this synthesis, the quasi-2D SPR is identified as a more robust and informative conceptual foundation for an integrated risk assessment. The quasi-2D SPR has been applied to seven European coastal floodplains as part of the THESEUS project. The second part of the paper discusses in detail the application of the quasi-2D SPR to three contrasting floodplain systems — an estuary, a coastal peninsula and a mixed open coast/estuary site. The quasi-2D SPR provides a consistent approach for achieving comprehensive floodplain descriptions that are individual to each coastal floodplain. These are obtained through a robust, participatory model-building exercise, that facilitates developing a shared understanding of the system. The constructed model is a powerful tool for structuring and integrating existing knowledge across multiple disciplines. Applications of the quasi-2D SPR provide key insights into the characteristics of complex coastal floodplains — insights that will inform the quantification process. Finally, the paper briefly describes the on-going quantitative extension to the quasi-2D SPR. [Copyright &y& Elsevier]

Background: This paper aims to review controversies in the management of minimally invasive follicular thyroid carcinoma (MIFTC) and to reach an evidence-based consensus. Method: MEDLINE search of the literature was conducted using keywords related to MIFTC. The search term was identified in the title, abstract, or medical subject heading. Available literature meeting the inclusion criteria were assigned the appropriate levels of evidence and recommendations in accordance with accepted international standards. Results were discussed at the 2013 Workshop of the European Society of Endocrine Surgeons devoted to MIFTC. Results: Published papers on MIFTC present inadequate power with a III-IV level of evidence and C grade of recommendation. Several issues demanded a comparison of published studies from different medical reports regarding MIFTC definition, specimen processing, characteristics, diagnosis, prognoses, and therapy. As a consequence, it is difficult to make valuable statements on MIFTC with a sufficient recommendation rating. MIFTC diagnosis requires clearer, unequivocal, and reproducible criteria for pathologist, surgeons, and endocrinologists to use in the management of these patients. If the distinction between MIFTC and WIFTC cannot be made, an expert in thyroid pathologist should be consulted. Conclusion: According to published papers, the following conclusions can be drawn. (a) Candidates for hemithyroidectomy are MIFTC with exclusive capsular invasion, patients <45 years old at presentation, tumor size <40 mm, without vascular invasion, and without any node or distant metastases. (b) Candidates for total thyroidectomy are MIFTC in patients ≥45 years at presentation, tumor size ≥40 mm, vascular invasion present, positive nodes, and positive distant metastases. (c) In the absence of clinical evidence for lymph node metastasis, patients with MIFTC do not require prophylactic lymph node dissection. (d) Radio iodine ablation is indicated in elderly patients (>45 years), large tumor size (>40 mm), extensive vascular invasion, presence of distant synchronous or metachronous metastasis, positive nodes, and if recurrence is noted at follow-up. [ABSTRACT FROM AUTHOR]