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Many countries have some kind of energy-system transformation either planned or ongoing for various reasons, such as to curb carbon emissions or to compensate for the phasing out of nuclear energy. One important component of these transformations is the overall reduction in energy demand. It is generally acknowledged that the domestic sector represents a large share of total energy consumption in many countries. Increased energy efficiency is one factor that reduces energy demand, but behavioral approaches (known as “sufficiency”) and their respective interventions also play important roles. In this paper, we address citizens’ heterogeneity regarding both their current behaviors and their willingness to realize their sufficiency potentials—that is, to reduce their energy consumption through behavioral change. We collaborated with three Swiss cities for this study. A survey conducted in the three cities yielded thematic sets of energy-consumption behavior that various groups of participants rated differently. Using this data, we identified four groups of participants with different patterns of both current behaviors and sufficiency potentials. The paper discusses intervention types and addresses citizens’ heterogeneity and behaviors from a city-based perspective. [ABSTRACT FROM AUTHOR]

This paper describes the process of adapting the Stanford Coreference resolution module to the Basque language, taking into account the characteristics of the language. The module has been integrated in a linguistic analysis pipeline obtaining an end-to-end coreference resolution system for the Basque language. The adaptation process explained can benefit and facilitate other languages with similar characteristics in the implementation of their coreference resolution systems. During the experimentation phase, we have demonstrated that language-specific features have a noteworthy effect on coreference resolution, obtaining a gain in CoNLL score of 7.07 with respect to the baseline system. We have also analysed the effect that preprocessing has in coreference resolution, comparing the results obtained with automatic mentions versus gold mentions. When gold mentions are provided, the results increase 11.5 points in CoNLL score in comparison with results obtained when automatic mentions are used. The contribution of each sieve is analysed concluding that morphology is essential for agglutinative languages to obtain good performance in coreference resolution. Finally, an error analysis of the coreference resolution system is presented which have revealed our system’s weak points and help to determine the improvements of the system. As a result of the error analysis, we have enriched the Basque coreference resolution adding new two sieves, obtaining an improvement of 0.24 points in CoNLL F1 when automatic mentions are used and of 0.39 points when the gold mentions are provided. [ABSTRACT FROM AUTHOR]

Autonomous Vehicles (AV) technology is emerging. Field tests on public roads have been on going in several states in the US as well as in Europe and Asia. During the US public road tests, crashes with AV involved happened, which becomes a concern to the public. Most previous studies on AV safety relied heavily on assessing drivers’ performance and behaviors in a simulation environment and developing automated driving system performance in a closed field environment. However, contributing factors and the mechanism of AV-related crashes have not been comprehensively and quantitatively investigated due to the lack of field AV crash data. By harnessing California’s Report of Traffic Collision Involving an Autonomous Vehicle Database, which includes the AV crash data from 2014 to 2018, this paper investigates by far the most current and complete AV crash database in the US using statistical modeling approaches that involve both ordinal logistic regression and CART classification tree. The quantitative analysis based on ordinal logistic regression and CART models has successfully explored the mechanism of AV-related crash, via both perspectives of crash severity and collision types. Particularly, the CART model reveals and visualize the hierarchical structure of the AV crash mechanism with knowledge of how these traffic, roadway, and environmental contributing factors can lead to crashes of various serveries and collision types. Statistical analysis results indicate that crash severity significantly increases if the AV is responsible for the crash. The highway is identified as the location where severe injuries are likely to happen. AV collision types are affected by whether the vehicle is on automated driving mode, whether the crashes involve pedestrians/cyclists, as well as the roadway environment. The method used in this research provides a proven approach to statistically analyze and understand AV safety issues. And this benefit is potential be even enhanced with an increasing sample size of AV-related crashes records in the future. The comprehensive knowledge obtained ultimately facilitates assessing and improving safety performance of automated vehicles. [ABSTRACT FROM AUTHOR]

Background: The concept of ‘patient experience’ has become central to how to improve healthcare. Remote communication with patients is today a frequent practice in healthcare services, showing similar outcomes to standard outpatient care while enabling cost reduction in both formal and informal care. The purpose of this study was to analyse the experiences of people with telemonitoring pacemakers. Methods: Patients were randomly allocated to either the telemonitoring or hospital monitoring follow-ups. Using the ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ), as well as an ad-hoc survey from the ‘telehealth patient satisfaction survey’ and ‘costs survey’, patients’ experiences were measured six months after the pacemaker implant in a cohort of 50 consecutive patients. The mean age was 74.8 (± 11.75) years and 26 (52%) patients were male of which 1 was lost in follow-up. Finally, 24 patients were followed up with standard hospital monitoring, while 25 used the telemonitoring system. Differences in baseline characteristics between groups were not found. Results: Findings showed overall positive and similar experiences in patients living with telemonitoring and hospital monitoring pacemakers. Significant differences were found in GS-PEQ concerning how telemonitoring patients received less information about their diagnosis/afflictions (p = 0.046). We did not find significant differences in other items such as ‘confidence in the clinicians’ professional skills’, ‘treatment perception adapted to their situation’, ‘involvement in decisions regarding the treatment’, ‘perception of hospital organisation’, ‘waiting before admission’, ‘satisfaction of help and treatment received’, ‘benefit received’, and ‘incorrect treatment’. Conclusions: The remote communication of pacemakers was met with positive levels of patients’ experiences similarly to patients in the hospital monitoring follow-up. However, telemonitoring patients received less information. Thus, improving the quality and timing of information is required in telemonitoring patients in the planning and organisation of future remote communication healthcare services for people living with a pacemaker implant. [ABSTRACT FROM AUTHOR]

This research quantifies the bias caused in hospital productivity measurements when cost heterogeneity is not considered. A multi-output stochastic cost frontier under a normalised translog specification is used to approximate the structure of technology of a sample of public general hospitals in Spain during the period 2002–2009. To control for observable heterogeneity in costs, a set of variables related to hospital characteristics are included in the cost frontier specification (i.e., hospital complexity, degree of specialisation, availability of outpatient clinics, variety of high-technology equipment available, teaching activity and quality of care), whereas unobservable heterogeneity is accounted for by means of individual dummy variables. A measure of hospitals’ cost efficiency is first obtained, and the analysis is then completed by measuring and decomposing the total factor productivity index (TFP-I) change. Findings reveal that controlling for heterogeneity decreases total productivity from an annual average rate of 0.028% to 1.330%, mainly driven by the negative contribution of the cost efficiency change component. Hence, a bias of 1.303 percentage points in the overall TFP-I is found as consequence of not controlling for heterogeneity. In addition to this, if heterogeneity factors are not accounted for, the mean cost efficiency index during the period analysed is 0.730, figure that increases up to 0.974 if heterogeneity is considered. Hence, the omission of heterogeneity leads to a bias of 24.4 percentage points in the mean cost efficiency. Therefore, not adjusting for heterogeneity in costs gives rise to distorted measurements of hospital productivity, as well as distortions in the contribution of each of its components, which may lead to the adoption of inadequate policies and decisions on resource allocation. [ABSTRACT FROM AUTHOR]

In recent years, an increasing number of democracies have adopted a runoff rule to elect their president. Some have argued, however, that the benefits of such a rule are dubious at best. In this article, I seek to counter this claim, as I posit that a runoff rule promotes the protection of human rights by reducing outcomes that are negatively associated with high government respect for human rights. Using ordered logistic regression and an analysis of predicted probabilities, I find that democratic presidential elections held using a runoff rule produce presidents that are less likely to be associated with lower government respect for human rights, and more likely to be associated with greater government respect for human rights. I conclude by suggesting that politicians should consider embracing a presidential runoff rule, as its adoption could be a relatively easy way to reduce repression. [ABSTRACT FROM AUTHOR]

Out-of-pocket payments might threaten the vertical equity of financing and generate unmet medical needs. The main objective was to assess the vertical equity of outpatient out-of-pocket payments for lymphedema patients in France. Twenty-seven centres, among which 11 secondary care hospitals and 16 primary care practices participated in this prospective national multicenter study. We measured the lymphedema-specific outpatient out-of-pocket payments over 6 months. The vertical equity of out-of-pocket payments was examined using concentration curves, the Gini coefficient for income, the Kakwani index, and the Reynolds-Smolensky index. We included 231 lymphedema patients aged 7 years or more, living in metropolitan France, and being able to use Internet and email. After voluntary health insurance reimbursement, the mean out-of-pocket payment was equal to 101.4 Euros per month, mainly due to transport (32%) and medical devices (26%). Concentration curves indicated regressivity of out-of-pocket payments. Total out-of-pocket payments represented 10.1% of the income by consumption unit for the poorest quintile and 3.5% for the wealthiest (p<0.05). The Kakwani index for out-of-pocket payments was equal to -0.18. Regarding outpatient health care, French lymphedema patients face significant and regressive out-of-pocket payments, associated with an increased risk of unmet medical needs. Such results shed light on significant socioeconomic inequalities and bring into question the current financing arrangements of outpatient health care in France. Trial registration: ClinicalTrials.gov ID: [ABSTRACT FROM AUTHOR]

Effective global collaboration is crucial to achieving the UN Sustainable Development Goals (SDGs). It requires an understanding of the needs of individual countries and their expectations related to bioeconomy. With the aim to explore the prospective developments in the global bioeconomy over the next 20 years, the German Bioeconomy Council, an independent advisory body to the German Federal Government, commissioned BIOCOM-AG to invite experts from around the globe to share their insights in a global expert survey. The survey was conducted online in autumn 2017. 345 experts from 46 countries completed the questionnaire about future developments and strategies in the global bioeconomy. As claimed by the experts, the upcoming bioeconomy must primarily meet humanity’s needs in the energy, agriculture, and food sectors. Moreover, innovative products based on renewable resources are anticipated to be of great importance. Even though all UN SDGs will be affected by future bioeconomy success stories, five SDGs stood out within the sample: SDG 12: ‘responsible consumption and production’; SDG 9: ‘industry, innovation and infrastructure’; SDG 13: ‘climate action’; SDG 7: ‘affordable and clean energy’; and SDG 11: ‘sustainable cities and communities’. About three quarters of the experts emphasized the need to specifically address three conflicting goals in any future bioeconomy strategy: non-food uses of arable land, use of crop land to produce feedstock for meat, milk and egg production and, finally, the conversion of virgin forests into agricultural land. Most experts stated that reducing food loss and waste is crucial to eradicating the world hunger problem. The proposed solutions relied greatly on innovation and technological development. Bioeconomy expertise and know-how should be shared in close cooperation between developed and developing economies to reach UN SDGs. A supportive political framework would be the ultimate goal towards furthering the progress of a future bioeconomy all over the world. [ABSTRACT FROM AUTHOR]

Most of the Paleolithic art and ornaments discovered in Romania come from the site of Poiana Cireșului. Four Paleolithic layers have been studied at this site—the oldest one belongs to the Early Gravettian period between 30 ka and 31 ka BP. The ornaments discovered in this layer include perforated shells from three species of mollusks: freshwater Lithoglyphus naticoide and Lithoglyphus apertus as well as Homalopoma sanguineum (an exclusively Mediterranean species). Poiana Cireșului is one of the very few Gravettian sites where perforated Homalopoma sanguineum shells were found, and the importance of this discovery is stressed even more by the very long distance between the site and the nearest source located over 900 km away. This find suggests the connection of communities here with the Mediterranean area as well as a possible movement of populations from the south of the continent to the east of the Carpathians with significant implications in understanding human group mobility and the origin of the Early Gravettian in this area. Furthermore, Poiana Cireșului is the only Gravettian settlement where Lithoglyphus naticoides shells were used. The unique association of perforated shells—not found in any other Gravettian settlement—contributes to the identity of the Paleolithic community of Poiana Cireșului through their ornaments. [ABSTRACT FROM AUTHOR]

The concept of multi-use of the sea has gained popularity in recent years as a result of ocean space (coastal areas and regions with relatively small sea space in particular) becoming increasingly crowded due to the development of the maritime economy. Competing claims for space can be a source of conflict, however this may also lead to mutual benefits for different users when sustainable combinations are sought. Despite increasing European-wide efforts, on-the-ground knowledge and practice of multi-use are still limited. Therefore, with the aim of investigating opportunities for multi-use development in the European seas, 10 case studies were selected, involving different site-specific contexts. This study analyses the characteristics and development potential for ocean multi-use, integrating results from desk analysis and stakeholder perceptions from different sectors in each of the case study locations. Similarities and differences between various combinations of sea uses are also identified. The results show a high heterogeneity of multi-use opportunities between case studies, with a range of combinations identified. The investigated combinations of maritime uses share an overall balance between factors promoting (drivers) and hindering (barriers) multi-use development. Based on stakeholder opinions, expected benefits (added values) of multi-use implementation outweigh potential negative impacts. Management actions are also proposed to further exploit multi-use potential at a local, regional (sub-national) and national levels. [ABSTRACT FROM AUTHOR]

Background: The Hopkins Symptom Checklist in 25 items (HSCL-25) helps to assess anxiety and depression in Primary Care. Anxiety and depression show considerable overlap in primary care. This self-administrated questionnaire is valid, reliable and ergonomic in the original US version. We have translated it into French. The aim of this study was to estimate the test characteristics of the HSCL-25, in its French version (F-HSCL-25), by comparing it to the Present State Examination-9 French version (F-PSE-9) and by determining its internal validity and dimensions. Method: Outpatients from three French General Practice settings (rural, semi-rural and urban) were recruited: approximately 20,000 outpatients among 17 GPs. Two groups were formed: F-HSCL-25 ≥1.75 and F-HSCL-25 <1.75. A validated cut-off score of > 1.75 was considered to indicate a clinically relevant level of symptoms of depression and anxiety. In order to obtain two balanced groups, a different method of randomization was chosen for each group. The F-PSE-9 was randomly administered to 1 in 2 patients in the F-HSCL-25 ≥1.75 group, and to 1 in 16 in the (much larger) F-HSCL-25 <1.75 group. The diagnostic performance was assessed and the test results obtained from both groups were compared with their F-PSE-9 results. Results: Of the 1126 patients who completed the F-HCL-25, 886 joined the F-HSCL-25 <1.75 group and 240 the F-HSCL-25 ≥1.75 group. The overall prevalence of depression, using the F-HSCL-25, was 21% in these medical practices. The diagnostic performance of the F-HSCL-25 versus the F-PSE-9, the external criteria were as follows: Positive Predictive Value (PPV) 69.8%, Negative Predictive Value (NPV) 87%; Sensitivity 59.1%, and Specificity 91.4%. The Principal Component Analysis showed that F-HSCL-25 is a one-dimensional tool (anxiety and depression dimensions combined) with a Cronbach Alpha of 0.93. Conclusion: The F-HSCL-25 is an appropriate diagnostic tool for anxiety and depression in primary care in France due to its high specificity and high NPV. The HSCL-25 scale has a high eigenvalue. This pilot study will be extended throughout Europe; however, preliminary evidence suggests that the HSCL-25 is a reliable and suitable diagnostic tool for primary care. [ABSTRACT FROM AUTHOR]

Conventional generators in power grids are steadily substituted with new renewable sources of electric power. The latter are connected to the grid via inverters and as such have little, if any rotational inertia. The resulting reduction of total inertia raises important issues of power grid stability, especially over short-time scales. With the motivation in mind to investigate how inertia reduction influences the transient dynamics following a fault in a large-scale electric power grid, we have constructed a model of the high voltage synchronous grid of continental Europe. To assess grid stability and resilience against disturbance, we numerically investigate frequency deviations as well as rates of change of frequency (RoCoF) following abrupt power losses. The magnitude of RoCoF's and frequency deviations strongly depend on the fault location, and we find the largest effects for faults located on the support of the slowest mode—the Fiedler mode—of the network Laplacian matrix. This mode essentially vanishes over Belgium, Eastern France, Western Germany, northern Italy and Switzerland. Buses inside these regions are only weakly affected by faults occuring outside. Conversely, faults inside these regions have only a local effect and disturb only weakly outside buses. Following this observation, we reduce rotational inertia through three different procedures by either (i) reducing inertia on the Fiedler mode, (ii) reducing inertia homogeneously and (iii) reducing inertia outside the Fiedler mode. We find that procedure (iii) has little effect on disturbance propagation, while procedure (i) leads to the strongest increase of RoCoF and frequency deviations. This shows that, beyond absorbing frequency disturbances following nearby faults, inertia also mitigates frequency disturbances from distant power losses, provided both the fault and the inertia are located on the support of the slowest modes of the grid Laplacian. These results for our model of the European transmission grid are corroborated by numerical investigations on the ERCOT transmission grid. [ABSTRACT FROM AUTHOR]

Purpose: Chronic disease is often associated with a reduced energy level, which limits the capacity to work full-time. This study aims to investigate whether the construct work endurance is part of disability assessment in European countries and what assessment procedures are used. We defined work endurance as the ability to sustain working activities for a number of hours per day and per week. Materials and methods: We conducted a survey using two self-constructed questionnaires. We addressed 35 experts from 19 countries through the European Union of Medicine in Assurance and Social Security (EUMASS). We gathered descriptive data on various aspects of (the assessment of) work endurance. Results: Experts from 16 countries responded. In most countries work endurance is assessed. We found few professional guidelines specific for the assessment of work endurance. Both somatic and mental diseases may cause limited work endurance. Methods to assess work endurance vary, objective methods rating as most suitable. Almost half of the countries report controversies on the assessment of work endurance. Conclusions: Work endurance is recognised and assessed as an aspect of work disability assessment in Europe. However, controversies exist and evidence based guidelines, including reliable and valid methods to assess work endurance, are lacking. [ABSTRACT FROM AUTHOR]

Background: While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods: Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results: The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions: While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning. [ABSTRACT FROM AUTHOR]

The burden of disease framework facilitates the assessment of the health impact of diseases through the use of summary measures of population health such as Disability-Adjusted Life Years (DALYs). However, calculating, interpreting and communicating the results of studies using this methodology poses a challenge. The aim of the Burden of Communicable Disease in Europe (BCoDE) project is to summarize the impact of communicable disease in the European Union and European Economic Area Member States (EU/EEA MS). To meet this goal, a user-friendly software tool (BCoDE toolkit), was developed. This stand-alone application, written in C++, is open-access and freely available for download from the website of the European Centre for Disease Prevention and Control (ECDC). With the BCoDE toolkit, one can calculate DALYs by simply entering the age group- and sex-specific number of cases for one or more of selected sets of 32 communicable diseases (CDs) and 6 healthcare associated infections (HAIs). Disease progression models (i.e., outcome trees) for these communicable diseases were created following a thorough literature review of their disease progression pathway. The BCoDE toolkit runs Monte Carlo simulations of the input parameters and provides disease-specific results, including 95% uncertainty intervals, and permits comparisons between the different disease models entered. Results can be displayed as mean and median overall DALYs, DALYs per 100,000 population, and DALYs related to mortality vs. disability. Visualization options summarize complex epidemiological data, with the goal of improving communication and knowledge transfer for decision-making. [ABSTRACT FROM AUTHOR]

Medieval European urbanization presents a line of continuity between earlier cities and modern European urban systems. Yet, many of the spatial, political and economic features of medieval European cities were particular to the Middle Ages, and subsequently changed over the Early Modern Period and Industrial Revolution. There is a long tradition of demographic studies estimating the population sizes of medieval European cities, and comparative analyses of these data have shed much light on the long-term evolution of urban systems. However, the next step—to systematically relate the population size of these cities to their spatial and socioeconomic characteristics—has seldom been taken. This raises a series of interesting questions, as both modern and ancient cities have been observed to obey area-population relationships predicted by settlement scaling theory. To address these questions, we analyze a new dataset for the settled area and population of 173 European cities from the early fourteenth century to determine the relationship between population and settled area. To interpret this data, we develop two related models that lead to differing predictions regarding the quantitative form of the population-area relationship, depending on the level of social mixing present in these cities. Our empirical estimates of model parameters show a strong densification of cities with city population size, consistent with patterns in contemporary cities. Although social life in medieval Europe was orchestrated by hierarchical institutions (e.g., guilds, church, municipal organizations), our results show no statistically significant influence of these institutions on agglomeration effects. The similarities between the empirical patterns of settlement relating area to population observed here support the hypothesis that cities throughout history share common principles of organization that self-consistently relate their socioeconomic networks to structured urban spaces. [ABSTRACT FROM AUTHOR]

After stone removal, accurate analysis of urinary stone composition is the most crucial laboratory diagnostic procedure for the treatment and recurrence prevention in the stone-forming patient. The most common techniques for routine analysis of stones are infrared spectroscopy, X-ray diffraction and chemical analysis. The aim of the present study was to assess the quality of urinary stone analysis of laboratories in Europe. Nine laboratories from eight European countries participated in six quality control surveys for urinary calculi analyses of the Reference Institute for Bioanalytics, Bonn, Germany, between 2010 and 2014. Each participant received the same blinded test samples for stone analysis. A total of 24 samples, comprising pure substances and mixtures of two or three components, were analysed. The evaluation of the quality of the laboratory in the present study was based on the attainment of 75% of the maximum total points, i.e. 99 points. The methods of stone analysis used were infrared spectroscopy (n = 7), chemical analysis (n = 1) and X-ray diffraction (n = 1). In the present study only 56% of the laboratories, four using infrared spectroscopy and one using X-ray diffraction, fulfilled the quality requirements. According to the current standard, chemical analysis is considered to be insufficient for stone analysis, whereas infrared spectroscopy or X-ray diffraction is mandatory. However, the poor results of infrared spectroscopy highlight the importance of equipment, reference spectra and qualification of the staff for an accurate analysis of stone composition. Regular quality control is essential in carrying out routine stone analysis. [ABSTRACT FROM AUTHOR]

Anthropogenic litter is present in all marine habitats, from beaches to the most remote points in the oceans. On the seafloor, marine litter, particularly plastic, can accumulate in high densities with deleterious consequences for its inhabitants. Yet, because of the high cost involved with sampling the seafloor, no large-scale assessment of distribution patterns was available to date. Here, we present data on litter distribution and density collected during 588 video and trawl surveys across 32 sites in European waters. We found litter to be present in the deepest areas and at locations as remote from land as the Charlie-Gibbs Fracture Zone across the Mid-Atlantic Ridge. The highest litter density occurs in submarine canyons, whilst the lowest density can be found on continental shelves and on ocean ridges. Plastic was the most prevalent litter item found on the seafloor. Litter from fishing activities (derelict fishing lines and nets) was particularly common on seamounts, banks, mounds and ocean ridges. Our results highlight the extent of the problem and the need for action to prevent increasing accumulation of litter in marine environments. [ABSTRACT FROM AUTHOR]