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Background: Information about airborne pollen concentrations is required by a range of end users, particularly from the health sector who use both observations and forecasts to diagnose and treat allergic patients. Manual methods are the standard for such measurements but, despite the range of pollen taxa that can be identified, these techniques suffer from a range of drawbacks. This includes being available at low temporal resolution (usually daily averages) and with a delay (usually 3–9 days from the measurement). Recent technological developments have made possible automatic pollen measurements, which are available at high temporal resolution and in real time, although currently only scattered in a few locations across Europe. Materials & Methods: To promote the development of an extensive network across Europe and to ensure that this network will respond to end user needs, a stakeholder workshop was organised under the auspices of the EUMETNET AutoPollen Programme. Participants discussed requirements for the groups they represented, ranging from the need for information at various spatial scales, at high temporal resolution, and for targeted services to be developed. Results: The provision of real‐time information is likely to lead to a notable decrease in the direct and indirect health costs associated with allergy in Europe, currently estimated between €50–150 billion/year.1 Discussion & Conclusion: A European measurement network to meet end user requirements would thus more than pay for itself in terms of potential annual savings and provide significant impetus to research across a range of disciplines from climate science and public health to agriculture and environmental management. [ABSTRACT FROM AUTHOR]

The high prevalence of allergic diseases warrants for sufficient health care provisions available to patients with allergic diseases. Allergy care should be delivered by well‐trained specialists. However, the current status of allergy care is not well documented. For this reason a survey among European and a few non‐European countries was launched by the National Allergy Society Committee from the European Academy of Allergy and Clinical Immunology and the Union Européenne des Médecins Spécialistes section and board of Allergology. The survey shows that in the vast majority of countries allergy care services are available. However, a substantial heterogeneity is reported regarding recognition of the full specialty, the number of practicing specialists or subspecialists, and training aspects. Growth but also decline of specialty and subspecialties is reported. In addition, the survey gives insight in strengths, weaknesses, opportunities and threats in this field. It appears that the recognition of the full specialty determines strength as well as weakness. Aging of specialists combined with a decline in the number of trainees form a major threat. Opportunities are seen in creating awareness for allergy, focus on attracting young physicians. The conclusion is that harmonization of allergy services across Europe is needed. Investment in young doctors, creating new opportunities and lobbying for the full specialty is required. [ABSTRACT FROM AUTHOR]

Aim: This paper introduces the Surveillance of Cerebral Palsy in Europe (SCPE) classification of events contributing to postneonatally acquired cerebral palsy, presents its interrater reliability, and describes the cases identified in the SCPE database. Method: The development of the classification, based on literature review and expert discussions, resulted in six main categories and 19 subcategories. The first chronological event designated as the primary event was mainly reported. Interrater reliability was assessed through online exercise providing 24 clinical vignettes representing single/complex pathways. Percent agreement and Gwet's AC1 index of reliability were estimated. Primary events were described using data of 221 children born between 2008 and 2012. Results: Thirty‐nine professionals (21 registries) participated in the reliability exercise. Substantial overall agreement was reached (0.75), with some contrast between complex (0.48, moderate agreement) and single events involved (0.89, almost perfect). The distribution of primary events showed that 32.1% were infections (category A), 23.1% head injuries (B), 15.4% related to surgery or medical interventions (C), 13.1% cerebrovascular accidents (D), 9.1% hypoxic brain damaging events of other origins (E), and 7.2% miscellaneous (F). Interpretation: This classification allows all the events involved to be recorded while consistently reporting the primary event, and may be used in different settings. What this paper adds: A standardized classification enables the description of the events contributing to postneonatal cerebral palsy (CP).The first chronological event in complex pathway leading to CP is coded.Category choice and coding of the primary event identify preventable situations.The detailed 2‐level classification is easy to use in various settings.Substantial overall interrater reliability shows that main categories can be consistently differentiated. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is common in patients with heart failure (HF) and associated with considerable morbidity and mortality. Significant advances have recently occurred in the treatment of T2DM, with evidence of several new glucose-lowering medications showing either neutral or beneficial cardiovascular effects. However, some of these agents have safety characteristics with strong practical implications in HF [i.e. dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RA), and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors]. Regarding safety of DPP-4 inhibitors, saxagliptin is not recommended in HF because of a greater risk of HF hospitalisation. There is no compelling evidence of excess HF risk with the other DPP-4 inhibitors. GLP-1 RAs have an overall neutral effect on HF outcomes. However, a signal of harm suggested in two small trials of liraglutide in patients with reduced ejection fraction indicates that their role remains to be defined in established HF. SGLT-2 inhibitors (empagliflozin, canagliflozin and dapagliflozin) have shown a consistent reduction in the risk of HF hospitalisation regardless of baseline cardiovascular risk or history of HF. Accordingly, SGLT-2 inhibitors could be recommended to prevent HF hospitalisation in patients with T2DM and established cardiovascular disease or with multiple risk factors. The recently completed trial with dapagliflozin has shown a significant reduction in cardiovascular mortality and HF events in patients with HF and reduced ejection fraction, with or without T2DM. Several ongoing trials will assess whether the results observed with dapagliflozin could be extended to other SGLT-2 inhibitors in the treatment of HF, with either preserved or reduced ejection fraction, regardless of the presence of T2DM. This position paper aims to summarise relevant clinical trial evidence concerning the role and safety of new glucose-lowering therapies in patients with HF. [ABSTRACT FROM AUTHOR]

The aim of this paper is to examine the status of national learned societies in social sciences and humanities (SSH) in Europe. Previous research shows that learned societies serve diverse roles in higher education and suggests that national societies come under pressure given different developments, such as internationalization or open science adoption. We investigate a comprehensive range of aspects within national learned societies: primary goals, activities, internationalization, organization, funding, membership, and recent changes, addressing potential pressures arising from them. Using a cross‐national survey involving 194 learned societies across eight European countries, we study: (a) do the previous findings from individual countries or small selections of national societies hold for a broad range of learned societies in SSH across Europe, and (b) are national learned societies coming under pressure due to internationalization and commercialization processes? Our findings confirm previous results from single countries and single disciplines and expand them as our results show that national learned societies in SSH play an important role in Europe in promoting multilingualism in science, collaborating with many stakeholders, and fostering interdisciplinarity. Contrary to previous research, most SSH societies in our study have not undergone significant changes in the past 5 years, challenging expectations of their declining role. [ABSTRACT FROM AUTHOR]

Focuses on options for reforming European governance. White Paper of the European Commission.

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented. [ABSTRACT FROM AUTHOR]

Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patient's functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patient's needs. Finally, gaps in our knowledge are discussed. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Background and purpose: Neurology residency programmes, which were first established at the beginning of the 20th century, have become mandatory all over Europe in the last 40–50 years. The first European Training Requirements in Neurology (ETRN) were published in 2005 and first updated in 2016. This paper reports the most recent revisions of the ETRN. Methods: Members of the EAN board performed an in depth revision of the ETNR 2016‐version, which was reviewed by members of the European Board and Section of Neurology of the UEMS, the Education and Scientific Panels, the Resident and Research Fellow Section and the Board of the EAN, as well as the presidents of the 47 European National Societies. Results: The new (2022) ETRN suggest a 5‐year training subdivided in three phases: a first phase (2 years) of general neurology training, a second phase (2 years) of training in neurophysiology/neurological subspecialties and a third phase (1 year) to expand clinical training (e.g., in other neurodisciplines) or for research (path for clinical neuroscientist). The necessary theoretical and clinical competences as well as learning objectives in diagnostic tests have been updated, are newly organized in four levels and include 19 neurological subspecialties. Finally, the new ETRN require, in addition to a programme director, a team of clinician‐educators who regularly review the resident's progress. The 2022 update of the ETRN reflects emerging requirements for the practice of neurology and contributes to the international standardization of training necessary for the increasing needs of residents and specialists across Europe. [ABSTRACT FROM AUTHOR]

Borders prevent the optimal exploitation of socio‐economic and environmental resources. A relevant obstacle due to missed integration is associated with legal and administrative barriers, which cause the emergence of untapped potentials. This paper exploits the case study of the Interreg Central Europe programme. Removing borders among countries in the area enhances scale economies due to a large market for inputs and goods, both within regions and across Central European area regions. This paper identifies untapped potentials by looking at the missed regional GDP growth due to the inefficient exploitation of regional growth assets. Results hint at a complex and heterogeneous spatial distribution of untapped potentials, involving several growth factors. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is a sudden multisystem allergic reaction which may result in a fatal outcome if not treated promptly. Guidelines worldwide suggest intramuscular adrenaline as the first‐line treatment for anaphylaxis outside a perioperative reaction. Adrenaline autoinjectors (AAIs) are widely used self‐administrable devices, especially in community settings. Different commercial AAIs have been authorized to be marketed in Europe. For an AAI to be efficacious, a rapid adrenaline delivery in patients, including those who are overweight or obese, resulting in an optimal cardiovascular (CV) response, is a key feature. AAIs are designed to achieve this requirement, which is reflected in their differing functional properties such as primary container selection, drug delivery mechanism (cartridge‐or syringe‐based), needle length, needle gauge, and adrenaline dose (150 μg, 300 μg, or 500 μg). However, the differences in functional properties across these devices may play a critical role in achieving these requirements as well as the differences in ergonomics in the handling of these devices. The purpose of this review: Considering the dynamic pharmacokinetic/pharmacodynamic (PK/PD) profiles of different AAIs marketed in Europe and their effect on adrenaline delivery, the expert panel, also serving as author for this paper have carried out a detailed analysis of the PK/PD profiles of four AAIs, namely, Anapen, Emerade, EpiPen, and Jext, to delineate the adrenaline delivery and their subsequent physiological effects on the backdrop of device characteristics, dose strength, and the skin‐to‐muscle distances of the participants. [ABSTRACT FROM AUTHOR]

In Europe, 50%–70% of former natural grassland area has been destroyed during the past 30 years due to land use changes, losses are expected to increase in the future. Restoration is thought to reverse this situation by creating suitable abiotic conditions. In this paper, we investigate the effects of sod translocation with specific vegetation to facilitate the restoration of a former intensive agricultural field into a wet meadow. First, starting conditions were optimized including modification of the local hydrology, removal of the fertilized topsoil, application of liming, and translocation of fresh clippings as a seed source. The second part aimed at restoring the habitat for the butterfly species Phengaris (Maculinea) teleius, one of the species that was especially affected by the loss of wet meadows. This species engages in a complex myrmecophilous relationship with one host plant, Sanguisorba officinalis, and one obligate host ant, Myrmica scabrinodis. We used sod translocation to create islands of habitat to promote host plant and host ant colonization. After 4 years following the restoration, we observed that plants spread from the transplanted sods to the surroundings. The vegetation composition and structure of the transplanted sods attracted colonization of Myrmica ants into the restored areas. Following the increase in vegetation cover and height, Myrmica ant colonies further spread into the restored areas. Therefore, sod translocations can be considered an effective restoration method following topsoil removal in the process of restoring wet meadows to provide a starting point for ant colonization and plant dispersion. With these findings, this paper contributes to the evidence‐based restoration of wet meadows on former agricultural fields, including complex interactions between invertebrates and their required ecological relationships. [ABSTRACT FROM AUTHOR]

This paper analyzes the impact of source‐country culture on the labor supply of female immigrants in Europe. We find that the labor supply of immigrant women is positively associated with the female‐to‐male labor force participation ratio in their source country, which serves as a proxy for the country's preferences and beliefs regarding women's roles. This suggests that the culture and norms of their source country play an important role for immigrant women's labor supply. However, contradicting previous evidence for the US, we do not find evidence that the cultural effect persists through the second generation. [ABSTRACT FROM AUTHOR]

Historically, the long wavelength side (6–7.5 μm) of the mid‐infrared water vapor absorption band has been used for imaging from the geostationary perspective. This began with the 6.4 μm band on Europe's Meteosat‐1. While geostationary sounders for moisture profiling, including China's hyperspectral resolution infrared sounder and a planned sounder from Europe, are or will be measuring the short wavelength side of the water vapor band, this is not the case for geostationary imagers. Shorter wavelength (5–6 μm) spectral bands for imaging applications should be considered for observing moisture in the mid and lower troposphere because of several potential advantages offered by this spectral range. The short wavelength side of the water vapor band contains fewer additional absorbing gases that overlap the water vapor absorption lines. In addition, the shorter wavelengths would show less diffraction blurring which could enable finer spatial resolution for turbulence detection. This study considers some of the differences and potential advantages of the spectral information in the short wavelength side of the water vapor absorption band from the perspective of geostationary imaging. For dry conditions land heating could impact the qualitative use of observed brightness temperatures at 5.1 μm, while the solar reflection component over most clear‐sky scenes is small for a 5.1 μm band and essentially zero for a 5.6 μm band. Plain Language Summary: Long before images are sent back to Earth from satellites, the needed spectral bands have to be specified. The band specification includes attributes such as the wavelength centers, widths, and signal‐to‐noise ratio. This paper investigates the rationale for including data from a region of the electromagnetic spectrum that has not been used for imaging from geostationary orbit. If implemented, these short wavelength water vapor bands would provide unique information regarding low‐level moisture and mid‐level turbulence. This paper quantifies the expected reflected component from the sun and the influence of land heating on observations, both of which are relatively larger at shorter wavelengths. Key Points: Historically, the long wavelength side of the mid‐infrared water vapor absorption band has been used for imagingShort wavelength (near 5 μm) spectral bands should be considered, especially with finer spatial resolutionsOver most clear‐sky surfaces, the reflective component ranges from small to zero for 5.1 and 5.6 μm bands [ABSTRACT FROM AUTHOR]

Aim: To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. Method: A comprehensive search of 22 databases identified eligible systematic reviews with and without meta‐analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews‐2 (AMSTAR‐2) to appraise methodological quality. Results: Eighty‐three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR‐2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR‐2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Interpretation: Most of these systematic reviews are considered unreliable according to AMSTAR‐2. Current recommendations for treating children with CP based on these flawed systematic reviews need re‐evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high‐level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper addsConfidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP).Quality issues in the sample were not limited to systematic reviews of non‐randomized trials, or to those about certain populations of CP or interventions.The inclusion of meta‐analysis did not improve the level of confidence in these systematic reviews.Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve. What this paper adds: Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP).Quality issues in the sample were not limited to systematic reviews of non‐randomized trials, or to those about certain populations of CP or interventions.The inclusion of meta‐analysis did not improve the level of confidence in these systematic reviews.Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve. This original article is commented by Negrini et al. on page 1244 of this issue. [ABSTRACT FROM AUTHOR]

This paper aims at an understanding of acquisition processes in a strongly industrialized and export‐oriented economy in Central Europe. Drawing on a proximity framework and behaviour theory, the paper investigates that the geographical proximity dimension is more influential than the cognitive proximity dimension. At the same time, cognitive proximity matters more for foreign firms investing into the economy than for domestic acquisitions. While the role of cognitive proximity diminished during the economic crisis, geographical proximity keeps its importance throughout the economic cycle. Moreover, cognitive proximity has become more important for acquisitions of large companies and less for SMEs. [ABSTRACT FROM AUTHOR]

Climate change is increasing the severity and frequency of droughts around the globe, leading to tree mortality that reduces production and provision of other ecosystem services. Recent studies show that growth of mixed stands may be more resilient to drought than pure stands. The two most economically important and widely distributed tree species in Europe are Norway spruce (Picea abies (L.) Karst) and Scots pine (Pinus sylvestris L.), but little is known about their susceptibility to drought when coexist.This paper analyses the resilience (resistance, recovery rate and recovery time) at individual‐tree level using a network of tree‐ring collections from 22 sites along a climatic gradient from central Europe to Scandinavia. We aimed to identify differences in growth following drought between the two species and between mixed and pure stands, and how environmental variables (climate, topography and site location) and tree characteristics influence them.We found that both the timing and duration of drought drive the different responses between species and compositions. Norway spruce showed higher vulnerability to summer drought, with both lower resistance and a longer recovery time than Scots pine. Mixtures provided higher drought resistance for both species compared to pure stands, but the benefit decreases with the duration of the drought. Especially climate sensitive and old trees in climatically marginal sites were more affected by drought stress.Synthesis. Promoting Scots pine and mixed forests is a promising strategy for adapting European forests to climate change. However, if future droughts become longer, the advantage of mixed stands could disappear which would be especially negative for Norway spruce. [ABSTRACT FROM AUTHOR]

This paper analyses the regional evolution of the market structure in the Spanish turbot industry, which is the leading turbot producer in Europe, using different concentration rates. The analysis is performed considering several factors that have influenced the evolution of the sector, the most important being the application of technology, business strategies and the institutional framework. The results confirm a process of concentration. Starting from an initial phase in which the sector was composed of a considerable number of small companies, this industry has evolved towards a situation in which only two large firms dominate the market. [ABSTRACT FROM AUTHOR]

Aim: To describe the frequency and types of major congenital anomalies present in children with pre‐ or perinatally acquired cerebral palsy (CP), and compare clinical outcomes for children with and without anomalies. Method: This multi‐centre total population collaborative study between Surveillance of Cerebral Palsy in Europe, Australian Cerebral Palsy Register, and European Surveillance of Congenital Anomalies (EUROCAT) involved six European and three Australian regions. Data were linked between each region's CP and congenital anomaly register for children born between 1991 and 2009, and then pooled. Children were classified into mutually exclusive categories based on type of anomaly. Proportions of children with congenital anomalies were calculated, and clinical outcomes compared between children with and without anomalies. Results: Of 8201 children with CP, 22.8% (95% confidence interval [CI] 21.9, 23.8) had a major congenital anomaly. Isolated cerebral anomalies were most common (45.2%), with a further 8.6% having both cerebral and non‐cerebral anomalies. Cardiac anomalies only were described in 10.5% of children and anomalies associated with syndromes were also reported: genetic (8.0%), chromosomal (5.7%), and teratogenic (3.0%). Clinical outcomes were more severe for children with CP and congenital anomalies, particularly cerebral anomalies. Interpretation: This large, international study reports major congenital anomalies in nearly one‐quarter of children with pre‐ or perinatally acquired CP. Future research must focus on aetiological pathways to CP that include specific patterns of congenital anomalies. What this paper adds: Congenital anomalies were reported in 23% of children with pre‐ or perinatally acquired cerebral palsy.A higher proportion of children born at or near term had anomalies.The most common type of anomalies were isolated cerebral anomalies.Clinical outcomes were more severe for children with congenital anomalies (particularly cerebral). What this paper adds: Congenital anomalies were reported in 23% of children with pre‐ or perinatally acquired cerebral palsy.A higher proportion of children born at or near term had anomalies.The most common type of anomalies were isolated cerebral anomalies.Clinical outcomes were more severe for children with congenital anomalies (particularly cerebral). This article is commented on by Kirby on pages 366–367 of this issue. [ABSTRACT FROM AUTHOR]

We focus on the extent to which polycentric urban regions can substitute for the agglomeration economies provided by large cities. Building on an open‐source software tool that helps identifying polycentric developments in urban regions, we analyse the spatial structure (in terms of size, dispersion and polycentricity) of 94 regions across 34 European countries and link this to their level of total factor productivity. We find that both more polycentric regions and more dispersed regions are associated with lower productivity levels. [ABSTRACT FROM AUTHOR]

Which role do city‐regions play in European innovation network formation? We study the evolution of innovation collaborative networks in European city‐regions outlining two opposite models: in the exclusive network model city‐regions establish a closed network of innovators among themselves; in the inclusive network models city‐regions build a network of innovators which includes the peripheral regions. Employing a temporal exponential random graph model on 248 regions for the period 2000–2016, we find that the two models coexist. We conclude that in the EU the city‐regions act as both engines of generation of innovation and integrators of innovation actors. [ABSTRACT FROM AUTHOR]

Acute heart failure is one of the main diagnostic and therapeutic challenges in clinical practice due to a non-specific clinical manifestation and the urgent need for timely and tailored management at the same time. In this position statement, the Heart Failure Association aims to systematize the use of various imaging methods in accordance with the timeline of acute heart failure care proposed in the recent guidelines of the European Society of Cardiology. During the first hours of admission the point-of-care focused cardiac and lung ultrasound examination is an invaluable tool for rapid differential diagnosis of acute dyspnoea, which is highly feasible and relatively easy to learn. Several portable and stationary imaging modalities are being increasingly used for the evaluation of cardiac structure and function, haemodynamic and volume status, precipitating myocardial ischaemia or valvular abnormalities, and systemic and pulmonary congestion. This paper emphasizes the central role of the full echocardiographic examination in the identification of heart failure aetiology, severity of cardiac dysfunction, indications for specific heart failure therapy, and risk stratification. Correct evaluation of cardiac filling pressures and accurate prognostication may help to prevent unscheduled short-term readmission. Alternative advanced imaging modalities should be considered to assist patient management in the pre- and post-discharge phase, including cardiac magnetic resonance, computed tomography, nuclear studies, and coronary angiography. The Heart Failure Association addresses this paper to the wide spectrum of acute care and heart failure specialists, highlighting the value of all available imaging techniques at specific stages and in common clinical scenarios of acute heart failure. [ABSTRACT FROM AUTHOR]

The global ocean overturning circulation, critically dependent on the global density stratification, plays a central role in regulating climate evolution. While it is well known that the global stratification profile exhibits a strong dependence to Southern Ocean dynamics and in particular to wind and buoyancy forcing, we demonstrate here that the stratification is also acutely sensitive to the mesoscale eddy energy dissipation timescale. Within the context of a global ocean circulation model with an energy constrained mesoscale eddy parameterization, it is shown that modest variations in the eddy energy dissipation timescale lead to significant variations in key metrics relating to ocean circulation, namely the Antarctic Circumpolar Current transport, Atlantic Meridional Overturning Circulation strength, and global ocean heat content, over long timescales. The results highlight a need to constrain uncertainties associated with eddy energy dissipation for climate model projections over centennial timescales and also for paleoclimate simulations over millennial timescales. Plain Language Summary: The ocean is populated by "eddies", analogous to weather systems in the atmosphere, but occurring on much smaller scales of typically 10–100 km. Recent advances in our understanding of the circulation of the Southern Ocean, which connects all of the major ocean basins to the north, have revealed a crucial role for the energy balance of Southern Ocean eddies. In this paper, we show that the timescale over which energy is removed from Southern Ocean eddies has a dramatic impact on the following: (a) the strength of the Antarctic Circumpolar Current, the largest current in the global ocean; (b) the strength of the Atlantic meridional overturning circulation, responsible in part for the relatively mild climatic conditions over northwestern Europe; and (c) global ocean heat content, a key parameter in the global climate system. These results have significant implications for both past and future climates, and highlight the importance of combining observational, theoretical and modeling efforts to better understand and constrain the energy balance of ocean eddies. Key Points: Key metrics of global ocean circulation (Antarctic Circumpolar Current transport, Atlantic Meridional Overturning Circulation strength, and Ocean Heat Content anomaly) acutely sensitive to an eddy energy dissipation timescaleModest variations in the dissipation timescale has a comparable effect to significant variations in the Southern Ocean wind forcingConstraints on the dissipation timescale critical to longtime integrations of ocean climate models such as paleoclimate scenarios [ABSTRACT FROM AUTHOR]

The influence of climate on the distribution of taxa has been extensively investigated in the last two decades through Habitat Suitability Models (HSMs). In this context, the Worldclim database represents an invaluable data source as it provides worldwide climate surfaces for both historical and future time horizons. Thousands of HSMs‐based papers have been published taking advantage of Worldclim 1.4, the first online version of this repository. In 2017, Worldclim 2.1 was released. Here, we evaluated spatially explicit prediction mismatch at continental scale, focusing on Europe, between HSMs fitted using climate surfaces from the two Worldclim versions (between‐version differences). To this aim, we simulated occurrence probability and presence‐absence across Europe of four virtual species (VS) with differing climate‐occurrence relationships. For each VS, we fitted HSMs upon uncorrelated bioclimatic variables derived from each Worldclim version at three grid resolutions. For each factor combination, HSMs attaining sufficient discrimination performance on spatially independent test data were projected across Europe under current conditions and various future scenarios, and importance scores of the single variables were computed. HSMs failed in accurately retrieving the simulated climate‐occurrence relationships for the climate‐tolerant VS and the one occurring under a narrow combination of climatic conditions. Under current climate, noticeable between‐version prediction mismatch emerged across most of Europe for these two VSs, whose simulated suitability mainly depended upon diurnal or yearly variability in temperature; differently, between‐version differences were more clustered toward areas showing extreme values, like mountainous massifs or southern regions, for VSs responding to average temperature and precipitation trends. Under future climate, the chosen emission scenarios and Global Climate Models did not evidently influence between‐version prediction discrepancies, while grid resolution synergistically interacted with VSs' niche characteristics in determining extent of such differences. Our findings could help in re‐evaluating previous biodiversity‐related works relying on geographical predictions from Worldclim‐based HSMs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The involvement of individuals and communities in health decision‐making is enshrined in WHO policies. However, migrant groups are under‐represented in health decision‐making processes. Our aim was to explore migrants' involvement in health policy, service development and research in the WHO European Region to identify levers for inclusive and meaningful practice. METHODS: We conducted a narrative review of grey literature and peer‐reviewed research on migrants' involvement in health decision‐making across the 53 countries in WHO Europe. We searched for articles published in English between 2010 and the present in two electronic databases (PubMed, Scopus), IOM MIPEX Health Strand country reports, the EU SOPHIE project and using a Google advanced search. Findings were analysed descriptively and using Normalisation Process Theory to investigate levers and barriers to implementation of policy into practice. RESULTS: Of 1,444 articles retrieved, 79 met the inclusion criteria. We identified 20 policies promoting migrants' involvement, but national‐level policies were present in only two countries. We identified 59 examples of migrants' involvement in practice from half of the WHO Europe countries (n = 27). Our Normalisation Process Theory (NPT) analysis of 14 peer‐reviewed empirical papers found that participatory research approaches are a lever to putting policy into practice in a meaningful way. CONCLUSIONS: Migrants' involvement in health decision‐making requires explicit national policies that are implemented evenly across policymaking, service provider and research activities in all countries in the WHO European Region. Participatory approaches to involvement activities are encouraged because they are a lever to perceived barriers to migrants' involvement. [ABSTRACT FROM AUTHOR]

The goal of this paper is to analyse the innovation activity convergence process across European regions from 2002 to 2012. A novel methodology that allows either detection of overall convergence or endogenous identification of groups of regions was applied. The results support the club convergence hypothesis for explaining the convergence process of Europe's regions during the period analysed and seven innovation convergence clubs were identified. In addition, the research results indicate that initial regional R&D expenditure is the most relevant factor driving the formation of the convergence clubs after controlling for the effects of regional structural characteristics. [ABSTRACT FROM AUTHOR]

Myriad advances in all fields of cardiac imaging have stimulated and reflected new understanding of cardiac performance, myocardial damage and the mechanisms of heart failure. In this paper, the Heart Failure Association assesses the potential usefulness of innovative imaging modalities in enabling more precise diagnostic and prognostic evaluation, as well as in guiding treatment strategies. Many new methods have gradually penetrated clinical practice and are on their way to becoming a part of routine evaluation. This paper focuses on myocardial deformation and three-dimensional ultrasound imaging; stress tests for the evaluation of contractile and filling function; the progress of magnetic resonance techniques; molecular imaging and other sound innovations. The Heart Failure Association aims to highlight the ways in which paradigms have shifted in several areas of cardiac assessment. These include reassessing of the simplified concept of ejection fraction and implementation of the new parameters of cardiac performance applicable to all heart failure phenotypes; switching from two-dimensional to more accurate and reproducible three-dimensional ultrasound volumetric evaluation; greater tissue characterization via recently developed magnetic resonance modalities; moving from assessing cardiac function and congestion at rest to assessing it during stress; from invasive to novel non-invasive hybrid techniques depicting coronary anatomy and myocardial perfusion; as well as from morphometry to the imaging of pathophysiologic processes such as inflammation and apoptosis. This position paper examines the specific benefits of imaging innovations for practitioners dealing with heart failure aetiology, risk stratification and monitoring, and, in addition, for scientists involved in the development of future research. [ABSTRACT FROM AUTHOR]

Although the number of plant translocations has been rapidly increasing for two decades, no study is available to date that examines the directions and distances of plant displacements, which is essential (though not sufficient) information for considering translocations as a management tool to enable species to cope with the consequences of climate change.In this paper, we study the geographical and climatic directions and distances from source to host sites in 638 source‐and‐host site pairs of plant translocations that aimed to achieve viable populations in the last decades in the Western Palearctic (Europe and the Mediterranean). Translocation distances ranged from 0 to 661 km, but were generally short, most (82%) being <25 km, due to both ecological considerations and legal and administrative constraints. The host sites were not preferentially located in any geographical direction or in any altitude relative to the source sites. In contrast, on a climate compass constructed from a principal component analysis of seven bioclimatic variables, the host sites were slightly, but significantly, under colder climatic conditions than the source sites.This observation appears more to be the consequence of an effort to counteract already felt effects of climate change than to anticipate future changes. The climatic distance between source sites and actual host sites was generally smaller than between source sites and randomly selected host sites at a given distance or within a given geographical area, which may be the result of a desire to minimise climatic differences or differences in other ecological factors correlated with climatic differences.Synthesis. This study is the first to compare, geographically and climatically, the source sites of biological material and the host sites in translocations of wild plant species to obtain viable populations. Past translocations in the Western Palearctic are in line with mitigating the consequences of global warming on plant species because the host sites were in slightly cooler conditions than the source sites. Despite this, climate considerations seem to have little been taken into account in plant translocation projects and will certainly have to be much more so in a future with rapid anthropogenic climate change. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic led to a 72% reduction of air traffic over Europe in March–August 2020 compared to 2019. Modeled contrail cover declined similarly, and computed mean instantaneous radiative contrail forcing dropped regionally by up to 0.7 W m−2. Here, model predictions of cirrus optical thickness and the top‐of‐atmosphere outgoing longwave and reflected shortwave irradiances are tested by comparison to Meteosat‐SEVIRI‐derived data. The agreement between observations and modeled data is slightly better when modeled contrail cirrus contributions are included. The spatial distributions and diurnal cycles of the differences in these data between 2019 and 2020 are partially caused by differences in atmospheric and surface conditions, particularly for solar radiation in the spring of 2020. Aviation signals become discernible in the observed differences of these data between 2019 and 2020 when subtracting numerical weather prediction model results that approximate the atmosphere and surface conditions without contrails. Plain Language Summary: Aircraft flying in cold and humid air masses induce contrails which warm the Earth‐atmosphere system by reducing the terrestrial radiation out into space and cool by increasing the Earth's albedo. Previous studies found that the warming effects dominate and that contrails may contribute most of the present radiative forcing of climate change induced by aviation. The COVID‐19 pandemic led to a worldwide and long‐duration reduction of air traffic. This paper compares model predictions and satellite‐observed cirrus properties and irradiances over Europe for 6 months in 2019 and 2020. The models account for changes in the atmosphere and at the Earth's surface in the two half‐years. Model and observation results show about 90% correlation and 20% mean normalized deviations. The agreement between observed and modeled optical cirrus thickness and terrestrial irradiances improves slightly when the modeled contrail cirrus contributions are included. Solar radiation changes show a larger variability because of large changes in the lower atmosphere and at the Earth surface. Since worldwide traffic activity has stayed at low levels after August 2020, the comparisons may be extended. Further model studies, including the effects of other emissions, are needed for a more comprehensive understanding of the observed changes. Key Points: Air traffic reduction during the COVID‐19 pandemic is used for testing aviation contrail cirrus and related radiative forcing modelingCirrus optical depth and top‐of‐atmosphere irradiances from satellite observations and model results show reasonable correlationsAviation contrail signatures are identifiable in spite of strongly different atmosphere and surface conditions in 2019 and 2020 [ABSTRACT FROM AUTHOR]

National city ranks do not describe a settlement's local and regional relevance adequately. We introduce a method to rank settlements' centrality based on travel time and settlement size. We investigate the relationship between a settlement's size, whether it is a local or regional centre, and its service endowment. The approach explains per capita service endowments in Europe well, adding nuances that national rankings do not fully capture. In addition, it establishes a characterization of service types by empirically discernible preferences in spatial scale. Finally, results suggest that service endowment in settlements can be reshuffled because of faster road connections, with services spatially concentrating in better connected areas. [ABSTRACT FROM AUTHOR]

Geographical variability of cancer burden was almost exclusively estimated for common cancers. Since rare cancers (RC) have become an area of priority for basic and clinical research and public health organizations, this paper provides, using a common methodology, a detailed comparison of incidence and survival for RC in the US and Europe. We estimated incidence and net survival of 199 malignant RC from data of 2 580 000 patients collected by 18 US‐SEER and 94 European registries, diagnosed within the most recent common period 2000‐2007. RC were defined according to the criterion of crude annual incidence rates <6/100 000. In total, 196 RC were classified as rare in both populations. Of these, 43 had incidence rates significantly different by at least 0.2 per 100 000:34 higher in the US and 9 higher in Europe. Five‐year net survival for all RC combined significantly differed: 54% in the US and 48% in Europe. Survival for 62 RC was significantly higher in the US vs 6 higher in Europe. Differences were not concentrated in a particular cancer family, and were mostly relevant for cases diagnosed >65+ years of age. Use of standardized methods evidenced that incidence and survival rate of majority of RC were higher in the United States compared to Europe. Possible reasons for such differences, requiring further studies, include distribution of risk factors, ability to diagnose RC, different registration practices, and use of updated International Classification of Diseases for Oncology. [ABSTRACT FROM AUTHOR]

Allergen exposure chambers (AECs) have been developed for controlled allergen challenges of allergic patients mimicking natural exposure. As such, these facilities have been utilized e.g., for proof of concept, dose finding or the demonstration of onset of action and treatment effect sizes of antiallergic medication. Moreover, clinical effects of and immunological mechanisms in allergen immunotherapy (AIT) have been investigated in AECs. In Europe AIT products have to fulfill regulatory requirements for obtaining market authorization through Phase I to III clinical trials. Multiple Phase II (dose-range-finding or proof-of-concept) trials on AIT products have been performed in AECs. However, they are not accepted by regulatory bodies for pivotal (Phase III) trials and a more thorough technical and clinical validation is requested. Recently, a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI) has outlined unmet needs in further development of AECs. The following review aims to address some of these needs on the basis of recently published data in the first part, whereas the second part overviews published examples of most relevant Phase II trials in AIT performed in AEC facilities. [ABSTRACT FROM AUTHOR]

Allergen exposure chambers (AECs) have been developed for controlled allergen challenges of allergic patients mimicking natural exposure. As such, these facilities have been utilized e.g., for proof of concept, dose finding or the demonstration of onset of action and treatment effect sizes of antiallergic medication. Moreover, clinical effects of and immunological mechanisms in allergen immunotherapy (AIT) have been investigated in AECs. In Europe AIT products have to fulfill regulatory requirements for obtaining market authorization through Phase I to III clinical trials. Multiple Phase II (dose‐range‐finding or proof‐of‐concept) trials on AIT products have been performed in AECs. However, they are not accepted by regulatory bodies for pivotal (Phase III) trials and a more thorough technical and clinical validation is requested. Recently, a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI) has outlined unmet needs in further development of AECs. The following review aims to address some of these needs on the basis of recently published data in the first part, whereas the second part overviews published examples of most relevant Phase II trials in AIT performed in AEC facilities. [ABSTRACT FROM AUTHOR]

The objective of the paper is to analyse the local determinants of innovation in a small European metropolitan region. First, we examine the extent to which geographic space is a determinant of innovation for five intra-regional units. Second, we investigate whether innovation is dependent on accessibility to the mean centre. In both cases we examine innovation propensity and innovation output using microdata from the Community Innovation Survey carried out in Luxembourg. The paper provides evidence of a link between the effects on innovation at the intra-regional level of firms' profiles and agglomeration externalities. [ABSTRACT FROM AUTHOR]

Objective: There is relative consensus that chronic conditions, disability, and time-to-death are key drivers of age-related health care expenditures. In this paper, we analyze the specific impact of frailty transitions on a wide range of health care outcomes comprising hospital, ambulatory care, and dental care use.Data Source: Five regular waves of the SHARE survey collected between 2004 and 2015.Study Design: We estimate dynamic panel data models on the balanced panel (N = 6078; NT = 30 390 observations). Our models account for various sources of selection into frailty, that is, observed and unobserved time-varying and time-invariant characteristics.Principal Findings: We confirm previous evidence showing that frailty transitions have a statistically significant and positive impact on hospital use. We find new evidence on ambulatory and dental care use. Becoming frail has greater impact on specialist compared to GP visit, and frail elderly are less likely to access dental care.Conclusions: By preventing transitions toward frailty, policy planners could prevent hospital and ambulatory care uses. Further research is needed to investigate the relationship between frailty and dental care by controlling for reverse causation. [ABSTRACT FROM AUTHOR]

Globalization has altered the appeal of each region to host economic activities. As firms are pushed to be more competitive, they develop outsourcing and relocation strategies, displacing some production activities to new emplacements. These changes have important impacts in some regions and are modifying the economic geography of Europe. This paper aims to present the impact that outsourcing and relocation strategies have across European regions and industries as well as to determine some of the characteristics of the more affected regions most affected. [ABSTRACT FROM AUTHOR]

Aim: Much of what is known about invasion biology is based on research conducted in North America and Europe, leading to limitations and potential biases in our knowledge. We address these limitations by conducting a systematic review to assess the literature on ecological studies of two major tropical and subtropical invasive plant species, Ageratina adenophora and Chromolaena odorata. Our goals were to: (1) collect the literature on the invasion biology of these species by broadly searching five databases (one international and four regional); (2) determine limitations to the international literature available in the ISI Web of Science (WOS); (3) quantitatively summarize the scope of the invasion literature on the two species; and (4) propose future studies based on what we found. Location: Global. Methods: Using specific search terms, we searched the literature for A. adenophora and C. odorata in the ISI WOS, Chinese National Knowledge Infrastructure (CNKI), Indian Journals, Nepal Journals Online and African Journals Online (AJOL). We extracted information on journal titles, publication years, study area locations, habitats investigated and study focus. Results: We found 101 papers for A. adenophora and 61 papers for C. odorata, published from 1987 to 2015. A high percentage of the studies were conducted in China, western and southern Africa, and India. Studies from WOS most frequently focused on the mechanism of invasion, while studies from CNKI and AJOL focused on the impacts of the invader. Main conclusions: Web of Science is not sufficient for generalizing about the invasion biology literature, particularly if the goal is a comprehensive assessment that includes areas other than North America, Hawaii, Europe, Australia, South Africa and New Zealand. In future systematic reviews, other databases should be used if possible, including those in languages other than English. For future research, several research areas should be studied more thoroughly for A. adenophora and C. odorata invasions, including possible multiple factors responsible for invasion, and impacts of co-occurring invasive species. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the prevalence of primary open‐angle glaucoma (POAG) in the European population > 40 years, and to provide the expected number of POAG patients forecasted up to 2050. Methods: Two authors independently conducted a systematic literature search on PubMed/MedLine, Web of Science, and Google Scholar to identify papers analysing the prevalence of POAG in European countries. Logit transformation (PLOGIT) of the data retrieved from selected articles, and a random intercept logistic regression model (GLMM) were used to analyse the overall proportions. The population projection data retrieved from the World Population Prospects reported by the United Nations, was incorporated into the GLMM. The estimated number of patients was calculated using the prevalence figures from the random‐effects model and the corresponding population number. Results: We retrieved 9348 eligible papers from the initial electronic search and included 10 of them in the qualitative and quantitative analyses. A total of 26 993 patients were included in this meta‐analysis (11 927 male and 14 556 female). We identified 755 POAG cases (397 male and 348 female), with a pooled prevalence estimate in Europe of 2.60% (95% CI: 1.90–3.56%). Increasing odds for POAG were related to increasing age and some geographic differences in the disease distribution in the continent were identified. Statistically significant sex‐related differences in the prevalence rate of POAG were not observed in this cohort. An increase of 3.3% in the number of people (aged >40 years) with POAG is expected by 2050, when the overall figure is expected to be 10 748 137. Conclusions: POAG is a neurodegenerative disease that affects a large proportion of the older European population. In the future, the prevalence of POAG is expected to grow in Europe because of the progressive ageing populations of Western 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]

Aim: Vegetation structure is a key determinant of animal diversity and species distributions. The introduction of Light Detection and Ranging (LiDAR) has enabled the collection of massive amounts of point cloud data for quantifying habitat structure at fine resolution. Here, we review the current use of LiDAR‐derived vegetation metrics in diversity and distribution research of birds, a key group for understanding animal–habitat relationships. Location: Global. Methods: We review 50 relevant papers and quantify where, in which habitats, at which spatial scales and with what kind of LiDAR data current studies make use of LiDAR metrics. We also harmonize and categorize LiDAR metrics and quantify their current use and effectiveness. Results: Most studies have been conducted at local extents in temperate forests of North America and Europe. Rasterization is currently the main method to derive LiDAR metrics, usually from airborne laser scanning data with low point densities (<10 points/m2) and small footprints (<1 m diameter). Our metric harmonization suggests that 40% of the currently used metric names are redundant. A categorization scheme allowed to group all metric names into 18 out of 24 theoretically possible classes, defined by vegetation part (total vegetation, single trees, canopy, understorey, and other single layers as well as multi‐layer) and structural type (cover, height, horizontal variability and vertical variability). Metrics related to canopy cover, canopy height and canopy vertical variability are currently most often used, but not always effective. Main conclusions: Light Detection and Ranging metrics play an important role in understanding animal space use. Our review and the developed categorization scheme may facilitate future studies in the selection, prioritization and ecological interpretation of LiDAR metrics. The increasing availability of airborne and spaceborne LiDAR data and the development of voxel‐based and object‐based approaches will further allow novel ecological applications, also for open habitats and other vertebrate and invertebrate taxa. [ABSTRACT FROM AUTHOR]

Aim: Poleward range shifts of species are among the most obvious effects of climate change on biodiversity. As a consequence of these range shifts, species communities are predicted to become increasingly composed of warm‐dwelling species, but this has only been studied for a limited number of taxa, mainly birds, butterflies and plants. As species groups may vary considerably in their adaptation to climate change, it is desirable to expand these studies to other groups, from different ecosystems. Freshwater macroinvertebrates, such as dragonflies (Odonata), have been ranked among the species groups with highest priority. In this paper, we investigate how the occurrence of dragonflies in Europe has changed in recent decades, and if these changes are in parallel with climate change. Location: Europe. Methods: We use data from 10 European geographical regions to calculate occupancy indices and trends for 99 (69%) of the European species. Next, we combine these regional indices to calculate European indices. To determine if changes in regional dragonfly communities in Europe reflect climatic warming, we calculate Species Temperature Indices (STI), Multi‐species Indicators (MSI) and Community Temperature Indices (CTI). Results: 55 of 99 considered species increased in occupancy at European level, 32 species remained stable, and none declined. Trends for 12 species are uncertain. MSI of cold‐dwelling and warm‐dwelling species differ in some of the regions, but increased at a similar rate at European level. CTI increased in all regions, except Cyprus. The European CTI increased slightly. Main conclusions: European dragonflies, in general, have expanded their distribution in response to climate change, even though their CTI lags behind the increase in temperature. Furthermore, dragonflies proved to be a suitable species group for monitoring changes in communities, both at regional and continental level. [ABSTRACT FROM AUTHOR]

Aim: To examine the prevalence, clinical characteristics, and risk factors of cerebral palsy (CP) in children in Bangladesh.Method: The Bangladesh CP Register is an ongoing population-based surveillance database of children with CP from a geographically defined area in Bangladesh. Cases were defined based on Surveillance of CP in Europe and Australian CP Register criteria after clinical assessments and identification by the key informant's method.Results: In total, 726 children with CP were identified between January 2015 and December 2016. Mean age was 7 years 7 months (standard deviation [SD] 4y 6mo; range: 4.8mo-18y; median 7y 1.2mo; 61.8% male, 38.2% female). Mean age at CP diagnosis was 5 years 2 months (SD 3.8). Observed prevalence was 3.4 per 1000 children (95% confidence interval [CI]: 3.2-3.7), resulting in an estimated 233 514 children (95% CI: 219 778-254 118) with CP in Bangladesh. The majority (79.6%) had spastic CP. Altogether, 79.6% of the children with CP had at least one associated impairment (speech 67.6%, intellectual 39.0%, epilepsy 23.7%, visual 10.2%, and hearing 10.2%). In total, 78.2% never received rehabilitation.Interpretation: In Bangladesh, the burden of CP is high, and diagnosis is substantially delayed, limiting opportunities for early intervention. There is a lack of available services and the majority of the children had preventable risk factors.What This Paper Adds: Prevalence of cerebral palsy (CP) is 3.4 per 1000 children in rural Bangladesh. There are an estimated 233 514 children with CP in Bangladesh. The majority have potentially preventable risk factors. Diagnosis of CP is delayed, limiting opportunities for early intervention. There is a lack of available services for children with CP in rural Bangladesh. [ABSTRACT FROM AUTHOR]

The aerosphere is utilized by billions of birds, moving for different reasons and from short to great distances spanning tens of thousands of kilometres. The aerosphere, however, is also utilized by aviation which leads to increasing conflicts in and around airfields as well as en‐route. Collisions between birds and aircraft cost billions of euros annually and, in some cases, result in the loss of human lives. Simultaneously, aviation has diverse negative impacts on wildlife. During avian migration, due to the sheer numbers of birds in the air, the risk of bird strikes becomes particularly acute for low‐flying aircraft, especially during military training flights. Over the last few decades, air forces across Europe and the Middle East have been developing solutions that integrate ecological research and aviation policy to reduce mutual negative interactions between birds and aircraft. In this paper we 1) provide a brief overview of the systems currently used in military aviation to monitor bird migration movements in the aerosphere, 2) provide a brief overview of the impact of bird strikes on military low‐level operations, and 3) estimate the effectiveness of migration monitoring systems in bird strike avoidance. We compare systems from the Netherlands, Belgium, Germany, Poland and Israel, which are all areas that Palearctic migrants cross twice a year in huge numbers. We show that the en‐route bird strikes have decreased considerably in countries where avoidance systems have been implemented, and that consequently bird strikes are on average 45% less frequent in countries with implemented avoidance systems in place. We conclude by showing the roles of operational weather radar networks, forecast models and international and interdisciplinary collaboration to create safer skies for aviation and birds. [ABSTRACT FROM AUTHOR]

Aim: The idea of combining predictions from different models into an ensemble has gained considerable popularity in species distribution modelling, partly due to free and comprehensive software such as the R package BIOMOD. However, despite proliferation of ensemble models, we lack oversight of how and where they are used for modelling distributions, and how well they perform. Here, we present such an overview. Location: Global. Methods: Since BIOMOD is freely available and widely used by ensemble species distribution modellers, we focused on articles that apply BIOMOD, filtering the initial 852 papers identified in our structured literature search to a relevant final subset of 224 eligible peer‐reviewed journal articles. Results: BIOMOD‐based ensembles are used across many taxa and locations, with terrestrial plants being the most represented group of species (n = 72) and Europe being the most represented continent (n = 106). These studies often focus on forecasting distributions in the future (n = 109), and commonly use presence‐only species data (n = 139) and climatic environmental predictors (n = 219). An average of six models are used in ensembles, and approximately half of ensembles weight contributions of models by their cross‐validation performance. However, discussion about choices made in the modelling process and unambiguous information on the performance of ensemble models versus individual models are limited. The use of independent data to validate model performance is particularly uncommon. Main conclusions: We document the breadth of ensemble applications, but could not draw strong quantitative conclusions about the predictive performance of ensemble models, due to lack of unambiguous information reported. Understanding how and where ensembles are best used when modelling species distributions is important for enabling best choices for different applications. To enable this objective to be achieved, we provide recommendations for thorough reporting practices in a BIOMOD‐based ensemble workflow. [ABSTRACT FROM AUTHOR]

Enterovirus D68 (EV-D68) is an emerging infection associated with acute flaccid myelitis (AFM). Cases of AFM associated with EV-D68 infection have increased in recent years and the evidence for a causal link is growing. However, our understanding of the epidemiology, clinical features, prognosis, and neurological sequelae of EV-D68 requires ongoing surveillance and investigation. We report five cases of AFM in previously typically developing children (2-6y) from South East Scotland during September and October 2016 after infection with EV-D68 (all detected in the nasopharyngeal aspirates). All cases presented with significant neurological symptoms, which were severe in two cases requiring intensive care support because of respiratory paralysis. At 18-month follow-up, two cases remain ventilator-dependent with other cases requiring ongoing community rehabilitation. These cases represent one of the largest reported paediatric cluster of AFM associated with EV-D68 in Europe. The epidemiology and clinical information add to the knowledge base and the 18-month outcome will help clinicians to counsel families. WHAT THIS PAPER ADDS: Nasopharyngeal aspirate is more sensitive for viral isolation and isolated in all cases. Clinical outcome at 18 months after enterovirus D68 with acute flaccid myelitis provides information on extent of recovery and level of disability. [ABSTRACT FROM AUTHOR]

Aim: To describe the impact austerity measures have had on families with disabled children across Europe and on professionals providing services for them.Method: Cross-sectional surveys were disseminated via professional and family networks in 32 European countries for 3 months from December 2016.Results: Families (n=731), of whom 45% met UNICEF criteria for severe poverty, and professionals (n=959) responded from 23 and 32 countries respectively. Respondents were grouped into those from countries with and without austerity. The direct and indirect impact of austerity cuts and worse working conditions were reported more often by professionals from countries with austerity, compared to those without. Most families reported services to be worse in quality than 3 years ago. Families with completely dependent disabled children said the needs of their disabled children are significantly less well met now, compared to 10 years ago.Interpretation: A decline in quality of services for disabled children was reported by most family and many professional respondents across Europe, regardless of austerity. Where implemented, austerity measures were reported to have impacted significantly on families with disabled children. What this paper adds Stigma about disability remains a challenge in many countries across Europe. Most families and many health care professionals reported worsening quality of services than 3 years ago, regardless of austerity. Austerity cuts are reported to have impacted especially negatively on families with dependent disabled children. [ABSTRACT FROM AUTHOR]

The vast majority of acute heart failure episodes are characterized by increasing symptoms and signs of congestion with volume overload. The goal of therapy in those patients is the relief of congestion through achieving a state of euvolaemia, mainly through the use of diuretic therapy. The appropriate use of diuretics however remains challenging, especially when worsening renal function, diuretic resistance and electrolyte disturbances occur. This position paper focuses on the use of diuretics in heart failure with congestion. The manuscript addresses frequently encountered challenges, such as (i) evaluation of congestion and clinical euvolaemia, (ii) assessment of diuretic response/resistance in the treatment of acute heart failure, (iii) an approach towards stepped pharmacologic diuretic strategies, based upon diuretic response, and (iv) management of common electrolyte disturbances. Recommendations are made in line with available guidelines, evidence and expert opinion. [ABSTRACT FROM AUTHOR]

Background: People with dementia are often marginalized and excluded from influence, also in relation to dementia research. There is, however, a growing requirement for inclusion through Patient and Public Involvement (PPI), but there is still limited knowledge on how researchers can fully benefit from the involvement of people with dementia in the development and testing of psychosocial interventions. This paper describes the results of a pan‐European consultation with people with dementia, synthesizing their views on outcomes of psychosocial interventions. Objective: To involve people with dementia in establishing what are meaningful outcomes when participating in psychosocial interventions. Setting and participants: Consultations took place at four divergent sites across Europe, involving twenty‐five people with dementia from nine European countries. Methods: The methods used for the consultation were developed through an iterative process involving people with dementia. Data from the consultation were analysed from a thematic analysis approach. Results: The results suggested that people with dementia wish to participate in interventions that enhance their well‐being, confidence, health, social participation and human rights. This highlights a need for improvements in psychosocial research to capture these outcomes. Discussion and conclusions: Involving people with dementia in discussions of psychosocial interventions has enhanced our understanding about meaningful outcome measures in research and methods of data collection. This study suggests that new outcome measures in psychosocial research are needed where concepts of positive psychology and social health can guide innovation and outcome measurement. [ABSTRACT FROM AUTHOR]