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This article contributes to two debates about international relations (IR) as a discipline: first, how global is IR, and how is it structured? Second, what is the state of theory in IR? We conducted (co-) citation analyses of both Web of Science (WoS) and—for the first time— non-WoS publications from Europe, North America, Latin America, Africa, and Asia. With regard to the first question, we find that global IR resembles a core–periphery structure as a "hub and spoke" system whereby transatlantic core nodes are interconnected to each other and to some periphery nodes, while the periphery nodes are connected to the core but not to each other. IR scholarship in the periphery quotes the transatlantic theory cluster but is not linked to each other, not even in the same region. Knowledge produced in the periphery has to go through the transatlantic core in order to be recognized globally. As to the transatlantic core, we identify two major (co-) citation clusters: one committed to IR theory-building across issue areas from a variety of perspectives and the other focused on security studies with a strong emphasis on quantitative methods. With regard to the second question, global IR hangs together through references to the IR theory cluster consisting of North American and European authors who appear to define what IR theory is. Scholars in the periphery refer to this transatlantic IR theory cluster when engaging in theory-building. IR theories have become rather diverse and pluralistic, even in the core. While scholars still refer to the big "isms," they use them around the globe in a synthesizing manner. [ABSTRACT FROM AUTHOR]

The role of evidence and expertise in policy-making has been of interest to public health professionals and political scientists alike. The public health community often sees its efforts as part of a linear knowledge transfer process and tends to blame itself for inadequate communication or translation of its arguments to policy-makers' language when its efforts fail. Political science, especially theories of the policy process, offer alternative perspectives to explain the success or failure of experts' preferred policy goals. This paper focuses on the concept of epistemic communities (groups of experts with a common policy goal derived from their shared knowledge) in policy-making, drawing on examples from the field of health technology assessment in Europe. By combining the parsimony and the central focus on experts of the linear knowledge transfer model with the recognition of complexity of political science, the epistemic communities concept provides a useful structure for the public health community to analyze its efforts to influence policy. [ABSTRACT FROM AUTHOR]

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue.Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries.Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90).Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined. [ABSTRACT FROM AUTHOR]

Background There is a broad consensus in the European public health community that international collaboration and coordination are key in the fight against antimicrobial resistance (AMR). Yet, while experts typically testify the importance of cross-national learning and a coordinated effort to reduce the spread of multi-resistant bacteria, there are mixed views about how that is best realized in practice, particularly on the dichotomy between horizontal and vertical activities. Methods National action plans (NAP) from all EU member states were systematically overviewed by two independent researchers. We followed a fixed procedure for locating a broad and comparable content on the international dimensions, and letting these vary on scales. Results We find that countries adhere to four different strategies for international coordination, varying between 'high' and 'low' on values of vertical and horizontal activities. Most countries spend none or very little space to discuss international activities, while some countries use their NAPs to outline their aspiration for taking leading roles in the international struggle. Moreover, in line with previous research, we find that many countries directly mimic the Global Action Plan, but also that a large share of countries describe independent arrangements in their international strategies. Conclusions European countries recognize AMR and its inherent international governance challenge differently in their NAPs, which may have implications for coordinated action to address the issue. [ABSTRACT FROM AUTHOR]

The article discusses vaccination hesitancy among people in Europe and U.S. with reference to the article published in "Journal of Public Health". Topics discussed include development of strategic approach against widespread misinformation and conspiracy theories on COVID-19 vaccines, research published by EU agency Eurofound on the vaccine hesitancy among adults in Europe, and progress on COVID-19 vaccination campaigns in US.

The quinquennial Nuclear Non-Proliferation Treaty (NPT) Review Conference represents a highly important event from the perspective of the EU Common Foreign and Security Policy (CFSP). Though not a party to the treaty itself, the EU has made a consistent effort since the 1990s to coordinate the positions of its member states and achieve higher visibility in the NPT review process. The aim of this article is to examine the role of the EU in the 2015 NPT Review Conference deliberations. Drawing on on-site observations, statements and in-depth research interviews, it argues that the recent institutional changes notwithstanding, the influence of the EU as a distinct actor in the NPT context remains very limited, and the EU's common position is in bigger disarray than ever before. This year's Review Conference demonstrated the widening rift between the member states, in particular in the area of nuclear disarmament and the related issues. The inability to maintain a coherent common position limits the EU 'actorness' and impedes its striving for relevance in the NPT forums. The dynamics outlined in this article further highlight the limits of the EU CFSP in security matters in which the national positions of individual member states are as divergent as in the case of nuclear disarmament. [ABSTRACT FROM AUTHOR]

The article informs that the U.S. European centrality is urgently needed toward cohesive and comprehensive transatlantic ‘One Health' approach in addressing global COVID19 response and health security. Topics include multifaceted and multilateral global COVID-19 ‘One Health' approach and develop an enhanced transatlantic post-pandemic recovery; and role of European Union (EU) joint procurement of medical countermeasures to large-scale disease outbreaks with considerable public support.

Background: End-of-life care attracts major policy interest. Place of death is an important metric of individual experience and health system performance. Most people prefer to die at home, but hospital is the most common place of death in high-income countries. Little is known about international trends in place of death over time. Methods: We aimed to collate population-level data on place of death in Europe for the years 2005-2017, and to evaluate association with national characteristics and policy choices. We sought outcome data from the 32 European Economic Area countries. We identified national economic, societal, demographic and health system predictors from Eurostat, OECD and the WHO. We analysed these cross-national panel data using linear regression with panel-corrected standard errors. Results: Our analytic dataset included 30 countries accounting for over 95% of Europe’s population and economic activity. Average national proportion of deaths occurring in hospital in the study period ranged from 26% to 68%, with a median of 52%. Trends vary markedly by region and wealth, with low and decreasing hospital deaths in the North-West, and high and increasing prevalence in the South and East. Controlling for demographic and economic factors, strong palliative care provision and generous government finance of long-term care were associated with fewer hospital deaths. Conclusions: We found modifiable policy choices associated with hospital mortality, as well as wider structural economic and societal factors. Policymakers can act to curb worrisome trends inhospital mortality. Data on places of death outside hospital can improve future research, policy and practice. Key messages: Cross-national longitudinal analysis. Trends of hospital deaths in Europe, association between hospital mortality rate, palliative care and other healthcare factors. [ABSTRACT FROM AUTHOR]

Credited with having fostered the renaissance of Francisco de Vitoria and the School of Salamanca in international law circles in the interwar period, Camilo Barcia Trelles has largely fallen into oblivion along with most Spanish international law professors of the Spanish Civil War generation. The first part of this article provides an outline of the long career of Barcia Trelles against the background of the radically transformed domestic and international context of the interwar years and the aftermath of World War II in both Spain and Europe. The second part surveys three key themes of Barcia Trelles' 60-year long contribution to the study of international law and international politics. First, it analyses his early interest in the process of regionalism in Latin America and the role of North American foreign policy in the region. This is followed by an analysis of Barcia Trelles's attention to the study of the Spanish classics of international law during the interwar period, and, finally, by an overview of his approach to the study of international law in the light of international politics during the Cold War. The conclusion briefly engages with the legacy of Barcia Trelles' life and works in the European tradition of international law. [ABSTRACT FROM AUTHOR]

The purpose of this discursive exploration that is influenced by ethnography and autoethnography is to present how Western-based music therapy intersects with the pluralistic healthcare culture in Malaysia. We will first be situating music therapy as a Eurocentric-based healthcare practice. We will then introduce the history of Malaysia and healthcare culture through a pluralistic lens, drawing inspiration from a popular Malaysian street food— rojak , a form of salad. We use rojak as an analogy to honor Malaysia's food culture while drawing similarities between the diverse flavors and textures between the distinct components of rojak, with the unique pluralism that exists throughout Malaysian culture and healthcare practices. Through this rojak pluralist lens, we will share several unique Malaysian vignettes to explore the different ways we consider Eurocentric music therapy as a potentially colonial practice, ranging from postcolonial theory perspective to a pragmatic, inclusive perspective. As Malaysia has maintained its pluralistic culture as a uniquely multiracial Asian country despite the lengthy history of colonization, we offer these Malaysian, post-British-colonial music therapy vignettes in this article. [ABSTRACT FROM AUTHOR]

Paul Rohrbach was an influential publicist in Wilhelmine Germany. He also routinely used racial justifications to defend brutal policies for managing the indigenous populations of Germany's African colonies. In recent years, scholars have interpreted Rohrbach's promotion of colonialism as evidence that colonial ideas increasingly saturated German political and imperial discourse before and during the First World War. His work has thus been cited to support an emerging narrative of pathological continuity, which contends that Wilhelmine German imperialists reflexively drew upon colonial ideologies, experiences and models to inform increasingly repressive and violent plans to rule ethnically diverse space in Eastern Europe. This article argues that Paul Rohrbach has been misinterpreted. His career represents not the ease with which colonial ideas infiltrated German imperial discourse, but rather the severe reluctance of an ardent colonialist to employ colonial methods in European space. Drawing upon his writings on Africa and his discussions of German war aims in Eastern Europe during the First World War, this article demonstrates Rohrbach's profound unwillingness to structure German imperial expansion in Russia's Baltic provinces and Congress Poland according to colonial precedents. Differences in the perceived cultural and political sophistication of African, Baltic and Polish societies convinced Rohrbach that repressive and brutal colonial models of rule would be inefficient or counterproductive for achieving German objectives in Eastern Europe. Indeed, Rohrbach's studies of colonialism actually reinforced his commitment to decentralization and respect for national diversity as essential instruments for governing politically sophisticated European societies. His experiences in Africa, in other words, steeled his confidence in multinational imperialism. [ABSTRACT FROM AUTHOR]

Background: Whereas it is generally accepted that maternal environment plays a key role in child health, emerging evidence suggests that paternal environment before conception also impacts child health. We aimed to investigate the association between children's asthma risk and parental smoking and welding exposures prior to conception.Methods: In a longitudinal, multi-country study, parents of 24 168 offspring aged 2-51 years provided information on their life-course smoking habits, occupational exposure to welding and metal fumes, and offspring's asthma before/after age 10 years and hay fever. Logistic regressions investigated the relevant associations controlled for age, study centre, parental characteristics (age, asthma, education) and clustering by family.Results: Non-allergic early-onset asthma (asthma without hay fever, present in 5.8%) was more common in the offspring with fathers who smoked before conception {odds ratio [OR] = 1.68 [95% confidence interval (CI) = 1.18-2.41]}, whereas mothers' smoking before conception did not predict offspring asthma. The risk was highest if father started smoking before age 15 years [3.24 (1.67-6.27)], even if he stopped more than 5 years before conception [2.68 (1.17-6.13)]. Fathers' pre-conception welding was independently associated with non-allergic asthma in his offspring [1.80 (1.29-2.50)]. There was no effect if the father started welding or smoking after birth. The associations were consistent across countries.Conclusions: Environmental exposures in young men appear to influence the respiratory health of their offspring born many years later. Influences during susceptible stages of spermatocyte development might be important and needs further investigation in humans. We hypothesize that protecting young men from harmful exposures may lead to improved respiratory health in future generations. [ABSTRACT FROM AUTHOR]

Background: Evidence on association of maternal pre-pregnancy weight with risk of orofacial clefts is inconsistent.Methods: Six large case-control studies of orofacial clefts from Northern Europe and the USA were included in analyses pooling individual-level data. Cases included 4943 mothers of children with orofacial clefts (cleft lip only: 1135, cleft palate with cleft lip: 2081, cleft palate only: 1727) and controls included 10 592 mothers of unaffected children. Association of orofacial cleft risk with pre-pregnancy maternal weight classified by level of body mass index (BMI, kg/m 2 ) was evaluated using logistic regression adjusting for multiple covariates.Results: Cleft palate, both alone and with cleft lip (CP+/-CL), was associated with maternal class II+ pre-pregnancy obesity (≥ 35)compared with normal weight [adjusted odds ratio (aOR) = 1.36; 95% confidence interval (CI) = 1.16, 1.58]. CP+/-CL was marginally associated with maternal underweight (aOR = 1.16; 95% CI = 0.98, 1.36). Cleft lip alone was not associated with BMI.Conclusions: In this largest population-based study to date, we found an increased risk of cleft palate, with or without cleft lip, in class II+ obese mothers compared with normal-weight mothers; underweight mothers may also have an increased risk, but this requires further study. These results also suggest that extremes of weight may have a specific effect on palatal development. [ABSTRACT FROM AUTHOR]

Aims: SYNARR-Flash study (Monitoring of SYNcopes and/or sustained palpitations of suspected ARRhythmic origin) is an international, multicentre, observational, prospective trial designed to evaluate the role of external 4-week electrocardiogram (ECG) monitoring in clinical work-up of unexplained syncope and/or sustained palpitations of suspected arrhythmic origin.Methods and Results: Consecutive patients were enrolled within 1 month after unexplained syncope or palpitations (index event) after being discharged from emergency room or hospitalization without a conclusive diagnosis. A 4-week ECG monitoring was obtained by external high-capacity loop recorder (SpiderFlash-T(®), Sorin) storing patient-activated and auto-triggered tracings. Diagnostic monitorings included (i) conclusive events with reoccurrence of syncope or palpitation with concomitant ECG recording (with/without arrhythmias) and (ii) events with asymptomatic predefined significant arrhythmias (sustained supraventricular or ventricular tachycardia, advanced atrio-ventricular block, sinus bradycardia <30 b.p.m., pauses >6 s). SYNARR-Flash study enrolled 395 patients (57.7% females, 56.9 ± 18.7 years, 28.1% with syncope, and 71.9% with palpitations) from 10 European centres. For syncope, the 4-week diagnostic yield was 24.5%, and predictors of diagnostic events were early start of recording (0-15 vs. >15 days after index event) (OR 6.2, 95% CI 1.3-29.6, P = 0.021) and previous history of supraventricular arrhythmias (OR 3.6, 95% CI 1.4-9.7, P = 0.018). For palpitations, the 4-week diagnostic yield was 71.6% and predictors of diagnostic events were history of recurrent palpitations (P < 0.001) and early start of recording (P = 0.001).Conclusion: The 4-week external ECG monitoring can be considered as first-line tool in the diagnostic work-up of syncope and palpitation. Early recorder use, history of supraventricular arrhythmia, and frequent previous events increased the likelihood of diagnostic events during the 4-week external ECG monitoring. [ABSTRACT FROM AUTHOR]

The article comments on the European Union (EU) Commission Communication promoting international academic cooperation amid geopolitical tension and polarization in 2021. The commission acknowledged the need to cooperate to improve research and innovation value chains in the document. It explains the implication of the reference to European values in the Communication. Also mentioned are the use of ambiguous terms in the document such as open strategic autonomy and rules-based cooperation.

The transatlantic partnership needs to be reassessed. Since the end of the Cold War, Europe has chosen to bandwagon with the United States and to outsource its security to Washington. Bandwagoning has serious consequences when the use of force is at stake: it may lead to entrapment, where weaker allies may be involuntarily dragged into a conflict. It may also lead to abandonment, where the dominant ally may choose to discard their vital security concerns. With the evolution of the international system towards a multipolar configuration, this strategy of bandwagoning is becoming increasingly costly for Europe while the dominant power, the United States, is progressively confronted by other competitors at the systemic level. These classic dilemmas attached to an asymmetric partnership are exacerbated in a multipolar configuration. In particular, the abandonment scenario may become more and more frequent precisely because there is competition-and thus potential costs-at the international level: the United States may leave Europe alone, not by choice but by necessity. The current crisis in Ukraine illustrates this shift: while some American leaders were keen to escalate the conflict by arming Ukraine, the Obama administration's commitment to the defence of Europe has been minimal and it has largely delegated the management of the crisis to the Europeans themselves. Washington had other and more important priorities. Strategic autonomy is not an option for Europe; it has become a reality, a Gaullist moment where Europeans will have to learn to think and act strategically for themselves. [ABSTRACT FROM AUTHOR]

Russian President Vladimir Putin claims that his country's annexation of Crimea in March 2014 was partly in response to NATO enlargement. NATO leaders counter that eastern enlargement is not a cause of the Ukraine crisis, and they argue that enlargement does not threaten Russia, but rather it creates stability for all of Europe. This article examines the history of NATO-Russian tensions over enlargement, considers how NATO's enlargement policy factored into the Ukraine crisis, and reviews options for the future of enlargement. Drawing on diplomatic history and geopolitical theory, the article explains Russia's persistent hostility towards NATO's policy of eastward expansion and highlights NATO's failure to convert Russia to its liberal world-view. The alliance's norm-driven enlargement policy has hindered the creation of an enduring NATO-Russia cooperative relationship and helped fuel the outbreak of conflict in Georgia and Ukraine. In light of this, NATO should alter its current enlargement policy by infusing it with geopolitical rationales. This means downgrading the transformative and democratization elements of enlargement and, instead, focusing on how candidate countries add to NATO capabilities and impact overall alliance security. A geopolitically-driven enlargement policy would prioritize countries in the Balkan and Scandinavian regions for membership and openly exclude Georgia and Ukraine from membership. Ultimately, this policy would have the effect of strengthening NATO while giving it more flexibility in dealing with Russia. [ABSTRACT FROM AUTHOR]

The unravelling of the post-Cold War security order in Europe was both cause and consequence of the crisis in Ukraine. The crisis was a symptom of the three-fold failure to achieve the aspirations to create a 'Europe whole and free' enunciated by the Charter of Paris in 1990, the drift in the European Union's behaviour from normative to geopolitical concerns, and the failure to institutionalize some form of pan-continental unity. The structural failure to create a framework for normative and geopolitical pluralism on the continent meant that Russia was excluded from the new European order. No mode of reconciliation was found between the Brussels-centred wider Europe and various ideas for greater European continental unification. Russia's relations with the EU became increasingly tense in the context of the Eastern Partnership and the Association Agreement with Ukraine. The EU and the Atlantic alliance moved towards a more hermetic and universal form of Atlanticism. Although there remain profound differences between the EU and its trans-Atlantic partner and tensions between member states, the new Atlanticism threatens to subvert the EU's own normative principles. At the same time, Russia moved from a relatively complaisant approach to Atlanticism towards a more critical neo-revisionism, although it does not challenge the legal or normative intellectual foundations of international order. This raises the question of whether we can speak of the 'death of Europe' as a project intended to transcend the logic of conflict on the continent. [ABSTRACT FROM AUTHOR]

The war in Ukraine is revelatory of a malaise in Europe's security order created by Russia's resistance to western institutions on the one hand and the western desire to maintain these institutions while partnering with Russia on the other. Absent a sense of priorities, western policy risks contributing to the erosion of Europe's security order that Russia seeks in opposition to western ambition. Europe's order is premised first and foremost on a distinctively western concert of nations-whereby Euro-Atlantic states coordinate policy according to a common purpose layered into both NATO and the EU-that forms part of a wider balance of power between Russia and the West. Western policy should aim to strengthen the concert and clarify the balance. However, the prevalent desire to include Russia in the concert confuses matters in a major way, eroding both the underlying sense of priorities and the foundation for order. This article examines this threatening erosion and traces it to three underlying trends: political contestation with regard to the meaning of 'restoration' post-1989; military instability following from the unpredictability of 'hybrid war'; and moral equivocation on the part of the West when it comes to defending the Euro-Atlantic security order. The article concludes that given the depth of contestation, western allies should learn to distinguish concert from balance and act on the condition that the former, a vibrant western concert, is a precondition for the latter, a manageable continental balance. [ABSTRACT FROM AUTHOR]