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This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is coming into the field of nuclear medicine, and it is likely here to stay. As a society, EANM can and must play a central role in the use of AI in nuclear medicine. In this position paper, the EANM explains the preconditions for the implementation of AI in NM and takes position. [ABSTRACT FROM AUTHOR]

Purpose: To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods: Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results: Twenty-four sections on HNC-specific OD topics. Conclusion: This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers. [ABSTRACT FROM AUTHOR]

European pharmaceutical companies have a legal requirement to provide non-promotional Medical Information (MI) services to support healthcare professionals (HCPs) who are using their medicinal products. While the industry has self-regulating bodies with established Codes of Practice, these mainly focus on promotional messaging and commercial activities. In the absence of similar frameworks for MI, such services struggle to understand how to meet HCP digital expectations, often in fear of breaching the promotional codes. This is limiting access to the wealth of non-promotional patient-focussed information held within the industry. Meanwhile, a large volume of unregulated, low-quality information can be readily found on the internet. To understand the current status, the Medical Information Leaders in Europe (MILE) industry association performed a benchmarking survey which explored the online MI service provision of 13 mid-large pharmaceutical companies across Europe. This highlighted a great diversity in approach in terms of geographical coverage and content. Visibility and access for HCPs is complex, compromising online engagement and website utilisation. This MILE position paper highlights the critical need to establish a clear governance model, which empowers pharmaceutical company MI functions to provide unbranded, non-promotional, medicinal product information sources to support HCP online information needs. It is essential to build confidence, transparency and trust by establishing a practical quality framework with principles and standards for online MI services for HCPs. [ABSTRACT FROM AUTHOR]

Executive Summary: The EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments. For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 ("activity-based prescription and patient-averaged dosimetry"), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 ("activity-based prescription and patient-specific dosimetry"), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 ("dosimetry-guided patient-specific prescription and verification"), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments. [ABSTRACT FROM AUTHOR]

Children are defined as hypertensive when their blood pressure values equal or exceed the 95th percentile of the blood pressure value distribution in a pediatric population, according to gender, age and height. The population on which reference tables are based is of fundamental importance to establish the threshold values for the diagnosis of hypertension in pediatric age. Before 2017, both American and European guidelines used nomograms created in the same reference population which included children of all weight classes. Given the close and well-known association between hypertension and excess weight in childhood, the 2017 American guidelines proposed new reference nomograms excluding subjects with overweight and obesity from the "historical" reference population. Furthermore, the new American guidelines suggested a fixed cut-off of 130/80 mmHg, starting from 13 years and regardless of gender and height, to make the diagnosis of hypertension. In this document, the Italian Hypertension Society (SIIA) and the Italian Pediatric Society (SIP) jointly discuss a number of issues raised by the new American guidelines that involve the entire medical community, and also address the definition of arterial hypertension in the transition phase between childhood and adulthood. [ABSTRACT FROM AUTHOR]

Buildings are energy- and resource-hungry: their construction and use account for around 39% of global carbon dioxide emissions; they consume around 40% of all the energy produced; they are responsible for over 35% of the EU's total waste generation; and account for about 50% of all extracted (fossil) materials. Therefore, they present a significant challenge to meeting national and international Net Zero targets of reducing greenhouse emissions and fossil resource use. The CircularB Project, is at the heart of this issue, which will underpin synergies of multi-scale circular perspectives (from materials, to components, to assets and built environments), digital transformation solutions, data-driven and complexity science, stakeholder behavioral science, and interdisciplinary capabilities towards achievable, affordable and marketable circular solutions for both new and existing buildings, for sustainable urban design, and for circular built environments across Europe. This paper contributes to the project by deriving new insights into the stakeholders' influences, inter-relationships, and obstacles in the implementation of circular economy concepts on existing building stocks in Europe, which represent over 90% of whole building assets. In order to identify and derive the insights, our study is rigorously based on (i) a robust critical literature review of key documentations such as articles, standards, policy reports, strategic roadmaps and white papers; and (ii) interviews with relevant stakeholders and decision makers. Uniquely, our work spans across all scales of CE implementation from materials, to products and components, to existing building stocks, and to living built environments. The findings point out the current challenges and obstacles required to be tackled. Inadequacies of financial incentives and governmental enforcement (via policy, legislation, or directive) are commonly found to be the most critical obstacles found throughout Europe. Circular economy is the global challenge and not just a single country can resolve the climate issue without the cooperation of other countries. The insights thus highlight the essential need for harmonized actions and tactical/pragmatic policies promoted and regulated by the European Commission, national and local governments who can dominate the influence, promote inter-relationship, and overcome the barriers towards circular economy much more effectively. [ABSTRACT FROM AUTHOR]

The study of security and computer privacy has become a significant focus in security and privacy research. To reflect a website's, service's, or app's privacy policies, they're frequently used as a beginning step for researchers investigating the reliability of stated data regulations, user comprehension of policy, or user control methods. It's challenging to collect information about privacy practices from Internet resources like websites and mobile applications for analysis because of the wide variations in the structure, presentation, and content. Most computer privacy studies attempt to test new methods for detecting, classifying, and analyzing computer privacy content. However, numerous papers have been published to promote research activities, and no trace of any bibliometric analysis work on computer privacy demonstrates research trends. By conducting a thorough analysis of computer privacy studies, it searches the Scopus database, which contains over 2000 papers published between 1976 and 2020. Using the bibliometric analysis technique, this study examines research activity in Europe, South America, and other continents. This work investigated the number of papers published, citations, research area, keywords, institutions, topics, and researchers in detail. An overview of the research efforts is followed by listing the words into a classification of computer privacy analysis tools, emphasizing the significance of a computer privacy research study. According to the investigation findings, there are numerous significant implications of research efforts in Europe compared to other continents. Finally, we summarize the review findings for each part by highlighting potential future research directions. [ABSTRACT FROM AUTHOR]

The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines 'value' as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes. [ABSTRACT FROM AUTHOR]

Nature-Based Solutions concepts and practices are being used worldwide as part of attempts to address societal challenges but have also been criticised for not dealing with deeper transformations needed to face urgent issues including biodiversity loss, climate change and inclusion. In this paper, we explore how an inclusive, integrated and long-sighted approach, emphasising a more radical integration of nature within cities, might support the transformations needed to endure major contemporary challenges. Addressing important emerging critiques of Nature-Based Solutions, we consider the potential of a more incisive form of Nature-Based Thinking (NBT) in cities, based on more holistic perspectives. The paper draws on a reflective and iterative research process that engaged both the research and practice communities through a symposium and a series of futures workshops that together explored the potential of NBT to develop future nature-cities relations in Europe and Latin America. The results of the reflective process suggest that notions of nature with people—not for people— new organisational structures, and the intention and capacity to apply long-term perspectives, are needed when planning for NBS interventions aimed at sustainable urban development. This includes developing a cultural-structural change based on new and inclusive understandings of human–nature relations, and novel governance paradigms that allow cross-sectoral coordination and engagement of local stakeholders beyond formal organisational structures. [ABSTRACT FROM AUTHOR]

Introduction: The total demand for freight transport in Europe has increased significantly in recent decades, but most of it has been handled by road transport. To fulfil the modal shift targets set in the EU White Paper 2011, it will be necessary to double rail's market share from today's 18 %, by 2050. Translating this into reality means rail will have to handle 3 to 4 times the cargo volume it does today. With this in mind, the paper develops a vision of an efficient rail freight system in 2050. Methodology: To achieve the above objective, the research applies literature survey and group discussion methodology and applying a system approach. Keeping on board the EU Transport White Paper 2011 modal shift targets, as well as future freight demand and customer requirements, the current research attempts to answer the following three critical questions: Results: The authors find that the service quality can be improved by better planning, application of appropriate ICT-systems and adoption of an integrated supply chain approach. A more customer-orientated service can also be achieved by further deregulation of rail. There is also an urgent need for a faster implementation of Rail Freight Corridors (RFC). As well as liner trains, future rail freight services should be offering end-point trains, with semi/ fully automated loading/unloading equipment in hub-terminals, as well as terminals at sidings to improve the availability of intermodal operation. Conclusion: To offer a competitive price and reliable service, a reduction in operating costs will be vital by implementing a number of measures, including operation of heavier and longer trains, wider loading gauge, higher average speed, and better utilisation of wagon space and all assets. This will bring increased capacity, as well as better timetable planning, signalling systems and infrastructure improvements. [ABSTRACT FROM AUTHOR]

Europe is characterized by an uneven record of Middle Paleolithic occupations. Specifically, large parts of southeastern Europe display markedly lower site densities and less intensive evidence of human presence than is found elsewhere; this has often resulted in the exclusion of the Balkans from debates related to Pleistocene human adaptation. The discrepancy stems either from the lower population densities of southeastern Europe or an imbalance in research across Europe. Additionally, our understanding of Balkan Middle Paleolithic stone tool industries suffers from the use of Mousterian labels defined when Bordian typology was the chief method of lithic analysis. Industrial facies then defined and still in use include Balkan Charentian, Levallois Mousterian, Micromousterian, Denticulate Mousterian; their relation with the rest of the Eurasian record was and remains unclear. This paper sets aside the issue of scarcity of Pleistocene occupations and tries to address Neanderthal biogeography, and variations in Neanderthal technological behavior and subsistence, based on the available record. It reviews the current Middle Paleolithic record in the Balkans, presents the apparent temporal and spatial trends, and presents the provisional biogeography of hominins, including scenarios for the demise of Neanderthals at or soon after the arrival of modern humans in Europe. The paper ends with a discussion of perspectives for future research arising from this analysis of the available record and proposes some hypotheses regarding the role of the Balkans in the overall context of the occupational history of western Eurasia in the Middle/Late Pleistocene. [ABSTRACT FROM AUTHOR]

While prior studies have examined various factors that affect immigration policymaking across Europe, little attention has been paid to the impact of the gender structure within parliament. It has been found that female parliamentarians are more concerned with the interests of women, children, and other marginalized groups than their male colleagues. Consequently, they are more likely to prioritize the rights of immigrants who represent an important social minority in European settings. Leveraging a panel data set spanning 26 European states from 2007 to 2019, the paper shows that an increase in the share of women parliamentarians is indeed associated with the liberalization of immigration policy. The results remain significant when employing historical female enrollment as an instrumental variable. Notably, the growth of the right-wing parties (including mainstream and radical right parties) in parliament would undercut the positive impact of female parliamentarians. The paper sheds some light on European immigration policymaking and female political representation. [ABSTRACT FROM AUTHOR]

Population aging has forced policy makers in most developed countries to reform pension systems with the aim of maintaining or re-establishing financial sustainability. This usually involves cost-cutting measures like later pension eligibility ages and lower replacement rates. Such reforms face harsh trade-offs with the objective of providing adequate pensions. Social welfare and inequality have emerged as crucial concerns about recent pension reforms, stressing that the lack of "social sustainability" may undermine financial sustainability. This paper analyzes such trade-offs and may explain why support for pension reform has dwindled in Europe. The paper evaluates reform effects on financial sustainability, social welfare, and intra- and inter-generational equality in a rich unified framework with several dimensions of heterogeneity and various behavioral reactions. Our simulations shed light on the complex distributional effects of pension reform on different cohorts and societal groups. They show where policy tends to reform unequally and why reforms may fail to find voters' approval. [ABSTRACT FROM AUTHOR]

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models. [ABSTRACT FROM AUTHOR]

Radiology has not been spared in recent economic crises with a substantial reduction in the turnover of imaging equipment. These problems are exacerbated by increasing demand for healthcare across Europe. Therefore, using existing radiological services while rigorously following evidence-based guidelines might improve patient care. Thus, diagnostic pathways should be assessed not only for technical and diagnostic performance but also for their impact on medical and social outcome. In this paper, we report the advice of the Research Committee of ESSR on how we may guide musculoskeletal radiological research towards studies that have useful clinical impact. The ESSR Research Committee intends to encourage research with potential to influence treatment, patient outcome, and social impact. Key Points • Research in medical imaging has the potential to improve human health. • High-level studies have the potential to place radiology at the pinnacle of quality in evidence-based practice. • The ESSR Research Committee intends to encourage research with potential to influence treatment, patient outcome, and social impact. [ABSTRACT FROM AUTHOR]

On 9 July 2014 the European Commission published the White Paper 'Towards more effective EU merger control'. The White Paper takes stock of the working of the EU Merger Regulation 10 years after the last reform in 2004. It evaluates what degree of coherence and convergence has been achieved in the application of merger control rules and practices at the EU and at Member State level. The White Paper supports recent suggestions to move towards a 'European Merger Area', in which the Commission and national competition authorities (NCAs) apply the same rules to mergers and acquisitions, but does not make concrete proposals in that respect. However, the White Paper proposes amendments to the Merger Regulation in two main areas. First, in order to address an enforcement gap in EU competition law with respect to acquisitions of non-controlling minority shareholdings, the Commission should have the possibility to review certain minority stake transactions creating a 'competitively significant link' between the acquirer and the target, without however making all acquisitions of minority shareholdings subject to the prior notification obligation. Second, the system for referring merger cases between the Commission and NCAs should be streamlined in order to reduce the administrative burden on companies and better ensure that cases are being dealt with by the best placed competition authority. Additional proposals made by the White Paper relate to removing joint ventures established outside the European Economic Area (EEA) and with no effect on EEA markets from the scope of the Merger Regulation and alleviating notification obligations for certain categories of unproblematic mergers. [ABSTRACT FROM AUTHOR]

Anorexia nervosa is a potentially life-threatening disorder with a typical onset in adolescence and high rates of medical complications and psychiatric comorbidity. This article summarizes issues relating to classification in DSM-5 and presents a narrative review of key evidence-based medical and behavioral interventions for adolescent AN and subthreshold restricting eating disorders, mainly, but not exclusively published between 2012 and 2014. In addition, it systematically compares the clinical guidelines of four European countries (Germany, Spain, The Netherlands, and United Kingdom) and outlines common clinical practice, in relation to treatment settings, nutritional rehabilitation, family-oriented and individual psychotherapy, and psychopharmacological treatment. With the exception of family-based treatment, which is mainly evaluated and practiced in Anglo-American countries, the evidence base is weak, especially for medical interventions such as refeeding and pharmacological intervention. There is a need for common European research efforts, to improve the available evidence base and resulting clinical guidance. [ABSTRACT FROM AUTHOR]

The European Universities Initiative (EUI), created by the European Commission in 2017, is a recent novel phenomenon within the European Union policy toolkit that explicitly targets the development of transnational cooperation in higher education (HE). To date, the EUI counts 44 European university alliances, involving around 340 HE institutions. In this paper, we argue that the EUI can be seen as a case of a transnational institution building process representing a potentially significant structural reform for European higher education. Anchored in new institutionalism, we explore the regulative, normative, and cultural-cognitive dimensions of the EUI. Methodologically, this study analyzes the perspectives of European policy actors (n = 4), a set of policy documents (n = 13) and the mission statements of the EUI's partnerships funded before 2022 (n = 41). The results show that the EUI emerges as the 'next level of cooperation' in European HE since it aims to transform European cooperation (regulative dimension), to create and diffuse a new model for European HE following a challenge-based approach (normative dimension), and to work as a way to reinforce and institutionalize European and global scripts for European HE (cultural-cognitive dimension). [ABSTRACT FROM AUTHOR]

Biochar incorporation into soil has shown potential, in enhancing nitrogen fertilizer (N-fertilizer) efficacy and soil organic carbon content (SOC). This study addresses a critical gap in the literature by investigating the effects of biochar addition over a seven-year period (2014–2020) on inorganic N, SOC, and pH in Haplic Luvisol. The research involved a rain-fed field experiment, with a crop rotation comprising spring barley, maize, spring wheat, and pea. Biochar, applied at the rates of 0, 10, and 20 t ha−1 in 2014, was reapplied to specific plots in 2018. Biochar was also combined with N-fertilizer at three level (N0, N1, and N2). Results showed a significant interactive influence of biochar and N-fertilizer combination on NO3− and NH4+ contents. Intriguingly, the addition of 10 t biochar ha−1 consistently decreased soil inorganic N levels across most of the examined months. Increasing biochar application rates led to a significant rise in pH, establishing a clear, negative correlation between soil pH and inorganic N content. Biochar significantly increased SOC compared to the control, particularly after the reapplication in 2018. However, this effect showed a diminishing trend over time. The study suggests that incorporating biochar treatments may enhance N-fertilizer effectiveness. However, the long-term implications of biochar application with N-fertilizer on N mineralization are specific to individual soil and biochar combinations. Except the application of 20 t ha−1 biochar at N2 in 2019, biochar did not affect the crop yields. Studied soil properties, including those influenced by biochar had nuanced impact on different aspects of crop yield. Article Highlights: Biochar obtained from mixed paper fiber sludge and the grain husks resulted in a significant increase of SOC over 7 years. Biochar aging resulted in a decrease in pH one year after its application in 2015 and 2019. The combination of N-fertilizer with biochar caused an improvement in soil inorganic N content in 2014 and reapplication in 2018. [ABSTRACT FROM AUTHOR]

Ordinary (customary) light gauge steel framing is a convenient construction technology; however, given the studs low axial capacity, it has been considered mainly for low-rise buildings in low seismicity regions. This paper investigates the boundaries of application of this type of steel framing (in moderate and high seismicity areas) by designing the structures of three representative 5, 7 and 10-storey buildings in order to examine their feasibility. The necessity of using built-up columns consisting of two or more sections is investigated. The axial capacity of studs is estimated by code-type analyses. The critical buckling stress is determined with well-known closed-form expressions; as they do not contemplate the flexibility of the screwed connections (in built-up sections), the obtained results are complemented with those of the finite strip method and generalized beam theory formulations. [ABSTRACT FROM AUTHOR]

This paper considers recent experiments in art and artificial intelligence that crystallize around training algorithms to generate artworks based on datasets derived from the Western art historical canon. Over the last decade, a shift towards the rejection of canonicity has begun to take shape in art historical discourse. At the same time, algorithmically enabled practices in the US and Europe have emerged that entrench the Western canon as a locus and guarantor of aesthetic value. Operating within the epistemic framework of a "view from nowhere," this tendency in generative art inherits the coloniality of both art history and artificial intelligence. Producing "art histories from nowhere," this tendency conflates the conceptual category of visual art with the histories of Western cultural production. It reproduces a set of aesthetic values that entrench the mythology of the artist-genius and his imputed whiteness and masculinity; the extolment of innovation and novelty as self-evident virtues; disembodied Cartesian models of knowing and sensing; and the erasure of contributions that have been occluded from canonical visibility. As we encounter systems trained on particular visions of art history and of the artist, how might we remain attentive to the specific lens through which they are taught to see? This essay addresses that question by bringing the coloniality of recent experiments into view, bridging data feminisms and decolonial studies to formulate alternative visions of encounters between art and AI. [ABSTRACT FROM AUTHOR]

Determining the underlying mechanisms leading to extreme events in dynamical systems is a challenging task. Under mild hypotheses, large deviations theory predicts that, as one increases the threshold defining an extreme, dynamical trajectories which reach the extreme look more and more like one another: they converge towards a typical, i.e. most probable, trajectory called the instanton. In this paper, we use a 2000-year simulation of the IPSL-CM6A-LR model under a stationary pre-industrial climate to test this prediction on the case of hot extremes. We investigate whether the physical mechanisms leading to extreme temperatures at four locations in Europe are more similar with increasing extreme temperatures. Our results show that most physical variables exhibit the expected convergence towards a most probable trajectory, with some geographical and temporal variations. In particular, we observe the presence of a cut-off low in some trajectories, which suggests the existence of multiple pathways leading to extreme temperatures. These findings confirm the relevance of instanton dynamics to understand the physical mechanisms driving extreme events in climate models. [ABSTRACT FROM AUTHOR]

Coppicing is a form of forest management in European broadleaved forests. While it is still practised in south-eastern Europe, in central and western Europe it was almost completely replaced by high forest management. Currently, there are increasing efforts to reintroduce coppice management into former coppice woods. However, little comprehensive knowledge is available about the extent and management of coppice reintroduction and the processes governing it. In this paper, we present an overview of localities in the Czech Republic where coppice reintroduction was taking place in 2020. We identified 8 localities and conducted 10 semi-structured interviews with experts involved in their management in order to understand what motivated them to restart coppicing and what obstacles they have had to face. The main motivation of site managers is nature conservation, while the most important obstacles are operational issues, such as bureaucracy, complicated land ownership and legal responsibilities or lack of workforce. Other motivating factors identified in other European countries (production of a renewable energy source and potential for rural employment) have so far played a minor role in the Czech Republic. We conclude that a major challenge for future forest policies will be to utilise the economic experiences of regions with active coppicing to foster the spread of coppice woods in order to combine renewable energy production with biodiversity conservation. [ABSTRACT FROM AUTHOR]

Acknowledged as a significant health hazard, increasing attention has been given to indoor and geogenic radon for some 20 years. One part of the efforts is surveying in order to assess the geographical extent of the hazard. Results acquired in surveys serve to support decisions in radon abatement policy, aimed to reduce exposure and consisting in prevention, mitigation and remediation measures. One particular element is delineation of so-called radon priority areas, or areas in which the hazard is such that abatement measures should be implemented with priority. These areas are estimated from radon measurements supported by different modelling methods. Methods which are based on estimating local probabilities that radon concentration exceeds a reference level often rely on measures of local variability, expressed for example by the geometric standard deviation or the coefficient of variation, because these describe the shape of the distribution whose tail areas are the sought-after probabilities. Evidently, delineation of radon priority areas thus depends, apart from mean concentration, on dispersion within the area whose priority status shall be assessed. A second use of spatial variability measures of radon is survey planning, because the sample size necessary to estimate a mean with given precision depends on the dispersion of the quantity to be assessed. It is estimated through pilot surveys or derived from general knowledge. The large radon databases accumulated for years allow more detailed insight into spatial properties of dispersion, some of which are discussed in this paper, in the first place the relation between local dispersion and mean and sampling density. Not least, they also grant insight—so far mostly speculative—about the process, understood as a stochastic process, which generates the spatial dynamic. Main conclusions are that a proportional effect in logarithmic scale exists and has an effect on estimation of local exceedance probability and that one should keep in mind that results, for example the local status as a radon priority area, depend on the estimation method. [ABSTRACT FROM AUTHOR]

Natural forest expansion (NFE), that is, the establishment of secondary forest on non-forested land through natural succession, has substantially contributed to the widespread expansion of forests in Europe over the last few decades. So far, EU policies have largely neglected the potential of NFE for meeting policy objectives on restoration. Synthesising recent interdisciplinary research, this paper assesses the challenges and opportunities of NFE in view of contributing to European forest and ecosystem restoration. Specifically, we discuss the potential for supporting climate change mitigation and adaptation, biodiversity conservation, and forestry and economic use, summarize the current knowledge about societal perceptions and the policymaking on NFE, and make policy recommendations to better use the potential of NFE. We conclude that NFE has the potential to contribute to the European restoration policy agenda if local contexts and possible trade-offs are properly considered. [ABSTRACT FROM AUTHOR]

Purpose: Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. Methods: An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. Conclusion: The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. Summary: This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice. [ABSTRACT FROM AUTHOR]

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right to health requirements. Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being. [ABSTRACT FROM AUTHOR]

In his article Willems (Clim Chang 120(4):931-944, ) proposed a methodology to analyse extremes in rainfall series. When applying it to artificially generated, non-cyclic random variables we were able to detect cyclic behavior. Therefor we had a closer look on the methodology. Here we discuss our considerations, why this method generates cycles, depending on chosen subperiods and their coherence between detected cycle lengths. To verify these relationships some examples based on random data samples are given. [ABSTRACT FROM AUTHOR]

This position paper aims to clarify the presumed place of febuxostat in the management of gout patients. Since this novel xanthine oxidase inhibitor is now available, an international group of gout experts decided to formulate an international consensus statement. This statement presents the place for this new xanthine oxidase inhibitor in the treatment of gout which may contribute to optimize treatment of gout patients in Europe and worldwide. [ABSTRACT FROM AUTHOR]

The population abundance of birds is an important way to gauge the sustainability and health of the environment. However, several factors influence their distribution and density in different habitats. This paper aims to provide a comprehensive and updated outlook on bird population dynamics in Europe in the past 40 years. With the use of Generalized Additive Mixed Models (GAMMs), we analyzed the data available from the Pan-European Common Bird Monitoring Scheme (PECBMS) on abundance indexes collected throughout Europe from 1980 to 2019 and explored the driving forces behind our observed changes for each habitat type. We also apply GAMMs to model the overall changes in abundance indices of eight bird species that showed the highest variations (i.e., Locustella fluviatilis, Locustella naevia, Alcedo atthis, Bombycilla garrulus, Tetrax tetrax, Tringa totanus, Anthus campestris and Larus ridibundus). It was noted that the general abundance of birds decreased, with farmland birds suffering the biggest decline. Forest bird species population abundance was found to be quite varied; specialist species decreased as compared to generalists, which generally increased. [ABSTRACT FROM AUTHOR]

This paper makes an attempt to describe the ideas about the Sun that dominated Europe in the 17th–19th centuries. [ABSTRACT FROM AUTHOR]

A person's health status is one of the strongest determinants of well-being. The negative impact of poor health on subjective well-being may be moderated by providing care to individuals in need. In this paper, we investigate the relationships between receiving informal care and the amount of care received and subjective well-being among people aged 65 or older in selected European countries. Our analysis of data from the 6th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) showed that receiving regular informal care was associated with higher subjective well-being among older people in Northern European countries, and with lower subjective well-being among older males in Southern European countries. Moreover, we found that the perception of the amount of help received affected the subjective well-being of older people, as those who reported that the support they received was either insufficient or met their needs had lower subjective well-being than those who were not in need of care. Our results also showed that receiving formal care was negatively related with subjective well-being among older adults in Northern Europe and Central and Eastern Europe. In the context of population ageing and the growing need for care, social policies that support both sides of the caregiving relationship could enhance subjective quality of life. [ABSTRACT FROM AUTHOR]

In the twenty-first century, it is crucial to see climate change not only as a risk that can cause large-scale forest disturbances but also as an opportunity for innovative approaches to forest management and silviculture of new resistant tree species, like the prospective black pine (Pinus nigra J. F. Arnold). This literature review compiles findings from 260 scientific papers. It presents a summary of research results of black pine potential in European forests from 1970 to 2023. It describes the importance of its taxonomy, area of distribution and introduction, ecological characteristics, production, silviculture, wood quality, threats, and pests, as well as the potential of this tree species in relation to global climate change. In Europe, black pine covers an area of over 9.5 million ha and is one of the most frequently planted tree species outside of its original range. This pine is an effective tree species for afforestation management in arid habitats, as well as in areas threatened by pollution or on reclamation sites. Moreover, it resists the negative effects of climate change exceptionally well, such as more intense heat waves and more frequent long-term droughts, especially in young stands with lower tree density. However, the consequences of climate change on growth are not homogeneous across black pine distribution ranges due to interpopulation variability. It also has a high production potential advantage, and the wood is easy to process for various purposes. Overall, black pine can be considered one of the most adaptable pine species to anthropogenic factors and ongoing climate change, and a valuable tree species in forestry for newly cultivated areas in Europe. [ABSTRACT FROM AUTHOR]

The article describes the revolutionary new ways of communicating the written word when moving from the Medieval to Modern period in Europe, primarily the use of paper and moveable typeface printing and how these catalysed important cultural developments. A similar revolution has taken place in the last 50 years with the development of the internet. The article looks at how scientific publishing has changed with electronic publishing, including the development of Open Access. The journal Heritage Science is placed into this context. Especially important for scientific journals in an era when anyone can post anything on a webpage, is maintaining standards through high quality refereeing which distinguishes formal scientific literature from informal websites. [ABSTRACT FROM AUTHOR]

This paper analyses the volatility transmission between European Global Systemically Important Banks (GSIBs) and implied stock market volatility. A Dynamic Conditional Correlation Generalized Autoregressive Conditional Heteroskedasticity model is applied to determine the dynamic correlation between returns of Europe's GSIBs and the world's most prominent measure of market "fear", the CBOE Volatility Index (VIX). The results identify a higher negative co-relationship between the VIX and GSIB returns during the COVID-19 period compared with the Global Financial Crisis (GFC), with one-day lagged changes in the VIX negatively Granger-causing bank returns. The asymmetric impact of changes in implied volatility is examined by quantile regressions, with the findings showing that in the lower quartile–where extreme negative bank returns are present–jumps in the VIX are highly significant. This effect is more pronounced during COVID-19 than during the GFC. Additional robustness analysis shows that these findings are consistent during the periods of the Swine Flu and Zika virus epidemics. [ABSTRACT FROM AUTHOR]

Recruitment is one of the main strategic tools for universities, which aim to hire the best possible candidates for their academic positions. However, not every institution can hire whom they perceive as the best. Our paper investigates what are perceived to be the most pressing hindrances to attracting the best researchers. We focus on national and disciplinary differences in researchers' perceptions of barriers to recruiting the best scholars in their fields. We surveyed researchers in economics and physics in the Netherlands, Norway, and the UK and find that economists emphasize salary level and institutional prestige as the main barriers, while physicists underline competition from non-academic actors and career development opportunities. We further find differences by country. In Norway, limited institutional prestige is a key barrier to attracting the best researchers, while researchers in the UK highlight salary levels. Respondents at Dutch universities claim that they experience multiple, equally important barriers. [ABSTRACT FROM AUTHOR]

Air transport has been identified as one of the primary means whereby COVID-19 spread throughout Europe during the early stages of the pandemic. In this paper we analyse two categories of methods – dynamic network markers (DNMs) and network analysis-based methods – as potential early warning signals for detecting and anticipating COVID-19 outbreaks in Europe on the basis of accuracy regarding the daily confirmed cases. The analysis was carried out from 15 February 2020, around two weeks before the first COVID-19 cases appeared in Europe, and 1 May 2020, approximately two weeks after all the air traffic in Europe had been shut down. Daily European COVID-19 information sourced from the World Health Organization was used, whereas air traffic data from Flightradar24 has been incorporated into the analyses by means of four alternative adjacency matrices. Some DNMs have been discarded since they output multiple time series, which makes it very difficult to interpret their results. The only DNM outputting a single time series does not emulate the COVID-19 trend: it does not detect all the main peaks, which means that peak heights do not match up with the increase in the number of infected people. However, many combinations of network analysis based methods and adjacency matrices output good results (with high accuracy and 20-day advance forecasts), with only minor differences from one to another. The number of edges and the network density methods are slightly better when dynamic flight frequency information is used. [ABSTRACT FROM AUTHOR]

Pyrethroid as an agent of biocide resistance (BR) and environmental contamination has become a major threat for global health and biodiversity conservation. After eradication of malaria in Europe, uncontrolled mosquito elimination performed just to decrease their nuisance became a long-term practice. Pyrethroids, compounds used for chemical control of mosquitoes are not selective. The main goal of this paper was to study the pyrethroid resistance among mosquitoes of genus Culex and Aedes in Central Europe. Experiment was performed by collecting mosquitoes of Culex spp. and Aedes spp. in four locations: Suchohrad, Vysoká pri Morave, Bratislava, and Bratislava surroundings, where pyrethroids are commonly used as a form of chemical control of mosquito population. The biocide resistance was determined by the CDC bottle bioassay. The second aim was the determination of presence and longevity of cypermethrin in the surrounding environment in the village Vysoká pri Morave. Samples were collected 7 days after ultra-low volume (ULV) fogging treatment in June 2021 and analyzed by liquid chromatography with tandem mass spectrometry (LS/MS). According to the results of performed tests we may state that in all tested localities there is a considerable possibility of occurrence of resistance of tested mosquitoes to deltamethrin and cypermethrin. Based on the results obtained by liquid chromatography with tandem mass spectroscopy from the collected vegetation samples we may conclude that the measured values of cypermethrin and deltamethrin exceeded the highest accepted measured residue levels (MRL) for food and animals products, and after the ULV treatment the population of mosquitoes increased. [ABSTRACT FROM AUTHOR]

A new era of stroke treatment may have begun with mechanical thrombectomy (MT) by fully deployed closed-cell self-expanding stents (stent-triever). Multiple case series and the first randomised controlled trials (RCTs) have now been published. More studies are under way involving large numbers of patients, which in turn has resulted in less strict 'pragmatic' study protocols. Problems with current trials include a lack of standardisation in the conduct of the recanalisation procedure, the definition of primary endpoints such as the grade of arterial recanalisation and tissue reperfusion, and the post-surgical care provided. In Part 1 of this two part series, we outline the current situation and the major research questions. [ABSTRACT FROM AUTHOR]

Based on current data and experience, the joint working group of the European Society of Minimally Invasive Neurological Therapy (ESMINT) and the European Society of Neuroradiology (ESNR) make suggestions on trial design and conduct aimed to investigate therapeutic effects of mechanical thrombectomy (MT). We anticipate that this roadmap will facilitate the setting up and conduct of successful trials in close collaboration with our neighbouring disciplines. [ABSTRACT FROM AUTHOR]

Objective: To develop clinical guidelines for musculoskeletal ultrasound (MSKUS) referral in Europe. Methods: Sixteen musculoskeletal radiologists from seven European countries participated in a consensus-based interactive process (Delphi method) using consecutive questionnaires and consensus procedure meetings at several European radiology meetings. The evaluation of musculoskeletal diseases was established by literature reviews, followed by consensus on clinical utility in three consensus meetings. This involved a thorough, transparent, iterative approach which including interview, questionnaire, Delphi and standard setting methodologies. European MSK radiologists with a special interest in MSKUS formed two different expert groups who worked on reaching a consensus in the first two meetings. The third meeting resolved questions that did not achieve a consensus level of 67% using the first two questionnaires. Results: On expert consensus, the use of MSKUS is indicated to detect joint synovitis, fluid and septic effusion for potential aspiration, and poorly indicated to detect loose bodies. Recommendations for most appropriate use of musculoskeletal ultrasound are reported in six areas relevant to musculoskeletal ultrasound: hand/wrist, elbow, shoulder, hip, knee and ankle/foot. Conclusion: A comprehensive evidence-based, expert consensus-defined educational framework on clinical ultrsound is presented. This should facilitate referrals for this important imaging technique throughout Europe. Key Points: • Musculoskeletal ultrasound is indicated for detecting joint synovitis, effusions and fluid collections. • Musculoskeletal ultrasound is poor at detecting loose bodies. • Musculoskeletal ultrasound is relevant for most joints. [ABSTRACT FROM AUTHOR]

A wave of company law reform has swept across Europe and has now reached Denmark, where a proposal for a new combined companies act has been put forward and will soon enter the legislative process. In this article, the driving forces behind these reforms are explored. They are: the freedom to choose among the company law regimes of the European Union that follows from the case law of the EC Court of Justice; the demise of the doctrine of protection of capital; and the increasing insignificance of the distinction within company law between public and private limited companies. The main tenets of the Danish reform are: the introduction of a combined companies act to cover both the public and the private limited company; the possibility to choose between the main corporate governance models known in European company law, which, in combination with the possibility to use English at board meetings, the general meeting of shareholders and in public documents and accounts, should cater to the needs of crossborder business and investment; and a relaxation of the capital regime allowing limited companies more freedom in deciding the structure of their share capital and the distribution of control. [ABSTRACT FROM AUTHOR]

The development of new molecular and neurobiological methods, computer-assisted quantification techniques and neurobiological investigation methods which can be applied to the human brain, all have evoked an increased demand for post-mortem tissue in research. Psychiatric disorders are considered to be of neurobiological origin. Thus far, however, the etiology and pathophysiology of schizophrenia, depression and dementias are not well understood at the cellular and molecular level. The following will outline the consensus of the working group for neuropsychiatric brain banking organized in the Brainnet Europe II, on ethical guidelines for brain banking, clinical diagnostic criteria, the minimal clinical data set of retrospectively analyzed cases as well as neuropathological standard investigations to perform stageing for neurodegenerative disorders in brain tissue. We will list regions of interest for assessments in psychiatric disorder, propose a dissection scheme and describe preservation and storage conditions of tissue. These guidelines may be of value for future implementations of additional neuropsychiatric brain banks world-wide. [ABSTRACT FROM AUTHOR]

It is a major clinical and public health problem that there is no clear strategy as to how we best make use of information obtained when pregnant women take drugs. For this reason, some pregnant women are not treated as they should be and some are given drugs they should not use. We suggest a monitoring system that combines some of the available datasets in Europe. Using these sources as a starting point, one can develop a system that has sufficient power to detect even rare diseases like congenital malformations and sufficient diversity to detect several possible outcomes from spontaneous abortions to childhood disorders. We also suggest that case-crossover designs should be used in case-control monitoring systems that carry a high risk of recall bias. These considerations are based upon our results from a European Union-funded concerted action called EuroMaP (Medicine and Pregnancy). [ABSTRACT FROM AUTHOR]

Although native to Australia, Eucalyptus species are found throughout Europe. At present, they are located mainly in the Iberian Peninsula and Eucalyptus globulus is the most commonly planted species. Climate forecasts anticipate an expansion of Eucalyptus to other regions of Europe. The fast growth of E. globulus, together with its resprouting ability and wood properties, has promoted the use of this species in the Iberian Peninsula. The total volume of E. globulus harvested there was close to 14 million m3 in 2019. Eucalyptus species represent the main source of raw material for the pulp and paper industries and provide an important source of income to non-industrial owners. Being exotic fast-growing trees, their expansion has also been associated with negative environmental impacts. The species therefore poses a series of challenges, while also generating opportunities. The objectives of this review paper are: (1) to summarize the importance of Eucalyptus plantations in Europe; (2) to analyse the opportunities and challenges of this genus in present and future plantations in Europe; (3) to assess to what extent forest management, at both stand and landscape levels, can reduce negative impacts; (4) to make policy and management recommendations that may support the use of this genus in other European regions. These aims are accomplished based on a thorough literature review, particularly focused on research developed in the Iberian Peninsula. [ABSTRACT FROM AUTHOR]

This paper looks at youth mobility as an ongoing, dynamic, processual experience in the making of an educational trajectory. By exploring the experiences of students who have undertaken more than one mobility experience under the Erasmus + program, we reflect on how underlying motivations change over the course of subsequent mobility experiences. In contrast to existing research, where the focus has been on reported motivations for one-off mobility experience, we discuss the latent motivations driving super-mobile educational trajectories. In doing so, we observe the ongoing reconfiguration of these trajectories through the concept of spatial reflexivity, which results in articulated and augmentative dynamics over time. Methodologically, the paper is based on qualitative material collected in person and online with such mobile young people across Europe. [ABSTRACT FROM AUTHOR]

This paper explores the gender gap in time allocation in European countries, offering a comparison of the 2000s and the 2010s, along with an explanation of the documented gender gaps, based on social norms and institutional factors. The results show that the gender gap in both paid and unpaid work has decreased in most countries, but with a significant level of cross-country heterogeneity in the size of the gender gaps. More traditional social norms are related to greater gender inequalities in paid and unpaid work, while countries with better family-friendly policies and a greater representation of women in politics and in the labour market exhibit smaller gender inequalities. This paper provides a comprehensive analysis of gender gaps in Europe, and attempts to monitor the progress towards the elimination of gender inequalities. Despite that some degree of gender convergence in paid and unpaid work has taken place, there remain inequalities in the distribution of labour in European countries, and possible solutions may be related to social norms and family-friendly policies. [ABSTRACT FROM AUTHOR]

EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged.Key Points: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future. [ABSTRACT FROM AUTHOR]

In 2014, the European Medicines Agency (EMA) released for comment a draft reflection paper on the use of patient-reported outcome (PRO) measures in oncology studies. A twelve-member International Society for Quality of Life Research (ISOQOL) taskforce was convened to coordinate the ISOQOL response. Twenty-one ISOQOL members provided detailed comments and suggestions on the paper: 81 % from academia and 19 % from industry. Taskforce members consolidated and further refined these comments and shared the recommendations with the wider ISOQOL membership. A final response was submitted to the EMA in November 2014. The impending publication of the EMA reflection paper presents a valuable opportunity for ISOQOL to comment on the current direction of EMA PRO guidance and strategy. The EMA paper, although focused on cancer, could serve as a model for using PROs in other conditions, as it provides a useful update surrounding some of the design issues common to all trial research including PRO endpoints. However, we believe there are a number of additional areas in need of greater consideration. The purpose of this commentary is therefore to highlight the strengths of this timely and potentially useful document, but also to outline areas that may warrant further discussion. [ABSTRACT FROM AUTHOR]