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This paper investigates the effects of digitalization and organizational practices on innovation in Europe, between 2010 and 2016. We analyze the cross-country and industry differences in firms' investments and capabilities to adopt and use new technologies and their effects on innovation outputs. Along with traditional drivers of innovation, such as research and development (R&D) expenditure, two composite indicators are constructed. One encompasses direct measures of the adoption and use in enterprises of a set of digital technologies. The other measures the learning capacity of organizations, which captures the use of management tools and organizational practices concerned with the improvement of individual and organizational learning. Product, process, organizational, and marketing innovations are identified as well as their combinations within companies. Empirical evidence is provided by a unique dataset based on the integration at the sector within the country level of European Union (EU)-wide employers' and employees' surveys: the Community Innovation Survey (CIS), the Community Information and Communication Technologies (ICT) usage and e-commerce in enterprises survey (Eurostat), and the European Working Conditions Survey (Eurofound). The descriptive evidence shows that Digital technology adoption and use is rapidly growing across Europe, while the Learning capacity of organizations remains stagnant. By contrast, our results from the econometric analysis show that these investments can favor all forms of innovations and that, further, they may show some complementarity. Overall, a mix of product/process innovations and organizational/marketing innovations rests on joint investments in R&D, digital technology adoption and use, and learning capacity of the organization. [ABSTRACT FROM AUTHOR]

A game of war, chess was played and pictured in a time of war by men and women, Jews and non-Jews in hiding, in the ghettos, and even behind the barbed wire of the transit, concentration, and extermination camps across Nazi-occupied Europe. Throughout the Second World War, instead of "throwing the game" and giving up, victims of National Socialism devised ingenious ways to improvise chess sets out of found materials and detritus—carved wood, folded paper, etched tin, and modeled bread. They also drew and painted chess games to document and allegorize their lives in extremis. Through a close reading of chess artifacts and artworks, this article reveals how access to materials and time, status within camp hierarchies, ethnic and national identities, and wartime experiences impacted the various ways these groups used the game of chess under difficult playing conditions. Insisting upon the central role of creativity and play, it argues that both material artifacts and artwork inform our knowledge of how individuals living under Nazi oppression thought and felt. [ABSTRACT FROM AUTHOR]

Background The value equation of value-based healthcare (VBHC) as a single figure remains ambiguous, closer to a theoretical framework than a useful tool for decision making. The challenge lies in the way patient-centred outcomes (PCOs) might be combined to produce a single value of the numerator. This paper aims to estimate the weights of PCOs to provide a single figure in the numerator, which ultimately will allow a VBHC figure to be reached. Methods A cohort of patients diagnosed with breast cancer (n  = 690) with a 6-month follow-up recruited in 2019–20 across six European hospitals was used. Patient-reported outcomes (PROs), clinical-related outcomes (CROs), and clinical and socio-demographic variables were collected. The numerator was defined as a composite indicator of the PCOs (CI-PCO), and regression analysis was applied to estimate their weights and consequently arrive at a single figure. Results Pain showed as the highest weight followed by physical functioning , emotional functioning , and ability to work , and then by a symptom, either arm or breast. PCOs weights were robust to sensitivity analysis. The CI-PCO value was found to be more informative than the health-related quality of life (HRQoL) value. Conclusions To the best of our knowledge, this is the first research to combine the PCOs proposed by ICHOM to provide a single figure in the numerator of the value equation. This figure shows a step forward in VBHC to reach a holistic benchmarking across healthcare centres and a value-based payment. This research might also be applied in other medical conditions as a methodological pathway. [ABSTRACT FROM AUTHOR]

This paper aims at revisiting the empirical evidence on the recent trends of countries' integration in global value chains (GVCs) in Europe. It investigates two potential sources of unbalances that these processes might relate to (i) the sectoral specialization of the patterns of international fragmentation, whether high-technology manufacturing or knowledge-intensive business services (KIBS), and (ii) the occupational categories that have benefited or been penalized by these trends. A rich empirical mapping of these trends in the European countries is provided, based on World Input–Output Database and European Union Labour Force Survey (EU LFS) data. The results on the overall and sectoral-specific trends of integration in GVCs and the associated changes in the shares of managers and manual workers show dual-speed and qualitatively different integration patterns in Europe, with Eastern European (EE) countries rapidly integrating in high-tech manufacturing and the core of Western countries strengthening their mutual integration in the KIBS area. Despite the relatively "good quality" integration of EE countries, the evidence does not seem to reveal a mirroring upgrading of employment structures. While this empirical contribution does not attempt to identify causal relationships, the picture provided in the paper shows that, overall, integration in GVCs seems to reproduce and perhaps exacerbate the initial asymmetries in the sectoral and employment structure, with employment shares of manual workers reducing on the whole and knowledge-intensive occupations concentrating in Western Europe. [ABSTRACT FROM AUTHOR]

Despite the common belief that the granting of a patent is a neutral act, patent protection is intended to encourage technological innovations that are acceptable from an ethical point of view: in fact, both international and supranational legislation exclude from patentability inventions whose commercial exploitation would be contrary to ordre public, a notion that certainly encompasses also the prevention of serious damage to the environment. However, the provisions excluding the patentability of inventions whose commercial exploitation is contrary to ordre public (and in particular to environmental ordre public) have rarely been applied in Europe. After outlining the reasons why ordre public exceptions have had very limited application in Europe so far, the paper offers a new perspective through which such exceptions should be interpreted and suggests how patent offices can play a new and more decisive role in promoting environmentally sustainable innovation. [ABSTRACT FROM AUTHOR]

Golden everlasting paper daisies (Xerochrysum , Gnaphalieae, Asteraceae) were some of the earliest Australian native plants to be cultivated in Europe. Reputedly a favourite of Napoléon Bonaparte and Empress Joséphine, X. bracteatum is thought to have been introduced to the island of St Helena in the South Atlantic during Napoléon's exile there. Colourful cultivars were developed in the 1850s, and there is a widely held view that these were produced by crossing Xerochrysum with African or Asian Helichrysum spp. Recent molecular phylogenetic analyses and subtribal classification of Gnaphalieae cast doubt on this idea. Using single-nucleotide polymorphism (SNP) data, we looked for evidence of gene flow between modern cultivars, naturalized paper daisies from St Helena and four Xerochrysum spp. recorded in Europe in the 1800s. There was strong support for gene flow between cultivars and X. macranthum. Paper daisies from St Helena were genotypically congruent with X. bracteatum and showed no indications of ancestry from other species or from the cultivars, consistent with the continuous occurrence of naturalized paper daisies introduced by Joséphine and Napoléon. We also present new evidence for the origin of colourful Xerochrysum cultivars and hybridization of congeners in Europe from Australian collections. [ABSTRACT FROM AUTHOR]

Cardiac computed tomography (CT) was initially developed as a non-invasive diagnostic tool to detect and quantify coronary stenosis. Thanks to the rapid technological development, cardiac CT has become a comprehensive imaging modality which offers anatomical and functional information to guide patient management. This is the second of two complementary documents endorsed by the European Association of Cardiovascular Imaging aiming to give updated indications on the appropriate use of cardiac CT in different clinical scenarios. In this article, emerging CT technologies and biomarkers, such as CT-derived fractional flow reserve, perfusion imaging, and pericoronary adipose tissue attenuation, are described. In addition, the role of cardiac CT in the evaluation of atherosclerotic plaque, cardiomyopathies, structural heart disease, and congenital heart disease is revised. [ABSTRACT FROM AUTHOR]

This paper studies the effects of carbon pricing on inflation dynamics. We construct a sample of carbon taxes implemented in Europe and Canada over three decades and estimate the response of inflation and price components to carbon pricing. Our empirical results suggest that carbon taxes did not significantly increase inflation, with dynamic effects estimated around zero in most specifications. Instead we find support for relative price changes, increasing the cost of energy but leaving the price of other goods and services unaffected. This is consistent with previous findings on the limited aggregate economic costs of carbon taxes. Based on the cross-section of taxes in Europe, we provide suggestive evidence that the response of inflation was especially muted in countries with revenue-neutral carbon taxes and autonomous central banks that can accommodate potential inflationary pressure associated with carbon pricing. [ABSTRACT FROM AUTHOR]

Social clinics are grassroots health initiatives characterized by the development of mutualist practices of healthcare provision and the articulation of their action at territorial and community level. The present paper explores the development and implementation of community participation practices across three social clinics in Europe: social clinic of solidarity KIA in Greece, Village2Santé in France, and Microclinica Fatih in Italy. Drawing on findings collected through qualitative methods, our paper reflects on three overlapping themes of community participation highlighting its collective and eminently political character. Inspired by the frameworks of health promotion, comprehensive Primary Health Care and community development, we analyze three levels of community participation in the social clinics: participatory medical practices, the co-creation of health services, and the connection with broader social movements. Our paper contributes to the literature on community development by stressing the urge to reimagine the principles and practices of community participation through the creation of alternative forms of organizing and of radical empowerment. At the same time, it can inspire practitioners in experimenting with community participation initiatives from a more critical perspective, resisting the worst elements of neoliberalism. [ABSTRACT FROM AUTHOR]

Smart Specialization policy, Europe's place-based innovation policy, is transitioning into an innovation policy for sustainability inspired by academic debate and the urgency of societal challenges. The implications in terms of policy design remain underexplored. This paper studies the policy implications of this transition on the design of monitoring indicators. First, a theoretical framework based on the literature is created. Then, monitoring indicators used in the first policy phase are summarized into categories and themes through inductive and deductive document analysis. The indicators' strengths and limitations are discussed. By highlighting how monitoring indicators need to adjust to the policy transition, this paper contributes to the literature on innovation policy and Smart Specialization. It also provides guidance to policymakers by developing a framework on indicator design and providing practical recommendations on aspects that need to be considered, captured, and analysed through the indicators. [ABSTRACT FROM AUTHOR]

Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study. [ABSTRACT FROM AUTHOR]

Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning. There is a need to foster an environment conducive to medical technology development and validation so that Europe can continue to play a major role in device innovation while providing high standards of safety. This paper summarizes viewpoints on the topic of device innovation in cardiovascular medicine at the European Society of Cardiology Cardiovascular Round Table, a strategic forum for high-level dialogue to discuss issues related to the future of cardiovascular health in Europe. Devices are developed and improved through an iterative process throughout their lifecycle. Early feasibility studies demonstrate proof of concept and help to optimize the design of a device. If successful, this should ideally be followed by randomized clinical trials comparing novel devices vs. accepted standards of care when available and the collection of post-market real-world evidence through registries. Unfortunately, standardized procedures for feasibility studies across various device categories have not yet been implemented in Europe. Cardiovascular imaging can be used to diagnose and characterize patients for interventions to improve procedural results and to monitor devices long term after implantation. Randomized clinical trials often use cardiac imaging-based inclusion criteria, while less frequently trials randomize patients to compare the diagnostic or prognostic value of different modalities. Applications using machine learning are increasingly important, but specific regulatory standards and pathways remain in development in both Europe and the USA. Standards are also needed for smart devices and digital technologies that support device-driven biomonitoring. Changes in device regulation introduced by the European Union aim to improve clinical evidence, transparency, and safety, but they may impact the speed of innovation, access, and availability. Device development programmes including dialogue on unmet needs and advice on study designs must be driven by a community of physicians, trialists, patients, regulators, payers, and industry to ensure that patients have access to innovative care. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250–340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health. [ABSTRACT FROM AUTHOR]

The paper provides new evidence on proxy indicators of market power for major European countries. The data show moderately increasing average industry concentration over the last two decades, a considerably increasing proportion of high-concentration industries, and an overall tendency toward oligopolistic structure. Estimates of aggregate profitability also show a sustained increase over the recent decades for European economies. Although the academic and policy debate is not settled as to whether the causes of these trends are policy driven or reflect technological improvement, our findings suggest that competition policy is likely to face more challenges as large companies are becoming more common in more and more industries. [ABSTRACT FROM AUTHOR]

Background The issue of reluctance towards vaccination is becoming more worrisome. Health care workers (HCWs) are the primary point of contact with individuals who make decisions about vaccination. Therefore, it is crucial that HCWs receive sufficient training and periodic updates. The main objective of this systematic review is to evaluate the HCWs' training needs in vaccination and vaccine uptake. Methods In February 2022, a search was conducted on MEDLINE, Scopus and Google Scholar databases. The search included papers written in English, Italian, Portuguese, Spanish, French and Romanian, with a publication date ranging from 1 January 2011 to 24 February 2022 and conducted in Europe. To assess the methodological quality of the papers, the Appraisal tool for Cross-Sectional Studies was utilized. Results The search of scientific literature yielded 640 outcomes on PubMed, 556 on Scopus and 15 on Google Scholar, for a total of 1211 records. After eliminating duplicates, screening titles and abstracts and evaluating the full text of the articles, only 25 of them were found suitable for inclusion. The studies' overall quality ranged from moderate to good. The majority of the research emphasized the need for improved knowledge of vaccine-preventable diseases, vaccine efficacy, immunization schedules and vaccine adverse effects. Conclusions It is vital to prioritize educational programmes on vaccinology and vaccine hesitancy for HCWs, with the objective of improving their knowledge, awareness and attitudes. Addressing the diversity of educational backgrounds, roles and training requirements of HCWs involved in vaccination across Europe is a critical issue that must be tackled for future initiatives. [ABSTRACT FROM AUTHOR]

Natural populations of Ulmus minor Mill. an outstanding component of European riparian forests, are endangered due to Dutch elm disease, which has led to the development of several breeding programs throughout Europe. However, the reproductive ecology of this species is scarcely known even though sexual regeneration is an essential factor that must be understood before implementing elm stand restoration. In this paper, the main ecological factors affecting seed germination and early seedling establishment in U. minor are studied through a factorial design with five different factors: Light (levels: Full-sun , Shade), Initial water (levels: Initially-flooded , Initially-irrigated), Subsequent water (levels: Semi-submerged , Later-irrigated), Soil cover (levels: Bare-soil , Litter) and Substrate (levels: Silty-clay , Sandy-loam). Seed germination and seedling survival were monitored for 7 weeks. All factors except Initial water and Substrate turned out to be highly significant. Shade increased seed germination and seedling survival. Response to Initial water fluctuated, with an early higher percentage of germinated seeds in Initially-flooded but a higher seedling survival in Initially-irrigated. Subsequent water did not affect seedling establishment and survival, but Semi-submerged treatments increased seed germination. Bare-soil increased seed germination too, whereas, in the medium term, Litter affected positively seedling survival. Sandy-loam substrates favoured seed germination, but Silty-clay substrates favoured seedling survival. Together, these results suggest that the most favourable scenario for U. minor sexual regeneration may be a combination of a not-too-severe late-winter or early-spring flood followed by a wet spring and summer, probably with a higher establishment in heavy-textured substrates located in small gaps and forest edges where the overstorey provides some protection against strong sunlight. [ABSTRACT FROM AUTHOR]

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

The European Radiation Dosimetry Group (EURADOS) was founded in 1982. Since then, the group has continuously developed and is currently a network of 80 institutions and more than 600 individual scientists across Europe, including exchange with the scientific community outside of Europe. EURADOS supports research and development of dosimetry and harmonising dosimetric practices. This paper describes the major milestones in the history of the organization. It starts from the very beginning when the idea was born and describes periods during which the role and strategy of the network had to be defined, elaborated and refined. Finally, it ends to date where EURADOS appears as an independent self-sustainable association, which is a reliable partner for various international organisations in radiation research and radiation protection. Major activities of EURADOS are highlighted such as (1) establishment and coordination of Working Groups, (2) regular organization of dosimetric intercomparisons for quality assurance of dosimetry procedures, (3) development and organization of education and training events, and (4) contributions towards the development of strategic and integrated radiation research in Europe. [ABSTRACT FROM AUTHOR]

This paper examines existing methods of evaluating sample quality, showing that their practical utility and applicability to large-scale cross-project comparisons depends on whether they require auxiliary individual-level data. Among those methods that do not demand any such additional data, we differentiate between two approaches that rely on (i) external criteria, that is, comparisons of sample estimates to benchmarks derived from external population statistics, and (ii) internal criteria, that is, comparisons of subsample estimates to a theoretically derived aprioristic value. Our analyses demonstrate the advantages and limitations of both approaches based on an evaluation of 1,125 national surveys carried out in Europe between 2002 and 2016 within four survey projects: the Eurobarometer, European Quality of Life Survey, European Social Survey, and International Social Survey Programme. We show that the prevailing absence of design weights in cross-national survey datasets severely limits the applicability of external criteria evaluations. In contrast, using internal criteria without any weights proves acceptable because incorporating design weights in calculations of internal sample quality has only minor consequences for estimates of sample bias. Furthermore, applying internal criteria, we find that around 75 percent of samples in the four analyzed projects are not significantly biased. We also identify surveys with extremely high sample bias and investigate its potential sources. The paper concludes with recommendations regarding future research, which are directed at secondary data users, as well as producers of cross-national surveys. [ABSTRACT FROM AUTHOR]

This paper derives a European Herfindahl–Hirschman concentration index from 15 micro-aggregated country datasets. In the last decade, European concentration rose due to a reallocation of economic activity toward large and concentrated industries. Over the same period, productivity gains from an increasing allocative efficiency of the European market accounted for 50% of European productivity growth while markups stayed constant. Using country-industry variation, we show that changes in concentration are positively associated with changes in productivity and allocative efficiency. This holds across most sectors and countries and supports the notion that rising concentration in Europe reflects a more efficient market environment rather than weak competition and rising market power. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of Resale Price Maintenance (RPM) agreements in Europe by studying a legally permitted form of RPM in the book market. In particular, we study the effects of such agreements on prices and sales, finding that countries which have Fixed Book Prices policies witness higher book sales, relative to countries without such a policy, with no noticeable effect on the average price of books. We suggest that the mechanism for these findings is that FBP policies promote non-price competition and a diverse network of retailers, increasing quantity, whereas a change in bargaining power reduces double marginalisation, offsetting upward pricing pressure from RPM. While these results are limited to the book sector and are based on a limited number of countries changing policy, they nonetheless highlight that RPM agreements have the ability to confer positive competition effects and absolute prohibition of such agreements may not always be warranted. [ABSTRACT FROM AUTHOR]

This paper introduces a normative, expert-informed, time-dependent index of Social Inclusion for European administrative regions in five countries, using longitudinal data from Eurostat. Our contribution is twofold: first, our indicator is based on a non-additive aggregation operator (the Choquet Integral), which allows us to model many preferences' structures and to overcome the limitations embedded in other approaches. Second, we elicit the parameters of the aggregation operator from an expert panel of Italian policymakers in Social Policy, and Economics scholars. Our results highlight that Mediterranean countries exhibit lower Inclusion levels than Northern/Central countries, and that this disparity has grown in the last decade. Our results complement and partially challenge existing evidence from data-driven aggregation methods. [ABSTRACT FROM AUTHOR]

Analysis of phylogenetic trees has become an essential tool in epidemiology. Likelihood-based methods fit models to phylogenies to draw inferences about the phylodynamics and history of viral transmission. However, these methods are often computationally expensive, which limits the complexity and realism of phylodynamic models and makes them ill-suited for informing policy decisions in real-time during rapidly developing outbreaks. Likelihood-free methods using deep learning are pushing the boundaries of inference beyond these constraints. In this paper, we extend, compare, and contrast a recently developed deep learning method for likelihood-free inference from trees. We trained multiple deep neural networks using phylogenies from simulated outbreaks that spread among 5 locations and found they achieve close to the same levels of accuracy as Bayesian inference under the true simulation model. We compared robustness to model misspecification of a trained neural network to that of a Bayesian method. We found that both models had comparable performance, converging on similar biases. We also implemented a method of uncertainty quantification called conformalized quantile regression that we demonstrate has similar patterns of sensitivity to model misspecification as Bayesian highest posterior density (HPD) and greatly overlap with HPDs, but have lower precision (more conservative). Finally, we trained and tested a neural network against phylogeographic data from a recent study of the SARS-Cov-2 pandemic in Europe and obtained similar estimates of region-specific epidemiological parameters and the location of the common ancestor in Europe. Along with being as accurate and robust as likelihood-based methods, our trained neural networks are on average over 3 orders of magnitude faster after training. Our results support the notion that neural networks can be trained with simulated data to accurately mimic the good and bad statistical properties of the likelihood functions of generative phylogenetic models. [ABSTRACT FROM AUTHOR]

Background Social inequalities in multimorbidity may occur due to familial and/or individual factors and may differ between men and women. Using population-based multi-generational data, this study aimed to (1) assess the roles of parental and individual education in the risk of multimorbidity and (2) examine the potential effect modification by sex. Methods Data were analysed from 62 060 adults aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe, comprising 14 European countries. Intergenerational educational trajectories (exposure) were High–High (reference), Low–High, High–Low and Low–Low, corresponding to parental–individual educational attainments. Multimorbidity (outcome) was ascertained between 2013 and 2020 as self-reported occurrence of ≥2 diagnosed chronic conditions. Inequalities were quantified as multimorbidity-free years lost (MFYL) between the ages of 50 and 90 and estimated via differences in the area under the standardized cumulative risk curves. Effect modification by sex was assessed via stratification. Results Low individual education was associated with higher multimorbidity risk regardless of parental education. Compared to the High–High trajectory, Low–High was associated with −0.2 MFYL (95% confidence intervals: −0.5 to 0.1), High–Low with 3.0 (2.4–3.5), and Low–Low with 2.6 (2.3–2.9) MFYL. This pattern was observed for both sexes, with a greater magnitude for women. This effect modification was not observed when only diseases diagnosed independently of healthcare-seeking behaviours were examined. Conclusions Individual education was the main contributor to intergenerational inequalities in multimorbidity risk among older European adults. These findings support the importance of achieving a high education to mitigate multimorbidity risk. [ABSTRACT FROM AUTHOR]

Background The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020–2022. Methods Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010–2019 used as reference period. We then compared excess mortality across the countries in 2020–2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. Results While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29–122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14–90), 130 (83–177) and 88 (48–128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. Conclusion Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates—arguably the most accurate available for any region in capturing pandemic-related excess deaths—may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background Type-2 diabetes (T2D) and hypertension (HTN) are two of the most prevalent non-communicable diseases (NCDs): they both cause a relevant number of premature deaths worldwide and heavily impact the national health systems. This study illustrates the impact of HTN and T2D in four European countries (Albania, Bulgaria, Greece and Spain) and compares their policies towards the monitoring and management of HTN and T2D and the prevention of NCDs as a whole. This analysis is conducted throughout the DigiCare4You Project (H2020)—which implements an innovative solution involving digital tools for the prevention and management of T2D and HTN. Methods The analysis is implemented through desk research, and it is enriched with additional information directly provided by the local coordinators in the four countries, by filling specific semi-structured forms. Results The countries exhibit significant differences in the prevalence of HTN and T2D and available policies and programs targeted to these two chronic conditions. Each country has implemented strategies for HTN and T2D, including prevention initiatives, therapeutic guidelines, educational programs and children's growth monitoring programs. However, patient education on proper disease management needs improvement in all countries, registries about patients affected by HTN and T2D are not always available, and not all countries promoted acts to contain the increasing rates of risk factors related to NCDs. Conclusions While political awareness of the risks associated with HTN, T2D and NCDs in general is growing, there is a collective need for countries to strengthen their policies for preventing and managing these chronic diseases. [ABSTRACT FROM AUTHOR]

Background Global threats, such as the coronavirus disease 2019 (COVID-19) pandemic, have highlighted the critical importance of robust and well-functioning health information systems (HIS) in effectively addressing public health emergencies. To enhance the understanding and the functioning of such systems, it is crucial to perform HIS assessments. This article explores key gaps and identifies best practices in the COVID-19 HIS of eight European countries. Furthermore, it provides recommendations to strengthen European systems for better pandemic preparedness. Methods Assessments were carried out in eight European countries using an adapted version of the WHO support tool to strengthen HIS and the Joint Action on Health Information assessment tool. The assessments took place between January 2022 and April 2023. Results Four main themes emerged regarding the gaps and best practices identified in the various HIS: organizational, technical, legal and resources. The results of these assessments show different approaches implemented by countries to improve their HIS and respond to the demands of the pandemic. Conclusions It is imperative for countries to draw valuable insights from the COVID-19 pandemic and strengthen their HIS. This involves the adaptation or development of pandemic preparedness plans, strengthening legislative framework for data sharing and privacy protection, promotion of data standards and international definitions and implementation of a unique person identifier. Additionally, countries will have to act in this post-pandemic era and integrate the newly developed systems and innovations into existing structures, maintain and develop trust by citizens through transparent communication and engage in infodemic management and address resource gaps in the workforce. [ABSTRACT FROM AUTHOR]

Background Before the COVID-19 pandemic, a need for a uniform approach to health information (HI) knowledge in population health analysis across Europe was evident. The Population Health Information Research Infrastructure (PHIRI) emerged as a proactive initiative to strengthen European HI capacities. This article describes the achievements of PHIRI, highlighting its capacity-building activities and their contribution towards a sustainable strategy for the implementation of the European Health Data Space (EHDS). Methods PHIRI collaboration established a work package for skill-building activities in population health in partnership with other organizations. Activities included webinars, workshops, sessions, training schools and courses for researchers and public administration workers from Europe and beyond. The primary goal of the activities was to examine the impact of COVID-19 on European health systems at both local and national levels, including healthcare facilities and policymaking entities. Results Twelve activities were organized between October 2020 and the summer of 2023. In March 2023, the Spring School on Health Information was organized to share the knowledge achieved from PHIRI and other European Union-related projects. This event also validated the European Health Information Training Programme. Conclusions PHIRI's findings emphasized the importance of equipping the workforce with core HI skills to improve health systems' preparedness and resilience. Through this research, it is possible to propose a strategy for building capacity that emphasizes the importance of providing training in human-machine dynamics. This approach will contribute to the sustainable implementation of the EHDS. [ABSTRACT FROM AUTHOR]

Background Resilience of national health systems in Europe remains a major concern in times of multiple crises and as more evidence is emerging relating to the indirect effects of the COVID-19 pandemic on health care utilization (HCU), resulting from de-prioritization of regular, non-pandemic healthcare services. Most extant studies focus on regional, disease specific or early pandemic HCU creating difficulties in comparing across multiple countries. We provide a comparatively broad definition of HCU across multiple countries, with potential to expand across regions and timeframes. Methods Using a cross-country federated research infrastructure (FRI), we examined HCU for acute cardiovascular events, elective surgeries and serious trauma. Aggregated data were used in forecast modelling to identify changes from predicted European age-standardized counts via fitted regressions (2017–19), compared against post-pandemic data. Results We found that elective surgeries were most affected, universally falling below predicted levels in 2020. For cardiovascular HCU, we found lower-than-expected cases in every region for heart attacks and displayed large sex differences. Serious trauma was the least impacted by the COVID-19 pandemic. Conclusion The strength of this study comes from the use of the European Population Health Information Research Infrastructure's (PHIRI) FRI, allowing for rapid analysis of regional differences to assess indirect impacts of events such as pandemics. There are marked differences in the capacity of services to return to normal in terms of elective surgery; additionally, we found considerable differences between men and women which requires further research on potential sex or gender patterns of HCU during crises. [ABSTRACT FROM AUTHOR]

This consensus paper provides a framework for grading of severity of cardiovascular magnetic resonance (CMR) imaging-based assessment of chamber size, function, and aortic measurements. This does not currently exist for CMR measures. Differences exist in the normal reference values between echocardiography and CMR along with differences in methods used to derive these. We feel that this document will significantly complement the current literature and provide a practical guide for clinicians in daily reporting and interpretation of CMR scans. This manuscript aims to complement a recent comprehensive review of CMR normal value publications to recommend cut-off values required for severity grading. Standardization of severity grading for clinically useful CMR parameters is encouraged to lead to clearer and easier communication with referring clinicians and may contribute to better patient care. To this end, the European Association of Cardiovascular Imaging (EACVI) has formed this expert panel that has critically reviewed the literature and has come to a consensus on approaches to severity grading for commonly quantified CMR parameters. [ABSTRACT FROM AUTHOR]

Morbidity and mortality from ischaemic heart disease (IHD) and heart failure (HF) remain significant in Europe and are increasing worldwide. Patients with IHD or HF might benefit from novel therapeutic strategies, such as cell-based therapies. We recently discussed the therapeutic potential of cell-based therapies and provided recommendations on how to improve the therapeutic translation of these novel strategies for effective cardiac regeneration and repair. Despite major advances in optimizing these strategies with respect to cell source and delivery method, the clinical outcome of cell-based therapy remains unsatisfactory. Major obstacles are the low engraftment and survival rate of transplanted cells in the harmful microenvironment of the host tissue, and the paucity or even lack of endogenous cells with repair capacity. Therefore, new ways of delivering cells and their derivatives are required in order to empower cell-based cardiac repair and regeneration in patients with IHD or HF. Strategies using tissue engineering (TE) combine cells with matrix materials to enhance cell retention or cell delivery in the transplanted area, and have recently received much attention for this purpose. Here, we summarize knowledge on novel approaches emerging from the TE scenario. In particular, we will discuss how combinations of cell/bio-materials (e.g. hydrogels, cell sheets, prefabricated matrices, microspheres, and injectable matrices) combinations might enhance cell retention or cell delivery in the transplantation areas, thereby increase the success rate of cell therapies for IHD and HF. We will not focus on the use of classical engineering approaches, employing fully synthetic materials, because of their unsatisfactory material properties which render them not clinically applicable. The overall aim of this Position Paper from the ESC Working Group Cellular Biology of the Heart is to provide recommendations on how to proceed in research with these novel TE strategies combined with cell-based therapies to boost cardiac repair in the clinical settings of IHD and HF. [ABSTRACT FROM AUTHOR]

We estimate a model-free term structure of the ex ante dividend risk premium by combining two data sets with different information about future dividends. We aggregate survey forecasts about future dividends for single companies over multiple horizons to construct a term structure of expected S&P 500 dividend growth rates. We use European call and put option prices on the S&P 500 to estimate the term structures of options-implied dividend growth rates and risk-free rates. Applying the method to 2004–2021 data offers a new, ex ante perspective on the conditional time variation of the term structure of the dividend risk premium. [ABSTRACT FROM AUTHOR]

In recent years, public policymakers in Europe have become increasingly aware of the need to support Europe's failing semiconductor industry. This is an emerging policy area, and this paper examines the current state of the industry in Europe and assesses its potential future. It contends that the competitiveness of the industry will be related to its innovative capacity, especially its capability to engage in processes of open innovation. The industry in Europe is largely located in a number of discrete regional clusters, and the analysis focuses on data collected from a series of interviews with lead representatives of these clusters. The analysis indicates that the challenges facing the industry stem from the structure of the industry in Europe and the structure of the wider European technology industry. It is concluded that policies, such as the introduction of the European Chips Act, are likely to have a limited, or even negative, impact on the types of open innovation–led growth that will improve long-term competitiveness. [ABSTRACT FROM AUTHOR]

This study aims to review the open science (OS) policy documents, identify their subject areas, and distinguish the topics of OS support policies in seven European countries, providing a platform for practical cooperation between countries in science popularization. With a qualitative–inductive approach, all pertinent policy documents in OS were collected through documentary study, and thematic analysis was conducted to identify OS policies for each country. Finally, forty-six policy documents extracted up to December 2020 were thematically analyzed through a qualitative–inductive case study. All selected countries had developed OS policies, and these supportive policies were generally related to the three dimensions of 'open input, open process, and open output'. In 'open input', recommendations for the performance of research data repositories, as well as management criteria, are considered. Most countries adopted 'open output' protectionist policies. Multiple policies in the 'open process' indicate the need for an appropriate OS platform. [ABSTRACT FROM AUTHOR]

Despite the increasing proportion of female medical and nursing students, there is still a significant under-representation of women working as healthcare providers in interventional cardiology, with very few of them reaching senior leadership, academic positions, or acting principal investigators, as well as actively involved in company advisory boards. In this position paper, we will describe the current status of women working in interventional cardiology across Europe. We will also provide an overview of the most relevant determinants of the under-representation of women at each stage of the interventional cardiology career path and offer practical suggestions for overcoming these challenges. [ABSTRACT FROM AUTHOR]

Background Early reports on the pandemic nature of coronavirus disease 2019 (COVID-19) directed the nephrology community to develop infection prevention and control (IPC) guidance. We aimed to make an inventory of strategies that dialysis centres followed to prevent infection with COVID-19 in the first pandemic wave. Methods We analyzed IPC measures taken by hemodialysis centres treating patients presenting with COVID-19 between 1 March 2020 and 31 July 2020 and that completed the European Renal Association COVID-19 Database centre questionnaire. Additionally, we made an inventory of guidelines published in European countries to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dialysis centres. Results Data from 73 dialysis units located in and bordering Europe were analyzed. All participating centres implemented IPC measures to mitigate the impact of SARS-CoV-2 during the first pandemic wave. Measures mentioned most often included triage with questions before entering the dialysis ward, measuring body temperature, hand disinfection, masking for all patients and staff, and personal protective equipment for staff members. These measures were also recommended in most of the 14 guidelines that were identified in the inventory of national guidelines and were also scored as being among the most important measures by the authors of this paper. Heterogeneity existed between centres and national guidelines regarding the minimal distance between dialysis chairs and recommendations regarding isolation and cohorting. Conclusions Although variation existed, measures to prevent transmission of SARS-CoV-2 were relatively similar across centres and national guidelines. Further research is needed to assess causal relationships between measures taken and spread of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

The GECEM Project Database stands out as a new Digital Humanities solution to accurately order and analyse the new historical Big Data gathered in Chinese and European historical archives. Traditional challenges such as capture, storage, analysis, data curation, searching, sharing, transfer, visualization, querying, updating, and information privacy are being tackled and solved within the design of this new multi-relational database. The implementation of this database has as its main innovative elements the capability of coding and cross-referring historical data in Chinese and Western languages. Thus, we present a new database as a digital solution to solve the long-lasting problem in historical research: the maximization and optimization of data collection when analysing historical sources and how to make use of a large amount of registers and information when developing case studies and work hypotheses for historical research. In this paper, we present a solution for data collection and analysis of probate inventories and trade records which is a relevant source when determining changes in patterns of consumption and global trade through the introduction of Chinese goods into Europe and vice versa during the early modern period. [ABSTRACT FROM AUTHOR]

Nothing puzzles sociologists of religion more than the reasons and the patterns behind religious change. In the literature on secularization processes, it is broadly accepted that ongoing modernization has undermined many of the pillars of institutional religions, leading to widespread religious decline. While a considerable body of research investigates the "why(s)" of this decline, the main focus of this paper is on the "how." Drawing on CARPE, a harmonized dataset concerning church attendance with almost 2 million observations spanning over 40 years in 39 European countries, this article disentangles the contributions of period change and cohort replacement to the general religious decline. It shows that this decline reflects a real population dynamic based on generational replacement. It is not historical events or developments affecting everyone that undermine religion: new and less religious cohorts are replacing old and more religious ones. Like many other population dynamics, this process is described by an S-shaped curve and applies—with different speeds and levels—to almost all the European countries considered herein. These findings suggest that the effects of the processes of modernization on the mechanisms of religious socialization should be scrutinized more carefully when studying the reasons behind religious decline. [ABSTRACT FROM AUTHOR]

We study the allocation of interest rate risk within the European banking sector using novel data. Banks' exposure to interest rate risk is small on aggregate, but heterogeneous in the cross-section. Contrary to conventional wisdom, net worth is increasing in interest rates for approximately half of the institutions in our sample. Cross-sectional variation in banks' exposures is driven by cross-country differences in loan-rate fixation conventions for mortgages. Banks use derivatives to partially hedge on-balance-sheet exposures. Residual exposures imply that changes in interest rates have redistributive effects within the banking sector. Received October 31, 2017; editorial decision August 30, 2018 by Editor Philip Strahan. Authors have furnished an Internet Appendix , which is available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

In the post-communist countries, limited access to treatment, lack of financial protection mechanisms, lack of information and low quality of health care frequently imposes an enormous burden on family's well-being when cancer is diagnosed. While many studies have explored barriers to cancer treatment, little attention is paid to the question how patients and their caregivers cope with cancer. In this paper, we systematically review the evidence on patients' coping strategies with cancer in post-communist countries. We performed a literature search in PubMed, JSTOR, Web of Science and EBSCO (CINAHL) to identify papers that describe patients' coping strategies because of organizational and financial barriers to cancer treatment. Papers published between January 1991 and January 2020 were included if they described individual experiences of patients at any stage of cancer treatment. We applied the Preferred Reporting Items for Systematic Literature Review as a guide for our review. In total, 28 publications from post-communist countries were included in this review. They presented evidence on coping strategies and barriers faced by patients when coping with poor access to cancer treatment, lack of finances, lack of information and low quality of health care services. Most sought coping strategies included using personal finances to pay for medical services, medicines and supplies, charitable contributions to the hospital and informal payments; visiting a private medical doctor; using personal connections and looking for additional information. We conclude that coping strategies are similar across post-communist countries and can be seen as an indicator of the shortcomings in cancer treatment. This evidence can be used to study and/or improve access to cancer treatment and improve health care policies. Research on the prevalence and quantification of coping strategies is needed to provide evidence-informed policies for countries that face gaps in cancer treatment. [ABSTRACT FROM AUTHOR]

Driven by innovations in the digital space, surveys have started to move towards online data collection across the world. However, evidence is needed to demonstrate that online data collection strategy will produce reliable data which could be confidently used to inform policy decisions. This issue is even more pertinent in cross‐national surveys, where the comparability of data is of the utmost importance. Due to differences in internet coverage and willingness to participate in online surveys across Europe, there is a risk that any strategy to move existing surveys online will introduce differential coverage and nonresponse bias. This paper explores representativeness across waves in the first cross‐national online probability‐based panel (CRONOS) by employing R‐indicators that summarize the representativeness of the data across a range of variables. The analysis allows comparison of the results over time and across three countries (Estonia, Great Britain and Slovenia). The results suggest that there are differences in representativeness over time in each country and across countries. Those with lower levels of education and those who are in the oldest age category contribute more to the lack of representativeness in the three countries. However, the representativeness of CRONOS panel does not become worse when compared to the regular face‐to‐face interviewing conducted in the European Social Survey (ESS). [ABSTRACT FROM AUTHOR]

Background There is substantial evidence on the importance of voluntary activities for the health of middle-aged and older adults. Evidence on the effects of health and well-being on volunteering is more limited. This study examines reciprocal longitudinal associations between voluntary and/or charity activities and 21 indicators related to physical health, well-being, cognitive impairment and daily life functioning among middle-aged and older adults. Methods Longitudinal data were collected between 2011 and 2020 from a sample of 19 821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing and Retirement in Europe. An outcome-wide analysis and an exposure-wide analysis were applied and generalized estimating equations were used. Robustness analyses were conducted. Results Voluntary and/or charity activities almost every week or more often were prospectively associated with greater emotional well-being, reduced risks of limitations in activities of daily living and of being diagnosed with Alzheimer's disease at a 6-year follow-up. Positive reverse associations were found from emotional well-being to volunteering. Limitations in daily life activities, increased loneliness, high blood cholesterol, hypertension and chronic lung disease were found to impede participation in voluntary and/or charity activities over time. Feedback loops between voluntary and/or charity activities and well-being and limitations in daily activities may exist. Conclusion Understanding the reciprocal nature of the relationship between volunteering and health and well-being can help identify strategies to encourage volunteering among middle-aged and older adults with specific health conditions and to target health promotion efforts towards volunteers. [ABSTRACT FROM AUTHOR]

Use of peritoneal dialysis and home haemodialysis remains low in Europe, with the highest use in Scandinavian countries and the lowest in Eastern and Central Europe despite the advantages for people on dialysis and economic advantages for healthcare systems. This is partly due to the impact of the haemodialysis industry resulting in proliferation of haemodialysis units and nephrologist reimbursement related to use of haemodialysis. Equally important is the bias against home dialysis at both clinician and healthcare system levels. The underlying causes of this bias are discussed in relation to a mechanistic view of the human body, lack of compassion, failure to adjust dialysis provision for older age and frailty, proliferation of small dialysis centres, and complexity of decision-making and clinical care. For home dialysis to flourish, we need to foster a change in attitude to and vision of the aims of healthcare so that enabling meaningful activities of people requiring dialysis, as explored in the Standardized Outcomes in Nephrology initiative, rather than achieving biological numbers become the focus of care delivery. [ABSTRACT FROM AUTHOR]

Peritoneal dialysis (PD) is a form of kidney replacement therapy with the major advantage that it can be performed at home. This has a positive impact on patients' autonomy and quality of life. However, the dialysis population is ageing and physical and/or cognitive impairments are common. These limitations often form a barrier to PD and contribute to the low incidence and prevalence of PD in Europe. Assisted PD can be a solution to this problem. Assisted PD refers to a patient being assisted by a person or device in performing all or part of their dialysis-related tasks, thereby making PD more accessible to elderly but also younger frail patients. In this way, offering an assisted PD program can help lower the threshold for initiating PD. In this review, we provide an overview of the epidemiology of assisted PD in Europe, we discuss the different categories and clinical outcomes of assisted PD, and we present how assisted PD can be implemented in clinical practice as a possible strategy to increase and maintain home dialysis in Europe. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, effective contact tracing was recognized as a crucial public health response to mitigate the spread of SARS-CoV-2 and reduce COVID-19-related morbidity and mortality, particularly before widespread vaccination. The World Health Organization (WHO) recommended implementing active surveillance strategies to trace and quarantine contacts of confirmed or suspected COVID-19 cases. Methods: A detailed review and analysis of the COVID-19 contact tracing responses was conducted in five European countries and territories, between March 2021 and August 2022. The countries and territories were selected to ensure geographical representation across the WHO European Region and applied a mixed-methods approach of in-depth interviews with various stakeholders across different administrative levels to identify good practices in COVID-19 contact tracing. The interviews covered 12 themes, including methods and procedures for COVID-19 contact tracing, information technology, quality assurance and key performance indicators. Results: The findings demonstrate that the policy approach, digitalization capabilities and implementation approach varied in the countries and territories and were dynamic throughout the pandemic. The analysis revealed that some practices were applicable across all countries and territories, while others were context-specific, catering to each country's and territory's unique needs. The study highlighted a need for all countries to institutionalize contact tracing as an essential function of existing health systems, to digitalize contact tracing practices and processes, and to build and retain contact tracing capacities for better pandemic preparedness. Conclusion: The lessons related to COVID-19 contact tracing should be utilized to strengthen future outbreak response operations as part of epidemic and pandemic preparedness. [ABSTRACT FROM AUTHOR]

Although firmly established as a global norm, the Women, Peace and Security Agenda (WPS) has been largely driven by the global North attempting to solve insecurities in the global South. Postcolonial feminist research shows that this western-centrism and colonial legacies continue to dominate both WPS practices and knowledge production. This article focuses on WPS in central Europe, a previously ignored 'non-region' that remains outside the North–South divide. Combining postcolonial and decolonial approaches with feminist institutionalism, we interrogate what WPS becomes in the Czech, Polish and Slovakian contexts characterized by illiberal populist and anti-gender governance and politics. Building on interviews with key stakeholders, on document analysis and our own encounters, we argue that the three countries understand WPS as key to their western belongingness and reliability as international partners. As a result, they replicate rather than challenge 'western' WPS thinking. The resulting National Action Plans are centred around women's participation and security problems 'out there'. This lack of localization enables them to stay immune to the anti-gender alliances, but limits the engagement of feminist civil society. Amidst Russian imperial aggression, central Europe's WPS agendas serve as mere paper tigers and are failing to address the multitude of domestic and regional gendered insecurities. [ABSTRACT FROM AUTHOR]