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Invasive plant species can impede the establishment and growth of native plants and affect several ecosystem properties. These properties include soil cover, nutrient cycling, fire regimes, and hydrology. Controlling invasive plants is therefore a necessary, but usually expensive, step in restoring an ecosystem. The sustainability of materials with an emphasis on the use of local resources plays an important role in the circular economy. The use of alternative fibers from invasive plants promotes local production in smaller paper mills that offer the protection of local species and the reduction of waste and invasive plants. A synthesis of the literature is needed to understand the various impacts of invasive plants and their practical control in the context of papermaking applications and to identify associated knowledge gaps. To improve our understanding of the practical application of invasive species in the paper industry, we reviewed the existing literature on invasive plant species in the area of fiber production, printability, coating solution production, dyes, and extracts, and collected information on the major invasive plant species in Europe and the methods used for various applications. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD., (© 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

This article shows how companies can circumvent competition legislation by developing new informal ways of cooperation. We focus on the case of the Nordic pulp and paper industry which was particularly eager to set up cartels. Scholars analysing this sector can utilise exceptionally rich sources that reveal how industrialists reacted to the introduction and development of European competition policies. The article shows that companies defended their collusive practices by making them less transparent and more informal than before, a change that did not automatically lessen their effectiveness. Tougher competition policies also encouraged industrialists to create new giant companies. [ABSTRACT FROM AUTHOR]

The building sector contributes to 40% of the total final energy consumption and 36% of CO2 emissions in Europe, and these are set to increase in the coming years. International directives are pushing towards a decarbonisation roadmap to improve the quality of cities and the health of citizens. Buildings have a potentially central role in terms of energy transition as a means to produce and save energy. Photovoltaic shading devices (PVSDs) protect buildings from direct solar radiation and overheating while producing renewable electricity onsite and increasing the users' thermal comfort. Even though the potential of the PVSD is considerable, the sector is still unexplored, and few studies on the topic are available in the literature. This systematic review aims to present an exhaustive overview of the current literature on state-of-the-art PVSDs by analysing the scientific framework in terms of the status of the research. It presents a performance-based approach focusing on innovative products, PVSD design strategies, and energetic performance in distinct climate conditions and configurations. In particular, 75 articles and about 250 keywords were identified, selected, and analysed. The literature review serves as a basis for further R&D activities led by both the industrial and the academic sectors. [ABSTRACT FROM AUTHOR]

The pulp and paper industry in Europe produces over 11 million tons of waste per year. Given high landfill operational costs, thermal coprocessing with biomass may be a viable management and valorisation option for such wastes. In this work, the analysis of biomass (wood sawdust), mixture of primary and secondary pulp mill sludge and their respective blends (50 wt.%, 60 wt.%, 70 wt.% of sludge) was assessed by thermogravimetric analysis. One of the possibilities to ensure valorisation of paper pulp mill sludge is its combustion in the form of pellets containing a different amount of sludge. Production of pellets samples was realised on laboratory experimental device. The measurements showed that increasing the content of paper sludge in the produced pellets reduced the calorific value and increased the ash content. This research deals also with the effect of paper sludge on the ash melting temperatures. The results indicated that a higher content of paper sludge in the pellets increased the ash melting temperatures. This advantage of paper sludge can be utilized in co-combustion of biomass with a low ash melting temperature. [ABSTRACT FROM AUTHOR]

Following the fast spread of Covid-19 across Europe and North America in March 2020, many people started stockpiling commodities like toilet paper. Despite the high relevance for public authorities to adequately address stockpiling behavior, empirical studies on the psychological underpinnings of toilet paper stockpiling are still scarce. In this study, we investigated the relation between personality traits, perceived threat of Covid-19, and stockpiling of toilet paper in an online survey (N = 996) across 22 countries. Results suggest that people who felt more threatened by Covid-19 stockpiled more toilet paper. Further, a predisposition towards Emotionality predicted the perceived threat of Covid-19 and affected stockpiling behavior indirectly. Finally, Conscientiousness was related to toilet paper stockpiling, such that individuals higher in Conscientiousness tended to stockpile more toilet paper. These results emphasize the importance of clear communication by public authorities acknowledging anxiety and, at the same time, transmitting a sense of control., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI., Aim: We herein summarize practical resources to support this guideline's implementation in clinical practice., Methods: For this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence-basis and user friendliness., Results: Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web-based and had limited evidence-basis., Conclusions: This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care., (© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

The increasing use in clinical practice of software such as mobile apps and clinical decision support (CDS) software has only recently been taken up by regulators around the world. Specifically, the European Commission and the US Food and Drug Administration (FDA) have updated their regulatory framework in the last years. Van Laere et al have given an extensive overview of the European and US approaches to regulate CDS software. This commentary further discusses regulatory differences between the two geographies and their impact on manufacturers of medical device software. We discuss the practical implementation of the regulatory framework for medical device software (especially CDS software) with a reference to the available international guidance documents and their limitations. Given the direction of stricter regulatory oversight in Europe, additional European guidelines/examples are desirable to enable a pragmatic regulatory approach ensuring continued access to innovative medical device software for European patients., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Economic regulation is an instrument of the state or other institutions to correct market failures, rectify the business environment, or protect consumers. Regulation can be a major driver of innovation, and it has proven to be so in the past. On the other hand, there are also documented cases of ineffective regulation due to information delays or shortcomings in government decision-making. The complexity of the impact of regulatory changes on innovation can currently be observed in the medical device market in Europe. Regulation (EU) 2017/745 whose main idea is to ensure greater safety and health protection for consumers, is a challenge for originator, manufacturer, mostly small and medium-sized enterprises. The regulation is associated with an increase in the cost of developing and maintaining the product on the market. We can now gradually begin to analyze whether it can be ranked among those that have become drivers of innovation., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

The trajectory of biological research may be affected by historical factors (such as locations of influential researchers) as well as by underlying biological dimensions (such as species diversity and location of potential study taxa). Such influences on research focus can be clarified by examining the topics of published papers. Based on 93,816 scientific papers published on snake biology since 1804 (from Web of Science), we found a nonrandom distribution of research output among snake clades, fields of research, and geographic locations and strong changes through time in overall research effort as well as in the foci of that work. Snakes have been the subject of more scientific papers than other lineages of reptiles, but research on turtles has been increasing faster, and research effort per species has been higher for smaller reptile lineages. Studies on systematics and taxonomy dominated snake research until the mid-20th century, when the field was overtaken by studies of venoms, ecology, morphology, and physiology. Colubrids and Vipers have been the most intensively studied taxa, reflecting a concentration of research on continents (Europe and the Americas) where these taxa are diverse and abundant. Research effort on Vipers (Viperidae) increased around 1920, reflecting advances in antivenom and radiotelemetry technology. Blindsnakes (Scolecophidia) and smaller families remain relatively neglected in absolute terms. The numbers of papers per species are 10-fold greater for North American and European snakes than those in most other regions. We attribute these nonrandom patterns to temporal and spatial variation in research priorities, methods, and availability of scientific infrastructure. [ABSTRACT FROM AUTHOR]

Background and Aims: This bibliometric analysis aims to analyze the high-cited papers (HCPs), those which have received >100 citations) on Sarcopenia to provide insight into publication performances and research characteristics of the literature., Methods: Global HCPs on Sarcopenia research were identified from the Scopus database from January 1993 to August 2022. VOSviewer, and Biblioshiny software were used to visualize the collaborative interaction among most productive countries, organizations, authors, and keywords. Select bibliometric measures were applied to evaluate the publication productivity and their influence in this area., Results: Out of 6219 publications on Sarcopenia only 398 were HCPs. These HCPs received an average of 271.7 citations per publication (CPP). The most productive organizations were the Università Cattolica del Sacro Cuore, Italy, and Jean Mayer USDA Human Nutrition Center on Aging, USA. The most impactful organizations in terms of CPP and relative citation index were CHU de Toulouse, France, and Università Cattolica del Sacro Cuore, Italy. The most productive authors were Landi F and Morley JE, and Anker SD from Italy and Germany respectively. The most impactful authors were: Cederholm T (Sweden), Cruz JAJ (Spain) and Rolland Y (France). There were few/no HCPs from South America, Africa, South Asia, and USSR., Conclusion: Sarcopenia research has been predominantly done in USA, Europe, and China, and rarely from low and middle-income countries. Further focus of research should be on its etiopathogenesis (especially at the molecular level), prevalence in different communities, methods to diagnose it in early stages, and its cost-effective management., Competing Interests: Declaration of competing interest Authors #1 (RV), and 3 (AM) are of the Editorial board of DMSCRR., (Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

• EFIM publishes a position paper about Environment Degradation and Climate Change. • Health industry should reduce its ecological footprint. • Internists should be involved in policy decisions related to climate change. • Internists must be active agents in advocating sustainable practices for the environment. • Internists should be role models in the adoption of environmentally friendly behavior. The current data on climate change and environmental degradation are dramatic. The consequences of these changes are already having a significant impact on people's health. Physicians — as advocates of the patients, but also as citizens — have an ethical obligation to be involved in efforts to stop these changes. The European Federation of Internal Medicine (EFIM) strongly encourages the Internal Medicine societies and internists across Europe to play an active role in matters related to climate change and environmental degradation. At a national level, this includes advocating the adoption of measures that reduce greenhouse gas (GHG) emissions and environmental degradation and contributing to policy decisions related to these issues. At a hospital level and in clinical practice, supporting actions by the health sector to reduce its ecological footprint is vital. At the level of EFIM and its associated internal societies, promoting educational activities and developing a toolkit to prepare internists to better care for citizens who suffer from the consequences of climate change. In addition to advocating and implementing effective actions to reduce the ecological footprint of the health industry, recommending the introduction of these themes in scientific programs of Internal Medicine meetings and congresses and the pre- and postgraduate medical training. At a personal level, internists must be active agents in advocating sustainable practices for the environment, increasing the awareness of the community about the health risks of climate change and environmental degradation, and being role models in the adoption of environmentally friendly behaviour. [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]

Heart failure (HF) is a long-term clinical syndrome, with increasing prevalence and considerable healthcare costs that are further expected to increase dramatically. Despite significant advances in therapy and prevention, mortality and morbidity remain high and quality of life poor. Epidemiological data, that is, prevalence, incidence, mortality, and morbidity, show geographical variations across the European countries, depending on differences in aetiology, clinical characteristics, and treatment. However, data on the prevalence of the disease are scarce, as are those on quality of life. For these reasons, the ESC-HFA has developed a position paper to comprehensively assess our understanding of the burden of HF in Europe, in order to guide future policies for this syndrome. This manuscript will discuss the available epidemiological data on HF prevalence, outcomes, and human costs-in terms of quality of life-in European countries., (© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Spinal dysraphism (SD) or spina bifida (SB) is a congenital deformity that results from embryonic neural tube closure failure during fetal development. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. This paper aims to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for children and adults with spinal dysraphism. A systematic literature review and a consensus procedure involved all European countries delegates represented in the UEMS PRM section through a Delphi process. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The professional role of the PRM physician requires specific expertise in the treatment of patients with SD to plan, lead and monitor the rehabilitation process in an interdisciplinary setting and to participate in the assessment of the needs of these patients in the transitional phase from childhood to adulthood, with particular attention to the activity limitation and participation restriction.

Management of datasets that include health information and other sensitive personal information of European study participants has to be compliant with the General Data Protection Regulation (GDPR, Regulation (EU) 2016/679). Within scientific research, the widely subscribed'FAIR' data principles should apply, meaning that research data should be findable, accessible, interoperable and re-usable. Balancing the aim of open science driven FAIR data management with GDPR compliant personal data protection safeguards is now a common challenge for many research projects dealing with (sensitive) personal data. In December 2020 a workshop was held with representatives of several large EU research consortia and of the European Commission to reflect on how to apply the FAIR data principles for environment and health research (E&H). Several recent data intensive EU funded E&H research projects face this challenge and work intensively towards developing solutions to access, exchange, store, handle, share, process and use such sensitive personal data, with the aim to support European and transnational collaborations. As a result, several recommendations, opportunities and current limitations were formulated. New technical developments such as federated data management and analysis systems, machine learning together with advanced search software, harmonized ontologies and data quality standards should in principle facilitate the FAIRification of data. To address ethical, legal, political and financial obstacles to the wider re-use of data for research purposes, both specific expertise and underpinning infrastructure are needed. There is a need for the E&H research data to find their place in the European Open Science Cloud. Communities using health and population data, environmental data and other publicly available data have to interconnect and synergize. To maximize the use and re-use of environment and health data, a dedicated supporting European infrastructure effort, such as the EIRENE research infrastructure within the ESFRI roadmap 2021, is needed that would interact with existing infrastructures., (Copyright © 2022. Published by Elsevier Ltd.)

Background and Purpose: This position paper makes recommendations following an audit of care provided to people presenting with a seizure to emergency departments (EDs) in Europe., Methods: Participating countries were asked to include five hospitals agreeing to identify 50 consecutive seizure patients presenting to their ED between 1 August 2016 and 31 August 2017. Anonymous data were collected to a web database. Where quoted, percentages are mean site values and ranges are the 10th-90th centile., Results: Data were collected on 2204 ED visits (47 sites, up to six per country, across 15 countries): 1270 (58%) known epilepsy, 299 (14%) previous blackouts but no epilepsy diagnosis, 634 (29%) with a first seizure. Wide variability was identified for most variables. Of those with known epilepsy, 41.2% (range 26.2%-59.6%) attended the ED in the previous 12 months, but only 64.7% (range 37.2%-79.8%) had seen an epilepsy specialist in the previous 12 months. 67.7% (range 34.0%-100%) were admitted, 53.1% to a neurology ward (range 0.0%-88.9%). Only 37.5% first seizure patients (range 0.0%-71.4%) were given advice about driving., Conclusions and Recommendations: It is recommended that in Europe guidance is agreed on the management and onward referral of those presenting to the ED with a seizure; a referral process is created that can be easily implemented; it is ensured that the seizure services receive referrals and see the patients within a short time period; and a simple system is developed and implemented to allow continuous monitoring of key indices of epilepsy care., (© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

The article reports on the issue regarding the way to understand the market changes in order to sustain profitable growth in the coated paper industry. Accordingly, Dow Chemical Co. is one example of coated paper company that should maintain techniques on how to sustain company's growth. Dow has created a forecasting model to assists coated paper businesses in North America, Europe and Asia in terms of determining the global imports and exports in the future.

Discusses how paper recovery is growing in Europe. Net trade in recovered paper from 1990 to 2010; Trends in recycling rates of paper and paperboard; Raw material consumption structure in paper and paperboard manufacturing in Western Europe in 2002; Effort by Confederation of European Paper Industries to encourage legislators to promote the separate collection of wastepaper, as well as trying to educate the authorities at all levels that recovered paper is not a waste product.

The aim of this study was to develop bio-based adhesives that can be used for various packaging papers. In addition to commercial paper samples, papers produced from harmful plant species in Europe, such as Japanese Knotweed and Canadian Goldenrod, were used. In this research, methods were developed to produce bio-based adhesive solutions in combinations of tannic acid, chitosan, and shellac. The results showed that the viscosity and adhesive strength of the adhesives were best in solutions with added tannic acid and shellac. The tensile strength with adhesives of tannic acid and chitosan was 30% better than with commercial adhesives and 23% for combinations of shellac and chitosan. For paper from Japanese Knotweed and Canadian Goldenrod, the most durable adhesive was pure shellac. Because the surface morphology of the invasive plant papers was more open and had numerous pores compared to the commercial papers, the adhesives penetrated the paper structure and filled the voids. There was less adhesive on the surface and the commercial papers achieved better adhesive properties. As expected, the bio-based adhesives also showed an increase in peel strength and exhibited favorable thermal stability. In summary, these physical properties support the use of bio-based adhesives use in different packaging applications. [ABSTRACT FROM AUTHOR]

Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease that affects both upper and lower motor neurons and is fatal in its course. This evidence-based position paper represents the official position of the UEMS PRM Section. The aim of the paper is to define the role of the physical and rehabilitation medicine (PRM) physician and PRM professional practice for people with ALS. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The responsibility of the PRM physician is functional assessment of persons with ALS and delivering the optimal and most effective PRM program of care. The rehabilitation program of patients with ALS should be delivered and monitored by the multiprofessional team, with the PRM physician as principal coordinator.

Examines the impact of factor input prices, output market size and agglomeration effects on the choice of location for investment projects in Europe's paper industry. Wastepaper recovery and utilization rate; Forest resources and wastepaper recovery distribution.

This paper focuses on digital education in European primary schools, examining trends, challenges, and financing strategies. The study uses a combination of research methods, including the comparative method, analysis, synthesis, induction and deduction, statistical data collection, and the monographic method. The paper identifies the current state of digital education in primary schools across Europe and highlights the challenges faced by educators and policymakers in implementing digital education initiatives. It analyzes the different financing strategies adopted by European countries and their effectiveness in promoting digital education in primary schools. The study finds that while many European countries have made significant progress in digital education, there are still challenges to be addressed, including infrastructure and connectivity issues, digital skills gaps, and funding constraints. The paper concludes with recommendations for policymakers and educators to promote digital education in primary schools and ensure that all students have access to quality digital learning opportunities. [ABSTRACT FROM AUTHOR]

Extracellular vesicles (EV) are emergent therapeutic effectors that have reached clinical trial investigation. To translate EV-based therapeutic to clinic, the challenge is to demonstrate quality, safety, and efficacy, as required for any medicinal product. EV research translation into medicinal products is an exciting and challenging perspective. Recent papers, provide important guidance on regulatory aspects of pharmaceutical development, defining EVs for therapeutic applications and critical considerations for the development of potency tests. In addition, the ISEV Task Force on Regulatory Affairs and Clinical Use of EV-based Therapeutics as well as the Exosomes Committee from the ISCT are expected to contribute in an active way to the development of EV-based medicinal products by providing update on the scientific progress in EVs field, information to patients and expert resource network for regulatory bodies. The contribution of our work group "Extracellular Vesicle translatiOn to clinicaL perspectiVEs - EVOLVE France", created in 2020, can be positioned in complement to all these important initiatives. Based on complementary scientific, technical, and medical expertise, we provide EV-specific recommendations for manufacturing, quality control, analytics, non-clinical development, and clinical trials, according to current European legislation. We especially focus on early phase clinical trials concerning immediate needs in the field. The main contents of the investigational medicinal product dossier, marketing authorization applications, and critical guideline information are outlined for the transition from research to clinical development and ultimate market authorization., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Florence Gazeau, Amanda Karine Andriola Silva, Claire Wilhelm and Gabriel Rahmi are co-founders of the spin-off Evora Biosciences. Amanda Karine Andriola Silva and Claire Wilhelm are co-founders of the spin-off EverZom. Max Piffoux is consultant and owns stocks in the spin-off Evora Biosciences and in the spin-off EverZom., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Muscular dystrophies present a group of inherited degenerative disorder that are characterized by progressive muscular weakness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section. The aim of the paper is to evaluate the role of the physical and rehabilitation medicine (PRM) physician and PRM practice for people with muscular dystrophies. A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty-three recommendations resulting from the Delphi procedure. The role of the PRM physician is to assess the functional status of persons with muscular dystrophy and to plan, monitor and lead PRM program in an interdisciplinary setting within a multiprofessional team.

Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. The aim of this study was to improve physicians' professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. A systematic review of the literature including an 18-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. As the result of a Consensus Delphi procedure, 74 recommendations are presented together with the systematic literature review. The PRM physician's role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM program developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients' health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions. This evidence-based position paper is representing the official position of The European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cerebral palsy.

Background: The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required., Aim: The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence., Design: In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process., Setting/participants: The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care., Results: In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% ( n = 87) and a follow-up response-rate of 79% ( n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements., Conclusions: The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.

Purpose -- European paper industry has been struggling with margins and profitability for more than decade time period. At typical in markets of west, paper product demand is at long-term decline, mostly driven by continuously increasing internet use. However, in emerging markets demand still exists, and in Europe numerous small markets in east have even some growth available. The paper aims to discuss these issues. Design/methodology/approach -- The authors analyse in this research work with longitudinal data (period of 2002-2009) from one large Finnish paper mill and data envelopment analysis (DEA) approach, how distribution efficiency to selected eight East European markets has evolved. Findings -- In general distribution efficiency has improved, but this has taken place in step-wise manner rather than being linear year-to-year development (year 2006 found to be the threshold). Reason is mostly in better management of transportation costs, and in particular lower monthly deviation of these costs. It is surprising that case paper mill has been able to manage transportation costs in rapidly increasing energy cost environment so efficiently. Maybe European Union enlargement of 2004 and 2007 has had its effects on distribution efficiency. Research limitations/implications -- The research is limited to the deliveries of one paper mill located in Finland. Also East European markets in the early periods of this study were emerging papers markets, and distribution practices were clearly evolving. Practical implications -- Based on the study East European paper market distribution should give more attention on transportation cost control, and trying to find solutions to minimize it with low monthly fluctuation. Originality/value -- Very few studies exist from East European distribution issues, and particularly that of paper industry. Also used quantitative method of DEA is relatively new in this context and gives valuable insights for the distribution efficiency development. [ABSTRACT FROM AUTHOR]

Aims: To examine the current status of care and needs of adult congenital heart disease (ACHD) services in the Central and South Eastern European (CESEE) region., Methods and Results: We obtained data regarding the national ACHD status for 19 CESEE countries from their ACHD representative based on an extensive survey for 2017 and/or 2018. Thirteen countries reported at least one tertiary ACHD centre with a median year of centre establishment in 2007 (interquartile range 2002-2013). ACHD centres reported a median of 2114 patients under active follow-up with an annual cardiac catheter and surgical intervention volume of 49 and 40, respectively. The majority (90%) of catheter or surgical interventions were funded by government reimbursement schemes. However, all 19 countries had financial caps on a hospital level, leading to patient waiting lists and restrictions in the number of procedures that can be performed. The median number of ACHD specialists per country was 3. The majority of centres (75%) did not have ACHD specialist nurses. The six countries with no dedicated ACHD centres had lower Gross Domestic Product per capita compared to the remainder (P = 0.005)., Conclusion: The majority of countries in CESEE now have established ACHD services with adequate infrastructure and a patient workload comparable to the rest of Europe, but important gaps still exist. ACHD care is challenged or compromised by limited financial resources, insufficient staffing levels, and reimbursement caps on essential procedures compared to Western Europe. Active advocacy and increased resources are required to address the inequalities of care across the continent., (© 2020 European Society of Cardiology.)

Waste paper, an essential substitute for wood and other plant-based fibers in paper making, is an indispensable part of the circular economy; yet, the impacts of China's ban on global waste paper cycles have not been well understood. We modeled the evolution of the global waste paper trade network during 1995-2019. We found that the cumulative trade volume of global waste paper reached 1010 million tons in the last 25 years and showed a downward trend since 2015. The global import center of waste paper experienced a transfer from Europe to East Asia and then to Southeast Asia. The ban has stimulated some developed countries to reduce the exports of unsorted waste paper since 2017, but for many major importers their changes in waste paper trade patterns were related to waste paperboard, which was not banned by China, suggesting that this import change trend may be inevitable and irrespective of China's ban. Besides, India has replaced China to become a new import hub of unsorted waste paper. Our results lay a foundation for exploring the evolution of the future global solid waste cycle under the background of zero import of solid waste increasingly implemented by China and many other developing countries.