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The Progress in International Reading Literacy Study (PIRLS) was conducted in paper and online reading modes in 2016 using the same samples of students in a number of countries. Differences in reading literacy scores were found in several European countries. In some countries, the differences favored the electronic reading mode. Yet in others, the paper reading mode was favored. As the electronic reading mode differs substantially in the cognitive demands compared to the paper mode, it can be expected that the differences between the two modes are related to the variables related to technology: availability and access, general use, use for educational purposes in class or out-of-school, and self-efficacy with technology. This study investigates the Information and Communication Technology (ICT) factors related to the differences in paper and online reading in six European countries participating in both modes in PIRLS 2016. This study uses linear regression models as the application of multilevel modeling is not suitable because of the low between-school variances across countries. The results from this study show limited support for the relative effect that the student individual, school, and classroom ICT variables have on the differences between paper and electronic reading. Access to technology is related to mode differences only in Italy, and the use of computer devices in and out of school is related to the mode differences in Italy and Portugal. Student self-efficacy is related to the mode differences in Portugal and Slovenia. School resources show significant effects in Denmark (computers to students ratio) and Italy (instruction affected by digital resource shortages). None of the classroom variables showed any significant relationship in any of the countries. In addition, socio-economic status (which is proxied by the variable on home resources for learning) is a significant predictor in half of the countries. In addition to these findings, the general technological context within countries is discussed as part of an evaluation of the difference in reading in the two test delivery modes. The general uptake of technology in different social and economic aspects, as measured by the Digital Economy and Society Index (DESI), follows the differences between the two reading modes.

Erasmus mobility has become an important feature of higher education in Europe and beyond, with the potential to generate significant changes at individual, institutional and systemic levels. More than three decades after the foundation of this successful program, evaluations reveal that, despite notable progress, several aspects of the Erasmus student experience can be further improved. Based on the lived experiences of Erasmus alumni, in this article, we explore recurrent challenges that emerge in educational mobility and how they could be better addressed. Three key dimensions are identified in the qualitative accounts of former Erasmus students and analyzed in light of previous research: mobility preparation, institutional support for integration, and recognition of study abroad.

Computer-based test (CBT) and paper-based test (PBT) are two test modes to the test takers that have been widely adopted in the field of language testing or assessment over the last few decades. Due to the rapid development of science and technology, it is a trend for universities and educational institutions striving rather hard to deliver the test on a computer. Therefore, research on the comparison between these two test modes has attracted much attention to investigate whether the PBT could be completely replaced. At the same time, task difficulty is always a key element to reflect test takers' performances. Numerous studies have laid a solid foundation and guidance about the comparative study of test takers' performance on CBT and PBT, but there still remains a scarcity from the perspective of task difficulties with different Common European Framework of Reference for Languages (CEFR) task levels in particular. This study, therefore, compared the test takers' performance on both CBT and PBT across tasks with different CEFR levels. A total of 289 principal recommended high school test takers from Macau took the pilot Test of Academic English (TAE) at a local university. The results indicated that there was a difference between test takers' performance on different test modes across different CEFR levels, but only CEFR A2 level showed a statistically difference between CBT and PBT. And since science and technology are continuously developing, it is essential for the university to consider switching the test mode from PBT to CBT.

In this study we compare the titles of scientific letters and those of research papers published in the field of astrophysics in order to identify the possible differences and/or similarities between both genres in terms of several linguistic and extra-linguistic variables (length, lexical density, number of prepositions, number of compound groups, number of authors and number of countries mentioned in the paper bylines). We also carry out a cross-genre and cross-journal analysis of the referred six variables. Our main findings may be summarized as follows: (1) When compared to research paper titles, scientific letter titles are usually shorter, they have a lower lexical density, they include a higher number of prepositions per number of words and a lower number of compound groups per number of words, although they have more up to 4-word compound groups, i.e. the simplest ones. As a consequence, scientific letter titles include less information, which is also less condensed, than research paper titles. (2) The predominance of compound adjectives over compound nouns in the titles of both genres highlights the scientificity of astrophysical discourse. (3) In general terms, our data show a positive correlation between title length and the number of countries mentioned in the bylines for both genres. The positive correlation between title length and number of authors is only met in the case of research papers. In light of these findings, it may be concluded that scientific letters are a clear example of a timeliness and more "immediate" science, whereas research papers are connected to a more timeless and "elaborate" science. It may also be concluded that two different collaboration scenarios are intertwining on the basis of three separate geographic and linguistic publication contexts (Mainland Europe, The United Kingdom and The United States of North America).

The pulp and paper industry (PPI) has several opportunities to contribute to meeting prevailing climate targets. It can cut its own CO2 emissions, which currently account for 2% of global industrial fossil CO2 emissions, and it has an opportunity to produce renewable energy, fuels, and materials for other sectors. The purpose of this study is to improve understanding of the decarbonization prospects of the PPI. The study provides insights on the magnitude of needed annual renewal rates for several possible net-zero target years of industrial fossil CO2 emissions in the PPI and discusses decarbonization opportunities, namely, energy and material efficiency improvement, fuel switching, electrification, renewable energy production, carbon capture, and new products. The effects of climate policies on the decarbonization opportunities are critically evaluated to provide an overview of the current and future business environment of the European PPI. The focus is on Europe, but other regions are analyzed briefly to widen the view. The analysis shows that there are no major technical barriers to the fossil-free operation of the PPI, but the sector renovates slowly, and many new opportunities are not implemented on a large scale due to immature technology, poor economic feasibility, or unclear political environment. [ABSTRACT FROM AUTHOR]

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Pietrantonio, Florczak, Kuhn, Kärberg, Leung, Said Criado, Sikorski, Ruggeri, Signorini, Rosiello, Drago, Vinci, Barreto, Montano, Dicker and Gomez Huelgas.)

In this study, we carry out a qualitative and quantitative analysis of abbreviations in 300 randomly collected research paper titles published in the most prestigious European and US-based Astrophysics journals written in English. Our main results show that the process of shortening words and groups of words is one of the most characteristic and recurrent features in Astrophysics research paper titling construction. In spite of the convenience of abbreviations as a mechanism for word-formation, some of them may pose certain difficulties of understanding and/or misinterpretation because of their specificity, ambiguity, or overlapping. To overcome these difficulties, we propose a series of options which with no doubt would lead to a better interaction among the different branches of Astrophysics in particular and of science in general and would definitely improve how research is currently performed and communicated.

Bisphenol A (BPA) is used as a color developer in a thermal paper that after a heating process reacts with a leuco dye and changes it to a colored form. Receipts from cash registers are considered as the main source of consumer exposure to bisphenols together with polycarbonates and epoxy resins. Levels of BPA and its possible alternatives were determined in thermal paper samples collected between May 2018 and May 2019 in 22 European and 17 non-European countries on all inhabited continents (220 samples in total, 133 of which were from Europe and 87 from other countries). These measurements were intended to check the level of BPA presence in receipts originating from different countries, especially from Europe in the light of changing regulations restricting its use. The effect of thermal printing on developer content was also analyzed, but no major changes in concentrations of bisphenols were observed during the process. Thus, printed receipts could be used for the determination of bisphenol content. Analysis of receipts from 39 countries has shown that BPA is still the most common compound used around the world with 69% samples containing this color developer. Among other tested bisphenols, BPS was used as a color developer in 20% samples, but it was noted that all samples collected from Japan and the United States of America were found to contain only BPS. Other bisphenols (F, AF, E, and B) considered as possible alternatives for BPA were detected only at trace levels or not detected at all, which showed that they were not used as color developers. The relatively large use of BPS as a BPA substitute is worrying because this compound not only has similar endocrine properties but is also poorly biodegradable. Besides, its relatively high polarity facilitates spreading in the environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Climate change is one of the greatest threats to health that societies face and can adversely affect mental health. Given the current lack of a European consensus paper on the interplay between climate change and mental health, we signal a need for a pan-European position paper about this topic, written by stakeholders working in mental health care., Methods: On behalf of the European Psychiatric Association (EPA), we give recommendations to make mental health care, research, and education more sustainable based on a narrative review of the literature., Results: Examples of sustainable mental healthcare comprise preventive strategies, interdisciplinary collaborations, evidence-based patient care, addressing social determinants of mental health, maintaining health services during extreme weather events, optimising use of resources, and sustainable facility management. In mental health research, sustainable strategies include investigating the impact of climate change on mental health, promoting research on climate change interventions, strengthening the evidence base for mental health-care recommendations, evaluating the allocation of research funding, and establishing evidence-based definitions and clinical approaches for emerging issues such as 'eco-distress'. Regarding mental health education, planetary health, which refers to human health and how it is intertwined with ecosystems, may be integrated into educational courses., Conclusions: The EPA is committed to combat climate change as the latter poses a threat to the future of mental health care. The current EPA position paper on climate change and mental health may be of interest to a diverse readership of stakeholders, including clinicians, researchers, educators, patients, and policymakers.

Introduction: The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future., Aim: The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions., Methods: To produce recommendations for PRM physicians on telerehabilitation, 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., Results: The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure., Conclusions: It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

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.

The purpose of the paper is to present the issues relating to methods of transport and commercial process management and support in logistics. Moreover, it will describe shipping actions in relation to the conflicts in Europe and worldwide. The study follows the work plan described as follows: The first chapter comprises an overview, logistics function, and classification of strategies in a logistics project. The second chapter includes information about the review and selection of methods of logistics project management. The third chapter pertains to the application of solutions restoring an old form of value stream mapping, known as the brown book exercise or the brown paper method. The fourth chapter refers to the aspects and solutions used in logistics project management in the hard times of logistic service market operations. Finally, the fifth chapter specifies the forms of trust management as the methods supporting logistics project management. [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]

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.)

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]

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]

This study focuses on the increased risk of high heat release and asphyxiation (toxic gas poisoning) in the event of a fire involving polyurethane (PU)- and MDF-based building materials, which are commonly used in buildings. Among them, polyurethane (PU) building materials are very commonly used in buildings, except in Europe and some other countries, due to their excellent thermal insulation performance. Still, problems of short-term heat release and the spread of toxic gases in the event of a fire continue to occur. To overcome these problems, researchers are actively working on introducing various flame retardants into building materials. Therefore, in this study, we produced a laboratory-sized (500 mm × 500 mm) plate-like flame-retardant board that can be utilized as a building material with a lower heat release rate and a lower toxicity index. The material was made by mixing expanded graphite and ceramic binder as flame retardants in a material that is formulated based on the cellulose of waste paper, replacing the existing building materials with a hot-press method. According to the ISO-5660-1 test on the heat release rate of the plate-like flame-retardant board, the Total Heat Release (THR) value was 2.9 (MJ/m2) for 10 min, showing an effect of reducing the THR value by 36.3 (MJ/m2) compared to the THR value of 39.2 (MJ/m2) of the specimen made using only paper. In addition, the toxicity index of the flame-retardant board was checked through the NES (Naval Engineering Standards)-713 test. As a result, the test specimen showed a toxicity index of 0.7, which is 2.4 lower than the toxicity index of 3.1 of MDF, which is utilized as a conventional building material. Based on the results of this study, the cellulose fire-retardant board showed the effect of reducing the heat release rate and toxicity index of building materials in a building fire, which reduces the risk of rapid heat spread and smoke toxicity. This has the potential to improve the evacuation time (A-SET) of evacuees in fires. It is also important to show that recycling waste paper and utilizing it as the main material for building materials can be an alternative in terms of sustainable development. [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.)

The studies reported here examined differences in user behaviour when presented with a low-fidelity paper prototype compared to fully operational product, and evaluated the effectiveness of different types of enhanced labelling of controls. In the first study with a paper prototype, 30 users of high-pressure washers were asked to choose the settings of the temperature control for different cleaning objects, comparing standard with information-enriched control labelling. In the second study, 34 users operated a real high-pressure washer with different forms of control labelling. The results of both studies provided evidence for some benefits of an information-enriched control labelling over traditional temperature-centred controls labelling. Furthermore, a comparative analysis of the data of the two studies suggested that low-fidelity paper prototypes may have to be used with caution. Therefore, designers need to be aware that the behavioural effects induced by different design modifications may be overestimated when using paper prototypes. The implications of the findings are discussed within the framework of an enlarged concept of fidelity.

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.

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.)

This position paper aims to increase awareness among primary care practitioners and policymakers about the specific and complex health needs of people who experience incarceration. We focus on the importance of primary care and of continuity of care between prison and community. We highlight what is known from the literature on the health of people who experience incarceration, on the organisation of prison health care, and on the role of primary care both during and after detention. We present three case descriptions of detainees' encounters with the organisation of prison health care in three European countries. Finally, we describe the position that the European Forum for Primary Care takes. Prisoners and ex-prisoners have a worse physical and mental health compared with a cross-section of the population. However, access to good quality treatment and care is often worse than in the outside situation. In particular, well-organised primary care in the prison context could benefit prisoners and, indirectly, society at large. Moreover, continuity of care between the community and the prison situation needs improvement. [ABSTRACT FROM AUTHOR]

Background: Pancreatic ductal adenocarcinoma is the deadliest cancer worldwide with a 98% loss-of-life expectancy and a 30% increase in the disability-adjusted life years during the last decade in Europe. The disease cannot be effectively prevented nor being early detected. When diagnosed, 80% of patients have tumors that are in incurable stages, while for those who undergo surgery, 80% of patients will present with local or distant metastasis. Importantly, chemotherapies are far from being effective., Objective: Pancreatic cancer represents a great challenge and, at the same time, a huge opportunity for advancing our understanding on the basis of the disease, the molecular profiles, that would lead to develop tools for early detection and effective treatments, thus, boosting patient survival., Results: Research on pancreatic cancer has being receiving little or minimal funds from European funding bodies. UEG is calling for public-private partnerships that would effectively fund research on pancreatic cancer., Conclusion: This would increase our understanding of this disease and better treatment, through pan-European efforts that take advantage of the strong academic European research landscape on pancreatic cancer, and the contribution by the industry of all sizes., (© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.)

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]

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]

We combine multivariate ratio analysis (MRA) of body measurements and analyses of mitochondrial and nuclear data to examine the status of several species of European paper wasps (Polistes Latreille, 1802) closely related to P. gallicus. Our analyses unambiguously reveal the presence of a cryptic species in Europe, as two distinct species can be recognized in what has hitherto been considered Polistes bischoffi Weyrauch, 1937. One species is almost as light coloured as P. gallicus, and is mainly recorded from Southern Europe and Western Asia. The other species is darker and has a more northern distribution in Central Europe. Both species occur syntopically in Switzerland. Given that the lost lectotype of P. bischoffi originated from Sardinia, we selected a female of the southern species as a neotype. The northern species is described as P. helveticus sp. n. here. We also provide a redescription of P. bischoffi rev. stat. and an identification key including three more closely related species, P. biglumis, P. gallicus and P. hellenicus. [ABSTRACT FROM AUTHOR]

It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe., Competing Interests: Funding The European Society for Medical Oncology (ESMO) (no grant number) and the European Society for Paediatric Oncology (SIOPE) (no grant number) were the legal sponsors of this position paper. No research funding for the meetings or manuscript preparation was received from any third parties. Disclosure DS reports receipt of research grants from Teenage Cancer Trust. FAP reports personal financial interest as a Scientific Director at the European School of Oncology; receipt of lecture/presentation fees from Prime Oncology and Takeda; receipt of honoraria for advisory board participation/advisory services from Roche, AstraZeneca, Clovis and Ipsen. LF reports receipt of funding from Teenage Cancer Trust. IB-S reports receipt of speaker fees from Roche, Novartis and Pfizer; direct research funding as Principal Investigator from Roche; financial support to institution for clinical trials from Roche. OS reports receipt of honoraria for advisory board participation from Genuity Science. LH reports receipt of speaker fees from Roche. WTAvdG reports receipt of research funding from Novartis, honoraria for advisory board from Bayer and consultancy fees from SpringWorks, all to her institutes. SB reports receipt of honoraria for advisory board participation from Pfizer, Bayer, Lilly, Novartis and Isofol. GM reports receipt of speakers fees from AstraZeneca, Roche, MSD, BMS, Pfizer, Takeda, Janssen, Novartis and Sanofi; receipt of consultancy fees from AstraZeneca, Roche, MSD, BMS, Novartis and Sanofi; direct research funding as Principal Investigator from AstraZeneca, Novartis and MSD; financial support to institution for clinical trials from AstraZeneca, Novartis and MSD. ES reports receipt of honoraria for the provision of advisory services from Roche Hellas, BMS, Pfizer Hellas, AstraZeneca, Amgen Hellas and Dimiourgiki Farmakeutikon Ypiresion AE; receipt of research funding from Astellas Pharma; travel and education support from Roche Hellas, Pfizer Hellas, Astellas Pharma, Novartis (Hellas), MSD Greece and Enorasis. All other authors have declared no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The coronavirus disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with heart failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and the Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and the United States., (© 2020 European Society of Cardiology.)

Background: The development of new genetic testing methods and the approval of the first treatments raises questions regarding when and how to perform screening for inherited neuromuscular conditions. Screening directives and access to the different techniques is not uniform across Europe. The patient advisory board of the European reference network for rare neuromuscular diseases (NMD) conducted a qualitative study to understand the state of play of screening for inherited NMD in Europe and patients' needs., Results: We collected answers from 30 patient organisations (POs) from 18 European countries. Fifteen acknowledge the existence of pre-implantation genetic diagnosis in their country. Regarding prenatal screening, we had 25 positive answers and 5 negative ones. Twenty-four POs mentioned that newborn screening was available in their country. We had some contradictory answers from POs from the same country and in some cases; diseases said to be part of the screening programmes were not hereditary disorders. Twenty-eight organisations were in favour of screening tests. The reasons for the two negative answers were lack of reimbursement and treatment, religious beliefs and eventual insurance constrains. Most POs (21) were in favour of systematic screening with the option to opt-out. Regarding the timing for screening, "at birth", was the most consensual response. The main priority to perform screening for NMDs was early access to treatment, followed by shorter time to diagnostic, preventive care and genetic counselling., Conclusions: This is the first study to assess knowledge and needs of POs concerning screening for NMDs. The knowledge of POs regarding screening techniques is quite uneven. This implies that, even in communities highly motivated and knowledgeable of the conditions they advocate for, there is a need for better information. Differences in the responses to the questions "how and when to screen" shows that the screening path depends on the disease and the presence of a disease modifying treatment. The unmet need for screening inherited NMDs should follow an adaptive pathway related to the fast moving medical landscape of NMDs. International coordination leading to a common policy would certainly be a precious asset tending to harmonize the situation amongst European countries.

Background: The EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups. Methods: Early in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care. Results: The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region. Conclusions: Better education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff. [ABSTRACT FROM AUTHOR]

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]

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Passive immunotherapy with plasma derived from convalescent patients recovering from SARS-CoV-2 infection can be a promising approach in the treatment of COVID-19 patients. It is important that blood establishments are ready to satisfy requests for immune plasma by defining the requirements applicable to plasma donors and the standards for preparation, qualification, storage, distribution, and control of product use. This Position paper aims to give recommendations on the biological characteristics of a plasma preparation from convalescent donors and to support the evaluation of this therapeutic approach in more rigorous investigations.

This paper provides empirical evidence that individuals substantially revise their stated wealth redistribution preferences after fiscal scandals. The 2016 Panama Papers scandal revealed top-income tax evasion behaviour simultaneously worldwide. The empirical investigation exploits this event as a quasi-natural experiment. I rely on two original datasets, a UK household longitudinal dataset and a survey conducted in 22 European countries. I use a difference-in-differences strategy and find that pro-redistribution statements increased between 2% and 3.3% after the scandal. Responses are heterogeneous and larger for right-wing individuals and low-income individuals. This change in wealth redistribution preferences is likely to have been translated into a slight change in votes. The results suggest an increase in stated voting intentions for the left and a decrease for the right. Complementary estimations reveal that more media coverage and more individuals involved by country increase the magnitude of the response., Competing Interests: The authors have declared that no competing interests exist.

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry., Competing Interests: Conflict of interest: H-U. Kauczor reports grants, personal fees for lectures and non-financial support from Siemens, grants and personal fees for lectures from Philips, and personal fees for lectures from Boehringer Ingelheim and Bracco, outside the submitted work. Conflict of interest: A-M. Baird reports personal fees and non-financial support for meeting attendance from Roche and MSD, outside the submitted work; and is a board member for Lung Cancer Europe (LuCE); LuCE have received support from Abbvie, Amgen, BMS, Boehringer Ingelheim, Lilly, Merck, MSD, Novartis, Pfizer, Roche and Takeda, and, as board member, A-M. Baird has participated on advisory boards for BMS, Takeda and Pfizer, with the fee paid directly to LuCE. Conflict of interest: T.G. Blum has nothing to disclose. Conflict of interest: L. Bonomo has nothing to disclose. Conflict of interest: C. Bostantzoglou has nothing to disclose. Conflict of interest: O. Burghuber reports grants from Boehringer Ingelheim, GSK, AstraZeneca, Menarini, Teva, Pfizer, Chiesi, Novartis and Federal State Department of Health, non-financial support (utilities and meeting facilities) from the Municipal Department of Health in Vienna and air liquid, during the conduct of the study; and personal fees for advisory board work and lectures from Boehringer Ingelheim, AstraZeneca, Chiesi, MSD, Menarini, Roche and GSK, outside the submitted work. Conflict of interest: B. Čepická is a member of the European Lung Foundation patient advisory group. Conflict of interest: A. Comanescu reports sponsorship from Merck Romania and Bristol-Myers Squibb România, during the conduct of the study; and patient advisory panel fees from Bristol-Myers Squibb, outside the submitted work. Conflict of interest: S. Couraud reports grants, personal fees and other from Roche, grants and personal fees from AstraZeneca, during the conduct of the study; and grants and personal fees from BMS, AstraZeneca, Lilly and Laidet Medical, grants, personal fees and other from Pfizer, Roche, Chugai, MSD and Boehringer Ingelheim, grants and non-financial support from Sysmex Innostics, grants from Novartis, Merck and Amgen, and personal fees from Exact Science, outside the submitted work. Conflict of interest: A. Devaraj has nothing to disclose. Conflict of interest: V. Jespersen has nothing to disclose. Conflict of interest: S. Morozov has nothing to disclose. Conflict of interest: I. Nardi Agmon has nothing to disclose. Conflict of interest: N. Peled reports consultancy for and honoraria from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Foundation Medicine, Guardant360, MSD, Novartis, NovellusDx, Pfizer, Roche and Takeda, outside the submitted work; and in addition, has patents WO2012023138, US20130150261 and WO/2015/059646 issued. Conflict of interest: P. Powell is an employee of the European Lung Foundation. Conflict of interest: H. Prosch reports grants from Siemens, outside the submitted work. Conflict of interest: S. Ravara has nothing to disclose. Conflict of interest: J. Rawlinson is a member of the patient advisory group of the ERS/European Lung Foundation (as a lung cancer patient) and a patient representative on the NHS England Screening advisory group; neither role is remunerated in any way. Conflict of interest: M-P. Revel has nothing to disclose. Conflict of interest: M. Silva has nothing to disclose. Conflict of interest: A. Snoeckx has nothing to disclose. Conflict of interest: B. van Ginneken reports grants and stock/royalties from Thirona, and grants and royalties from Delft Imaging Systems and MeVis Medical Solutions, outside the submitted work. Conflict of interest: J.P. van Meerbeeck has nothing to disclose. Conflict of interest: C. Vardavas has nothing to disclose. Conflict of interest: O. von Stackelberg has nothing to disclose. Conflict of interest: M. Gaga reports grants from Novartis, Chiesi, Elpen and Menarini, and personal fees from BMS and MSD, outside the submitted work., (This official statement of the European Society of Radiology (ESR) and the European Respiratory Society (ERS) is published jointly in European Radiology [DOI: 10.1007/s00330-020-06727-7] and the European Respiratory Journal [DOI: 10.1183/13993003.00506-2019]. The versions are identical aside from minor differences in typesetting and presentation in accord with the journal styles. ©European Society of Radiology and European Respiratory Society 2020.)