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• Drivers on slip roads want vehicles on the target lane to decelerate. • Drivers in target lanes rate the behaviour of vehicles on slip roads ambiguously. • AVs are rated identically or even more positively than MVs with identical behaviour. • No different safety distance is kept from automated vehicles. • Results show that cross-border traffic between Germany and UK with AVs is feasible. • Intercultural aspects must still be considered in the development of AVs. To ensure safe and uninterrupted traffic flow, (semi-)automated vehicles must be capable of providing comprehensible and agreeable implicit communication cues to human drivers. This driving simulator study investigated the assessment of implicit communication at a motorway slip road through longitudinal driving dynamics (acceleration, deceleration, and maintaining speed). The second aim of the study was to determine whether expectations of automated vehicles are different from those of human drivers. And thirdly, we investigated whether these findings are country-specific or can be (partially) generalised to other countries. The perception of three means of communication in connection with the presence of a labelling as an automated vehicle (eHMI) was examined in two samples in Germany and England. 27 participants drove from a slip road onto the motorway and interacted with another vehicle. After a stretch on the motorway, they passed a second slip road on which there was a vehicle merging onto the participants lane. This was repeated six times to test all variables. After each situation, the perceived cooperativity and criticality was recorded, as well as the time headway (THW) to the other vehicle. This paper presents the findings from the UK sample and compares them with the German results, which were previously published. Results show, that when the cooperating vehicles are on the slip road, participants from both countries prefer this vehicle to decelerate. However, when participants themselves are on the slip road, expectations for vehicles on the target lane are ambiguous in the UK sample. Except for one aspect (perceived cooperativity of decelerating vehicles on the slip road), the perception of automated vehicles is similar to those of manual drivers. Also, UK participants do not maintain a different safety distance from these vehicles, while this is the case in the German sample. This paper contributes valuable insights into the cross-cultural evaluation of driving dynamics, shedding light on implications for the development and acceptance of automated vehicles. [ABSTRACT FROM AUTHOR]

Digital health technologies (DHTs) can optimise healthcare costs and improve quality and efficiency of care. However, the fast-paced rate of innovation and varying evidence standards can make it difficult for decision-makers to assess these technologies in an efficient and evidence-based manner. We sought to develop a comprehensive framework to assess the value of novel patient-facing DHTs used to manage chronic diseases by eliciting stakeholder value preferences. Literature review and primary data collection from a three-round web-Delphi exercise was utilized. 79 participants from 5 stakeholder groups (patients, physicians, industry, decision makers, and influencers) and 3 countries (United States of America, United Kingdom, and Germany) took part. Likert scale data were statistically analyzed to determine intergroup differences in both country and stakeholder groups, stability of results, and overall consensus. The resulting co-created framework comprised 33 stable indicators with consensus from quantitative value judgments across domains: health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics, and user preferences. Lack of stakeholder consensus was observed on the importance of value-based care models, optimizing resources for sustainable systems, and stakeholder involvement in DHT design, development, and implementation; however, this was because of high rates of neutrality and not negative judgments. Supply-side actors and academic experts were the most unstable stakeholder groups. Stakeholder value judgments revealed a need for a coordinated regulatory and health technology assessment policy response that updates laws to meet technological innovations, offers a pragmatic approach to evidence standards to assess DHTs, and involves stakeholders to understand and meet their needs. • Digital health technologies (DHTs) differ from traditional medical technologies because they involve widespread, and sometimes continuous, collection, analysis, and transmission of patient data after market entry. There is currently no technology-agnostic wide-reaching value framework for evaluating DHTs, capturing multiple stakeholder value preferences in different health system archetypes. Through a Delphi exercise, we incorporated diverse stakeholder viewpoints from the United Kingdom, United States, and Germany to propose an evidence-based value framework for assessing patient-facing DHTs focused on chronic disease management. • Statistically significant stakeholder consensus relates to clinical and economic characteristics, which align with current regulations and health technology assessment methodologies and around value indicators that are not reflected in current regulations and health technology assessment policies, particularly regarding personal data rights. Lack of stakeholder consensus centers around the importance of value-based care models, optimizing resources for sustainable systems, and stakeholder involvement in DHT design, development, and implementation and results from high rates of neutrality rather than negative judgments. • We have created a value framework comprising 33 stable indicators with consensus across 6 value domains, notably health inequalities, data rights and governance, technical and security, economic characteristics, clinical characteristics and user preferences. Included indicators are split between ratings of "very important" and "important" resulting from consensus between key stakeholder groups consisting of patients, physicians, supply-side actors, decision makers, and influencers. Decision makers can utilize this framework when assessing potential technologies to include in their health system packages. [ABSTRACT FROM AUTHOR]

There is ample evidence documenting the problem of Islamophobia (discrimination and racism against the Muslim community). However, the extent to which the European population is aware of this injustice has not exhaustively been assessed. The aim of this research was to measure in a valid and reliable way the degree of social awareness of Islamophobia in four European countries: Spain, France, United Kingdom and Germany. The sample consisted of 1846 volunteers from these countries. All of them answered a structured protocol on social awareness called Degree of Islamophobia Recognition (DIR). Several cross-cultural analyses based on the Exploratory Factor Analysis (EFA) technique, the ordinal alpha coefficient and the Greatest Lower Bound (GLB) were applied to analyze the dimensionality of the DIR and its reliability. Six sex-differentiated population scales were made based on derived typical scores (TS). The results revealed that the DIR consisted of two cultural dimensions: perceived vulnerability and connection. Both dimensions explained between 51% and 61% of the variance in all countries. Reliability coefficients were acceptable in all cases (>0.7). We propose that public policies combat Islamophobia considering these dimensions and taking into consideration the thresholds of the derived PTs to identify in which regions or social groups these intervention policies are needed. • Measuring social awareness of Islamophobia (SAI) is crucial to establish effective religious conflict prevention policies. • SAI describes the social tendency to recognize unfair or vulnerable situations against the Muslim community. • The DIR (Degree of Islamophobia Recognition) as a valid and reliable measure of SAI is adapted in four Western countries. • Typical derived scores below 40 (out of 100) indicate an absence of social awareness of Islamophobia. [ABSTRACT FROM AUTHOR]

Using long panels of industry-specific offshoring information and subjectively reported well-being datasets mainly from Germany, which is also supported by datasets from the UK and Australia, this paper aims to investigate the relationship between offshoring and workers' subjective well-being in the source country. We employ panel data fixed-effects models with time-variant personality measures and industry-specific measures to alleviate the bias stemming from the non-random sorting of individuals in industries. Our findings suggest that offshoring negatively relates to workers' subjective well-being. The result is unexceptionally consistent across Germany, the UK, and Australia, and the effect is larger in business services and among high-skilled workers. We extensively discuss how contextual "fear-factors" prevailing in the source countries interact with the angst generated by the negative framing of offshoring. To single out such angst, we first show that objective and subjective job security concerns, job characteristics, and labor market conditions only marginally relate to the well-being effect of offshoring. Then, we investigate how the effect of offshoring on well-being is amplified by a larger set of contextual factors pertaining to temporary economic shocks, negative narratives about offshoring during electoral cycles, partisan political preferences, and high immigration rates. Finally, we show that a recent skill upgrade significantly diminishes the negative effect of offshoring on well-being. [ABSTRACT FROM AUTHOR]

Objectives: The Patient-Reported Outcome Measurement Information System (PROMIS) Preference score (PROPr) can be used to assess health state utility (HSU) and estimate quality-adjusted life-years in cost-effectiveness analyses. It is based on item response theory and promises to overcome limitations of existing HSU scores such as ceiling effects. The PROPr contains 7 PROMIS domains: cognitive abilities, depression, fatigue, pain, physical function, sleep disturbance, and ability to participate in social roles and activities. We aimed to compare the PROPr with the 5-level EQ-5D (EQ-5D-5L) in terms of psychometric properties using data from 3 countries.Methods: We collected PROMIS-29 profile and EQ-5D-5L data from 3 general population samples (United Kingdom = 1509, France = 1501, Germany = 1502). Given that cognition is not assessed by the PROMIS-29, it was predicted by the recommended linear regression model. We compared the convergent validity, known-groups construct validity, and ceiling and floor effects of the PROPr and EQ-5D-5L.Results: The mean PROPr (0.48, 0.53, 0.48; P<.01) and EQ-5D-5L scores (0.82, 0.85, 0.83; P<.01) showed significant differences of similar magnitudes (d = 0.34; d = 0.32; d = 0.35; P<.01) across all samples. The differences were invariant to sex, income, occupation, education, and most conditions but not for age. The Pearson correlation coefficients between both scores were r = 0.74, r = 0.69, and r = 0.72. PROPr's ceiling and floor effects both were minor to moderate. The EQ-5D-5L's ceiling (floor) effects were major (negligible).Conclusions: Both the EQ-5D-5L and the PROPr assessed by the PROMIS-29 show high validity. The PROPr yields considerably lower HSU values than the EQ-5D-5L. Consequences for quality-adjusted life-year measurements should be investigated in future research. [ABSTRACT FROM AUTHOR]

In the frame of knowledge management, it is important to transfer ideas and explanations regularly. Same terms can have several meanings, and this can be misleading. For break exclusion several national concepts exist: Leak-before-Break (LBB) according to the US Standard Review Plan 3.6.3 (SRP 3.6.3) and "Superpipe" for main steam line (MSL) between containment penetration fixed point and main steam valve (MSV) fixed point, Break Preclusion Concept (BPC) in Germany, French Break Preclusion Concept for European (or Evolutionary) Pressurized Reactor EPR (FA3/TSN), High Integrity Component (HIC) e.g. for EPR in the UK. All concepts with almost the same goal: support demonstration of safety while removing of dynamic effects of break from the design basis and safety demonstration. The meaning of LBB will be recalled. The several concepts for break exclusion will be summarized. An overview of the main efforts of the previous different concepts will be given. Finally, an overview of past and actual R&D with focus on LBB will be shown as well as an outlook of success and remaining challenges. • Leak-before-break and other concept of break preclusion for nuclear power plant piping and vessels, generic safety issue A-2. • LBB behaviour demonstration is required to demonstrate low risk of DEGB i.e. significant asymmetric forces • Similar methodologies applied worldwide however with different pilar. • PWSCC = new challenge for LBB approval of plant running for extended operation. • Common perceptions on several concepts regarding break exclusion for the achievement of worldwide standardization. [ABSTRACT FROM AUTHOR]

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

Morality is an integral part of Corporate Social Responsibility (CSR). However, the academic debate so far has mostly stated the importance of morality from a purely theoretical perspective, without empirically assessing it. We, therefore, draw on the moral foundations dictionary to conduct an automated content analysis of corporations' (N = 277) annual CSR reports (N = 5010) over a period of 22 years. Looking into Germany, the United Kingdom, and the United States, we investigated morality salience, differences across sectors, countries, and over time as well as the association of morality with different stakeholder groups. Results inform the broader debate on CSR and morality and highlight avenues for future research. • We analyzed morality salience in CSR communication of 22 years and 3 countries. • Results overall show stable salience of morality over time. • U.S. CSR is different from UK and Germany, using more morality-references. • Fairness is identified as a moral foundation separating different sectors. [ABSTRACT FROM AUTHOR]

This study investigates wage outcomes of former temporary workers by distinguishing workers obtaining permanent jobs with the same employer from those who find permanent work with a new employer. With this distinction, we build on studies investigating the wage consequences of temporary jobs, which have thus far mainly focused on cross-sectional wage gaps and longer-term wage consequences without considering employer changes. We compare Germany and the UK as two prime examples of different labour market settings and look at labour market subgroups relevant for social stratification. We estimate fixed effects individual slopes regression with data from the German Socio-Economic Panel (1995–2021), the British Household Panel Study (1992–2008), and the UK Household Longitudinal Study (2010–2021). Results show that in the rigid German and in the more flexible UK labour market, wage increase of former temporary workers is larger if the permanent job is obtained with the same employer, but only if it coincides with a job change within the firm. For transitions occurring on the same job, only workers in Germany experience wage increase. This wage increase is not higher compared to the wage increase of workers who switch employers. These patterns are similar across subgroups, with the largest deviances found for older workers in Germany. [ABSTRACT FROM AUTHOR]

• Within-subject biological variation of PCSK9 in human serum was 23.2%, between-subject biological variation was 10.9%. • Index of individuality was 2.13, thus enabling the use of reference intervals. • Reference change value was 66.3%. • The estimation of homeostatic point can be based on at least 3 blood samples to assess its value within ±25%. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in the regulation of LDL receptors. Inhibition of PCSK9 increase uptake of LDL-particles and pathogen-associated molecular patterns (PAMPs). The aim of our study was to evaluate biological variation of serum PCSK9. Within-subject (CV I) and between-subject (CV G) biological variations were assessed in 14 healthy volunteers in a 6-week protocol (7 samples, equidistant time intervals). Serum concentration of PCSK9 was measured by a Quantikine ELISA assay (R&D systems, Bio-Techne Ltd., UK) on a DS2 ELISA reader (Dynex Technologies GmbH, Germany). Precision (CV A) was assessed by duplicate measurements. Two methods with different levels of robustness were used for the estimation of CV I , SD-ANOVA and CV-ANOVA method. We calculated the index of individuality and reference change values. The experiment was fully compliant with EFLM database checklist. The within-subject values of PCSK9 in healthy persons, as calculated by two statistical methods, were 23.2% (SD-ANOVA with CV A of 5.6%) and 26.6% (CV-ANOVA with CV A of 4.8%). The CV G was 10.9% (SD-ANOVA), index of individuality and RCV were 2.13 and 66.3%, respectively. The high index of individuality indicates that common reference intervals can be used to interpret serum PSCK9 values. [ABSTRACT FROM AUTHOR]

Recently, there has been growing focus on the intergroup influences of acculturation preferences, and in particular majority members' perceptions of how minority members want to acculturate. This paper contributes to this emergent literature by examining the extent to which majority members in the UK perceive that minority members' preferences for heritage culture maintenance and majority culture adoption are conflicting, and whether this is moderated by perceived threat. One hundred and sixty-three participants who self-reported being white British completed an online survey. Participants were asked about their perceptions of minority acculturation preferences for two target groups living in the UK: Pakistani and German minority groups. Overall, perceived culture maintenance and perceived culture adoption were weakly negatively associated for both groups. Moreover, results confirmed the pre-registered hypotheses, but only for the Pakistani target group. At higher levels of perceived threat, perceived culture maintenance was related to less perceived culture adoption. However, when threat was low, there was no association between perceived heritage culture maintenance and perceived culture adoption. For the German target group, threat did not moderate the relationship between perceived culture maintenance and perceived culture adoption. Findings suggest that depending on levels of perceived threat and the minority group in question, majority members perceiving that minority members maintain their heritage culture has different consequences. Results are discussed in relation to implications for integration, intergroup relations in culturally plural societies, and the need to focus on specific minority groups when studying acculturation processes. [ABSTRACT FROM AUTHOR]

The electric grid's available capacity to accommodate solar photovoltaic on national scales is currently uncertain. This makes decisions about grid capacity expansion, which can be very costly for local grid operators, difficult to make. Yet, knowledge of national solar photovoltaic grid capacity is central in order to formulate realistic solar PV targets and strategies. We present a methodology based on publicly available data to estimate the grid's hosting capacity of residential solar photovoltaic at both the national and local scale. The model is applied to Sweden, Germany and the UK and shows that low-voltage grid capacity for residential solar photovoltaic is very large, 33 (+5/-7) GW (Sweden), 248 (+5/-24) GW (Germany) and 63 (+1/-14) GW UK, and similar to current total generation capacity. Based on our estimations, we find that with the capacity of the present grid Sweden can supply 24%, Germany 60% and UK 21% of their current annual net electricity consumption from residential solar photovoltaic. In addition, we find that the grid-supported individual solar PV system sizes increase as population density decreases. Finally, our work highlights the importance of implementing sizing incentives for customers when installing their solar PV systems. • We estimate national and local residential solar PV low-voltage grid capacity. • Estimate is done in Sweden, Germany and UK. • Low-voltage capacity for residential solar PV is similar to current installed total generation capacity. • Presents a method for generating synthetic low-voltage grids based on public data. • Low-voltage grid capacity varies significantly based on location. [ABSTRACT FROM AUTHOR]

Background: Pediatric patients are becoming increasingly referred for cardiovascular magnetic resonance (CMR). Measurement of ventricular wall thickness is typically part of the assessment and can be of diagnostic importance, e.g. in arterial hypertension. However, normal values for left ventricular (LV) and right ventricular (RV) wall thickness in pediatric patients are lacking. The aim of this study was to establish pediatric centile charts for segmental LV and RV myocardial thickness in a retrospective multicenter CMR study. Methods: CMR was performed in 161 healthy children and adolescents with an age range between 6 and 18 years from two centers in the UK and Germany as well as from a previously published CMR project of the German Competence Network for Congenital Heart Defects. LV myocardial thickness of 16 segments was measured on the short axis stack using the American Heart Association segmentation model. In addition, the thickness of the RV inferior and anterior free wall as well as biventricular mass was measured. Results: The mean age (standard deviation) of the subjects was 13.6 (2.9) years, 64 (39.7%) were female. Myocardial thickness of the basal septum (basal antero- and inferoseptal wall) was 5.2 (1.1) mm, and the basal lateral wall (basal antero- and inferolateral) measured 5.1 (1.2) mm. Mid-ventricular septum (antero- and inferoseptal wall) measured 5.5 (1.2) mm, and mid-ventricular lateral wall (antero- and inferolateral wall) was 4.7 (1.2) mm. Separate centile charts for boys and girls for all myocardial segments and myocardial mass were created because gender was significantly correlated with LV myocardial thickness (p < 0.001 at basal level, p = 0.001 at midventricular level and p = 0.005 at the apex) and biventricular mass (LV, p < 0.001; RV, p < 0.001). Conclusion: We established CMR normal values of segmental myocardial thickness and biventricular mass in children and adolescents. Our data are of use for the detection of abnormal myocardial properties and can serve as a reference in future studies and clinical practice. [ABSTRACT FROM AUTHOR]

• The UK's and Germany's coal phase-out pathways diverge in timing and measures. • Different powers of actor groups contribute to diverging trends in UK and Germany. • Influential German coal corporations and unions slow down coal's decline. • Energy security concerns, domestic mining and economic dependence create resistance. • Reducing the influence incumbents have on policy making might enable coal phase-out. Political decisions and trends regarding coal use for electricity generation developed differently in the UK and Germany, despite being subject to relatively similar climate protection targets and general political and economic conditions. The UK agreed on a coal phase-out by 2024. In Germany, a law schedules a coal phase-out by 2038 at the latest. This paper investigates reasons for the different developments and aims to identify main hurdles and drivers of coal phase-outs by using the Triple Embeddedness Framework. The comparative case study approach reveals that policy outcomes regarding coal consumption are deeply influenced by several actor groups, namely, coal companies, unions, environmental NGOs, and the government. The most discussed aspects of a coal phase-out in both countries are energy security concerns, whether coal is mined domestically, (regional) economic dependence, as well as the relative power of actors with vested interests in coal consumption. [ABSTRACT FROM AUTHOR]

• We compared multilevel coastal flood risk reduction governance and public finance in the UK, Germany, the Netherlands and Australia. • We evaluated alignment of multilevel governance arrangements to spillovers from coastal risk reduction based on fiscal federalism. • We find diverse coastal flood risk governance arrangements ranging from highly centralised to full decentralisation. • We find that multilevel coastal flood risk governance arrangements are reflective of the distribution of the benefits across different levels of government. • We find that major fiscal redistributions may be put under pressure by rising costs under SLR and coastal development. Coastal flood risk reduction (CFRR) presents a significant public funding challenge, due to its high upfront costs and long-term benefits, and this challenge will increase with future sea-level rise. The funding challenge necessarily involves multiple levels of government, due to the regional nature of CFRR public goods involved. Yet there has been little research comparing such multilevel arrangements across countries, and in particular exploring the performance of public funding arrangements for providing coastal flood risk reduction. We address this gap, applying fiscal federalism to develop a multilevel governance analysis of public decision-making and fiscal authorities for CFRR in the Netherlands, Germany, the UK and Australia. For each country, we locate key decision-making and fiscal authorities in multilevel governance arrangements, and analyse their alignment with the benefits of CFRR measures (spillovers). We find diverse coastal flood risk governance arrangements ranging from highly centralised (NL), mixed arrangements, involving regional centralisation (Germany) or partial devolvement (UK), to full decentralisation (AUS). Further, we find that in accordance with fiscal federalism, multilevel coastal flood risk governance arrangements are generally reflective of the distribution of the benefits across different levels of government, with some exceptions (Germany and UK). Finally, exploring the outlook of current arrangements under sea-level rise, we find that major fiscal redistributions may be put under pressure by rising costs likely under SLR and future coastal development. This is particularly the case for those systems which operate under hazard-based, as opposed to risk-based, coastal protection policies. Further, we find that both fully and moderately decentralised arrangements may require greater central support for alternative measures, such as retreat, in light of growing financial burdens on local governments. [ABSTRACT FROM AUTHOR]

The clinical utility of the 70-gene signature (MammaPrint®) to guide chemotherapy use in T1-3N0-1M0 breast cancer was demonstrated in the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) study. One thousand four ninety seven of 3356 (46.2%) enrolled patients with high clinical risk (in accordance with the modified Adjuvant! Online clinical-pathological assessment) had a low-risk 70-gene signature. Using patient-level data from the MINDACT trial, the cost-effectiveness of using the 70-gene signature to guide adjuvant chemotherapy selection for clinical high risk, estrogen receptor positive (ER+), human epidermal growth factor 2 negative (HER2-) patients was analysed. A hybrid decision tree-Markov model simulated treatment strategies in accordance with the 70-gene signature with clinical assessment versus clinical assessment alone, over a 10-year time horizon. Primary outcomes were quality-adjusted life years (QALYs), country-specific costs and incremental cost-effectiveness ratios (ICERs) for six countries: Belgium, France, Germany, Netherlands, UK and the US. Treatment strategies guided by the 70-gene signature result in more QALYs compared with clinical assessment alone. Costs of the 70-gene signature strategy were lower in five of six countries. This led to dominance of the 70-gene signature in Belgium, France, Germany, Netherlands and the US and to a cost-effective situation in the UK (ICER £22,910/QALY). Annual national cost savings were €4.2M (Belgium), €24.7M (France), €45.1M (Germany), €12.7M (Netherlands) and $244M (US). UK budget increase was £8.4M. Using the 70-gene signature to safely guide chemotherapy de-escalation in clinical high risk patients with ER+/HER2- tumours is cost-effective compared with using clinical assessment alone. Long-term follow-up and outcomes from the MINDACT trial are necessary to address uncertainties in model inputs. • The 70-gene signature is cost-effective compared with clinical assessment alone • Minimal survival differences are balanced against quality of life gains • Results are consistent amongst the five studied countries [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is a devastating disease with high mortality. Most guidelines recommend routine use of antibiotic prophylaxis during oral surgery to prevent IE in patients with specific predisposing cardiac conditions, but this is not the case in the UK. The conflicting opinions and guidance are confusing and may affect IE prophylaxis implementation. We investigated how IE prophylaxis standards are defined in hospitals and outpatient clinics of oral and maxillofacial surgery. A survey was sent to 80 surgeons heading departments of oral and maxillofacial surgery in Germany. We observed significant heterogeneity in IE prophylaxis implementation among the clinics. This diversity was in relation to the definition of predisposing cardiac conditions, the type of dental and surgical procedures performed that require IE prophylaxis, the spectrum of compounds used, and the timing of antibiotic prophylaxis. We observed under-prescription of IE prophylaxis in high-risk patients, the overuse of antibiotic prophylaxis in patients not at high risk of IE, and the use of inappropriate drugs. These findings suggest that educational strategies and guideline implementation advice are needed to improve standards of IE prophylaxis in oral and maxillofacial surgery clinics. [ABSTRACT FROM AUTHOR]

Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990–2020 and predicted the number of deaths and rates by 2025. We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994–2025. Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010–2014 to 2015–2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (−7.0%) compared to Transitional countries (−2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27. Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role. • Ovarian cancer mortality decreased over the last decade in most European countries. • Favourable trends will continue in the next 5 years. • Less favourable epidemiological situation was observed in Transitional countries. • The largest decrease of mortality in 2025 is predicted to be in Germany. • Until 2025 nearly 131,000 deaths from ovarian cancer would be avoided in EU. [ABSTRACT FROM AUTHOR]

The expansion of variable renewable energy (VRE) generation propagates numerous challenges for national energy systems. Despite recent years of VRE expansion and declining coal utilisation in the overall market profile, coal energy generation has maintained and grown its position as a marginal seller in the imbalance market. Coal's disproportionate resurgence as a bidder of later resort in the imbalance market also represents a shift in its bidding behaviour. A comparative breakdown of Britain's overall market with that of Germany, followed by a specific investigation of Britain's imbalance market provides insight into changing roles of VRE, fossil fuelled energy, and compensation technologies. Historically, VRE trends in the British and German markets have been broadly consistent. Recently, increasing distress in Britain's overall market is found to result in the increased use of high pollution technologies to meet imbalances. As a result, the composition of the overall and imbalance markets have increasingly diverged, and although the dominance of gas in the latter is expected, the resurgence of coal energy is more remarkable. Thus, while the proportion of generation by renewables has continued to increase, fossil fuelled (notably including coal) capacity, and its associated infrastructure costs and influence as the price setting marginal seller, remains dominant in the imbalance market. [Display omitted] • Review of VRE market trends and 'paradoxes'. • Breakdown of VRE penetration in the markets in Germany and Britain. • Gas dominance in the British imbalance market. • Coal re-emergence as a marginal seller. • Recommendations for techno-economic and storage modelling. [ABSTRACT FROM AUTHOR]

The increasingly efficient use of scarce resources is a central theme in the gradual transition towards a circular economy. Hazardous materials represent a category of resources that is often difficult—and potentially risky—to transport, store, or neutralize. As a result, hazardous materials are rarely included in closed material loops. The present paper analyzes HorsePower, a business concept centered around an innovative way of utilizing horse manure. Horse manure is generated in millions of tons in horse-rich countries such as the UK, Germany, and France. It is a hazardous resource, as it may spread diseases, and cannot be disposed of or landfilled economically. The content analysis of 21 semi-structured interviews carried out with different business actors participating in the HorsePower business network reveals that the success of HorsePower stems from its ability to combine the complementary capabilities and material needs of a relatively complex network of business actors including stables, sawmills, logistical service providers, and heat and power plants. Each actor receives added value; the benefits from participation are greater than the sacrifices of participation. Furthermore, the findings show that certain types of hazardous resources, when combined with resources produced by another actor, may be burned efficiently and safely in specific power plants, reducing the need for other types of fuel. The observations imply that novel approaches for effectively sharing ideas and resource needs across organizational boundaries are needed to facilitate the development of additional innovative CE business concepts, leveraging both actor-specific capabilities and intra-actor resource dependencies. [ABSTRACT FROM AUTHOR]

Affecting millions of Europeans, energy poverty is increasingly high on the political agenda. This paper compares space and water heating demand at household level in Germany and in the United Kingdom (UK) between 1991 and 2015. The elasticities of consumption of space and water heating with respect to price, income and heating degree days (HDD) are examined using non-parametric models. Domestic heating consumption is highly elastic with HDD in both countries and HDD elasticities are found to be higher in the UK. From a certain income threshold, heating demand decreases as income increases in German households whereas demand rises with higher incomes in the UK. High price elasticities indicate that UK households are very responsive to energy conservation measures, therefore implying that a pricing policy will effectively reduce heating consumption. However, in Germany, the impact of pricing policies is unclear. Thus, the most effective policy measure to decrease domestic heating consumption in Germany in the long-run should be one which targets improvements of building envelope performance levels. [ABSTRACT FROM AUTHOR]

This study estimates total, inland, water and air transport net forward, backward and internal carbon linkages of EU's top seven emitters from 1995 to 2011. Moreover, it also reports direct emissions and intensities. Direct emissions of the seven for all four sectors mostly increased with varying proportions, while direct intensities followed a downward trend. Total, inland, water and air net backward emissions were reasonably stable excluding Germany who's total and inland net backward emissions sharply declined during 2000 while water and air emissions increased sharply. Although some nations witnessed a decrease, overall total, inland and air transport net forward emissions increased. While water transport net forward emissions had huge fluxes in the middle, stabilised towards the end. Total, inland, and air transport internal emissions for most of the nations increased over time. However, water transport internal emissions except for the UK were reasonably stable. 'Electricity, Gas and Water Supply' was the top source of German; Polish; Italian; British and Dutch net backward emissions. France and Spain's highest carbon imports were from 'Coke, Refined Petroleum and Nuclear Fuel.' Highest destinations of net forward emissions keep changing over time. The paper also discusses policy implications. Image 1 • Extended modified hypothetical extraction model to time series and cross-regional analysis. • Estimated total, inland, water and air transport carbon linkages of EU's top seven emitters from 1995 to 2011. • Also reported direct emissions and intensities. • On average forward and internal linkages increased while backward linkages marginally decreased. [ABSTRACT FROM AUTHOR]

• The performance of on-line vis-NIR for estimating soil organic carbon was evaluated. • Predictions for three datasets single field, UK with spiking, and UK were compared. • Random forest (RF) regression and spiking technique were used. • The best results obtained with the spiked UK dataset. Accurate on-line visible and near infrared (vis-NIR) spectroscopy prediction of soil organic carbon (OC) is essential for food security and environmental management. This paper aims at using on-line vis-NIR spectra coupled with random forest (RF) modelling approach for the prediction of soil organic carbon (OC), comparing between single field (SF), non-spiked UK multiple-field (NSUK) and spiked UK multiple-field (SUK) calibration models. Fresh soil samples collected from 6 fields in the UK (including two target fields) were scanned with a fibre-type vis-NIR spectrophotometer (tec5 Technology for Spectroscopy, Germany), with a spectral range of 305–2200 nm. After dividing spectra into calibration and independent validation sets, RF was run on the calibration set to develop calibration models for OC for the three studied datasets. Results showed that the model prediction performance depends on the dataset used and varies between fields. Less accurate prediction performance was obtained for the on-line prediction compared to laboratory (samples scanned in the laboratory under non-mobile measurement) prediction, and for non-spiked models compared to spiked models. The best model performance in both laboratory and on-line predictions was obtained when samples from the SF were spiked into the UK samples, with coefficients of determination (R2) values of 0.80 to 0.84 and 0.74 to 0.75, root mean square error of prediction (RMSEP) values of 0.14% and 0.17 to 0.18%, and ratio of prediction deviation (RPD) values of 2.30 to 2.5 and 1.98 to 2.04, respectively. Therefore, these results suggest that RF modelling approach when coupled with spiking provides high prediction performance of OC under both non-mobile laboratory and on-line field scanning conditions. [ABSTRACT FROM AUTHOR]

This paper studies the experience of Europe's three most liberalised railways - Sweden, Germany and Britain - in opening-up rail passenger services to competition by means of competitive tendering, and seeks to draw lessons for countries that are just starting the process, such as France. It also comments on experience of competition in the market in these and other countries (this form of competition has been taken furthest in other countries - notably Italy and the Czech Republic, as well as on a single route in Austria). The paper fills an important gap in the literature - that has so far focused on econometric modelling of the impact of rail reforms - by considering how competition can best be introduced in practice. This investigation is important and timely given the requirements of EU legislation (4th Railway Package) which will require competition to be introduced into passenger rail services (by 2020 for commercial services, and 2023 for public transport contracts) across the whole of the EU. It finds evidence that competitive tendering has helped increase demand for and reduce subsidies to the rail passenger sector, but that there are many decisions that have to be taken as to how it is to be implemented. Short gross cost contracts may work well for regional services where the tendering authority takes the lead in planning and marketing such services. If services where ticket revenue recovers a larger share of costs – "more commercial services" – are to be tendered, long net cost contracts may make more sense. An alternative is to leave them operated by the incumbent but with open access for competitors to enter the market. Two particular issues face countries starting on the liberalisation process. Firstly, if existing rolling stock is owned by the incumbent rather than the franchising authority or an independent company; that remains a major barrier to entry. The second is the position of existing staff. If new operators are required to take them on at existing wages and conditions; that is a barrier to improved efficiency, but for new operators to recruit their own staff may also be problematic, particularly where the pace of change is fast. • In all three liberalised countries (GB, Sweden and Germany) there has been rapid growth in demand for regional services. • Subsidies per train-km and passenger-km have also fallen in all three countries, though in GB unit costs rose post-reforms. • Gross-cost contracts useful where regional body controls marketing/services; otherwise net-cost contracts may be preferred. • Where large-scale competition introduced for first time, treatment of rolling stock and existing staff biggest issues. [ABSTRACT FROM AUTHOR]

Abstract Amino acid δ15N values of foliage of various plant taxa, grown at the experimental farm stations of North Wyke, UK and Bad Lauchstädt, Germany were determined by GC-C-IRMS. The difference between δ15N values of glutamate (Glx) and phenylalanine (Phe) were found to differ significantly between woody and herbaceous plants, with mean Δ15N Glx-Phe (i.e. δ15N Phe - δ15N Glx) values of −9.3 ± 1.6‰ and −5.8 ± 2.1‰, respectively. These differences in values are hypothesised to be due to the involvement of Phe in the phenylpropanoid pathway, by which lignin and other phenolic secondary metabolites are produced, leading to isotopic fractionation and enrichment of the remaining Phe pool available for protein biosynthesis. This results in the more negative Δ15N Glx-Phe values observed in woody plants relative to herbaceous plants, as the former are assumed to produce more lignin. To test this assumption, plant leaf tissue lignin concentrations were estimated by solid state 13C cross-polarisation, magic-angle-spinning (CPMAS) NMR spectroscopy for a subset of plants, which showed that tree foliage has a higher concentration of lignin (12.6 wt%) than herbaceous foliage (6.3 wt%). The correlation of lignin concentration with Δ15N Glx-Phe values demonstrates that the difference in these values with plant type is indeed due to differential production of lignin. The ability to estimate the lignin content of plants from amino acid δ15N values will, to give one example, allow refinement of estimates of herbivore diet in present and past ecosystems, enabling more accurate environmental niche modelling. Graphical abstract Image 1084 Highlights • Amino acid δ15N values were determined by GC-C-IRMS for various plant species. • These δ15N values are linked to their biosynthetic pathways and relationships. • Phenylalanine and glutamate δ15N values can differentiate herbs and woody plants. • Δ15N Glx-Phe values correlate with foliage lignin concentration by 13C CP-MAS NMR. • Differences in values with plant type are due to differential lignin production. [ABSTRACT FROM AUTHOR]

• Paper highlights the role of wider extra-regional factors in regional path creation. • Develops an analytical framework based on the interplay between four factors. • Adopts an international comparative approach, covering Germany, the UK and Norway. • Outlines the qualitative characteristics of the paths created. • Emphasises the role of national states in the strategic coupling process. The question of how regions and nations develop new sources of industrial growth is of recurring interest in economic geography and planning studies. From an evolutionary economic geography (EEG) perspective, new growth paths emerge out of existing economic activities and their associated assets and conditions. In response to the micro-economic and endogenous focus of much EEG research, this paper utilises a broader evolutionary perspective on path creation which stresses the dynamic interplay between four sets of factors: regional assets; key economic and organisational actors; mechanisms of path creation; and multi-scalar institutional environments and policy initiatives. Reflecting the importance of extra-regional networks and institutions, this framework is also informed by the Global Production Networks (GPN) approach, which highlights the process of strategic coupling between firms and regions and its political and institutional mediation by state institutions at different spatial scales. We deploy this framework to investigate regional path creation in the context of renewable energy technologies, focusing specifically on the offshore wind industry. We adopt a comparative cross-national approach, examining the evolution of offshore wind in Germany, the UK and Norway. Of the three cases, Germany has developed the most deep-rooted and holistic path to date, characterised by leading roles in both deployment and manufacturing. By contrast, path creation in the UK and Norway has evolved in more partial and selective ways. The UK's growth path is developing in a relatively shallow manner, based largely upon deployment and 'outside in' investment, whilst Norway's path is emerging in an exogenous, 'inside-out' fashion around a fairly confined set of actors and deployment and supply functions. In conclusion, the paper emphasises the important role of national states in orchestrating the strategic coupling of regional and national assets to particular mechanisms of path creation. [ABSTRACT FROM AUTHOR]

Abstract Introduction Guanidino compounds, including l -homoarginine (l -hArg), symmetric dimethylarginine (SDMA), asymmetric dimethylarginine (ADMA) and l -arginine (l -Arg) are associated with mortality, fatal strokes, stroke incidence, and atherosclerosis. Objectives We aimed to study the association of guanidino compounds (l -hArg/ADMA and l -hArg/SDMA) with stroke etiology, internal carotid artery (ICA) stenosis and CHA 2 DS 2 -VASc score in patients with cerebrovascular disease. Methods We analyzed l -hArg, SDMA, ADMA, l -Arg, and compound molar ratios, i.e. l -hArg/ADMA and l -hArg/SDMA, in 272 patients with cerebrovascular disease in a cross-sectional discovery cohort and two cross-sectional validation cohorts of acute stroke patients from Germany (n = 137) and UK (n = 394). The guanidino compound levels were compared with clinical, imaging, and ultrasound parameters. Results Low l -hArg/ADMA and l -hArg/SDMA molar ratios predicted territorial infarcts (OR 1.74; 95% CI 1.34–2.26 and OR 1.64; 95% CI 1.26–2.15, respectively) and were associated with stroke subtypes due to large vessel disease or cardio-embolism (OR 1.52; 95% CI 1.12–2.06 and OR 2.01; 95% CI 1.35–3.00, respectively) in meta-analysis of the discovery and validation cohort data. In line with these results, a low l -hArg/ADMA and l -hArg/SDMA molar ratio was found in patients with ICA stenosis (OR 0.73; 95% CI 0.55–0.97 and OR 0.69; 95% CI 0.50–0.94, respectively) in the discovery and validation cohort. Furthermore, guanidino compound ratios (i.e. l -hArg/ADMA and l -hArg/SDMA) were strongly correlated with CHA 2 DS 2 -VASC score (p <.001) in all three cohorts. Discussion The results from these three cross-sectional studies reveal that guanidino compound ratios (i.e. l -hArg/ADMA and l -hArg/SDMA) can discriminate stroke etiologies, predict ICA stenosis and estimate risk prediction in patients with cerebrovascular disease. Graphical abstract Unlabelled Image Highlights • Low l -hArg/ADMA and l -hArg/SDMA are associated with territorial stroke. • l -hArg/ADMA and l -hArg/SDMA ratios are low in the presence of carotid stenosis • Low l -hArg/ADMA and l -hArg/SDMA correlate with an increased risk prediction score. [ABSTRACT FROM AUTHOR]

Background: Recent network models of schizophrenia propose it is the consequence of mutual interaction between its symptoms. While cross-sectional associations between negative and positive symptoms are consistent with this idea, they may merely reflect their involvement in the diagnostic process. Longitudinal analyses however may allow the identification of possible causal relationships. The European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose.Methods: EuroSC includes 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures were repeated after 12 and 24 months. Latent variable structural equation modelling was used to investigate the direction of effect between positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, controlling for the effects of depressed mood and antipsychotic medication.Results: The structural model provided acceptable overall fit [χ2 (953) = 2444.32, P < 0.001; CFI = 0.909; RMSEA = 0.046 (90% CI: 0.043, 0.048); SRMR = 0.052]. Both positive and negative symptoms were persistent, and strongly auto-correlated. There were also persistent cross-sectional associations between positive and negative symptoms. While the path from latent positive to negative symptoms from T1 to T2 approached conventional levels of statistical significance (P = 0.051), that from T2 to T3 did not (P = 0.546). Pathways in the reverse direction were uniformly non-significant.Conclusions: There was no evidence that negative symptoms predict later positive symptoms. The prediction of negative symptoms by positive symptoms was ambiguous. We discuss implications for conceptualization of schizophrenic processes. [ABSTRACT FROM AUTHOR]

Abstract The Scarr-Rowe hypothesis predicts that the heritability of cognitive abilities is higher in more privileged socioeconomic conditions, meaning that genetic potential can be more fully expressed in environments characterized by high socioeconomic status (SES) compared to low SES. This gene × SES interaction, however, has been replicated mostly in the United States, but not in other Western nations like the United Kingdom. In the current study, we tested the interaction between childhood SES and the heritability of cognitive ability in 3074 German twin pairs comprising three age cohorts at different developmental stages (mean ages of 11, 17, and 23 years). Higher SES was associated with significantly higher mean cognitive ability scores in the two younger cohorts, with reduced variances at higher SES levels. Results further support the Scarr-Rowe hypothesis in middle childhood, and to some degree in adolescence, but not in adulthood. This indicates that the role of family SES as a moderator of the heritability of cognitive ability changes as children grow older. Moreover, children's shared experiences appear to be explain more variance in cognitive ability at the lower end of the SES distribution in middle childhood and adolescence. Highlights • Examined Scarr-Rowe interaction with the modified twin correlation model in Germany • Large cohort sample of 3074 German twin pairs aged 11, 17, and 23 • Higher SES associated with higher mean cognitive ability and less variance. • Evidence for Scarr-Rowe interaction in middle childhood and adolescence • Evidence for C x SES interaction with higher C at lower SES levels [ABSTRACT FROM AUTHOR]

The present article's aim is to sum up the knowledge generated in the field of Community Energy (CE) as of today. The geographical focus lies on Germany, the UK and the USA while the thematic focus lies on the benefits provided for society by community energy and the barriers community energy projects face in their respective countries. Key features of this review are a compilation of definitions of Community Energy and a comparison of country-specific circumstances concerning Community Energy. The aim of this review is to help the scientific community to form a common understanding of the CE concept and to show the relationship between policy schemes and CE development. [ABSTRACT FROM AUTHOR]

The case study at hand investigates a largely neglected phenomenon: the discontinuation of incumbent socio-technical regimes by means of deliberate governance. Comparing actor constellations and policy measures in four different countries (the UK, Germany, France and the Netherlands) and on the EU level, we identify strategies and measures that have been applied to challenge the automobility regime. Instead of creating a new analytical framework for studying the governance of discontinuation, we propose to use three existing concepts, namely the multi-level perspective (MLP), multi-level governance (MLG) as well as actor-centred approaches, combining them into one integrated concept labelled “multi-level governance of socio-technical regimes”. From this perspective, the European Union is the most active actor in attempts to restrict automobility, especially exerting pressure at the landscape level. However, in spite of various challenges, the automobility regime still remains considerably stable. [ABSTRACT FROM AUTHOR]

Ethnopharmacological relevance The regulation policies of substances used in Chinese Herbal Medicine (CHM), have a direct influence on the ability of health providers to practice in the clinic. Aim of the study We set out to assess the truth behind the assumption that practice of CHM in the west is constrained by the regulations imposed by authorities in western countries. Materials and methods For the first part of our study we surveyed and compiled lists of banned and restricted Chinese Materia Medica (CMM) from six countries: USA, UK, Germany, Israel, Canada and Australia. Afterwards, we estimated the relevant importance of the 300 CMM most-commonly-prescribed to the practice of CHM according to prescriptions from 2,000,000 randomly selected patients, from the Taiwanese National Health Insurance Research Database (NHIRD). We then compared both lists and determined the clinical importance of the banned and restricted CMM. Results Except for regulations from Canada, most of the information of banned CMM proved to be difficult to organize. The USA was found to have the least amount of banned herbs, with 9 substances. Canada had the highest amount, with 98. In Germany, Australia, the UK, and Israel 10, 29, 36, 68 banned CMM were found, respectively. Apart from aristolochic acid containing substances, ma huang (麻黃, Ephedra sinica ) was the only CMM banned in all countries. Most of the banned CMM were not found to be among the most-commonly-prescribed according to the NHIRD. Conclusion Authorities should make this information more accessible. No clear relation exists between CHM regulations and any ‘Western’ common denominator, and the amount of banned CMM varied greatly among the surveyed countries. However, even among countries with a larger amount of banned CMM, the majority of these were in the bottom two-thirds in respect to the frequency of their use. Thus, regulations in some western countries surely influence the practice of CHM, however, the variability of CMM have been influenced by regulations only to a limited extent. [ABSTRACT FROM AUTHOR]

• Beef products scrutinized due to high degree of greenhouse gas emissions. • Understanding preferences is relevant in the light of changing market demand. • Choice experiments in Germany and UK reveal heterogeneous preferences. • Meat eaters differ in their preference for country-of-origin and price sensitivity. • Flexitarians prefer either higher quality or low-priced beef. In light of increasing evidence of climate change and the related negative effects for the environment, consumers are slowly changing their eating habits not only towards healthier, but also towards more sustainable diets. A key factor of more sustainable diets is the reduction of meat consumption. A large share of consumers follows this advice, thus adopting a flexitarian diet. This trend has led to an observable change in market demand for meat products and product offerings that meat producers are competing with. Beef is characterized by high greenhouse gas emissions, hence, it does not fare well from a sustainability perspective. To understand consumer preferences for beef, we conduct choice experiments in Germany (n = 621) and the UK (n = 625) across meat eaters and meat reducers. We highlight segment-specific preferences across different levels of meat consumption using latent class choice analysis. Results show that beef preferences are heterogeneous; while meat-eaters prevail they differ in their preferences for price and country-of-origin. Flexitarian consumers' preferences differ; while some segments prefer gourmet beef, most flexitarian segments are value-seekers. Our results contribute to the literature on the diversity in flexitarian consumption by providing a more nuanced picture of consumers' preferences for beef products. In addition, our results provide relevant insights for practitioners in the beef value chain in order to design target-oriented products. [ABSTRACT FROM AUTHOR]

This study examines how intra generational class mobility can lead to differing over-time trends in inter generational class mobility depending on when class destination is measured in individuals' careers. Specifically, it tackles the puzzle why increases in social fluidity are observed when class destination is measured at labour market entry, while only trendless fluctuation is found when class destination is measured 15 years later in Germany and the UK. Using data from the German Socio-Economic Panel (1984–2019) and the UK Household Longitudinal Survey (2009–2020) on respondents entering the labour market during the second half of the twentieth century, the analyses show that this divergence is driven by increases in 'counter mobility' that are subject to country-specific patterns. In the UK, rising counter mobility results from a growing proportion of individuals from salariat origins who enter the labour market in a lower class position but experience upward career mobility. In Germany, it is driven by a rising proportion of individuals from working class backgrounds who start their careers in a higher class but experience downward career mobility. No evidence for origin-specific changes in the relative importance of upward and downward career mobility is found. The results provide a strikingly similar picture for women and men in either country. [ABSTRACT FROM AUTHOR]

National health departments across the globe have utilized persuasive strategies to promote COVID-19 vaccines through Twitter. However, the effectiveness of those strategies is unclear. This study thereby examined how national health departments deployed persuasive strategies to promote citizen engagement in COVID-19 vaccine-related tweets in six countries, including the UK, the US, Germany, Japan, South Korea, and India. Guided by the heuristic-systematic model and the health belief model, we found that national health departments differed significantly in the use of systematic-heuristic cues and health belief constructs in COVID-19 vaccine-related tweets. Generally, the provision of scientific information and appeals to anecdotes and fear positively, while appeals to bandwagon negatively, predicted citizen engagement. Messages about overcoming barriers and promoting vaccine benefits and self-efficacy positively affected engagement. Emphases of COVID-19 threats and cues to vaccinate demonstrated negative impacts. Importantly, health departments across countries often used futile or detrimental strategies in tweets. A locally adapted evidence-based approach for COVID-19 vaccination persuasion was discussed. • Health departments often used detrimental tactics in promoting COVID-19 vaccines. • Appeals to facts, anecdotes, and fear promoted citizen engagement. • Appeals to bandwagon reduced citizen engagement. • Messages about efficacies and benefits promoted citizen engagement. • Emphases of COVID-19 threats and cues to vaccinate harmed citizen engagement. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

This study introduces a new approach to estimate biomethane market potential by analysing biogas markets and their relative environmental and economic advantages. This potential is then combined with greenhouse gas emission values for different feedstock shares (farm-fed and waste-fed systems) and different application share to determine the possible contribution of biomethane to national greenhouse gas emission saving goals. Markets that are considered are Germany and the UK being the biggest emitters of CO 2eq in the European Union. The current use was compared with the scenarios (i) market projection, derived from literature study and (ii) reasonable potential, derived from environmental and economic calculations. The current market status is presented to show the past market development until the present date and associated greenhouse gas savings. Additionally the potential of biomethane to contribute to greenhouse gas emission savings is extensively described. Results indicate that the share of application in Germany is more environmental beneficial than the one in the UK achieving higher greenhouse gas savings at comparable feed-in level. In contrast, the UK has a higher share of waste-fed systems to produce biomethane. The use of biomethane in CHP plants achieves the highest GHG emission savings and if organic waste is used as feedstock the possible savings are even higher. With an increase of biomethane used in CHP plants and a decrease of biomethane used for direct heating the savings in the UK could increase up to 52%. Current savings of 2446 kt CO 2eq (Germany) and 606 kt CO 2eq (UK) can be extended to 4483 kt CO 2eq (Germany) and 1443 kt CO 2eq (UK) respectively. Scenario results were determined based on the environmental and economic advantageousness development of the existing biogas market. In this way positive future market development as well as improved shares of feedstock and application can contribute to further greenhouse gas emission savings of Germany and the UK. [ABSTRACT FROM AUTHOR]

This study examined the inter-relationships of acculturative stressors experienced by Chinese international students. A sample of 463 Chinese students in six EU countries (UK, Germany, France, Netherlands, Spain and Belgium) responded to a web-based survey. The results showed that Chinese students in France suffered from bigger constraints in linguistic issues and dealing with life tasks than Chinese students in UK. Structural equation modeling (SEM) analysis revealed that language constraints and perceived cultural differences play a key role in influencing other stressors. The findings indicated that language constraints and perceived cultural differences accounted for 62% of the total variance of academic integration difficulty; language constraints accounted for 17% of the variance of problems in dealing with daily tasks; perceived cultural differences accounted for 56% of the variance of social integration difficulty; academic integration and problems in dealing with daily tasks explained 14% of the variance of homesickness. [ABSTRACT FROM AUTHOR]

Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs.Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow.Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers.Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) has become the standard of care for many patients with symptomatic severe aortic stenosis who are at increased risk of morbidity and mortality during surgical aortic valve replacement. However, there is still no general consensus regarding the use of general anesthesia (GA) versus local anesthesia with sedation (non-GA) during the TAVI procedure. Using propensity score-matching analysis, we analyzed the characteristics and outcomes of patients who underwent TAVI with either GA (n = 245) or non-GA (n = 245) in the fully monitored, international, CoreValve ADVANCE Study. No statistically significant differences existed between the non-GA and GA groups in all-cause mortality (25.4% vs 23.9%, p = 0.78), cardiovascular mortality (16.4% vs 16.6%, p = 0.92), or stroke (5.2% vs 6.9%, p = 0.57) through 2-year follow-up. Major vascular complications were more common in the non-GA group. Total hospital stay was similar between the 2 groups. Conversion from non-GA to GA occurred in 13 patients (5.3%) because of procedural complications in 9 patients and discomfort or restlessness in 4 patients. Most procedural complications were related to valve positioning or vascular issues. Two of the 13 converted patients died during the procedure. Both GA and non-GA are widely used in real-world TAVI practice, and the decision appears to be guided by only a few patient-related factors and dominated by local and national practice. The outcomes of both anesthesia modes are equally good. When conversion from non-GA did occur, the complication requiring GA affected outcomes. [ABSTRACT FROM AUTHOR]

The paper addresses the important question of how institutional structures matter to the delivery of climate change policy for urban transport. It examines the strategic goals, policy tools in operation and initial progress towards carbon emission reduction in seven cities across the UK and Germany where different institutional structures exist. The UK has the presence of a strong national carbon target and strong hierarchical national–local government relationships whilst Germany has a more integrated system of local transport provision in a context where local and regional government is stronger. Our findings show that the carbon agenda has made very little difference to what is happening on the ground in the cities. Across all sites, progress is being made but largely through technological improvements which are being almost completely offset by population growth. Even in the more integrated city environments there has not be an additional stimulus to manage the demand for travel. Contrary to previous research therefore, we cannot conclude that institutional structures are paramount in delivering effective carbon reduction policies. The institutional structures in the UK and in Germany are not perfectly aligned to carbon management but, given the cross policy impacts of most transport interventions, this is perhaps inevitable. We can clearly conclude however that “better” structures are not sufficient to achieve the implementation of more effective carbon policies. Whilst institutional structures must matter, it is the broader governance environment and the resources and politics involved in transport policy that currently seem to dominate the importance of the carbon agenda and implementation paths that emerge. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. Methods: In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50 % stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50 % stenoses. To calculate the proportion of patients with ≥50 % stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. Results: Revascularizations were performed in 6.2 %, 4.5 %, and 12.9 % of all patients, patients with atypical chest pain (n =1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3 %, 1.1 %, and 1.5 %, respectively. The CMR + CXA-strategy reduced costs by 14 %, 34 %, 27 %, and 24 % in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59 %, 52 %, 61 % and 71 %, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3 %), intermediate in the US and Swiss (11.6 % and 12.8 %, respectively), and remained substantial in the UK (18.9 %) systems. Sensitivity analyses proved the robustness of results. Conclusions: A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate. [ABSTRACT FROM AUTHOR]

Crispin Matson looks at the potential advantages of district heating for the UK, where the technology is expected to meet 20% of the country's heat demand by 2030, and discusses the Gospel Oak project, one of the country's success stories. [ABSTRACT FROM AUTHOR]

Secular increases in brain mass over nearly a century have been noted for both males and females in the UK and Germany. It has been argued that such trends may be associated with the Flynn effect. The IQ gain predicted on the basis of these trends is 0.19 and 0.08 points per decade for UK, and 0.2 and 0.15 points per decade for German males and females respectively, indicating a small contribution to the Fullscale IQ trends in these countries (2.95% of the German decadal gain and 12.73% of the UK gain). There is also a sex difference in the rates of brain mass gain in both countries, favoring males. Temporal correlations between the secular trend in UK brain mass and European Flynn effects on Fullscale IQ, Crystallized, Fluid and Spatial abilities reveal correlations ranging from 0.751 in the case of Fluid ability to 0.761 in the case of Crystallized ability. The brain mass increase may be an imperfect proxy for changes in specific neuroanatomical structures important for IQ gains. Its small contribution to these gains is also consistent with the influence of other contributing factors. Increasing brain mass is predicted by the life history model of the Flynn effect as it suggests increased somatic effort allocation into bioenergetically expensive cortical real estate facilitating the development of specialized cognitive abilities. [ABSTRACT FROM AUTHOR]

Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) is licensed in Europe for open tibia fractures treated with unreamed nails. However, there is limited data available on the specific use of rhBMP-2 in combination with unreamed nails for open tibia fractures. The intention of the current study was to evaluate the medical and health-economic effects of rhBMP-2 in Gustilo-Anderson grade III open tibia fractures treated with unreamed nails based on individual patient data from two previously published studies. Linear regression analysis was performed on raw data of 90 patients that were either treated by standard of care with soft tissue management and unreamed nailing (SOC group) (n=50) or with rhBMP-2 in addition to soft tissue management and unreamed nailing (rhBMP-2 group) (n=40). For all types of revision, a significant lower percentage of patients (27.5%) of the rhBMP-2 group had to be revised compared to 48% of the patients of the SOC group (p=0.04). When only invasive secondary interventions such as bone grafting and nail exchange were considered, there was also a statistically significant reduction in the rhBMP-2 group with a revision rate of 10.0% (4 of 40 patients) compared to the SOC group with a revision rate of 28.0% (14 of 50 patients) (p=0.01). Mean fracture healing time of 228 days in the rhBMP-2 compared to 266 days in the SOC group was not statistically significant (p=0.24). Health-economic analysis based on a societal perspective with calculation of overall treatment costs after initial surgery and including productivity losses revealed savings of €6,239 per patient for Germany and €4,752 for the UK in favour of rhBMP-2 which was mainly driven by reduction of productivity losses. In conclusion, rhBMP-2 reduces secondary interventions in patients with grade III open tibia fractures treated with an unreamed nail and its use leads to financial savings for Germany and the UK from a societal perspective. [ABSTRACT FROM AUTHOR]

The phenomenon of doping is rarely researched in Paralympic sport, especially from the coach perspective. This study responds directly to this gap in research by exploring coaches' doping-related perceptions, knowledge, and opinions of the current anti-doping system in order to inform future interventions specific to disabled elite sport contexts. Eleven coaches from Germany (n = 6) and the UK (n = 5) working across physiological (n = 7) and skill-based (n = 4) sport disciplines at an elite level (Paralympic, n = 10 and World Championship, n = 1) took part in semi-structured interviews. Data were analysed using abductive reflexive thematic analysis (Braun & Clarke, 2019a). Four themes were developed to capture the coaches' perspectives. The first represents coaches' perception that doping is an issue in Paralympic sport. The second theme shows that risk factors to dope are typically multiple and intertwined, stemming especially from financial incentives and pressure to win. Theme three captures coaches' opinion of differences in testing and education across countries due to budget, resource, or infrastructure issues. Finally, data showed that coaches prefer to refer responsibility for doping prevention to their national anti-doping organisation, rather than taking on personal responsibility for anti-doping efforts. According to the interviewed coaches, doping has the potential to be a big issue in disabled elite sport. The main risk factors of money and pressure to win (earn prize money or funding/sponsorship) are knitted together and can be additionally impacted (negatively) by a nation's sporting system. These factors should be addressed by thinking both on an individual level (e.g., support dual careers) and a structural/policy level (e.g., aim to have minimum standards to level the global inconsistent anti-doping systems, including anti-doping education/testing). Furthermore, coaches should take their role and be proactively made aware of their responsibility in doping prevention to coach clean and protect their athletes properly. • Coaches see doping as an issue for disabled elite sport. • Interviewees suggest that factors like financial incentives or pressure to win increase doping likelihood. • Coaches propose that an imbalanced global anti-doping systems affect doping risk. • Coaches see others (e.g., anti-doping organisations) as responsible for anti-doping. [ABSTRACT FROM AUTHOR]

In the innovation framing literature, scholars argue that green innovations are being challenged by legitimacy barriers associated with strong lock-in effects on the fossil-based economy. To break down barriers and create legitimacy, we stress the role of demarcation frames. Demarcation frames we argue are an important supplement to the established framing mechanisms that signal alignment and similarity with existing systems. Building on a machine-learning topic modeling approach, we investigate the development of the perception and meaning of the electric vehicle over a period of 27 years—i.e., its framing. By using public media data to undertake a systematic cross-country study in Germany and the UK, we show how and through which combinations of framing mechanisms the electric vehicle overcame the initial skepticism that was closely linked to the internal combustion vehicle. Hence, our research contributes to a better understanding of the framing processes around green innovations in the carbon-based economy. Firstly, we offer a novel analytical perspective focusing on the overarching public framing of green innovations. Secondly, we contribute to the literature by describing the theoretical implications and functionality of demarcation frames to overcome lock-ins. And thirdly, we discuss policy implications to support the dissemination of green innovations and propose future research avenues relevant for the green innovation and innovation framing field. • The framing of green innovations. • We demonstrate how green innovations can overcome legitimacy barriers. • We decode important barriers of green innovations on the example of the EV. • We show the potential of topic modeling to compare green innovation in different countries. • The findings allow to develop response strategies to support green innovation diffusion. [ABSTRACT FROM AUTHOR]