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Abstract: Introduction: Culture is an important factor influencing how students develop learning and how educators provide support to students. The aim of this paper is to explore a concept of national European cultures, and relationships between culture and educational practice with the intention of helping the dental profession gain a better understanding of effective teaching and learning in dentistry. Content: Culture represents the collective behaviours, values and beliefs of people in a society. How people react to education is partly explained by culture. Students utilise different culturally based strategies to develop learning. We apply Hofstede's model to explore European cultures and implications for dental education and educational practice. Most Western students possess assimilating learning styles enabling them to learn effectively in student‐centred contexts while most Eastern students have accommodating learning styles and are more familiar with teacher‐centred learning. Eastern students may need to adapt their approach to learning to better benefit from student‐centred learning. Conclusion: Culture influences students’ learning and educational practice. Dental educators should be aware of such influences and provide support that acknowledges students’ different cultural backgrounds. Cultural competence is fundamental for effective teaching and learning in dentistry. [ABSTRACT FROM AUTHOR]

Corporate value statements communicate what a firm aspires for and what drives their value creation. In addition, corporate values often also define which behaviors are acceptable and which are not. Ideally, corporate values are representations of a firm's informal corporate values and organizational culture. However, in practice, there is an inherent tension between the aspirations and actual values and ensuing behaviors of and within a firm—let alone the potentially different interpretations of abstract corporate value statements. In this paper, we set out to provide more clarity on what corporate values are, how they are inherently ambiguous, and how in practice they compare to firm involvement in scandals. For this purpose, we study the corporate values of the 25 largest European banks after the financial crisis. “Integrity” appeared to be the most common value among the 25 banks, followed by “customer focus.” Nonetheless, over the past 6 years, 15 out of the 25 studied banks were involved in one or more scandals. Scandals can be systematic or caused by rogue employees, and benefitting the firm or their customers—in the latter case, providing an interesting interpretation of the customer focus value. Additionally, we found that courage or its synonyms were barely mentioned among banks' corporate values, potentially providing an additional explanation for the fast size of the financial crisis. Finally, we found that banks that had inclusive social principles such as respect, solidarity, and equality did not face large‐scale scandals. [ABSTRACT FROM AUTHOR]

Objectives: With persisting high numbers of new HIV diagnoses in Europe, HIV testing remains an important aspect of HIV prevention. The traditional centralized and medicalized HIV testing approach has been complemented with newly developed and evaluated non‐traditional approaches. Two important factors guided this process: technological innovation and empowerment of the patient. Methods: We present a matrix to develop an HIV testing approach, and elaborate on three commonly used ones: community based testing, self‐testing, and self‐sampling. Despite non‐traditional HIV testing approaches, barriers for testing remain. A potential disadvantage for users is the risk for false‐reactive test results. As users receive an orientation test result, a reactive result should be confirmed. Another issue is the window phase, which is longer for some orientation tests compared to a traditional, laboratory‐based test. Results: Future implementation of non‐traditional HIV testing approaches will depend on legal frameworks throughout Europe. Community testing centers may additionally improve empowerment of key populations by expanding their portfolio to testing and treatment for sexually transmitted infections. Community engagement and ownership may imply a shrinking role for health care providers, but they remain crucial actors for personalized information, counselling and referral to specialized HIV‐care for many people. Conclusions: A highly effective HIV testing strategy to reduce undiagnosed people living with HIV in Europe is needed. Any approach, chosen according to the principles outlined in this paper, should reach the right people, diagnose them in the most accurate way, and optimize linkage to care. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to describe the data collected by the CBVCT services from the Community‐based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community‐based voluntary counselling and testing (CBVCT) services’ testing activity in Europe. Methods: A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014–2016. Results: During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non‐foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). Conclusions: These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work within OptTEST by HiE has been to demonstrate the role of legal and regulatory barriers in hindering access to HIV testing, treatment and care across Europe and to produce tools to help dismantle them. Methods: An online survey to assess country‐specific data on legal and regulatory barriers distributed widely across the WHO Europe region. Literature reviews conducted in January‐October 2015 in English, in November 2015 in Russian, and updated in April 2017. Semi‐structured interviews were conducted with 25 key actors within the HIV field to feed into case studies and tip sheets on how to dismantle legal and regulatory barriers. Results: More than 160 individuals and organisations from 49 countries across the WHO European region provided responses which were analysed and cross checked with other data sources and a searchable database produced (legalbarriers.peoplewithhiveurope.org). The conducted literature reviews yielded 88 papers and reports which identify legal and regulatory barriers to key populations’ access to HV testing and care. Based on the interviews with key actors, ranging from PLHIV activists to government officials, on lessons‐learned, a series of tip sheets and ten case studies were written‐up intended to inform and inspire the HIV community to address and overcome existing barriers (opttest.eu/Tools). Conclusion: While some of the barriers identified may require major changes to wider health systems, or long term legal reform, many are open to a simple change in regulations or custom and practice. We have the tools. Why can't we finish the job? [ABSTRACT FROM AUTHOR]

Abstract: A quarter of the European population lives in ‘polycentric urban regions’ (PURs): clusters of historically and administratively distinct but proximate and well‐connected cities of relatively similar size. This paper explores whether tighter integration can increase agglomeration benefits at the PUR‐level. We provide the first comprehensive list of European PURs (117 in total), establish their level of functional, institutional and cultural integration and measure whether this affects their performance. ‘Performance’ is defined as the extent to which urbanisation economies have developed, proxied by the presence of metropolitan functions. In this first‐ever cross‐sectional analysis of PURs we find that while there is evidence for all dimensions of integration having a positive effect, particularly functional integration has great significance. Regarding institutional integration, it appears that having some form of metropolitan co‐operation is more important than its exact shape. Theoretically, our results substantiate the assumption that networks may substitute for proximity. [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that higher seizure burden in Dravet syndrome is associated with increased comorbidities and lower quality of life (QoL) in a large cohort of patients with Dravet syndrome and their caregivers in Europe.Method: An extensive survey of caregivers of patients with Dravet syndrome on experiences of diagnosis, seizure burden, management, social and financial impact, and health services use was administered online in 10 languages.Results: The survey received 584 unique responses from caregivers of paediatric (83%) and adult (17%) patients with Dravet syndrome (aged <1-48y). Despite broadly following current treatment guidance, less than 10% of patients were seizure free in the previous 3 months. Nearly all (99.6%) patients aged 5 years or older experienced at least one or more motor, speech, learning, or behavioural impairment. High seizure frequency was related to more reports of emergency treatment, comorbidities, and a lower QoL (as measured by the standardized instrument EQ-5D-5L). If not diagnosed at the first instance, the majority (83%) of adults, but less than 20% of 6- to 11-year-olds were diagnosed after 4 or more years.Interpretation: Patients with Dravet syndrome with the highest current seizure frequency suffer from more comorbidities and have a lower QoL. Therefore, more effective antiepileptic treatments are needed.What This Paper Adds: The survey captured about 15% of all patients with Dravet syndrome in Europe. Less than 10% of patients had current seizure freedom. Patients with a high current seizure burden have more comorbidities and lower quality of life. [ABSTRACT FROM AUTHOR]

This article argues that we know little about how small farmers in post-communist Europe survive and even grow while having little access to credit markets. In approaching small farmers, this paper builds on ideas of self-provisioning, contending that the tendency among small farmers is not one of growth towards and through economies of scale, but one of internalising and de-monetising costs, by growing in order to control upstream and downstream links in the value chain. It asks what is it that makes self-provisioning possible in two post-communist regions (located in Romania and Ukraine) and identifies various assets in the smallholders' environments, such as most importantly a diverse scene of intermediaries supplying smallholders with cash incomes. The implication of the research is that the existence of these assets is crucial for the smallholders' survival and growth, and these assets should be valued accordingly rather than dismissed in favour of integrating smallholders into modern, retailer-dominated, value chains. [ABSTRACT FROM AUTHOR]

This paper investigates how spinoffs in peripheral regions can profit from the work experience of their founders. More specifically, it discusses which firm routines and business contacts entrepreneurs gather through their prior work experience, and how this experience influences the organizational structure and orientation of the newly founded firm. The transfer of capabilities from parent firm to spinoff has been identified as important aspect of industrial clustering, but empirical evidence from peripheral areas is still sparse. It compares 22 semi-structured interviews with founders of manufacturing firms from different peripheral regions in Switzerland to investigate whether routine and network transfer differs in varying peripheral contexts. The results show that not only inherited routines are important, but also inherited business contacts. Further, instead of simply reproducing acquired routines and networks, founders employ a mixture of continuity and change to find a good trade-off between relying on well-proven practices and introducing novelty. Finally, the geographical proximity of inherited business contacts seems to have an influence on the implementation strategy founders choose. Entrepreneurs with strong inherited local business contacts do not have to invest as much in building up new business contacts as those entrepreneurs in more isolated locations. [ABSTRACT FROM AUTHOR]

The automotive industry has long had a reputation for organising its production networks on a macro-regional scale. However, over the 2000-2012 time span, extended vertical disintegration of both carmakers and mega-suppliers, and the 2008-2009 trade collapse suggest that this geographical organisation pattern could have weakened, giving way to a genuine globalisation of auto-parts trade. This paper first reviews arguments likely to explain why automotive production networks are multi-scalar, ranging from local to global. Empirical analysis of international auto-parts trade data from Germany, France, UK, and Spain suggests that there has been little progression in globalisation of production networks. General data features can be best explained as follows: 1) the auto-parts import level of a given country is mainly driven by its automobile production level, and by the degree of presence of foreign headquartered carmakers; and 2) the breakdown of imports into procurement flows from near-distant and far-distant countries is mainly driven by the degree of presence of carmakers headquartered in far-distant countries. [ABSTRACT FROM AUTHOR]

Despite the importance of national borders in the process of European integration and its destiny, border areas remain relatively misrecognised. This is particularly true as regards the contemporary geography of border cities across Europe. It is therefore difficult to assess what importance border cities and cross-border urban regions have and how they have evolved in parallel with the transformation of European borders. The aim of this paper is to highlight the urban dimension of border regions in Europe and, in particular, the diversity of configurations present. Through an original cartography of border cities, we hope to draw the attention of the research community interested in borders and border regions to an unfamiliar aspect of European borderlands and some of the issues and questions it raises. [ABSTRACT FROM AUTHOR]

This paper provides a first attempt at the construction of a unified, homogeneous inventory of different classes of urban settlements in the European space, building on the approach of international institutions such as OECD and the EU in relation to larger urban areas and extending it to the specific challenge presented by smaller settlements. Its objective is twofold. The first is to address the fundamental empirical problem that was central to the development of the ESPON 2013 project 'Small and Medium sized Towns in their Functional Territorial Context' (TOWN), that is the proper geographic identification of different classes of urban settlements. The second is to introduce one basic classification of urban settlements, and two more refined typologies of small and medium sized towns (SMST). These typologies are used to provide a first impression of territorial structures of urbanisation throughout Europe, further elaborated in functional terms in the TOWN project. [ABSTRACT FROM AUTHOR]

Despite that small and medium-sized towns (SMSTs) have been, and continue to be, a central part of the history of Europe, these places have largely been neglected by urban research. The ESPON TOWN project, on which this Special Issue builds, sought to redress this neglect performing a comparative analysis of their position and role across Europe. In this introductory paper we discuss some of the theoretical and methodological challenges when it came to identifying, studying and analysing SMSTs and the theoretical framework developed to inform our understanding of SMSTs. In particular, three themes are discussed. The first one is about the ontological problem of defining a town. Administrative, morphological and functional perspectives are considered. The second one reflects on a wide array of interpretative approaches about the relationship between towns and their regional context. The third one is about the thematic and multi-scalar perspectives that can characterise the policy approach to towns. [ABSTRACT FROM AUTHOR]

This paper is part of the research on functional roles of European towns conducted by a group of researchers gathered around the ESPON project 'TOWN'. Building on the systematic analysis of the socio-economic dynamics of 31 European small and medium-sized towns (SMSTs), we identified three profiles of their local economies. The first profile is defined as a dominant 'residential' economy that mostly relies on local activities that satisfy the needs of people in an area (residents, commuters or tourists). The second profile corresponds to a dominant 'productive' economy based on the production of goods and services to be mainly exported and consumed out of its area. The third profile is the mixed type that is characterised by an important share of activities in productive and residential sector with a complementary 'creative-knowledge' dimension, based on entrepreneurship, creativity and collaboration in innovation. Moreover, we analysed the economic performance and the shift in profiles in order to detect in which way towns make choices between residential economy, competitiveness and innovation for their local development. [ABSTRACT FROM AUTHOR]

The relationship between cannabis and psychosis and schizophrenia has tested the field of addiction for decades, and in some ways serves as measure of our ability to provide a credible contribution to public health. As cannabis is used widely, many people are interested in the risks the drug poses to mental health. This paper focuses upon a seminal study examining this, the trajectory of subsequent research findings and what this has meant for understanding and communicating risk factor information. These studies provided evidence of a dose-response relationship between cannabis and psychosis, and that for those individuals with schizophrenia cannabis exacerbated their symptoms. The findings fit with a multi-causal model in which vulnerability interacts with a precipitating agent to produce a disease outcome. Even though this is a common model in epidemiology, it has proved difficult to communicate it in this case. This may be because at a population level the increased risk is weak and the vulnerabilities relatively rare. It may also be because people bring strongly held preconceptions to interpreting a complex multi-causal phenomenon. [ABSTRACT FROM AUTHOR]

The question of whether Late Iron Age oppida in Europe were truly 'urban' has dominated debate over these sites since the nineteenth century. Oppida have been surprisingly absent from comparative urban studies, however, despite increasingly nuanced perspectives on the nature and diversity of the urban phenomenon. In particular, Roland Fletcher's implication that oppida might represent part of a broader alternative form of low-density urbanism has been largely overlooked, by Iron Age scholars and urbanism specialists alike. With the complex nature of many oppida now becoming increasingly apparent, I suggest it is a pertinent time to assess Fletcher's claim and examine whether oppida can be convincingly compared to low-density urbanism elsewhere in the world and, if so, what implications this might have for understanding Iron Age societies. This paper argues that oppida do indeed display aspects of low-density urbanism and that this is likely to be due to the negotiated nature of power in Iron Age societies. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Objectives To assess the efficacy of comprehensive geriatric assessment ( CGA) in prevention of delirium after hip fracture. Design Systematic review and metaanalysis. Setting Ward based models on geriatrics wards and visiting team based models on orthopaedics wards were included. Participants Four trials (three European, one U.S.; 973 participants) were identified. Two assessed ward-based, and two assessed team-based interventions. Measurements MEDLINE, EMBASE, CINAHL and Psyc INFO databases; Clinicaltrials.gov; and the Central Register of Controlled Trials were searched. Reference lists from full-text articles were reviewed. Incidence of delirium was the primary outcome. Length of stay, delirium severity, institutionalization, long-term cognition and mortality were predefined secondary outcomes. Duration of delirium was included as a post hoc outcome. Results There was a significant reduction in delirium overall (relative risk ( RR) = 0.81, 95% confidence interval ( CI) = 0.69-0.94) in the intervention group. Post hoc subgroup analysis found this effect to be preserved in the team-based intervention group ( RR = 0.77, 95% CI = 0.61-0.98) but not the ward-based group. No significant effect was observed on any secondary outcome. Conclusion There was a reduction in the incidence of delirium after hip fracture with CGA. This is in keeping with results of non-randomized controlled trials and trials in other populations. Team-based interventions appeared superior in contrast to the Ellis CGA paper, but it is likely that heterogeneity in interventions and population studied affected this. [ABSTRACT FROM AUTHOR]

Introduction Implant dentistry is a treatment modality which has mainstream clinical practice of comprehensive care, which however is not adequately represented in the undergraduate dental curricula. A consensus workshop organised by ADEE in 2008, set the benchmarks for the knowledge and competences a modern dental practitioner must possess with regard to implant dentistry, as well as defined undergraduate and postgraduate pathways for the acquisition of these competences. Today, 5 years later, there exist several challenges for the implementation of these benchmarks in both undergraduate curricula but also post-graduation educational pathways. Methods A consensus workshop was organised by ADEE, bringing together 48 opinion leaders, including academic teachers of all disciplines related to implant dentistry, specialists, representatives of relevant scientific and professional associations, as well as industry delegates. The objectives of the workshop were to evaluate the existing scientific literature, reported experience and best practices in order to identify potential and limitations for the implementation of implant dentistry in the undergraduate curriculum, as well produce recommendations for the optimal educational structures for postgraduate programmes and continuing professional development. Results The scientific committee conducted two European-wide questionnaire surveys to better document the current state of education in implant dentistry. Upon completion of the surveys, reviewers were appointed to produce three scientific review papers, identifying current achievements and future challenges. Finally, during the 3 days of the workshop, all the evidence was reviewed and the main conclusions and recommendations that were adopted by all participants are reported in the present Consensus Paper. Conclusions Implementation of implant dentistry in the undergraduate curriculum has improved significantly, but still lags behind the benchmarks set in 2008 and the diversity between institutions remains big. At the post-graduation level, there is currently a wide diversity of courses and pathways towards competences related to implant dentistry and there is at present a great need for quality assurance, as well as standardisation and transparency of the learning outcomes. [ABSTRACT FROM AUTHOR]

Ten years after the first global rankings appeared, it is clear that they have had an extraordinary impact on higher education. While there are fundamental questions about whether rankings measure either quality or what's meaningful, they have succeeded in exposing higher education to international comparison. More so, because of the important role higher education plays as a driver of economic development, rankings have exposed both an information deficit and national competitiveness. Accordingly, both nations and institutions have sought to maximise their position vis-á-vis global rankings with positive and perverse effects. Their legacy is evident in the way rankings have become an implicit - and often explicit - reference point for policymaking and higher education decision-making, and have reinforced an evaluative state's over-reliance on quantitative indicators to measure quality. They are embedded in popular discourse, and have informed the behaviour of many stakeholders, within and outside the academy. This paper reflects on three inter-related issues; i) considers the way rankings have heightened policy and investment interest in higher education, ii) discusses whether the modifications to rankings have resolved some of the questions about what they measure, and iii) looks at how rankings have influenced stakeholder behaviour. Finally, the paper reflects on what we have learned and some outstanding issues. [ABSTRACT FROM AUTHOR]

This paper provides a critical examination of the development of border management in Finland and the Schengen Area, the point of departure being that contemporary performances of border enforcement and security cannot be understood as distinct from the process of neoliberalization. The particular case which is examined is that of the Finnish Border Guard (FBG) service. Border management in Finland provides an interesting case not only because Finland is responsible for controlling the Schengen, European Union-Russian border but also because since Finnish state reforms in the early 1990s, neoliberal rationales have increasingly provided the guidelines for how to calculate and optimize border security. This paper emphasizes that the rationales of border management should be made transparent and opened for public debate. The analysis is structured around the themes of internationalization, competitiveness, risk prevention and the functioning of society, all of which are regarded as the key rationales of neoliberalized border governance. [ABSTRACT FROM AUTHOR]

This paper analyses the characteristics of SMEs in less-developed areas in comparison with more advanced economies. The conceptual framework includes different factors making up the so-called 'entrepreneurial quality' of the SME sector: the personal characteristics of the entrepreneurs (motivations and previous experience), different dimensions of the SMEs' entrepreneurial orientation, and the patterns of the SMEs' insertion in national and global value chains. The empirical analysis uses data of SMEs in four different Spanish provinces representing examples of low income economies and comparatively high income ones, respectively. Results show the SMEs in the low income economies to be characterized by a lower entrepreneurial quality. [ABSTRACT FROM AUTHOR]

Background and objective The spread of self-care holds the promise of containing chronic illness burden. Falling within the framework of a FP7 collaborative research project, this paper reports the views of key informants from six countries regarding who the main stakeholders are at different levels in the support system for self-care for patients with chronic illness ( SSSC) and how they accomplish their role and collaborate. Methods 90 Interviews with purposefully selected key informants from Bulgaria, Greece, the Netherlands, Norway, Spain and United Kingdom were conducted. Interviews involved government and local authorities, politicians, academics, health professionals and private sector representatives. Interviewers followed an expert opinion-based guide. Analysis involved a cross-country examination with thematic analysis and framework method techniques. Results Key informants described the ideal SSSC as inclusive, interdependent and patient-centred. The following main stakeholders in SSSC were identified: patients, governments, health-care professionals, associations, private companies and the media. In the current SSSCs, collaboration among stakeholders within and across different levels was said to be lacking. Patients were seen as playing a passive subordinate role based on the following: their own attitudes; the paternalistic and medicalized attitudes of the health-care professionals; their misrepresentation by patient associations; and their exposure to the damaging influences of media and industries. Conclusions Making SSSC patient-centred constitutes the greatest challenge for European authorities. Strategies must be revised for promoting patient participation. They should undergo changes so as to promote industry and media social responsibility and patient association advocacy capacity. [ABSTRACT FROM AUTHOR]

In order to tackle the increasing problem of malnutrition ( i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly ( MaNu EL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative ( JPI) A Healthy Diet for a Healthy Life ( HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNu EL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNu EL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNu EL will provide insight into current clinical practice, policies and health professionals' education on malnutrition and will make recommendations for improvement. MaNu EL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies. [ABSTRACT FROM AUTHOR]

The objective of this paper is to summarize the outcomes of the Euroguidelines in Central and Eastern Europe (ECEE) conference held in Warsaw in February 2016. The main aim of this conference was to facilitate a discussion on European AIDS Clinical Society (EACS) guidelines implementation across the region and neighbouring countries and to present the current obstacles in benchmarking HIV care in Europe. Methods During a 2-day meeting, there were country-based presentations using a predefined template so as to make the data comparable and focus the discussion. Areas covered were country epidemiology, surveillance, national strategy for treatment and prevention, standards of care, access to care and treatment availability. Each participant filled in a questionnaire investigating HIV guidelines usage per country. Results In total, 16 Central and Eastern Europe (CEE) and neighbouring countries were represented at the conference: Albania, Armenia, Belarus, Croatia, Czech Republic, Estonia, Georgia, Hungary, Lithuania, Moldova, Poland, Romania, Russia, Serbia, Slovakia and Turkey. EACS guidelines version 7.1 were used in 14 (87%) countries. In 11 (69%) countries, national guidelines were available, of which eight had been recently updated. Half of the countries declared that they use World Health Organization (WHO) and Department of Health and Human Services (DHHS) guidelines, over one-third the European Centre for Disease Prevention and Control (ECDC) HIV testing guidelines and one in five the International Antiviral Society USA (IAS-USA) Panel guidelines from 2012. Conclusions Participants declared their will to promote the widespread use of EACS guidelines for HIV infection in the CEE region and neighbouring countries by signing the Warsaw Declaration. They also emphasized the need to increase publishing of data from national cohorts in that region. [ABSTRACT FROM AUTHOR]

Different tree species influence litter decomposition directly through species-specific litter traits, and indirectly through distinct modifications of the local decomposition environment. Whether these indirect effects on decomposition are influenced by tree species diversity is presently not clear., We addressed this question by studying the decomposition of two common substrates, cellulose paper and wood sticks, in a total of 209 forest stands of varying tree species diversity across six major forest types at the scale of Europe., Tree species richness showed a weak but positive correlation with the decomposition of cellulose but not with that of wood. Surprisingly, macroclimate had only a minor effect on cellulose decomposition and no effect on wood decomposition despite the wide range in climatic conditions among sites from Mediterranean to boreal forests. Instead, forest canopy density and stand-specific litter traits affected the decomposition of both substrates, with a particularly clear negative effect of the proportion of evergreen tree litter., Our study suggests that species richness and composition of tree canopies modify decomposition indirectly through changes in microenvironmental conditions. These canopy-induced differences in the local decomposition environment control decomposition to a greater extent than continental-scale differences in macroclimatic conditions. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Online modified Delphi (OMD) panel approaches can be used to engage large and diverse groups of clinical experts and stakeholders in developing health services performance measures. Such approaches are increasing in popularity among health researchers. However, information about their acceptability to participating experts and stakeholders is lacking but important to determine before recommending widespread use of online approaches. Therefore, the objective of this paper is to explore acceptability of the OMD panel approach from the participants' perspective. Method: We use data from participants in three OMD panels designed to develop performance measures for use in arthritis research and quality improvement efforts. At the end of each online panel, we surveyed clinical experts and stakeholders who shared their experiences with the OMD process by answering 13 close-ended questions using 7-point Likert-type scales. A mean of 5 or higher on a given question was treated as an indication of acceptability. Results: Ninety-eight clinical experts and stakeholders (92% participation rate) answered survey questions about the online process. They considered the OMD panel approach to be acceptable, particularly the ease of using the online system (mean = 5.3, standard deviation = 1.3) and the understanding gained from online discussions (mean = 5.2, standard deviation = 1.0). Participants also felt that participation in the Delphi study was interesting (mean = 5.6, standard deviation =1.1). Conclusion: These findings illustrate likely acceptability and a potential for a more widespread use of OMD panel approaches by stakeholders in developing health services performance measures. [ABSTRACT FROM AUTHOR]

The EU's borderland between Finland and Russia provides a fascinating setting to study how different understandings of state and civil society meet, overlap, and fuse. Focusing on this border region, this study pits the conventional bilateral framework against the more recent EU one in depicting a cross-border space for civic activity. It offers a critical perspective on the official European Neighbourhood and illustrates a complementary vision of a non-territorial civic neighbourhood seeking to capture the networked and fluid topologies of contemporary cross-border processes. The paper underlines the role of civil society in bridging the gaps created by borders, and suggests that they provide a powerful driver for maintaining neighbourly relations in a tense climate. To better understand the transnational network-space they fashion, we must abandon the geographical idea of territorial exceptionality and be receptive to alternative interpretations not tied to a particular policy framework and the restrictions defined by it. [ABSTRACT FROM AUTHOR]

The law on nutrition and, especially, health claims on food is complex and evolving. There is a widely felt need for guidance and dialogue between stakeholders. A well-attended seminar was organised in September 2016 that brought together regulators, enforcement practitioners and the trade and appeared to go some way to addressing this need. It was generally agreed that several next steps are desirable: to run the seminar again ( e.g. in the north of England); to develop a multiple stakeholder forum in order to arrive at correct interpretation and shorten the decision-making process in difficult cases; to introduce an 'improvement notice' option for UK implementation of Regulation 1924/2006; and to develop a checklist for use in examining labels and advertisements. This paper offers an illustration of how this might be commenced; readers are invited to comment. More guidance on priorities and analytical methods is needed for food and food supplements for which health claims are made. The US and European Union regulatory and enforcement attitudes to health claims have developed in quite different directions. With the withdrawal of the UK from the European Union, it will be interesting to see what challenges there are ahead for the protection of consumers and responsible businesses from food health fraud. [ABSTRACT FROM AUTHOR]

Migration and border scholars have argued that the Europeanization and securitization of borders and migration have led to forms of population regulation that constitute a questionable divide between EU and non-EU groups, as well as between different non-EU groups. This paper argues that these processes have impacted not only centrifugally, on non-EU populations, but also centripetally, on the 'intra-EU' divide regarding minorities such as Europe's Muslims and Roma. I explain how a de-nationalization of the concepts and methods of migration and border studies-beyond methodological nationalism and Eurocentrism-sheds light on the under-researched impact of the EU's external border regime on minoritized EU citizens. I introduce the notion of 'evictability' to articulate this de-nationalization and discuss the case study of Europe's Romani minority to show how contemporary forms of securitization further divide Europe bio-politically along intra-European lines. [ABSTRACT FROM AUTHOR]

Sminthurus viridis (Collembola: Sminthuridae) is a native of grasslands across Europe and feeds preferentially on clover ( Trifolium spp.) and lucerne ( Medicago sativa), although its abundance does not normally reach damaging pest levels (as occurs in Australasia). This research note describes the first quantitative assessment of a pest outbreak of this springtail in Europe, which occurred within an existing experiment investigating the effects of cultivation practices on forage establishment. Using sticky traps to assess the incidence of S. viridis, we found a significant outbreak consisting of catches that were 10-fold greater than background levels in nearby undamaged fields. Within the experimental area, lucerne established by direct drilling with herbicide had the highest incidence (105 (± 4·9) individuals per trap) compared to other treatments [79 (± 3·9)]. Results are discussed in terms of how cultivation practice may have imbalanced the ecosystem; for example, herbicide use may have diminished potential refugia for predators during forage establishment. This paper highlights the potential of a currently innocuous, widely established invertebrate to become present at damaging levels in agricultural crops. [ABSTRACT FROM AUTHOR]

English proficiency is viewed across societal levels as a necessary commodity for accessing the best educational and professional prospects. The high value associated with English as symbolic capital may be seen to impact negatively upon the promotion of individual and societal multilingualism beyond an emergent dominant pattern of L1+ English. To date, few empirical studies have been conducted into the ecology and ideologies that prevail within European English-medium degree programmes regarding English and the concomitant acquisition of additional languages. On the basis of empirical data generated from questionnaires and semi-structured interviews, this paper explores the experiences of students and lecturers within English-medium degree programmes in Germany as they negotiate their English-speaking environments and explores their practices of multilingualism beyond their L1 and English. [ABSTRACT FROM AUTHOR]

First tunnel breakthrough at the Granitztal tunnel chain / Erster Tunneldurchschlag bei der Tunnelkette Granitztal Works acceptance for Europe's largest EPB machine / Werksabnahme für Europas größte EBP-Maschine Porr win their first tunnel contract in Norway / Porr erhält ersten Tunnelauftrag in Norwegen Brenner Base Tunnel site in Wolf to gain a rail siding / BB-Baustelle in Wolf erhält Gleisanschluss End of the Fehmarnbelt Tunnel participation period in Germany / Ende der Einwendungsfrist zum Fehmarnbelt-Tunnel in Deutschland Powerhouse of the Gemeinschaftskraftwerk Inn enters the next phase / Krafthaus des Gemeinschaftskraftwerks Inn geht in die nächste Phase DB passes 50 km mark at Stuttgart 21 / Bahn überschreitet 50-km-Marke bei Stuttgart 21 TBMs for Metro in Ecuador / TVMs für Metro in Ecuador Call for papers - Themes for the next issues of Geomechanics and Tunnelling / Themen für die nächsten Ausgaben der 'Geomechanics and Tunnelling' [ABSTRACT FROM AUTHOR]

ABSTRACT Transport infrastructure investment is a cornerstone of growth-promoting strategies. However, the link between infrastructure investment and economic performance remains unclear. This may be a consequence of overlooking the role of government institutions. This paper assesses the connection between regional quality of government and the returns of different types of road infrastructure in the regions of the European Union. The results unveil the influence of regional quality of government on the economic returns of transport infrastructure. In weak institutional contexts, investment in motorways-the preferred option by governments-yields significantly lower returns than the more humble secondary road. Government institutions also affect the returns of transport maintenance investment. [ABSTRACT FROM AUTHOR]

This paper introduces a nonparametric measure of coordination productivity growth where the subprocesses are explicitly modelled in the production technology. The coordination productivity indicator is decomposed into a coordination technical inefficiency change component and a coordination technical change component. This decomposition allows assessment of reallocation impacts on the different sources of productivity growth. The empirical application focuses on a large panel of English and Welsh farms over the period 2007-2013. The results show that coordination inefficiency significantly increases with the proportion of resources allocated to livestock production in economic and statistical terms. Coordination inefficient farms should generally allocate more land to crop production. Depending on the region, the average coordination productivity growth ranges from −9.7% to 15.9% per year. It is driven by coordination technical change rather than coordination inefficiency change. [ABSTRACT FROM AUTHOR]

Introduction The bleeding propensity in von Willebrand disease ( VWD) is usually moderate or mild and patients with VWD do not need continuous treatment, but do require extra increased haemostatic cover when undergoing dental or surgical procedures. Desmopressin can be effective in certain patient groups and this has been considered in a previous publication. Aim This paper now seeks to evaluate current knowledge and practice in the use of factor concentrate in the management of VWD patients undergoing invasive procedures. Methods A literature search was performed on the use of factor concentrates to cover invasive procedures and a survey of current practice in a number of specialist haematology centres across Europe represented by the European Haemophilia Strategy Board was conducted. Results Our review of the literature and the results of the survey showed considerable heterogeneity in treatment regimens, and a lack of consistency in reporting of the variables that determine factor concentrate dosing and monitoring. Conclusion By analysing the literature, examining guidelines and using consensus deliberation, this survey allowed the group to develop recommendations for management of VWD patients undergoing invasive procedures. [ABSTRACT FROM AUTHOR]

The paper enquires into the implementation of the European Standards and Guidelines for Internal Quality Assurance of Higher Education Institutions (ESG 1). The enquiry uses data from universities in the Czech Republic and compares them against those obtained in the relevant pan-European survey. The aims are to empirically deconstruct ESG 1 translation through instrument mixes, to identify the corresponding implementation styles and to explore the implications of such styles for institutional quality cultures. In these respects, the enquiry yielded three corresponding findings. First, the ESG 1 instrument mixes are complex and entail the application of up to four major types of tools, cutting across the substantive and procedural categories over time. Second, two typical ESG 1 implementation styles were identified: managerial and academic. Third, the managerial style was found to bear on regenerative culture while the academic style bore on reproductive culture. Furthermore, utilisation of hybrid quality cultures (regenerative-reproductive, reproductive-regenerative) was found, depending on internal institutional configurations. It is through verification of these findings in other policy settings that international research on higher education quality assurance may gainfully proceed. [ABSTRACT FROM AUTHOR]

The progressive nature of Type 2 diabetes necessitates treatment intensification over time in order to maintain glycaemic control, with many patients ultimately requiring insulin therapy. While insulin has unlimited potential efficacy, its initiation is often delayed and improvements in glycaemic control are typically accompanied by weight gain and an increased risk of hypoglycaemia, particularly as HbA1c approaches and falls below target levels. This may account for the sub-optimal control often achieved after insulin initiation. Combining insulin with antihyperglycaemic therapies that have a low risk of hypoglycaemia and are weight-neutral or result in weight loss is a therapeutic strategy with the potential to improve Type 2 diabetes management. Although the effects differ with each individual class of therapy, clinical trials have shown that adding a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor to insulin regimens can offer a significant reduction in HbA1c without substantially increasing hypoglycaemia risk, or weight. The evidence and merit of each approach are reviewed in this paper. Once-daily co-formulations of a basal insulin and a glucagon-like peptide-1 receptor agonist have been developed (insulin degludec/liraglutide) or are under development (lixisenatide/insulin glargine). Insulin degludec/liraglutide phase III trials and a lixisenatide/insulin glargine phase II trial have shown robust HbA1c reductions, with weight loss and a low risk of hypoglycaemia. With insulin degludec/liraglutide now approved in Europe, an important consideration will be the types of patients who may benefit most from a fixed-ratio combination; this is discussed in the present review, and we also take a look toward future developments in the field. [ABSTRACT FROM AUTHOR]

ABSTRACT The current economic crisis has had spatially differentiated impacts in both the US and Europe. A growing collection of literature investigates the determinants of the magnitude of this recession across regions. This paper aims to contribute to this literature by analysing variations in unemployment rate across European regions over the period 2004-11. In particular, we focus on two apparently neglected issues, namely labour market rigidity and the sensitivity of the local economy to the national or European business cycle. The rigidity of the labour market is increasingly viewed as a possible reason for differences among countries in terms of the performance of labour markets, although existing empirical evidence remains inconclusive. In this respect, our aim is to assess the relevance of national labour legislation, as measured by the OECD Employment Protection Legislation (EPL) Index for the performance of regional labour markets by taking advantage of the natural experiment provided by the crisis. Furthermore, for the first time in economic literature, we employ quarterly data on unemployment rate for all European regions over the period 2000-11 to construct an index of co-movement regarding regional cycles with national or European cycles, to be used as an important determinant of variation in the unemployment rate. After controlling for a number of covariates, as well as for spatial dependence in various forms, our results indicate that EPL did not affect unemployment growth over the entire period. However, we did find that regions with a low long-term unemployment rate in countries with high EPL performed better in the pre-crisis period (2004-07), whereas no effect was found during the crisis. We also found that synchronisation of the regional cycle with the national one was significant for explaining regional labour market performance. Taken together, these results denote the limited relevance of national policies and legislation for accommodating spatially differentiated shocks, whereas policies aimed at modifying local cycles may prove to be more effective. [ABSTRACT FROM AUTHOR]

Purpose: Diabetic Macular Œdema (DME) and Age‐related Macular Degeneration (nAMD) are the leading causes of vision loss in developed nations. Anti‐Vascular Endothelial Growth Factor (aVEGF) has revolutionized the treatment of both conditions, but access is limited by costs. Biosimilars of aVEGF can cut costs, but prescriber concerns over the lack of clinical data can slow uptake. This paper reports all biosimilar aVEGF in development for Europe and the USA, and pools the results of clinical confirmatory trials to provide statistically greater reassurance in the similarity of outcomes. Methods: Biosimilars in the clinical development phase were identified from US and EU trial registries. Results: There are 13 biosimilars of ranibizumab and aflibercept in final clinical comparative trial stage of development in Europe and the USA, recruiting 6126 patients. Five studies of intravitreal bevacizumab biosimilars are recruiting 772 patients. Equivalence outcomes are typically based on Best‐Corrected Visual Acuity (BCVA) with 90% confidence limits of −3 to +3 letters between reference and biosimilar medicines. Completed trials to date with 1166 participants analysed together show BCVA outcomes of ≤1 letter between Originator Reference Products and Biosimilars; for serious adverse events the risk ratio is 1.17, with 95% confidence intervals of 0.85–1.63, p = 0.32. Conclusions: Biosimilars of aVEGF are expected soon. There are likely sufficient brands expected to create meaningful price competition. To date, the EU/US regulatory pathway is delivering biosimilars with close equivalence of safety and efficacy outcomes. [ABSTRACT FROM AUTHOR]

The present debate on regional policy design to fit the Europe 2020 Agenda calls for additional reflections on the way sectoral policies, like innovation policies, can be translated appropriately into a regional setting. The paper enters the debate on smart specialization strategies by stressing the need to overcome the simplistic dichotomy between core and periphery in the Union and between an advanced 'research area' (the core) and a 'co-application area' of general purpose technologies to local technological specificities (the periphery). The geography of innovation is much more complex than a simple core-periphery model, and the logical pathway toward innovation is much more complex than the linear model of research and development-invention-innovation direct link: the innovation patterns are differentiated among regions according to their regional context conditions. The identification of specific 'innovation patterns' is necessary to design 'smart innovation' policies. The paper presents a critique to the smart specialization debate, suggests a new taxonomy of European innovative regions based on their innovation patterns, and proposes innovation policies for each regional mode of innovation. [ABSTRACT FROM AUTHOR]

This paper proposes the notion of territorial patterns of innovation as a new conceptualization to understand the relationship among knowledge, innovation, and economic growth at the regional level. The territorial patterns of innovation approach reject the simplistic view of an invention-innovation equivalence and advance alternative patterns, alternative ways in which knowledge and innovation can take place and mix in space. Each of them represents a different way of innovating, one not necessarily more efficient than the other. On the empirical ground, the paper demonstrates this statement for all NUTS2 regions of the 27 European Union states by showing that the efficiency in taking advantage of innovation does not only link to the strength of the local knowledge base; rather, territorial patterns of innovation characterized by relatively low knowledge intensity can be relatively more efficient in grasping and exploiting innovation returns for growing. Interesting policy implications can be drawn from the empirical analysis presented. If the results do not deny the importance of research and development ( R&D) activities for regional growth, and therefore the right focus put forward by the Europe 2020 on a 'smart growth' based on knowledge and innovation, they call for particular attention when the Europe 2020 goal is translated into a regional setting. [ABSTRACT FROM AUTHOR]

Aim: To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. Method: The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. Results: One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. Conclusion: To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment. [ABSTRACT FROM AUTHOR]

Introduction In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. Aim One aim of the 'Dent CPD' project ( HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. Methods Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' ( n = 143) views on compulsory topics; a paper-based questionnaire to practitioners ( n = 411); leading to a proposal discussed at the Association for Dental Education ( ADEE) 2011 Lifelong Learning special interest group ( SIG). Results From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. Conclusion Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe. [ABSTRACT FROM AUTHOR]

All the papers in this collection examine various aspects of the theory and practices of the translation system adopted by the EU institutions as an instrument to implement their policy of multilingualism. My own paper adopts an ecological perspective with a view to providing an overview of how translation, rather than being a neutral operation free of ideological implications, can seriously impact on the ecosystem of the languages involved. This is certainly the case when a translation approach neglects the resources of the target language and ignores the models of its native speakers. In this sense, translation can function as a test of language vitality and a mirror of an organisation's real commitment to multilingualism. [ABSTRACT FROM AUTHOR]

In recent years, the endogenous development ( ED) approach has gained influence within the rhetoric of European rural development policies ( RP). This paper provides a fundamental critique of the approach and shows that neither the economic elements of RP in general nor ED in particular are targeted towards the specific economic needs and capabilities of rural areas. The second part of this paper consists of the search for possible alternative concepts for a more targeted and effective RP. Based on a synopsis of existing theories, an integrated approach is proposed that builds upon the different coordination mechanisms for economic activity suggested by different theories. The new, integrated perspective enables an economic characterisation of rural areas and indicates that the successful support of local coordination of economic activity is determined by specific local conditions. It also makes evident that localised approaches usually cannot compensate rural areas for the lack of agglomeration advantages. Therefore, programmes for the economic development of rural areas which support the local coordination of economic activity remain a second-best policy. As such, they do not free the state from policies of spatial redistribution if the political aim is the creation of comparable living conditions. [ABSTRACT FROM AUTHOR]

This paper is meant to provide guidance to anyone wishing to write a neurological guideline for diagnosis or treatment, and is directed at the Scientist Panels and task forces of the European Federation of Neurological Societies ( EFNS). It substitutes the previous guidance paper from 2004. It contains several new aspects: the guidance is now based on a change of the grading system for evidence and for the resulting recommendations, and has adopted The Grading of Recommendations, Assessment, Development and Evaluation system ( GRADE). The process of grading the quality of evidence and strength of recommendations can now be improved and made more transparent. The task forces embarking on the development of a guideline must now make clearer and more transparent choices about outcomes considered most relevant when searching the literature and evaluating their findings. Thus, the outcomes chosen will be more critical, more patient-oriented and easier to translate into simple recommendations. This paper also provides updated practical recommendations for planning a guideline task force within the framework of the EFNS. Finally, this paper hopes to find the approval also by the relevant bodies of our future organization, the European Academy of Neurology. [ABSTRACT FROM AUTHOR]

Introduction In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education. Aim One aim of the 'Dent CPD' project ( HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes. Methods Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' ( n = 143) views on compulsory topics; a paper-based questionnaire to practitioners ( n = 411); leading to a proposal discussed at the Association for Dental Education ( ADEE) 2011 Lifelong Learning special interest group ( SIG). Results From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry. Conclusion Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe. [ABSTRACT FROM AUTHOR]

The economic growth literature suggests that knowledge spillovers are subject to distance decay effects. In this paper the main aim is to provide a theoretical framework and empirical evidence on the role played by other kinds of proximities, namely relational, social and technological proximity, in explaining productivity growth. Using a sample of 249 EU 27 NUTS 2 regions in the period 1990-2004, semiparametric spatial autoregressive models are estimated. Results provide evidence of a positive role of social and relational proximities as important channels of knowledge spillovers, and on the fact that, when simultaneously present, different kinds of proximities generate synergic effects on growth. Resumen La literatura sobre el crecimiento económico sugiere que los spillovers de conocimiento están sujetos a efectos de deterioro por distancia. El objetivo principal de este artículo es proporcionar un marco teórico y pruebas empíricas sobre el papel desempeñado por otros tipos de proximidades (relacional, social y tecnológica), a la hora de explicar el crecimiento de la productividad. Utilizando una muestra de 249 regiones NUTS 2 de la UE 27 para el período 1990-2004, se estiman modelos autorregresivos espaciales semiparamétricos. Los resultados aportan pruebas del papel positivo de las proximidades sociales y relacionales como canales importantes de spillovers de conocimientos, y del hecho de que, cuando se presentan simultáneamente, los diferentes tipos de proximidades generan efectos sinérgicos sobre el crecimiento. [ABSTRACT FROM AUTHOR]

Aim: To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. Method: The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. Results: One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. Conclusion: To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment. [ABSTRACT FROM AUTHOR]