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Drawing on insights from a four-day online workshop, which explored geo-engineering and policy making with 13 youth participants, an academic and youth authorial team provide a guide to the co-creation of policy briefs. Drawing on excerpts from the policy brief at different stages of development and commentary provided by the authors during the workshops, we set out four stages including (1) Identifying the key message and audience, (2) Reading and critically engaging with examples of policy briefs during the drafting process, (3) Developing the policy brief text, and (4) Reviewing and revising the policy brief. We have developed this guidance with a co-creative, group work approach in mind and suggest that this has relevance for those working in and beyond the discipline of geography.

Evaluation of interdisciplinary, team science research initiatives is an evolving and challenging field. This descriptive, longitudinal, mixed methods case study examined how an embedded, formative evaluation approach contributed to team science in the interdisciplinary Research into Policy to Enhance Physical Activity (REPOPA) project, which focused on physical activity policymaking in six European countries with divergent policy systems and researcher--policymaker networks. We assessed internal project collaboration, communication, and networking in four annual data collection cycles with REPOPA team members. Data were collected using work package team and individual interviews, and quantitative collaboration and social network questionnaires. Interviews were content analyzed; social networks among team members and with external stakeholder were examined; collaboration scores were compared across 4 years using analysis of variance (ANOVA). Annual monitoring reports with action recommendations were prepared and discussed with consortium members. Results revealed consistently high response rates. Collaboration and communication scores, high at baseline, improved slightly, but ANOVA results were nonsignificant. Internal network changes tracked closely with implementation progress. External stakeholders were primarily governmental, with a marked shift from local/provincial level to national/international during the project. Diversity (disciplinary, organizational, and geopolitical) was a project asset influencing and also challenging collaboration, implementation, and knowledge translation strategies. In conclusion, formative evaluation using an embedded, participatory approach demonstrated utility, acceptability, and researcher engagement. A trusting relationship between evaluators and other project members built on joint identification of team science objectives for the evaluation at project outset, codeveloping guiding principles, and encouraging team reflexivity throughout the evaluation.

Background There are conflicting data regarding baseline determinants of virological nonsuppression outcomes in persons with human immunodeficiency virus (HIV) starting antiretroviral treatment (ART). We evaluated the impact of different baseline variables in the RESPOND cohort. Methods We included treatment-naive participants aged ≥18 who initiated 3-drug ART, in 2014–2020. We assessed the odds of virological suppression (VS) at weeks 48 and 96 using logistic regression. Viral blips, low-level viremia (LLV), residual viremia (RV), and virological failure (VF) rates were assessed using Cox regression. Results Of 4310 eligible participants, 72% started integrase strand transfer inhibitor (INSTI)-based regimens. At 48 and 96 weeks, 91.0% and 93.3% achieved VS, respectively. At 48 weeks, Kaplan-Meier estimates of rates were 9.6% for viral blips, 2.1% for LLV, 22.2% for RV, and 2.1% for VF. Baseline HIV-1 RNA levels >100 000 copies/mL and CD4+ T-cell counts ≤200/µL were negatively associated with VS at weeks 48 (adjusted odds ratio, 0.51 [95% confidence interval,.39–.68] and.40 [.27–.58], respectively) and 96 and with significantly higher rates of blips, LLV, and RV. CD4+ T-cell counts ≤200/µL were associated with higher risk of VF (adjusted hazard ratio, 3.12 [95% confidence interval, 2.02–4.83]). Results were consistent in those starting INSTIs versus other regimens and those starting dolutegravir versus other INSTIs. Conclusions Initial high HIV-1 RNA and low CD4+ T-cell counts are associated with lower rates of VS at 48 and 96 weeks and higher rates of viral blips, LLV, and RV. Low baseline CD4+ T-cell counts are associated with higher VF rates. These associations remain with INSTI-based and specifically with dolutegravir-based regimens. These findings suggest that the impact of these baseline determinants is independent of the ART regimen initiated. [ABSTRACT FROM AUTHOR]

Background: Black patients of African descent are an ethnically diverse demographic and have unique anatomical features, aging processes, and responses to aesthetic procedures that must be considered when planning treatment. Aims: To discuss similarities and differences in the anatomy and treatment preferences of Black patients of African descent and explore how these differences may influence aesthetic practices. Patients/Methods: In support of clinicians who wish to serve a diverse patient population, a 6‐part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. Results: The results of the third roundtable in the series, the African Patient, are described here. The expertise and perspectives of African physicians, US physicians who treat African American patients, and physicians practicing within Latin America and Europe who treat patients of color (POC) of African descent are included, as well as information gleaned from injection demonstrations. Conclusions: Black African patients seek aesthetic treatment for a variety of conditions. Patients with darker skin can benefit from treatment with fillers, neurotoxins, and energy‐based devices, but the application of these approaches should take into account the unique characteristics of each individual patient and the cultural and biological influences that impact treatment outcomes. [ABSTRACT FROM AUTHOR]

The rate of urbanization in Europe is increasing rapidly. Traffic congestion has become one of the biggest challenges for cities. Additionally, thousands of people die each year in accidents on European roads. In addition, road transport is one of the biggest reasons for the increase in air pollution and greenhouse gases in Europe. To solve these problems, cooperative intelligent transport systems (C-ITS) have accelerated in Europe, after more than ten years of research and development. The European Commission has carried out significant work in this field in recent years and has prepared a strategy document for the deployment of C-ITS services in Europe. The Commission considers that C-ITS have significant potential in reducing the negative effects of road traffic and expects these systems to deploy rapidly in European cities. However, in order to achieve this, it is imperative to clearly identify the needs of cities in implementing and managing these systems, the extent to which these systems will respond to different mobility problems of the cities, and the important barriers to widespread deployment. This study focused on qualitatively examining the C-ITS deployment from the stakeholder perspective. The knowledge generated is useful to facilitate the large-scale future deployment of C-ITS. [ABSTRACT FROM AUTHOR]

Background: There is unfinished reform in primary care in Russia and other former Soviet Union (FSU) countries. The traditional 'Semashko' multi-specialty polyclinic model has been retained, while its major characteristics are increasingly questioned. The search for a new model is on a health policy agenda. It is relevant for many other countries. Objectives: In this paper, we explore the strengths and weaknesses of the multi-specialty polyclinic model currently found in Russia and other FSU countries, as well as the features of the emerging multi-disciplinary and large-scale primary care models internationally. The comparison of the two is a major research question. Health policy implications are discussed. Methods: We use data from two physicians' surveys and recent literature to identify the characteristics of multi-specialty polyclinics, indicators of their performance and the evaluation in the specific country context. The review of the literature is used to describe new primary care models internationally. Results: The Semashko polyclinic model has lost some of its original strengths due to the excessive specialization of service delivery. We demonstrate the strengths of extended practices in Western countries and conclude that FSU countries should "leapfrog" the phase of developing solo practices and build a multi-disciplinary model similar to the extended practices model in Europe. The latter may act as a 'golden mean' between the administrative dominance of the polyclinic model and the limited capacity of solo practices. The new model requires a separation of primary care and outpatient specialty care, with the transformation of polyclinics into centers of outpatient diagnostic and specialty services that become part of hospital services while working closely with primary care. Conclusion: The comprehensiveness of care in a big setting and potential economies of scale, which are major strengths of the polyclinic model, should be retained in the provision of specialty care rather than primary care. Internationally, there are lessons about the risks associated with models based on narrow specialization in caring for patients who increasingly have multiple conditions. Highlights: • The Semashko polyclinic model has lost strengths due to excessive specialization. • Solo and group PHC practices are no longer suitable to manage multimorbidity. • A new 'extended general practice' reorients the health system towards PHC. • Restructuring polyclinics is possible by transforming them into outpatient specialty units of hospital structures. [ABSTRACT FROM AUTHOR]

Introduction: Data on safety and effectiveness of RPV from the real-world setting as well as comparisons with other NNRTIs such as efavirenz (EFV) remain scarce. Methods: Participants of EuroSIDA were included if they had started a RPV- or an EFV-containing regimen over November 2011-December 2017. Statistical testing was conducted using non-parametric Mann–Whitney U test and Chi-square test. A logistic regression model was used to compare participants' characteristics by treatment group. Kaplan–Meier analysis was used to estimate the cumulative risk of virological failure (VF, two consecutive values > 50 copies/mL). Results: 1,355 PLWH who started a RPV-based regimen (11% ART-naïve), as well as 333 initiating an EFV-containing regimen were included. Participants who started RPV differed from those starting EFV for demographics (age, geographical region) and immune-virological profiles (CD4 count, HIV RNA). The cumulative risk of VF for the RPV-based group was 4.5% (95% CI 3.3–5.7%) by 2 years from starting treatment (71 total VF events). Five out of 15 (33%) with resistance data available in the RPV group showed resistance-associated mutations vs. 3/13 (23%) among those in the EFV group. Discontinuations due to intolerance/toxicity were reported for 73 (15%) of RPV- vs. 45 (30%) of EFV-treated participants (p = 0.0001). The main difference was for toxicity of central nervous system (CNS, 3% vs. 22%, p < 0.001). Conclusion: Our estimates of VF > 50 copies/mL and resistance in participants treated with RPV were similar to those reported by other studies. RPV safety profile was favourable with less frequent discontinuation due to toxicity than EFV (especially for CNS). [ABSTRACT FROM AUTHOR]

This scientific opinion focuses on the welfare of pigs on farm, and is based on literature and expert opinion. All pig categories were assessed: gilts and dry sows, farrowing and lactating sows, suckling piglets, weaners, rearing pigs and boars. The most relevant husbandry systems used in Europe are described. For each system, highly relevant welfare consequences were identified, as well as related animal‐based measures (ABMs), and hazards leading to the welfare consequences. Moreover, measures to prevent or correct the hazards and/or mitigate the welfare consequences are recommended. Recommendations are also provided on quantitative or qualitative criteria to answer specific questions on the welfare of pigs related to tail biting and related to the European Citizen's Initiative 'End the Cage Age'. For example, the AHAW Panel recommends how to mitigate group stress when dry sows and gilts are grouped immediately after weaning or in early pregnancy. Results of a comparative qualitative assessment suggested that long‐stemmed or long‐cut straw, hay or haylage is the most suitable material for nest‐building. A period of time will be needed for staff and animals to adapt to housing lactating sows and their piglets in farrowing pens (as opposed to crates) before achieving stable welfare outcomes. The panel recommends a minimum available space to the lactating sow to ensure piglet welfare (measured by live‐born piglet mortality). Among the main risk factors for tail biting are space allowance, types of flooring, air quality, health status and diet composition, while weaning age was not associated directly with tail biting in later life. The relationship between the availability of space and growth rate, lying behaviour and tail biting in rearing pigs is quantified and presented. Finally, the panel suggests a set of ABMs to use at slaughter for monitoring on‐farm welfare of cull sows and rearing pigs. [ABSTRACT FROM AUTHOR]

A detailed, well‐dated record of pollen and sedimentary ancient DNA (sedaDNA) for the period 15 000–9500 cal a bp describes changes at Lake Bolshoye Shchuchye in the Polar Ural Mountains, located far east of the classical Lateglacial sites in western Europe. Arctic tundra rapidly changed to lusher vegetation, possibly including both dwarf (Betula nana) and tree birch (B. pubescens), dated in our record to take place 14 565 cal a bp, coincident with the onset of the Bølling in western Europe; this was paralleled by increased summer temperatures. A striking feature is an early decline in Betula pollen and sedaDNA reads 300 years before the onset of the Younger Dryas (YD) in western Europe. Given the solid site chronology, this could indicate that the YD cooling started in Siberia and propagated westwards, or that the vegetation reacted to the inter‐Allerød cooling at 13 100 cal a bp and did not recover during the late Allerød. During the YD, increases in steppe taxa such as Artemisia and Chenopodiaceae suggest drier conditions. At the onset of the Holocene, the vegetation around the lake reacted fast to the warmer conditions, as seen in the increase of arboreal taxa, especially Betula, and a decrease in herbs such as Artemisia and Cyperaceae. [ABSTRACT FROM AUTHOR]

Background: Older adults with osteoarthritis (OA) often report that their disease symptoms are exacerbated by weather conditions. This study examines the association between outdoor physical activity (PA) and weather conditions in older adults from 6 European countries and assesses whether outdoor PA and weather conditions are more strongly associated in older persons with OA than in those without the condition. Methods: The American College of Rheumatology classification criteria were used to diagnose OA. Outdoor PA was assessed using the LASA Physical Activity Questionnaire. Data on weather parameters were obtained from weather stations. Results: Of the 2439 participants (65-85 years), 29.6% had OA in knee, hand and/or hip. Participants with OA spent fewer minutes in PA than participants without OA (Median = 42.9, IQR = 20.0 to 83.1 versus Median = 51.4, IQR = 23.6 to 98.6; P < .01). In the full sample, temperature (B = 1.52; P < .001) and relative humidity (B = -0.77; P < .001) were associated with PA. Temperature was more strongly associated with PA in participants without OA (B = 1.98; P < .001) than in those with the condition (B = 0.48; P = .47). Conclusions: Weather conditions are associated with outdoor PA in older adults in the general population. Outdoor PA and weather conditions were more strongly associated in older adults without OA than in their counterparts with OA. [ABSTRACT FROM AUTHOR]

Actinic keratosis (AK) is a chronic skin condition that may progress to cutaneous squamous cell carcinoma. We conducted a systematic review of efficacy and safety for key treatments for AK of the face and scalp, including the novel 5-day tirbanibulin 1% ointment. MEDLINE, PubMed, Embase, Cochrane Library, clinical trial registries and regulatory body websites were searched. The review included 46 studies, of which 35 studies included interventions commonly used in Europe and were sufficiently homogenous to inform a Bayesian network meta-analysis of complete clearance against topical placebo or vehicle. The network meta-analysis revealed the following odds ratios and 95% credible intervals: cryosurgery 13.4 (6.2–30.3); diclofenac 3% 2.9 (1.9–4.3); fluorouracil 0.5% + salicylic acid 7.6 (4.6–13.5); fluorouracil 4% 30.3 (9.1–144.7); fluorouracil 5% 35.0 (10.2–164.4); imiquimod 3.75% 8.5 (3.5–22.4); imiquimod 5% 17.9 (9.1–36.6); ingenol mebutate 0.015% 12.5 (8.1–19.9); photodynamic therapy with aminolevulinic acid 24.1 (10.9–52.8); photodynamic therapy with methyl aminolevulinate 11.7 (6.0–21.9); tirbanibulin 1% 11.1 (6.2–20.9). Four sensitivity analyses, from studies assessing efficacy after one treatment cycle only, for ≤25 cm2 treatment area, after 8 weeks post-treatment, and with single placebo/vehicle node confirmed the findings from the base case. Safety outcomes were assessed qualitatively. These results suggest that tirbanibulin 1% offers a novel treatment for AK, with a single short treatment period, favourable safety profile and efficacy, in line with existing topical treatments available in Europe. [ABSTRACT FROM AUTHOR]

Introduction: Chemsex in a European context is the use of any of the following drugs to facilitate sex: crystal methamphetamine, mephedrone and gamma‐hydroxybutyrate (GHB)/gamma‐butyrolactone (GBL) and, to a lesser extent, cocaine and ketamine. This study describes the prevalence of self‐reported recreational drug use and chemsex in HIV‐positive men who have sex with men (MSM) accessing HIV services in four countries. It also examines the problematic impacts and harms of chemsex and access to chemsex‐related services. Methods: This is a cross‐sectional multi‐centre questionnaire study of HIV‐positive MSM accessing nine HIV services in the UK, Spain, Greece and Italy. Results: In all, 1589 HIV‐positive MSM attending HIV services in four countries completed the questionnaire. The median age of participants was 38 years (interquartile range: 32–46 years) and 1525 (96.0%) were taking antiretroviral therapy (ART). In the previous 12 months, 709 (44.6%) had used recreational drugs, 382 (24.0%) reported chemsex and 104 (6.5%) reported injection of chemsex‐associated drugs ('slamsex'). Of the 382 engaging in chemsex, 155 (40.6%) reported unwanted side effects as a result of chemsex and 81 (21.2%) as a result of withdrawal from chemsex. The reported negative impacts from chemsex were on work (25.1%, 96), friends/family (24.3%, 93) and relationships (28.3%, 108). Fifty‐seven (14.9%) accessed chemsex‐related services in the past year, 38 of whom (67%) felt the service met their needs. Discussion: A quarter of participants self‐reported chemsex in the past 12 months. There were high rates of harms from chemsex across all countries, including negative impacts on work, friends/family and relationships. Although a minority of those engaging in chemsex accessed support, most found this useful. [ABSTRACT FROM AUTHOR]

Knowledge regarding the spatial behavior of the Eurasian lynx is mainly inferred from populations in Europe. We used GPS telemetry to record the spatial behavior of nine individuals in northwestern Anatolia obtaining eleven home ranges (HRs). Analyses revealed the smallest mean HR sizes (nHR♀ = 4) at 57 km2 (95% kernel utilization distribution, KUD) and 56 km2 (95% minimum convex polygon, MCP), ever reported for adult female Eurasian lynx. Adult males either occupied small permanent territories (nHR♂.T = 2), with a mean of 176 km2 (95% KUD) and 150 km2 (95% MCP), or were residents without territories (floaters, nHR♂.F = 2) roaming across large, stable HRs with a mean size of 2,419 km2 (95% KUD) and 1,888 km2 (95% MCP), comparable to HR sizes of Scandinavian lynx populations. Three disperser subadult males did not hold stable HRs (mean 95% KUD = 203 km2, mean 95% MCP = 272 km2). At 4.9 individuals per 100 km2, population density was one of the highest recorded, suggesting that the presence of adult male floaters was a consequence of a landscape fully occupied by territorials and revealing a flexibility of spatial behavior of Eurasian lynx not previously recognized. Such a high population density, small HRs, and behavioral flexibility may have been aided by the legal protection from and apparent low levels of poaching of this population. The observed spatial tactics are unlikely to be seen in most of the previously studied Eurasian lynx populations, as they either suffer medium to high levels of human‐caused mortality or were unlikely to be at carrying capacity. For effective and appropriate conservation planning, data from felid populations in a reasonably natural state such as ours, where space, density, prey, and pathogens are likely to be the key drivers of spatial dynamics, are therefore essential. [ABSTRACT FROM AUTHOR]

Aims: We aimed to assess ethnic differences in inflammatory markers and their relationships with insulin sensitivity and regional adiposity between white European and black African men. Methods: A total of 53 white European and 53 black African men underwent assessment of inflammatory markers alongside Dixon‐magnetic resonance imaging to quantify subcutaneous and visceral adipose tissue and intrahepatic lipid. A hyperinsulinaemic‐euglycaemic clamp was used to measure whole‐body and adipose tissue insulin sensitivity. To assess ethnic differences in relationships, the statistical significance of an interaction term between adipokines and ethnic group was tested in multivariable regression models. Results: The black African men exhibited significantly lower adiponectin and tumour necrosis factor‐α (TNF‐α) and greater interleukin‐10 (IL‐10) compared to white European men (all p < 0.05). There were no statistically significant ethnic differences in leptin, resistin, IL‐6, interferon‐γ, IL‐13, IL‐1β, IL‐8 and vascular endothelial growth factor. Several relationships differed significantly by ethnicity such that they were stronger in white European than black African men including IL‐6 with visceral adipose tissue; adiponectin with subcutaneous adipose tissue; leptin with intrahepatic lipid; adiponectin, IL‐6 and TNF‐α with whole‐body insulin sensitivity and TNF‐α with adipose tissue insulin sensitivity (all pinteraction <0.05). Leptin significantly predicted whole‐body insulin sensitivity in white European (R2 = 0.51) and black African (R2 = 0.29) men; however, adiponectin was a statistically significant predictor in only white European men (R2 = 0.22). Conclusions: While adiponectin is lower in black African men, its insulin sensitising effects may be greater in white men suggesting that the role of adipokines in the development of type 2 diabetes may differ by ethnicity. [ABSTRACT FROM AUTHOR]

This study compared the movement demands of players competing in matches from the elite Australian and European rugby league competitions. Methods: Global positioning system devices were used to measure 192 performances of forwards, adjustables, and outside backs during National Rugby League (NRL; n = 88) and European Super League (SL; n = 104) matches. Total and relative distances covered overall and at low (0-3.5 m/s), moderate (3.6-5 m/s), and high (>5 m/s) speeds were measured alongside changes in movement variables across the early, middle, and late phases of the season. Results: The relative distance covered in SL matches (95.8 ± 18.6 m/min) was significantly greater (P < .05) than in NRL matches (90.2 ± 8.3 m/min). Relative low-speed activity (70.3 ± 4.9 m/min vs 75.5 ± 18.9 m/min) and moderate-speed running (12.5 ± 3.3 m m/min vs 14.2 ± 3.8 m/min) were highest (P < .05) in the SL matches, and relative high-speed distance was greater (P < .05) during NRL matches (7.8 ± 2.1 m/min vs 6.1 ± 1.7 m/min). Conclusions: NRL players have better maintenance of high-speed running between the first and second halves of matches and perform less low- and moderate-speed activity, indicating that the NRL provides a higher standard of rugby league competition than the SL. [ABSTRACT FROM AUTHOR]

Background and Aim: Striving for harmonisation of specialty training and excellence of care in rheumatology, the European League Against Rheumatism (EULAR) established a task force to develop points to consider (PtCs) for the assessment of competences during rheumatology specialty training.Methods: A systematic literature review on the performance of methods for the assessment of competences in rheumatology specialty training was conducted. This was followed by focus groups in five selected countries to gather information on assessment practices and priorities. Combining the collected evidence with expert opinion, the PtCs were formulated by the multidisciplinary task force, including rheumatologists, medical educationalists, and people with rheumatic and musculoskeletal diseases. The level of agreement (LoA) for each PtC was anonymously voted online.Results: Four overarching principles and 10 PtCs were formulated. The overarching principles highlighted the importance of assessments being closely linked to the rheumatology training programme and protecting sufficient time and resources to ensure effective implementation. In the PtCs, two were related to overall assessment strategy (PtCs 1 and 5); three focused on formative assessment and portfolio (PtCs 2-4); three focused on the assessment of knowledge, skills or professionalism (PtCs 6-8); one focused on trainees at risk of failure (PtC 9); and one focused on training the trainers (PtC 10). The LoA (0-10) ranged from 8.75 to 9.9.Conclusion: These EULAR PtCs provide European guidance on assessment methods throughout rheumatology training programmes. These can be used to benchmark current practices and to develop future strategies, thereby fostering continuous improvement in rheumatology learning and, ultimately, in patient care. [ABSTRACT FROM AUTHOR]

The growing use of functional traits in ecological research has brought new insights into biodiversity responses to global environmental change. However, further progress depends on overcoming three major challenges involving (a) statistical correlations between traits, (b) phylogenetic constraints on the combination of traits possessed by any single species, and (c) spatial effects on trait structure and trait–environment relationships. Here, we introduce a new framework for quantifying trait correlations, phylogenetic constraints and spatial variability at large scales by combining openly available species' trait, occurrence and phylogenetic data with gridded, high‐resolution environmental layers and computational modelling. Our approach is suitable for use among a wide range of taxonomic groups inhabiting terrestrial, marine and freshwater habitats. We demonstrate its application using freshwater macroinvertebrate data from 35 countries in Europe. We identified a subset of available macroinvertebrate traits, corresponding to a life‐history model with axes of resistance, resilience and resource use, as relatively unaffected by correlations and phylogenetic constraints. Trait structure responded more consistently to environmental variation than taxonomic structure, regardless of location. A re‐analysis of existing data on macroinvertebrate communities of European alpine streams supported this conclusion, and demonstrated that occurrence‐based functional diversity indices are highly sensitive to the traits included in their calculation. Overall, our findings suggest that the search for quantitative trait–environment relationships using single traits or simple combinations of multiple traits is unlikely to be productive. Instead, there is a need to embrace the value of conceptual frameworks linking community responses to environmental change via traits which correspond to the axes of life‐history models. Through a novel integration of tools and databases, our flexible framework can address this need. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine whether there is an association between osteoarthritis (OA) and incident social isolation using data from the European Project on OSteoArthritis (EPOSA) study. DESIGN: Prospective, observational study with 12 to 18 months of follow‐up. SETTING: Community dwelling. PARTICIPANTS: Older people living in six European countries. MEASUREMENTS: Social isolation was assessed using the Lubben Social Network Scale and the Maastricht Social Participation Profile. Clinical OA of the hip, knee, and hand was assessed according to American College of Rheumatology criteria. Demographic characteristics, including age, sex, multijoint pain, and medical comorbidities, were assessed. RESULTS: Of the 1967 individuals with complete baseline and follow‐up data, 382 (19%) were socially isolated and 1585 were nonsocially isolated at baseline; of these individuals, 222 (13.9%) experienced social isolation during follow‐up. Using logistic regression analyses, after adjustment for age, sex, and country, four factors were significantly associated with incident social isolation: clinical OA, cognitive impairment, depression, and worse walking time. Compared to those without OA at any site or with only hand OA, clinical OA of the hip and/or knee, combined or not with hand OA, led to a 1.47 times increased risk of social isolation (95% confidence interval = 1.03‐2.09). CONCLUSION: Clinical OA, present in one or two sites of the hip and knee, or in two or three sites of the hip, knee, and hand, increased the risk of social isolation, adjusting for cognitive impairment and depression and worse walking times. Clinicians should be aware that individuals with OA may be at greater risk of social isolation. J Am Geriatr Soc 68:87–95, 2019 [ABSTRACT FROM AUTHOR]

Background: The aim of the European Youth Heart Study (EYHS) is to establish the nature, strength, and interactions between personal, environmental, and lifestyle influences on cardiovascular disease (CVD) risk factors in European children. Methods: The EYHS is an international study measuring CVD risk factors, and their associated influences, in children. Relationships between these independent factors and risk of disease will inform the design of CVD interventions in children. A minimum of 1000 boys and girls ages 9 and 15 y were recruited from four European countries—Denmark, Estonia, Norway, and Portugal. Variables measured included physical, biochemical, lifestyle, psychosocial, and sociodemographic data. Results: Of the 5664 children invited to participate, 4169 (74%) accepted. Response rates for most individual tests were moderate to high. All test protocols were well received by the children. Conclusions: EYHS protocols are valid, reliable, acceptable to children, and feasible for use in large, field-based studies. [ABSTRACT FROM AUTHOR]

Adalimumab, the first fully humanised monoclonal antibody against tumour necrosis factor alpha (TNF-α), has played a leading role in the revolution brought about by the introduction of biologics, and has received the widest range of indications among TNF-α inhibitors. Post-registration, observational and registry studies of real-life use have largely supported the outcomes seen in registrational clinical trials. With the recent loss of exclusivity for the originator medicinal product in Europe, a number of biosimilar adalimumab molecules have been licensed for use in the same indications as the originator molecule across rheumatology, dermatology, gastroenterology and ophthalmology. Clinicians in these areas first gained experience with biosimilar infliximab, followed by etanercept and rituximab. However, adalimumab is likely to present unique challenges given the numbers of patients treated and the range of biosimilar adalimumab products available. The biosimilar approval pathway has an emphasis on the pre-clinical analytic data in combination with clinical studies conducted to confirm therapeutic equivalence. To date, several adalimumab biosimilars have entered the EU market following successful marketing authorisation applications and recent expiration of originator patent protection. This overview covers the extent of use of adalimumab and summarises the regulatory process involved in the development of biosimilars as well as their use in clinical practice. The authors also discuss clinical data available so far on adalimumab biosimilars and their envisaged impact in the field of immune-mediated inflammatory diseases. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: Damage to ash trees by ash dieback caused by the emerging fungal pathogen Hymenoscyphus fraxineus is impacting people across Europe. This poses challenges to: public safety; productivity of commercial forestry; green spaces and human wellbeing; and ecosystem services and carbon sequestration. Here, we seek to quantify the impact of ash dieback on tree mortality by analyzing surveys counting the proportion of trees that have died in sites across Europe. However, more and better data are needed to inform policy makers, foresters, conservationists, and other stakeholders as they plan for a long‐term future with ash dieback. Summary: The ash dieback epidemic, caused by the fungus Hymenoscyphus fraxineus, has been present in Europe for over 20 years and caused widespread damage and mortality in ash tree (Fraxinus excelsior) populations. Ash is a major natural capital asset and plays an important role in nature's contribution to people in Europe.Here, we present a meta‐analysis of surveys of ash mortality due to ash dieback, and a time‐dependent model to estimate longer term mortality. In plantations established previous to the arrival of the epidemic, we analyze 12 surveys, finding a maximum recorded mortality of ~85%. In woodlands with exposure to ash dieback of between 4 and 20 years, we analyze 36 surveys, finding a maximum recorded mortality (which may have missed some dead trees) of ~70%. We also analyze 10 surveys of naturally regenerated saplings, finding maximum recorded mortality of ~82%. We apply logistic models to these data sets to seek longer term predictions.More data are needed before our models can be relied upon for policy decisions. If survival found so far in woodlands is due in part to heritable resistance, natural selection or a breeding program may allow future recovery of ash populations in Europe. We review surveys of ash tree death due to ash dieback in Europe and find a maximum mortality so far of 70% of trees in woodlands and 85% of trees in plantations established before the epidemic. It is still hard to predict what the long‐term outcomes will be, and more data are needed. [ABSTRACT FROM AUTHOR]

Background: Previous studies indicate that low initial sensitivity to alcohol may be a risk factor for later alcohol misuse. Evidence suggests that initial sensitivity is influenced by genetic factors, but few molecular genetic studies have been reported. Methods: We conducted a meta‐analysis of 2 population‐based genome‐wide association studies of the Self‐Rating of the Effects of Alcohol scale. Our final sample consisted of 7,339 individuals (82.3% of European descent; 59.2% female) who reported having used alcohol at least 5 times. In addition, we estimated single nucleotide polymorphism (SNP)‐based heritability and conducted a series of secondary aggregate genetic analyses. Results: No individual locus reached genome‐wide significance. Gene and set based analyses, both overall and using tissue‐specific expression data, yielded largely null results, and genes previously implicated in alcohol problems and consumption were overall not associated with initial sensitivity. Only 1 gene set, related to hormone signaling and including core clock genes, survived correction for multiple testing. A meta‐analysis of SNP‐based heritability resulted in a modest estimate of hSNP2 = 0.19 (SE = 0.10), though this was driven by 1 sample (N = 3,683, hSNP2 = 0.36, SE = 0.14, p = 0.04). No significant genetic correlations with other relevant outcomes were observed. Conclusions: Findings yielded only modest support for a genetic component underlying initial alcohol sensitivity. Results suggest that its biological underpinnings may diverge somewhat from that of other alcohol outcomes and may be related to core clock genes or other aspects of hormone signaling. Larger samples, ideally of prospectively assessed samples, are likely necessary to improve gene identification efforts and confirm the current findings. Initial sensitivity to alcohol is associated with later problematic alcohol‐related outcomes. The current study found evidence of aggregate genetic influences on initial sensitivity, though no individual SNP met genome‐wide significance criteria. Further analyses suggest that the biology of initial sensitivity may diverge from that of other alcohol outcomes. As with other complex traits, how initial sensitivity is assessed is likely critical to the identification of robust genetic signals. [ABSTRACT FROM AUTHOR]

Background: Access to formal care is not always timely and a better understanding on the impact of untimely access is needed.Objective: To examine, from a societal perspective, the impact of untimely access to formal care in terms of total costs and quality of life over one year in community dwelling people with dementia.Methods: Within the Actifcare study, needs, resource use, and quality of life were observed for one year in a cohort of 451 community dwelling people with dementia in 8 European countries. Untimely access to care was operationalized as having at least one unmet need for care identified by the Camberwell Assessment of Need for the Elderly (CANE) instrument. Two regression models were built for both total costs and quality of life measured by the EQ-5D-5L, one using sum of unmet needs and one using a predefined selection of need items.Results: Unmet needs were not associated with higher total costs but they were associated with a lower quality of life of people with dementia. Of all CANE items, only an unmet need for "company" was significantly related to lower total costs.Conclusion: Total costs did not seem to differ between participants with unmet and met needs. Only few associations between specific unmet needs and costs and quality of life were found. Furthermore, quality of life of people with dementia decreases when multiple unmet needs are experienced, indicating that assessing and meeting needs is important to improve quality of life. [ABSTRACT FROM AUTHOR]

Background: With 10.5 million people with dementia in Europe and $301 billion associated costs, governments face challenges organizing access to care.Objective: To examine the costs related to formal and informal care use and quality of life for people with dementia in eight European countries, and explore the association with unmet needs.Methods: Cross-sectional data from 451 persons with dementia and their informal caregivers of the Actifcare cohort study were obtained. Formal and informal care use was multiplied by country specific unit prices of services. Needs were measured using the CANE and health-related quality of life (HRQOL) of the person with dementia (both self- and proxy-rated) and informal caregiver's quality of life using EQ-5D-5L, ICECAP-O, DEMQOL-U, and CarerQol utility scores. The association between costs and country, European region, and unmet needs was assessed using multi-level linear regression.Results: Self-rated EQ-5D-5L utility score was higher than proxy-rated (0.84 and 0.71, respectively). Informal caregivers' utility score was 0.84. Across eight countries annual mean costs of formal and informal care were approximately € 17,000. Unmet needs were not associated with annual costs of care, nor with proxy-rated HRQOL, but were associated with self-rated HRQOL.Conclusion: We found varying relationships between unmet needs and quality of life, and no association between unmet needs and care costs, although the results were sensitive to various factors. Future research should further investigate the relation between unmet needs, quality of life and costs to generate a better understanding of the effects of (un)timely access to care. [ABSTRACT FROM AUTHOR]

Purpose: Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.Methods: Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.Results: The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.Conclusions: Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care. [ABSTRACT FROM AUTHOR]

BackgroundPrevious studies have demonstrated that several major psychiatric disorders are influenced by shared genetic factors. This shared liability may influence clinical features of a given disorder (e.g. severity, age at onset). However, findings have largely been limited to European samples; little is known about the consistency of shared genetic liability across ethnicities.MethodThe relationship between polygenic risk for several major psychiatric diagnoses and major depressive disorder (MDD) was examined in a sample of unrelated Han Chinese women. Polygenic risk scores (PRSs) were generated using European discovery samples and tested in the China, Oxford, and VCU Experimental Research on Genetic Epidemiology [CONVERGE (maximum N = 10 502)], a sample ascertained for recurrent MDD. Genetic correlations between discovery phenotypes and MDD were also assessed. In addition, within-case characteristics were examined.ResultsEuropean-based polygenic risk for several major psychiatric disorder phenotypes was significantly associated with the MDD case status in CONVERGE. Risk for clinically significant indicators (neuroticism and subjective well-being) was also associated with case–control status. The variance accounted for by PRS for both psychopathology and for well-being was similar to estimates reported for within-ethnicity comparisons in European samples. However, European-based PRS were largely unassociated with CONVERGE family history, clinical characteristics, or comorbidity.ConclusionsThe shared genetic liability across severe forms of psychopathology is largely consistent across European and Han Chinese ethnicities, with little attenuation of genetic signal relative to within-ethnicity analyses. The overall absence of associations between PRS for other disorders and within-MDD variation suggests that clinical characteristics of MDD may arise due to contributions from ethnicity-specific factors and/or pathoplasticity. [ABSTRACT FROM AUTHOR]

Fossils of juvenile Mesozoic birds provide insight into the early evolution of avian development, however such fossils are rare. The analysis of the ossification sequence in these earlybranching birds has the potential to address important questions about their comparative developmental biology and to help understand their morphological evolution and ecological differentiation. Here we report on an early juvenile enantiornithine specimen from the Early Cretaceous of Europe, which sheds new light on the osteogenesis in this most species-rich clade of Mesozoic birds. Consisting of a nearly complete skeleton, it is amongst the smallest known Mesozoic avian fossils representing post-hatching stages of development. Comparisons between this new specimen and other known early juvenile enantiornithines support a clade-wide asynchronous pattern of osteogenesis in the sternum and the vertebral column, and strongly indicate that the hatchlings of these phylogenetically basal birds varied greatly in size and tempo of skeletal maturation. [ABSTRACT FROM AUTHOR]

We have analyzed the recently developed pan-European strong motion database, RESORCE-2012: spectral parameters, such as stress drop (stress parameter, Δ σ), anelastic attenuation ( Q), near surface attenuation ( κ ) and site amplification have been estimated from observed strong motion recordings. The selected dataset exhibits a bilinear distance-dependent Q model with average κ value 0.0308 s. Strong regional variations in inelastic attenuation were also observed: frequency-independent Q of 1462 and 601 were estimated for Turkish and Italian data respectively. Due to the strong coupling between Q and κ , the regional variations in Q have strong impact on the estimation of near surface attenuation κ . κ was estimated as 0.0457 and 0.0261 s for Turkey and Italy respectively. Furthermore, a detailed analysis of the variability in estimated κ revealed significant within-station variability. The linear site amplification factors were constrained from residual analysis at each station and site-class type. Using the regional Q model and a site-class specific κ , seismic moments ( M ) and source corner frequencies f were estimated from the site corrected empirical Fourier spectra. Δ σ did not exhibit magnitude dependence. The median Δ σ value was obtained as 5.75 and 5.65 MPa from inverted and database magnitudes respectively. A comparison of response spectra from the stochastic model (derived herein) with that from (regional) ground motion prediction equations (GMPEs) suggests that the presented seismological parameters can be used to represent the corresponding seismological attributes of the regional GMPEs in a host-to-target adjustment framework. The analysis presented herein can be considered as an update of that undertaken for the previous Euro-Mediterranean strong motion database presented by Edwards and Fäh (Geophys J Int 194(2):1190-1202, 2013a). [ABSTRACT FROM AUTHOR]

Background Alcohol dependence ( AD) shows evidence for genetic liability, but genes influencing risk remain largely unidentified. Methods We conducted a genomewide association study in 706 related AD cases and 1,748 unscreened population controls from Ireland. We sought replication in 15,496 samples of European descent. We used model organisms (MOs) to assess the role of orthologous genes in ethanol (EtOH)-response behaviors. We tested 1 primate-specific gene for expression differences in case/control postmortem brain tissue. Results We detected significant association in COL6A3 and suggestive association in 2 previously implicated loci, KLF12 and RYR3. None of these signals are significant in replication. A suggestive signal in the long noncoding RNA LOC339975 is significant in case:control meta-analysis, but not in a population sample. Knockdown of a COL6A3 ortholog in Caenorhabditis elegans reduced EtOH sensitivity. Col6a3 expression correlated with handling-induced convulsions in mice. Loss of function of the KLF12 ortholog in C. elegans impaired development of acute functional tolerance (AFT). Klf12 expression correlated with locomotor activation following EtOH injection in mice. Loss of function of the RYR3 ortholog reduced EtOH sensitivity in C. elegans and rapid tolerance in Drosophila. The ryanodine receptor antagonist dantrolene reduced motivation to self-administer EtOH in rats. Expression of LOC339975 does not differ between cases and controls but is reduced in carriers of the associated rs11726136 allele in nucleus accumbens (NAc). Conclusions We detect association between AD and COL6A3, KLF12, RYR3, and LOC339975. Despite nonreplication of COL6A3, KLF12, and RYR3 signals, orthologs of these genes influence behavioral response to EtOH in MOs, suggesting potential involvement in human EtOH response and AD liability. The associated LOC339975 allele may influence gene expression in human NAc. Although the functions of long noncoding RNAs are poorly understood, there is mounting evidence implicating these genes in multiple brain functions and disorders. [ABSTRACT FROM AUTHOR]

Background: While transcatheter aortic valve implantation (TAVI) is established for treating high-operative risk surgical aortic valve replacement candidates, until recently the smallest transcatheter heart valve (THV) measured 23 mm, posing greater risk for annular rupture and THV failure in patients with aortic stenosis (AS) with small aortic annuli (≤20 mm).Objectives: In the setting of a multicentre registry, we report on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm balloon-expanding THV.Results: Among TAVI 55 recipients (n=30 for native AS, n=25 for a valve-in-valve procedure (V-in-V)), median age and Society of Thoracic Surgeons score were 85 (81 to 87) years and 7.8 (4.7 to 12.4)%, respectively. Mean and minimum annular diameters were 19±1 and 17±2 mm, respectively, in native patients with AS, and 17±1 mm (internal diameter) in V-in-V recipients. Successful device implantation rate was 96%, with no procedural-related death. Overall in-hospital-30-day death, stroke and major bleeding rates were 5%, 2% and 9%, respectively. In native AS TAVI recipients, mean transaortic gradient decreased from 54±20 to 12±5 mm Hg (p<0.001), and from 45±17 to 24±8 mm Hg (p<0.001) in V-in-V recipients. Severe prosthesis-patient mismatch (PPM) rates were 10% and 48% in native AS and V-in-V TAVI recipients, respectively (p=0.03). Post-TAVI, the rate of moderate aortic regurgitation was 7% and 0% in native AS and V-in-V TAVI recipients, respectively.Conclusions: TAVI with the 20 mm SAPIEN XT THV appears safe and technically feasible, with acceptable short-term clinical outcomes and low rates of severe PPM in those with native AS. [ABSTRACT FROM AUTHOR]

Despite the prevalence of international mergers and acquisitions (M&A) there is a dearth of studies that draw on employee accounts of how they are affected by the associated restructuring. This omission is important because of the likely role of national context in conditioning the way employees are affected by organizational change in the post-merger period and the way in which employee perceptions of a merger are likely to vary according to which party to the merger an employee worked for previously. This article addresses three questions. First, to what extent are employee perceptions of an international M&A conditioned by the national context in which they operate? Second, how do employee perceptions of an international M&A differ between those in the dominant and those in the dominated parties to the merger? Third, are these twin effects independent or interdependent? [ABSTRACT FROM AUTHOR]

Objective To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self-reported and performance-based physical function in a general population of elderly persons. Methods We studied data from 2,942 participants ages 65-85 years in the European Project on OSteoArthritis, a collaborative observational study of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcome measures included self-reported physical function of the hands measured by the AUStralian/CANadian Osteoarthritis Hand Index (AUSCAN) for hand OA physical function subscale and performance-based grip strength measured using a strain gauge dynamometer. Results Comorbidity was not a confounder in the association of hand OA with self-reported and performance-based functional limitations, while the role of pain as a mediator was confirmed. Anxiety, depression, stroke, and osteoporosis were associated with AUSCAN scores reflecting more impairment. Depression and osteoporosis were associated with less grip strength. Conclusion Although comorbidity was decidedly and independently associated with hand functional limitation, it had no effect on the relationship of hand OA with physical function. Hand OA was found to be associated with both self-reported and performance-based physical function impairment; the association was found to be partially mediated by pain, which reduced its impact. [ABSTRACT FROM AUTHOR]

The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases convened a task force of experts in rheumatoid arthritis (RA) and clinical trial methodology to comment on the new draft 'Guideline on clinical investigation of medicinal products for the treatment of RA' released by the European Medicines Agency (EMA). Special emphasis was placed by the group on the development of new drugs for the treatment of early RA. In the absence of a clear definition of early RA, it was suggested that clinical investigations in this condition were conducted in disease-modifying antirheumatic drugs naïve patients with no more than 1 year disease duration. The expert group recommended using an appropriate improvement in disease activity (American College of Rheumatology (ACR) or Simplified/Clinical Disease Activity Index (SDAI/CDAI) response criteria) or low disease activity (by any score) as primary endpoints, with ACR/European League Against Rheumatism remission as a secondary endpoint. Finally, as compelling evidence showed that the Disease Acrivity Score using 28-joint counts (DAS28) might not provide a reliable definition of remission, or sometimes even low disease activity, the group suggested replacing DAS28 as a measurement instrument to evaluate disease activity in RA clinical trials. Proposed alternatives included SDAI, CDAI and Boolean criteria. [ABSTRACT FROM AUTHOR]

Background: Knowledge about influenza transmission in the workplace and whether staying home from work when experiencing influenza-like illness can reduce the spread of influenza is crucial for the design of efficient public health initiatives. Aim: This review synthesizes current literature on sickness presenteeism and influenza transmission in the workplace and provides an overview of sick leave recommendations in Europe for influenza. Methods: A search was performed on Medline, Embase, PsychINFO, Cinahl, Web of Science, Scopus and SweMed to identify studies related to workplace contacts, -transmission, -interventions and compliance with recommendations to take sick leave. A web-based survey on national recommendations and policies for sick leave during influenza was issued to 31 European countries. Results: Twenty-two articles (9 surveys; 13 modelling articles) were eligible for this review. Results from social mixing studies suggest that 20-25% of weekly contacts are made in the workplace, while modelling studies suggest that on average 16% (range 9-33%) of influenza transmission occurs in the workplace. The effectiveness of interventions to reduce workplace presenteeism is largely unknown. Finally, estimates from studies reporting expected compliance with sick leave recommendations ranged from 71 to 95%. Overall, 18 countries participated in the survey of which nine (50%) had issued recommendations encouraging sick employees to stay at home during the 2009 A(H1N1) pandemic, while only one country had official recommendations for seasonal influenza. Conclusions: During the 2009 A(H1N1) pandemic, many European countries recommended ill employees to take sick leave. Further research is warranted to quantify the effect of reduced presenteeism during influenza illness. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self-reported as well as performance-based functional limitations in a general elderly population.Methods: We analyzed the data of 2,942 individuals, ages between 65 and 85 years, who participated in the European Project on Osteoarthritis, which was made up of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcomes included self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the participants' performance-based physical function was evaluated using the walking test.Results: While comorbidity did not affect the significant association between hip/knee OA and physical function limitations found in the participants, pain reduced the effect of OA on self-reported physical function, and it cancelled the effect of OA on the walking test. Obesity, anxiety, depression, and cardiovascular diseases were associated with the worst WOMAC scores. Obesity, cognitive impairment, depression, peripheral artery disease, and stroke were associated with the worst walking times.Conclusion: These findings demonstrate that while comorbidity is strongly and independently associated with functional limitations, it does not affect the OA-physical function association. Hip/knee OA is associated with self-reported impairment in physical function, which was only partially mediated by pain. Its association with physical function, as evaluated by the walking test, was instead completely mediated by pain. [ABSTRACT FROM AUTHOR]

Introduction: Terrorists have used the explosive device successfully globally, with their effects extending beyond the resulting injuries. Suicide bombings, in particular, are being increasingly deployed due to the devastating effect of a combination of high lethality and target accuracy. The aim of this study was to identify trends and analyse the demographics and casualty figures of terrorist bombings worldwide.Methods: Analysis of the Global Terrorism Database (GTD) and a PubMed/Embase literature search (keywords "terrorist", and/or "suicide", and/or "bombing") from 1970 to 2014 was performed.Results: 58,095 terrorist explosions worldwide were identified in the GTD. 5.08% were suicide bombings. Incidents per year are increasing (P<0.01). Mean casualty statistics per incidents was 1.14 deaths and 3.45 wounded from non-suicide incidents, and 10.16 and 24.16 from suicide bombings (p<0.05). The kill:wounded ratio was statistically higher in suicide attacks than non-suicide attacks, 1:1.3 and 1:1.24 respectively (p<0.05). The Middle East witnessed the most incidents (26.9%), with Europe (13.2%) ranked 4th. The literature search identified 41 publications reporting 167 incidents of which 3.9% detailed building collapse (BC), 60.8% confined space (CS), 23.5% open space (OS) and 11.8% semi-confined space (SC) attacks. 60.4% reported on suicide terrorist attacks. Overall 32 deaths and 180 injuries per incident were seen, however significantly more deaths occurred in explosions associated with a BC. Comparing OS and CS no difference in the deaths per incident was seen, 14.2(SD±17.828) and 15.63 (SD±10.071) respectively. However OS explosions resulted in significantly more injuries, 192.7 (SD±141.147), compared to CS, 79.20 (SD±59.8). Extremity related wounds were the commonest injuries seen (32%).Discussion/conclusion: Terrorist bombings continue to be a threat and are increasing particularly in the Middle East. Initial reports, generated immediately at the scene by experienced coordination, on the type of detonation (suicide versus non-suicide), the environment of detonation (confined, open, building collapse) and the number of fatalities, and utilising the Kill:Wounded ratios found in this meta-analysis, can be used to predict the number of casualties and their likely injury profile of survivors to guide the immediate response by the medical services and the workload in the coming days. [ABSTRACT FROM AUTHOR]

Objective: To investigate patterns of physical activity in older adults with knee osteoarthritis (OA) compared to older adults without knee OA across 6 European countries. We expect country-specific differences in the physical activity levels between persons with knee OA compared to persons without knee OA. A varying degree of physical activity levels across countries would express a facilitating or impeding influence of the social, environmental, and other contextual factors on a physically active lifestyle.Methods: Baseline cross-sectional data from the European Project on Osteoarthritis were analyzed. In total, 2,551 participants from 6 European countries (Germany, Italy, The Netherlands, Spain, Sweden, and the UK) were included.Results: Participants with knee OA were less likely to follow physical activity recommendations and had poorer overall physical activity profiles than those without knee OA (mean 62.9 versus 81.5 minutes/day, respectively; P = 0.015). The magnitude of this difference varied across countries. Detailed analysis showed that low physical activity levels in persons with knee OA could be attributed to less everyday walking time (odds ratio 1.31, 95% confidence interval 1.07-1.62).Conclusion: This study highlighted the fact that having knee OA is associated with a varying degree of physical activity patterns in different countries. This national variation implies that low levels of physical activity among persons with knee OA cannot be explained exclusively by individual or disease-specific factors, but that social, environmental, and other contextual factors should also be taken into account. [ABSTRACT FROM AUTHOR]

Anaerobic digestion (AD) of biomass has become a common technology used in many European nations and is receiving increased attention in other nations. The chief attraction of AD is it generates renewable energy. Yet it also manages and treats organic waste, recycles key nutrients to soil, and can create local jobs; making AD an attractive technology to governments. In this paper we review the role government policy has played in promoting AD use and driving its growth in five developed nations studied; Australia, Denmark, Germany, the UK and USA. These nations were chosen for review as they provide a breadth of AD use with the number of AD plants in the aforementioned nations totaling 78, 114, 9545, 265, and 1497. This review looks to demonstrate and discuss policy mechanisms introduced by each nation that has helped drive AD use, and identify areas where policy can help overcome enduring challenges that face the AD industry. Focused discussion is given to waste management, climate change and energy security policies, and to financial incentives made available to AD installations. Analysis shows that the impact of performance based incentives targeted at small-medium capacity AD plants, less than 500 kW, have a significant positive correlation with the growth of AD use in the UK and Germany. The relatively new AD industry faces a number of barriers, which are also discussed, but with the help of supportive government policy for the technology, that considers the wide-ranging benefits of AD across government portfolios; investors will be more likely to show interest in the developing AD industry. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project.Methods: Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates.Results: The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints.Conclusions: Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management. [ABSTRACT FROM AUTHOR]

Greenland Stadial 1 (GS-1) was the last of a long series of severe cooling episodes in the Northern Hemisphere during the last glacial period. Numerous North Atlantic and European records reveal the intense environmental impact of that stadial, whose origin is attributed to an intense weakening of the Atlantic Meridional Overturning Circulation in response tofreshening of the North Atlantic. Recent high-resolution studies of European lakes revealed a mid-GS-1 transition in the climatic regimes. The geographical extension of such atmospheric changes and their potential coupling with ocean dynamics still remains unclear. Here we use a subdecadally resolved stalagmite record from the Northern Iberian Peninsula tofurther investigate the timing and forcing of this transition. A solid interpretation of the environmental changes detected in this new, accurately dated, stalagmite record is based on a parallel cave monitoring exercise. This record reveals a gradual transition from dry to wet conditions starting at 12,500 y before 2000 A.D. in parallel to a progressive warming of the subtropical Atlantic Ocean. The observed atmospheric changes are proposed to be led by a progressive resumption of the North Atlantic convection and highlight the complex regional signature of GS-1, very distinctive from previous stadial events. [ABSTRACT FROM AUTHOR]