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The long-run U-shaped patterns of economic inequality are standardly explained by basic economic trends (Piketty's r > g), taxation policies or 'great levellers' such as catastrophes. This article argues that housing policy, and particularly rent control, is a neglected explanatory factor in understanding macro inequality. We hypothesize that rent control could decrease overall housing wealth, lower incomes of generally richer landlords and increase disposable incomes of generally poorer tenants. Using original long-run data for up to 16 countries (1900–2016), we show that rent controls lowered wealth-to-income ratios, top income shares, Gini coefficients, rents and rental expenditure. Overall, rent controls need to be strict in order to have tangible effects, and only the stricter historical rent controls did significantly reduce inequalities. The study argues that housing policies should generally receive more attention in understanding economic inequalities. [ABSTRACT FROM AUTHOR]

With the current expansion of vector-based research and an increasing number of facilities rearing arthropod vectors and infecting them with pathogens, common measures for containment of arthropods as well as manipulation of pathogens are becoming essential for the design and running of such research facilities to ensure safe work and reproducibility, without compromising experimental feasibility. These guidelines and comments were written by experts of the Infravec2 consortium, a Horizon 2020-funded consortium integrating the most sophisticated European infrastructures for research on arthropod vectors of human and animal diseases. They reflect current good practice across European laboratories with experience of safely handling different mosquito species and the pathogens they transmit. As such, they provide experience-based advice to assess and manage the risks to work safely with mosquitoes and the pathogens they transmit. This document can also form the basis for research with other arthropods, for example, midges, ticks or sandflies, with some modification to reflect specific requirements. [ABSTRACT FROM AUTHOR]

Aerosols influence the Earth's energy balance directly by modifying the radiation transfer and indirectly by altering the cloud microphysics. Anthropogenic aerosol emissions dropped considerably when the global COVID-19 pandemic resulted in severe restraints on mobility, production, and public life in spring 2020. We assess the effects of these reduced emissions on direct and indirect aerosol radiative forcing over Europe, excluding contributions from contrails. We simulate the atmospheric composition with the ECHAM5/MESSy Atmospheric Chemistry (EMAC) model in a baseline (business-as-usual) and a reduced emission scenario. The model results are compared to aircraft observations from the BLUESKY aircraft campaign performed in May–June 2020 over Europe. The model agrees well with most of the observations, except for sulfur dioxide, particulate sulfate, and nitrate in the upper troposphere, likely due to a biased representation of stratospheric aerosol chemistry and missing information about volcanic eruptions. The comparison with a baseline scenario shows that the largest relative differences for tracers and aerosols are found in the upper troposphere, around the aircraft cruise altitude, due to the reduced aircraft emissions, while the largest absolute changes are present at the surface. We also find an increase in all-sky shortwave radiation of 0.21 ± 0.05 Wm-2 at the surface in Europe for May 2020, solely attributable to the direct aerosol effect, which is dominated by decreased aerosol scattering of sunlight, followed by reduced aerosol absorption caused by lower concentrations of inorganic and black carbon aerosols in the troposphere. A further increase in shortwave radiation from aerosol indirect effects was found to be much smaller than its variability. Impacts on ice crystal concentrations, cloud droplet number concentrations, and effective crystal radii are found to be negligible. [ABSTRACT FROM AUTHOR]

This paper argues that the binary opposition in the treatment of hate speech in the US and Europe hides non-binary preoccupations that reflect different primary fears which do not fall along the same 'scale'. European liberal democracies fear the consequences of hate speech being left uncensored in the public domain (a WHAT concern) whilst America fears the consequences of content interventions by government (a WHO concern). The paper then proposes that the German Network Enforcement Law of 2017 builds a bridge between American and European speech traditions. NetzDG requires major platforms to moderate content in response to user takedown notices based on legally imposed speech standards. The mechanism of public standards being enforced through private processes is arguably uniquely adept at simultaneously assuaging the primary European fear about the absence of effective speech controls in the public domain and the primary American fear about the presence of governmental censorship. [ABSTRACT FROM AUTHOR]

Background: Rare Eye Diseases (RED) are the leading cause of visual impairment and blindness for children and young adults in Europe. This heterogeneous group of conditions includes over 900 disorders ranging from relatively prevalent disorders such as retinitis pigmentosa to very rare entities such as developmental eye anomalies. A significant number of patients with RED have an underlying genetic etiology. One of the aims of the European Reference Network for Rare Eye Diseases (ERN-EYE) is to facilitate improvement in diagnosis of RED in European member states.Main Body: Technological advances have allowed genetic and genomic testing for RED. The outcome of genetic testing allows better understanding of the condition and allows reproductive and therapeutic options. The increase of the number of clinical trials for RED has provided urgency for genetic testing in RED. A survey of countries participating in ERN-EYE demonstrated that the majority are able to access some forms of genomic testing. However, there is significant variability, particularly regarding testing as part of clinical service. Some countries have a well-delineated rare disease pathway and have a national plan for rare diseases combined or not with a national plan for genomics in medicine. In other countries, there is a well-established organization of genetic centres that offer reimbursed genomic testing of RED and other rare diseases. Clinicians often rely upon research-funded laboratories or private companies. Notably, some member states rely on cross-border testing by way of an academic research project. Consequently, many clinicians are either unable to access testing or are confronted with long turnaround times. Overall, while the cost of sequencing has dropped, the cumulative cost of a genomic testing service for populations remains considerable. Importantly, the majority of countries reported healthcare budgets that limit testing.Short Conclusion: Despite technological advances, critical gaps in genomic testing remain in Europe, especially in smaller countries where no formal genomic testing pathways exist. Even within larger countries, the existing arrangements are insufficient to meet the demand and to ensure access. ERN-EYE promotes access to genetic testing in RED and emphasizes the clinical need and relevance of genetic testing in RED. [ABSTRACT FROM AUTHOR]

Many ephemeral mudflat species, which rely on a soil seed bank to build up the next generation, are endangered in their natural habitat due to the widespread regulation of rivers. The aim of the present study was to elucidate the role of the soil seed bank and dispersal for the maintenance of genetic diversity in populations of near‐natural river habitats and anthropogenic habitats created by traditional fish farming practices using Cyperus fuscus as a model. Using microsatellite markers, we found no difference in genetic diversity levels between soil seed bank and above‐ground population and only moderate differentiation between the two fractions. One possible interpretation is the difference in short‐term selection during germination under specific conditions (glasshouse versus field) resulting in an ecological filtering of genotypes out of the reservoir in the soil. River populations harbored significantly more genetic diversity than populations from the anthropogenic pond types. We suggest that altered levels and patterns of dispersal together with stronger selection pressures and historical bottlenecks in anthropogenic habitats are responsible for the observed reduction in genetic diversity. Dispersal is also supposed to largely prohibit genetic structure across Europe, although there is a gradient in private allelic richness from southern Europe (high values) to northern, especially north‐western, Europe (low values), which probably relates to postglacial expansion out of southern and/or eastern refugia. [ABSTRACT FROM AUTHOR]

Almost three decades ago, a paradigm change in funding policies for rural regions took effect in Europe and Germany involving a move towards cooperative, actor-oriented regional development. Although meanwhile a large number of elaborated evaluations of different types on the effects of programmes for regional development was provided in particular, the results of impact evaluations do not allow distinct conclusions if the programmes have the intended impacts on the economic and demographic development of the German regions. Presented here is the first impact evaluation for Germany - if not for Europe - comprising projects and competitions from various policy fields of regional development, covering 27 programmes in five policy fields in the period from 1991 to 2016. Although the number of programmes and not the amount of funding gional development policies in a multi-level political system has emerged. Measures to develop business-support infrastructures and trade investments, e.g. ERDF (European Regional Development Fund), are completed by increasing supportive instruments like regional cooperation, networking and management structures. However, the funding is remote from classic development programmes. The basic theoretical framework behind this paradigm shift is provided by the concepts of "relational economic geography" (Bathelt, Glückler 2002), which focuses more on the institutional context of a space and interactions between actors than classical regional-economic approaches. The theoretical stringency of these concepts and their empirical underpinnings are, however, the subject of dispute within economic geography (Schätzl 2003: 243). The effectiveness of these was analysed, the results serve to strengthen doubts about the effectiveness of the regional development programmes. In any case, a simple accumulation of a large number of funded regional development activities does not have measurable effects on the demographic and economic evolution of the regions. [ABSTRACT FROM AUTHOR]

Objectives: To elucidate the genome-based epidemiology and phylogenomics of azithromycin-resistant (MIC >2 mg/L) Neisseria gonorrhoeae strains collected in 2009-14 in Europe and clarify the azithromycin resistance mechanisms.Methods: Seventy-five azithromycin-resistant (MIC 4 to >256 mg/L) N. gonorrhoeae isolates collected in 17 European countries during 2009-14 were examined using antimicrobial susceptibility testing and WGS.Results: Thirty-six N. gonorrhoeae multi-antigen sequence typing STs and five phylogenomic clades, including 4-22 isolates from several countries per clade, were identified. The azithromycin target mutation A2059G (Escherichia coli numbering) was found in all four alleles of the 23S rRNA gene in all isolates with high-level azithromycin resistance (n = 4; MIC ≥256 mg/L). The C2611T mutation was identified in two to four alleles of the 23S rRNA gene in the remaining 71 isolates. Mutations in mtrR and its promoter were identified in 43 isolates, comprising isolates within the whole azithromycin MIC range. No mutations associated with azithromycin resistance were found in the rplD gene or the rplV gene and none of the macrolide resistance-associated genes [mef(A/E), ere(A), ere(B), erm(A), erm(B), erm(C) and erm(F)] were identified in any isolate.Conclusions: Clonal spread of relatively few N. gonorrhoeae strains accounts for the majority of the azithromycin resistance (MIC >2 mg/L) in Europe. The four isolates with high-level resistance to azithromycin (MIC ≥256 mg/L) were widely separated in the phylogenomic tree and did not belong to any of the main clades. The main azithromycin resistance mechanisms were the A2059G mutation (high-level resistance) and the C2611T mutation (low- and moderate-level resistance) in the 23S rRNA gene. [ABSTRACT FROM AUTHOR]

Purpose: Due to the juvenility of research in the field of periprosthetic joint infection (PJI), approaches employed for diagnosis of PJI vary amongst surgeons in different geographic regions. The aim of this study was to determine common diagnostic approaches utilized by European knee arthroplasty surgeons for the diagnosis of PJI.Methods: A task force was established for questionnaire development, consisting of surgeons and clinical researchers who each had a record of publishing in the field of PJI. A pool of items was initially generated from a Medline literature search. These were organized into a file and independently sent to each task force member for evaluation and additional supplementation. After reaching a consensus, a final online version was generated and administered to all 4865 members of the "European Society of Sports Traumatology Knee Surgery & Arthroscopy".Results: There were 262 respondents between August 2015 and March 2016. Most European surgeons (41.1 %) diagnose between 2 and 5 PJIs yearly, and only 5.8 % diagnose >30 PJIs per year. Serum tests to rule out infection were commonly CRP (97.7 %), leucocyte count (73.6 %) and microbiology cultures (45.3 %), while serum interleukins were least common (<5 %). Synovial fluid exams most commonly included microbiology (97.7 %), leucocyte count (74.8 %), percentage polymorphonuclear cells (65.8 %), synovial fluid CRP (26.4 %) and α-defensin (19.4 %). Conventional radiographs represent the most common radiographic exam (87.6 %) followed by SPECT-CT scans (41.7 %). The majority (93.6 %) take biopsies at the time of surgery, 62.0 % take 1-5 biopsies, and 34.9 % take >5. Most biopsies (98.8 %) are sent for culture exams and 72.5 % for histology, and 36.4 % of surgeons send the implants for sonication.Conclusion: Microbiology and cell count remain the most commonly applied synovial fluid tests in Europe, while α-defensin and leucocyte esterase are currently less common. Serum interleukins have not gained widespread use. Implant sonication, despite evidence of diagnostic effectiveness, was only applied by one-third of survey respondents, highlighting the problematic issues of cost and accessibility of some tools. The results highlight the current state of European diagnostic practice, emphasizing the areas of divergence from state of evidence and demonstrating the need for development of standard diagnostic algorithms.Level Of Evidence: Cross-sectional survey, Level IV. [ABSTRACT FROM AUTHOR]

Background: Since 1996, genetically modified (GM) crops have been grown on an ever increasing area worldwide. Maize producing a Cry protein from the bacterium Bacillus thuringiensis (Bt) was among the first GM crops released for commercial production and it is the only GM crop currently cultivated in Europe. A major part of the regulatory process that precedes the commercial release of GM crops is the environmental risk assessment. Because Bt maize is modified to produce insecticidal proteins, potential interactions with non-target organisms are a major area of concern to be addressed in the risk assessment. In particular, beneficial arthropods that provide important agro-ecological services, such as pollination, decomposition, and biological control are the focus. This systematic review will evaluate if the growing of Bt maize changes abundance or ecological function of non-target animals compared to the growing of conventional, non-GM maize. The review will be limited to plot or field level data including field margins. Potential cropping system effects and off-field effects will not be addressed. Bt maize will be compared to conventional maize either untreated or treated with chemical insecticides. Methods: Stakeholders from academia, competent authorities, industry, and civil society organizations were given the opportunity to comment on the review question and an earlier draft of this review protocol. Keyword searches will be conducted in a range of abstracting and full text literature databases. Retrieved records will be screened against a set of inclusion criteria, first on title and abstract level, then on full text level. Selected studies will be evaluated for risks of bias (quality assessment). Data on field/plot characteristics, maize cultivars, insecticide treatments, non-target animal taxa, sampling methods, and response variables of populations and ecological functions will be extracted. Meta-analysis will be conducted using the effect size estimator Hedge's d on a range of comparisons and including sensitivity analysis. The review process will be fully documented in CADIMA, an open access online data portal for evidence synthesis. [ABSTRACT FROM AUTHOR]

Abstract: Background: The results of pediatric renal transplantation have improved markedly in the last decade. However, a number of relevant clinical problems remain, such as organ damage caused by chronic rejection, long-term toxicity of immunosuppressive therapy, difficulty in developing tolerance-inducing protocols, secondary cardiovascular comorbidity, post-transplantation lymphoproliferative disease, suboptimal longitudinal growth, quality of life, adherence to immunosuppressive medication, and structured transition programs to adult care. These unmet clinical needs require intense collaborative and interdisciplinary clinical research. We recently founded the Cooperative European Paediatric Renal TransplAnt INitiative (CERTAIN; www.certain-registry.eu) as a research network and platform built on a novel, web-based registry. Results: The registry's dataset provides essential information on generic kidney transplantation-related topics and also captures pediatric-specific topics, such as growth, physical and psychosocial development, and adherence. Due to its flexibility the system can be used as follows: (1) as a registry capturing a minimal or an extended dataset; (2) as a center and/or country-specific transplantation database; or (3) as a patient-specific electronic transplantation chart. The data can be exported directly from the CERTAIN web application into statistical software packages for scientific analyses. The rights regarding data ownership, evaluation, and publications are regulated in the registry's rules of procedure. Data quality is ensured by automatic software validation and a manual data review process. To avoid redundant data entry, CERTAIN has established interfaces for data change with Eurotransplant, the Collaborative Transplant Study (CTS), and the registry of the European Society of Pediatric Nephrology (ESPN) and European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) (ESPN/ERA-EDTA registry). CERTAIN fulfils all regulatory and ethical requirements of the European Union and Germany, in particular, regarding patients' data privacy and security. Conclusion: Using modern information technology, the recently established multinational CERTAIN Registry fills a gap in Europe for collaborative 5research and quality assurance in the field of pediatric renal transplantation. [Copyright &y& Elsevier]

In this article we analyse the relationship between the institutional set-up of healthcare systems and patterns of public support. Two dimensions are distinguished, namely, state responsibility for healthcare provision and satisfaction with healthcare systems. Using data on 14 European countries from the Eurobarometer survey, we find only small effects of institutional indicators on preferences for a strong role of the state. Almost everywhere in Europe, there is high public support for state responsibility in healthcare. Satisfaction with the healthcare system, in contrast, is more strongly related to specific institutional arrangements. In healthcare systems with lower levels of expenditure, fewer general practitioners and higher co-payments, the overall level of satisfaction is lower. This is especially the case in Southern Europe where more pronounced differences between social groups also become apparent. In contrast, healthcare systems with a long tradition of comprehensive coverage regardless of occupation or income seem to generate rather homogenous attitudinal patterns. These characteristics hold for the Scandinavian systems and for the British National Health Service, and therefore, these healthcare systems still seem to live up to the promise of treating all members of the society equally. Countries with high levels of expenditure, high density of general practitioners, and free choice of doctors, which is mainly the case in Social Health Insurance systems, finally, show the highest levels of satisfaction but also more pronounced differences between social classes. [ABSTRACT FROM PUBLISHER]

The aim of this study was to describe the development and implementation of a multifaceted, low-fat, weight-loss strategy for a Pan-European randomized controlled dietary intervention study, Diogenes. There were 891 families with at least one overweight/obese parent who underwent screening. Eligible, overweight/obese adults followed an 8-week weight-loss phase with a fixed low-energy diet (800 kcal). On attaining weight loss of ≥8%, families were randomized to a 6- or 12-month low-fat (25–30%E) diet either based on national dietary guidelines or one of four interventions: low protein (LP)/low glycaemic index (LGI), LP/high GI (HGI), high protein (HP)/LGI and HP/HGI. The impact of each diet in preventing weight (re)gain was tested. A points-based system was used to manipulate dietary protein and carbohydrate. Manipulating carbohydrate composition involved substituting foods with a relatively high or low GI. A questionnaire was designed and completed by study investigators, providing feedback on the dietary intervention methods used to inform future interventions. The points system allowed macronutrient manipulations without compromising dietary flexibility or enforcing energy restrictions. Reported centre/participant differences in the ease of implementing the intervention may reflect dietary diversity and personal preferences for specific weight-management strategies. The points system provides a useful starting point for designing improved experimental paradigms for the manipulation of dietary intake in future trials. [ABSTRACT FROM AUTHOR]

There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly consumed carbohydrate-rich foods in European countries. A new methodology has been developed for consistent assignment of GI values to foods across five European databases used in the Diogenes intervention study. GI values were assigned according to five decreasing levels of confidence (1) Measured values for specific foods; (2) Published values from published sources; (3) Equivalent values where published values for similar foods existed; (4) Estimated values assigned as one of three values representing low/medium/high GI ranges and (5) Nominal values assigned as 70, where no other value could be assigned with sufficient confidence. GI values were assigned to 5105 foods. In food records collected at baseline, the contribution to carbohydrate intake of foods assigned levels 1–2 ranged from 16% to 43% depending on country, and this increased to 53–81% including level 3 foods. The degree of confidence to assigned GI values differed across Europe. This standardized approach of assigning GI values will be made available to other researchers to facilitate further investigation into the effects of dietary GI on health. [ABSTRACT FROM AUTHOR]

The article presents abstracts on topics related to Buddhism which include the similarities between the Buddhist philosophy and quantum physics, the significance of contemporary Buddhist memoirs to the investigation of the phenomena of modern Buddhism, and the historical aspects of the introduction of Buddhism in Europe.

The transformation of formerly socialist countries in Central and Eastern Europe presented trade unions with an enormous challenge. Their status as mass organizations with a clearly defined mandate from the state suddenly disappeared in 1989 / 90. The first restructuring phase in the 1990s was characterized by introduction of the market economy, competition, privatization, start-up companies, and job cuts, and, in association with this, the unions were compelled to engage in social dialogue with governments and employers in order to renegotiate working conditions and pay. In addition, countries in the region were required to transpose Community law (acquis communautaire) and to integrate into transnational contexts in the run-up to EU accession. This two-pronged pressure to modernize stretched labor organizations' ability to adapt and innovate in the extreme. They had to build up new structures of industrial relations in a short period of time — something that had taken Western Europe decades to develop. This led to differences in union structures and capacity-building, and to different outcomes of their distributional and representational policies. [ABSTRACT FROM AUTHOR]

ABSTRACT A European panel of physicians reviewed the current treatments and perceptions of recurrent genital herpes (GH) across the continent. The panel consisted of specialists in dermatology and venereology from France, Finland, Germany, Italy, Norway, Spain, Sweden and the UK. A wide variety of factors that influence GH management were considered, including different health delivery systems, funding and cultural differences. The poor awareness of GH among both the general public and physicians was highlighted. The effectiveness of GH management was then examined from a patient's viewpoint, including the confirmation of the diagnosis, information and counselling about GH, as well as prescriptions for treatment. It was agreed that both physicians and patients often feel uncomfortable about discussing the disease, and that a European-wide effort is needed to re-educate patients and physicians about GH. The panel identified clear and unmet needs to manage a patient with clinical recurrences and to attempt to reduce the risk of GH transmission. Finally, resiquimod, an immune response modifier, was considered as a potential treatment option for GH. [ABSTRACT FROM AUTHOR]

Biting midges (Culicoides species) are vectors of arboviruses and were responsible for the emergence and spread of Schmallenberg virus (SBV) in Europe in 2011 and are likely to be involved in the emergence of other arboviruses in Europe. Improved surveillance and better understanding of risks require a better understanding of the circulating viral diversity in these biting insects. In this study, we expand the sequence space of RNA viruses by identifying a number of novel RNA viruses from Culicoides impunctatus (biting midge) using a meta-transcriptomic approach. A novel metaviromic pipeline called MetaViC was developed specifically to identify novel virus sequence signatures from high throughput sequencing (HTS) datasets in the absence of a known host genome. MetaViC is a protein centric pipeline that looks for specific protein signatures in the reads and contigs generated as part of the pipeline. Several novel viruses, including an alphanodavirus with both segments, a novel relative of the Hubei sobemo-like virus 49, two rhabdo-like viruses and a chuvirus, were identified in the Scottish midge samples. The newly identified viruses were found to be phylogenetically distinct to those previous known. These findings expand our current knowledge of viral diversity in arthropods and especially in these understudied disease vectors. [ABSTRACT FROM AUTHOR]

Background: Confidence in any diagnostic and antimicrobial susceptibility testing data is provided by appropriate and regular quality assurance (QA) procedures. In Europe, the European Gonococcal Antimicrobial Susceptibility Programme (Euro-GASP) has been monitoring the antimicrobial susceptibility in Neisseria gonorrhoeae since 2004. Euro-GASP includes an external quality assessment (EQA) scheme as an essential component for a quality-assured laboratory-based surveillance programme. Participation in the EQA scheme enables any problems with the performed antimicrobial susceptibility testing to be identified and addressed, feeds into the curricula of laboratory training organised by the Euro-GASP network, and assesses the capacity of individual laboratories to detect emerging new, rare and increasing antimicrobial resistance phenotypes. Participant performance in the Euro-GASP EQA scheme over a 10 year period (2007 to 2016, no EQA in 2013) was evaluated.Methods: Antimicrobial susceptibility category and MIC results from the first 5 years (2007-2011) of the Euro-GASP EQA were compared with the latter 5 years (2012-2016). These time periods were selected to assess the impact of the 2012 European Union case definitions for the reporting of antimicrobial susceptibility.Results: Antimicrobial susceptibility category agreement in each year was ≥91%. Discrepancies in susceptibility categories were generally because the MICs for EQA panel isolates were on or very close to the susceptibility or resistance breakpoints. A high proportion of isolates tested over the 10 years were within one (≥90%) or two (≥97%) MIC log2 dilutions of the modal MIC, respectively. The most common method used was Etest on GC agar base. There was a shift to using breakpoints published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in the latter 5 years, however overall impact on the validity of results was limited, as the percentage categorical agreement and MIC concordance changed very little between the two five-year periods.Conclusions: The high level of comparability of results in this EQA scheme indicates that high quality data are produced by the Euro-GASP participants and gives confidence in susceptibility and resistance data generated by laboratories performing decentralised testing. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).Design: Cross-sectional analysis nested in a retrospective observational study (n = 940).Setting: Hospitals and associated private practices.Patient(s): Previously pregnant women (n = 268) within reproductive age in matched pairs.Intervention(s): Retrospective analysis of surgical reports and self-administered questionnaires.Main Outcome Measure(s): Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).Result(s): The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]).Conclusion(s): Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.Clinical Trial Registration Number: NCT02511626. [ABSTRACT FROM AUTHOR]

Stenotrophomonas maltophilia is one of the most frequently isolated multidrug-resistant nosocomial opportunistic pathogens. It contributes to disease progression in cystic fibrosis (CF) patients and is frequently isolated from wounds, infected tissues, and catheter surfaces. On these diverse surfaces S. maltophilia lives in single-species or multispecies biofilms. Since very little is known about common processes in biofilms of different S. maltophilia isolates, we analyzed the biofilm profiles of 300 clinical and environmental isolates from Europe of the recently identified main lineages Sgn3, Sgn4, and Sm2 to Sm18. The analysis of the biofilm architecture of 40 clinical isolates revealed the presence of multicellular structures and high phenotypic variability at a strain-specific level. Further, transcriptome analyses of biofilm cells of seven clinical isolates identified a set of 106 shared strongly expressed genes and 33 strain-specifically expressed genes. Surprisingly, the transcriptome profiles of biofilm versus planktonic cells revealed that just 9.43% 1.36% of all genes were differentially regulated. This implies that just a small set of shared and commonly regulated genes is involved in the biofilm lifestyle. Strikingly, iron uptake appears to be a key factor involved in this metabolic shift. Further, metabolic analyses implied that S. maltophilia employs a mostly fermentative growth mode under biofilm conditions. The transcriptome data of this study together with the phenotypic and metabolic analyses represent so far the largest data set on S. maltophilia biofilm versus planktonic cells. This study will lay the foundation for the identification of strategies for fighting S. maltophilia biofilms in clinical and industrial settings. [ABSTRACT FROM AUTHOR]