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Belowground biodiversity distribution does not necessarily reflect aboveground biodiversity patterns, but maps of soil biodiversity remain scarce because of limited data availability. Earthworms belong to the most thoroughly studied soil organisms and—in their role as ecosystem engineers—have a significant impact on ecosystem functioning. We used species distribution modeling (SDMs) and available data sets to map the spatial distribution of commonly observed (i.e., frequently recorded) earthworm species (Annelida, Oligochaeta) across Europe under current and future climate conditions. First, we predicted potential species distributions with commonly used models (i.e., MaxEnt and Biomod) and estimated total species richness (i.e., number of species in a 5 × 5 km grid cell). Second, we determined how much the different types of protected areas covered predicted earthworm richness and species ranges (i.e., distributions) by estimating the respective proportion of the range area. Earthworm species richness was high in central western Europe and low in northeastern Europe. This pattern was mainly associated with annual mean temperature and precipitation seasonality, but the importance of predictor variables to species occurrences varied among species. The geographical ranges of the majority of the earthworm species were predicted to shift to eastern Europe and partly decrease under future climate scenarios. Predicted current and future ranges were only poorly covered by protected areas, such as national parks. More than 80% of future earthworm ranges were on average not protected at all (mean [SD] = 82.6% [0.04]). Overall, our results emphasize the urgency of considering especially vulnerable earthworm species, as well as other soil organisms, in the design of nature conservation measures. [ABSTRACT FROM AUTHOR]

European soils are under increasing pressure, making it difficult to maintain the provision of soil ecosystem services (SESs). A better understanding of soil processes is needed to counteract soil threats (STs) and to promote sustainable soil management. The EJP SOIL programme of the EU provides a framework for the necessary research. However, different definitions of soil‐related terms potentially lead to varied understandings of concepts. Furthermore, there are numerous indicators available to quantify STs or SESs. As unclear communication is a key barrier that hinders the implementation of research results into practice, this study aimed to answer the question about whether the terminology of large‐scale initiatives is adequately understood within the soil‐science community and non‐research stakeholders. An online questionnaire was used to provide definitions for 33 soil‐related terms in both scientific and plain language, as well as indicators for seven SESs and 11 STs. Participants were asked to rate their agreement with the definitions and indicators on a seven‐grade Likert scale. The level of agreement was calculated as the percentage of ratings above 4, the neutral position. The survey was available from June to September 2023 and was distributed by a snowball approach. More than 260 stakeholders assessed the survey; 70% of respondents were researchers, and 15% were practitioners. Mean agreement levels for the definitions and indicators were generally high, at 85% and 78% respectively. However, it was apparent that the lowest agreement was found for terms that are relatively new, such as Ecosystem Services and Bundle, or unfamiliar for certain subgroups, such as ecological terms for stakeholders working at the farm scale. Due to their distinct majority, the results of this study primarily reflect the opinions of scientists. Thus, broad conclusions can only be drawn by comparing scientists with non‐scientists. In this regard, the agreement was surprisingly high across all types of questions. The combined outcomes indicate that there is still a need to facilitate communication between stakeholders and to improve knowledge distribution strategies. Nevertheless, this study can support and be used by future projects and programmes, especially regarding the harmonization of terminology and methods. [ABSTRACT FROM AUTHOR]

The European Aerosol Research Lidar Network (EARLINET), part of the Aerosols, Clouds and Trace gases Research Infrastructure (ACTRIS), organized an intensive observational campaign in May 2020, with the objective of monitoring the atmospheric state over Europe during the COVID-19 lockdown and relaxation period. Besides the standard operational processing of the lidar data in EARLINET, for seven EARLINET sites having collocated sun-photometric observations in the Aerosol Robotic Network (AERONET), a network exercise was held in order to derive profiles of the concentration and effective column size distributions of the aerosols in the atmosphere, by applying the GRASP/GARRLiC (from Generalized Aerosol Retrieval from Radiometer and Lidar Combined data – GARRLiC – part of the Generalized Retrieval of Atmosphere and Surface Properties – GRASP) inversion algorithm. The objective of this network exercise was to explore the possibility of identifying the anthropogenic component and of monitoring its spatial and temporal characteristics in the COVID-19 lockdown and relaxation period. While the number of cases is far from being statistically significant so as to provide a conclusive description of the atmospheric aerosols over Europe during this period, this network exercise was fundamental to deriving a common methodology for applying GRASP/GARRLiC to a network of instruments with different characteristics. The limits of the approach are discussed, in particular the missing information close to the ground in the lidar measurements due to the instrument geometry and the sensitivity of the GRASP/GARRLiC retrieval to the settings used, especially for cases with low aerosol optical depth (AOD) like the ones we show here. We found that this sensitivity is well-characterized in the GRASP/GARRLiC products, since it is included in their retrieval uncertainties. [ABSTRACT FROM AUTHOR]

Soil eukaryotes play a crucial role in maintaining ecosystem functions and services, yet the factors driving their diversity and distribution remain poorly understood. While many studies focus on some eukaryotic groups (mostly fungi), they are limited in their spatial scale. Here, we analyzed an unprecedented amount of observational data of soil eukaryomes at continental scale (787 sites across Europe) to gain further insights into the impact of a wide range of environmental conditions (climatic and edaphic) on their community composition and structure. We found that the diversity of fungi, protists, rotifers, tardigrades, nematodes, arthropods, and annelids was predominantly shaped by ecosystem type (annual and permanent croplands, managed and unmanaged grasslands, coniferous and broadleaved woodlands), and higher diversity of fungi, protists, nematodes, arthropods, and annelids was observed in croplands than in less intensively managed systems, such as coniferous and broadleaved woodlands. Also in croplands, we found more specialized eukaryotes, while the composition between croplands was more homogeneous compared to the composition of other ecosystems. The observed high proportion of overlapping taxa between ecosystems also indicates that DNA has accumulated from previous land uses, hence mimicking the land transformations occurring in Europe in the last decades. This strong ecosystem‐type influence was linked to soil properties, and particularly, soil pH was driving the richness of fungi, rotifers, and annelids, while plant‐available phosphorus drove the richness of protists, tardigrades, and nematodes. Furthermore, the soil organic carbon to total nitrogen ratio crucially explained the richness of fungi, protists, nematodes, and arthropods, possibly linked to decades of agricultural inputs. Our results highlighted the importance of long‐term environmental variables rather than variables measured at the time of the sampling in shaping soil eukaryotic communities, which reinforces the need to include those variables in addition to ecosystem type in future monitoring programs and conservation efforts. [ABSTRACT FROM AUTHOR]

Objectives: The use of remdesivir (RDV) as the first drug approved for coronavirus disease 2019 (COVID-19) remains controversial. Based on the Lean European Open Survey on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected patients (LEOSS), we aim to contribute timing-focused complementary real-world insights to its evaluation. Methods: SARS-CoV-2 infected patients between January 2020 and December 2021 treated with RDV were matched 1:1 to controls considering sociodemographics, comorbidities and clinical status. Multiple imputations were used to account for missing data. Effects on fatal outcome were estimated using uni- and multivariable Cox regression models. Results: We included 9,687 patients. For those starting RDV administration in the complicated phase, Cox regression for fatal outcome showed an adjusted hazard ratio (aHR) of 0.59 (95%CI 0.41–0.83). Positive trends could be obtained for further scenarios: an aHR of 0.51 (95%CI 0.16–1.68) when RDV was initiated in uncomplicated and of 0.76 (95% CI 0.55–1.04) in a critical phase of disease. Patients receiving RDV with concomitant steroids exhibited a further reduction in aHR in both, the complicated (aHR 0.50, 95%CI 0.29–0.88) and critical phase (aHR 0.63, 95%CI 0.39–1.02). Conclusion: Our study results elucidate that RDV use, in particular when initiated in the complicated phase and accompanied by steroids is associated with improved mortality. However, given the limitations of non-randomized trials in estimating the magnitude of the benefit of an intervention, further randomized trials focusing on the timing of therapy initiation seem warranted. [ABSTRACT FROM AUTHOR]

The European Aerosol Research Lidar Network (EARLINET), part of the Aerosols, Clouds and Trace gases Research Infrastructure (ACTRIS), organized an intensive observational campaign in May 2020, with the objective monitoring the atmospheric state over Europe during the COVID-19 lockdown and relaxation period. Besides the standard operational processing of the lidar data in EARLINET, for seven EARLINET sites having co-located sun-photometric observations in AERONET, a network exercise was held in order to derive profiles of the concentration and effective-column size distributions of the aerosols in the atmosphere, by applying the GRASP/GARRLiC inversion algorithm. The objective of this network exercise was to explore the possibility to identify the anthropogenic component and to monitor its spatial and temporal characteristics in the COVID-19 lockdown and relaxation period. While the number of cases are far from being statistically significant so as to provide a conclusive description of the atmospheric aerosols over Europe during this period, this network exercise was fundamental to derive a common methodology for applying GRASP/GARRLiC on a network of instruments with different characteristics. The limits of the approach are discussed, in particular the missing information close to the ground in the lidar measurements due to the instrument geometry, and the sensitivity of the GRASP/GARRLiC retrieval to the settings used, especially for cases with low AOD as the ones we show here. We found that this sensitivity is wellcharacterized in the GRASP/GARRLiC products, since it is included in their retrieval uncertainties. [ABSTRACT FROM AUTHOR]

Introduction: The pandemic outbreak of coronavirus disease 2019 (COVID-19) greatly restricted routine healthcare services across Europe, including cancer diagnosis and treatment. Amongst skin cancers, malignant melanoma (MM) is responsible for most deaths. Objective: This study aimed to compare the number and characteristics of diagnosed MM cases before and during the pandemic in a Portuguese secondary hospital. Methods: This was an observational, retrospective study comparing a prepandemic (diagnosis from March 2019 to February 2020) and a pandemic group of patients with MM diagnosis (diagnosis between March 2020 and February 2021). Results: A total of 59 patients were included, 44 in the pre-pandemic group and 15 in the pandemic period. In the first year of the pandemic, there was a significantly lower number of MM diagnoses compared to the precedent year (15 vs 44, p < 0.01), without significant differences in tumor characteristics. The time from referral to first consultation was slightly shorter in the pandemic group (median of 36 vs 76 days, p = 0.056). Conclusions: This study provides evidence of a reduction in MM diagnosis during the first year of the COVID pandemic, despite no significant differences in prognostic factors. As the pandemic persists, one must emphasize the importance of early MM diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: Artisanal fishing constitutes a subsistence activity in much of the world. Changes in fishing legislation can damage the sector if rapid adaptations are not achieved. As Europe demands landing of all catches, except those whose survival is scientifically proven, this study proposes possible improvements for the sector through a pilot study. We evaluated the survival of discarded fish and the possible recapture once they have reached a commercially profitable size. Europe calls for the end to fisheries discards, which means bringing all caught fish (subject to minimum sizes or quotas) to land. This decision is beneficial to the ecosystem, since it forces the selectivity of the fishing gears to improve. However, artisanal fishermen find themselves in a vulnerable situation where their subsistence depends on catches with small profit margins. An exemption to this landing obligation exists, as it is also ruled that those animals whose survival is scientifically guaranteed may be returned to the sea. Here we study the survival of Plectorhinchus mediterraneus captured by hookline and gillnet, as well as their physiological recovery. Survival exceeds 93% in both cases. The physiological assessment of primary (cortisol) and secondary (energy mobilization, acid-base and hydromineral balance, and immune system) stress responses indicates that surviving animals are able to recover after fishing. Thus, we propose the optimal size of capture of this species to achieve greater economic benefit. For this, we rely on the prices according to size in recent years, as well as on the growth curves of the species. In this way, by releasing fish of less than 1 kg, the current benefits could be multiplied between 2.3 and 9.6 times. This pilot study lays the groundwork for regulating artisanal fisheries through scientific data related to survival of discards along with information on the sale prices. [ABSTRACT FROM AUTHOR]

Relationship quality (RQ) between a person with dementia and a family carer may influence their health and quality of life. However, evidence regarding its course and influencing factors is limited. We aimed to explore RQ trajectories in dementia, and identify predictors of change. We analysed longitudinal data from a cohort of 350 community-dwelling people with dementia and their informal carers, participating in the Actifcare study in eight European countries. The Positive Affect Index, rated separately by both people with dementia and their carers, assessed RQ. Other measures included the Neuropsychiatric Inventory Questionnaire (regarding persons with dementia), and the Relative Stress Scale, Sense of Coherence Scale and Lubben Social Network Scale (for carers). Trajectories and influencing factors were explored applying a latent growth model (LGM). RQ in the group of carers declined over 1 year, but RQ scores for the persons with dementia did not change. Higher stress in carers negatively influenced their baseline RQ ratings. Carer sense of coherence and being a spouse were associated with more positive baseline RQ carer assessments. Higher levels of neuropsychiatric symptoms were linked to decline in carers' RQ, whereas social support was associated with more positive RQ trajectories. This study provides a valuable insight into the course of RQ. LGM proved useful to explore the factors that influence RQ trajectories and variability within- and between-persons. Our findings emphasise the importance of carer-perceived social support and sense of coherence, and of reducing neuropsychiatric symptoms, in maintaining a good RQ. [ABSTRACT FROM AUTHOR]

The onset of agriculture improved the capacity of ecosystems to produce food, but inadvertently altered other vital ecosystem functions. Plant traits play a central role in determining ecosystem properties, therefore we investigated how the onset of agriculture in Europe changed plant trait composition using 78 pollen records. Using a novel Bayesian approach for reconstructing plant trait composition from pollen records, we provide a robust method that can account for trait variability within pollen types. We estimate an overall four‐fold decrease in plant size through agriculture and associated decreases in leaf and seed size. We show an increase in niche space towards the resource‐acquisitive end of the leaf economic spectrum. Decreases in leaf phosphorus might have been caused by nutrient depletion through grazing and burning. Our results show that agriculture, from its start, has likely been gradually impacting biogeochemical cycles through altered vegetation composition. [ABSTRACT FROM AUTHOR]

In Europe, the widespread transition from the Traditional Staircase (TS) model to the Housing First (HF) model is transforming the way social service providers work with people experiencing homelessness. This study examined social service providers' perspectives in both models regarding factors that facilitate or hinder their work. Data were collected through 17 photovoice projects involving 81 social service providers from eight European countries. The results show factors affecting social service providers' work at three levels: systemic, organizational, and individual. Professionals in TS and HF identified similar topics; however, TS providers discussed more obstacles to work. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND : Increased awareness of gastric cancer risk, easy access to upper endoscopy, and high definition endoscopes with virtual chromoendoscopy may have led to the increase in early diagnosis of gastric cancer observed in recent years in Europe, which may be associated with improved survival. Currently, no data exist on the impact of early diagnosis on survival at a populational level in Europe. Our aim was to assess gastric cancer incidence, early diagnosis, and survival in northwestern and southern European countries with a low-to-moderate incidence of gastric cancer. METHODS : Data on 41 138 gastric cancers diagnosed in 2007-2016 were retrieved from national cancer registries of Belgium, the Netherlands, and northern Portugal. Age-standardized incidence and mortality rates were assessed and expressed per 100 000 person-years. Early diagnosis was defined as T1 tumors. Net survival estimates for 2007-2011 vs. 2012-2016 were compared. RESULTS : Age-standardized incidence and mortality decreased over time in Belgium, northern Portugal, and the Netherlands (relative incidence decrease 8.6 %, 4.5 %, and 46.8 %, respectively; relative mortality decrease 22.0 %, 30.9 %, and 50.0 %, respectively). Early gastric cancer diagnosis increased over time for all countries. Net 1-year survival improved significantly between the two time periods in all countries, and at 5 years in Belgium and Portugal. CONCLUSIONS : This is the first study comparing trends (2007-2016) in gastric cancer incidence and mortality in some European countries. We found an increasing proportion of T1 gastric cancers and a decrease in age-standardized mortality over time, supporting the use of secondary prevention strategies. [ABSTRACT FROM AUTHOR]

To examine prospectively the association between unmet needs for daytime activities and company and behavioural and psychological symptoms of dementia. We included 451 people with mild or moderate dementia, from eight European countries, who were assessed three times over 12 months. Unmet needs were measured with the Camberwell Assessment of Need for the Elderly. Three sub-syndromes of the Neuropsychiatric Inventory-Questionnaire were regressed, one-by-one, against unmet needs for daytime activities and company, adjusting for demographic and clinical-functional covariates. Unmet needs for daytime activities were associated with more affective symptoms at baseline, six and twelve months, mean 0.74 (p < 0.001), 0.76 (p < 0.001) and 0.78 (p = 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.39 points, p = 0.007) and at six months follow-up (mean 0.31 points, p = 0.006). Unmet needs for company were associated with more affective symptoms at baseline, six and twelve months, mean 0.44 (p = 0.033), 0.67 (p < 0.001) and 0.91 (p < 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.40 points, p = 0.005) and at six months (mean 0.35 points, p = 0.002) follow-up. Interventions to reduce unmet needs for daytime activities and company could reduce affective and psychotic symptoms in people with dementia. [ABSTRACT FROM AUTHOR]

The capabilities approach, a framework for understanding and measuring inequality, stipulates that equality is best understood as the freedom to do and be within a particular context. Homelessness has been referred to as a situation of 'capabilities deprivation', and the extent to which homeless services restore or enhance capabilities is of increasing interest. As part of a large, eight‐country study of homelessness in Europe, we examined the extent to which adults with histories of homelessness perceived the services they receive as capabilities‐enhancing. We collected data at two time points: baseline (nt1 = 565) and follow‐up (nt2 = 399). Measures included perceived capabilities, choice and housing quality. Participants engaged with Housing First (HF) programmes perceived services as more capabilities‐enhancing than participants engaged with treatment as usual (TAU); this relationship was mediated by consumer choice and perceived housing quality. Implications for social policy, practice and training are discussed. [ABSTRACT FROM AUTHOR]

Home-dwelling people with dementia and their informal carers experience barriers impeding access to community care services. This study is a part of the Actifcare project where eight countries participated. The aim was to achieve consensus on best practice recommendations for enhancing access to and use of formal community care services. A Delphi consensus process was conducted. A total of 48 professional experts, 14 people with dementia and 20 informal carers rated the importance of 72 statements on a 7-point Likert scale. Consensus was based on the median and level of dispersion. Sixty-two statements reached consensus, resulting in three categories of recommendations. An appointed contact person was central in Recommendations to enhance access. Coordination and flexibility in setting and type of services were among the Recommendations to enhance use. Training of health care personnel and person-centred care were central Recommendations that can facilitate access or use indirectly. The Actifcare Best Practice Recommendations suggest practical measures that can be taken by decision makers to enhance access and use of community care services, and thereby enhance quality of care and quality of life for home dwelling people with dementia and their informal carers. [ABSTRACT FROM AUTHOR]

Introduction: Disseminated infection due to non-tuberculous mycobacteria has been a major factor of mortality and comorbidity in HIV patients. Until 2018, U.S. American guidelines have recommended antimycobacterial prophylaxis in patients with low CD4 cell counts, a practice that has not been adopted in Europe. This study aimed at examining the impact of disseminated NTM disease on clinical outcome in German HIV patients with a severe immunodeficiency. Materials and methods: In this retrospective case control study, HIV patients with disseminated NTM disease were identified by retrospective chart review and matched by their CD4 cell counts to HIV patients without NTM infection in a 1:1 alocation. Primary endpoints were mortality and time to first rehospitalisation. In addition, other opportunistic diseases, as well as antimycobacterial and antiretroviral treatments were examined. Results: Between 2006 and 2016, we identified 37 HIV patients with disseminated NTM disease. Most of them were suffering from infections due to M. avium complex (n = 31, 77.5%). Time to event analysis showed a non-significant trend to higher mortality in patients with disseminated NTM disease (p = 0.24). Rehospitalisation took place significantly earlier in patients with disseminated NTM infections (median 40.5 days vs. 109 days, p<0.0001). Conclusion: In this retrospective case control study, we could demonstrate that mortality is not significantly higher in HIV patients with disseminated NTM disease in the ART era, but that they require specialised medical attention in the first months following discharge. [ABSTRACT FROM AUTHOR]

Many countries are reshaping their agricultural policies to better enhance biodiversity and ecosystem services (BES) in farmlands, but measuring the effectiveness of policy instruments in BES delivery is challenging. Using the European Agricultural Policy as an example, we propose the application of a farming systems (FS) approach as a cost‐effective tool for linking policy design and expected BES outcomes. On the basis of available data from subsidy payment agencies, such an approach can identify groups of farms that share similar management practices as well as the associations between FS and corresponding BES potential, and improve modeled outputs of farm management responses to policies and other drivers of change. We describe how this relatively unexplored source of information can help to support applied ecological research and relevant policy, and call for these data to be made available across Europe and elsewhere. [ABSTRACT FROM AUTHOR]

A comprehensive European dataset on monthly atmospheric NH 3 , acid gases (HNO 3 , SO 2 , HCl), and aerosols (NH 4+ , NO 3- , SO 42- , Cl - , Na + , Ca 2+ , Mg 2+) is presented and analysed. Speciated measurements were made with a low-volume denuder and filter pack method (DEnuder for Long-Term Atmospheric sampling, DELTA®) as part of the EU NitroEurope (NEU) integrated project. Altogether, there were 64 sites in 20 countries (2006–2010), coordinated between seven European laboratories. Bulk wet-deposition measurements were carried out at 16 co-located sites (2008–2010). Inter-comparisons of chemical analysis and DELTA® measurements allowed an assessment of comparability between laboratories. The form and concentrations of the different gas and aerosol components measured varied between individual sites and grouped sites according to country, European regions, and four main ecosystem types (crops, grassland, forests, and semi-natural). The smallest concentrations (with the exception of SO 42- and Na +) were in northern Europe (Scandinavia), with broad elevations of all components across other regions. SO 2 concentrations were highest in central and eastern Europe, with larger SO 2 emissions, but particulate SO 42- concentrations were more homogeneous between regions. Gas-phase NH 3 was the most abundant single measured component at the majority of sites, with the largest variability in concentrations across the network. The largest concentrations of NH 3 , NH 4+ , and NO 3- were at cropland sites in intensively managed agricultural areas (e.g. Borgo Cioffi in Italy), and the smallest were at remote semi-natural and forest sites (e.g. Lompolojänkkä, Finland), highlighting the potential for NH 3 to drive the formation of both NH 4+ and NO 3- aerosol. In the aerosol phase, NH 4+ was highly correlated with both NO 3- and SO 42- , with a near- 1:1 relationship between the equivalent concentrations of NH 4+ and sum (NO 3-+ SO 42-) , of which around 60 % was as NH 4 NO 3. Distinct seasonality was also observed in the data, influenced by changes in emissions, chemical interactions, and the influence of meteorology on partitioning between the main inorganic gases and aerosol species. Springtime maxima in NH 3 were attributed to the main period of manure spreading, while the peak in summer and trough in winter were linked to the influence of temperature and rainfall on emissions, deposition, and gas–aerosol-phase equilibrium. Seasonality in SO 2 was mainly driven by emissions (combustion), with concentrations peaking in winter, except in southern Europe, where the peak occurred in summer. Particulate SO 42- showed large peaks in concentrations in summer in southern and eastern Europe, contrasting with much smaller peaks occurring in early spring in other regions. The peaks in particulate SO 42- coincided with peaks in NH 3 concentrations, attributed to the formation of the stable (NH 4)2 SO 4. HNO 3 concentrations were more complex, related to traffic and industrial emissions, photochemistry, and HNO 3 :NH 4 NO 3 partitioning. While HNO 3 concentrations were seen to peak in the summer in eastern and southern Europe (increased photochemistry), the absence of a spring peak in HNO 3 in all regions may be explained by the depletion of HNO 3 through reaction with surplus NH 3 to form the semi-volatile aerosol NH 4 NO 3. Cooler, wetter conditions in early spring favour the formation and persistence of NH 4 NO 3 in the aerosol phase, consistent with the higher springtime concentrations of NH 4+ and NO 3-. The seasonal profile of NO 3- was mirrored by NH 4+ , illustrating the influence of gas–aerosol partitioning of NH 4 NO 3 in the seasonality of these components. Gas-phase NH 3 and aerosol NH 4 NO 3 were the dominant species in the total inorganic gas and aerosol species measured in the NEU network. With the current and projected trends in SO 2 , NO x , and NH 3 emissions, concentrations of NH 3 and NH 4 NO 3 can be expected to continue to dominate the inorganic pollution load over the next decades, especially NH 3 , which is linked to substantial exceedances of ecological thresholds across Europe. The shift from (NH 4)2 SO 4 to an atmosphere more abundant in NH 4 NO 3 is expected to maintain a larger fraction of reactive N in the gas phase by partitioning to NH 3 and HNO 3 in warm weather, while NH 4 NO 3 continues to contribute to exceedances of air quality limits for PM 2.5. [ABSTRACT FROM AUTHOR]

Highlights: Housing First reports more service user recovery but little is known about how this is achieved.Certain features of homeless services are likely to promote service users' recovery.Housing First service users reported more choice, better housing quality, and more satisfaction.Service features predicted independent housing, psychiatric symptoms, and community integration.Across socio‐political and economic contexts, Housing First predicts greater recovery than traditional services. Across Europe, as governments turn to housing‐led strategies in attempts to reverse rising rates of homelessness, increasing numbers of Housing First (HF) programs are being implemented. As HF programs become more widespread, it is important to understand how service users experience them compared to the more prevalent traditional treatment‐first approach to addressing long‐term homelessness. Although there is a large body of research on service users' experiences of Housing First compared to treatment‐first in North American contexts, comparatively less is known about how these two categories of homeless services are experienced in the European context. In a correlational and cross‐sectional study, part of a larger examination of homelessness in Europe, participants (n = 520) engaged with either HF (n = 245) or traditional services (TS; n = 275) programs in seven countries completed measures of their experiences of services (consumer choice, housing quality, and service satisfaction) and recovery (time in independent housing, psychiatric symptoms, and community integration). Across the seven countries, participants engaged with HF programs reported experiencing more consumer choice, better perceived housing quality, and more satisfaction with services than participants engaged in TS programs. Participants in HF programs also reported a greater proportion of time in independent accommodation, fewer psychiatric symptoms, and more community integration. Varying patterns of association between experiences of services and recovery outcomes were observed. Findings indicate HF consistently predicts greater recovery than TS across diverse sociopolitical and economic contexts. Implications of findings for configurations of homeless services and homeless services policy are discussed. [ABSTRACT FROM AUTHOR]

Objectives: To assess the admission prevalence of third-generation cephalosporin-resistant Enterobacterales (3GCREB) and to assess whether risk factors vary by β-lactamase genotype.Methods: Adult patients were recruited within 72 h of admission to general wards of six university hospitals in 2014 and 2015. Rectal swabs were screened for 3GCREB and isolates were analysed phenotypically and genotypically. Patients were questioned on potential risk factors. Multivariable analyses were performed to identify risk factors for 3GCREB colonization and for specific β-lactamases.Results: Of 8753 patients screened, 828 were 3GCREB positive (9.5%). Eight hundred and thirteen isolates were available for genotyping. CTX-M-15 was the most common ESBL (38.0%), followed by CTX-M-1 (22.5%), CTX-M-14 (8.7%), CTX-M-27 (7.5%) and SHV-ESBL (4.4%). AmpC was found in 11.9%. Interestingly, 18 Escherichia coli isolates were AmpC positive, 12 of which (67%) contained AmpC on a gene of plasmid origin [CMY (n = 10), DHA (n = 2)]. Risk factors for 3GCREB colonization varied by genotype. Recent antibiotic exposure and prior colonization by antibiotic-resistant bacteria were risk factors for all β-lactamases except CTX-M-14 and CTX-M-27. Travel outside Europe was a risk factor for CTX-M-15 and CTX-M-27 [adjusted OR (aOR) 3.49, 95% CI 2.88-4.24 and aOR 2.73, 95% CI 1.68-4.43]. A previous stay in a long-term care facility was associated with CTX-M-14 (aOR 3.01, 95% CI 1.98-4.59). A preceding hospital stay in Germany increased the risk of CTX-M-15 (aOR 1.27, 95% CI 1.14-1.41), while a prior hospital stay in other European countries increased the risk of SHV-ESBL colonization (aOR 3.85, 95% CI 1.67-8.92).Conclusions: The detection of different ESBL types is associated with specific risk factor sets that might represent distinct sources of colonization and ESBL-specific dissemination routes. [ABSTRACT FROM AUTHOR]

Objectives: Previously developed dementia caregiver profiles defined by caregiver age and burden, have been associated with caregiver quality of life, depression and perseverance time. The current aim was to investigate whether these caregiver profiles could predict subsequent service use. In addition, non-personal (e.g. meals on wheels) and supportive services (e.g. Alzheimer café) in early dementia were investigated as predictors. Methods: A total of 451 dyads of people with dementia and their informal caregivers from eight European countries were followed for one year. People were included if they did not use formal (personal) care but were expected to do so within 1 year. Logistic regression analyses were used with four clusters of service use as dependent variables (home social care, home personal care, day care and admission). The independent variables were caregiver profiles, and non-personal and supportive services at baseline. Results: Caregiver profiles were significant predictors of service use; those experiencing high strain were more likely to use formal care. The use of low-intensity, less intrusive services at baseline significantly predicted the use of home personal care and admission at follow-up. The use of day care at follow-up was predicted by the baseline use of supportive services. Conclusion: Caregiver profiles are valuable predictors for service use: this knowledge can aid professionals in ensuring optimal access to services, which is important for maintaining independence at home. In addition, the use of supportive and less intrusive, non-personal services in the early stages of dementia is to be advised. [ABSTRACT FROM AUTHOR]

This paper reports on qualitative data from the Actifcare study investigating experiences, attitudes, barriers and facilitators concerning access to and use of formal care. A total of 85 semi‐structured in‐depth interviews were conducted in eight European countries. Results were analysed with a deductive content analysis, first within country and then integrated in a cross‐national analysis. Overall, analysis of the in‐depth interviews revealed two major themes with five subcategories. The results can be summarised in an optimal pathway for access to dementia care. This pathway includes fixed factors such as disease‐related factors and system‐related factors. In addition there are personal factors that are subject to change such as attitudes towards care. An important finding consisted of the necessity of having sufficient information about the disease and available care and having a key contact person to guide you through the process of finding suitable care while monitoring your needs. In addition, it is important to involve your social network as they can take on care‐giving tasks. It is helpful to have a diagnosis (in most countries). Concerning decision‐making, the person closest to the person with dementia is in the majority of cases the one who makes the ultimate decision to access and use services and he/she should therefore be supported in this process. These results provide insight into the factors that influence the pathway to formal care use and help professionals to enhance access to formal dementia care by focusing on factors that can be modified. [ABSTRACT FROM AUTHOR]

The connections between European rainfall variability in winter (from January to March) and Northern Hemisphere circulation patterns, as represented by 500-hPa geopotential height, are investigated in the period 1900–2014. Initially, three statistically significant pairs of linearly-related circulation and precipitation patterns, explaining 45% of the variance in the latter field, are identified. The first two essentially represent the North Atlantic Oscillation (NAO) and the East Atlantic (EA) patterns, while the third corresponds to a structure described in recent literature as a blend of the Pacific North America (PNA) pattern and the so-called Asia Bering North America (ABNA) pattern. The residual precipitation field is then examined for patterns that can introduce non-linear modulations into the circulation-precipitation links. It is so found that the NAO impact on European rainfall is modulated by North American and Pacific factors controlling cyclogenesis over Newfoundland. The positive-phase EA rainfall anomalies over Central Europe and the British Isles seem to be markedly affected by the NAO phase. Finally, a possible signature from the Circumglobal Teleconnection Pattern disrupting the NAO influence on East Mediterranean precipitation anomalies is detected. [ABSTRACT FROM AUTHOR]

Ethnic-racial classification criteria are widely recognized to vary according to historical, cultural and political contexts. In Brazil, the strong influence of individual socio-economic factors on race/colour self-classification is well known. With the expansion of genomic technologies, the use of genomic ancestry has been suggested as a substitute for classification procedures such as self-declaring race, as if they represented the same concept. We investigated the association between genomic ancestry, the racial composition of census tracts and individual socioeconomic factors and self-declared race/colour in a cohort of 15,105 Brazilians. Results show that the probability of self-declaring as black or brown increases according to the proportion of African ancestry and varies widely among cities. In Porto Alegre, where most of the population is white, with every 10% increase in the proportion of African ancestry, the odds of self-declaring as black increased 14 times (95%CI 6.08–32.81). In Salvador, where most of the population is black or brown, that increase was of 3.98 times (95%CI 2.96–5.35). The racial composition of the area of residence was also associated with the probability of self-declaring as black or brown. Every 10% increase in the proportion of black and brown inhabitants in the residential census tract increased the odds of self-declaring as black by 1.33 times (95%CI 1.24–1.42). Ancestry alone does not explain self-declared race/colour. An emphasis on multiple situational contexts (both individual and collective) provides a more comprehensive framework for the study of the predictors of self-declared race/colour, a highly relevant construct in many different scenarios, such as public policy, sociology and medicine. [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]

Background: People with dementia and informal carers often access formal care late in the process of dementia. The barriers and facilitators to service use from the perspectives of different stakeholders involved are not well understood. Thus, we aimed to explore the barriers and facilitators of access to and utilisation of formal care from the perspectives of people with dementia, their informal carers and health and social care professionals.Method: Focus groups with people with dementia, informal carers and professionals were conducted in eight European countries. Recruitment targeted people with dementia, informal carers with experience of formal care and professionals involved in providing (access to) formal care. Qualitative content analysis using open coding was used on a national level. Cross-national synthesis was based on the translated national reports.Results: Overall, 55 focus groups with 261 participants were conducted, involving 51 people with dementia, 96 informal carers and 114 professionals. Sixteen categories describing barriers and facilitators were identified, referring to three global themes: Aspects related to 1) individuals involved, 2) the system or 3) overarching aspects. The attitudes and beliefs of people with dementia and their carers may have a major impact, and they often serve as barriers. Formal care was perceived as a threat to the individual independence of people with dementia and was thus avoided as long as possible. A healthcare professional serving as a constant key contact person could be an essential facilitator to overcome these barriers. Contact should be initiated proactively, as early as possible, and a trusting and consistent relationship needs to be established. Beyond that, the findings largely confirm former research and show that barriers to accessing and using formal care still exist across Europe despite a number of national and European initiatives.Conclusion: Further investigations are needed to elaborate how the concept of a key contact person could be integrated with existing case management approaches and how the independence and autonomy of people with dementia can be strengthened when formal care needs to be accessed and used. These may be meaningful facilitators regarding enhanced access to formal care for people with dementia and their families. [ABSTRACT FROM AUTHOR]

Background: Nurses are pivotal in the provision of high quality care in acute hospitals. However, the optimal dosing of the number of nurses caring for patients remains elusive. In light of this, an updated review of the evidence on the effect of nurse staffing levels on patient outcomes is required. Aim: To undertake a systematic review and meta-analysis examining the association between nurse staffing levels and nurse-sensitive patient outcomes in acute specialist units. Methods: Nine electronic databases were searched for English articles published between 2006 and 2017. The primary outcomes were nurse-sensitive patient outcomes. Results: Of 3429 unique articles identified, 35 met the inclusion criteria. All were cross-sectional and the majority utilised large administrative databases. Higher staffing levels were associated with reduced mortality, medication errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receiving percutaneous coronary intervention within 90 minutes. A meta-analysis involving 175,755 patients, from six studies, admitted to the intensive care unit and/or cardiac/cardiothoracic units showed that a higher nurse staffing level decreased the risk of inhospital mortality by 14% (0.86, 95% confidence interval 0.79–0.94). However, the meta-analysis also showed high heterogeneity (I2=86%). Conclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly inhospital mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse-sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations of optimal nurse-to-patient ratios in acute specialist units. [ABSTRACT FROM AUTHOR]

This research seeks to explore academics’ perceptions of the importance and degree of implementation of the Standards and Guidelines for Quality Assurance in the European Higher Education Area (ESG) for internal quality assurance. It uses empirical evidence from Portugal, gathered via a questionnaire given to all university academics. Results show academics’ perceptions of the importance and implementation of the ESG in their institutions to be quite positive. Nevertheless, academics tend to find the standards more important than effectively implemented. Furthermore, significant differences in perceptions emerge between groups of academics. This study intends to contribute to a better understanding of the implementation of quality management practices in universities, and the influence of the ESG in this process. [ABSTRACT FROM AUTHOR]

Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries.Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness.Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations. [ABSTRACT FROM AUTHOR]

Aims: The 'obesity paradox' is consistently observed in patients with heart failure (HF). We investigated the relationship of body surface area (BSA) to mortality and hospitalizations in patients with chronic HF.Methods and Results: Data from the outpatient cohort of the observational, prospective, Heart Failure Long-Term Registry of the Heart Failure Association of the European Society of Cardiology was analysed in order to evaluate the prognostic significance of BSA in chronic HF. A total of 9104 chronic HF patients (age 64.8 ± 13.4 years; 71.6% males) were enrolled. Mortality during 1-year follow-up was observed in 718 of 8875 (8.1%) patients. A progressive, inverse relationship between all-cause mortality and BSA levels was observed; the adjusted hazard ratio (HR) for 1-year mortality was 1.823 [95% confidence interval (CI) 1.398-2.376], P < 0.001 for the lowest quartile of BSA <1.78 m(2) , and 1.255, 95% CI 1.000-1.576, P = 0.05 for the middle two quartiles (1.78 ≤BSA ≤2.07 m(2) ), compared with the highest quartile (BSA >2.07 m(2) ). For each increase of 0.1 m(2) in BSA, an adjusted HR of 0.908 (95% CI 0.870-0.948), P < 0.001 for mortality was calculated. HF hospitalizations were not associated with BSA subgroup distribution. In both genders, subjects within the lowest BSA quartile (males <1.84 m(2) and females <1.64 m(2) ) had significantly higher mortality rates during follow-up (log-rank P < 0.0001). However, the stepwise association with mortality was more distinct in males.Conclusions: Total and cardiovascular mortality, but not HF hospitalizations was inversely associated with BSA levels in chronic HF patients. BSA may serve as a prognostic indicator for adverse outcome in HF patients. [ABSTRACT FROM AUTHOR]

Background: To estimate the incidence of hazardous drinking in middle-aged people during an economic recession and ascertain whether individual job loss and contextual changes in unemployment influence the incidence rate in that period. Methods: Longitudinal study based on two waves of the SHARE project (Survey of Health, Ageing and Retirement in Europe). Individuals aged 50–64 years from 11 European countries, who were not hazardous drinkers at baseline (n = 7,615), were selected for this study. We estimated the cumulative incidence of hazardous drinking (≥40g and ≥20g of pure alcohol on average in men and women, respectively) between 2006 and 2012. Furthermore, in the statistical analysis, multilevel Poisson regression models with robust variance were fitted and obtained Risk Ratios (RR) and their 95% Confidence Intervals (95%CI). Results: Over a 6-year period, 505 subjects became hazardous drinkers, with cumulative incidence of 6.6 per 100 persons between 2006 and 2012 (95%CI:6.1–7.2). Age [RR = 1.02 (95%CI:1.00–1.04)] and becoming unemployed [RR = 1.55 (95%CI:1.08–2.23)] were independently associated with higher risk of becoming a hazardous drinker. Conversely, having poorer self-perceived health was associated with lower risk of becoming a hazardous drinker [RR = 0.75 (95%CI:0.60–0.95)]. At country-level, an increase in the unemployment rate during the study period [RR = 1.32 (95%CI:1.17–1.50)] and greater increases in the household disposable income [RR = 0.97 (95%CI:0.95–0.99)] were associated with risk of becoming a hazardous drinker. Conclusions: Job loss among middle-aged individuals during the economic recession was positively associated with becoming a hazardous drinker. Changes in country-level variables were also related to this drinking pattern. [ABSTRACT FROM AUTHOR]

Background: European countries are increasingly adopting systems of self -care support (SMS) for long term conditions which focus on enhancing individual, competencies, skills, behaviour and lifestyle changes. To date the focus of policy for engendering greater self- management in the population has been focused in the main on the actions and motivations of individuals. Less attention has been paid to how the broader influences relevant to SMS policy and practice such as those related to food production, distribution and consumption and the structural aspects and economics relating to physical exercise and governance of health care delivery systems might be implicated in the populations ability to self- manage. This study aimed to identify key informants operating with knowledge of both policy and practice related to SMS in order to explore how these influences are seen to impact on the self-management support environment for diabetes type 2. Methods: Ninety semi-structured interviews were conducted with key stakeholder informants in Bulgaria, Spain, Greece, Norway, Netherlands and UK. Interviews were transcribed and analysed using thematic and textual analysis. Results: Stakeholders in the six countries identified a range of influences which shaped diabetes self-management (SM). The infrastructure and culture for supporting self- management practice is viewed as driven by political decision-makers, the socio-economic and policy environment, and the ethos and delivery of chronic illness management in formal health care systems. Three key themes emerged during the analysis of data. These were 1) social environmental influences on diabetes self-management 2) reluctance or inability of policy makers to regulate processes and environments related to chronic illness management 3) the focus of healthcare system governance and gaps in provision of self-management support (SMS). Nuances in the salience and content of these themes between partner countries related to the presence and articulation ofdedicated prevention and self- management policies, behavioural interventions in primary care, drug company involvement and the impact of measures resulting from economic crises, and differences between countries with higher versus lower social welfare support and public spending on shaping illness management. Conclusions: The results suggest reasons for giving increasing prominence to meso level influences as a means of rebalancing and improving the effectiveness of implementing an agenda for SMS. There is a need to acknowledge the greater economic and policy challenging environment operating in some countries which act as a source of inequality between countries in addressing SMS for chronic illness management and impacts on people's capacity to undertake self-care activities. [ABSTRACT FROM AUTHOR]

Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ≥30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity.Objectives: To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion.Methods: Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema.Measurements and Main Results: Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%.Conclusions: LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed. [ABSTRACT FROM AUTHOR]

Accelerating introductions of forest insects challenge decision-makers who might or might not respond with surveillance programs, quarantines, eradication efforts, or biological control programs. Comparing ecological controls on indigenous vs. introduced populations could inform responses to new introductions. We studied the European woodwasp, Sirex noctilio, which is not a pest in its native forests, is a serious invasive pest in the southern hemisphere, and now has an uncertain future in North America after its introduction there. Indigenous populations of S. noctilio (in Galicia, Spain) resembled those in New York in that S. noctilio were largely restricted to suppressed trees that were also dying for other reasons, and still only some dying trees showed evidence of S. noctilio: 20–40% and 35–51% in Galicia and New York, respectively. In both areas, P. sylvestris (native to Europe) was the species most likely to have attacks in non-suppressed trees. P. resinosa, native to North America, does not appear dangerously susceptible to S. noctilio. P. radiata, which sustains high damage in the southern hemisphere, is apparently not innately susceptible because in Galicia it was less often used by native S. noctilio than either native pine (P. pinaster and P. sylvestris). Silvicultural practices in Galicia that maintain basal area at 25–40 m2/ha limit S. noctilio abundance. More than 25 species of other xylophagous insects feed on pine in Galicia, but co-occurrences with S. noctilio were infrequent, so strong interspecific competition seemed unlikely. Evidently, S. noctilio in northeastern North America will be more similar to indigenous populations in Europe, where it is not a pest, than to introduced populations in the southern hemisphere, where it is. However, S. noctilio populations could behave differently when they reach forests of the southeastern U.S., where tree species, soils, climate, ecology, management, and landscape configurations of pine stands are different. [ABSTRACT FROM AUTHOR]

Objectives. The objectives of this study are to examine the efficacy and safety of low-dose aspirin (LDA) vs LDA plus low-intensity warfarin (LDA + W) in the primary thrombosis prevention of aPL-positive patients with SLE and/or obstetric morbidity and the role of clinical and serological markers in the development of thrombosis.Methods. In this 5-year prospective, randomized, open, controlled trial, 166 patients with aPL were randomly assigned using a minimization protocol to receive treatment with LDA (n = 82) or LDA + W [international normalized ratio (INR) = 1.5] (n = 84). Sixty-six patients who declined randomization were followed up in an observational arm. Clinical and laboratory characteristics and medication side effects were recorded.Results. There were no differences in the number of thromboses between patients treated with LDA (4/82) or LDA + W (4/84) [hazard ratio (HR) 1.07, 95% CI 0.27, 4.3]. The incidence of thrombosis in the randomized patients was 8/166 (1.8 events/100 person-years) (HR 1.07, 95% CI 0.27, 4.3) and in the observational arm was 7/66 (4.9 events/100 person-years) (HR 2.43, 95% CI 0.87, 6.79). Sixty-five of 66 patients included in the observational arm received LDA. None of the examined clinical or serological factors appeared to predict thrombosis. Medication side effects included mild gastrointestinal symptoms in the LDA group (n = 2) and bleeding in the LDA + W group (n = 11; 1 nasal and 10 menorrhagia). The risk difference for bleeding was 13% (CI 6, 20).Conclusion. No differences in the number of thromboses were observed between patients treated with LDA vs those treated with LDA + W. More episodes of bleeding were detected in the LDA + W group. The LDA + W regime was significantly less safe and not as acceptable as LDA alone.Trial registration: ISRCTN81818945; http://isrctn.org/. [ABSTRACT FROM PUBLISHER]

The main mission statement of the European Association of Echocardiography (EAE) is 'to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular ultrasound in Europe'. As competence and quality control issues are increasingly recognized by patients, physicians, and payers, the EAE has established recommendations for training, competence, and quality improvement in echocardiography. [ABSTRACT FROM AUTHOR]

This paper describes a practical experience of adapting the teaching of a course in Computer Technology (CT) to the new demands of the European Higher Education Area (EHEA). CT is a core course taught in the first year of the degree program Technical Engineering in Management Computing in the Faculty of Computer Science at the University of A Coruña (UDC), Spain. The contents of this course are mainly devoted to the design of digital systems. The main purpose of the adaptation has been to focus more on students, clearly defining the abilities they will develop during the course and suggesting activities that facilitate the development of those abilities. The aim of this work is to describe how this adaptation was performed, the materials and activities prepared, the difficulties encountered, the goals achieved and the response of students and teachers to these changes. [ABSTRACT FROM AUTHOR]

This study analyses the evolution in large firms' strategy and structure in a new spatial and temporal context (Spain 1993-2003). The central question of this work is to determine whether transformations undergone in this country have led Spanish companies' strategies and structures to converge with those of other European countries, following the predictions of 'universalistic' theories of strategy and organization; or whether cultural/institutional effects have remained strong, following a path-dependence/cultural-lag type logic. The Spanish experience is particularly significant for theory in general because its late development and very distinctive institutional origins allow us to test theories applied before in a new country and more recent time period. Our findings show that a changing context (e.g. liberalization) has led Spanish firms to converge with those of other European economies in the pattern of strategy and structure (increasing levels of diversification and divisionalization). Thus, the findings of this study in a new context are consistent with universalistic predictions that strategies and structures will evolve towards a common model of corporate development, as Chandler postulated initially. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although in the last few years some European countries have implemented smoking bans in hospitality venues, the levels of secondhand smoke (SHS) in this occupational sector could still be extremely high in most countries. OBJECTIVE: The aim of this study was to assess exposure to SHS in hospitality venues in 10 European cities. METHODS: We included 167 hospitality venues (58 discotheques and pubs, 82 restaurants and cafeterias, and 27 fast-food restaurants) in this cross-sectional study. We carried out fieldwork in 10 European cities: Vienna (Austria), Paris (France), Athens (Greece), Florence and Belluno (Italy), Galway (Ireland), Barcelona (Spain), Warsaw and Lublin (Poland), and Bratislava (Slovak Republic). We measured vapor-phase nicotine as an SHS marker. RESULTS: We analyzed 504 samples and found nicotine in most samples (97.4%). We found the highest median concentrations in discos/pubs [32.99 µg/m3; interquartile range (IQR), 8.06--66.84 µg/m3] and lower median concentrations in restaurants/cafeterias (2.09 µg/m3; IQR, 0.49--6.73 µg/m3) and fast-food restaurants (0.31 µg/m3; IQR, 0.11--1.30 µg/m3) (p < 0.05). We found differences of exposure between countries that may be related to their smoking regulations. Where we sampled smoking and nonsmoking areas, nicotine concentrations were significantly lower in nonsmoking areas. CONCLUSIONS: Hospitality venues from European cities without smoking regulations have very high levels of SHS exposure. Monitoring of SHS on a regular basis as well as a total smoking ban in hospitality sector would be needed. [ABSTRACT FROM AUTHOR]

To describe the methodology and to present the baseline findings of the Attention-deficit/hyperactivity Disorder Observational Research in Europe (ADORE) study, the primary objective of which is to describe the relationship between treatment regimen prescribed and quality of life of children with ADHD in actual practice. In this 2-year prospective observational study, data on diagnosis, prescribed treatment and outcomes of ADHD were collected at seven time points by paediatricians and child psychiatrists on 1,573 children recruited in 10 European countries. The data presented here from the 1,478 patients included in the analyses describe the baseline condition, initial treatment regimen prescribed and quality of life of families with children with ADHD. Patients had a mean age of 9.0 years (SD 2.5) and 84% were male. Physicians diagnoses were made using DSM-IV (43 %), ICD-10 (32%) and both DSM-IV and ICD-10 (12 %). Mean age of awareness of a problem was 5.1 years, suggesting an average delay of approximately 4 years between awareness and diagnosis of ADHD. Baseline ADHD rating scale scores (physicianrated) indicated moderate to severe ADHD. Parent-rated SDQ scores were in agreement and suggested significant levels of co-existing problems. CGI-S, CGAS and CHIPCE scores also indicated significant impairment. Patients were offered the following treatments after the initial assessment: pharmacotherapy (25 %), psychotherapy (19 %), combination of pharmacotherapy and psychotherapy (25 %), other therapy (10 %) and no treatment (21 %). The ADORE study shows that ADHD is similarly recognised across 10 European countries and that the children are significantly impaired across a wide range of domains. In this respect, they resemble children described in previous ADHD samples. [ABSTRACT FROM AUTHOR]

Population genetic theory predicts that the self-incompatible and perennial herb, Arabidopsis lyrata, will have a genetic structure that differs from the self-fertilizing, annual Arabidopsis thaliana. We quantified the genetic structure for eight populations of A. lyrata ssp. petraea in historically nonglaciated regions of central Europe. Analysis of 20 microsatellite loci for 344 individuals demonstrated that, in accordance with predictions, diploid populations had high genome-wide heterozygosity ( HO = 0.48; HE = 0.52), high within-population diversity (83% of total) compatible with mutation–drift equilibrium, and moderate differentiation among populations ( FST = 0.17). Within a single population, the vast majority of genetic variability (92%) was found at the smallest spatial scale (< 3 m). Although there was no evidence of biparental inbreeding or clonal propagation at this scale ( FIS = 0.003), significant fine-scale spatial autocorrelation indicated localized gene flow presumably due to gravity dispersed seeds ( Sp = 0.018). Limited gene flow between isolated population clusters (regions) separated by hundreds of kilometres has given rise to an isolation by distance pattern of diversification, with low, but significant, differentiation among regions ( FST = 0.05). The maintenance of geographically widespread polymorphisms and uniformly high diversity throughout central Europe is consistent with periglacial survival of A. lyrata ssp. petraea north of the Alps in steppe-tundra habitats during the last glacial maximum. As expected of northern and previously glaciated localities, A. lyrata in Iceland was genetically less diverse and highly differentiated from central Europe ( HE = 0.37; FST = 0.27). [ABSTRACT FROM AUTHOR]

An experimental site was selected for fog- and rain-water quality analyses. The selected location corresponds to Mount Monduver of 843 m elevation, being geographically centered in the Mediterranean Iberian Peninsula. Single fog- and rain-water samples were taken manually with a dedicated fog and rain collectors, to prevent any contamination with dry-deposition. Besides, a permanently exposed fog collector and a rain gauge were also used for the collection of water samples affected by dry deposition. Results indicated that all chemical analyses complied with Spanish drinking water regulations, except for the particular case of the dry-deposition contaminated water samples. A further statistical data analysis, together with five-day air mass backward trajectories, was performed. Two sample clusters could be differentiated which were also discriminated against by the two principal components obtained. Cluster-1 members comprised higher levels of conductivity and ion concentration, while cluster-2 members corresponded to lower levels of solutes. The second principal component related to pH levels showed the majority of samples centered at neutral values. The backward trajectory analysis indicated that the origin and route followed by the air masses leading to sample members in cluster-1 were over the Mediterranean Sea and mainly obtained in summer and autumn; while trajectories associated to sample members in cluster-2 had their origin primarily over the Atlantic Sea occurring only in winter and spring. The larger ion loads presented in fogs developed from Mediterranean air masses may be explained through the role of sea breezes on the confinement of pollutants into the atmosphere. [Display omitted] • Fog water can be an alternative to traditional water sources that can help to mitigate water scarcity in Southern Europe • Knowing the chemical characteristics of the collected fog-water might show if any restriction should be applied • The chemical values of fog water are compared with those of rain, presenting the first higher ionic concentrations • Chemical analyses have shown that water is suitable for human consumption according to Spanish regulations [ABSTRACT FROM AUTHOR]

Presents information on a study which proposed the integration of small solar tower fields into Modular Integrated Utility Systems (MIUS) in Europe. Review of the MIUS concept; Sensitivity analysis of solar fields; Solar tower performance capabilities; Conclusions.

Within the European Community (EG) drinking patterns in the southern countries can be characterised by daily consumption of wine at meals, and in the northern countries by less frequent consumption of beer outside meals. Yet, as in past decades in the southern countries beer consumption and in the northern countries wine consumption strongly increased, the question is whether the distinction in drinking patterns still applies. This paper (1) describes for each country of the EC total alcohol consumption, (2) examines the frequency and the context of consumption of the new beverage type and (3) analyses whether subpopulations, defined by sex, age and educational level, differ in the adoption of the new beverage type. In all countries wine is consumed more often at meals compared to beer. Older people consume wine in greater numbers and more frequently than younger people, who consume beer in greater numbers. People of higher educational level consume the new beverage type more often compared to people of lower educational level, who consume the traditional beverage type more frequently. Finally, males and females differ less in the frequency of consumption of the new beverage type than in the frequency of the traditional beverage type. [ABSTRACT FROM AUTHOR]

Highlights • The most comprehensive global study of the genetic diversity of D. siricidicola. • Three lineages associated with North America, the Southern Hemisphere and Europe. • An admixed North American and Southern Hemisphere population identified in Chile. • An opportunity exists to augment the reduced diversity in some biocontrol programs. Abstract The nematode Deladenus siricidicola is the primary biological control agent of Sirex noctilio, a globally invading woodwasp pest of Pinus species. Preliminary studies on the diversity of populations of D. siricidicola revealed very low diversity in the Southern Hemisphere where they have been introduced for the purpose of biological control. The potential to augment biocontrol efficacy by increasing genetic diversity in biocontrol programs motivated this study, which investigated the patterns of genetic diversity in D. siricidicola across eight countries, including the presumed native range (Spain), areas of accidental introduction (Canada and the USA) and countries D. siricidicola has been intentionally released (Argentina, Brazil, Chile, New Zealand and South Africa). Nematodes were screened using mitochondrial COI sequence data and twelve microsatellite markers. Analyses of these data identified three distinct lineages from North America (Lineage A), the Southern Hemisphere (Lineage B) and Spain (Lineage C). Strains from Chile were an exception as they appear to represent an admixture of lineages A and B. This suggests a common origin of populations throughout the Southern Hemisphere, with a second introduction from North America into Chile. The introduction into North America is distinct from that in the Southern Hemisphere and probably originated from Europe. It is evident that substantial genetic diversity exists in D. siricidicola globally, which could be exploited to augment the reduced diversity in some populations used in biocontrol programs. [ABSTRACT FROM AUTHOR]

Presents a proposal to conserve the name Tortula solmsii against Tortula limbata (Pottiaceae, Bryophyta). Characteristics of Tortula solmsii; Acceptance on the name of the species in Europe; Use of the species in bryological literature.

Adherence to European Association of Urology guidelines to refrain from giving neoadjuvant androgen deprivation therapy (ADT) before prostate cancer surgery is variable, especially in high-risk subgroups. Inappropriate ADT use may cause serious harm to patients and the consequences are burdensome and costly for health care providers and payers. Evidence-practice gaps exist in urology. We previously surveyed European Association of Urology (EAU) guidelines for strong recommendations underpinned by high-certainty evidence that impact patient experience for which practice variations were suspected. The recommendation "Do not offer neoadjuvant androgen deprivation therapy (ADT) before surgery for patients with prostate cancer" was prioritised for further investigation. ADT before surgery is neither clinically effective nor cost effective and has serious side effects. The first step in improving implementation problems is to understand their extent. A clear picture of practice regarding ADT before surgery across Europe is not available. To assess current ADT use before prostate cancer surgery in Europe. This was an observational cross-sectional study. We retrospectively audited recent ADT practices in a multicentre international setting. We used nonprobability purposive sampling, aiming for breadth in terms of low- versus high-volume, academic, versus community and public versus private centres. Our primary outcome was adherence to the ADT recommendation. Descriptive statistics and a multilevel model were used to investigate differences between countries across different factors (volume, centre type, and funding type). Subgroup analyses were performed for patients with low, intermediate, and high risk, and for those with locally advanced prostate cancer. We also collected reasons for nonadherence. We included 6598 patients with prostate cancer from 187 hospitals in 31 countries from January 1, 2017 to May 1, 2020. Overall, nonadherence was 2%, (range 0–32%). Most of the variability was found in the high-risk subgroup, for which nonadherence was 4% (range 0–43%). Reasons for nonadherence included attempts to improve oncological outcomes or preoperative tumour parameters; attempts to control the cancer because of long waiting lists; and patient preference (changing one's mind from radiotherapy to surgery after neoadjuvant ADT had commenced or feeling that the side effects were intolerable). Although we purposively sampled for variety within countries (public/private, academic/community, high/low-volume), a selection bias toward centres with awareness of guidelines is possible, so adherence rates may be overestimated. EAU guidelines recommend against ADT use before prostate cancer surgery, yet some guideline-discordant ADT use remains at the cost of patient experience and an additional payer and provider burden. Strategies towards discontinuation of inappropriate preoperative ADT use should be pursued. Androgen deprivation therapy (ADT) is sometimes used in men with prostate cancer who will not benefit from it. ADT causes side effects such as weight gain and emotional changes and increases the risk of cardiovascular disease, diabetes, and osteoporosis. Guidelines strongly recommend that men opting for surgery should not receive ADT, but it is unclear how well the guidance is followed. We asked urologists across Europe how patients in their institutions were treated over the past few years. Most do not use ADT before surgery, but this still happens in some places. More research is needed to help doctors to stop using ADT in patients who will not benefit from it. [ABSTRACT FROM AUTHOR]

Background. Since there is little information about the naturalistic way of treatment in daily European practice, the Attention–Deficit Hyperactivity Disorder Observational Research in Europe (ADORE) project was designed as a prospective, non–interventional study of approximately 1,500 patients observed by approximately 300 investigators in various European regions. Objective. The primary objective is the description of the relationship between treatment regimen prescribed and quality of life in ADHD patients over a two–year period. Method. The naturalistic care provided and the outcomes (psychopathology, quality of life) are recorded at 7 data collection points. Results. The present preliminary report provides data on the first 315 patients who were included in the study by the beginning of January 2004. The data provide an impression of the sample characteristics, the clinical diversity, and the effects of ADHD on school careers and social activities. Furthermore, treatment information dealing with the time both before and at baseline is given. Conclusion. Even with this limited sample the negative effects on psychosocial development and quality of life in ADHD children are apparent. [ABSTRACT FROM AUTHOR]