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The contribution of school curricula to public understanding and acceptance of evolution is still mostly unknown, due to the scarcity of studies that compare the learning goals present in different curricula. To overcome this lack of data we analysed 19 school curricula (18 European and one from Israel) to study the differences regarding the inclusion of learning goals targeting evolution understanding. We performed a quantitative content analysis using the Framework for the Assessment of school Curricula on the presence of Evolutionary concepts (FACE). For each country/region we analysed what this educational system considered the minimum evolution education a citizen should get. Our results reveal that: (i) the curricula include less than half of the learning goals considered important for scientific literacy in evolution; (ii) the most frequent learning goals address basic knowledge of evolution; (iii) learning goals related with the processes that drive evolution are often not included or rarely mentioned; (iv) evolution is most often not linked to its applications in everyday life. These results highlight the need to rethink evolution education across Europe.

Public health edicts necessitated by COVID-19 prompted a rapid pivot to remote online teaching and learning. Two major consequences followed: households became students' main learning space, and technology became the sole medium of instructional delivery. We use the ideas of "digital disconnect" and "digital divide" to examine, for students and faculty, their prior experience with, and proficiency in using, learning technology. We also explore, for students, how household lockdowns and digital capacity impacted learning. Our findings are drawn from 3806 students and 283 faculty instructors from nine higher education institutions across Asia, Australia, Europe, and North America. For instructors, we find little evidence of a digital divide but some evidence of a digital disconnect. However, neither made a difference to self-reported success in transitioning courses. Faculty instructors were impacted in a myriad of diverse ways. For students, we show that closure and confinement measures which created difficult living situations were associated with lower levels of confidence in learning. The digital divide that did exist among students was less influential than were household lockdown measures in undermining student learning.

"Experience design" is a term that has risen to the forefront in a variety of professional fields and has relevance for the field of park and recreation. Park and recreation professionals are primarily focused on providing experiences and thus could naturally consider themselves experienced designers. Surprisingly, experience design is not a topic often discussed within park and recreation publications or curriculum. This absence is at least in part attributable to the fact that experience design is an emerging field that has grown independently out of multiple disciplines. Consequently, the fields of park and recreation and experience design overlap in a variety of mutually beneficial ways which deserve further consideration. The purpose of this paper is to provide leisure educators a brief introduction to the practice of experience design and present information drawn from experience designers across a variety of fields about the skills, certifications, and resources necessary to become an experienced designer.

Understanding visual narratives requires readers to track dimensions of time, spatial location, and characters across a sequence. Previous work has found situational changes across adjacent panels differ cross-culturally, but few works have examined such situational dimensions across extended sequences. We therefore investigated situational "runs" -- uninterrupted sequences of the situational dimensions (time, space, characters) -- in a corpus of 300+ annotated comics from the United States, Europe, and Asia. We compared runs' proportion and average lengths and found that across books, semantic information changed frequently and run length correlated with proportion. Yet, cross-cultural patterns arose, with American and European comics using more continuous runs than Asian comics. American and European comics also used more and longer temporal and character continuity, while Asian comics used more spatial continuity. These findings raise questions about comprehenders' processing strategies of visual narratives across cultures and how general frameworks of visual narrative comprehension account for variations in situational (dis)continuity.

Environmental factors amplified by climate change contribute significantly to the global burden of disease, disproportionately impacting vulnerable populations, such as individuals with rare diseases. Researchers require innovative, dynamic data linkage methods to enable the development of risk prediction models, particularly for diseases like vasculitis with unknown aetiology but potential environmental triggers. In response, we present the Semantic Environmental and Rare Disease Data Integration Framework (SERDIF). SERDIF was evaluated with researchers studying climate-related health hazards of vasculitis disease activity across European countries (NP1 = 10, NP2 = 17, NP3 = 23). Usability metrics consistently improved, indicating SERDIF's effectiveness in linking complex environmental and health datasets. Furthermore, SERDIF-enabled epidemiologists to study environmental factors in a pregnancy cohort in Lombardy, showcasing its versatility beyond rare diseases. This framework offers for the first time a user-friendly, FAIR-compliant design for environment-health data linkage with export capabilities enabling data analysis to mitigate health risks posed by climate change. [ABSTRACT FROM AUTHOR]

The contribution of school curricula to public understanding and acceptance of evolution is still mostly unknown, due to the scarcity of studies that compare the learning goals present in different curricula. To overcome this lack of data we analysed 19 school curricula (18 European and one from Israel) to study the differences regarding the inclusion of learning goals targeting evolution understanding. We performed a quantitative content analysis using the Framework for the Assessment of school Curricula on the presence of Evolutionary concepts (FACE). For each country/region we analysed what this educational system considered the minimum evolution education a citizen should get. Our results reveal that: (i) the curricula include less than half of the learning goals considered important for scientific literacy in evolution; (ii) the most frequent learning goals address basic knowledge of evolution; (iii) learning goals related with the processes that drive evolution are often not included or rarely mentioned; (iv) evolution is most often not linked to its applications in everyday life. These results highlight the need to rethink evolution education across Europe. [ABSTRACT FROM AUTHOR]

Universities' aims for educating global citizens are rarely supported by a theoretical underpinning or evidence of outcomes. This study explored how international higher education experts conceptualize the global citizen or related terms representing the "ideal global graduate." A global notion of citizenship was accepted by the majority (24/26) of participants. Four participants used other terms to describe the "ideal global graduate," yet the knowledge, skills, and attitudes described by all participants were highly consistent and provide a close "fit" with the epistemology and ontology of moral and transformative cosmopolitanism. This evidence could suggest that terms describing the "ideal global graduate" are of less consequence than the underpinning values and mind-set they represent. This article suggests that the inevitable ambiguity surrounding the global citizen term could be tolerated. As such, future discourse and research could be directed toward organizational and pedagogical strategies that foster ethical and transformative thinking citizens and work-ready professionals.

Prevalence estimations for Autism Spectrum Disorder have been increasing over the past few years with rates now reported to be at 1:68. Interventions that are based on Applied Behaviour Analysis are significantly related to best outcomes and are widely considered 'treatment as usual' in North America. In Europe, this is not the case, instead a rather ill-defined 'eclectic' approach is widely promoted and in this paper we discuss some of the roots of this gulf between Europe and North America and correct some of the misconceptions that prevail about Applied Behaviour Analysis in Europe.

This paper foregrounds the use of "Living Labs" as instruments for the delivery of just low carbon transformations. Living Labs are commonly understood as stakeholder-centred, iterative and open-innovation ecosystems that involve multiple forms of co-creation and engagement among different actors in a given territory. Over a period of three years, thanks to a unique pan-European action research study, three such Labs were set up in different locations in Europe -- a large North-western European city (Manchester, England), a mid-sized mountainous town in South-eastern Europe (Metsovo, Greece) and a series of rural settlements in Central Europe (Nyírbátor, Hungary). Working closely with local residents and relevant organisational stakeholders, the research teams that led the Labs undertook multiple low-carbon interventions in the homes of low-income residents, while continuously monitoring the broader impacts of intermediation practices on energy equity and sustainability across three consecutive cycles of activity. We present and discuss the results of these activities, so as to uncover the impacts of Living Labs on energy poverty both before and during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: The implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process. Methods: In‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method. Results: We conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes. Conclusion: The I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities. Patient or Public Contribution: Patient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit. Trial registration: ClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018. [ABSTRACT FROM AUTHOR]

Economic change over the past 20 years has rendered many individuals and territories vulnerable, leading to greater interpersonal and interterritorial inequality. This rising inequality is seen as a root cause of populism. Yet, there is no comparative evidence as to whether this discontent is the consequence of localised interpersonal inequality or stagnant growth in 'left-behind' places. This article assesses the association between levels and changes in local GDP per capita and interpersonal inequality, and the rise of far-right populism in Europe and in the USA. The analysis—conducted at small region level for Europe and county level for the USA—shows that there are both similarities and differences in the factors connected to populist voting on both sides of the Atlantic. In the USA, neither interpersonal inequality nor economic decline can explain populist support on their own. However, these factors gain significance when considered together with the racial composition of the area. Counties with a large share of white population where economic growth has been stagnant and where inequalities have increased supported Donald Trump. Meanwhile, counties with a similar economic trajectory but with a higher share of minorities shunned populism. In Europe, the most significant factor behind the rise of far-right populism is economic decline. This effect is particularly large in areas with a high share of immigration. [ABSTRACT FROM AUTHOR]

Simple Summary: Stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS) with conventional photon radiotherapy (XRT) are well-established treatment options for oligorecurrent/oligometastatic disease. Here, we review the available evidence surrounding the current use of proton beam therapy (PBT) in this setting. We describe how the particular physical properties of PBT could be used for the treatment of oligometastases/oligorecurences. Moreover, we further outline how current research has the potential to expand the therapeutic window of PBT whilst minimising the intrinsic uncertainties of this technique. This would potentially lead to an expansion of the commissioning of PBT to include these indications. Background: Stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS) with conventional photon radiotherapy (XRT) are well-established treatment options for selected patients with oligometastatic/oligorecurrent disease. The use of PBT for SABR-SRS is attractive given the property of a lack of exit dose. The aim of this review is to evaluate the role and current utilisation of PBT in the oligometastatic/oligorecurrent setting. Methods: Using Medline and Embase, a comprehensive literature review was conducted following the PICO (Patients, Intervention, Comparison, and Outcomes) criteria, which returned 83 records. After screening, 16 records were deemed to be relevant and included in the review. Results: Six of the sixteen records analysed originated in Japan, six in the USA, and four in Europe. The focus was oligometastatic disease in 12, oligorecurrence in 3, and both in 1. Most of the studies analysed (12/16) were retrospective cohorts or case reports, two were phase II clinical trials, one was a literature review, and one study discussed the pros and cons of PBT in these settings. The studies presented in this review included a total of 925 patients. The metastatic sites analysed in these articles were the liver (4/16), lungs (3/16), thoracic lymph nodes (2/16), bone (2/16), brain (1/16), pelvis (1/16), and various sites in 2/16. Conclusions: PBT could represent an option for the treatment of oligometastatic/oligorecurrent disease in patients with a low metastatic burden. Nevertheless, due to its limited availability, PBT has traditionally been funded for selected tumour indications that are defined as curable. The availability of new systemic therapies has widened this definition. This, together with the exponential growth of PBT capacity worldwide, will potentially redefine its commissioning to include selected patients with oligometastatic/oligorecurrent disease. To date, PBT has been used with encouraging results for the treatment of liver metastases. However, PBT could be an option in those cases in which the reduced radiation exposure to normal tissues leads to a clinically significant reduction in treatment-related toxicities. [ABSTRACT FROM AUTHOR]

In this sense, Weeda contends, the power relations embedded within the construction of ideas of ethnicity in medieval Europe involved "triangular" positioning between Christian I imperium i , individual bodies politic and those considered an inferior "other". Weeda's study offers a compelling account of how Europeans imagined the nation, that is, a distinctive, cohesive ethnic group who dwelt within and indeed was produced by a particular territory, in the period 950-1250. Claire Weeda's work examines how ethnotypes were imagined and rhetorically constructed in Europe in the period 950-1250. [Extracted from the article]

This data paper describes the multinational Database of Flood Fatalities from the Euro-Mediterranean region FFEM-DB that hosts data of 2,875 flood fatalities from 12 territories (nine of which represent entire countries) in Europe and the broader Mediterranean region from 1980 to 2020. The FFEM-DB database provides data on fatalities' profiles, location, and contributing circumstances, allowing researchers and flood risk managers to explore demographic, behavioral, and situational factors, as well as environmental features of flood-related mortality. The standardized data collection and classification methodology enable comparison between regions beyond administrative boundaries. The FFEM-DB is expandable, regularly updated, publicly available, and with anonymized data. The key advantages of the FFEM-DB compared to existing datasets containing flood fatalities are its high level of detail, data accuracy, record completeness, and the large sample size from an extended area. [ABSTRACT FROM AUTHOR]

Purpose: To externally evaluate the performance of two European risk prediction models, for identifying patients at high-risk of medication harm, in an Australian hospital setting. Methods: This was a secondary analysis of a pre-existing cohort study described in a recently published study by Falconer et al. (Br J Clin Pharmacol 87(3):1512–1524, 2021) describing the development of a predictive risk model for inpatient medication harm. We retrospectively extracted relevant variables using the electronic health records of general medical and geriatric patients admitted to a quaternary hospital, in Brisbane, over 6 months from July to December 2017. This dataset was used to externally evaluate the two European models, The Brighton Adverse Drug Reaction Risk (BADRI) model by Tangiisuran et al. and a risk model developed by Trivalle et al. The variables were entered into both models and the patients' risk of medication harm was calculated, and compared with actual patient outcomes. Predictive performance was evaluated by measuring area under the receiver operative characteristic (AuROC) curves. Results: The Australian patient cohort included 1982 patients (median age 74 years), of which 136 (7%) patients experienced ≥ 1 medication harm event(s). External evaluation of the two European models identified that both the BADRI and the Trivalle models had reduced predictive performance in an Australian patient cohort, compared with their original studies (AuROC of 0.63 [95% CI: 0.58–0.68] and 0.60 [95% CI: 0.55–0.65], respectively). Conclusion: Neither model demonstrated sufficient discrimination to warrant further evaluation in our local setting. This is likely a result of variations between the development and the validation cohorts, and the change in healthcare systems over time, and highlights the need for an up-to-date and context-specific risk prediction model. [ABSTRACT FROM AUTHOR]

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Familial hypercholesterolaemia (FH) is the most common inherited metabolic disorder characterized by high cholesterol and if left untreated leads to premature cardiovascular disease, such as heart attacks. Treatment that begins early in life, particularly in childhood, is highly efficacious in preventing cardiovascular disease and cost-effective, thus early detection of FH is crucial. However, in Europe, less than 10% of people living with FH are diagnosed and even less receive life-saving treatment. The Prague Declaration is a call to action for national and European Union policymakers and decision-makers and a result of the Czech EU Presidency meeting on FH Paediatric Screening (early detection of inherited high cholesterol) at the Czech Senate in Prague on 6th September 2022. It builds on a considerable body of evidence which was discussed at the Technical Meeting under the auspices of the Slovenian EU Presidency in October 2021. The Prague meeting addressed the outstanding barriers to the systematic implementation of FH paediatric screening across Europe. In this article, we present the key points from the Prague meeting and concrete actions needed to move forward. [ABSTRACT FROM AUTHOR]

Incidence rates of Merkel cell carcinoma (MCC), an uncommon skin cancer with an aggressive disease course, have increased in recent decades. Limited treatment options are available for patients with metastatic MCC (mMCC). Avelumab, an anti‐programmed cell death‐ligand 1 monoclonal antibody, became the first approved treatment for mMCC after the results of the phase 2 JAVELIN Merkel 200 study. Prior to its regulatory approval, an expanded access program (EAP) enabled compassionate use of avelumab in patients with mMCC. Here we report findings from patients enrolled in the EAP in Europe and the Middle East. Efficacy and safety data were provided at the discretion of treating physicians. Between March 2, 2016, and December 22, 2018, 403 requests for avelumab were received from 21 countries, and avelumab was supplied to 335 patients. Most patients (96.7%) received avelumab as second‐line or later treatment. In 150 patients for whom response data were available, the objective response rate was 48.0%, and in responding patients, median duration of treatment was 7.4 months (range, 1.0‐41.7 months). The most common treatment‐related adverse events were infusion‐related reaction (2.4%) and pyrexia (2.1%), and no new safety signals were observed. Overall, results from European and Middle Eastern patients enrolled in this EAP confirm the efficacy and safety of avelumab treatment observed in previous studies in patients with mMCC. What's new? Patients with the aggressive skin cancer Merkel cell carcinoma (MCC) have few treatment options. The first approved treatment for metastatic MCC, the anti‐PD‐L1 monoclonal antibody avelumab, was made available through an expanded access program (EAP) prior to regulatory approval. Here, the authors analyze data from 150 patients in Europe and the Middle East enrolled in that EAP. Avelumab's efficacy and safety in this real‐world population of patients, they found, confirm the findings reported from the JAVELIN Merkel 200 trial. [ABSTRACT FROM AUTHOR]

Background: A year following the onset of the COVID-19 pandemic, new infections and deaths continue to increase in Europe. Serological studies, through providing evidence of past infection, can aid understanding of the population dynamics of SARS-CoV-2 infection. Objectives: This systematic review of SARS-CoV-2 seroprevalence studies in Europe was undertaken to inform public health strategies including vaccination, that aim to accelerate population immunity. Methods: We searched the databases Web of Science, MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews and grey literature sources for studies reporting seroprevalence of SARS-CoV-2 antibodies in Europe published between 01/12/2019–30/09/20. We provide a narrative synthesis of included studies. Studies were categorized into subgroups including healthcare workers (HCWs), community, outbreaks, pregnancy and children/school. Due to heterogeneity in other subgroups, we only performed a random effects meta-analysis of the seroprevalence amongst HCWs stratified by their country. Results: 115 studies were included spanning 17 European countries, that estimated the seroprevalence of SARS-CoV-2 from samples obtained between November 2019 –August 2020. A total of 54/115 studies included HCWs with a reported seroprevalence among HCWs ranging from 0.7% to 45.3%, which did not differ significantly by country. In community studies significant heterogeneity was reported in the seroprevalence between different age groups and the majority of studies reported there was no significant difference by gender. Conclusion: This review demonstrates a wide heterogeneity in reported seroprevalence of SARS-CoV-2 antibodies between populations. Continued evaluation of seroprevalence is required to understand the impact of public health measures and inform interventions including vaccination programmes. [ABSTRACT FROM AUTHOR]

Background: There is increased recognition that incorporating patients' perspectives and insights into the medicines development process results in better health outcomes and benefits for all involved stakeholders. Despite the increased interest and the existence of frameworks and practical recommendations, patient engagement (PE) is not yet considered standard practice. The objective of this work was to provide a roadmap to support systematic change in all stakeholder organisations involved in medicines development across Europe, patients and patient organisations, medicines developers, academia, regulatory authorities, Health Technology Assessment bodies, payers, policy-makers and public research funders, to sustain PE practices. Methods: A mixed-methods approach was used by the EU-funded Innovative Medicines Initiative PARADIGM Consortium to co-develop the sustainability roadmap including background work to identify success factors and scenarios for sustainable PE. The roadmap development was based on the Theory of Change concept and populated with findings from (1) interviews with national/ and international institutions with the potential to increase PE uptake by other stakeholders; (2) multi-stakeholder workshops and webinars; and (3) consultations with specific stakeholder groups, Consortium members and a consultative body formed by international PE initiatives. Results: This roadmap sets strategic goals for the PE community to achieve meaningful and systematic PE through changes in the culture, processes and resources of stakeholder organisations. It brings in key PARADIGM outputs to work in a coordinated fashion with existing frameworks and mechanisms to achieve system-wide sustained PE. Conclusions: The roadmap provides a framework for all stakeholders to take collective action within their organisations and across Europe to implement PE in a sustainable manner. [ABSTRACT FROM AUTHOR]

Background: Clinical studies with work participation (WP) as an outcome domain pose particular methodological challenges that hamper interpretation, comparison between studies and meta-analyses.Objectives: To develop Points to Consider (PtC) for design, analysis and reporting of studies of patients with inflammatory arthritis that include WP as a primary or secondary outcome domain.Methods: The EULAR Standardised Operating Procedures were followed. A multidisciplinary taskforce with 22 experts including patients with rheumatic diseases, from 10 EULAR countries and Canada, identified methodologic areas of concern. Two systematic literature reviews (SLR) appraised the methodology across these areas. In parallel, two surveys among professional societies and experts outside the taskforce sought for additional methodological areas or existing conducting/reporting recommendations. The taskforce formulated the PtC after presentation of the SLRs and survey results, and discussion. Consensus was obtained through informal voting, with levels of agreement obtained anonymously.Results: Two overarching principles and nine PtC were formulated. The taskforce recommends to align the work-related study objective to the design, duration, and outcome domains/measurement instruments of the study (PtC: 1-3); to identify contextual factors upfront and account for them in analyses (PtC: 4); to account for interdependence of different work outcome domains and for changes in work status over time (PtC: 5-7); to present results as means as well as proportions of patients reaching predefined meaningful categories (PtC: 8) and to explicitly report volumes of productivity loss when costs are an outcome (PtC:9).Conclusion: Adherence to these EULAR PtC will improve the methodological quality of studies evaluating WP. [ABSTRACT FROM AUTHOR]

Aim: Among children who receive hospital care, preterm infants are Europe's largest group, whose numbers are continually increasing. Currently, no pan‐European standards of care for preterm or critically ill infants are available, except for a few specific topics, and practices vary widely in different regions. Methods: The European Foundation for the Care of Newborn Infants (EFCNI) has initiated a transdisciplinary collaboration project to provide agreed standards for high‐quality perinatal and neonatal care, whose implementation will ensure fairer and more equitable care across Europe. This will improve care for these vulnerable infants and their families, ameliorate the long‐term conditions found in preterm and critically ill infants and enhance the quality of family life of affected families. More than 220 experts—healthcare professionals, patient representatives and other relevant stakeholders—have come together for the first time to develop a broad reference guidance in neonatology and associated fields. Results: Ninety‐six standards on 11 overarching topic areas were developed and endorsed. Conclusion: This reference framework serves as a basis for the development of binding national standards for high‐quality care. A robust translation and implementation strategy is facilitated, with the goal of improved health outcomes following preterm birth all around Europe. [ABSTRACT FROM AUTHOR]

Background Socioeconomic status is associated with health status among older adults, including hearing and vision impairments, and healthcare system performance is an important consideration in examining that association. We explored the link between a country's healthcare system performance and the hearing and visual impairments of its people in Europe. Methods This study enrolled 65 332 individuals aged 50+ from 17 countries participating in the Survey of Health, Ageing and Retirement in Europe Wave 6. We used latent class analysis to identify groups of countries based on six domains of healthcare system performance. We then performed multiple logistic regressions to quantify the association between socioeconomic status and hearing and visual impairments adjusted for demographic and other co-variates; finally, we compared the patterns of observed associations in each of the country groups. Results The latent class analysis separated countries into three groups based on the performance of their healthcare systems: poor, moderate and high. Respondents in countries with moderate and poor healthcare performance were more likely to experience hearing and visual impairment than those in countries with high healthcare performance. With respect to hearing and visual impairments, wealth gradients at the individual level varied among countries in different healthcare performance groups, with less wealth associated with worse hearing and seeing only in the countries with moderate and poor healthcare performance. Conclusion The relationships between wealth and hearing and visual impairments differ among countries with different healthcare performance. [ABSTRACT FROM AUTHOR]

Landscapes occupied by recovering carnivore populations in Europe are highly modified by human activity. It is unclear how recovering predators will adapt and sustain populations in highly altered landscapes, with most existing research focused on large carnivores. To address this we contrast population demographics and denning behaviour of a small carnivore, the pine marten Martes martes, in a semi-natural wooded landscape and a human-modified landscape with limited forest cover composed of conifer plantation, using radio-telemetry on 20 free-ranging individuals in Northern Ireland. In the semi-natural landscape, martens selected old growth, native forest making almost exclusive use of arboreal dens in living trees and standing deadwood. Martens persisted in the human-modified landscape but with lower population density and recruitment, with a male-biased sex ratio. In the human-modified landscape martens denned in marginal habitats such as scrub, heath and property boundaries, while making use of subterranean or man-made structures for dens in response to a lack of above ground denning opportunities. We demonstrate landscape change-induced differences in behaviour and population structure in a recovering carnivore. The results highlight the importance of evaluating the availability of denning sites in carnivore conservation and provide valuable management considerations, key to mitigating human–wildlife conflict as carnivores continue to recover and recolonise Europe. [ABSTRACT FROM AUTHOR]

Roses (Rosa) are one of the most valuable ornamental flowering shrubs around the globe. They are susceptible to numerous pathogens that require management, increasing the cost of cultivation. Rose rosette virus (RRV; genus Emaravirus) is a devastating virus that has been spreading since the 1940s in the United States and Canada. It is an emerging risk to European and worldwide rose cultivation, causing symptoms such as witches' broom, malformations, excessive thorn production, and eventually plant death. RRV is transmitted by the eriophyid mite Phyllocoptes fructiphilus and by grafting. Research is being undertaken to understand RRV and to find control measures and resistant cultivars, as they are not currently available. Early detection of the disease is the key to prevent the establishment and spread of RRV and its vector. Different molecular and serological diagnostic methods have been designed and implemented, including ELISA, RT‐PCR, RT‐qPCR, LAMP, and high‐throughput sequencing. RRV infected plants can remain symptomless for long periods, so these diagnostic assays are necessary in conjunction with visual assessment to facilitate early detection. Significant social, economic, and environmental impacts are expected if RRV and its vector establish and spread in Europe. Rose trade between countries is the most likely pathway of introduction of RRV into Europe. In this review we describe current knowledge about RRV, the molecular and serological methods available for the detection of this virus, pathways to entry, and the possible impact if it establishes and spreads in Europe. [ABSTRACT FROM AUTHOR]

Prioritizing the management of invasive alien species (IAS) is of global importance and within Europe integral to the EU IAS regulation. To prioritize management effectively, the risks posed by IAS need to be assessed, but so too does the feasibility of their management. While the risk of IAS to the EU has been assessed, the feasibility of management has not. We assessed the feasibility of eradicating 60 new (not yet established) and 35 emerging (established with limited distribution) species that pose a threat to the EU, as identified by horizon scanning. The assessment was carried out by 34 experts in invasion management from across Europe, applying the Non‐Native Risk Management scheme to defined invasion scenarios and eradication strategies for each species, assessing the feasibility of eradication using seven key risk management criteria. Management priorities were identified by combining scores for risk (derived from horizon scanning) and feasibility of eradication. The results show eradication feasibility score and risk score were not correlated, indicating that risk management criteria evaluate different information than risk assessment. In all, 17 new species were identified as particularly high priorities for eradication should they establish in the future, whereas 14 emerging species were identified as priorities for eradication now. A number of species considered highest priority for eradication were terrestrial vertebrates, a group that has been the focus of a number of eradication attempts in Europe. However, eradication priorities also included a diverse range of other taxa (plants, invertebrates and fish) suggesting there is scope to broaden the taxonomic range of attempted eradication in Europe. We demonstrate that broad scale structured assessments of management feasibility can help prioritize IAS for management. Such frameworks are needed to support evidence‐based decision‐making. [ABSTRACT FROM AUTHOR]

This is the second of two papers that document the creation of the New European Wind Atlas (NEWA). In Part 1, we described the sensitivity experiments and accompanying evaluation done to arrive at the final mesoscale model setup used to produce the mesoscale wind atlas. In this paper, Part 2, we document how we made the final wind atlas product, covering both the production of the mesoscale climatology generated with the Weather Research and Forecasting (WRF) model and the microscale climatology generated with the Wind Atlas Analysis and Applications Program (WAsP). The paper includes a detailed description of the technical and practical aspects that went into running the mesoscale simulations and the downscaling using WAsP. We show the main results from the final wind atlas and present a comprehensive evaluation of each component of the NEWA model chain using observations from a large set of tall masts located all over Europe. The added value of the WRF and WAsP downscaling of wind climatologies is evaluated relative to the performance of the driving ERA5 reanalysis and shows that the WRF downscaling reduces the mean wind speed bias and spread relative to that of ERA5 from -1.50±1.30 to 0.02±0.78 m s -1. The WAsP downscaling has an added positive impact relative to that of the WRF model in simple terrain. In complex terrain, where the assumptions of the linearized flow model break down, both the mean bias and spread in wind speed are worse than those from the raw mesoscale results. [ABSTRACT FROM AUTHOR]

This is the first of two papers that document the creation of the New European Wind Atlas (NEWA). It describes the sensitivity analysis and evaluation procedures that formed the basis for choosing the final setup of the mesoscale model simulations of the wind atlas. The suitable combination of model setup and parameterizations, bound by practical constraints, was found for simulating the climatology of the wind field at turbine-relevant heights with the Weather Research and Forecasting (WRF) model. Initial WRF model sensitivity experiments compared the wind climate generated by using two commonly used planetary boundary layer schemes and were carried out over several regions in Europe. They confirmed that the most significant differences in annual mean wind speed at 100 m a.g.l. (above ground level) mostly coincide with areas of high surface roughness length and not with the location of the domains or maximum wind speed. Then an ensemble of more than 50 simulations with different setups for a single year was carried out for one domain covering northern Europe for which tall mast observations were available. We varied many different parameters across the simulations, e.g. model version, forcing data, various physical parameterizations, and the size of the model domain. These simulations showed that although virtually every parameter change affects the results in some way, significant changes in the wind climate in the boundary layer are mostly due to using different physical parameterizations, especially the planetary boundary layer scheme, the representation of the land surface, and the prescribed surface roughness length. Also, the setup of the simulations, such as the integration length and the domain size, can considerably influence the results. We assessed the degree of similarity between winds simulated by the WRF ensemble members and the observations using a suite of metrics, including the Earth Mover's Distance (EMD), a statistic that measures the distance between two probability distributions. The EMD was used to diagnose the performance of each ensemble member using the full wind speed and direction distribution, which is essential for wind resource assessment. We identified the most realistic ensemble members to determine the most suitable configuration to be used in the final production run, which is fully described and evaluated in the second part of this study. [ABSTRACT FROM AUTHOR]

Emerging evidence suggests that a metabolic profile associated with obesity may be a more relevant risk factor for some cancers than adiposity per se. Basal metabolic rate (BMR) is an indicator of overall body metabolism and may be a proxy for the impact of a specific metabolic profile on cancer risk. Therefore, we investigated the association of predicted BMR with incidence of 13 obesity‐related cancers in the European Prospective Investigation into Cancer and Nutrition (EPIC). BMR at baseline was calculated using the WHO/FAO/UNU equations and the relationships between BMR and cancer risk were investigated using multivariable Cox proportional hazards regression models. A total of 141,295 men and 317,613 women, with a mean follow‐up of 14 years were included in the analysis. Overall, higher BMR was associated with a greater risk for most cancers that have been linked with obesity. However, among normal weight participants, higher BMR was associated with elevated risks of esophageal adenocarcinoma (hazard ratio per 1‐standard deviation change in BMR [HR1‐SD]: 2.46; 95% CI 1.20; 5.03) and distal colon cancer (HR1‐SD: 1.33; 95% CI 1.001; 1.77) among men and with proximal colon (HR1‐SD: 1.16; 95% CI 1.01; 1.35), pancreatic (HR1‐SD: 1.37; 95% CI 1.13; 1.66), thyroid (HR1‐SD: 1.65; 95% CI 1.33; 2.05), postmenopausal breast (HR1‐SD: 1.17; 95% CI 1.11; 1.22) and endometrial (HR1‐SD: 1.20; 95% CI 1.03; 1.40) cancers in women. These results indicate that higher BMR may be an indicator of a metabolic phenotype associated with risk of certain cancer types, and may be a useful predictor of cancer risk independent of body fatness. What's new? Although the basal metabolic rate (BMR) – defined as the daily rate of energy metabolism required to preserve vital functions – has been positively associated with increased breast cancer risk, its relevance to other cancers remains unknown. Here, the authors examined associations between predicted BMR and risk of 13 cancers in over 520,000 individuals in Europe. Predicted BMR was generally positively associated with cancer risk. Importantly, among normal weight individuals, BMR was positively associated with cancers of the colon, pancreas, thyroid, esophageal adenocarcinoma, postmenopausal breast, and endometrium, indicating that BMR may identify subgroups of the population who are at greater risk of these malignancies. [ABSTRACT FROM AUTHOR]

Rationale: Although the carcinogenicity of diesel engine exhaust has been demonstrated in multiple studies, little is known regarding exposure-response relationships associated with different exposure subgroups and different lung cancer subtypes.Objectives: We expanded on a previous pooled case-control analysis on diesel engine exhaust and lung cancer by including three additional studies and quantitative exposure assessment to evaluate lung cancer and subtype risks associated with occupational exposure to diesel exhaust characterized by elemental carbon (EC) concentrations.Methods: We used a quantitative EC job-exposure matrix for exposure assessment. Unconditional logistic regression models were used to calculate lung cancer odds ratios and 95% confidence intervals (CIs) associated with various metrics of EC exposure. Lung cancer excess lifetime risks (ELR) were calculated using life tables accounting for all-cause mortality. Additional stratified analyses by smoking history and lung cancer subtypes were performed in men.Measurements and Main Results: Our study included 16,901 lung cancer cases and 20,965 control subjects. In men, exposure response between EC and lung cancer was observed: odds ratios ranged from 1.09 (95% CI, 1.00-1.18) to 1.41 (95% CI, 1.30-1.52) for the lowest and highest cumulative exposure groups, respectively. EC-exposed men had elevated risks in all lung cancer subtypes investigated; associations were strongest for squamous and small cell carcinomas and weaker for adenocarcinoma. EC lung cancer exposure response was observed in men regardless of smoking history, including in never-smokers. ELR associated with 45 years of EC exposure at 50, 20, and 1 μg/m3 were 3.0%, 0.99%, and 0.04%, respectively, for both sexes combined.Conclusions: We observed a consistent exposure-response relationship between EC exposure and lung cancer in men. Reduction of workplace EC levels to background environmental levels will further reduce lung cancer ELR in exposed workers. [ABSTRACT FROM AUTHOR]

Rationale: Millions of workers around the world are exposed to respirable crystalline silica. Although silica is a confirmed human lung carcinogen, little is known regarding the cancer risks associated with low levels of exposure and risks by cancer subtype. However, little is known regarding the disease risks associated with low levels of exposure and risks by cancer subtype.Objectives: We aimed to address current knowledge gaps in lung cancer risks associated with low levels of occupational silica exposure and the joint effects of smoking and silica exposure on lung cancer risks.Methods: Subjects from 14 case-control studies from Europe and Canada with detailed smoking and occupational histories were pooled. A quantitative job-exposure matrix was used to estimate silica exposure by occupation, time period, and geographical region. Logistic regression models were used to estimate exposure-disease associations and the joint effects of silica exposure and smoking on risk of lung cancer. Stratified analyses by smoking history and cancer subtypes were also performed.Measurements and Main Results: Our study included 16,901 cases and 20,965 control subjects. Lung cancer odds ratios ranged from 1.15 (95% confidence interval, 1.04-1.27) to 1.45 (95% confidence interval, 1.31-1.60) for groups with the lowest and highest cumulative exposure, respectively. Increasing cumulative silica exposure was associated (P trend < 0.01) with increasing lung cancer risks in nonsilicotics and in current, former, and never-smokers. Increasing exposure was also associated (P trend ≤ 0.01) with increasing risks of lung adenocarcinoma, squamous cell carcinoma, and small cell carcinoma. Supermultiplicative interaction of silica exposure and smoking was observed on overall lung cancer risks; superadditive effects were observed in risks of lung cancer and all three included subtypes.Conclusions: Silica exposure is associated with lung cancer at low exposure levels. An exposure-response relationship was robust and present regardless of smoking, silicosis status, and cancer subtype. [ABSTRACT FROM AUTHOR]

Background and Aims: Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry. Method: Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe. Results: A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP–CSO relationship, CRAFT modality and integration of treatment for IP. Meta‐analysis found CRAFT to be twice as effective as controls/comparison groups. Multi‐modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5–71%), group (60%) and self‐directed workbook (13.3–40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5–23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. Conclusions: Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success. [ABSTRACT FROM AUTHOR]

Purpose: This work aimed to design and validate a novel short food frequency questionnaire (SFFQ) to assess habitual intakes of food items related to non-alcoholic fatty liver disease (NAFLD) in a cohort of European patients. Methods: A 48-item SFFQ was created, with questions from existing FFQs and expert knowledge, emphasizing foods and nutrients implicated in NAFLD pathogenesis. Consenting, fibroscan-diagnosed, NAFLD patients completed the SFFQ during a short interview and were asked to complete a 4-day diet diary (4DDD) at home for return by mail. Nutritional intakes were assessed utilizing the myfood24™ food composition dataset and estimated energy requirements (EER) were calculated using sex-, age- and weight-specific equations. Agreement between the dietary instruments was assessed by Spearman correlations and Bland Altman analysis. Results: Fifty-five patients completed both the SFFQ and the 4DDD within 30 weeks; 42 (76%) were diagnosed with simple steatosis, whereas 13 (24%) had biopsy-proven steatohepatitis; the majority were overweight or obese, with a median (25th; 75th percentile) BMI of 33.2 kg/m2 (29.3; 36.0). Reported energy intakes were well below EER with a median intake of 73% of requirements, suggesting widespread under-reporting. Significant correlations were observed between sugar (r = 0.408, P = 0.002), fat (r = 0.44, P = 0.001), fruits (r = 0.51, P = 0.0001) and vegetables (r = 0.40, P = 0.0024) measurements by the SFFQ and 4DDD. Bland Altman plots with regression analysis demonstrated broad comparability with the 4DDD for intakes of fat (bias − 13.8 g/day) and sugar (bias + 12.9 g/day). Conclusions: A novel SFFQ designed to be minimally burdensome to participants was effective at assessing dietary intakes in NAFLD patients. [ABSTRACT FROM AUTHOR]

The coalition government that resulted from the 2010 general election represents a new scenario in the British political marketplace with implications for political marketing theory and practice. The modelling of political marketing in the UK has evolved in relatively stable market conditions in which majority governments are elected; the market restructure arising from the 2010 election outcome offers an opportunity for a revised understanding of the field. Political science has established an important and dynamic body of knowledge that explains the founding and operation of coalitions. A comparative appraisal of coalition government and commercial cooperative arrangements indicates some commonalities. Western European elections are characterised by multiple actors, regional preferences, smaller parties, cooperative distribution of power, and assumed negotiability of the offer. As the British political marketplace evolves to exhibit similar characteristics, insights from these markets are used to contribute to the more multifaceted, cooperative models of political marketing management required for the UK. [ABSTRACT FROM AUTHOR]

Public debates about both immigration policy and social safety net programs are increasingly contentious. However, little research has explored differences in health within America's diverse population of foreign-born workers, and the effect of these workers on public benefit programs is not well understood. We investigate differences in work disability by nativity and origins and describe the mix of health problems associated with receiving Social Security Disability Insurance benefits. Our analysis draws on two large national data sources-the American Community Survey and comprehensive administrative records from the Social Security Administration-to determine the prevalence and incidence of work disability between 2001 and 2010. In sharp contrast to prior research, we find that foreign-born adults are substantially less likely than native-born Americans to report work disability, to be insured for work disability benefits, and to apply for those benefits. Overall and across origins, the foreign-born also have a lower incidence of disability benefit award. Persons from Africa, Northern Europe, Canada, and parts of Asia have the lowest work disability benefit prevalence rates among the foreign-born; persons from Southern Europe, Western Europe, the former Soviet Union, and the Caribbean have the highest rates. [ABSTRACT FROM AUTHOR]

Background: Although commonly diagnosed, gout often remains a poorly managed disease. This is partially due to a lack of awareness of the long-term effect of gout among patients and healthcare professionals. Aim: To understand unmet needs for patients and provide insight into achieving better treatment. Design & setting: A quantitative online questionnaire collected from 1100 people with gout from 14 countries within Europe. Method: Patients were recruited to complete an online survey via healthcare professional (HCP) referral, patient associations, or market research panels. Patients were included if they had been diagnosed with gout by a physician. Prior to commencement, patients were made aware that this study was sponsored by Grünenthal. The responses collected were collated and analyses were performed. Results: Patients had an average of 2.9 gout flares within a 12-month period. Although 79% of patients were satisfied with treatment, inadequate gout control was also reported by 71% of patients. Furthermore, 84% experienced moderate-to- severe pain with their most recent flare. Of those who acknowledged treatment dissatisfaction, only 24% discussed other options with their GP. Most patients reported irregular follow-up and serum uric acid (sUA) monitoring. In addition, loss of belief that more can be done was a key barrier for patients. Conclusion: Patients reported severe pain and social burden, coupled with low treatment expectation and lack of awareness of target sUA. Education around knowing and reaching sUA target is needed so that patients can receive and GPs can deliver higher quality management. [ABSTRACT FROM AUTHOR]

Aim: The aim was to decipher Europe‐wide spatio‐temporal patterns of forest growth dynamics and their associations with carbon isotope fractionation processes inferred from tree rings as modulated by climate warming. Location: Europe and North Africa (30‒70° N, 10° W‒35° E). Time period: 1901‒2003. Major taxa studied: Temperate and Euro‐Siberian trees. Methods: We characterize changes in the relationship between tree growth and carbon isotope fractionation over the 20th century using a European network consisting of 20 site chronologies. Using indexed tree‐ring widths (TRWi), we assess shifts in the temporal coherence of radial growth across sites (synchrony) for five forest ecosystems (Atlantic, boreal, cold continental, Mediterranean and temperate). We also examine whether TRWi shows variable coupling with leaf‐level gas exchange, inferred from indexed carbon isotope discrimination of tree‐ring cellulose (Δ13Ci). Results: We find spatial autocorrelation for TRWi and Δ13Ci extending over a maximum of 1,000 km among forest stands. However, growth synchrony is not uniform across Europe, but increases along a latitudinal gradient concurrent with decreasing temperature and evapotranspiration. Latitudinal relationships between TRWi and Δ13Ci (changing from negative to positive southwards) point to drought impairing carbon uptake via stomatal regulation for water saving occurring at forests below 60° N in continental Europe. An increase in forest growth synchrony over the 20th century together with increasingly positive relationships between TRWi and Δ13Ci indicate intensifying impacts of drought on tree performance. These effects are noticeable in drought‐prone biomes (Mediterranean, temperate and cold continental). Main conclusions: At the turn of this century, convergence in growth synchrony across European forest ecosystems is coupled with coordinated warming‐induced effects of drought on leaf physiology and tree growth spreading northwards. Such a tendency towards exacerbated moisture‐sensitive growth and physiology could override positive effects of enhanced leaf intercellular CO2 concentrations, possibly resulting in Europe‐wide declines of forest carbon gain in the coming decades. [ABSTRACT FROM AUTHOR]

Legislative pressures have led to the mature dominant chromium‐coated steel (ECCS) substrate and epoxy phenolic lacquer replacement in Europe. An investigation was carried out to examine the interaction between a steel surface engineered with a novel, developmental substrate coated using Cr (III)‐based electrolytes and the food stuff being canned. Samples of lacquered material were subjected to a typical retort process (121°C for 90 minutes) and examined using a variety of laboratory analytical techniques. The foodstuff being packaged has a significant impact on the substrate/lacquer adhesion with clear differences in failure mechanisms between foodstuffs. There is clear evidence of chemical species transfer through the next generation lacquer, and this can instigate corrosion at the surface where incomplete chromium coverage leads to exposed iron. In general, the novel developmental material exhibits lower adhesive properties and shows a greater sensitivity to the foodstuff, although this is largely attributed to the homogeneity of the coverage. The novel substrate proves to be a promising alternative to ECCS due to REACH legislation, but improvement is required to achieve equivalent performance. [ABSTRACT FROM AUTHOR]

Conceptually, many energy poverty studies to date have been narrowly focused on inadequate indoor heating, paying little attention to other domestic energy services. Yet there are indications that a growing number of households in Europe are struggling to achieve adequate levels of indoor cooling, with adverse consequences for their health, well-being and productivity. This situation is exacerbated by changing global weather patterns, with many countries facing increases in the frequency and intensity of extreme heatwaves. There is limited understanding of the ways in which households respond to extreme heat, and consequently how this might create greater demand for indoor space cooling and air conditioning, and the consequences for increased stress on power grids and conflicts with carbon reduction goals. Using custom-built survey data collected from 2337 households in Gdańsk (Poland), Prague (Czech Republic), Budapest (Hungary) and Skopje (North Macedonia), along with in-depth qualitative fieldwork with 55 households in the same cities, this paper presents novel evidence on the issue of summertime energy poverty and space cooling difficulties. We identify the driving forces of household vulnerability to excessive indoor heat, in terms of risk of exposure, adaptive capacity, and sensitivity, and explore the implications for addressing energy poverty. [ABSTRACT FROM AUTHOR]

Introduction. The present study investigates the taxonomy of European members of Weissia Hedw. subgenus Astomum Hampe., a group considered taxonomically difficult and including species of high conservation concern. Methods. A broad set of samples were subject to DNA sequencing and morphological analysis, plus a review of type material was undertaken. Key Results and Conclusions. Three taxonomic additions and changes are supported. (1) Weissia longifolia var. angustifolia (Baumgartner) Crundw. & Nyholm is raised to species rank, W. angustifolia (Baumgartner) D.A.Callaghan, comb. et. stat. nov. (2) The type of W. multicapsularis (Sm.) Mitt. comprises an intermix of Phascum cuspidatum Hedw. and W. longifolia Mitt., and the protologue refers to unique features of P. cuspidatum but no such features of W. longifolia. Weissia multicapsularis is therefore described as a new synonym of P. cuspidatum. (3) Plants that have been named as W. multicapsularis by modern authors comprise an undescribed species, here named W. wilsonii D.A.Callaghan, sp. nov. An illustrated key to European species of Weissia subgenus Astomum is provided. [ABSTRACT FROM AUTHOR]