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of the Mind A Semiotic Theory of CultureYuri M. LotmanIntroduction by Umberto Eco Translated by Ann ShukmanA major book by one of the initiators of cultural studies. Universe of the Mind is an ambitious, complex, and wide-ranging book that semioticians, textual critics, and those interested in cultural studies will find stimulating and immensely suggestive. Journal of CommunicationSoviet semiotics offers a distinctive, richly productive approach to literary and cultural studies and of the Mind represents a summation of the intellectual career of the man who has done most to guarantee this. Slavic and East European JournalUniverse of the Mind addresses three main areas: meaning and text, culture, and history. The result is a full-scale attempt to demonstrate the workings of the semiotic space or intellectual world. Part One is concerned with the ways that texts generate meaning. Part Two addresses Lotman s central idea of the semiosphere the domain in which all semiotic systems can function presented through an analogy with the global biosphere. Part Three focuses on semiotics from the point of view of history.A seminal text in cultural semiotics, the book s ambitious scope also makes it applicable to disciplines outside The book will be of great interest to those concerned with cultural studies, anthropology, Slavic studies, critical theory, philosophy, and historiography.Yuri Mikhailovich Lotman is the founder of the Moscow-Tartu School and the initiator of the discipline of cultural semiotics.

This article revisits the notion of ‘postfeminism’ 10 years after its formulation in critical terms as a sensibility characterizing cultural life. The article has two broad aims: first to reflect upon postfeminism as a critical term – as part of the lexicon of feminist scholarship – and second to discuss the current features of postfeminism as a sensibility. The first part of the article discusses the extraordinary uptake of the term and considers its continuing relevance in a changed context marked by deeply contradictory trends, including the resurgence of interest in feminism, alongside the spectacular visibility of misogyny, racism, homophobia and nationalism. I document a growing attention to the specificities of postfeminism, including attempts to map its temporal phases, its relevance to place, and intersectional developments of the term. The second part of the article examines the contours of the contemporary postfeminist sensibility. I argue that postfeminism has tightened its hold upon contemporary life and become hegemonic. Compared with a decade ago, it is much more difficult to recognize as a novel and distinctive sensibility, as it instantiates a common sense that operates as a kind of gendered neoliberalism. It has both spread out and intensified across contemporary culture and is becoming increasingly dependent upon a psychological register built around cultivating the ‘right’ kinds of dispositions for surviving in neoliberal society: confidence, resilience and positive mental attitude. Together these affective, cultural and psychic features of postfeminism exert a powerful regulatory force. This article forms part of ‘On the Move’, a special issue marking the twentieth anniversary of the journal. It also heads up a special online dossier on ‘Postfeminism in the European Journal of Cultural Studies’.

BACKGROUND: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING: Bill & Melinda Gates Foundation.

With the Total Food Quality Model as point of departure, a study is described which analyses how consumers evaluate the quality of beef in a purchase situation in four European countries: France, Germany, Spain and the UK. The study consisted of a series of focus groups and of an extended form of conjoint analysis which allows an estimation of meansend structures. Tradition and security, variation, atmosphere and social life, health, acceptance from family/children/ guests, nutrition, demonstration of cooking abilities, and status are the most important purchasing motives in all four countries. The most important quality aspects of beef are that it tastes good, is tender, juicy, fresh, lean, healthy and nutritious. Purchasing motives as well as quality aspects are uni-dimensional in Germany, Spain, and the UK, while they are multi-dimensional in France. Place of purchase and quality perception are related in all four countries, i.e. the butcher is regarded as a sort of guarantor of high quality. This applies less in the UK than in the other countries, however. The most important concrete product characteristics which consumers base their quality evaluation on are fat content and colour. Fat is generally negative, and this applies to all aspects of fat. The positive effects of fat on taste and tenderness are not perceived. German consumers prefer dark meat, whereas Spanish consumers tend to prefer light meat. Information about country of origin and breeding and feeding has no effect on quality perception. The results suggest that producers of superior beef have a problem in communicating this quality to consumers, and that a quality grading system developed in co-operation between producer and retailer may be the best way to overcome consumer uncertainty in evaluating the quality of beef.

The European Hernia Society (EHS) is proud to present the EHS Guidelines for the Treatment of Inguinal Hernia in Adult Patients. The Guidelines contain recommendations for the treatment of inguinal hernia from diagnosis till aftercare. They have been developed by a Working Group consisting of expert surgeons with representatives of 14 country members of the EHS. They are evidence-based and, when necessary, a consensus was reached among all members. The Guidelines have been reviewed by a Steering Committee. Before finalisation, feedback from different national hernia societies was obtained. The Appraisal of Guidelines for REsearch and Evaluation (AGREE) instrument was used by the Cochrane Association to validate the Guidelines. The Guidelines can be used to adjust local protocols, for training purposes and quality control. They will be revised in 2012 in order to keep them updated. In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research. Therefore, we provide recommendations for further research that can be performed to raise the level of evidence concerning certain aspects of inguinal hernia treatment. In addition, a short summary, specifically for the general practitioner, is given. In order to increase the practical use of the Guidelines by consultants and residents, more details on the most important surgical techniques, local infiltration anaesthesia and a patient information sheet is provided. The most important challenge now will be the implementation of the Guidelines in daily surgical practice. This remains an important task for the EHS. The establishment of an EHS school for teaching inguinal hernia repair surgical techniques, including tips and tricks from experts to overcome the learning curve (especially in endoscopic repair), will be the next step. Working together on this project was a great learning experience, and it was worthwhile and fun. Cultural differences between members were easily overcome by educating each other, respecting different views and always coming back to the principles of evidence-based medicine. The members of the Working Group would like to thank the EHS board for their support and especially Ethicon for sponsoring the many meetings that were needed to finalise such an ambitious project.

AIMS: To determine whether the Joint European Societies guidelines on cardiovascular prevention are being followed in everyday clinical practice of secondary prevention and to describe the lifestyle, risk factor and therapeutic management of coronary patients across Europe. METHODS AND RESULTS: EUROASPIRE IV was a cross-sectional study undertaken at 78 centres from 24 European countries. Patients <80 years with coronary disease who had coronary artery bypass graft, percutaneous coronary intervention or an acute coronary syndrome were identified from hospital records and interviewed and examined ≥ 6 months later. A total of 16,426 medical records were reviewed and 7998 patients (24.4% females) interviewed. At interview, 16.0% of patients smoked cigarettes, and 48.6% of those smoking at the time of the event were persistent smokers. Little or no physical activity was reported by 59.9%; 37.6% were obese (BMI ≥ 30 kg/m(2)) and 58.2% centrally obese (waist circumference ≥ 102 cm in men or ≥88 cm in women); 42.7% had blood pressure ≥ 140/90 mmHg (≥140/80 in people with diabetes); 80.5% had low-density lipoprotein cholesterol ≥ 1.8 mmol/l and 26.8% reported having diabetes. Cardioprotective medication was: anti-platelets 93.8%; beta-blockers 82.6%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers 75.1%; and statins 85.7%. Of the patients 50.7% were advised to participate in a cardiac rehabilitation programme and 81.3% of those advised attended at least one-half of the sessions. CONCLUSION: A large majority of coronary patients do not achieve the guideline standards for secondary prevention with high prevalences of persistent smoking, unhealthy diets, physical inactivity and consequently most patients are overweight or obese with a high prevalence of diabetes. Risk factor control is inadequate despite high reported use of medications and there are large variations in secondary prevention practice between centres. Less than one-half of the coronary patients access cardiac prevention and rehabilitation programmes. All coronary and vascular patients require a modern preventive cardiology programme, appropriately adapted to medical and cultural settings in each country, to achieve healthier lifestyles, better risk factor control and adherence with cardioprotective medications.

BACKGROUND: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING: Bill & Melinda Gates Foundation.

Cultural ecosystem services (ES) are consistently recognized but not yet adequately defined or integrated within the ES framework. A substantial body of models, methods, and data relevant to cultural services has been developed within the social and behavioral sciences before and outside of the ES approach. A selective review of work in landscape aesthetics, cultural heritage, outdoor recreation, and spiritual significance demonstrates opportunities for operationally defining cultural services in terms of socioecological models, consistent with the larger set of ES. Such models explicitly link ecological structures and functions with cultural values and benefits, facilitating communication between scientists and stakeholders and enabling economic, multicriterion, deliberative evaluation and other methods that can clarify tradeoffs and synergies involving cultural ES. Based on this approach, a common representation is offered that frames cultural services, along with all ES, by the relative contribution of relevant ecological structures and functions and by applicable social evaluation approaches. This perspective provides a foundation for merging ecological and social science epistemologies to define and integrate cultural services better within the broader ES framework.

The aim of this study was to review research conducted in 2003–2006 in the EU-15 countries on how consumers perceive, understand, like and use nutrition information on food labels. Based on a search of databases on academic publications, Google-based search, and enquiries directed to a range of food retailers, food companies, consumer associations and government agencies, a total of 58 studies were identified. These studies were summarised using a standard format guided by a model of consumer information processing, and these summaries were subsequently processed using the MAXqda software in order to identify key findings and common themes across the studies. The studies show widespread consumer interest in nutrition information on food packages, though this interest varies across situations and products. Consumers like the idea of simplified front of pack information but differ in their liking for the various formats. Differences can be related to conflicting preferences for ease of use, being fully informed and not being pressurised into behaving in a particular way. Most consumers understand the most common signposting formats in the sense that they themselves believe that they understand them and they can replay key information presented to them in an experimental situation. There is, however, virtually no insight into how labelling information is, or will be, used in a real-world shopping situation, and how it will affect consumers’ dietary patterns. Results are largely in line with an earlier review by Cowburn and Stockley (Public Health Nutr 8:21–28, 2005), covering research up to 2002, but provide new insights into consumer liking and understanding of simplified front of pack signposting formats. There is an urgent need for more research studying consumer use of nutritional information on food labels in a real-world setting.

The intermingling of people and media from different cultures is a communication-based phenomenon known as hybridity. Drawing on original research from Lebanon to Mexico and analyzing the use of the term in cultural and postcolonial studies (as well as the popular and business media), Marwan Kraidy offers readers a history of the idea and a set of prescriptions for its future use. Kraidy analyzes the use of the concept of cultural mixture from the first century A.D. to its present application in the academy and the commercial press. The book's case studies build an argument for understanding the importance of the dynamics of communication, uneven power relationships, and political economy as well as culture, in situations of hybridity. Kraidy suggests a new framework he developed to study cultural mixture—called critical transculturalism—which uses hybridity as its core concept, and provides a practical method for examining how media and communication work in international contexts.

This article analyses and contextualises a variety of relationships between the cultural industries and cultural policy.A principal aim is to examine policies which are explicitly formulated as cultural (or creative) industries policies.It seeks to address questions such as: what lies behind such policies?How do they relate to other kinds of cultural policy, including those more oriented towards media, communications, arts and heritage?The first section asks how the cultural industries became such an important idea in cultural policy, when those industries had been largely invisible in traditional (arts and heritage-based) policy for many decades.What changed and what drove the major changes?In the second section, we look at a number of problems and conceptual tensions which arise from the new importance of the cultural industries in contemporary public policy, including problems concerning definition and scope, and the accurate mapping of the sector, but also tensions surrounding the insertion of commercial and industrial culture into cultural policy regimes characterised by legacies of romanticism and idealism.We also look at problems surrounding the academic division of labour in this area of study.In the final section, we conclude by summarising some of the main contemporary challenges facing cultural policy and cultural policy studies with regard to the cultural industries.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

PURPOSE: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. DESIGN AND METHODS: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries. Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation. RESULTS: Among all three samples, the LSNS-6 and two subscales (Family and Friends) demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables. The proposed clinical cut-points showed good convergent validity, and classified 20% of the respondents in Hamburg, 11% of those in Solothurn (Switzerland), and 15% of those in London as at risk for social isolation. IMPLICATIONS: We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.

The number of educational and psychological measures being translated and adapted into multiple languages and cultures is very much on the increase. Cross-cultural research has become important in the fields of education and psychology, and articles addressing translation and adaptation over the past 30 years have increased by 350% (van de Vijver, 2009). Journals such as the European Journal of Psychological Assessment and the International Journal of Testing (see, e.g., the recent special issue on the topic of advances in test adaptation research, Gregoire & Hambleton, 2009) are full of articles either advancing the methodology for test translation and adaptation or describing initiatives to translate and adapt particular tests, especially popular intelligence, achievement, and personality tests. Interest among policy makers, educators, and the public in international comparative studies such as those sponsored by the Organization for Economic Cooperation and Development (OECD) (see the Programme for International Student Achievement and better known as PISA), and the International Association for the Evaluation of Educational Achievement (IEA) (see Trends in International Mathematics and Science Studies and better known as TIMSS), is also considerable. Because of the policy implications of these large-scale international assessments, governments are willing to spend large sums of money to see that these studies are carried out correctly. This means that state-of-the-art methodology for test translation and adaption is expected to be used. The use of the International Test Commission (ITC) Guidelines for Test Adaptation (see, e.g., Hambleton, 2005; van de Vijver & Hambleton, 1996) has become important to guide as well as to evaluate current initiatives to carry out test translation and adaptation studies.

This research note argues that much of the literature on support for European integration misses the heart of the nature of opposition to this process by ignoring the notion of perceived threat. Essentially, people are hostile toward the European project in great part because of their perceptions of threats posed by other cultures. I analyze this hypothesis by replicating a piece of research that previously appeared in this journal, adding measures of perceived threat to that model. The results support the main contention, which is that perceived cultural threat is an important factor that has been mistakenly ignored in explanations of hostility toward the European Union.

Cardiovascular disease (CVD) due to atherosclerosis of the arterial vessel wall and to thrombosis is the foremost cause of premature mortality and of disability-adjusted life years (DALYs) in Europe, and is also increasingly common in developing countries.1 In the European Union, the economic cost of CVD represents annually E192 billion1 in direct and indirect healthcare costs. The main clinical entities are coronary artery disease (CAD), ischaemic stroke, and peripheral arterial disease (PAD). The causes of these CVDs are multifactorial. Some of these factors relate to lifestyles, such as tobacco smoking, lack of physical activity, and dietary habits, and are thus modifiable. Other risk factors are also modifiable, such as elevated blood pressure, type 2 diabetes, and dyslipidaemias, or non-modifiable, such as age and male gender. These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention. Prevention and treatment of dyslipidaemias should always be considered within the broader framework of CVD prevention, which is addressed in guidelines of the Joint European Societies’ Task forces on CVD prevention in clinical practice.2 – 5 The latest version of these guidelines was published in 20075; an update will become available in 2012. These Joint ESC/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias are complementary to the guidelines on CVD prevention in clinical practice and address not only physicians [e.g. general practitioners (GPs) and cardiologists] interested in CVD prevention, but also specialists from lipid clinics or metabolic units who are dealing with dyslipidaemias that are more difficult to classify and treat.