West-east policy transfer: The case of urban transport policy

European policies on urban transport policy attach great importance to the role of best practices in promoting urban sustainability. The underlying assumption appears to be that best practices are equally applicable and effective in other parts of Europe. However, the current size of the European Union and the diversity of member states, especially since the accession of 12 new member states since 2004, draw this assumption into question. There are after all substantial differences in governance, administrative cultures and professional capacities across the 27 member states of the European Union. To date, research in the field has neither fully nor satisfactorily explored the issue of transferability of best practices, especially from west to east Europe (i.e. from ‘old’ to ‘new’ member states). What is already known about the transfer of policy models, concepts, ideas, goals and instruments from west to east Europe is that drawing lessons from the west has often been seen by countries in central and eastern Europe as a way of catching up politically and economically (Rose, 1993). The uncertainties of policy making in some of these countries have made policy transfer a particularly attractive option, as politicians see it as the quickest solution to many problems without having to reinvent the wheel (Rose, 2005; Tavits, 2003). However, the technological, economic, political and social situations in the ‘lending’ and ‘borrowing’ countries are often very different. So too are the institutional frameworks. As a consequence, the transfer process is far from straight-forward and certainly not just a matter of copying or emulation. The paper employs a case study approach to examine two closely related projects (funded by the German government) that both sought to transpose policy concepts between west and east Europe. Both projects focused on transferring the underlying concepts and principles behind German public transport executives (Verkehrsverbünde) as a way of promoting public transport and improving environmental quality in two cities in new member states of the European Union: Riga in Latvia and Wroclaw in Poland. In both cases, The paper draws on policy transfer theory to help explain the transferability of policy models, concepts, ideas, goals and instruments between west and east Europe, and to help evaluate the factors of success and failure in the specific cases of Riga and Wroclaw.Urban and Regional DevelopmentOTB Research Institut

The European Public Sectors in the Age of Managerialism

During the past 50 years, European public sectors have undergone a profound process of organizational change, where managerial tools and principles from the private sector have permeated through governments and administrations of many countries. A substantial amount of academic literature has now been devoted to public management reforms. Many scholars have associated them with the diffusion of a managerialist ideology. However, the relationship between public management reforms, political ideology, and public expressions of support for these reforms by political parties has been a relatively under-explored topic within the literature and is the gap we address in this article. Using a longitudinal framework of study, our analysis shows how issues surrounding managerialist reforms have evolved across the electoral manifestos of European parties during the past 50 years. Our findings reveal that these reforms have enjoyed a growing political profile over time in many countries within Western and Eastern Europe. Furthermore, we also examine and discuss the differences and similarities of these reforms across countries

Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF). a multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study

Background: Direct-acting oral anticoagulant use for stroke prevention in atrial fibrillation is limited by bleeding concerns. Asundexian, a novel, oral small molecule activated coagulation factor XIa (FXIa) inhibitor, might reduce thrombosis with minimal effect on haemostasis. We aimed to determine the optimal dose of asundexian and to compare the incidence of bleeding with that of apixaban in patients with atrial fibrillation. Methods: In this randomised, double-blind, phase 2 dose-finding study, we compared asundexian 20 mg or 50 mg once daily with apixaban 5 mg twice daily in patients aged 45 years or older with atrial fibrillation, a CHA2DS2-VASc score of at least 2 if male or at least 3 if female, and increased bleeding risk. The study was conducted at 93 sites in 14 countries, including 12 European countries, Canada, and Japan. Participants were randomly assigned (1:1:1) to a treatment group using an interactive web response system, with randomisation stratified by whether patients were receiving a direct-acting oral anticoagulant before the study start. Masking was achieved using a double-dummy design, with participants receiving both the assigned treatment and a placebo that resembled the non-assigned treatment. The primary endpoint was the composite of major or clinically relevant non-major bleeding according to International Society on Thrombosis and Haemostasis criteria, assessed in all patients who took at least one dose of study medication. This trial is registered with ClinicalTrials.gov, NCT04218266, and EudraCT, 2019-002365-35. Findings: Between Jan 30, 2020, and June 21, 2021, 862 patients were enrolled. 755 patients were randomly assigned to treatment. Two patients (assigned to asundexian 20 mg) never took any study medication, resulting in 753 patients being included in the analysis (249 received asundexian 20 mg, 254 received asundexian 50 g, and 250 received apixaban). The mean age of participants was 73·7 years (SD 8·3), 309 (41%) were women, 216 (29%) had chronic kidney disease, and mean CHA2DS2-VASc score was 3·9 (1·3). Asundexian 20 mg resulted in 81% inhibition of FXIa activity at trough concentrations and 90% inhibition at peak concentrations; asundexian 50 mg resulted in 92% inhibition at trough concentrations and 94% inhibition at peak concentrations. Ratios of incidence proportions for the primary endpoint were 0·50 (90% CI 0·14–1·68) for asundexian 20 mg (three events), 0·16 (0·01–0·99) for asundexian 50 mg (one event), and 0·33 (0·09–0·97) for pooled asundexian (four events) versus apixaban (six events). The rate of any adverse event occurring was similar in the three treatment groups: 118 (47%) with asundexian 20 mg, 120 (47%) with asundexian 50 mg, and 122 (49%) with apixaban. Interpretation: The FXIa inhibitor asundexian at doses of 20 mg and 50 mg once daily resulted in lower rates of bleeding compared with standard dosing of apixaban, with near-complete in-vivo FXIa inhibition, in patients with atrial fibrillation. Funding: Bayer