The effort to strengthen social cohesion and lower social inequalities is among Europe's main policy challenges. At the urban level, these great challenges become visible and tangible, which in many senses makes cities a microcosm of society. It means that local welfare systems are at the forefront of the struggle to address this challenge-and they are far from winning. While the statistics show some positive signs, the overall picture still shows sharp and sometimes rising inequalities, a loss of social cohesion and failing policies of integration and inclusion. When we focus on specific groups in society (e.g. migrants), the situation is even more dire. It is clear that new ideas and approaches to tackle these very wicked problems are needed. Contrary to what is sometimes thought, a lack of bottom-up innovation is not the issue in itself. European cities are teeming with new ideas, initiated by citizens, professionals and policymakers. There are by now many examples of innovation, paraded by think tanks and policymakers as tomorrow's answers. This is certainly promising. Yet this altogether too rosy picture obscures some of the drawbacks,

How do social innovations come to the fore? Are they exclusively based on the entrepreneurial spirit of change makers? And what makes social innovations work? Can a solid business plan make innovations sustainable? In other words, does survival of the fittest also hold true for social innovations? From this Darwinist perspective, social innovations are perceived as new products geared towards addressing new societal needs in competitive markets. We question whether this perspective, based on microeconomics, really helps us understand how social innovations emerge, are further developed and finally integrated into the repertoire of welfare politics at the local level. Instead, we argue that, particularly at the local level, the emergence, development and firm establishment of social innovations constitute a political process whose outcome is highly dependent on both a decisive set of environmental factors, including coalition building, and specific constellations of actors. From our point of view, social innovations are highly embedded in their environment. And indeed, environments differ significantly. Research has demonstrated that some environmental factors, like freedom, diversity and density of contacts, are correlated with innovation (Evers et al. 2014). That is why cities have always been places of innovation (Cattacin 2011). But the innovative capacity of cites differs, and we think that these differences are related not only to the factors mentioned but also to strategies and dynamics linked to government decisions and lobbies in the economic and social spheres. In particular, analyses of social innovation have to take into account these decisions and these actors. European cities, which are at the centre of our analysis, stand out for their diversity in terms of government setup , social-policy traditions and local political cultures.

Background-The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear.Methods-We analyzed data on 20,379 treatment-naive HIV-1-infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of followup, 1844 AIDS events, and 1005 deaths).Results-Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART).Conclusions-Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART.

Introduction: Descriptive data indicate a high burden of chronic illness among immigrant women in Switzerland. Little is known about how immigrant women with chronic illnesses experience healthcare services. This paper presents a methodological approach theoretically informed by Sen's capability approach and Levesque's framework of access to healthcare to study patient-reported experiences (PREs) of Swiss healthcare services among immigrant women with chronic conditions. Methods: We conducted 48 semi-structured qualitative interviews in Bern and Geneva with Turkish (n = 12), Portuguese (n = 12), German (n = 12), and Swiss (n = 12) women. Participants were heterogenous in age, length of stay, SES, and educational attainment, illness types and history. We also conducted semi-structured interviews with healthcare and social service providers (n = 12). Interviewed women participated in two focus group discussions (n = 15). Interviews were transcribed verbatim and analyzed using Atlas.ti software, based on Gale et al.'s framework approach. Findings informed three stakeholder dialogues in which women as well as healthcare providers and policymakers from various territorial levels participated. Results: Our methodological approach succeeded in integrating women's perspectives-from initial data collection in interviews to identify issues, focus group discussions to increase rigor, and stakeholder dialogues to develop tailored recommendations based on PREs. Discussion: This is one of the first studies in Switzerland that used PREs to research healthcare services and healthcare needs among immigrant women with chronic illnesses. This paper provides new insights on how to better understand existing challenges and potentially improve access to and quality of care.

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