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This paper examines the ethical and legal challenges encountered during the GATEKEEPER Project and how these challenges informed the development of a comprehensive framework for future Large-Scale Pilot (LSP) projects. GATEKEEPER is a LSP Project with 48 partners conducting 30 implementation studies across Europe with 50,000 target participants grouped into 9 Reference Use Cases. The project underscored the complexity of obtaining ethical approval across various jurisdictions with divergent regulations and procedures. Through a detailed analysis of the issues faced and the strategies employed to navigate these challenges, this study proposes an ethical and legal framework. This framework, derived from a comparative analysis of ethical application forms and regulations, aims to streamline the ethical approval process for future LSP research projects. By addressing the hurdles encountered in GATEKEEPER, the proposed framework offers a roadmap for more efficient and effective project management, ensuring smoother implementation of similar projects in the future. [ABSTRACT FROM AUTHOR]

In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study. [ABSTRACT FROM AUTHOR]

Regulatory frameworks for artificial intelligence (AI) are needed to mitigate risks while ensuring the ethical, secure, and effective implementation of AI technology in healthcare and population health. In this article, we present a synthesis of 141 binding policies applicable to AI in healthcare and population health in the EU and 10 European countries. The EU AI Act sets the overall regulatory framework for AI, while other legislations set social, health, and human rights standards, address the safety of technologies and the implementation of innovation, and ensure the protection and safe use of data. Regulation specifically pertaining to AI is still nascent and scarce, though a combination of data, technology, innovation, and health and human rights policy has already formed a baseline regulatory framework for AI in health. Future work should explore specific regulatory challenges, especially with respect to AI medical devices, data protection, and data enablement. [ABSTRACT FROM AUTHOR]

Background: Elevated rates of suicidal behavior were reported during the COVID-19 pandemic. However, information is scarce on patients' profiles during this period. Studies evoke the potential adverse effects of the mandatory lockdown, but they remain relatively speculative. Methods: We monitored fluctuations in suicide attempts (SA) in six European countries. We gathered data, retrospectively for under 18-year-old SA episodes (1 January 2018 to 31 December 2021), through records of psychiatric emergency services. We collected clinical profiles individually. We extracted environmental indicators by month, as provided by Oxford COVID-19 Government Response Tracker (OxCGRT). We used the Pruned Exact Linear Time (PELT) method to identify breakpoints in SA episodes reported for each country, and logistic regressions to estimate changes in patients' characteristics after the breakpoints. Finally, we used a univariate and multivariate negative binomial model to assess the link between SA and OxCGRT indicators, accounting for the delay (lag) between the interventions and their impact on SA. Results: The study comprised 2,833 children and adolescents (mean age = 15.1 years (SD 1.6); M: F sex-ratio = 1:5.4). A significant increase in SA was found either 6 or 10 months after the beginning of the pandemic, varying by country. Patients were more likely to be girls (aOR = 1.77 [1.34; 2.34]) and used SA methods "other than self-poisoning" (aOR = 1.34 [1.05; 1.7]). In the multivariate model, an association was found between SA and the contact tracing indicator with an 11 months delay, and the number of COVID-19 deaths with a 3-months delay. Conclusions: Findings confirmed a delayed increase in SA during the COVID-19 pandemic in children and adolescents as well as changes in patients' profiles. The duration and severity of the pandemic emerged as the strongest predictor in the rise of SA. If faced with a similar pandemic in the future, the gap between the onset of pandemic and the increase in suicide attempts presents an opportunity for prevention. [ABSTRACT FROM AUTHOR]

We propose a novel decomposition approach that breaks down the levels and trends of lifespan inequality as the sum of cause-of-death contributions. The suggested method shows whether the levels and changes in lifespan inequality are attributable to the levels and changes in (1) the extent of inequality in the cause-specific age-at-death distribution (the "Inequality" component), (2) the total share of deaths attributable to each cause (the "Proportion" component), or (3) the cause-specific mean age at death (the "Mean" component). This so-called Inequality–Proportion–Mean (or IPM) method is applied to 10 low-mortality countries in Europe. Our findings suggest that the most prevalent causes of death (in our setting, "circulatory system" and "neoplasms") do not necessarily contribute the most to overall levels of lifespan inequality. In fact, "perinatal and congenital" causes are the strongest drivers of lifespan inequality declines. The contribution of the IPM components to changes in lifespan inequality varies considerably across causes, genders, and countries. Among the three components, the Mean one explains the least lifespan inequality dynamics, suggesting that shifts in cause-specific mean ages at death alone contributed little to changes in lifespan inequality. [ABSTRACT FROM AUTHOR]

New propulsion systems in aircrafts must meet strict regulations and emission limitations. The Flightpath 2050 goals set by the Advisory Council for Aviation Research and Innovation in Europe (ACARE) include reductions of 75%, 90%, and 65% in CO2, NOx, and noise, respectively. These goals are not fully satisfied by marginal improvements in gas turbine technology or aircraft design. A novel control design procedure for the next generation of turbofan engines is proposed in this paper to improve Full Authority Digital Engine Control (FADEC) systems and reduce the emission levels to meet the Flightpath 2050 regulations. Hence, an Adaptive Network–based Fuzzy Inference System (ANFIS), nonlinear autoregressive network with exogenous inputs (NARX) techniques, and the block-structure Hammerstein–Wiener approach are used to develop a model for a turbofan engine. The Min–Max control structure is chosen as the most widely used practical control algorithm for gas turbine aero engines. The objective function is considered to minimize the emission level for the engine in a pre-defined maneuver while keeping the engine performance in different aspects. The Genetic Algorithm (GA) is applied to find the optimized control structure. The results confirm the effectiveness of the proposed approach in emission reduction for the next generation of turbofan engines. [ABSTRACT FROM AUTHOR]

Trustworthy medical AI requires transparency about the development and testing of underlying algorithms to identify biases and communicate potential risks of harm. Abundant guidance exists on how to achieve transparency for medical AI products, but it is unclear whether publicly available information adequately informs about their risks. To assess this, we retrieved public documentation on the 14 available CE-certified AI-based radiology products of the II b risk category in the EU from vendor websites, scientific publications, and the European EUDAMED database. Using a self-designed survey, we reported on their development, validation, ethical considerations, and deployment caveats, according to trustworthy AI guidelines. We scored each question with either 0, 0.5, or 1, to rate if the required information was "unavailable", "partially available," or "fully available." The transparency of each product was calculated relative to all 55 questions. Transparency scores ranged from 6.4% to 60.9%, with a median of 29.1%. Major transparency gaps included missing documentation on training data, ethical considerations, and limitations for deployment. Ethical aspects like consent, safety monitoring, and GDPR-compliance were rarely documented. Furthermore, deployment caveats for different demographics and medical settings were scarce. In conclusion, public documentation of authorized medical AI products in Europe lacks sufficient public transparency to inform about safety and risks. We call on lawmakers and regulators to establish legally mandated requirements for public and substantive transparency to fulfill the promise of trustworthy AI for health. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the performance of a deep learning (DL)–based model for multiple sclerosis (MS) lesion segmentation and compare it to other DL and non-DL algorithms. Methods: This ambispective, multicenter study assessed the performance of a DL-based model for MS lesion segmentation and compared it to alternative DL- and non-DL-based methods. Models were tested on internal (n = 20) and external (n = 18) datasets from Latin America, and on an external dataset from Europe (n = 49). We also examined robustness by rescanning six patients (n = 6) from our MS clinical cohort. Moreover, we studied inter-human annotator agreement and discussed our findings in light of these results. Performance and robustness were assessed using intraclass correlation coefficient (ICC), Dice coefficient (DC), and coefficient of variation (CV). Results: Inter-human ICC ranged from 0.89 to 0.95, while spatial agreement among annotators showed a median DC of 0.63. Using expert manual segmentations as ground truth, our DL model achieved a median DC of 0.73 on the internal, 0.66 on the external, and 0.70 on the challenge datasets. The performance of our DL model exceeded that of the alternative algorithms on all datasets. In the robustness experiment, our DL model also achieved higher DC (ranging from 0.82 to 0.90) and lower CV (ranging from 0.7 to 7.9%) when compared to the alternative methods. Conclusion: Our DL-based model outperformed alternative methods for brain MS lesion segmentation. The model also proved to generalize well on unseen data and has a robust performance and low processing times both on real-world and challenge-based data. Clinical relevance statement: Our DL-based model demonstrated superior performance in accurately segmenting brain MS lesions compared to alternative methods, indicating its potential for clinical application with improved accuracy, robustness, and efficiency. Key Points: • Automated lesion load quantification in MS patients is valuable; however, more accurate methods are still necessary. • A novel deep learning model outperformed alternative MS lesion segmentation methods on multisite datasets. • Deep learning models are particularly suitable for MS lesion segmentation in clinical scenarios. [ABSTRACT FROM AUTHOR]

Algorithmic decision-making and other types of artificial intelligence (AI) can be used to predict who will commit crime, who will be a good employee, who will default on a loan, etc. However, algorithmic decision-making can also threaten human rights, such as the right to non-discrimination. The paper evaluates current legal protection in Europe against discriminatory algorithmic decisions. The paper shows that non-discrimination law, in particular through the concept of indirect discrimination, prohibits many types of algorithmic discrimination. Data protection law could also help to defend people against discrimination. Proper enforcement of non-discrimination law and data protection law could help to protect people. However, the paper shows that both legal instruments have severe weaknesses when applied to artificial intelligence. The paper suggests how enforcement of current rules can be improved. The paper also explores whether additional rules are needed. The paper argues for sector-specific – rather than general – rules, and outlines an approach to regulate algorithmic decision-making. [ABSTRACT FROM AUTHOR]

Individual tree detection algorithms (ITD) are used to obtain accurate information about trees. Following the process of individual tree detection, it is possible to use additional processing tools to determine tree parameters such as tree height, crown base height, crown volume, or stem volume. However, many of the methods developed so far have focused on parameterising the algorithms based on the study area, height structure or tree species analysed. Applying the parameters of the method can be challenging in areas with dense and heterogeneous forests with a diverse stand structure. Therefore, this work aimed to develop a method to correct the results of ITD algorithms to identify individual trees more reliably, taking into account different ITD methods based on the Canopy Height Model. In the present study, we proposed a three-step approach to correct segmentation errors. In the first step, erroneous (under- and over-segmentation errors) and correct segments were classified. After classification, the second step was to refine the under-segmentation errors. The final step was to merge segments from the over-segmentation class with correct segments based on the specified conditions. The study was conducted in one of the most complex and diverse forest communities in Europe, making tree identification a major challenge. The accuracy of the segmentation improvements varied depending on the method applied and tree species group examined. Thus, based on the results, the paper advocates for the correction method due to its efficiency in mixed forest stands. Therefore, the present study offers a possible solution to reduce segmentation errors by considering different forest types and different CHM-based ITD methods for identifying individual trees. [ABSTRACT FROM AUTHOR]

BACKGROUND: Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS: The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking- from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS: Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS: A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment [ABSTRACT FROM AUTHOR]

Indirect methods for the indirect estimation of reference intervals are increasingly being used, especially for validation of reference intervals, as they can be applied to routine patient data. In this study, we compare three statistically different indirect methods for the verification and validation of reference intervals in eight laboratories distributed throughout Europe. The RefLim method is a fast and simple approach which calculates the reference intervals by extrapolating the theoretical 95 % of non-pathological values from the central linear part of a quantile-quantile plot. The Truncated Maximum Likelihood (TML) method estimates a smoothed kernel density function for the distribution of the mixed data, for which it is assumed that the "central" part of the distribution represents the healthy population. The refineR utilizes an inverse modelling approach. This algorithm identifies a model that best explains the observed data before transforming the data with the Box-Cox transformation. We show that the different indirect methods each have their advantages but can also lead to inaccurate or ambiguous results depending on the approximation of the mathematical model to real-world data. A combination of different methodologies can improve the informative value and thus the reliability of results. Based on routine measurements of four enzymes alkaline phosphatase (ALP), total amylase (AMY), cholinesterase (CHE) and gamma-glutamyl transferase (GGT) in adult women and men, we demonstrate that some reference limits taken from the literature need to be adapted to the laboratory's particular local and population characteristics. [ABSTRACT FROM AUTHOR]

Determining contingency aware dispatch decisions by solving a security-constrained optimal power flow (SCOPF) is challenging for real-world power systems, as the high problem dimensionality often leads to impractical computational requirements. This problem becomes more severe when the SCOPF has to be solved not only for a single instance, but for multiple periods, e.g. in the context of electricity market analyses. This paper proposes an algorithm that identifies the minimal set of constraints that exactly define the space of feasible nodal injections for a given network and contingency scenarios. By internalizing the technical limits of the nodal injections and enforcing a minimal worst-case impact of contingencies to line flows, computational effort can be further improved. The case study applies and analyzes the methods on the IEEE 118 and A&M 2000 bus systems, as well as the German and European transmission systems. In all tested cases the proposed algorithm identifies at least 95% of the network and security constraints as redundant, leading to significant SCOPF solve time reductions. Scalability and practical implementation are explicitly discussed. The code and input data of the case study is published supplementary to the paper under an open-source license. [ABSTRACT FROM AUTHOR]

Atmospheric inversions are used to derive constraints on the net sources and sinks of CO 2 and other stable atmospheric tracers from their observed concentrations. The resolution and accuracy that the fluxes can be estimated with depends, among other factors, on the quality and density of the observational coverage, on the precision and accuracy of the transport model used by the inversion to relate fluxes to observations, and on the adaptation of the statistical approach to the problem studied. In recent years, there has been an increasing demand from stakeholders for inversions at higher spatial resolution (country scale), in particular in the framework of the Paris agreement. This step up in resolution is in theory enabled by the growing availability of observations from surface in situ networks (such as ICOS in Europe) and from remote sensing products (OCO-2, GOSAT-2). The increase in the resolution of inversions is also a necessary step to provide efficient feedback to the bottom-up modeling community (vegetation models, fossil fuel emission inventories, etc.). However, it calls for new developments in the inverse models: diversification of the inversion approaches, shift from global to regional inversions, and improvement in the computational efficiency. In this context, we developed LUMIA, the Lund University Modular Inversion Algorithm. LUMIA is a Python library for inverse modeling built around the central idea of modularity: it aims to be a platform that enables users to construct and experiment with new inverse modeling setups while remaining easy to use and maintain. It is in particular designed to be transport-model-agnostic, which should facilitate isolating the transport model errors from those introduced by the inversion setup itself. We have constructed a first regional inversion setup using the LUMIA framework to conduct regional CO 2 inversions in Europe using in situ data from surface and tall-tower observation sites. The inversions rely on a new offline coupling between the regional high-resolution FLEXPART Lagrangian particle dispersion model and the global coarse-resolution TM5 transport model. This test setup is intended both as a demonstration and as a reference for comparison with future LUMIA developments. The aims of this paper are to present the LUMIA framework (motivations for building it, development principles and future prospects) and to describe and test this first implementation of regional CO 2 inversions in LUMIA. [ABSTRACT FROM AUTHOR]

Objectives Comprehensive smokefree laws, as recommended by the WHO Framework Convention of Tobacco Control (WHO FCTC), are the most effective tool to protect the population from secondhand smoke (SHS) and to ensure healthy environments. Studies evaluating how laws govern SHS protection are scarce. This study assessed the level of protection from SHS of laws from countries belonging to the WHO European Region. Methods A new methodology system was developed to evaluate the smokefree legislation according to the principles provided by the WHO guidelines for the correct implementation of Article 8 of the FCTC. For each law, six main sectors and 28 facilities were evaluated. Results Overall 68 laws from 48 countries from the WHO European Region were reviewed. 'Education' and 'Public transport' were the most protected sectors from SHS. Many WHO European laws do not provide protection from SHS across all public sectors. For example, 48.5% of general health facilities and 71.2% of restaurants are unprotected from SHS. The level of protection provided in the 28 facilities studied was low; many WHO European laws still allow smoking under certain conditions, permitting smoking in designated and/or ventilated areas. Conclusions Nine years after the adoption of the WHO FCTC there are still legal formulas in which smoking is allowed in several facilities, through the inclusion of separated areas, ventilated areas and other conditions. Tobacco control efforts still face the challenge of eradicating the legal clauses that prevent 100% smokefree environments. [ABSTRACT FROM AUTHOR]

Growing numbers of asylum seekers across Europe have created heightened pressure on governments to employ technologies to assist immigration systems in meeting humanitarian standards of international law. This article analyses the potential of hybrid intelligence (HI)—a machine learning (ML) utility supervised by and supervising human intelligence—for assisting both asylum seekers and immigration officers in performing fair and just assessments, while addressing theoretical underpinnings of what hybridity entails from the perspective of stakeholders and humanitarian systems. While aspects of ML demonstrate promise in reducing bias in immigration decisions, such technology itself suffers from various inherent biases. In addition, technological mediation poses several unforeseen, unintended, and subtle threats to humanitarian missions. By analysing ML algorithms currently employed in refugee status determination pilot programs and immigration control, this article synthesizes universal complications of using assistive technology in Refugee Status Determinations, with special focus on evaluating resultant theoretical refugee identity reconfigurations. Conceptually, this article expands on the theoretical model of what has been termed 'ID entity' by biometrics researchers and ethnographers by analysing potential latent consequences from technological mediation in asylum cases, while addressing use cases such as German and Canadian immigration services' pilot programs, along with automated pilot border screening projects such as Iborderctrl, among others. In addition, several hypothetical scenarios are presented to concretize and further theoretical inquiry of using HI in asylum seeker interviews, with special focus on the requisite criterion of possessing a well-founded fear of persecution. [ABSTRACT FROM AUTHOR]

Aim: To develop and validate models based on logistic regression and artificial intelligence for prognostic prediction of molar survival in periodontally affected patients. Materials and Methods: Clinical and radiographic data from four different centres across four continents (two in Europe, one in the United States, and one in China) including 515 patients and 3157 molars were collected and used to train and test different types of machine‐learning algorithms for their prognostic ability of molar loss over 10 years. The following models were trained: logistic regression, support vector machine, K‐nearest neighbours, decision tree, random forest, artificial neural network, gradient boosting, and naive Bayes. In addition, different models were aggregated by means of the ensembled stacking method. The primary outcome of the study was related to the prediction of overall molar loss (MLO) in patients after active periodontal treatment. Results: The general performance in the external validation settings (aggregating three cohorts) revealed that the ensembled model, which combined neural network and logistic regression, showed the best performance among the different models for the prediction of MLO with an area under the curve (AUC) = 0.726. The neural network model showed the best AUC of 0.724 for the prediction of periodontitis‐related molar loss. In addition, the ensembled model showed the best calibration performance. Conclusions: Through a multi‐centre collaboration, both prognostic models for the prediction of molar loss were developed and externally validated. The ensembled model showed the best performance in terms of both discrimination and validation, and it is made freely available to clinicians for widespread use in clinical practice. [ABSTRACT FROM AUTHOR]

Digitization in transplantation is not a new phenomenon. Algorithms are being used, for example, to allocate organs based on medical compatibility and priority criteria. However, digitization is accelerating as computer scientists and physicians increasingly develop and use machine learning (ML) models to obtain better predictions on the chances of a successful transplant. The objective of the article is to shed light on the potential threats to equitable access to organs allocated through algorithms, whether these are the consequence of political choices made upstream of digitization or of the algorithmic design, or are produced by self-learning algorithms. The article shows that achieving equitable access requires an overall vision of the algorithmic development process and that European legal norms only partially contribute to preventing harm and addressing equality in access to organs. [ABSTRACT FROM AUTHOR]

In more or less noticeable ways, algorithms are pervading every sector of life. As algorithm-related activities multiply around us, it is reasonable to predict that so will accidents and, consequently, compensation claims framed as torts. Against this background, the paper investigates from a comparative perspective how legal systems in three regions of the world--the U.S., (continental) Europe, and China--could approach the rise of algorithmic torts. First, the paper sketches out the main features that might be associated with algorithm-related torts and the specific challenges that they might bring to current legal frameworks. It then presents the state-of-the-art of the legal debate about algorithmic liability in U.S., Europe, and China. Finally, the paper delves into the ways in which tort laws in these three regions might address injuries associated with algorithmic activities, reviewing in particular the criteria for grounding jurisdiction, the procedural devices applying to tort law claims, the liability regimes under which claims could be framed, the mechanisms for damage attribution and apportionment, and the type and amount of potential recoverable losses. [ABSTRACT FROM AUTHOR]

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems. [ABSTRACT FROM AUTHOR]

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems. [ABSTRACT FROM AUTHOR]

The research field of crisis informatics examines, amongst others, the potentials and barriers of social media use during conflicts and crises. Social media allow emergency services to reach the public easily in the context of crisis communication and receive valuable information (e.g. pictures) from social media data. However, the vast amount of data generated during large-scale incidents can lead to issues of information overload and quality. To mitigate these issues, this paper proposes the semi-automatic creation of alerts including keyword, relevance and information quality filters based on cross-platform social media data. We conducted empirical studies and workshops with emergency services across Europe to raise requirements, then iteratively designed and implemented an approach to support emergency services, and performed multiple evaluations, including live demonstrations and field trials, to research the potentials of social media-based alerts. Finally, we present the findings and implications based on semi-structured interviews with emergency services, highlighting the need for usable configurability and white-box algorithm representation. [ABSTRACT FROM AUTHOR]

Many countries have some kind of energy-system transformation either planned or ongoing for various reasons, such as to curb carbon emissions or to compensate for the phasing out of nuclear energy. One important component of these transformations is the overall reduction in energy demand. It is generally acknowledged that the domestic sector represents a large share of total energy consumption in many countries. Increased energy efficiency is one factor that reduces energy demand, but behavioral approaches (known as “sufficiency”) and their respective interventions also play important roles. In this paper, we address citizens’ heterogeneity regarding both their current behaviors and their willingness to realize their sufficiency potentials—that is, to reduce their energy consumption through behavioral change. We collaborated with three Swiss cities for this study. A survey conducted in the three cities yielded thematic sets of energy-consumption behavior that various groups of participants rated differently. Using this data, we identified four groups of participants with different patterns of both current behaviors and sufficiency potentials. The paper discusses intervention types and addresses citizens’ heterogeneity and behaviors from a city-based perspective. [ABSTRACT FROM AUTHOR]

Background: Precise risk prediction of type 1 diabetes (T1D) facilitates early intervention and identification of risk factors prior to irreversible beta‐islet cell destruction, and can significantly improve T1D prevention and clinical care. Sharp et al. developed a genetic risk scoring (GRS) system for T1D (T1D‐GRS2) capable of predicting T1D risk in children of European ancestry. The T1D‐GRS2 was developed on the basis of causal genetic variants, thus may be applicable to minor populations, while a trans‐ethnic GRS for T1D may avoid the exacerbation of health disparities due to the lack of genomic information in minorities. Methods: Here, we describe a T1D‐GRS2 calculator validated in two independent cohorts, including African American children and European American children. Participants were recruited by the Center for Applied Genomics at the Children's Hospital of Philadelphia. Results: It demonstrates that GRS2 is applicable to the T1D risk prediction in the AA cohort, while population‐specific thresholds are needed for different populations. Conclusions: The study highlights the potential to further improve T1D‐GRS2 performance with the inclusion of additional genetic markers. [ABSTRACT FROM AUTHOR]

Background: Tier 1 exposure tools recommended for use under REACH are designed to easily identify situations that may pose a risk to health through conservative exposure predictions. However, no comprehensive evaluation of the performance of the lower tier tools has previously been carried out. The ETEAM project aimed to evaluate several lower tier exposure tools (ECETOC TRA, MEASE, and EMKG-EXPO-TOOL) as well as one higher tier tool (STOFFENMANAGER®). This paper describes the results of the external validation of tool estimates using measurement data. Methods: Measurement data were collected from a range of providers, both in Europe and United States, together with contextual information. Individual measurement and aggregated measurement data were obtained. The contextual information was coded into the tools to obtain exposure estimates. Results were expressed as percentage of measurements exceeding the tool estimates and presented by exposure category (non-volatile liquid, volatile liquid, metal abrasion, metal processing, and powder handling). We also explored tool performance for different process activities as well as different scenario conditions and exposure levels. Results: In total, results from nearly 4000 measurements were obtained, with the majority for the use of volatile liquids and powder handling. The comparisons of measurement results with tool estimates suggest that the tools are generally conservative. However, the tools were more conservative when estimating exposure from powder handling compared to volatile liquids and other exposure categories. In addition, results suggested that tool performance varies between process activities and scenario conditions. For example, tools were less conservative when estimating exposure during activities involving tabletting, compression, extrusion, pelletisation, granulation (common process activity PROC14) and transfer of substance or mixture (charging and discharging) at nondedicated facilities (PROC8a; powder handling only). With the exception of STOFFENMANAGER® (for estimating exposure during powder handling), the tools were less conservative for scenarios with lower estimated exposure levels. Conclusions: This is the most comprehensive evaluation of the performance of REACH exposure tools carried out to date. The results show that, although generally conservative, the tools may not always achieve the performance specified in the REACH guidance, i.e. using the 75th or 90th percentile of the exposure distribution for the risk characterisation. Ongoing development, adjustment, and recalibration of the tools with new measurement data are essential to ensure adequate characterisation and control of worker exposure to hazardous substances. [ABSTRACT FROM AUTHOR]

Since Francis Fontan first introduced the eponymous technique, the Fontan procedure, this type of surgical palliation has allowed thousands of children affected by specific heart malformations to reach adulthood. Nevertheless, abdominal, thoracic, lymphatic and neurologic complications are the price that is paid by these patients. Our review focuses on Fontan-associated liver disease; the purpose is to summarize the current understanding of its physiopathology, the aim of follow-up and the specific radiologic follow-up performed in Europe. Finally, we as members of the Abdominal Task Force of the European Society of Paediatric Radiology propose a consensus-based imaging follow-up algorithm. [ABSTRACT FROM AUTHOR]

Linear solvers for large and sparse systems are a key element of scientific applications, and their efficient implementation is necessary to harness the computational power of current computers. Algebraic MultiGrid (AMG) preconditioners are a popular ingredient of such linear solvers; this is the motivation for the present work, where we examine some recent developments in a package of AMG preconditioners to improve efficiency, scalability, and robustness on extreme scale problems. The main novelty is the design and implementation of a parallel coarsening algorithm based on aggregation of unknowns employing weighted graph matching techniques; this is a completely automated procedure, requiring no information from the user, and applicable to general symmetric positive definite (s.p.d.) matrices. The new coarsening algorithm improves in terms of numerical scalability at low operator complexity upon decoupled aggregation algorithms available in previous releases of the package. The preconditioners package is built on the parallel software framework PSBLAS, which has also been updated to progress towards exascale. We present weak scalability results on one of the most powerful supercomputers in Europe for linear systems with sizes up to O(1010) unknowns. [ABSTRACT FROM AUTHOR]

Aim: The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) algorithm for the management of knee osteoarthritis (OA) is available worldwide from 2014, but in 2019 an update was published. Based on this algorithm, a Working Group (WG), including ESCEO members and Chinese experts, wished to see how the new ESCEO algorithm was perceived by Chinese experts in knee OA and how it was integrated into their clinical practice. Methods: A WG was held between members of the international ESCEO task force and a group of Chinese experts. Results: Non-pharmacological approach should be combined with pharmacological interventions. In step 1, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) are the most important background drugs. Evidence, supported by high-quality research, is available only for crystalline glucosamine sulfate (pCGS) and chondroitin sulfate. Topical NSAIDs could be used as an additional option. In step 2, oral NSAIDs could be useful, but cardiovascular/renal/gastrointestinal profiles of the patients should be considered. Intra-articular hyaluronic acid and corticosteroids are alternative to oral NSAIDs, but the evidence is still limited. If steps 1 and 2 are not sufficient, weak opioids could be used. Overall, the conclusions of the ESCEO algorithm are accepted in China for products available in this country. The WG suggests the importance of economic studies, specifically made in China. Conclusion: This work provides evidence-based advice to establish a treatment algorithm in knee OA, for practical implementation in clinical practice in China. [ABSTRACT FROM AUTHOR]

This article examines counterdisinformation policies to investigate how European countries are shaping the meaning and boundaries of social platforms' accountability. We describe the cultural determinants of social platforms' accountability through a content analysis technique that considered principles, actors, and instruments, resulting in four models of social platform accountability: accountability set by law, codecided accountability, regulated self-regulation, and pure self-regulation. Our results suggest that most of the 11 countries in this study maintain specific positions on the role of digital media in society. At the same time, some patterns of convergence were evident: the weakening of State control in favor of freedom of information; the enhancement of transparency in social platforms' politics-related activities as a guiding principle to ensure public monitoring; and the standardization of a multistakeholder model of coregulation. The article also focuses on the technological dimension of social platform accountability, enabling us to recognize the degree to which different models rely on algorithms. It then problematizes the limitations and risks of social platforms' accountability. [ABSTRACT FROM AUTHOR]

Background: Over the past half century the global tendency for improvements in longevity has been uneven across countries. This has resulted in widening of inter-country disparities in life expectancy. Moreover, the pattern of divergence appears to be driven in part by processes at the level of country groupings defined in geopolitical terms. A systematic quantitative analysis of this phenomenon has not been possible using demographic decomposition approaches as these have not been suitably adapted for this purpose. In this paper we present an elaboration of conventional decomposition techniques to provide a toolkit for analysis of the inter-country variance, and illustrate its use by analyzing trends in life expectancy in developed countries over a 40-year period. Methods: We analyze trends in the population-weighted variance of life expectancy at birth across 36 developed countries and three country groups over the period 1970-2010. We have modified existing decomposition approaches using the stepwise replacement algorithm to compute age components of changes in the total variance as well as variance between and within groups of Established Market Economies (EME), Central and Eastern Europe (CEE), and the Former Soviet Union (FSU). The method is generally applicable to the decomposition of temporal changes in any aggregate index based on a set of populations. Results: The divergence in life expectancy between developed countries has generally increased over the study period. This tendency dominated from the beginning of 1970s to the early 2000s, and reversed only after 2005. From 1970 to 2010, the total standard deviation of life expectancy increased from 2.0 to 5.6 years among men and from 1.0 to 3.6 years among women. This was determined by the between-group effects due to polarization between the EME and the FSU. The latter contrast was largely fueled by the long-term health crisis in Russia. With respect to age, the increase in the overall divergence was attributable to between-country differences in mortality changes at ages 15-64 years compared to those aged 65 and older. The within-group variance increased, especially among women. This change was mostly produced by growing mortality differences at ages 65 and older. Conclusions: From the early 1970s to the mid-2000s, the strong divergence in life expectancy across developed countries was largely determined by the between-group variance and mortality polarization linked to the East--West geopolitical division. [ABSTRACT FROM AUTHOR]

This paper proposes an enhanced algorithm to estimate the differential code biases (DCB) on three frequencies of the BeiDou Navigation Satellite System (BDS) satellites. By forming ionospheric observables derived from uncombined precise point positioning and geometry-free linear combination of phase-smoothed range, satellite DCBs are determined together with ionospheric delay that is modeled at each individual station. Specifically, the DCB and ionospheric delay are estimated in a weighted least-squares estimator by considering the precision of ionospheric observables, and a misclosure constraint for different types of satellite DCBs is introduced. This algorithm was tested by GNSS data collected in November and December 2013 from 29 stations of Multi-GNSS Experiment (MGEX) and BeiDou Experimental Tracking Stations. Results show that the proposed algorithm is able to precisely estimate BDS satellite DCBs, where the mean value of day-to-day scattering is about 0.19 ns and the RMS of the difference with respect to MGEX DCB products is about 0.24 ns. In order to make comparison, an existing algorithm based on IGG: Institute of Geodesy and Geophysics, China (IGGDCB), is also used to process the same dataset. Results show that, the DCB difference between results from the enhanced algorithm and the DCB products from Center for Orbit Determination in Europe (CODE) and MGEX is reduced in average by 46 % for GPS satellites and 14 % for BDS satellites, when compared with DCB difference between the results of IGGDCB algorithm and the DCB products from CODE and MGEX. In addition, we find the day-to-day scattering of BDS IGSO satellites is obviously lower than that of GEO and MEO satellites, and a significant bias exists in daily DCB values of GEO satellites comparing with MGEX DCB product. This proposed algorithm also provides a new approach to estimate the satellite DCBs of multiple GNSS systems. [ABSTRACT FROM AUTHOR]

Therapy for polymyalgia rheumatica (PMR) varies widely in clinical practice as international recommendations for PMR treatment are not currently available. In this paper, we report the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology as a framework for the project. Accordingly, the direction and strength of the recommendations are based on the quality of evidence, the balance between desirable and undesirable effects, patients' and clinicians' values and preferences, and resource use. Eight overarching principles and nine specific recommendations were developed covering several aspects of PMR, including basic and follow-up investigations of patients under treatment, risk factor assessment, medical access for patients and specialist referral, treatment strategies such as initial glucocorticoid (GC) doses and subsequent tapering regimens, use of intramuscular GCs and disease modifying anti-rheumatic drugs (DMARDs), as well as the roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions. These recommendations will inform primary, secondary and tertiary care physicians about an international consensus on the management of PMR. These recommendations should serve to inform clinicians about best practices in the care of patients with PMR. [ABSTRACT FROM AUTHOR]

In the sparse polynomial multiplication problem, one is asked to multiply two sparse polynomials $f$ and $g$ in time that is proportional to the size of the input plus the size of the output. The polynomials are given via lists, $F$ and $G$ , of their coefficients. Cole and Hariharan (STOC 02) have given a nearly optimal algorithm when the coefficients are positive, and Arnold and Roche (ISSAC 15) devised an algorithm running in time proportional to the “structural sparsity” of the product, i.e. the set $\mathrm {supp}(F) + \mathrm {supp}(G)$. The latter algorithm is particularly efficient when there are not “too many cancellations” of coefficients in the product. In this work we give a clean, nearly optimal algorithm for the sparse polynomial multiplication problem. [ABSTRACT FROM AUTHOR]

Rain/no-rain detection error is a key source of uncertainty in regional and global precipitation products that propagates into offline hydrological and land surface modeling simulations. Such detection error is difficult to evaluate and/or filter without access to high-quality reference precipitation datasets. For cases where such access is not available, this study proposes a novel approach for improved rain/no-rain detection. Based on categorical triple collocation (CTC) and a probabilistic framework, a weighted merging algorithm (CTC-M) is developed to combine noisy, but independent, precipitation products into an optimal binary rain/no-rain time series. Compared with commonly used approaches that directly apply the best parent product for rain/no-rain detection, the superiority of CTC-M is demonstrated analytically and numerically using spatially dense precipitation measurements over Europe. Our analysis also suggests that CTC-M is tolerant to a range of cross-correlated rain/no-rain detection errors and detection biases of the parent products. As a result, CTC-M will benefit global precipitation estimation by improving the representation of precipitation occurrence in gauge-based and multisource merged precipitation products. [ABSTRACT FROM AUTHOR]

Air quality measures that were implemented in Europe in the 1990s resulted in reductions of ozone precursor concentrations. In this study, the effect of these reductions on ozone is investigated by analyzing surface measurements of this pollutant for the time period between 2000 and 2015. Using a nonparametric timescale decomposition methodology, the long-term, seasonal and short-term variation in ozone observations were extracted. A clustering algorithm was applied to the different timescale variations, leading to a classification of sites across Europe based on the temporal characteristics of ozone. The clustering based on the long-term variation resulted in a site-type classification, while a regional classification was obtained based on the seasonal and short-term variations. Long-term trends of deseasonalized mean and meteo-adjusted peak ozone concentrations were calculated across large parts of Europe for the time period 2000–2015. A multidimensional scheme was used for a detailed trend analysis, based on the identified clusters, which reflect precursor emissions and meteorological influence either on the inter-annual or the short-term timescale. Decreasing mean ozone concentrations at rural sites and increasing or stabilizing at urban sites were observed. At the same time, downward trends for peak ozone concentrations were detected for all site types. In addition, a reduction of the amplitude in the seasonal cycle of ozone and a shift in the occurrence of the seasonal maximum towards earlier time of the year were observed. Finally, a reduced sensitivity of ozone to temperature was identified. It was concluded that long-term trends of mean and peak ozone concentrations are mostly controlled by precursor emissions changes, while seasonal cycle trends and changes in the sensitivity of ozone to temperature are among other factors driven by regional climatic conditions. [ABSTRACT FROM AUTHOR]

The recruitment of athletes with limited resources is a global problem in professional sports. In US Major League Baseball, the experience of the Oakland Athletics' general manager in the last decade turned his "Moneyball" model into a synonym of quantitative analysis in the transfer market of baseball players. His strategy focused on hiring players with outstanding technical skills but relatively low market value. This study adapted this model to the framework of a multiple criteria decision aid (MCDA), by selecting undervalued players who have complementary abilities. The novelty here refers to the joint use of four algorithms explored by the composition of probabilistic preferences (CPP) (i.e., ranking, classification, dynamic evaluation and regularity analysis) and their application to soccer player performance evaluation. The new model analysed the recent transfer of a left-back soccer player to Europe. The results indicated 12 opportunities for better investment, among 32 left and right-back players considered. Two years later, the value of the same player was considerably lower. He played only five matches in the 2018–2019 season, without scoring or providing any assists. On the other hand, the players better classified by the CPP-MB model presented higher performances and market values. [ABSTRACT FROM AUTHOR]

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Objective: The long-term predictive value of the new proposed algorithm in the updated 2016 guidelines of the European Association of Cardiovascular Imaging to assess diastolic dysfunction (DD) in patients with heart failure with preserved ejection fraction (HFpEF) has not been validated.Methods: The analysis included 451 patients who were diagnosed with HFpEF as confirmed via echocardiography. The endpoints were mortality and hospitalization for HF. The Kaplan-Meier curves and Cox regression models were generated to determine the risk of all-cause mortality based on the 2016 and 2009 DD grading algorithm, respectively. We evaluated the net reclassification index of outcomes on the basis of 2009 DD grade after abiding by the 2016 recommendations.Results: After a follow-up of 2976 days, 119 patients (26.4%) died. According to the 2016 DD grading, grade III DD was associated with a significantly higher risk of mortality (hazard ratio [HR], 2.209; 95% CI 1.144-4.266) and HF hospitalization (HR, 2.047; 95% CI 1.348-3.870), as compared with grade I DD. Grade II DD was also associated with a higher risk of mortality (HR, 1.538; 95% CI 1.313-1.924). However, only grade III DD was independently associated with worse mortality based on 2009 DD grading. The net reclassification index for mortality increased significantly after grading by 2016 algorithm (10.6%, p < 0.001).Conclusions: The 2016 DD grading algorithm showed improved prognostic value of long-term mortality in patients with HFpEF. Based on the findings of the study, the appropriate grading of DD is important in the prognostication of patients with HFpEF.Key Points: • The application of the 2016 European Association of Cardiovascular Imaging recommendations diastolic dysfunction (DD) grading algorithm improves the predictive value for mortality. • Our analysis suggests DD grades II and III based on 2016 guidelines is associated with poor outcomes as compared with grade I. The echocardiographic indices of the new algorithm should be obtained and applied to effectively evaluate DD. [ABSTRACT FROM AUTHOR]

The paper proposes a fully automatic algorithm approach to map burned areas from remote sensing characterized by human interpretable mapping criteria and explainable results. This approach is partially knowledge-driven and partially data-driven. It exploits active fire points to train the fusion function of factors deemed influential in determining the evidence of burned conditions from reflectance values of multispectral Sentinel-2 (S2) data. The fusion function is used to compute a map of seeds (burned pixels) that are adaptively expanded by applying a Region Growing (RG) algorithm to generate the final burned area map. The fusion function is an Ordered Weighted Averaging (OWA) operator, learnt through the application of a machine learning (ML) algorithm from a set of highly reliable fire points. Its semantics are characterized by two measures, the degrees of pessimism/optimism and democracy/monarchy. The former allows the prediction of the results of the fusion as affected by more false positives (commission errors) than false negatives (omission errors) in the case of pessimism, or vice versa; the latter foresees if there are only a few highly influential factors or many low influential ones that determine the result. The prediction on the degree of pessimism/optimism allows the expansion of the seeds to be appropriately tuned by selecting the most suited growing layer for the RG algorithm thus adapting the algorithm to the context. The paper illustrates the application of the automatic method in four study areas in southern Europe to map burned areas for the 2017 fire season. Thematic accuracy at each site was assessed by comparison to reference perimeters to prove the adaptability of the approach to the context; estimated average accuracy metrics are omission error = 0.057, commission error = 0.068, Dice coefficient = 0.94 and relative bias = 0.0046. [ABSTRACT FROM AUTHOR]

Objectives: Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. Methods: The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands—patients in all NYHA classes of severity, and patients in NYHA IV class only. Results: The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. Conclusions: Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities. [ABSTRACT FROM AUTHOR]

Background The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Methods Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan's method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010–11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0–10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Results Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Conclusion Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state. [ABSTRACT FROM AUTHOR]

Romani people are a significant minority in Europe counting about 10 million individuals scattered throughout the continent. They are a migratory group originating from Northwestern India. Their exodus from India occurred approximately 1000–1500 years ago. The migration route of the Romani people was reconstructed with the help of cultural anthropology, linguistics and historical records. Their migration made them through Central Asia, Middle East and the Caucasus region, prior to the arriving into Europe. Yet the significance of these regions, especially of the Caucasus, in Roma ancestry was a rather neglected topic. Contribution of the Caucasus and further affected regions to the ancestry of Roma was investigated based on genome-wide autosomal marker data. 158 European Roma samples and 41 populations from the Caucasus region, from Middle East, Central Asia and from South Asia were considered in our tests. Population structure and ancestry analysis algorithms were applied to investigate the relationship of Roma with these populations. Identical by descent DNA segment analyses and admixture linkage disequilibrium based tests were also applied. Our results suggest that the Caucasus region plays also a significant role in the genetic legacy of Romani people besides the main sources, Europe and South Asia, previously investigated by other population genetic studies. The Middle East and Central Asia seems slightly less important but far from negligible in connection with the sources of Roma ancestry. Our results point out that the Caucasus region and altogether the area of the Caspian and Black Seas had a significant role in the migration of Romani people towards Europe and contributed significantly to the genetic legacy of Roma rival to the European and Indian main sources. [ABSTRACT FROM AUTHOR]

Purpose: This prospective study explores high sensitivity C-reactive protein (hs-CRP) levels in relation to dietary patterns at two time points in European children.Methods: Out of the baseline sample of the IDEFICS study (n = 16,228), 4020 children, aged 2-9 years at baseline, with available hs-CRP levels and valid data from a food frequency questionnaire (FFQ) at baseline (T0) and 2 years later (T1) were included. K-means clustering algorithm based on the similarities between relative food consumption frequencies of the FFQ was applied. hs-CRP was dichotomized according to sex-specific cutoff points. Multilevel logistic regression was performed to assess the relationship between dietary patterns and hs-CRP adjusting for covariates.Results: Three consistent dietary patterns were found at T0 and T1: ‘animal protein and refined carbohydrate’, ‘sweet and processed’ and ‘healthy’. Children allocated to the ‘protein’ and ‘sweet and processed’ clusters at both time points had significantly higher odds of being in the highest category of hs-CRP (OR 1.47; 95% CI 1.03-2.09 for ‘animal protein and refined carbohydrate’ and OR 1.44; 95% CI 1.08-1.92 for ‘sweet and processed’) compared to the ‘healthy’ cluster. The odds remained significantly higher for the ‘sweet and processed’ pattern (OR 1.39; 95% CI 1.05-1.84) when covariates were included.Conclusions: A dietary pattern characterized by frequent consumption of sugar and processed products and infrequent consumption of vegetables and fruits over time was independently related with inflammation in European children. Efforts to improve the quality of the diet in childhood may prevent future diseases related with chronic inflammation. [ABSTRACT FROM AUTHOR]

We examine the evolution of the decentralized clearinghouse mechanisms that were in use throughout Europe from the thirteenth century to the eighteenth century; in particular, we explore the clearing of nontradable or limited-tradable debts such as bills of exchange. We construct a theoretical model of these clearinghouse mechanisms and show that the specific decentralized multilateral clearing algorithms known as rescontre, skontrieren, or virement des parties, used by merchants in this period, were efficient in specific historical contexts. Our analysis contributes to the understanding of these mechanisms during late medieval and early modern fairs and their robustness during the seventeenth and eighteenth centuries. [ABSTRACT FROM AUTHOR]

Background: Traumatic injury is the fourth leading cause of death globally. Half of all trauma deaths are due to bleeding and most of these will occur within 6 h of injury. Haemorrhagic shock following injury has been shown to induce a clotting dysfunction within minutes, and this early trauma-induced coagulopathy (TIC) may exacerbate bleeding and is associated with higher mortality and morbidity. In spite of improved resuscitation strategies over the last decade, current transfusion therapy still fails to correct TIC during ongoing haemorrhage and evidence for the optimal management of bleeding trauma patients is lacking. Recent publications describe increasing the use of Viscoelastic Haemostatic Assays (VHAs) in trauma haemorrhage; however, there is insufficient evidence to support their superiority to conventional coagulation tests (CCTs).Methods/design: This multicentre, randomised controlled study will compare the haemostatic effect of an evidence-based VHA-guided versus an optimised CCT-guided transfusion algorithm in haemorrhaging trauma patients. A total of 392 adult trauma patients will be enrolled at major trauma centres. Participants will be eligible if they present with clinical signs of haemorrhagic shock, activate the local massive haemorrhage protocol and initiate first blood transfusion. Enrolled patients will be block randomised per centre to either VHA-guided or CCT-guided transfusion therapy in addition to that therapy delivered as part of standard care, until haemostasis is achieved. Patients will be followed until discharge or 28 days. The primary endpoint is the proportion of subjects alive and free of massive transfusion (less than 10 units of red blood cells) at 24 h. Secondary outcomes include the effect of CCT- versus VHA-guided therapy on organ failure, total hospital and intensive care lengths of stay, health care resources needed and mortality. Surviving patients will be asked to complete a quality of life questionnaire (EuroQol EQ-5DTM) at day 90.Discussion: CCTs have traditionally been used to detect TIC and monitor response to treatment in traumatic major haemorrhage. The use of VHAs is increasing, but limited evidence exists to support the superiority of these technologies (or comparatively) for patient-centred outcomes. This knowledge gap will be addressed by this trial.Trial Registration: ClinicalTrials.gov, ID: NCT02593877 . Registered on 15 October 2015. Trial sponsor Queen Mary University of London The contact person of the above sponsor organisation is: Dr. Sally Burtles, Director of Research Services and Business Development, Joint Research Management Office, QM Innovation Building, 5 Walden Street, London E1 2EF; phone: 020 7882 7260; Email: sponsorsrep@bartshealth.nhs.uk Trial sites Academic Medical Centre, Amsterdam, The Netherlands Kliniken der Stadt Köln gGmbH, Cologne, Germany Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark John Radcliff Hospital, Oxford, United Kingdom Oslo University Hospital, Oslo, Norway The Royal London Hospital, London, United Kingdom Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom Sites that are planning to start recruitment in mid/late 2017 Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom University of Kansas Hospital (UKH), Kansas City, MO, USA Protocol version: 3.0/14.03.2017 (Additional file 1). [ABSTRACT FROM AUTHOR]

Objective: Our aim was to determine the prevalence of tuberculosis (TB), the number needed to screen (NNS), and the diagnostic accuracy of chest X-ray (CXR) screening to detect active pulmonary TB during the 2015 European refugee crisis.Materials and Methods: We evaluated data of all refugees who underwent CXR screening in a single-centre of one German metropolitan area in 2015. We determined the prevalence of TB, NNS, and accuracy of CXR to detect active pulmonary TB. Reference method for active TB was the database of all definite TB cases registered at the Department of Public Health.Results: A total of 17,487 immigrants underwent single-centre CXR screening in 2015; prevalence of definite pulmonary TB was 0.103%. The NNS for detecting one case of active pulmonary TB was 1749. CXR had a sensitivity of 55.6% [95% confidence interval (CI) 30.8-78.5%) and a specificity 98.3% (CI 98.1-98.5%) to reveal one case of active TB.Conclusion: Our single-centre study indicates that chest X-ray screening for TB during the 2015 European refugee crisis was of low yield due the low prevalence of TB and high number needed to screen, thus implicating the need for improved screening algorithms adapted to the overwhelming number of refugees.Key Points: • Prevalence of pulmonary tuberculosis (TB) among refugees in 2015 was low (0.103%). • The number needed to screen to detect one case of active pulmonary TB was 1749. • Tuberculosis X-ray screening resulted in a low sensitivity and high specificity. • Tuberculosis X-ray screening during the European refugee crisis is of low yield. • Improved screening algorithms are needed due to the overwhelming the number of refugees. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to estimate the prevalence-based cost of illness imposed by nocturia (≥2 nocturnal voids per night) in Germany, Sweden, and the UK in an average year.Methods: Information obtained from a systematic review of published literature and clinicians was used to construct an algorithm depicting the management of nocturia in these three countries. This enabled an estimation of (1) annual levels of healthcare resource use, (2) annual cost of healthcare resource use, and (3) annual societal cost arising from presenteeism and absenteeism attributable to nocturia in each country.Results: In an average year, there are an estimated 12.5, 1.2, and 8.6 million patients ≥20 years of age with nocturia in Germany, Sweden, and the UK, respectively. In an average year in each country, respectively, these patients were estimated to have 13.8, 1.4, and 10.0 million visits to a family practitioner or specialist, ~91,000, 9000, and 63,000 hospital admissions attributable to nocturia and 216,000, 19,000, and 130,000 subjects were estimated to incur a fracture resulting from nocturia. The annual direct cost of healthcare resource use attributable to managing nocturia was estimated to be approximately €2.32 billion in Germany, 5.11 billion kr (€0.54 billion) in Sweden, and £1.35 billion (€1.77 billion) in the UK. The annual indirect societal cost arising from both presenteeism and absenteeism was estimated to be approximately €20.76 billion in Germany and 19.65 billion kr (€2.10 billion) in Sweden. In addition, in the UK, the annual indirect cost due to absenteeism was an estimated £4.32 billion (€5.64 billion).Conclusions: Nocturia appears to impose a substantial socioeconomic burden in all three countries. Clinical and economic benefits could accrue from an increased awareness of the impact that nocturia imposes on patients, health services, and society as a whole. [ABSTRACT FROM AUTHOR]

Background: Glycaemia control (GC) remains an important therapeutic goal in critically ill patients. The enhanced Model Predictive Control (eMPC) algorithm, which models the behaviour of blood glucose (BG) and insulin sensitivity in individual ICU patients with variable blood samples, is an effective, clinically proven computer based protocol successfully tested at multiple institutions on medical and surgical patients with different nutritional protocols. eMPC has been integrated into the B.Braun Space GlucoseControl system (SGC), which allows direct data communication between pumps and microprocessor. The present study was undertaken to assess the clinical performance and safety of the SGC for glycaemia control in critically ill patients under routine conditions in different ICU settings and with various nutritional protocols. Methods: The study endpoints were the percentage of time the BG was within the target range 4.4 - 8.3 mmol.l-1, the frequency of hypoglycaemic episodes, adherence to the advice of the SGC and BG measurement intervals. BG was monitored, and insulin was given as a continuous infusion according to the advice of the SGC. Nutritional management (enteral, parenteral or both) was carried out at the discretion of each centre. Results: 17 centres from 9 European countries included a total of 508 patients, the median study time was 2.9 (1.9-6.1) days. The median (IQR) time-in-target was 83.0 (68.7-93.1) % of time with the mean proposed measurement interval 2.0 ± 0.5 hours. 99.6 % of the SGC advices on insulin infusion rate were accepted by the user. Only 4 episodes (0.01 % of all BG measurements) of severe hypoglycaemia <2.2 mmol.l-1 in 4 patients occurred (0.8 %; 95 % CI 0.02-1.6 %). Conclusion: Under routine conditions and under different nutritional protocols the Space GlucoseControl system with integrated eMPC algorithm has exhibited its suitability for glycaemia control in critically ill patients. Trial registration: ClinicalTrials.gov NCT01523665 [ABSTRACT FROM AUTHOR]