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Erasmus mobility has become an important feature of higher education in Europe and beyond, with the potential to generate significant changes at individual, institutional and systemic levels. More than three decades after the foundation of this successful program, evaluations reveal that, despite notable progress, several aspects of the Erasmus student experience can be further improved. Based on the lived experiences of Erasmus alumni, in this article, we explore recurrent challenges that emerge in educational mobility and how they could be better addressed. Three key dimensions are identified in the qualitative accounts of former Erasmus students and analyzed in light of previous research: mobility preparation, institutional support for integration, and recognition of study abroad.

Purpose: To assess the extent of paper waste generated per year by instructions for use (IFUs) brochures included in intraocular lens (IOL) packaging in Europe and the U.S. Setting: Rothschild Foundation Hospital, Paris, France; Royal Free London NHS Foundation Trust; Center for Sight, London, United Kingdom. Design: Experimental study. Methods: A sample of IOLs were collected and each IFU was weighed. In addition, the cumulative weight of these brochures used in cataract surgeries performed annually in Europe and the U.S. was estimated, and the potential annual paper conservation that could be achieved if all manufacturers adopted electronic IFUs (e-IFUs) in Europe and the U.S. was determined. Results: The mean and standard deviation of the weight for overall IFUs, classic IFUs, and e-IFUs were 17.6 ± 13.8 g, 23.5 ± 13.2 g, and 2.9 ± 1.9 g, respectively. The estimated cumulative weight of paper generated from the IFUs accompanying implants used in European and U.S. cataract surgeries is 153 tons. If all manufacturers transition to e-IFUs, the cumulative weight saved would be 128 tons (-84%), equivalent to 120 tons of carbon dioxide equivalent and the preservation of more than 2000 trees annually. Conclusions: The classic IFUs in IOL packaging result in a significant amount of paper waste annually. Therefore, there is an urgent need for a rapid transition to e-IFU technology. The adoption of e-IFUs has already been authorized in Europe and the U.S., and it is crucial to expedite this process. [ABSTRACT FROM AUTHOR]

Nowadays, a high percentage (> 50%) of the paper produced in Europe uses recovered paper (secondary fibers) as raw material. In order to improve the mechanical properties of the paper produced, different kinds of additives are usually incorporated into the paper. Emerging renewable materials based on agricultural or forest residues, such as cellulose nanomaterials, have recently proved good capacities as reinforcing agents for different applications. In this work, pulp from wheat straw with a content of cellulose nanomaterial has been produced and tested as a mechanical reinforcing agent for paper production. A soda semi-chemical process was applied for the delignification of straw, to produce pulp with high cellulose content. Posteriorly, pulps with cellulose nanofibers were obtained in a high-pressure homogenizer, applying three different pretreatments to the cellulose pulp (acid hydrolysis, enzymatic hydrolysis and thermal treatment with glycerol) in order to facilitate the obtention of cellulose nanomaterial. Handsheets of paper were prepared from two sources of secondary fiber (fluting paper and old corrugated containers), adding different percentages of wheat straw derivatives (0, 3.5, 5 and 7%). The fibers' morphology and the papers' mechanical properties were investigated. Noticeable improvement rates (up to 25%) were observed for some mechanical properties of paper containing nanocellulose produced after the enzymatic and acid pretreatments. The quality of the secondary fibers source also affected the improvement rates achieved, with higher percentage changes for the lower-quality recycled paper. [ABSTRACT FROM AUTHOR]

This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Incisional hernia (IH) is one of the most common complications after abdominal surgeries and may bring great suffering to patients. This study aims to evaluate the global trends in IH research from 2003 to 2023 and visualize the frontiers using bibliometric analysis., Methods: The literature search was conducted on the Web of Science for IH studies published from 2003 to 2023 and sorted by citation frequency. The top 100 most-cited articles were analyzed by the annual publication number, prolific countries and institutions, influential author and journal, and the number of citations through descriptive statistics and visualization., Results: The top paper was cited 1075 times and the median number of citations was 146. All studies were published between 2003 and 2019 and the most prolific year was 2003 with 14 articles. Jeekel J and Rosen M were regarded as the most productive authors with ten articles each and acquired 2738 and 2391 citations, respectively. The top three institutions with the most productive articles were Erasmus Mc, Carolinas Med Ctr, and Univ Utah, while the top three countries were the United States, Netherlands and Germany. The most frequent keyword was "incisional hernia" with 55 occurrences, followed by "mesh repair", "randomized controlled trial", and "polypropylene"., Conclusion: The 100 most-cited papers related to IH were published predominantly by USA and European countries, with randomized controlled trial (RCT) and observational study designs, addressing topics related to risk factors, complications, mesh repair, and mesh components., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Psychodermatology is a subspecialty of dermatology that is of increasing interest to dermatologists and patients. The case for the provision of at least regional psychodermatology services across Europe is robust. Psychodermatology services have been shown to have better, quicker and more cost-efficient clinical outcomes for patients with psychodermatological conditions. Despite this, psychodermatology services are not uniformly available across Europe. In fact many countries have yet to establish dedicated psychodermatology services. In other countries psychodermatology services are in development. Even in countries where psychodermatolgy units have been established, the services are not available across the whole country. This is especially true for the provision of paediatric psychodermatology services. Also whilst most states across Europe are keen to develop psychodermatology services, the rate at which this development is being implemented is very slow. Our paper maps the current provision of psychodermatology services across Europe and indicates that there is still very much more work to be done in order to develop the comprehensive psychodermatology services across Europe, which are so crucial for our patients., (© 2023 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

The pulp and paper industry (PPI) has several opportunities to contribute to meeting prevailing climate targets. It can cut its own CO2 emissions, which currently account for 2% of global industrial fossil CO2 emissions, and it has an opportunity to produce renewable energy, fuels, and materials for other sectors. The purpose of this study is to improve understanding of the decarbonization prospects of the PPI. The study provides insights on the magnitude of needed annual renewal rates for several possible net-zero target years of industrial fossil CO2 emissions in the PPI and discusses decarbonization opportunities, namely, energy and material efficiency improvement, fuel switching, electrification, renewable energy production, carbon capture, and new products. The effects of climate policies on the decarbonization opportunities are critically evaluated to provide an overview of the current and future business environment of the European PPI. The focus is on Europe, but other regions are analyzed briefly to widen the view. The analysis shows that there are no major technical barriers to the fossil-free operation of the PPI, but the sector renovates slowly, and many new opportunities are not implemented on a large scale due to immature technology, poor economic feasibility, or unclear political environment. [ABSTRACT FROM AUTHOR]

In Southeast Europe countries (SEE) asset declarations are a strong, yet currently under-utilised instrument for preventing corruption and illicit financing among civil servants, and in particular among politically exposed persons (PEP). The media and civil society, along with international organisations, continuously investigate and report on the evident gaps between the living standards of politicians and their families on the one side and what they officially declare to the public as assets and income on the other. All SEE countries have in place a legal framework regulating asset declarations as part of their anti-corruption toolboxes. However, these regulations are rarely enforced in a consistent manner, and instead mostly result in short-lived annual scandals or occasional repression campaigns against political opponents. The aim of the present Note is to raise awareness of the public and decision makers about the loopholes in the procedures for verifying asset declarations and penalising irregularities in them and offer solutions for more efficient verifications in order to increase the liability of institutions and enhance the rule of law. [ABSTRACT FROM AUTHOR]

Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) "Basophil activation test in the evaluation of Drug Hypersensitivity Reactions" from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus‐based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug‐specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti‐inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory. [ABSTRACT FROM AUTHOR]

The growing prevalence and burden of Alzheimer's disease has catalysed huge investments in research on its causes, diagnosis, treatment and care. After many high-profile failures, recent clinical trials of anti-amyloid drugs have marked a turning point for the field, leading to the approval of the first disease-modifying therapies for Alzheimer's disease by the FDA. It is now up to European regulators to determine whether there is sufficient evidence to approve these drugs for patients with mild cognitive impairment or mild dementia due to Alzheimer's disease. Here, we outline Alzheimer Europe's position on anti-amyloid therapies for Alzheimer's disease, which was adopted by the Board of Alzheimer Europe following consultations with our member associations and with the European Working Group of People with Dementia. Beyond questions of drug efficacy, safety and cost, we highlight important issues that must be addressed by industry, regulators, payers, healthcare systems and governments, to ensure that patients have timely, appropriate and equitable access to innovative treatments, regardless of their socio-economic background, insurance status, or place of residence. We also call for continued investment in research on treatments that might benefit people with more advanced Alzheimer's disease - as well as support and care services that can help people live well with dementia at all stages of the disease., Competing Interests: Angela Bradshaw and Jean Georges are employees of Alzheimer Europe, which has received grants from the European Union’s Health, Horizon Europe and Citizens, Equality, Rights and Values programme (CERV) programmes, the Innovative Health Initiative, the Joint Programme for Neurodegenerative Disease Research (JPND) and the Luxembourg Fonds National de la Recherche, as well as sponsorship and support from AbbVie, Biogen, Eisai, Essity, Fujirebio, GE Healthcare, Grifols, Janssen, Lilly, MSD, Novo Nordisk, Nutricia, Prothena, Roche and TauRx.

Cesarean delivery rates are rapidly increasing in Southeastern Europe (to more than 60%), North Africa (with a rate as high as 72% in Egypt), and in urban areas in Southern Africa (a rate of over 50% in Lagos, Nigeria). Data on the background to these increases are scarce, but likely to include poor birthing facilities in general hospitals, convenience for the doctor, private medicine, fear of litigation, socioeconomic status, shortage of midwives and nurses, and disappearance of vaginal instrumental deliveries. Options to reverse cesarean delivery trends are discussed. In this context there is a need to be better informed about how women are being counseled regarding vaginal or cesarean delivery. The long-term consequences in subsequent pregnancies for mothers and children may well be largely ignored, while these risks are highest in LMICs where higher birth numbers are desired. FIGO has begun discussions with obstetric and gynecologic societies, healthcare bodies, and governments in several countries discussed in this article, to find ways to lower the cesarean delivery rate. The requests came from the countries themselves, which may prove beneficial in helping advance progress., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

A large proportion of the world's disease burden is attributable to mental illnesses. Although effective interventions are available, many patients still have limited access to evidence-based treatments. Aside from access, treatment gaps, including inappropriate medication selection and monitoring, are also routinely recognised. Mental health clinical pharmacists can help address these gaps and enable patients to receive optimised pharmaceutical care, particularly appropriate medication selection and monitoring. The European Society of Clinical Pharmacy (ESCP) Special Interest Group on Mental Health was established to improve standardised service provision in mental health settings across Europe. The Special Interest Group identified significant barriers (predominantly associated with reimbursement and position within the multidisciplinary team) to effective pharmaceutical care amongst those with mental illnesses. This commentary presents recommendations to address these gaps through improved mental health clinical pharmacy service provision., (© 2023. The Author(s).)

Purpose: Frequent renegotiations within public-private partnership (PPP) have been recognised and affect project efficiency. Literature has focussed on diverse issues associated with renegotiation within PPP, especially in Latin America and Europe. However, a systematic summary what they have already provided appears lacking. Thus, the paper aims to conduct a critical review of publications concerning PPP renegotiation and explore the status quo, future interests and gaps in research. Design/methodology/approach: This study carried out a four-phase literature review research framework to identify the quality PPP-renegotiation articles published from 2003 to 2020. Assessing the full articles for eligibility by providing a structured summary including: background; objectives; data sources; study appraisal; results; limitations; conclusions and implications of key findings. After that, filtering papers associated with PPP renegotiation in terms of the structured summary, and a total of 60 research papers were selected in the database of web of science and Scopus for review. Findings: Methods adopted by researchers, research topics and theoretical foundations of PPP renegotiation research in different disciplines were identified through content analysis. Amongst the popular research topics identified were renegotiation factors, the outcomes with renegotiations, the framework to deal with renegotiations and contract design dealing with renegotiation based on rigid or flexible contracts. Originality/value: This study contributes to the current body of PPP knowledge by revealing the research trend in the past 20 years. It also points out the directions that the renegotiations of PPP research may go towards in the future. Moreover, this study is very valuable in understanding how governments and concessionaires effectively handle renegotiations. [ABSTRACT FROM AUTHOR]

Non-native species are spreading at an unprecedented rate over large spatial scales, with global environmental change and growth in commerce providing novel opportunities for range expansion. Assessing the pattern and rate of spread is key to the development of strategies for safeguarding against future invasions and efficiently managing existing ones. Such assessments often depend on spatial distribution data from online repositories, which can be spatially biased, imprecise, and lacking in quantity. Here, the influence of disparities between occurrence records from online data repositories and what is known of the invasion history from peer-reviewed published literature on non-native species range expansion was evaluated using 6693 records of the Pacific oyster, Magallana gigas (Thunberg, 1793), spanning 56 years of its invasion in Europe. Two measures of spread were calculated: maximum rate of spread (distance from introduction site over time) and accumulated area (spatial expansion). Results suggest that despite discrepancies between online and peer-reviewed data sources, including a paucity of records from the early invasion history in online repositories, the use of either source does not result in significantly different estimates of spread. Our study significantly improves our understanding of the European distribution of M. gigas and suggests that a combination of short- and long-range dispersal drives range expansions. More widely, our approach provides a framework for comparison of online occurrence records and invasion histories as documented in the peer-reviewed literature, allowing critical evaluation of both data sources and improving our understanding of invasion dynamics significantly., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

This study focuses on the increased risk of high heat release and asphyxiation (toxic gas poisoning) in the event of a fire involving polyurethane (PU)- and MDF-based building materials, which are commonly used in buildings. Among them, polyurethane (PU) building materials are very commonly used in buildings, except in Europe and some other countries, due to their excellent thermal insulation performance. Still, problems of short-term heat release and the spread of toxic gases in the event of a fire continue to occur. To overcome these problems, researchers are actively working on introducing various flame retardants into building materials. Therefore, in this study, we produced a laboratory-sized (500 mm × 500 mm) plate-like flame-retardant board that can be utilized as a building material with a lower heat release rate and a lower toxicity index. The material was made by mixing expanded graphite and ceramic binder as flame retardants in a material that is formulated based on the cellulose of waste paper, replacing the existing building materials with a hot-press method. According to the ISO-5660-1 test on the heat release rate of the plate-like flame-retardant board, the Total Heat Release (THR) value was 2.9 (MJ/m2) for 10 min, showing an effect of reducing the THR value by 36.3 (MJ/m2) compared to the THR value of 39.2 (MJ/m2) of the specimen made using only paper. In addition, the toxicity index of the flame-retardant board was checked through the NES (Naval Engineering Standards)-713 test. As a result, the test specimen showed a toxicity index of 0.7, which is 2.4 lower than the toxicity index of 3.1 of MDF, which is utilized as a conventional building material. Based on the results of this study, the cellulose fire-retardant board showed the effect of reducing the heat release rate and toxicity index of building materials in a building fire, which reduces the risk of rapid heat spread and smoke toxicity. This has the potential to improve the evacuation time (A-SET) of evacuees in fires. It is also important to show that recycling waste paper and utilizing it as the main material for building materials can be an alternative in terms of sustainable development. [ABSTRACT FROM AUTHOR]

The European Universities Initiative (EUI), created by the European Commission in 2017, is a recent novel phenomenon within the European Union policy toolkit that explicitly targets the development of transnational cooperation in higher education (HE). To date, the EUI counts 44 European university alliances, involving around 340 HE institutions. In this paper, we argue that the EUI can be seen as a case of a transnational institution building process representing a potentially significant structural reform for European higher education. Anchored in new institutionalism, we explore the regulative, normative, and cultural-cognitive dimensions of the EUI. Methodologically, this study analyzes the perspectives of European policy actors (n = 4), a set of policy documents (n = 13) and the mission statements of the EUI's partnerships funded before 2022 (n = 41). The results show that the EUI emerges as the 'next level of cooperation' in European HE since it aims to transform European cooperation (regulative dimension), to create and diffuse a new model for European HE following a challenge-based approach (normative dimension), and to work as a way to reinforce and institutionalize European and global scripts for European HE (cultural-cognitive dimension).

Invasive plant species can impede the establishment and growth of native plants and affect several ecosystem properties. These properties include soil cover, nutrient cycling, fire regimes, and hydrology. Controlling invasive plants is therefore a necessary, but usually expensive, step in restoring an ecosystem. The sustainability of materials with an emphasis on the use of local resources plays an important role in the circular economy. The use of alternative fibers from invasive plants promotes local production in smaller paper mills that offer the protection of local species and the reduction of waste and invasive plants. A synthesis of the literature is needed to understand the various impacts of invasive plants and their practical control in the context of papermaking applications and to identify associated knowledge gaps. To improve our understanding of the practical application of invasive species in the paper industry, we reviewed the existing literature on invasive plant species in the area of fiber production, printability, coating solution production, dyes, and extracts, and collected information on the major invasive plant species in Europe and the methods used for various applications. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA-associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA-associated GORD and medical and dietary management. The task force (TF) on non-IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web-based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA-associated GORD., (© 2022 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

The building sector contributes to 40% of the total final energy consumption and 36% of CO2 emissions in Europe, and these are set to increase in the coming years. International directives are pushing towards a decarbonisation roadmap to improve the quality of cities and the health of citizens. Buildings have a potentially central role in terms of energy transition as a means to produce and save energy. Photovoltaic shading devices (PVSDs) protect buildings from direct solar radiation and overheating while producing renewable electricity onsite and increasing the users' thermal comfort. Even though the potential of the PVSD is considerable, the sector is still unexplored, and few studies on the topic are available in the literature. This systematic review aims to present an exhaustive overview of the current literature on state-of-the-art PVSDs by analysing the scientific framework in terms of the status of the research. It presents a performance-based approach focusing on innovative products, PVSD design strategies, and energetic performance in distinct climate conditions and configurations. In particular, 75 articles and about 250 keywords were identified, selected, and analysed. The literature review serves as a basis for further R&D activities led by both the industrial and the academic sectors. [ABSTRACT FROM AUTHOR]

Introduction: Adolescence is a critical stage of rapid biological, emotional and social change and development. Adolescents and young adults (AYA) with asthma and allergies need to develop the knowledge and skills to self-manage their health independently. Healthcare professionals (HCP), parents and their wider network play an essential role in supporting AYA in this process. Previous work showed significant limitations in transition care across Europe. In 2020, the first evidence-based guideline on effective transition for AYA with asthma and allergies was published by EAACI., Aim: We herein summarize practical resources to support this guideline's implementation in clinical practice., Methods: For this purpose, multi-stakeholder Task Force members searched for resources in peer review journals and grey literature. These resources were included if relevant and of good quality and were pragmatically rated for their evidence-basis and user friendliness., Results: Resources identified covered a range of topics and targeted healthcare professionals, AYA, parents/carers, schools, workplace and wider community. Most resources were in English, web-based and had limited evidence-basis., Conclusions: This position paper provides a valuable selection of practical resources for all stakeholders to support effective transitional care for AYA with asthma and allergies. Future research should focus on developing validated, patient-centred tools to further assist evidence-based transition care., (© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

The increasing use in clinical practice of software such as mobile apps and clinical decision support (CDS) software has only recently been taken up by regulators around the world. Specifically, the European Commission and the US Food and Drug Administration (FDA) have updated their regulatory framework in the last years. Van Laere et al have given an extensive overview of the European and US approaches to regulate CDS software. This commentary further discusses regulatory differences between the two geographies and their impact on manufacturers of medical device software. We discuss the practical implementation of the regulatory framework for medical device software (especially CDS software) with a reference to the available international guidance documents and their limitations. Given the direction of stricter regulatory oversight in Europe, additional European guidelines/examples are desirable to enable a pragmatic regulatory approach ensuring continued access to innovative medical device software for European patients., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Economic regulation is an instrument of the state or other institutions to correct market failures, rectify the business environment, or protect consumers. Regulation can be a major driver of innovation, and it has proven to be so in the past. On the other hand, there are also documented cases of ineffective regulation due to information delays or shortcomings in government decision-making. The complexity of the impact of regulatory changes on innovation can currently be observed in the medical device market in Europe. Regulation (EU) 2017/745 whose main idea is to ensure greater safety and health protection for consumers, is a challenge for originator, manufacturer, mostly small and medium-sized enterprises. The regulation is associated with an increase in the cost of developing and maintaining the product on the market. We can now gradually begin to analyze whether it can be ranked among those that have become drivers of innovation., (© 2023 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)