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Under exacerbated environmental conditions due to climate change and more frequent and more severe disturbances the establishment of forest stands has become a challenge for forest managers. This study aims at comparing stand establishment methods on a European scale. We differentiated between five biogeographic regions to detect similarities and differences regarding current practices as well as trends considering the climatic background using an expert survey. Our results allowed identifying two clusters, one boreal cluster and one European mainland cluster. In both cases mechanical soil preparation and measures against drought are seen as key factors. Experts from the boreal region give high importance to appropriate plant material and fertilization for growth acceleration, and consider insects and fungi as a primary threat. In the mainland cluster, experts rely mainly on silvicultural measures and expect damage by game to be highly detrimental for stand establishment. Across Europe the preferable countermeasure to face drought is not irrigation but a combination of strategies related to mechanical site preparation, plant material, planting method, and silviculture. This study identifies three focal areas for forest practitioners to consider when establishing new forest stands: (1) careful selection of the plant material; (2) suitable site preparation and (3) prudent deliberation on beneficial silvicultural options. [ABSTRACT FROM AUTHOR]

The ongoing COVID‐19 pandemic caused by the SARS‐CoV‐2 coronavirus has affected the health of tens of millions of people worldwide. In particular, in elderly and frail individuals the infection can lead to severe disease and even fatal outcomes. Although the pandemic is primarily a human health crisis its consequences are much broader with a tremendous impact on global economics and social systems. Vaccines are considered the most powerful measure to fight the pandemic and protect people from COVID‐19. Based on the concerted activities of scientists, manufacturers and regulators, the urgent need for effective countermeasures has provoked the development and licensure of novel COVID‐19 vaccines in an unprecedentedly fast and flexible manner within <1 year. To ensure the safety and efficacy of these novel vaccines during the clinical development and the routine use in post‐licensure vaccination campaigns existing regulatory requirements and procedures had to be wisely and carefully adapted to allow for an expedited evaluation without compromising the thoroughness of the regulatory and scientific assessment. In this review, we describe the regulatory procedures, concepts and requirements applied to guide and promote the highly accelerated development and licensure of safe and efficacious COVID‐19 vaccines in Europe. [ABSTRACT FROM AUTHOR]

Background: Civil society organisations (CSOs) play a vital role in developing and implementing effective measures to reduce the harms of drug use. They are also fundamental actors to monitor and evaluate programmes and policies for improvement. While harm reduction services are subject to monitoring, and international and European indicators exist, a framework for civil society-led monitoring does not exist. This paper analyses the challenges and added values of developing such a framework for the European region. Methods: Since 2018, a technical working group within Correlation-European Harm Reduction Network (C-EHRN) is developing and revising a monitoring framework, collecting—through National Focal Points—the experience of harm reduction service providers and service users in 34 European countries. The first round of data collection, in 2019, focused on hepatitis C, overdose prevention, new drug trends and civil society involvement in drug policies. Results: Developing CSO-based harm reduction monitoring is a learning by doing process. Assuring reliability and national representativeness of the data was a central challenge. As most CSOs have little or no experience with monitoring and research and work in a local-based context, the monitoring approach and its indicators were adjusted to the local context in the second round, bringing more in-depth information and helping to improve results' reliability. While this implied shifting from the initial focus on comparing responses at a national level, the change to collecting qualitative data reflecting local realities of service policies and delivery provides the foundations for a critical appraisal of these realities against European policy goals. This allowed to map discrepancies between official policies and their implementation, as well as identify gaps in and complement data collection from national-level agencies. Conclusions: By focusing on local experiences regarding the delivery of global and European policy targets, C-EHRN monitoring uses the unique strengths of its CSOs network and generates information that complements the reporting by other monitoring agencies. Data reflecting the CSOs perspective is essential for optimising local planning of service provision and development of effective and respectful drug policies at national and European level. If data quality issues, as well as the sustainability of reporting, are adequately addressed, civil society monitoring can provide excellent added value for the monitoring of harm reduction in Europe. [ABSTRACT FROM AUTHOR]

Severe feather pecking (SFP) is a serious problem in the egg production industry with regard to animal welfare and performance. The multifactorial causes of SFP are discussed in the areas of genetics, feeding, husbandry, stable climate and management. Several studies on the influence of manipulable material on the incidence of SFP in different environments and housing systems have been performed. This review presents current knowledge on the effects of litter and additional enrichment elements on the occurrence of SFP in pullets and laying hens. Because SFP is associated with foraging and feed intake behaviour, the provision of manipulable material in the husbandry environment is an approach that is intended to reduce the occurrence of SFP by adequate exercise of these behaviours. As shown in the literature, the positive effect of enrichment and litter substrate on SFP in a low‐complexity cage environment is evident. On the other hand, consistent results have not been reported on the influence of additional enrichment material in housing systems with litter substrate, which represent the most common type of husbandry in Northwestern Europe. Thus, further research is recommended. [ABSTRACT FROM AUTHOR]

By 31 December 2018, 39 537 quality-controlled reports of large hail had been submitted to the European Severe Weather Database (ESWD) by volunteers and ESSL. This dataset and the NatCatSERVICE Database of Munich RE jointly allowed us to study the hail hazard and its impacts across Europe over a period spanning multiple decades. We present a spatiotemporal climatology of the ESWD reports, diurnal and annual cycles of large hail, and indicate where and how they may be affected by reporting biases across Europe. We also discuss which hailstorms caused the most injuries and present the only case with hail fatalities in recent times. Additionally, we address our findings on the relation between hail size to the type of impacts that were reported. For instance, the probability of reported hail damage to roofs, windows, and vehicles strongly increases as hail size exceeds 5 cm, while damage to crops, trees, and greenhouses is typically reported with hailstone diameters of 2–3 cm. Injuries to humans are usually reported with hail 4 cm in diameter and larger, and number of injuries increases with increasing hail size. Using the NatCatSERVICE data, we studied economic losses associated with hailstorms occurring in central Europe and looked for long-term changes. The trend in hail losses and the annual number of hail loss days since 1990 to 2018 are compared to that of meteorological conditions favorable for large hail as identified by ESSL's Additive Regression Convective Hazards model. Both hail loss days and favorable environments show an upward trend, in particular since 2000. [ABSTRACT FROM AUTHOR]

In 2023, the steering committee will prepare a draft version of the LRP2024 recommendations, which will be presented at a dedicated Town Meeting and largely consulted on with the European nuclear physics community. The steering committee of the LRP2024 and all NuPECC members encourage active participation of the whole community in the elaboration of an ambitious and achievable strategic plan for the future of European nuclear physics. The Nuclear Physics European Collaboration Committee (NuPECC; http://nupecc.org/), hosted by the European Science Foundation, represents today a large nuclear physics community from 22 countries, three European Strategy Forum for Research Infrastructures (ESFRI) nuclear physics infrastructures and the European Centre for Theoretical Studies in Nuclear Physics and Related Areas, as well as from four associated members and nine observers. [Extracted from the article]

Introduction: We present two consensus definitions of advanced and late stage liver disease being used as epidemiological tools. These definitions can be applied to assess the morbidity caused by liver diseases in different health care systems. We focus is on hepatitis B and C virus infections, because effective and well tolerated treatments for both of these infections have greatly improved our ability to successfully treat and prevent advanced and late stage disease, especially if diagnosed early. A consensus definition of late presentation with viral hepatitis is important to create a homogenous, easy-to-use reference for public health authorities in Europe and elsewhere to better assess the clinical situation on a population basis.Methods: A working group including viral hepatitis experts from the European Association for the Study of the Liver, experts from the HIV in Europe Initiative, and relevant stakeholders including patient advocacy groups, health policy-makers, international health organisations and surveillance experts, met in 2014 and 2015 to develop a draft consensus definition of late presentation with viral hepatitis for medical care. This was refined through subsequent consultations among the group.Results: Two definitions were agreed upon. Presentation with advanced liver disease caused by chronic viral hepatitis for medical care is defined as a patient with chronic hepatitis B and C and significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.25, Fibrotest > 0.59 or alternatively transient elastography (FibroScan) > 9.5 kPa or liver biopsy ≥ METAVIR stage F3) with no previous antiviral treatment. Late stage liver disease caused by chronic viral hepatitis is clinically defined by the presence of decompensated cirrhosis (at least one symptom of the following: jaundice, hepatic encephalopathy, clinically detectable ascites, variceal bleeding) and/or hepatocellular carcinoma.Conclusion: These consensus definitions will help to improve epidemiological understanding of viral hepatitis and possibly other liver diseases, as well as testing policies and strategies. [ABSTRACT FROM AUTHOR]

Background: Severe aortic stenosis (AS) is a common, serious valve disease in which no effective medical therapy is available and, if not treated by intervention, has a 5-year survival of only 40-60%. Despite the availability of guidelines supporting the effective use of surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) to treat the majority of these patients, adherence to these guidelines in clinical practice is still unsatisfactory. Several recent studies have emphasised the necessity for improved communication between multidisciplinary teams, with the aim to ensure that severe AS patients receive appropriate treatment.Methods/design: IMPULSE is a prospective, multicentre, European registry designed to gather data over 12 months on the treatment decisions made by referring physicians for patients newly diagnosed with severe AS. Each patient has a follow-up of 3 months. The study will consist of two observational phases to assess the appropriateness and rate of referral based on current guidelines prior to and after an interventional phase aiming to determine whether a simple quality of care intervention improves patient management.Discussion: Data will be analysed firstly, to determine the appropriateness of treatment decisions for the management of severe AS in current European clinical practice, and secondly, to evaluate the effectiveness of facilitated data relay from a designated echocardiography department nurse to the referring physician early after diagnosis in improving quality of care. Additionally, variables will be identified that are associated with inappropriate decision-making. Collectively, the aim will be to design a clinical pathway that will improve the timely management of patients with newly diagnosed severe AS. [ABSTRACT FROM AUTHOR]

Anorectal malformations (ARM) have a low prevalence, patients need specialized surgical care, and in many cases, patients born with ARM even need life-long aftercare. Due to its low prevalence most patients are still treated in low-volume pediatric surgical centers without any adequate monitoring of the outcome. Data on prevalence, comparison of different surgical techniques, and prospective outcome measurements are still scarce and difficult to interpret. In 2010, a consortium was founded (ARM-Net consortium) including several European pediatric surgical centers to collaborate more in research and share knowledge on ARM. One of the structures started by the consortium was an ARM-Net registry for the inclusion of all future patients treated in these centers. With this review, we report the structure of the ARM-Net registry, some of the results, and discuss the challenges we faced and still face after its introduction in 2010. [ABSTRACT FROM AUTHOR]

Background: The ROAdmap for MEntal health Research in Europe project aimed to create an integrated European roadmap for mental health research. Leading mental health research experts across Europe have formulated consensus-based recommendations for future research within the public mental health field. Methods: Experts were invited to compile and discuss research priorities in a series of topic-based scientific workshops. In addition, a Delphi process was carried out to reach consensus on the list of research priorities and their rank order. Three web-based surveys were conducted. Nearly 60 experts were involved in the priority setting process. Results: Twenty priorities for public mental health research were identified through the consensus process. The research priorities were divided into summary principles--encompassing overall recommendations for future public mental health research in Europe--and thematic research priorities, including area-specific top priorities on research topics and methods. The priorities represent three overarching goals mirroring societal challenges, that is, to identify causes, risk and protective factors for mental health across the lifespan; to advance the implementation of effective public mental health interventions and to reduce disparities in mental health. Conclusions: The importance of strengthening research on the implementation and dissemination of promotion, prevention and service delivery interventions in the mental health field needs to be emphasized. The complexity of mental health and its broader conceptualisation requires complementary research approaches and interdisciplinary collaboration to better serve the needs of the European population. [ABSTRACT FROM AUTHOR]

We analyze the interplay of public and private law enforcement when an infringement affects multiple parties, and where detection by just one party is sufficient to avoid the harm. Detection causes a positive externality on other victims, so that private effort incentives are inefficiently low. The public agency has might reduce its own inspection frequency in order to increase the number of private inspections (Peltzman-effect). However, due to the private parties' incentive compatibility constraints, the agency can only trigger inspection by one more private party compared to the number of inspections when itself inspects with full frequency. Inspecting with full frequency is more likely to be second-best when the number of private parties affected is high. [ABSTRACT FROM AUTHOR]

Background: Worldwide superficial and deep venous diseases are common and associated with significant individual and socioeconomic morbidity. Increasing burden of venous disease requires Phlebology to define itself as an independent specialty representing not only patients but the multidisciplinary physicians involved in venous care.Methods & Results: In this article the scope of venous disease in Europe and subsequent future governance for treatment in the region is discussed. Superficial venous disease is common with 26.9-68.6% of European populations reported to have C2-C6 disease according to the CEAP (Clinical severity, Aetiology, Anatomy and Pathophysiology) scoring system. However, a significant disparity is observed in the treatment of superficial venous disease across Europe.Post thrombotic syndrome (PTS) after deep vein thrombosis (DVT) contributes to the increasing burden of deep venous disease. Aggressive thrombus removal for acute ileofemoral DVT provides a cost-effective 14.4% risk reduction in the development of PTS. Additionally, deep venous lesions requiring endovascular intervention are being increasingly performed to prevent recurrent thrombosis. The European College of Phlebology (ECoP) has been formed to provide a responsible body for the care of the European patient with venous disease. The role of the ECoP includes unifying European member states through standardised guideline production, identification of research strategy and provision of training and accreditation of physicians. Conclusion: Creation of a European venous disease specific speciality will provide a patient centred approach through understanding of the impact of disease in the region and delivery of high quality diagnostics and treatment from an appropriately certified Phlebologist. [ABSTRACT FROM AUTHOR]

Background: spa typing is a common genotyping tool for methicillin-resistant Staphylococcus aureus (MRSA) in Europe. Given the high prevalence of dominant clones, spa-typing is proving to be limited in its ability to distinguish outbreak isolates from background isolates. New molecular tools need to be employed to improve subtyping of dominant local MRSA strains (e.g., spa type t003). Methods: Phylogenetically critical, or canonical, SNPs (can-SNPs) were identified as subtyping targets through sequence analysis of 40 MRSA whole genomes from Luxembourg. Real-time PCR assays were designed around target SNPs and validated using a repository of 240 previously sub-typed and epidemiologically characterized Luxembourg MRSA isolates, including 153 community and hospital isolates, 69 isolates from long term care (LTC) facilities, and 21 prospectively analyzed MRSA isolates. Selected isolates were also analyzed by whole genome SNP typing (WGST) for comparison to the SNP assays and other subtyping techniques. Results: Fourteen real-time PCR assays were developed and validated, including two assays to determine presence of spa t003 or t008. The other twelve assays successfully provided a high degree of resolution within the t003 subtype. WGST analysis of the LTC facility isolates provided greater resolution than other subtyping tools, identifying clusters indicative of ongoing transmission within LTC facilities. Conclusions: canSNP-based PCR assays are useful for local level MRSA phylotyping, especially in the presence of one or more dominant clones. The assays designed here can be easily adapted for investigating t003 MRSA strains in other regions in Western Europe. WGST provides substantially better resolution than other typing methods. [ABSTRACT FROM AUTHOR]

The endangered African dwarf crocodile Osteolaemus tetraspis is distributed in Central and Western Africa. Conventionally, two subspecies were distinguished: Osteolaemus tetraspis tetraspis and Osteolaemus tetraspis osborni. The taxonomic significance of diagnostic morphological characters is still being discussed and the existence of additional species in the Osteolaemus group remains unclear. Recent molecular studies suggest the existence of three allopatric species in the genus Osteolaemus. These results supported a division of the dwarf crocodile into a Congo Basin form ( O. osborni), an Ogooué Basin form ( O. tetraspis), and a third separate evolutionary lineage from Western Africa. Several European zoos host African dwarf crocodiles. For reasons of conservation and possible reintroduction, it is important to clarify provenance of these zoo animals. Therefore, we conducted molecular and phylogenetic analyses of three mitochondrial and two nuclear gene sequences with all available samples from European zoos and museums. We also estimated the origin of the zoo animals by comparing sequences of wild animals and museum samples of known provenance. Our study strongly supports three distinct lineages of Osteolaemus as recently postulated, but also reveals a fourth evolutionary lineage. We demonstrate that, of the European zoo animals sampled, only one dwarf crocodile corresponds to the Congo Basin form ( O. osborni) whereas the majority of individuals correspond to the three other forms. Four zoo animals belong to the new fourth group; but their provenance is still unresolved. The origin of these animals is probably located in an African region from which no wild animal samples are currently available. Further investigations and sampling of other regions should be completed to clarify the identity of this fourth lineage. We found potential hybrids from European zoological gardens using nuclear DNA sequences. The European Studbook will use these results for further breeding programmes to keep genetically suitable ex-situ populations as reassurance colonies for prospective reintroduction into African countries. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of different chemical and meteorological boundary and initial conditions on the state-of-the-art Weather Research and Forecasting (WRF) model with its chemistry extension (WRF-Chem). The evaluation is done for July 2005 with 50 km horizontal resolution. The effect of monthly mean chemical boundary conditions derived from the chemical transport model LMDZ-INCA on WRF-Chem is evaluated against the effect of the preset idealized profiles. Likewise, the impact of different meteorological initial and boundary conditions (GFS and Reanalysis II) on the model is evaluated. Pearson correlation coefficient between these different runs range from 0.96 to 1.00. Exceptions exists for chemical boundary conditions on ozone and for meteorological boundary conditions on PM, where coefficients of 0.90 were obtained. Best results were achieved with boundary and initial conditions from LMDZ-INCA and GFS. Overall, the European simulations show encouraging results for observed air pollutant, with ozone being the most and PM being the least satisfying. [ABSTRACT FROM AUTHOR]

International student mobility amongst and between countries has become increasingly common and forms a central feature of the global higher education system. This paper examines the key learning experiences relating to the student mobility component of the Canadian-European Initiative for Health Promotion Advanced Learning (CEIHPAL) project. CEIHPAL was a unique and innovative project that fostered advanced intercontinental education and learning in health promotion from 2005–2008. With co-funding from the European Commission and the Canadian Government, the project facilitated institutional, student and faculty cooperation, by developing a high level of international communication. In particular, this paper focuses on the student mobility component and experiences of the CEIHPAL programme, a central part of the project activities. Feedback from both Canadian and European students themselves is used to document their participation in the programme, including the benefits derived from taking part as well as the problems and difficulties they encountered. [ABSTRACT FROM PUBLISHER]

The science of seasonal predictions has advanced considerably in the last decade. Today, operational predictions are generated by several institutions, especially for variables such as (sea) surface temperatures and precipitation. In contrast, few studies have been conducted on the seasonal predictability of extreme meteorological events such as European windstorms in winter. In this study, the predictive skill of extratropical wintertime windstorms in the North Atlantic/European region is explored in sets of seasonal hindcast ensembles from the Development of a European Multimodel Ensemble System for Seasonal-to-Interannual Prediction (DEMETER) and the ENSEMBLE-based predictions of climate changes and their impacts (ENSEMBLES) projects. The observed temporal and spatial climatological distributions of these windstorms are reasonably well reproduced in the hindcast data. Using hindcasts starting on 1 November, significant predictive skill is found for the December-February windstorm frequency in the period 1980-2001, but also for the January-April storm frequency. Specifically, the model suite run at Météo France shows consistently high skill. Some aspects of the variability of skill are discussed. Predictive skill in the 1980-2001 period is usually higher than for the 1960-2001 period. Furthermore, the level of skill turns out to be related to the storm frequency of a given winter. Generally, winters with high storm frequency are better predicted than winters with medium storm frequency. Physical mechanisms potentially leading to such a variability of skill are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The recently established International Consortium on Anorectal Malformations aims to identify genetic and environmental risk factors in the etiology of syndromic and nonsyndromic anorectal malformations (ARM) by promoting collaboration through data sharing and combined research activities.Methods: The consortium attempts to recruit at least 1,000 ARM cases. DNA samples are collected from case-parent triads to identify genetic factors involved in ARM. Several genetic techniques will be applied, including SNP arrays, gene and whole exome sequencing, and a genome-wide association study. Questionnaires inquiring about circumstances before and during pregnancy will be used to obtain environmental risk factor data.Results: Currently, 701 ARM cases have been recruited throughout Europe. Clinical data are available from all cases, and DNA samples and questionnaire data mainly from the Dutch and German cases. Preliminary analyses on environmental risk factors in the Dutch and German cohort found associations between ARM and family history of ARM, fever during first trimester of pregnancy and maternal job exposure to cleaning agents and solvents.Conclusion: First results show that both genetic and environmental factors may contribute to the multifactorial etiology of ARM. The International Consortium on Anorectal Malformations will provide possibilities to study and detect important genes and environmental risk factors for ARM, ultimately resulting in better genetic counseling, improved therapies, and primary prevention. [ABSTRACT FROM AUTHOR]

The concept of “reference conditions” describes the benchmark against which current conditions are compared when assessing the status of water bodies. In this paper we focus on the establishment of reference conditions for European lakes according to a phytoplankton biomass indicator—the concentration of chlorophyll- a. A mostly spatial approach (selection of existing lakes with no or minor human impact) was used to set the reference conditions for chlorophyll- a values, supplemented by historical data, paleolimnological investigations and modelling. The work resulted in definition of reference conditions and the boundary between “high” and “good” status for 15 main lake types and five ecoregions of Europe: Alpine, Atlantic, Central/Baltic, Mediterranean, and Northern. Additionally, empirical models were developed for estimating site-specific reference chlorophyll- a concentrations from a set of potential predictor variables. The results were recently formulated into the EU legislation, marking the first attempt in international water policy to move from chemical quality standards to ecological quality targets. [ABSTRACT FROM AUTHOR]

The intercalibration (IC) exercise is a key element in the implementation of the Water Framework Directive (WFD) in Europe. Its focus lies on the harmonization of national classification methods to guarantee a common understanding of ‘Good Ecological Status’ in surface waters. This article defines reference conditions and sets class boundaries for deep (mean depth >15 m, IC lake type L-AL3) and moderately deep (mean depth 3–15 m, IC lake type L-AL4) Alpine lakes >0.5 km2. Data were collated from each of the five EU member states included in the Alpine Geographical Intercalibration Group (Alpine GIG: Austria, France, Germany, Italy and Slovenia). Hydro-morphological, chemical and biological data from 161 sites (sampling stations) in 144 Alpine lakes over a period of seven decades were collated in a database. Based on a set of reference criteria, 18 L-AL3 and 13 L-AL4 reference sites were selected. Reference conditions were defined using a combined approach, based on historical, paleolimnological and monitoring data in conjunction with trophic modelling and expert judgement. Reference values and class boundaries were set for annual mean total biomass (biovolume), and then derived for annual mean chlorophyll- a using a regression between the two parameters. In order to allow for geographical differences within the Alpine GIG and to facilitate the inclusion of the broadly defined common IC types and national lake types, ranges were defined for each reference value. Range of reference values are 0.2–0.3 mg l−1 (L-AL3) and 0.5–0.7 mg l−1 (L-AL4) for total biovolume and 1.5–1.9 μg l−1 (L-AL3) and 2.7–3.3 μg l−1 (L-AL4) for chlorophyll- a. Depending on lake type and variable, the ecological quality ratios (EQR) for setting the class boundaries lie between 0.60 and 0.75 for the high/good class boundary and between 0.25 and 0.41 for the good/moderate class boundary. The response of sensitive phytoplankton taxa along a nutrient gradient and the occurrence of ‘undesirable conditions and secondary effects’ as defined in the WFD was used to validate the class boundary values, which are thus considered to be compliant with the requirements of the WFD. [ABSTRACT FROM AUTHOR]

As mathematical modeling of wastewater treatment plants has become more common in research and consultancy, a mismatch between education and requirements for model-related jobs has developed. There seems to be a shortage of skilled people, both in terms of quantity and in quality. In order to address this problem, this paper provides a framework to outline different types of model-related jobs, assess the required skills for these jobs and characterize different types of education that modelers obtain "in school" as well as "on the job". It is important to consider that education of modelers does not mainly happen in university courses and that the variety of model related jobs goes far beyond use for process design by consulting companies. To resolve the mismatch, the current connection between requirements for different jobs and the various types of education has to be assessed for different geographical regions and professional environments. This allows the evaluation and improvement of important educational paths, considering quality assurance and future developments. Moreover, conclusions from a workshop involving practitioners and academics from North America and Europe are presented. The participants stressed the importance of non-technical skills and recommended strengthening the role of realistic modeling experience in university training. However, this paper suggests that all providers of modeling education and support, not only universities, but also software suppliers, professional associations and companies performing modeling tasks are called to assess and strengthen their role in training and support of professional modelers. [ABSTRACT FROM AUTHOR]

The new European chemical regulation (REACH) requires a short-term fish test for chemicals where the level of production exceeds 10tons per year. For ethical reasons (3R-concept), an alternative to the acute fish test should be introduced to decrease the number of animal testing with fish. The zebrafish embryo (Danio rerio) test became a valuable tool in ecotoxicology and already replaces the acute fish test for the evaluation of wastewater in Germany. Recent efforts are targeted to use this and other fish embryo tests for the effect assessment of chemicals. The toxic effects of the carbamate insecticide aldicarb and its metabolite aldicarb-sulfoxide to zebrafish embryos were analysed using two approaches with different endpoints. Organismic tests were conducted with zebrafish embryos exposed to the pesticides for 48h. In addition, suborganismic effects were examined analysing the enzyme inhibition of cholinesterases and carboxylesterases. On the organismic level, the only sublethal effect seen was the increase of heart rate at low and decrease at higher concentration with the use of aldicarb-sulfoxide but not with aldicarb (concentration range 0. 2–300μM). In contrast, analysis of enzyme inhibitions showed high to very high effects caused by the two carbamates. The enzyme inhibition analysis of whole homogenates of exposed embryos may be advantageous for toxicant screening (biomarker of exposure) and might be used to bridge the gap of sensitivity of the (48h old) zebrafish embryos to adult fish when exposed to anti-cholinesterase substances (biomarker of prospective effect). [Copyright &y& Elsevier]

Background: The treatment of Parkinson's disease (PD) is complex and highly individual. The choice between available treatment options depends on clinical characteristics such as the patient's age, disease severity and presence of comorbidities, lifestyle characteristics and preferences, costs of different medications and awareness and perception of available treatment options, and education of the treating physician. The impact of PD treatment regimens on patients' health-related quality of life (QOL) is also an important healthcare feature. The objective of the present study was to assess treatment options, treatment satisfaction and opinions about treatment improvements in patients with PD and neurologists treating the disease. Methods: Two surveys using face-to-face interviews and an additional phone survey were carried out in the US and five European countries (France, Germany. Italy, Spain and the UK). Patients with early and advanced stages of PD were included. To participate in the neurologist survey, neurologists were required to personally treat ten or more PD patients per month, including both early and advanced stage patients. Interviews consisted of a mix of closed and open-ended questions; some of these questions involved show cards. Results: Of the 500 patients who were surveyed, 49% had early and 51% had advanced PD. Early-stage PD patients, both in the US and Europe, take a mean of 3.2 tablets daily of PD-medication. In contrast, the mean daily tablet load of PD medication is much higher for advanced-stage patients (9.9 and 8.4 tablets in the US and Europe, respectively). Tablet load was perceived as a major problem; the majority of patients wished to see improvements regarding daily medication intake and expressed interest in other delivery systems such as patches. Overall, patients rated their treatment with a score of 6.6 points (6.7 for early-stage and 6.6 for advanced-stage patients) [scale of 1-10; l0 being highest]. Physicians (n = 592) were satisfied with a number of current PD medications and assumed they improve the QOL of the patients. They regarded efficacy and safety as the most important features for the improvement of PD medication. Conclusion: Further research is needed into PD treatment options not only for symptom alleviation but for better delivery systems that could improve compliance and QOL for patients with PD. Treatment guidelines need to incorporate QOL aspects and general communication between the health professional and the patient. [ABSTRACT FROM AUTHOR]

Abstract: In many bird species, the female participates in defending a pair''s breeding territory, however, the endocrine control mechanism of female aggressive behavior is largely unknown. The general statement that androgens are involved in the regulation of aggressive behavior is based on studies conducted only in males. Here, we tested whether paired female stonechats show a hormonal response to a simulated male territorial intruder. Since in males of territorial bird species androgen levels usually increase following a male–male encounter, we measured androgen-levels before and after a simulated male intrusion. In addition, we measured estradiol, the main gonadal hormone in females, and corticosterone, a stress hormone. The results show that a male intruder does not affect any of the measured hormones in females. In a second experiment, we also tested whether the endocrine state of the male partner affects the hormonal response of females to a male intruder by comparing the hormonal response of females paired with pharmacologically castrated males and females paired with control males. Females paired with pharmacologically castrated males had lower corticosterone levels both before and after the intrusion than females paired with control males. Additionally, in both groups, female corticosterone levels were increased following a male intrusion. We suggest that the differences found between females paired with pharmacologically castrated males and females paired with control males are due to differences in intra-pair interactions. [Copyright &y& Elsevier]

This article provides an operationalisation of the concept of integration within the meaning of the IPPC Directive along the dimensions of procedural, organisational, and substantive integration. Within this conceptual framework of integration, the national transpositions of the IPPC Directive in Germany, Denmark, Spain, France, Italy, the Netherlands, Sweden and the UK are presented, and critically reviewed. On the basis of empirical implementation data and the results of legal analyses it is shown that the holistic approach of the IPPC Directive remains elusive in Europe. Therefore, the discussion concludes with some observations on regulatory credibility, efficiency, and strategy in a Union of 25 Member States. [ABSTRACT FROM AUTHOR]

The European Communities Confederation of Clinical Chemistry and Laboratory Medicine (EC4) opened a Register for European Chemists in 1997. The operation of the Register is undertaken by a Register Committee (EC4RC). During the last 5 years more than 1400 clinical chemists entered the register. In this article an update of the first Guide to the Register is given, based on the experience of 5 years of operation and the development of the discipline. The registration is valid for 5 years. In a second part the procedure and the conditions for re-registration are presented. Clin Chem Lab Med 2003; 41(2):238-247. [ABSTRACT FROM AUTHOR]

We discuss the effects of three different transfer fee systems in European football on contract lengths, wages, profits, education incentives and the number of talents being educated. The different regimes, being used until the Bosman judgement of 1995, currently in use, and recently proposed by the European Commission differ with respect to the transfer fee an initial club must accept in case of a transfer depending on whether a player has a valid contract or not. In particular, we argue that due to its averse effects on investment incentives, the Commission should refrain from its Suggestion of abolishing freely negotiable transfer fees. Our analysis also sheds some light on the issue under which circumstances binding long-term contracts should be allowed in general labor law. [ABSTRACT FROM AUTHOR]

This paper examines auditor liability rules under imperfect information, costly litigation and risk-averse auditors. A negligence rule fails in such a setting, because in equilibrium auditors will deviate with positive probability from any given standard. It is shown that strict liability outperforms negligence with respect to risk allocation and the probability that a desired level of care is met by the auditor if competitive liability insurance markets exist. Furthermore, our model explains the existence of insurance contracts containing obligations a type of contract often observed in liability insurance markets. [ABSTRACT FROM AUTHOR]

Focuses on mission and evangelism as the task of the church in Europe. Existence of a theological distortion of missionary practice; Nature of the practice of mission and evangelism; Details on the origin of the terms mission and evangelism; Proclamation of evangelism through human words.

In view of the increasing demand for forest resources in Europe, it is an option to foster the use of non-native tree species that can keep pace with the rapidly changing environmental conditions, such as Douglas-fir (Pseudotsuga menziesii). Thus, sufficient knowledge of how to manage such introduced species is highly required. In this study, we investigate theoretical silvicultural management options of Douglas-fir for forests in central Europe. We follow a three-step approach: (i) we collect the current central European management practices based on 434 Douglas-fir stands managed by 19 forest companies in Eastern Austria and Southern Germany using a survey. (ii) We calibrate and validate a Douglas-fir parameter set for the tree growth simulator MOSES so that we are able to (iii) simulate the silvicultural management options of Douglas-fir management. Our simulation results suggest: in mixed stands, Douglas-fir should be planted in mono-species patches. This leads to about six times higher productivity compared to a random arrangement. Natural regeneration is possible but requires active management at further development since the productivity might decrease up to 86% when growing in association with the highly competitive native tree species, Common beech (Fagus sylvatica). Intensive tending, as well as thinning, yields a surplus stem volume production of more than 30% in comparison with a moderate intervention. Even if our simulation results were not validated in the field, this analysis suggests that modeling as a heuristic tool is a useful instrument for forest managers in the decision-making process. [ABSTRACT FROM AUTHOR]

Focuses on the impact of the problems concerning unity in Germany on the structure of Europe. Ineffectivity of the principle of the nation state; Dominance of the superpowers over the weaker countries; Evaluation of the power relation in the country.

Background: In this paper, we present evidence that biologging is strongly correlated with eye irritation, with sometimes severely impairing effects. A migratory population of the Northern Bald Ibis (Geronticus eremita, NBI) is reintroduced in Europe, in course of a LIFE + project. Since 2014, all individuals have been equipped with GPS-devices. Remote monitoring allows the implementation of focussed measures against major mortality causes. Methods: Initially all birds carried battery-powered devices, fixed on the lower back of the birds. Since 2016 an increasing amount of birds has been equipped with solar-powered devices, fixed on the upper back, the more sun-exposed position. In 2016, we observed opacity in the cornea of one eye (unilateral corneal opacity; UCO) during a regular health monitoring for the first time. Results: By 2018, a total of 25 birds were affected by UCO, with varying intensity up to blindness. Clinical examination of the birds revealed no clear cause for the symptoms. However, only birds carrying a device on the upper back were affected (2017 up to 70% of this group). In contrast, none of the birds carrying devices on the lower back ever showed UCO symptoms. This unexpected relationship between tagging and UCO was discovered in 2017. After we took countermeasures by removing the device or repositioning it on the lower back, we observed an immediate reduction of the incidence rate without any new cases reported since January 2019. NBI roost with their head on the back, one eye closely placed to the device if it was positioned on the upper back. Thus, we conclude that the most parsimonious explanation for the symptomatology is either a repetitive slight temperature rise in the corneal tissue due to electromagnetic radiation by the GSM module of the device or a repetitive slight mechanical irritation of the corneal surface. Concrete evidence is missing so far. Meanwhile, cases of UCO were found in another NBI population. Conclusion: Our observations indicate that further research in the fast-growing field of biologging is urgently needed. The findings question the positioning of devices on the upper back in birds roosting with the head on the back. [ABSTRACT FROM AUTHOR]

Presents an obituary for political scientist Jürgen Domes who died on September 22, 2001 in Europe.

Background: Hepatitis C virus (HCV) infection is the leading cause of cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC) worldwide. In Europe, people who inject drugs (PWID) represent the majority of HCV infections, but are often excluded from treatment. The aim of this study was to report on national HCV strategies, action plans and guidelines in European countries that include HCV treatment for the general population as well as for PWID. Data on access to direct-acting antivirals (DAAs) were also collected. Methods: In 2016, 38 non-governmental organisations, universities and public health institutions that work with PWID in 34 European countries were invited to complete a 16-item online survey about current national HCV treatment policies and guidelines. Data from 2016 were compared to those from 2013 for 33 European countries, and time trends are presented. Differences in the data were analysed. Data from 2016 on general access to DAAs in PWID are presented separately. Results: The response rate was 100%. Fourteen countries (42%) reported having a national HCV strategy covering HCV treatment; 12 of these addressed HCV treatment for PWID. Respondents from ten countries (29%) reported having a national HCV action plan. PWID were specifically included in seven of them. Twenty-nine countries (85%) reported having national HCV treatment guidelines. PWID were specifically included in 23 (79%) of them. Compared to 2013, respondents reported that an additional seven countries (25%) had national strategies, an additional eight countries (29%) had action plans and an additional six countries (19%) had HCV treatment guidelines. However, PWID were not included in two, four and six of those countries, respectively. DAAs were reported to be available in 91% of the study countries, with restrictions reported in 71% of them. Conclusion: Respondents reported that fewer than half of the European countries in this study had a national HCV strategy and/or action plan, with even fewer including PWID. However, when compared to 2013, the number of such countries had slightly increased. Although PWID are often addressed in clinical guidelines, strategic action is needed to increase access to HCV treatment for this group and the situation should be regularly monitored. [ABSTRACT FROM AUTHOR]

Saisonal dynamics of concentration and optical properties (aromaticity and molecular weight) of dissolved organic carbon in a restored perculation mire (Burgwald, Hesse)Lukas Ditzel (1), Eberhard Leicht (2), Martin Reiss (1), Peter Chifflard (1)1 Philipps-Universität Marburg, Faculty of Geography, Germany2 HessenForst, Burgwald, GermanyAlthough peatlands are significant carbon storages, the understanding of the export of dissolved organic carbon of percolation mires is still insufficient. Especially in the low mountains areas in middle Europe percolation mires were widely spread before they were cultured. Currently the questions arises, whether it is necessary to restore such percolation mires since in one hand it is not an easy feat and in the other hand the functioning of their organic matter turnover is not well studied. Thus, in this study we will investigate and identify the seasonal dynamics of concentration and optical characteristics of dissolved organic carbon in a restored percolation mire in the low mountain ranges (Burgwald, Hesse, Germany) to assess the functioning in exporting dissolved organic carbon, especially during spring and early summer, when the influence of an increasing dehydration is recognizable. The study took place in the restored percolation mire Franzosenwiesen, located in the Burgwald Forrest near Wetter (Hesse, Germany). This moor is the last percolation mire to be found in the German low mountain range. During the period of February to July 2018 water samples were taken weekly at different locations within the percolation mire and at the outlet to analyze concentration and optical characteristics of dissolved organic carbon. Additionally, water level was recorded automatically at the inlet and at the outlet of the percolation mire. Concentration and optical characteristics (aromaticity and molecular weight) of dissolved organic carbon were analyzed by a TOC-Analyzer (Shimadzu, TOC-L), a fluorescence spectrometer (RF-6000, Shimadzu) and a UV–VIS spectrophotometer (Genesys 10S, ThermoFisher), respectively. Factor analysis and The results indicate that the dynamics of dissolved organic carbon in the restored percolation mire Franzosenwiesen are contrary to the dynamics predicted in the literature. The quality of dissolved organic carbon in the percolation mire during the summer period is growing instead of declining. The results of this study underlines the important role of percolation mires as carbon storage and demonstrated the importance to restore similar destroyed percolation mires, which still exist in the low montain range in middle Europe. [ABSTRACT FROM AUTHOR]

The article focuses on phlebotomy training, education and certification in Europe and mentions that there is a need of more physicians educated in phlebotomy that are able to diagnose and treat venous diseases. It also mentions that despite of growing numbers of venous disease patients in Europe, phlebology still is not a recognized specialty in the European medical system. It also expands on the development of European phlebological training curriculum and the certification system.

Reports on a discussion on neutron imaging methods and their implementation on beam lines hosted by the International Science Information Service of the Rutherford Appleton Laboratory in Great Britain from March 29 to 30, 2004. Use of a pulsed spallation neutron source for neutron imaging techniques; Situation of the neutron imaging community in Europe; Proposal concerning a network that will assist in sharing information on beam time access and other information.

The Pre-Kyoto period and the outcome of the Kyoto conference demonstrated significant differences between the climate change policy in the United States and that in Western Europe. Although scientific methods and knowledge are universal and globally available, the scientificresults on climate change are taken up differently by the political systems on each side of the Atlantic. Different preferences for the results of economic modelling may be due to differences in the expectations of the average American/European of the government's responsibility, different reactions in cases of uncertainty, in the political system, the openness of public controversial discussions, and in the lobbyist intensity of interest groups. Both industrialized regions, however, face the problem of the short-term orientation of market economies and of the voters of representative national democracies versus the very long-term necessities of climate change policy. The different views and traditions on each side of the Atlantic could be used fora very fruitful process of global climate change policy. [ABSTRACT FROM AUTHOR]

Takes a look at developments in European cooperation in the field of higher education. Differences in scientific links between different 'Europes'; Impact of shortage of funds on cooperation in the field of research; Exchange of academic staff and students from classical universities.

Background: Unlike for extremity sarcomas, the efficacy of radiotherapy for retroperitoneal sarcoma is not established. The aim of this study was to evaluate the impact of preoperative radiotherapy plus surgery versus surgery alone on abdominal recurrence-free survival.Methods: EORTC-62092 is an open-label, randomised, phase 3 study done in 31 research institutions, hospitals, and cancer centres in 13 countries in Europe and North America. Adults (aged ≥18 years) with histologically documented, localised, primary retroperitoneal sarcoma that was operable and suitable for radiotherapy, who had not been previously treated and had a WHO performance status and American Society of Anesthesiologists score of 2 or lower, were centrally randomly assigned (1:1), using an interactive web response system and a minimisation algorithm, to receive either surgery alone or preoperative radiotherapy followed by surgery. Randomisation was stratified by hospital and performance status. Radiotherapy was delivered as 50·4 Gy (in 28 daily fractions of 1·8 Gy) in either 3D conformal radiotherapy or intensity modulated radiotherapy, and the objective of surgery was a macroscopically complete resection of the tumour mass with en-bloc organ resection as necessary. The primary endpoint was abdominal recurrence-free survival, as assessed by the investigator, and was analysed in the intention-to-treat population. Safety was analysed in all patients who started their allocated treatment. This trial is registered with ClinicalTrials.gov, NCT01344018.Findings: Between Jan 18, 2012 and April 10, 2017, 266 patients were enrolled, of whom 133 were randomly assigned to each group. The median follow-up was 43·1 months (IQR 28·8-59·2). 128 (96%) patients from the surgery alone group had surgery, and 119 (89%) patients in the radiotherapy and surgery group had both radiotherapy and surgery. Median abdominal recurrence-free survival was 4·5 years (95% CI 3·9 to not estimable) in the radiotherapy plus surgery group and 5·0 years (3·4 to not estimable) in the surgery only group (hazard ratio 1·01, 95% CI 0·71-1·44; log rank p=0·95). The most common grade 3-4 adverse events were lymphopenia (98 [77%] of 127 patients in the radiotherapy plus surgery group vs one [1%] of 128 patients in the surgery alone group), anaemia (15 [12%] vs ten [8%]), and hypoalbuminaemia (15 [12%] vs five [4%]). Serious adverse events were reported in 30 (24%) of 127 patients in the radiotherapy plus surgery group, and in 13 (10%) of 128 patients in the surgery alone group. One (1%) of 127 patients in the radiotherapy plus surgery group died due to treatment-related serious adverse events (gastropleural fistula), and no patients in the surgery alone group died due to treatment-related serious adverse events.Interpretation: Preoperative radiotherapy should not be considered as standard of care treatment for retroperitoneal sarcoma.Funding: European Organisation for Research and Treatment of Cancer, and European Clinical Trials in Rare Sarcomas. [ABSTRACT FROM AUTHOR]

Background Postanalytic issues of Ki67 assessment in breast cancers like counting method standardisation and interrater bias have been subject of various studies, but little is known about analytic variability of Ki67 staining between pathology labs. Our aim was to study interlaboratory variability of Ki67 staining in breast cancer using tissue microarrays (TMAs) and central assessment to minimise preanalytic and postanalytic influences. Methods Thirty European pathology labs stained serial slides of a TMA set of breast cancer tissues with Ki67 according to their routine in-house protocol. The Ki67-labelling index (Ki67-LI) of 70 matched samples was centrally assessed by one observer who counted all cancer cells per sample. We then tested for differences between the labs in Ki67-LI medians by analysing variance on ranks and in proportions of tumours classified as luminal A after dichotomising oestrogen receptor–positive cancers into cancers showing low (<14%, luminal A) and high (≥14%, luminal B HER2 negative) Ki67-LI using Cochran's Q. Results Substantial differences between the 30 labs were indicated for median Ki67-LI (0.65%–33.0%, p < 0.0001) and proportion of cancers classified as luminal A (17%–57%, p < 0.0001). The differences remained significant when labs using the same antibody (MIB-1, SP6, or 30-9) were analysed separately or labs without prior participation in external quality assurance programs were excluded (p < 0.0001, respectively). Conclusion Substantial variability in Ki67 staining of breast cancer tissue was found between 30 routine pathology labs. Clinical use of the Ki67-LI for therapeutic decisions should be considered only fully aware of lab-specific reference values. [ABSTRACT FROM AUTHOR]

BACKGROUND: For decades, monitoring depth of anesthesia was mainly based on unspecific effects of anesthetics, for example, blood pressure, heart rate, or drug concentrations. Today, electroencephalogram-based monitors promise a more specific assessment of the brain function. To date, most approaches were focused on a 'head-to-head' comparison of either electroencephalogram- or standard parameter-based monitoring. In the current study, a multimodal indicator based on a combination of both electro encephalographic and standard anesthesia monitoring parameters is defined for quantification of 'anesthesia depth.' METHODS: Two hundred sixty-three adult patients from six European centers undergoing surgery with general anesthesia were assigned to 1 of 10 anesthetic combinations according to standards of the enrolling hospital. The anesthesia multimodal index of consciousness was developed using a data-driven approach, which maps standard monitoring and electroencephalographic parameters into an output indicator that separates different levels of anesthesia from awake to electroencephalographic burst suppression. Obtained results were compared with either a combination of standard monitoring parameters or the electroencephalogram-based bispectral index. RESULTS: The anesthesia multimodal index of consciousness showed prediction probability (PK) of 0.96 (95% CI, 0.95 to 0.97) to separate different levels of anesthesia (wakefulness to burst suppression), whereas the bispectral index had significantly lower PK of 0.80 (0.76 to 0.81) at corrected threshold P value of less than 0.05. At the transition between consciousness and unconsciousness, anesthesia multimodal index of consciousness yielded a PK of 0.88 (0.85 to 0.91). CONCLUSION: A multimodal integration of both standard monitoring and electroencephalographic parameters may more precisely reflect the level of anesthesia compared with monitoring based on one of these aspects alone. [ABSTRACT FROM AUTHOR]

Abstract: Model evaluation studies are essential for determining model performance as well as assessing model deficiencies, and are the focus of the Air Quality Model Evaluation International Initiative (AQMEII). The chemistry-transport model system COSMO–MUSCAT participates in this initiative. In this paper the robustness and variability of the model results against changes in the model setup are analyzed. Special focus is given to the formation of secondary particulate matter and the ability to reproduce unusually high levels of PM10 in Central Europe caused by long-range transported smoke of fires in western Russia. Seven different model configurations are investigated in this study. The COSMO–MUSCAT results are evaluated in comparison with ground-based measurements in Central Europe. The analysis is performed for two selected periods in April/May 2006 and October 2006 which are characterized by elevated concentrations of PM. Furthermore, the sensitivity of the results is studied against the used grid resolution and the meteorological forcing. Here, COSMO–MUSCAT is applied with different horizontal grid sizes and, alternatively, forced by reanalysis data with finer resolution. The use of finer grid resolutions in COSMO–MUSCAT has direct consequences on the meteorological forcing as well as on the calculated emission and deposition rates. The presented results suggest a large impact of the meteorological effects on the PM concentrations. The more accurate spatial appointment of the emissions and deposition fluxes seems to be of little consequence compared to the meteorological forcing. [Copyright &y& Elsevier]

Background: Harm reduction (HR) interventions are essential to reduce human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission in people who inject drugs (PWID). Preliminary testing of the Individually Tailored Support and Education for Safer Injection (ITSESI) evidence-based educational intervention for PWID was performed in France in 2011. We created the Eurosider project to implement and evaluate ITSESI at a wider European level, with a view to its future pan-European diffusion.Methods: We performed a mixed-methods study involving quantitative (a 6-month before-after study with PWID) and qualitative (focus groups with field workers) components. The study was conducted in 2018-2019 with 307 eligible PWID participating in four existing HR programmes in Bulgaria, Greece, Portugal, and Romania. ITSESI consists in trained field workers observing PWID injection practices and providing an educational exchange. For the present study, PWID participants were allocated to either the control group (i.e., they continued receiving only the current HR services) or the intervention group (i.e., current HR services plus ITSESI). We used the RE-AIM QuEST framework to assess the effectiveness of ITSESI and its acceptability by field workers. Effectiveness was defined as a reduction in both syringe sharing - the highest HIV/HCV transmission risk practice - and in cutaneous abscesses. We used a multivariable mixed logit model to analyse both effectiveness outcomes and to provide adjusted odds ratios (aOR) and 95% confidence intervals (CI). Field workers' acceptability of the intervention was described using a thematic analysis of the qualitative data.Results: Of the 307 PWID, 55% received ITSESI. Syringe sharing and cutaneous abscesses decreased during follow-up in the intervention group (from 25 to 16% and from 27 to 14%, respectively). Reductions were smaller in the control group (from 29 to 24% and from 23 to 18%, respectively). The multivariable analyses confirmed the effect of the intervention on both of these outcomes (aOR [95% CI]: 0.38 [0.17, 0.85]) and (aOR [95% CI]: 0.38 [0.16, 0.90], respectively). Our qualitative data on acceptability showed the feasibility of involving field workers as proactive research partners in making ITSESI more accessible and acceptable across Europe.Conclusions: We demonstrated both the effectiveness of ITSESI in reducing syringe sharing and cutaneous abscesses in four European countries, and a high level of intervention acceptability by field workers. Our findings provide important insights into how ITSESI can be adapted for pan-European implementation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).Design: Cross-sectional analysis nested in a retrospective observational study (n = 940).Setting: Hospitals and associated private practices.Patient(s): Previously pregnant women (n = 268) within reproductive age in matched pairs.Intervention(s): Retrospective analysis of surgical reports and self-administered questionnaires.Main Outcome Measure(s): Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).Result(s): The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]).Conclusion(s): Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.Clinical Trial Registration Number: NCT02511626. [ABSTRACT FROM AUTHOR]

Objective: To compare the criteria for Wegener's granulomatosis (WG) of the American College of Rheumatology (ACR) with those of the European League Against Rheumatism/Pediatric Rheumatology European Society (EULAR/PRES) in a cohort of children with WG and other antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs), and to describe the interval to diagnosis, presenting features, and initial treatment for WG., Methods: Eligible patients had been diagnosed by site rheumatologists (termed the "MD diagnosis") since 2004. This diagnosis was used as a reference standard for sensitivity and specificity testing of the 2 WG classification criteria. Descriptive analyses were confined to ACR-classified WG patients., Results: MD diagnoses of 117 patients (82 of whom were female) were WG (n = 76), microscopic polyangiitis (n = 17), ANCA-positive pauci-immune glomerulonephritis (n = 5), Churg-Strauss syndrome (n = 2), and unclassified vasculitis (n = 17). The sensitivities of the ACR and EULAR/PRES classification criteria for WG among the spectrum of AAVs were 68.4% and 73.6%, respectively, and the specificities were 68.3% and 73.2%, respectively. Two more children were identified as having WG by the EULAR/PRES criteria than by the ACR criteria. For the 65 ACR-classified WG patients, the median age at diagnosis was 14.2 years (range 4-17 years), and the median interval from symptom onset to diagnosis was 2.7 months (range 0-49 months). The most frequent presenting features by organ system were constitutional (89.2%), pulmonary (80.0%), ear, nose, and throat (80.0%), and renal (75.4%). Fifty-four patients (83.1%) commenced treatment with the combination of corticosteroids and cyclophosphamide, with widely varying regimens; the remainder received methotrexate alone (n = 1), corticosteroids alone (n = 4), or a combination (n = 6)., Conclusion: The EULAR/PRES criteria minimally improved diagnostic sensitivity and specificity for WG among a narrow spectrum of children with AAVs. Diagnostic delays may result from poor characterization of childhood WG. Initial therapy varied considerably among participating centers.