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Learners who learn from OER often cannot have their learning assessed or receive a credential. Open credentials offer a potential solution to this problem, combining badges or micro-credentials with competence frameworks and digital seals. This study identified the current situation of open credentials in post-secondary education in Europe, the main themes of the discourse, and the points of agreement and divergence surrounding them. The data comprised a corpus of transcriptions from 12 expert interviews and a focus group. Qualitative text analysis identified the principal themes. Findings included the following: (a) few assessments are available as open content; (b) linking OER and credentials requires detailed and expensive work on learning outcomes and assessment; (c) the aggregation of open credentials to create higher-level qualifications is a widely accepted ambition; (d) the European Union's infrastructure to support open credentials is appropriate and effective and can foster trust; (e) the outstanding challenges are organisational and practical, not technological; (f) assessment and content provisions should belong to separate organisational functions; and finally, (g) funding and support for open credentials in professional accreditation are essential for further progress.

The article observes changes in opioid problems in Europe with alarming signs of the potential role of synthetic opioid in the future and the need for better preparedness to respond to changes in patterns of opioid consumption. Signals of synthetic opioid use causing harm include increased prescribing of opioid-containing pain medicines, diverted use of fentanyl from medical use, increased availability of nitazene opioids and outbreaks of drug-associated and overdose deaths.

Learners who learn from OER often cannot have their learning assessed or receive a credential. Open credentials offer a potential solution to this problem, combining badges or micro-credentials with competence frameworks and digital seals. This study identified the current situation of open credentials in post-secondary education in Europe, the main themes of the discourse, and the points of agreement and divergence surrounding them. The data comprised a corpus of transcriptions from 12 expert interviews and a focus group. Qualitative text analysis identified the principal themes. Findings included the following: (a) few assessments are available as open content; (b) linking OER and credentials requires detailed and expensive work on learning outcomes and assessment; (c) the aggregation of open credentials to create higher-level qualifications is a widely accepted ambition; (d) the European Union's infrastructure to support open credentials is appropriate and effective and can foster trust; (e) the outstanding challenges are organisational and practical, not technological; (f) assessment and content provisions should belong to separate organisational functions; and finally, (g) funding and support for open credentials in professional accreditation are essential for further progress. [ABSTRACT FROM AUTHOR]

Objective: For cost-effectiveness comparison of child vision and hearing screening programmes, methods and data should be available. We assessed the current state of data collection and its availability in Europe. Methods: The EUSCREEN Questionnaire, conducted in 2017–2018, assessed paediatric vision and hearing screening programmes in 45 countries in Europe. For the current study, its items on data collection, monitoring and evaluation, and six of eleven items essential for cost-effectiveness analysis: prevalence, sensitivity, specificity, coverage, attendance and loss to follow-up, were reappraised with an additional questionnaire. Results: The practice of data collection in vision screening was reported in 36% (N = 42) of countries and in hearing screening in 81% (N = 43); collected data were published in 12% and 35%, respectively. Procedures for quality assurance in vision screening were reported in 19% and in hearing screening in 26%, research of screening effectiveness in 43% and 47%, whereas cost-effectiveness analysis was performed in 12% for both. Data on prevalence of amblyopia were reported in 40% and of hearing loss in 77%, on sensitivity of screening tests in 17% and 14%, on their specificity in 19% and 21%, on coverage of screening in 40% and 84%, on attendance in 21% and 37%, and on loss to follow-up in 12% and 40%, respectively. Conclusions: Data collection is insufficient in hearing screening and even more so in vision screening: data essential for cost-effectiveness comparison could not be reported from most countries. When collection takes place, this is mostly at a local level for quality assurance or accountability, and data are often not accessible. The resulting inability to compare cost-effectiveness among screening programmes perpetuates their diversity and inefficiency. [ABSTRACT FROM AUTHOR]

This article presents an original and critical interrogation of how disabled activists establish claims and coordinate activities to progress the independent living agenda. The article achieves this by employing Beckett and Campbell's (2015) concept of 'oppositional device', which is used to understand resistance practices and the technologies of power that coalesce around disabled people's collective action. The article argues that the independent living concept could, similarly, be understood as an oppositional device and this holds potential for furthering the emancipatory claims of disabled people's social movements. This allows for an understanding of Independent Living Movements as assemblages of technologies that open heterotopias, which engage in the experimentation of what disabled people can be and do through the ideas of independent living. The article draws on empirical data from a study exploring young disabled people's views and experiences of disability activism across Europe to evidence the claims made. [ABSTRACT FROM AUTHOR]

Increasing technological advancements and changing consumer behavior has resulted in individuals having access to a wider range of online gambling markets and sporting events than ever before. Sports betting in real time has been aided by the accessibility of smartphone devices. Consequently, the popularity of live sports betting (i.e., 'in-play' betting) has spread across Europe and around the rest of world. The aim of the present exploratory study was to examine attitudes and opinions towards online sports betting. Qualitative interviews were conducted with 17 males and 2 females aged between 21 and 32 years. Participants were asked a range of semi-structured interview questions based on pre-determined topic areas. Socio-demographic data were collected and the Problem Gambling Severity Index (PGSI) was used to assess problem gambling. The data were analyzed using thematic analysis in order to identify themes. Analysis of the transcripts identified several notable areas including the ease of engaging in in-play sports betting, motivations for engaging in in-play sports betting (including increased excitement, demonstrating knowledge/skill and response to live odds), and different reasons for using the 'cash-out' feature. The findings will contribute to the design of future research investigating in-play sports betting behaviours. [ABSTRACT FROM AUTHOR]

There is an absence of absence in legal geography and materialist studies of the law. Drawing on a multi‐sited ethnography of European asylum appeal hearings, this paper illustrates the importance of absences for a fully‐fledged materiality of legal events. We show how absent materials impact hearings, that non‐attending participants profoundly influence them, and that even when participants are physically present, they are often simultaneously absent in other, psychological registers. In so doing we demonstrate the importance and productivity of thinking not only about law's omnipresence but also the absences that shape the way law is experienced and practised. We show that attending to the distribution of absence and presence at legal hearings is a way to critically engage with legal performance. [ABSTRACT FROM AUTHOR]

Background: While it is apparent that much has been learned about "mental health literacy" (MHL) relating to certain mental health problems, such as depression, in recent years, what has been learned about MHL relating to eating disorders (ED-MHL) is unclear. Aims: A scoping review was conducted to inform the current state of knowledge in this field. Methods: A systematic search of relevant literature published between 1997 and 2017 was followed by a narrative synthesis of the findings. Results: The number of eligible studies increased from 32 in 1997–2001 to 98 in 2012–2017 (total = 264). Most studies originated from North America or Europe, recruited individuals with EDs receiving treatment or college students and included both female and male or only female participants. The majority of studies examined MHL relating to anorexia nervosa or bulimia nervosa and examined attitudes which facilitate recognition and appropriate help-seeking and knowledge and beliefs about professional help available. Conclusion: Interest in ED-MHL is increasing and there is now a considerable body of research addressing some aspects of ED-MHL in a range of study populations. Notable gaps in the literature exist, including a paucity of information about ED-MHL relating to EDs other than anorexia nervosa and bulimia nervosa, ED behaviour in males and the use of self-help interventions. We hope the findings will provide an incentive to further research in these and other aspects of ED-MHL. [ABSTRACT FROM AUTHOR]

The fate of future food productivity depends primarily upon the health of soil used for cultivation. For Atlantic Europe, increased precipitation is predicted during both winter and summer months. Interactions between climate change and the fertilization of land used for agriculture are therefore vital to understand. This is particularly relevant for inorganic phosphorus (P) fertilization, which already suffers from resource and sustainability issues. The soil microbiota are a key indicator of soil health and their functioning is critical to plant productivity, playing an important role in nutrient acquisition, particularly when plant available nutrients are limited. A multifactorial, mesocosm study was established to assess the effects of increased soil water availability and inorganic P fertilization, on spring wheat biomass, soil enzymatic activity (dehydrogenase and acid phosphomonoesterase) and soil bacterial community assemblages. Our results highlight the significance of the spring wheat rhizosphere in shaping soil bacterial community assemblages and specific taxa under a moderate soil water content (60%), which was diminished under a higher level of soil water availability (80%). In addition, an interaction between soil water availability and plant presence overrode a long-term bacterial sensitivity to inorganic P fertilization. Together this may have implications for developing sustainable P mobilization through the use of the soil microbiota in future. Spring wheat biomass grown under the higher soil water regime (80%) was reduced compared to the constant water regime (60%) and a reduction in yield could be exacerbated in the future when grown in cultivated soil that have been fertilized with inorganic P. The potential feedback mechanisms for this need now need exploration to understand how future management of crop productivity may be impacted. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the association between registered nurses' (referred to as "nurses" for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers. Background: The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps. Design: Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries. Methods: The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist. Results: When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant. Conclusion: Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care. Relevance to clinical practice: Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients. [ABSTRACT FROM AUTHOR]

Technology has changed the nature of gambling practices over the last decade and is continuing to do so. The online sports betting industry has become a rapidly growing sector of the global economy, with online sports betting contributing 37% of the annual online gambling market in Europe. There has been an integration of social and technological processes that has enabled the cultural saliency of contemporary online betting. One of the more newly introduced forms of online sports betting is in-play sports betting behaviour (the betting on events within a sporting event such as football and cricket). In-play sports betting features (such as 'cash out') are increasing in popularity amongst online gambling operators. A scoping study was carried out examining the evolution of this new form of gambling practice which included both a systematic literature review and the examination of 338 online gambling websites that offered sports betting. The present study identified a comprehensive list of what in-play betting features are currently being offered on online gambling websites as well as other information concerning in-play sports betting. A total of 16 academic papers and two 'grey literature' reports and were identified in the systematic review. Out of 338 online gambling websites that were visited, 26% of these offered at least on in-play betting feature. Results from the systematic review suggest that in-play sports betting has the potential to be more harmful than other ways of gambling because of the inherent structural characteristics. [ABSTRACT FROM AUTHOR]

In this work, patterns of geographical genetic diversity in Atlantic salmon Salmo salar were studied across the whole Atlantic Arc; whether these patterns (and thus genetic population structure) were affected by water temperatures was also evaluated. Salmo salar populations were characterized using microsatellite loci and then analysed with reference to ocean surface temperature data from across the region. Analysis showed the presence of a latitudinal cline of genetic variability (higher in northern areas) and water temperatures (sea surface temperatures) determining genetic population structure (the latter in combination with genetic drift in southern populations). Under the current global change scenario, northern areas of Europe would constitute refugia for diversity in the future. This is effectively the inverse of what appears to have happened in glacial refugia during the last glacial maximum. From this perspective, the still abundant and large northern populations S. salar should be considered as precious as the small almost relict southern ones and given appropriate protection. Careful management of the species, coordinated across countries and latitudes, is needed in order to avoid its extinction in Europe. [ABSTRACT FROM AUTHOR]

Aims: To quantify changes in (i) potency (concentration of Δ9‐tetrahydrocannabinol; %THC), (ii) price (euros/g of cannabis) and (iii) value (mg THC/euro) of cannabis resin and herbal cannabis in Europe. Design Repeated cross‐sectional study. Setting and participants: Data collected from 28 European Union (EU) member states, Norway and Turkey by the European Monitoring Centre for Drugs and Drug Addiction. Measurements Outcome variables were potency, price and value for cannabis resin and herbal cannabis in Europe, 2006–16. Inflation was estimated using the Harmonised Indices of Consumer Prices. Mixed‐effects linear regression models were used to estimate linear and quadratic time trends, with a random intercept and slope fitted to account for variation across countries. Findings Resin potency increased from a mean [95% confidence interval (CI)] of 8.14% THC (6.89, 9.49) in 2006 to 17.22 (15.23, 19.25) in 2016. Resin price increased from 8.21 euros/g (7.54, 8.97) to 12.27 (10.62, 14.16). Resin increased in value, from 11.00 mg THC per euro (8.60, 13.62) to 16.39 (13.68, 19.05). Quadratic time trends for resin potency and value indicated minimal change from 2006 to 2011, followed by marked increases from 2011 to 2016. Herbal cannabis potency increased from 5.00% THC (3.91, 6.23) to 10.22 (9.01, 11.47). Herbal price increased from 7.36 euros/g (6.22, 8.53) to 12.22 (10.59, 14.03). The value of herbal cannabis did not change from 12.65 mg of THC per euro (10.18, 15.34) to 12.72 (10.73, 14.73). All price trends persisted after adjusting for inflation. Conclusions: European cannabis resin and herbal cannabis increased in potency and price from 2006 to 2016. Cannabis resin (but not herbal cannabis) increased in the quantity of Δ9‐tetrahydrocannabinol per euro spent. Marked increases in resin potency and value from 2011 to 2016 are consistent with the emergence of new resin production techniques in European and neighbouring drug markets. [ABSTRACT FROM AUTHOR]

Abstract: Aims: This review provides an up‐to‐date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future. Methods: Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation. Results: In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past‐year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High‐income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age‐standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age‐standardized tobacco mortality rates and DALYs were highest in Oceania. Conclusions: In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low‐ and middle‐income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden. [ABSTRACT FROM AUTHOR]

Aims: To estimate temporal trends in adolescents’ current cigarette, alcohol and cannabis use in Europe by gender and region, test for regional differences and evaluate regional convergence. Design and Setting: Five waves of the European School Survey Project on Alcohol and Other Drugs (ESPAD) from 28 countries between 1999 and 2015. Countries were grouped into five regions [northern (NE), southern (SE), western (WE), eastern Europe (EE) and the Balkans (BK)]. Participants: A total of 223 814 male and 211 712 female 15–16‐year‐old students. Measurements: Daily cigarette use, weekly alcohol use, monthly heavy episodic drinking (HED) and monthly cannabis use. Linear and quadratic trends were tested using multi‐level mixed‐effects logistic regression; regional differences were tested using pairwise Wald tests; mean absolute differences (MD) of predicted prevalence were used for evaluating conversion. Findings: Daily cigarette use among boys in EE showed a declining curvilinear trend, whereas in all other regions a declining linear trend was found. With the exception of BK, trends of weekly drinking decreased curvilinear in both genders in all regions. Among girls, trends in WE, EE and BK differed from trends in NE and SE. Monthly HED showed increasing curvilinear trends in all regions except in NE (both genders), WE and EE (boys each). In both genders, the trend in EE differed from the trend in SE. Trends of cannabis use increased in both genders in SE and BK; differences were found between the curvilinear trends in EE and BK. MD by substance and gender were generally somewhat stable over time. Conclusions: Despite regional differences in prevalence of substance use among European adolescents from 1999 to 2015, trends showed remarkable similarities, with strong decreasing trends in cigarette use and moderate decreasing trends in alcohol use. Trends of cannabis use only increased in southern Europe and the Balkans. Trends across all substance use indicators suggest no regional convergence. [ABSTRACT FROM AUTHOR]

Tuna fisheries and processing represent economic activities of paramount importance around the world. Most of these products are traded for human consumption and in general are highly demanded commodities. However, not all tuna products achieve the same market price, some consumers are willing to pay a huge amount of money for certain species (i.e. Japanese market for Bluefin tuna) while other species are rather affordable (i.e. Skipjack tuna), therefore mislabelling has been observed frequently. We collected and analysed 545 tuna samples in six European countries, including fresh, frozen and canned products, and we have investigated whether or not these products were correctly labelled under European and national legislations. We found an overall mislabelling rate of 6.79%; in particular, 6.70% of the fresh and frozen tuna products and 7.84% of canned tuna were mislabelled, and only in the case of fresh and frozen tuna samples significant differences among countries were found. Mislabelling rates for Atlantic Bluefin tuna labelled products were very high, ranging from 50 up to 100%. In general, mislabelling was higher when specific names were included in the labels. The “tuna” umbrella term is a very popular one with consumers, but also one that remains vulnerable to ambiguity, hampering efforts towards market transparency and with potential negative consequences to the adequate management of tuna species stocks. [ABSTRACT FROM AUTHOR]

Trust and confidence in such criminal justice institutions as the police is considered crucial for the successful functioning of society and to allow for greater voluntary compliance and cooperation with institutions of control. There is a plethora of existing research, however, that shows the often strained relationships between the police and particular ethnic minority groups in the UK, Europe and the US, with such groups exhibiting a great deal of mistrust and lack of cooperation. This article aims to add to this body of literature by presenting the findings of a case study that used quantitative and qualitative methods to explore new Polish migrants’ and established local residents’ trust in and cooperation with the police following a period of mass migration in a small working-class town in the north-west of England. The key results show that, contrary to expectations, Polish migrants in fact have greater trust in the police than do the more established local residents in the area. Notwithstanding this high confidence, Polish migrants remain reluctant to contact the police. Adding greater complexity to Tyler’s ‘normative’ model of police contact (Tyler, 2006; Tyler and Fagan, 2008), the article presents the nuances of police relations with majority and minority groups in this working-class town. [ABSTRACT FROM AUTHOR]

This paper explores the recent resurgence in use of ecstasy/MDMA in Europe and highlights keys areas of continuity and divergence between the ecstasy market of the 1990s and the current MDMA market. Based on a scoping study involving a targeted multi-source data collection exercise on MDMA, it highlights nine areas that have undergone some level of change, linked with both supply and demand for the drug. Factors discussed include: innovation in production techniques; changes in precursor chemical availability; the role of online markets; competition with other stimulants and new psychoactive substances; the increased availability of high-strength MDMA; and the shift from subcultural towards more mainstream use of the drug. The paper proposes that the MDMA on Europe's contemporary market is in some respects a third generation product with a different consumer profile, with implications that responses developed at the time of the drug's earlier iteration, may be in need of a review and revamp. [ABSTRACT FROM AUTHOR]

Pustular psoriasis ( PP) is a group of inflammatory skin conditions characterized by infiltration of neutrophil granulocytes in the epidermis to such an extent that clinically visible sterile pustules develop. Because of clinical co-incidence, PP is currently grouped with psoriasis vulgaris ( PV). However, PP and PV are phenotypically different, respond differently to treatments and seem to be distinct on the genetic level. In contrast to PV, the phenotypes of PP are not well defined. Descriptions of each form of PP are discordant among standard dermatology textbooks [ Saurat Dermatologie 2016, Rook's Dermatology 2016, Fitzpatrick's 2012 and Braun-Falco 2012], encumbering the collection of phenotypically well-matched groups of patients as well as clinical trials. The European Rare and Severe Psoriasis Expert Network ( ERASPEN) was founded to define consensus criteria for diagnosis, deeply phenotype large groups of PP patients, analyse the genetics and pathophysiology and prepare for prospective clinical trials. This work reviews historical aspects of these conditions, new genetic findings and presents our initial considerations on the phenotypes of PP and a consensus classification of clinical phenotypes that will be used as a baseline for further, prospective studies of PP. Generalized pustular psoriasis ( GPP) is defined as primary, sterile, macroscopically visible pustules on non-acral skin (excluding cases where pustulation is restricted to psoriatic plaques). GPP can occur with or without systemic inflammation, with or without PV and can either be a relapsing (>1 episode) or persistent (>3 months) condition. Acrodermatitis continua of Hallopeau ( ACH) is characterized by primary, persistent (>3 months), sterile, macroscopically visible pustules affecting the nail apparatus. Palmoplantar pustulosis ( PPP) has primary, persistent (>3 months), sterile, macroscopically visible pustules on palms and/or soles and can occur with or without PV. [ABSTRACT FROM AUTHOR]

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80

This article presents an editorial in which the authors comment on the legal aspects of cannabis use in Europe. They discuss the inconsistencies associated with punishments related to the use of cannabis as well as other psychoactive substances, citing data from the European Monitoring Centre for Drugs and Drug Addiction.

On 11 June 2015, A.G. Pedro Cruz Villalon delivered his Opinion in the HP Belgium v Reprobel case then pending before the Court of Justice of the EU (CJEU). The Advocate General's Opinion and the underlying case raise one important issue: is it permissible for a national copyright law to allocate a portion of the fair compensation fo r reproductions exempted under art.5(2)(a) and (b) of the 2001/29 Infosoc Directive directly to publishers, although they are not listed among the initial holders of the reproduction right under art. 2 of the Infosoc Directive? As a group of academics concerned about the copyright reforms envisaged in the EU as well as by the interpretation and development of the law by the CJEU, the European Copyright Society (ECS) takes this opportunity to share its view on this matter of principle. [ABSTRACT FROM AUTHOR]

Aim A central task for the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is to produce an annual report of the latest data available on drug demand and drug supply in Europe. This paper is intended to facilitate a better understanding of, and easier access to, the main quantitative European level data sets available in 2015. Methods The European reporting system formally covers all 28 European Union (EU) Member States, Norway and Turkey and incorporates multiple indicators alongside an early warning system (EWS) on uncontrolled new psychoactive substances (NPS). While epidemiological information is based largely on registries, surveys and other routine data reported annually, the EWS collects case-based data on an ongoing basis. The 2015 reporting exercise is centred primarily on a set of standardized reporting tools. Results The most recent data provided by European countries are presented, including data on drug use, drug-related morbidity and mortality, treatment demand, drug markets and new psychoactive substances, with data tables provided and methodological information. A number of key results are highlighted for illustrative purposes. Drug prevalence estimates from national surveys since 2012 (last year prevalence of use among the 15-34 age band) range from 0.4% in Turkey to 22.1% in France for cannabis, from 0.2% in Greece and Romania to 4.2% in the United Kingdom for cocaine, from 0.1% in Italy and Turkey to 3% in the Czech Republic and the United Kingdom for ecstasy, and from 0.1% or less in Romania, Italy and Portugal to 2.5% in Estonia for amphetamine. Declining trends in new HIV detections among people who inject drugs are illustrated, in addition to presentation of a breakdown of NPS reported to the EU early warning system, which have risen exponentially from fewer than 20 a year between 2005 and 2008, to 101 reported in 2014. Conclusions Structured information is now available on patterns and trends in drug consumption in Europe, which permits triangulation of data from different sources and consideration of methodological limitations. Opioid drugs continue to place a burden on the drug treatment system, although both new heroin entrants and injecting show declines. More than 450 new psychoactive substances are now monitored by the European early warning system with 31 new synthetic cathinones and 30 new synthetic cannabinoid receptor agonists notified in 2014. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate between-site agreement of apparent diffusion coefficient (ADC) measurements in preclinical magnetic resonance imaging (MRI) systems.Materials and Methods: A miniaturized thermally stable ice-water phantom was devised. ADC (mean and interquartile range) was measured over several days, on 4.7T, 7T, and 9.4T Bruker, Agilent, and Magnex small-animal MRI systems using a common protocol across seven sites. Day-to-day repeatability was expressed as percent variation of mean ADC between acquisitions. Cross-site reproducibility was expressed as 1.96 × standard deviation of percent deviation of ADC values.Results: ADC measurements were equivalent across all seven sites with a cross-site ADC reproducibility of 6.3%. Mean day-to-day repeatability of ADC measurements was 2.3%, and no site was identified as presenting different measurements than others (analysis of variance [ANOVA] P = 0.02, post-hoc test n.s.). Between-slice ADC variability was negligible and similar between sites (P = 0.15). Mean within-region-of-interest ADC variability was 5.5%, with one site presenting a significantly greater variation than the others (P = 0.0013).Conclusion: Absolute ADC values in preclinical studies are comparable between sites and equipment, provided standardized protocols are employed. [ABSTRACT FROM AUTHOR]

Background: Ethnic minority women are at greater risk of maternal morbidity and mortality. Antenatal care reduces risks of adverse maternal and neonatal outcomes and supports a positive transition to motherhood. Important components of quality antenatal care are interactions between women and care providers which are supportive and empowering. Methods: We conducted a systematic review to identify and synthesise qualitative evidence on ethnic minority women's experiences of accessing antenatal care in European countries. Following a comprehensive search of 8 databases and two-step screening process, we included 27 studies from various European countries. Study findings were coded and synthesised using a 'best-fit' framework approach. Findings: Overall women expressed satisfaction with their antenatal care, frequently framed in relation to experiences of maternity care in countries of origin. Women highly valued interactions with antenatal care providers which were supportive and trustinducing, and when there was continuity of carer to facilitate this. However, studies frequently showed a dichotomy between reported satisfaction with antenatal care and experiences of interactions with care providers which could be discriminatory, stigmatising and disempowering. Some women blamed themselves for negative interactions. Language barriers were frequently identified by women as a factor which hindered their communication with antenatal care providers and the subsequent quality of care received, when suitable interpreters were not available. Negative interactions with antenatal care providers could result in a withdrawal from ongoing antenatal care for some women. Conclusions: This review highlights the importance of quality interactions between ethnic minority women and antenatal care providers. Policy implications: Antenatal care should be provided in such a way as to facilitate trust, support and effective communication between women and care providers. Key messages: Positive interactions with care providers form an important element of quality antenatal care for ethnic minority women in Europe. Trust, support and the provision of suitable interpreters, where needed, contribute to positive interactions with antenatal care providers for ethnic minority women in Europe. [ABSTRACT FROM AUTHOR]

Aims To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Design Analyses of raw wastewater over a 1-week period in 2012 and 2013. Setting and Participants Catchment areas of wastewater treatment plants ( WWTPs) across Europe, as follows: 2012: 25 WWTPs in 11 countries (23 cities, total population 11.50 million); 2013: 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Measurements Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Findings Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years ( P ranging from insignificant to <10−3), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Conclusions Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To investigate the effect of climatic, historical and spatial variables on species richness patterns in freshwater fish. Location North America and Europe. Methods Regional species lists were used to document the spatial richness patterns. Three realms, Europe and Pacific and Atlantic North America, were identified. The numbers of species, by habitat, migration and distributional range categories, were calculated and the contributions of regional mean and seasonal temperature and rainfall, historical (realm, glaciation), and spatial (area, elevational range) variables to predicting richness were assessed using boosted regression trees, model-averaging and spatially explicit models. Results The latitudinal temperature gradient is stronger than that for rainfall in the Atlantic realm whereas the rainfall gradient in Europe is independent of the temperature gradient. Species richness is more strongly correlated with temperature than rainfall, and the effects are stronger in the Atlantic realm than in Europe. The influence of environmental variables differs between habitat specialist and generalist species. Climate, particularly maximum monthly temperature, is the best predictor of richness in rivers whereas climate variables are less important than historical/spatial variables for diadromous species. Main conclusions Freshwater fish richness differences between realms follow differences in spatial climatic trends. The contributions of climatic, historical and spatial predictor variables vary with ecology: temperature is a better predictor than rainfall in river-dwellers. The richness gradient is driven more by physiological than by energetic constraints on species. The importance of history is probably underestimated because of correlations with climate variables. [ABSTRACT FROM AUTHOR]

In this article it is argued that an important task of career-long teacher education is the encouragement of imagination and creativity in experienced teachers. The task implies a reversal of the managerialism that currently afflicts so many European education systems. The article begins by giving an analysis of pedagogical relationships to expose some of the reasons that teaching is an extraordinarily complex activity, which it is difficult to do well. Indeed it is so complex that it is not something that can be learnt in advance of experience. Therefore early-career teachers need to develop their skills before they can become fully competent. However experience is not enough on its own. To become excellent - that is, more than proficient - requires a career-long commitment to self-cultivation as teachers. Part of the reason that the commitment needs to be career-long is that teaching contexts are in a continual state of change, and teachers need to adapt through a process of self-cultivation. [ABSTRACT FROM AUTHOR]

Aims: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7. Methods and results: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases ( P = 0.009). Conclusions: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization. [ABSTRACT FROM AUTHOR]

Background: Cocaine-related health consequences are difficult to observe. Data on drug users in health-emergency settings may be a useful source of information on consequences that are not visible via other information sources Methods: Thirty European countries submit an annual national report on the drug situation to the EMCDDA. All reports for the period 2007-2010 were analyzed, with particular attention given to auditing cocaine-related mentions. Analysis was also performed in order to identify sources and case definitions, assess coverage, audit cases and, where possible, to identify long-term trends. Results: Considerable heterogeneity existed between countries in their approach to recording drug-related emergencies, with only Spain and the Netherlands having established formal indicators. The highest annual numbers of cocaine-related episodes were reported by the UK (3,502), Spain (2,845) and the Netherlands (1,211). A considerable (2- to 3-fold) increase in the numbers of cocaine-related episodes has been reported since the end of the 1990s in these countries; these increases peaked in Spain and England around 2007/08. Conclusions: The analysis reported here suggests the need to develop more standardized approaches to monitoring drug-related emergencies. It points to the potential value of developing effective referral links between the emergency and specialized drug services working with cocaine users. [ABSTRACT FROM AUTHOR]

I consider if and how far it is possible to live an educational philosophical life, in the fast-changing, globalised world of Higher Education. I begin with Socrates' account of a philosophical life in the Apology. I examine some tensions within different conceptions of what it is to do philosophy. I then go on to focus more closely on what it might be to live a philosophical, educational life in which educational processes and outcomes are influenced by philosophy, using examples taken from published sources and from conversational interviews with philosophers carried out by myself with Kenneth Wain, Bas Levering and Richard Pring. I then outline the directions of current European policy for Higher Education. Finally I discuss how far current policies and trends leave room for doing philosophy of education, concluding that it is possible, but only for individuals who are very much in sympathy with current policy trends or who are creative in constructing smoke screens. [ABSTRACT FROM AUTHOR]

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Background: Invasive predators may change the structure of invaded communities through predation and competition with native species. In Europe, the invasive signal crayfish Pacifastacus leniusculus is excluding the native white clawed crayfish Austropotamobius pallipes. Methodology and Principal Findings: This study compared the predatory functional responses and prey choice of native and invasive crayfish and measured impacts of parasitism on the predatory strength of the native species. Invasive crayfish showed a higher (>10%) prey (Gammarus pulex) intake rate than (size matched) natives, reflecting a shorter (16%) prey handling time. The native crayfish also showed greater selection for crustacean prey over molluscs and bloodworm, whereas the invasive species was a more generalist predator. A. pallipes parasitised by the microsporidian parasite Thelohania contejeani showed a 30% reduction in prey intake. We suggest that this results from parasite-induced muscle damage, and this is supported by a reduced (38%) attack rate and increased (30%) prey handling time. Conclusions and Significance: Our results indicate that the per capita (i.e., functional response) difference between the species may contribute to success of the invader and extinction of the native species, as well as decreased biodiversity and biomass in invaded rivers. In addition, the reduced predatory strength of parasitized natives may impair their competitive abilities, facilitating exclusion by the invader. [ABSTRACT FROM AUTHOR]

In bread wheat ( Triticum aestivum L.), crop height is an important determinant of agronomic performance. The aim of this study was to identify genes controlling variation in crop height segregating in elite European winter wheat germplasm. Four doubled haploid populations derived from the crosses Avalon × Cadenza, Savannah × Rialto, Spark × Rialto and Charger × Badger were selected, representing wide diversity in European winter wheat breeding programmes. Genetic maps based on simple sequence repeat (SSR) and Diversity Arrays Technology (DArT) markers were constructed for each population. One hundred and four significant quantitative trait loci (QTL) were identified in the four populations. A meta-analysis was conducted and the effects condensed into sixteen meta-QTL on chromosomes 1A, 1B, 1D, 2A (two meta-QTL), 2B, 2D, 3A, 3B, 4B, 4D, 5A, 5B, 6A, 6B and 6D. These include QTL with additive effects equivalent to Rht- D1 and a potentially new allele of Rht8. The description of these effects offers new opportunities for the manipulation of crop height, biomass and yield in wheat breeding programmes. [ABSTRACT FROM AUTHOR]

Patients with moderate to severe psoriasis are undertreated. To solve this persistent problem, the consensus programme was performed to define goals for treatment of plaque psoriasis with systemic therapy and to improve patient care. An expert consensus meeting and a collaborative Delphi procedure were carried out. Nineteen dermatologists from different European countries met for a face-to-face discussion and defined items through a four-round Delphi process. Severity of plaque psoriasis was graded into mild and moderate to severe disease. Mild disease was defined as body surface area (BSA) ≤10 and psoriasis area and severity index (PASI) ≤10 and dermatology life quality index (DLQI) ≤10 and moderate to severe psoriasis as (BSA > 10 or PASI > 10) and DLQI > 10. Special clinical situations may change mild psoriasis to moderate to severe including involvement of visible areas or severe nail involvement. For systemic therapy of plaque psoriasis two treatment phases were defined: (1) induction phase as the treatment period until week 16; however, depending on the type of drug and dose regimen used, this phase may be extended until week 24 and (2) maintenance phase for all drugs was defined as the treatment period after the induction phase. For the definition of treatment goals in plaque psoriasis, the change of PASI from baseline until the time of evaluation (ΔPASI) and the absolute DLQI were used. After induction and during maintenance therapy, treatment can be continued if reduction in PASI is ≥75%. The treatment regimen should be modified if improvement of PASI is <50%. In a situation where the therapeutic response improved ≥50% but <75%, as assessed by PASI, therapy should be modified if the DLQI is >5 but can be continued if the DLQI is ≤5. This programme defines the severity of plaque psoriasis for the first time using a formal consensus of 19 European experts. In addition, treatment goals for moderate to severe disease were established. Implementation of treatment goals in the daily management of psoriasis will improve patient care and mitigate the problem of undertreatment. It is planned to evaluate the implementation of these treatment goals in a subsequent programme involving patients and physicians. [ABSTRACT FROM AUTHOR]

Aim of the study: To review the information available on the use of khat (Catha edulis) in the EU, and to assess the future use of this drug and related substances. Material and methods: Khat is not controlled by international law and it has not been systematically included in the list of illicit drugs monitored in the EU. The current principal source of information on khat use in Europe is the early-warning system set up to monitor new and emerging drugs. Further information was obtained from official national reports to the EMCDDA and from the scientific literature. Results: Across Europe, the use of khat is low. Khat use is limited to countries with immigrant communities from countries where khat use is common (such as Ethiopia, Somalia and Kenya). Information on the prevalence of khat use in the general population is scarce. Data on seizures provide an insight on the situation, though these may be difficult to interpret. The most recent estimates suggest that Europe accounts for about 40% of the khat seized worldwide. Conclusion: The shortage of data on the use and patterns of use of khat in Europe does not allow an evaluation of the needs for health and social interventions in communities in which the drug is used. But seizures of the plant are increasing in the EU, and more synthetic derivatives of the pharmacologically active ingredients of the plant (cathine and cathinone) are appearing on the market. Some of these, like mephedrone, have significant potential for future diffusion, and are likely to play a greater role on the European drug scene of the future. [Copyright &y& Elsevier]

The article discusses a study on the genetic aspect of European starlings breeding in the Azores archipelago and in mainland Europe. Results of trial polymerase chain reactions (PCR) and mitochondrial protein-coding gene sequencing showed that the gene ND2 was more variable than cytochrome-b (cyt b). There was 0.7% maximal ND2 divergence among the populations. No genetic variation among the Azores individuals was found. Also noted is the presence of common haplotypes between the Fair Isle populations and Spain, Great Britain and Norway populations.

The inflammatory bowel diseases (IBD) Crohn's disease and ulcerative colitis are common causes of morbidity in children and young adults in the western world. Here we report the results of a genome-wide association study in early-onset IBD involving 3,426 affected individuals and 11,963 genetically matched controls recruited through international collaborations in Europe and North America, thereby extending the results from a previous study of 1,011 individuals with early-onset IBD. We have identified five new regions associated with early-onset IBD susceptibility, including 16p11 near the cytokine gene IL27 (rs8049439, P = 2.41 × 10−9), 22q12 (rs2412973, P = 1.55 × 10−9), 10q22 (rs1250550, P = 5.63 × 10−9), 2q37 (rs4676410, P = 3.64 × 10−8) and 19q13.11 (rs10500264, P = 4.26 × 10−10). Our scan also detected associations at 23 of 32 loci previously implicated in adult-onset Crohn's disease and at 8 of 17 loci implicated in adult-onset ulcerative colitis, highlighting the close pathogenetic relationship between early- and adult-onset IBD. [ABSTRACT FROM AUTHOR]

The article presents the October 2009 issue of the "Journal of the European Academy of Dermatology and Venereology," which offers information on the European S3-Guidelines for treating psoriasis vulgaris. It notes that the guidelines are intended for dermatologists and for medical specialists involved treating the disease. The guidelines are also meant to aid the activity of contributing to the fulfilment of a need or purpose to health insurance organizations and political decision-makers.

Two contrasting phases of work are described that help inform the development and requirements of a soil monitoring system: firstly, the development and application of a multi-criterion analysis of soil quality indicators grounded in the basic natural sciences; and secondly, scrutiny of the outcome of that process by a wide range of non-specialist but key stakeholders at a workshop. This process ensures that the final monitoring design meets both the scientific rigour expected from a monitoring system and as far as possible meets the aspirations of policy and regulatory stakeholders. Individual indicators of soil quality were evaluated in terms of their applicability against a number of important environmental and logistical parameters and therefore their overall fitness for purpose. These included relevance to different soil types, functions, habitats and threats to soil, the inherent variability of soil, and a range of technical aspects such as analytical complexity, precision and reproducibility of analytical results and whether a standard operating procedure (SOP) existed for the technique. A tiered approach to soil monitoring was supported by workshop delegates. This will require indicators that are suitable and effective at national, site-specific and process-level scales. In addition, the opportunities for synchronizing soil monitoring with air and water quality monitoring should be considered and the potential for integrating on-site measurements with remote methods should be researched further. It was considered by workshop attendees that soil monitoring should be rooted in pedological principles (i.e. recognizing defined soil horizons) to ensure that results can be extrapolated from individual sites and to retain flexibility. [ABSTRACT FROM AUTHOR]

Lifelong learning is recognized as an important tool to reduce social exclusion, but out of the many investigations into the provision of lifelong learning in Europe none has yet sought to examine the specific situation of mental health care service users. This study examines the provision of lifelong learning for this disadvantaged group; it identifies current policies and explores the access to, and nature of, lifelong learning practices for mental health care service users in eight European countries. Data have been collected through a literature and policy review and through questionnaires completed by mental health practitioners in the eight countries. The study found broad compliance amongst the eight countries with the Lisbon policy goals on lifelong learning, but evidence of specific lifelong learning provision for mental health care service users is patchy and sporadic. The study identified the main benefits of, and the barriers to, the participation in lifelong learning for mental health care service users from the viewpoint of mental health professionals and practitioners. The implications for practice were described, and suggestions for actions were made for improving the lifelong learning provision for the target group. [ABSTRACT FROM AUTHOR]

We are living in an era of fast and fundamental changes with an uneven impact on geographies and generations. The pace of the social transformations and technology innovations is accelerating and outpacing policies and responses in place. Also, the European drug situation and drug markets are becoming more complex and dynamic, with important implications for the EU drug monitoring system and research. Therefore the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) conducted the first ‘futures exercise’ to inform the agency’s strategic reflection on how to improve the response of the EU monitoring system in the context of rapid changes in the information environment and new information needs. The EMCDDA piloted the usefulness of the foresight approach for transforming the agency and its monitoring activities into a more sensitive and agile system, which could, in turn, help increase Europe’s preparedness for future challenges in health and security areas. The ‘futures exercise’ applied the horizon-scanning method to study events, issues, and trends affecting the drug area and went far beyond the drugs or the addiction field and the European region. It analysed global drivers of change that may have in the future implications for the drugs situation, drug monitoring and related responses. The methods applied ranged from literature review, thematic analysis, workshops and expert panels. It had a robust participatory component to enable stakeholders representing different disciplines and countries to contribute to and benefit from the process. Out of 14 Megatrends, five were selected as most significant for the drugs field, and the future EMCDDA work: technological change, climate change and environmental degradation, diversified inequalities, shifts in health challenges and population. Moreover, four categories of emerging changes in the drugs field were identified: shifts in drug policy, the discourse of addictions, drug markets and drug services. Key messages: Foresight is a valuable tool for analysis going beyond specific areas of expertise and recognising that a single-issue focus is often insufficient in dealing with emerging threats and opportunities. A participatory approach contributes to building a shared vision of the major drivers of change impacting the drugs field, information needs and future developments in the EU drug monitoring system. [ABSTRACT FROM AUTHOR]

Aims: To survey current European practices in handling and reporting of radical prostatectomy (RP) specimens. Methods and results: A European Network of Uropathology (ENUP) was organized for the dissemination of information, survey studies and research collaborations. Contact data of uropathologists were collected from 321 pathology laboratories in 15 West European countries. In the first ENUP survey, 67.6% (217/321) of the members replied to a web-based questionnaire. Some practices were adopted by a large majority, e.g. inking of the specimen (96.6%), Gleason grading (99.5%), stratifying extraprostatic extension (EPE) according to extent (88.2%), reporting TNM stage (88.6%) and reporting location of positive margins (98%). As many as 71.6% of respondents always embedded the entire prostate and only 10.8% always practised partial embedding. Whole mounts were routinely used by 37.5% and standard blocks by 55.5%. Among areas with variable routines were methods to define focal versus extensive EPE and methods to quantify margin positivity, probably reflecting that the optimal method has yet to be determined. Conclusions: Some practices are almost universally adopted in Europe, whereas others still need to be standardized. The results of the study may be helpful when judging what recommendations are reasonable to issue. [ABSTRACT FROM AUTHOR]

Introduction and Aims. This paper provides an overview of the historical development, current situation and potential future diffusion of methamphetamine (MA) use in Europe. Design and Methods. The analysis is based on a review of published and grey literature, as well as data collected as part of the ongoing monitoring of the drug situation in Europe. Some qualitative surveys among high-risk populations do exist, but overall the general low prevalence of methamphetamine use in most of Europe means that the data available to explore patterns of use are limited. Results. In many parts of Europe, amphetamine use is well established and the injecting of amphetamines has historically constituted an important component of the drug problem in many Nordic countries. Methamphetamine problems are long documented in the Czech and Slovak republics, but there is no current evidence of widespread use of MA elsewhere in Europe. Concern that MA use is spreading in Europe is prompted by some reports of use among high-risk groups. However, the evidence available suggests that even in high-risk populations, the use of MA currently remains uncommon. Europe accounted for less than 1% of worldwide MA seizures in 2005, and over the period 2004 - 05 European ephedrine seizures amounted for 6% of the global figure. Discussion. The spread of MA use is limited and no strong evidence exists that significant diffusion is occurring. It appears likely that methamphetamine diffusion in Europe is impeded by a strong market for other stimulant drugs [cocaine, amphetamine and methylenedioxymethamphetamine (MDMA)]. The future potential for the diffusion of MA may be influenced by factors such as: the relative availability and popularity of other drugs; possible 'leakage' from areas of historical high prevalence; travel by young Europeans to areas of high prevalence; and how users perceive MA as a desirable, suitable and cost-effective alternative to other stimulants available on the European illicit drug market. [Griffiths P, Mravcik V, Lopez D, Klempova D. Quite a lot of smoke but very limited fire - the use of methamphetamine in Europe. Drug Alcohol Rev 2008;27:236-242] [ABSTRACT FROM AUTHOR]

Objective: This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices.Design: Prospective multi-centre follow-up study out to 3 months after ICU discharge.Setting: Two district general hospitals and three teaching hospitals across Europe.Patients and Participants: Two hundred and thirty-eight recovering, post-ventilated ICU patients.Interventions: None.Measurements and Results: Assessment of patients' memories of ICU was undertaken at 1-2 weeks post ICU discharge. Patients' psychological recovery was assessed by examining the level of PTSD-related symptoms and rate of PTSD by 3 months post ICU. The rate of defined PTSD was 9.2%, ranging from 3.2% to 14.8% in the different study ICUs. Independent of case mix and illness severity, the factors found to be related to the development of PTSD were recall of delusional memories, prolonged sedation, and physical restraint with no sedation.Conclusion: The development of PTSD following critical illness is associated with a number of different precipitating factors that are in part related to how patients are cared for within intensive care. This study raises the hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in the ICU and how physical restraint is used. [ABSTRACT FROM AUTHOR]