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This report presents the conceptual design of a new European research infrastructure EuPRAXIA. The concept has been established over the last four years in a unique collaboration of 41 laboratories within a Horizon 2020 design study funded by the European Union. EuPRAXIA is the first European project that develops a dedicated particle accelerator research infrastructure based on novel plasma acceleration concepts and laser technology. It focuses on the development of electron accelerators and underlying technologies, their user communities, and the exploitation of existing accelerator infrastructures in Europe. EuPRAXIA has involved, amongst others, the international laser community and industry to build links and bridges with accelerator science — through realising synergies, identifying disruptive ideas, innovating, and fostering knowledge exchange. The Eu-PRAXIA project aims at the construction of an innovative electron accelerator using laser- and electron-beam-driven plasma wakefield acceleration that offers a significant reduction in size and possible savings in cost over current state-of-the-art radiofrequency-based accelerators. The foreseen electron energy range of one to five gigaelectronvolts (GeV) and its performance goals will enable versatile applications in various domains, e.g. as a compact free-electron laser (FEL), compact sources for medical imaging and positron generation, table-top test beams for particle detectors, as well as deeply penetrating X-ray and gamma-ray sources for material testing. EuPRAXIA is designed to be the required stepping stone to possible future plasma-based facilities, such as linear colliders at the high-energy physics (HEP) energy frontier. Consistent with a high-confidence approach, the project includes measures to retire risk by establishing scaled technology demonstrators. This report includes preliminary models for project implementation, cost and schedule that would allow operation of the full Eu-PRAXIA facility within 8—10 years. [ABSTRACT FROM AUTHOR]

Aims: Progress towards meeting the goal of measles elimination in the EU and the European Economic Area (EEA) by 2015 is being obstructed, as some children are either not immunized on time or never immunized. One group thought to be at increased risk of measles is migrants; however, the extent to which this is the case is poorly understood, due to a lack of data. This paper addresses this evidence gap by providing an overview of the burden of measles in migrant populations in the EU/EEA. Methods: Data were collected through a comprehensive literature review, a country survey of EU/EEA member states and information from measles experts gathered at an infectious disease workshop. Results: Our results showed incomplete data on measles in migrant populations, as national surveillance systems do not systematically record migration-specific information; however, evidence from the literature review and country survey suggested that some measles outbreaks in the EU/EEA were due to sub-optimal vaccination coverage in migrant populations. Conclusions: We conclude that it is essential that routine surveillance of measles cases and measles, mumps and rubella (MMR) vaccination coverage become strengthened, to capture migrant-specific data. These data can help to inform the provision of preventive services, which may need to reach out to vulnerable migrant populations that currently face barriers in accessing routine immunization and health services. [ABSTRACT FROM AUTHOR]

Abstract: The European Water Framework Directive (WFD) 2000/60/EC requests the achievement of the Good Status for all surface waters, including the coastal waters, by 2015. In order to check compliance with the needs of Directive, Italian national monitoring data on Posidonia oceanica meadows have been explored and the relationships among the Posidonia Rapid and Easy Index (PREI), and human-induced pressures have been analyzed along the Italian coasts. The aim of this work is to establish functional relationships between a response variable (i.e. the PREI) and a set of potential pressure (i.e. land use, potential organic and nutrient loading, pesticides) and status (i.e. transparency, trophic level and stability of the water column) indicators in a quantitative way. The ecological responses of coastal marine environment have been evaluated using appropriate statistical tools, such as the multiple linear regression analyses and “linear programming” techniques. Results show that more than 70% of the variability of the P. oceanica meadows status, expressed as PREI value, is significantly explained only by a few pressure/status indicators (namely: potential organic load, specific nitrogen load, natural areas extent, water column transparency), among all those initially considered in the model. The application of the proposed model could allow decision makers to better address remedial actions and to achieve the environmental targets proposed by the EU Directives. [Copyright &y& Elsevier]

Presents a survey of malignant fibrous histiocytoma of bone in Europe, conducted by the European Musculo-Skeletal Oncology Society. Patient and tumor characteristics; Treatment approaches; Treatment outcome assessment.

Simple Summary: The red deer, also known as the royal deer or European deer, is an artiodactyl mammal belonging to the Cervidae family, widely diffused in almost all of continental Europe. At the beginning of autumn in the Northern Hemisphere, the mating season begins. The males of red deer, called stags, are synchronized with the females, called hinds; indeed, at the beginning of the mating season, they show a marked increase in testosterone to match the hinds' estrus cycle. Gestation lasts about 230 days, so that calves are born in mid to late spring, the most favorable period for their survival. Scientific data on the reproduction physiology of this peculiar species in wild conditions are lacking, including hormonal variations during pregnancy. The present study describes mean levels of two critical hormones, cortisol and progesterone, in both blood and hair of wild pregnant red deer hinds. Correlation analysis confirmed how animals hunted in later phases of pregnancy have higher hair progesterone. The red deer (Cervus elaphus L., 1758) is one of the largest deer species in the world. Females are seasonal polyestrous, with negative photoperiod: the increase of the night peak of melatonin determines the secretion of GnRH and, therefore, LH and FSH. To date there is little information regarding the hormonal control during pregnancy for this species; this could be due to the difficulty of sampling wild subjects, while farmed animals' hormonal concentrations may not reflect the physiology of the animal in a natural state. In this study we evaluated the concentration of cortisol and progesterone, extracted from blood and hair, on 10 wild and pregnant red deer females. Belonging to the population of the Bolognese Apennines (Italy), the hinds were sampled in the January–March 2018 period, according to the regional selective hunting plan. Plasma progesterone (P4) ranged from a minimum of 1.9 to a maximum of 7.48 ng/mL; while hair P4 concentrations varied from 41.68 to 153.57 pg/mg. The plasma and hair cortisol ranges are respectively 0.4–2.97 ng/mL and 0.03–0.55 pg/mg; the only significant correlation was found between hair concentration of P4 and the date of death. The results of this preliminary study represent a small step towards a better knowledge of this species' physiology during pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: Background: The elimination of rubella and prevention of congenital rubella syndrome (CRS) by 2015 are established goals for Europe. Our aim was to review the epidemiology of rubella in relation to this goal. Material and methods: National surveillance institutions from 32 European countries provided information on rubella and CRS surveillance systems and data for 2000–08. We reported the number of notified rubella cases by year for countries with a national mandatory notification system for rubella covering total country population consistently throughout 2000–08 and analysed rubella surveillance data for 2008. Results: Throughout 2000–08, 24 countries conducted passive routine surveillance based on mandatory reporting rubella covering total country population. Altogether these countries reported 526,751 rubella cases. The median incidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By 2008, the number of countries with mandatory notification systems for rubella increased to 28. These countries reported 21,475 rubella cases of which 1.5% (n =317) were laboratory-confirmed. Most cases (n =21,075; 98%) were reported from Poland, Italy and Romania. Ten countries reported zero rubella cases and five others reported an incidence of <1 per million inhabitants. In 2008, 20 CRS cases were reported from five countries. Conclusion: The overall decline in rubella incidence and increase in the number of countries conducting rubella surveillance through a mandatory notification system are notable achievements toward the goal of rubella elimination in Europe. However, in a few countries with high rubella incidence the risk for CRS still exists. Achievement and maintenance of the required high vaccination coverage and high-quality surveillance of rubella and CRS including laboratory testing of all suspected cases are fundamental to eliminate rubella and prevent CRS in Europe. [Copyright &y& Elsevier]

Background: A substantial proportion of maternal and neonatal mortality and morbidity is attributable to gaps in quality of care. A systematic, standard-based tool for quality assessment and improvement for maternal and neonatal hospital care (QA/QI MN tool) was developed in 2009 by the World Health Organization (WHO). The tool guides the assessment process along the whole continuum from admission to discharge, collects the views of the recipients of care and engages hospital mangers and staff in identifying gaps and drafting an action plan., Methods: Publications describing use of the WHO QA/QI MN tool from 2009 to 2017 and reports retrievable from WHO or other development partners' websites were searched and considered for inclusion in the review. Only assessments of hospitals were considered. Quality gaps were classified as regarding case management in maternal care, case management in neonatal care, hospital infrastructure, hospital policies and according to severity and frequency. Quotations from women regarding key issues in effective communication, respect and dignity, emotional support and costs incurred were selected., Results: In the period 2009-2017, use of the WHO QA/QI MN tool was documented in 25 countries, belonging to Central and Eastern Europe (8), Central Asia (4), Sub-Saharan Africa (11), Latin America (1) and Middle East (1). Overall, 133 hospitals were assessed. The tool allowed to identify in great detail serious quality gaps including: insufficient or incomplete adherence to recommended evidence-based procedures for normal childbirth and maternal and neonatal complications; excess of inappropriate or unnecessary interventions; insufficient infection control; failure to provide respectful care, adequate communication and emotional support to mothers and babies; poor use of information generated locally to analyse processes and outcomes. These gaps were observed in all countries. Significant differences were observed among facilities belonging to the same health systems, ie, with very similar staffing, infrastructure and equipment., Conclusions: The experience made, the largest of this kind, provides comprehensive and detailed insight into the existing quality gaps in a wide variety of settings. QI cycles at facility level should be primarily based on assessments made by multidisciplinary teams of professionals to identify the parts of the care pathways which require improvement through a participatory approach involving managers, staff and patients., Competing Interests: Competing interests: AB was Programme manager, Making Pregnancy Safer, WHO European Office from 2001 to 2011. GT, SH, DJ, GS and PS received consultancy fees for taking part in some of the quality assessment and improving activities. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no further conflicts of interest., (Copyright © 2020 by the Journal of Global Health. All rights reserved.)

Background: Information about the use of the findings of quality assessments in maternal and neonatal (MN) care is lacking and the development of tools capable to effectively address quality gaps is a key priority. Furthermore, little is known about factors that act as barriers or facilitators to change at facility level. Based on the extensive experience made with the WHO Quality Assessment and Improvement MN (QA/QI MN) tool, an overview is provided of the improvements in quality of care (QoC) which were obtained over time and of the factors influencing change., Methods: All documented reports on the implementation of the WHO QA/QI MN tool were searched and screened for inclusion. Reports were considered if bringing evidence from both the baseline assessment and the reassessment. Changes were considered in four domains: maternal care, neonatal care, infrastructure and policies, with reference made to WHO maternal and neonatal care standards. The observed improvements were categorized according to intensity and extent across the sample of health facilities. Factors influencing change were categorized into internal and external and further classified as barriers or facilitators., Results: Changes were documented after an average period of 1.2 years from first assessment in 27 facilities belonging to 9 different countries in Central and Eastern Europe (3), Central Asia (3), sub-Saharan Africa (2) and Latin America (1). Improvements were observed in all areas of care but were greater and more frequently observed in areas related to appropriate case management and respectful care for both mothers and newborns. Although widespread across most facilities and countries, the observed improvements were not covering all the quality gaps observed at the baseline assessment nor were always sufficient to achieve standard care. Factors facilitating change as well as barriers were mainly related to the capacity of the managers and head of units to involve and motivate their staff members., Conclusions: The use of WHO QA/QI MN tool proved effective in promoting significant changes in quality of care. The review of observed improvements and of factors influencing change at facility level shows that participatory assessment tools that promote a constructive dialogue with hospital managers and staff and support them in acquiring capacity in this role are crucial to implement effective quality cycles., Competing Interests: Competing interests: AB was Programme manager, Making Pregnancy Safer, WHO European Office from 2001 to 2011. GT, SH, DJ, AM, GS, and FU received consultancy fees for taking part in some of the quality assessment and improving activities. The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author) and declare no conflicts of interest., (Copyright © 2020 by the Journal of Global Health. All rights reserved.)

In the World Health Organization (WHO) European region despite official high coverage of essential interventions for maternal and neonatal care, there are still significant gaps in the delivery of effective interventions. Since 2001, WHO designed and implemented the Making Pregnancy Safer programme, which includes hands-on training courses in effective perinatal care for maternity teams, development of clinical guidelines, maternal mortality and morbidity case reviews, and assessments of quality of care. This has contributed to enhancing capacity at country level to improve organisation and provision of care. This paper describes the programme's components, challenges, achievements and results., (© 2014 Royal College of Obstetricians and Gynaecologists.)

Most maternal deaths can be averted with known, effective interventions but countries require information about which women are dying and why, and what can been done to prevent such deaths in future. This paper describes the introduction of two approaches to reviewing maternal deaths and severe obstetric complications in 12 countries in transition in the WHO European Region - national-level confidential enquiries into maternal deaths and facility-based near-miss case reviews. Initially, two regional meetings involving stakeholders from 12 countries were held in 2004-2005, followed by national meetings in seven of the countries. The Republic of Moldova was the first to pilot the review process, preceded by a technical workshop to make detailed plans, provide training in how to facilitate and carry out a review, finalise clinical guidelines against which the findings of the confidential enquiry and near-miss case review could be judged, and a range of other preparatory work. To date, near-miss case reviews have been carried out in the three main referral hospitals in Moldova, and a national committee appointed by the Ministry of Health to conduct the confidential enquiry has met twice. Several other countries have begun a similar process, but progress may remain slow due to continuing fears of punitive actions against health professionals who have a mother or baby die in their care.