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Background: Studies on medication safety in pregnancy are increasingly focusing on child neurodevelopmental outcomes. Establishing neurodevelopmental safety is complex due to the range of neurodevelopmental outcomes and the length of follow-up needed for accurate assessment. The aim of this study was to provide an inventory of European data sources for use in pharmacoepidemiologic studies investigating neurodevelopment following maternal medication exposure. Method: The EUROmediSAFE inventory of data sources in Europe for evaluating perinatal and long-term childhood risks associated with in-utero exposure to medication was updated by contacting colleagues across 31 European countries, literature review and internet searches. Included data sources must record at least one neurodevelopmental outcome and maternal medication use in pregnancy must be available, either in the data source itself or through linkage with another data source. Information on the domain of neurodevelopment, measure/scale used and the approach to measurement were recorded for each data source. Results: Ninety data sources were identified across 14 countries. The majority (63.3%) were created for health surveillance and research with the remaining serving administrative purposes (21.1% healthcare databases,15.6% other administrative databases). Five domains of neurodevelopment were identified—infant development (36 data sources,13 countries), child behaviour (27 data sources, 10 countries), cognition (29 data sources, 12 countries), educational achievement (20 data sources, 7 countries), and diagnostic codes for neurodevelopmental disorders (42 data sources, 11 countries). Thirty-nine data sources, in 12 countries, had information on more than one domain of neurodevelopment. Conclusion: This inventory is invaluable to future studies planning to investigate the neurodevelopmental impact of medication exposures during pregnancy. Caution must be used when combining varied approaches to neurodevelopment outcome measurement, the age of children in the data source, and the sensitivity and specificity of the outcome measure selected should be borne in mind. [ABSTRACT FROM AUTHOR]

Background: Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD.Methods: A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information.Results: There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults.Conclusions: The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group. [ABSTRACT FROM AUTHOR]

The present article reviews the molecular and cellular mechanisms involved in the pathophysiology of chronic rhinosinusitis with nasal polyps (CRSwCRSwNP) and underlying the action mechanisms of biotherapies. Biotherapy uses substances naturally produced by the organism or their specific antagonists targeting a proinflammatory mechanism. CRSwCRSwNP is a form of chronic rhinosinusitis (CRS), which is classically subdivided in to 2 types according to the presence of polyps. In recent years, the concept of endotypes emerged, with a more exhaustive definition of the types of CRS according to inflammatory mechanism, with a view to developing personalized treatments. CRSwNP pathophysiology is poorly understood. Polyps arise from a primary epithelial lesion in a context of chronic local inflammation, mainly type 2 in Europe, implicating eosinophils, IgE, Th2 cytokines (IL-4/IL-13, IL-5) and T and B cells. Biotherapy seems promising in CRSwNP. The present review details the various pathophysiological pathways underlying the action mechanisms of biotherapies, and the various published studies, assessing efficacy and mode of action in the treatment of CRSwNP. [ABSTRACT FROM AUTHOR]

Aims To evaluate the interest of brain natriuretic peptide (BNP) for heart failure (HF) diagnosis in very old patients. Methods and results A total of 383 patients aged 80 years or older, hospitalized in geriatrics care for dyspnoea, had a BNP measurement at the acute phase. Independent cardiologists blinded to BNP values classified the patients into cardiac vs. respiratory aetiology according to the European Society of Cardiology guidelines. Mean (SD) age was 88.5 (5.4) years, 66% (n=254) of patients were women, 62% (n=238) had cardiac dyspnoea and 38% (n=145) had respiratory dyspnoea. The BNP levels were significantly higher in the cardiac group (median=385.5 ng/L, interquartile range=174.0-842.0) than in the respiratory group (median=172.0 ng/L, interquartile range=70.8-428.0; P <0.001). On its own, BNP showed poor discriminative ability [area under the curve (AUC)=0.68; 95% confidence interval (CI) 0.62-0.73] for the diagnostic. In multivariate analysis, BNP remained independently associated with the cardiac aetiology after full-adjustment (odds ratio 1 log increase=1.87; 95% CI 1.28-2.74), but did not improve the discrimination between the cardiac and the respiratory aetiologies (ΔAUC=0.013, P =0.16). In addition, although adding BNP to the other predictive covariates yielded a significant continuous NRI of 57.8% (95% CI 31.2-83.5%), the mean changes in individual predicted probabilities were too low (<3%) to be clinically relevant. Conclusion In this population of very old patients with acute dyspnoea, despite being independently associated with the cardiac aetiology, BNP was not useful for better discriminating cardiac vs. respiratory origin. [ABSTRACT FROM AUTHOR]

The incidence of BSE in Europe is in continued decline. At present, iatrogenic transmission from person to person is considered a serious threat to public health. This report of the International Society of Blood Transfusion Working Party on Transmissible Spongiform Encephalopathy will focus on the state of the art in relation to blood components and plasma safety. Latest information on the pathogenicity of the infectious agent, the frequency and dynamics of infection in blood and transfusion transmissibility will be documented. Preventive measures including donor deferral policies, technologies for prion removal from labile blood components and for prion detection in plasma, the absence of a sensitive and rapid reference assay able to confirm the positive results from any putative blood screening assay will be updated. At last, as many uncertainties remain and a number of assumptions await confirmation, the areas to continue to explore are listed. [ABSTRACT FROM AUTHOR]

The paper critically discusses key theoretical concepts and definitions attached to the notion of a 'plurilingual social actor', and assesses their impact and implications for European language policies and for the development of plurilingualism and citizenship in schools. [ABSTRACT FROM AUTHOR]

The European Union (EU)’s Water Framework Directive (WFD) requires that all Member States participate in intercalibration exercises in order to ensure that ecological status concepts and assessment levels are consistent across the EU. This paper describes one such exercise, performed by the countries in the Central/Baltic Geographical Intercalibration Group stretching from Ireland in the west to Estonia in the east and from the southern parts of Scandinavia to the northern regions of Spain and Italy (but excluding alpine regions, which were intercalibrated separately). In this exercise, methods used to measure ecological status of rivers using benthic diatoms were compared. Ecological status is estimated as the ratio between the observed value of a biological element and the value expected in the absence of significant human impact. Approaches to defining the ‘reference sites’, from which these ‘expected’ values were derived, varied from country to country. Minimum criteria were established as part of the exercise but there was still considerable variation between national reference values, reflecting typological differences that could not be resolved during the exercise. A simple multimetric index was developed to compare boundary values using two widely used diatom metrics. Boundary values for high/good status and good/moderate status set by each participant were converted to their equivalent values of this intercalibration metric using linear regression. Variation of ±0.05 EQR units around the median value was considered to be acceptable and the exercise provided a means for those Member States who fell significantly above or below this line to review their approaches and, if necessary, adjust their boundaries. [ABSTRACT FROM AUTHOR]

The article provides an analysis on the thermal-hydraulic phenomena of pressurized thermal shock (PTS) in pressurized water reactors under the Nuclear Reactor Simulations (NURESIM) Project of the European Commission. It explores the two-phase phenomena in the cold leg and downcomer regions of the nuclear reactor through computational fluid dynamics (CFD) simulation. It shows the involvement of several two-phase subphenomena, but limitations on its performance and interaction were observed.

Background: Recent population-based surveys have reported that large majorities of children in France, Europe and in the US are not complying with international physical activity (PA) guidelines. There is, therefore, a need to find programs that will improve children's PA habits from an early age. Theory-based interventions that include school, family, and community involvement have the potential to generate a considerable increase in the PA level of children. The theory of planned behavior (TPB) is one of the most widely tested models of the factors influencing health-related behaviors. The Great Live and Move Challenge (GLMC) is an extended TPB-based intervention designed to promote PA in French primary school children aged 7-11 years. The objective of this paper is to describe the protocol of a randomized controlled trial to evaluate the effectiveness of the GLMC on the PA level of children.Methods: This is a two-year cluster-randomized controlled trial comparing an intervention group to a control group, randomized into clusters (community of communes) and stratified by department (Hérault, Gard, Aude) and residential environment (urban, rural). The goal is to recruit 4000 children. The GLMC involves children and their parents, and multiple local grassroots partners, such as school teachers, municipal officials and policy stakeholders. The intervention will be delivered over 3.5 months per year for a two-year period. Pre- and post-intervention, children and parents will be asked to fulfill a questionnaire concerning current PA level, TPB variables (i.e., intentions, attitudes, subjective norms, perceived behavioral control) and other psychosocial variables (e.g., perceptions of activity opportunities). A subsample of 400 children will be proposed to wear an accelerometer (i.e., the Actigraph GT3X+). The primary hypothesis is that the GLMC intervention will increase the proportion of children achieving the World Health Organization's recommended 60 min of moderate to vigorous PA per day by 15%.Discussion: This study will evaluate the effectiveness of a multilevel, theory-based PA program and potentially provide valuable information for schools and public health officers looking for innovative PA programs.Trial Registration: ISRCTN:61116221 , 19/06/2018. [ABSTRACT FROM AUTHOR]

Abstract: Freshwater diatoms are considered to be reliable indicators of the trophic status of rivers and lakes. In the past 30 years, a number of indicator indices have been developed and used for the assessment of trophic conditions all over Europe. It is however still not clear whether the ecologic signature of diatoms differs between these indicator indices. The present study assessed a large number of published European indices on the response of freshwater diatoms to trophic conditions by evaluating the consistency in the use of taxa and their trophic score from seven European indicator indices. The STAR (Standardisations of River Classifications) diatom database, a large set of samples from European running waters, was used to test the application of trophic classifications in water quality assessment. The analysis of taxa in common within the trophic indices showed that there are considerable differences between the indices, for example in the score of trophic values. There was more agreement in classification of taxa within the oligotrophic and the hypertrophic preferences than within the mesotrophic range. Based on these results, a list of diatom taxa, that are consistently used in different trophic indices, was composed. It included 159 ‘reliable’ taxa that are not sensitive to regional setting, water type and taxonomic uncertainty. The list was further accompanied by a description of the taxa''s trophic preferences. The large deviation in trophic scores for a number of diatom taxa could most probably be explained by taxonomic uncertainties. Application of these taxa for trophic assessment was questionable. The test set of the 359 STAR samples showed that differences between the trophic indices also lead to a significant variation in the water quality assessment results. Although trophic indices provide an excellent biomonitoring tool, they should be applied with caution, considering the recommendations provided in this paper. [Copyright &y& Elsevier]

Abstract: This paper focuses on the application of various biomonitoring techniques in China. We report a study in the Pearl River Basin (Guangzhou) based on the application of diatom indices as well as a study on the waterways in Wuhan based on evaluation of toxicity (using phytotoxicity, Daphnia magna and Microtox™ tests) and the Extended Biotic Index (EBI). Regarding the diatom indices, acceptable results were obtained based on comparison of the chemical water quality level and the European and Japanese indices, despite a lack of taxonomic information. The toxicity tests applied to the Wuhan waterways (Yangtze and Han Rivers) produced interesting results and can be considered to represent a useful tool for water pollution control in this area. Application of the EBI in Wuhan produced results that were contradictory to the toxicological analyses, as there were no indications of toxicity, whereas EBI indicated poor water quality. It can be concluded that in principle, certain European biological indicators can be considered to represent feasible tools to be applied in China. However, further studies will have to be carried out to develop bioindices based on Chinese data sets. The use of bioindices based on macroinvertebrates is limited to less polluted and smaller rivers with a lithic river substratum, whereas diatom indices are also applicable under extreme conditions (e.g., under high pollution loads or in large river streams with sandy riverbed sediments through installing artificial substrates). [Copyright &y& Elsevier]

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is one of the categories of chronic rhinosinusitis and is defined by the presence of bilateral polyps. It is frequently associated with other conditions (asthma, atopy, aspirin intolerance), which worsen its prognosis., State of Art: The pathophysiology of CRSwNP is still poorly understood. The genesis of polyps is thought to be based on an initial epithelial lesion caused by environmental factors in the context of self-maintained chronic local inflammation. Multiple local and general factors can be involved in this inflammation, which is mainly of Th2 type in Europe. Abnormalities of the epithelial barrier and the immune system (eosinophilia, cytokines, T and B lymphocytes), genetic factors and pathogens, including Staphylococcus aureus, have been incriminated. The treatment of CRSwNP is mainly based on the application of local corticosteroids. Surgery remains an important part of patient management where CRSwNP becomes resistant to topical therapy. The management of CRSwNP may be at a turning point thanks to the arrival of biological therapies (anti-IgE, anti-IL-5, anti-IL-4/IL-13) the initial results of which are promising., Perspectives/conclusions: With the new concept of endotypes, current avenues of research are moving towards a better understanding of the inflammatory mechanisms of CRSwNP. Immunotherapy appears to be a promising future for the treatment of CRSwNP., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)