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The educational potential of video is a long-lasting, multi-faceted topic, and the affordances of technological advancement have recently revitalised this discussion. However, teachers are still far from competently integrating or becoming accustomed to video-based pedagogy, especially in collaborative pedagogy. To provide teachers and teacher educators with sound principles for implementing video-supported collaborative learning (VSCL), this contribution analyses 12 VSCL case studies by five teacher-education institutions. The analysis verifies the benefits of a VSCL pedagogy for learning, and on this basis, we propose a pedagogical model for effective VSCL and a related instructional design tool. We also discuss implications for practice and research.

As the needs and interests of young people are shifting under the influence of demographics and other social developments, "new stories" have started to attract many that undermine the human rights narrative and nurture radical attitudes. This has consequences for human rights education (HRE). As competing narratives have gained a foothold in major target audiences of HRE, the latter has to realize it is facing an uphill battle. The evidence suggests that HRE can no longer rely on the mere transfer of knowledge and that the "story of human rights" needs to be told in completely new ways. If HRE aims to change attitudes to be more inclusive and respectful, and to promote a struggle for justice, it has to make its story heard and win people over. Here HRE faces a central dilemma: how to promote fundamental freedoms while including the freedom not to subscribe to these same values? Instead of conceptual persuasion, emphasis should be put more on the affect, and relate to people's lived experiences. Crucially, HRE has to be prepared to make room for the discussion of the paradoxes of political violence. By making clear that it has vital relevance for its audience and can better answer the question of what someone should meaningfully do in life, HRE can change the narrative.

There is little evidence on the association between child and adolescent mental health (CAMH) policies and adolescent mental health. This study examined this association using data on indicators of adolescent mental health--aggressive behavior, life satisfaction, and psychosomatic symptoms--in 172,829 eleven- to fifteen-year-olds from 30 European countries in the 2013-2014 Health Behaviour in School-Aged Children (HBSC) study. Individual records were linked to national-level policies for CAMH, controlling for national-level adult violence, adult well-being, and income inequality. Multilevel analyses revealed lower adolescent aggressive behavior in countries with more CAMH policies, even after controlling for other national-level indicators. Adolescent life satisfaction and psychosomatic symptoms were not associated with CAMH policies. Results may inform policy recommendations regarding investments in adolescent mental health.

The purpose of this paper is to carry out an empirical examination of the supply-side factors influencing dropout rates in MBA programs. We analyze the extent to which the resources and characteristics of the program (content, teaching methodology, course load, class size, partnerships, reputation) influence these rates. A GLM analysis was conducted on data obtained from a final sample of 94 executive MBA programs in Western Europe. The results indicate that several supply side factors significantly affect dropout: intensity of case study learning, number of credits per month, class size, and proportion of lessons given at partner institutions. Several implications for the design and management of higher education programs have been drawn from this research.

Developing social innovation and entrepreneurship competences and skills of children and young people is on the agenda of European educational policy-makers. The European research and innovation project "DOIT -- Entrepreneurial skills for young social innovators in an open digital world" suggests using makerspaces and tools, within schools and externally, to promote practice-based social innovation and entrepreneurial learning of children and young people. This article first gives an overview of different types of maker-spaces, addresses the concept of maker education, and highlights common development goals of such education with entrepreneurship education regarding particular attitudes and competences. The main part then describes the DOIT learning program that allows children and young people (6-16 years) to acquire skills and an entrepreneurial mind-set for turning creative ideas into potential social innovations. This program is currently trialed in DOIT pilots in different types of makerspaces in ten European countries. The article describes learning processes and outcomes that are promoted by the program with two examples that are different regarding the makerspaces, topics and other aspects. Some first experiences and lessons learned from these and other pilots are summarized.

Background Falls have high socioeconomic costs. Information and communication technologies may support provision and monitoring of multisensory (MSR) physiotherapy programmes. The HOLOBalance platform used augmented reality holograms to provide patient-centred, individualised MSR. Objectives To determine the platform's safety, acceptability and feasibility, investigate functional gait and dynamic balance benefits and provide data for a definitive trial. Design and setting Single-blinded pilot randomised controlled feasibility study. Interventions were conducted at clinical sites or participants' homes in three European countries. Participants Community-dwelling older adults (median age 73 years; 64.2% female) at risk of falls were enrolled (May 2020-August 2021). Methods Participants were randomised to an 8-week clinic or home-based telerehabilitation MSR or OTAGO (control group) programme. Compliance, satisfaction, and adverse events determined feasibility. Clinical outcomes, assessed (blinded) within one-week prior to and post-intervention, included functional gait assessment (FGA), Mini BESTest and cognitive function. Results Randomisation to completion rate was 76.15% with 109 participants recruited (n = 289 screened). Drop-out rate was similar between groups. Adverse events were reported (n = 3) in the control group. Sixty-nine percent would recommend the HOLOBalance intervention. Findings were similar for the home and clinic-based arms of each intervention; data was combined for analysis. FGA (95%CI [1.63, 4.19]) and Mini-BESTest (95%CI [1.46, 3.93]) showed greater improvement in the HOLOBalance group with a clinically meaningful change of 4/30 noted for the FGA. Conclusions HOLObalance was feasible to implement and acceptable to older adults at risk of falls, with FGA and Mini-BEST improvements exceeding those for the OTAGO programme. A definitive trial is warranted. [ABSTRACT FROM AUTHOR]

Purpose: European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES). Methods: Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship. Results: Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring. Conclusions: Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community. [ABSTRACT FROM AUTHOR]

Humans have considerably influenced accumulation rates and sediment composition in lake deposits. Due to near‐continuous accumulation, lakes and reservoirs are an excellent archive of these anthropogenic influences. The Urft Reservoir in the Eifel Mountains, western Germany, provides a unique record of the human influence on the landscape for the past 115 years. In 2020 and 2021, 24 cores and 23 surface samples were obtained from the bottom of the, by that time drained, reservoir. Grain size, heavy metals, weathering signatures and microplastic were analysed. For the chronology, caesium‐137 and microplastic were used. Using the first occurrence of microplastic as well as different plastic types for dating was not successful. However, a distinct layer with a high number of microplastic particles could be traced back to a fire in 1991 and was used as an additional stratigraphic marker in the age‐depth model. A period of relatively high accumulation rates in the reservoir occurred in the mid‐1950s and was related to enhanced construction works in the local valleys. Analysis of heavy metal content in the reservoir sediments shows a strong connection to historical changes in ore industry in the valley of the Urft. Stricter environmental protection laws and the decline of the metal processing industry resulted in a reduced input of lead, copper and zinc in the reservoir until the mid‐1980s. Since then, heavy metal content has remained relatively constant. A major flooding event in July 2021 did not lead to the remobilisation of older contaminated deposits as indicated by low heavy metal content in flood deposits. Accordingly, also the microplastic content is not increasing following the extreme event. Due to the degree of weathering of the flood deposits, it is argued that mainly hillslope material was transported into the Urft and subsequently into the Urft Reservoir during this event. [ABSTRACT FROM AUTHOR]

• Cardiovascular (CV) disease is the most common cause of death in Europe. • Lipid-lowering therapies continue to be under-used, and treatment goals often not achieved. • CV events that occur in patients, despite optimal risk factor control, are called " residual risk ". • Lifestyle measures and the full and appropriate use of pharmacotherapies are needed to lower CV risk. • There is a need for simplified clinical recommendations, promotion of earlier lifestyle changes, and the use of combination therapies. Cardiovascular (CV) disease is the most common cause of death in Europe. Despite proven benefits, use of lipid-lowering therapy remains suboptimal. Treatment goals are often not achieved, even in patients at high risk with atherosclerotic CV disease (ASCVD). The occurrence of CV events in patients on lipid-lowering drugs is defined as " residual risk ", and can result from inadequate control of plasma lipids or blood pressure, inflammation, diabetes, and environmental hazards. Assessment of CV risk factors and vascular imaging can aid in the evaluation and management decisions for individual patients. Lifestyle measures remain the primary intervention for lowering CV risk. Where drug therapies are required to reach lipid treatment targets, their effectiveness increases when they are combined with lifestyle measures delivered through formal programs. However, lipid drug dosage and poor adherence to treatment remain major obstacles to event-free survival. This article discusses guideline-supported treatment algorithms beyond statin therapy that can help reduce residual risk in specific patient profiles while also likely resulting in substantial healthcare savings through better patient management and treatment adherence. Types of residual lipid-related risk in patients with known CVD after initial optimal treatment of other risk factors CVD, cardiovascular disease; HDL-C, hsCRP, high-density lipoprotein cholesterol; high-sensitivity C-reactive protein; LDL-C, low-density lipoprotein cholesterol; Lp(a), lipoprotein(a); TG, triglyceride. [Display omitted] [ABSTRACT FROM AUTHOR]

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Recent technological advancements in spectral imaging core-scanning techniques have proved to be a promising tool to study lake sediments at extremely high resolution. We used this novel analytical approach to scan core AU3 of the Pleistocene Auel maar, Western Germany. The resulting ultra-high-resolution RABD670 spectral index, a proxy for the lake's primary production, shows an almost complete succession of Greenland Interstadials of the NGRIP ice core chronology back to around 60,000 years. Using the ELSA-20 chronology and its anchor points to the NGRIP record as a stratigraphic basis, we were able to compare and fine-tune prominent climate signals occurring in both regions. This in-depth correlation yields strong evidence that the climates of Greenland and Central Europe were not only strongly coupled on timescales of stadials and interstadials but even on multidecadal scales, showing prominent climate cycles between 20 and 125 years. As climate changes in these regions were ultimately driven by variations in the North Atlantic meridional heat transport, their strong coupling becomes most apparent during cold and arid intervals. In contrast, longer-lasting warmer and more humid phases caused the activation of various regional feedback mechanisms (e.g., soil formation, forest growth), resulting in more complex patterns in the proxy records. [ABSTRACT FROM AUTHOR]

Seven published and four new pollen records from well-dated sediment cores from six Pleistocene and Holocene maar structures located in the Eifel, Germany, are combined to a pollen stack that covers the entire last 132,000 years. This stack is complemented by new macroremain data from one additional sediment core. The pollen data included into the stack show consistently that the Eifel was covered by a dense forest during the Eemian, early Marine Isotope Stage (MIS) 3, and the Holocene. While other European records indeed indicate a warming, the early MIS 3 fully developed forest remains a unique feature in central European pollen records. Comparison to orbital parameters and insolation hints to warm and humid, however, not fully interglacial conditions, which are also visible in speleothem growth throughout Europe. With the cooling trend towards the glacial maxima of MIS 4 and 2, tree pollen declined, with recovering phases during MIS 5c and 5a, as well as during all MIS 3 interglacials. During the colder stadials, steppe vegetation expanded. For MIS 5 and 4, we defined six new landscape evolution zones based on pollen and macroremains. [ABSTRACT FROM AUTHOR]

Background: In Europe, physical activity levels tend to be lower in ethnic minority groups than the general population. Interventions and policies based on research examining isolated determinants of physical activity have had limited success in increasing physical activity levels. This study used systems dynamics theory and the capability approach theoretical framework to develop a conceptual model of how individual characteristics, institutional and physical environments and the migration context may interact to promote or hinder physical activity in ethnic minority groups living in Europe. Methods: A systematic update of Langøien et al.'s 2017 review of the determinants of physical activity in ethnic minority groups living in Europe was conducted. Our target population included individuals of all ages who reported a familial migration background from any low- and middle-income countries or belonging to minority indigenous population in Europe. Outcomes pertaining to non-work related physical activity of light, moderate or vigorous intensity performed in any setting were included. Included studies provided an evidence base from which to derive the causal loop diagrams comprising our conceptual model. Sub-system causal loop diagrams were interpreted in co-author review sessions to explicate non-linear system mechanisms, such as reinforcing and balancing feedback loops. Results: Forty-one studies were identified, of which the majority was qualitative. The conceptual model consisted of 4 causal loop diagrams relating to psychosocial constructs; sociocultural constructs; health and health communication and social and material resources, in interaction with environmental/migration context. Four hypothetical mechanisms were identified, e.g. hypothesizing that participation in organised activities leads to increased self-efficacy, thereby enabling further participation. Conclusions: This study contributes an evidence-based conceptual systems model which elucidates how low levels of physical activity in ethnic minority groups in Europe could be supported by reinforcing and balancing mechanisms involving factors relating to physical and institutional environments, migration context and individuals. A pluralistic approach to literature review, integrating complexity methods such as CLDs into more conventional systematic literature review, supports novel insights into how factors could interact to support persistently low levels of activity, moving beyond the identification of potential relationships between isolated factors to indicating the ways in which these relationships are sustained and could be modified by intervention or policy. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD‐induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin–angiotensin–aldosterone system inhibitors, beta‐blockers, diuretics and sodium–glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end‐diastolic/end‐systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre‐clinical evaluation. [ABSTRACT FROM AUTHOR]

A major aim of evolutionary biology is to understand why patterns of genomic diversity vary within taxa and space. Large‐scale genomic studies of widespread species are useful for studying how environment and demography shape patterns of genomic divergence. Here, we describe one of the most geographically comprehensive surveys of genomic variation in a wild vertebrate to date; the great tit (Parus major) HapMap project. We screened ca 500,000 SNP markers across 647 individuals from 29 populations, spanning ~30 degrees of latitude and 40 degrees of longitude – almost the entire geographical range of the European subspecies. Genome‐wide variation was consistent with a recent colonisation across Europe from a South‐East European refugium, with bottlenecks and reduced genetic diversity in island populations. Differentiation across the genome was highly heterogeneous, with clear 'islands of differentiation', even among populations with very low levels of genome‐wide differentiation. Low local recombination rates were a strong predictor of high local genomic differentiation (FST), especially in island and peripheral mainland populations, suggesting that the interplay between genetic drift and recombination causes highly heterogeneous differentiation landscapes. We also detected genomic outlier regions that were confined to one or more peripheral great tit populations, probably as a result of recent directional selection at the species' range edges. Haplotype‐based measures of selection were related to recombination rate, albeit less strongly, and highlighted population‐specific sweeps that likely resulted from positive selection. Our study highlights how comprehensive screens of genomic variation in wild organisms can provide unique insights into spatio‐temporal evolutionary dynamics. [ABSTRACT FROM AUTHOR]

Background: Seed endophytes have a significant impact on plant health and fitness. They can be inherited and passed on to the next plant generation. However, the impact of breeding on their composition in seeds is less understood. Here, we studied the indigenous seed microbiome of a recently domesticated perennial grain crop (Intermediate wheatgrass, Thinopyrum intermedium L.) that promises great potential for harnessing microorganisms to enhance crop performance by a multiphasic approach, including amplicon and strain libraries, as well as molecular and physiological assays. Results: Intermediate wheatgrass seeds harvested from four field sites in Europe over three consecutive years were dominated by Proteobacteria (88%), followed by Firmicutes (10%). Pantoea was the most abundant genus and Pantoea agglomerans was identified as the only core taxon present in all samples. While bacterial diversity and species richness were similar across all accessions, the relative abundance varied especially in terms of low abundant and rare taxa. Seeds from four different breeding cycles (TLI C3, C5, C704, C801) showed significant differences in bacterial community composition and abundance. We found a decrease in the relative abundance of the functional genes nirK and nifH as well as a drop in bacterial diversity and richness. This was associated with a loss of amplicon sequence variants (ASVs) in Actinobacteria, Alphaproteobacteria, and Bacilli, which could be partially compensated in offspring seeds, which have been cultivated at a new site. Interestingly, only a subset assigned to potentially beneficial bacteria, e.g. Pantoea, Kosakonia, and Pseudomonas, was transmitted to the next plant generation or shared with offspring seeds. Conclusion: Overall, this study advances our understanding of the assembly and transmission of endophytic seed microorganisms in perennial intermediate wheatgrass and highlights the importance of considering the plant microbiome in future breeding programs. [ABSTRACT FROM AUTHOR]

Background: The IMPACT survey aimed to elucidate the humanistic, clinical and economic burden of osteogenesis imperfecta (OI) on individuals with OI, their families, caregivers and wider society. Research methodology, demographics and initial insights from the survey have been previously reported. The cost of illness (healthcare resource use, productivity loss, out-of-pocket spending) and drivers of the economic impact of OI are reported here. Methods: IMPACT was an international mixed-methods online survey in eight languages (fielded July–September 2021) targeting adults (aged ≥ 18 years) or adolescents (aged ≥ 12–17 years) with OI, caregivers with or without OI and other close relatives. Survey domains included demographics, socioeconomic factors, clinical characteristics, treatment patterns, quality of life and health economics. The health economic domain for adults, which included questions on healthcare resource use, productivity loss and out-of-pocket spending, was summarised. Regression and pairwise analyses were conducted to identify independent drivers and associations with respondent characteristics. Results: Overall, 1,440 adults with OI responded to the survey. Respondents were mostly female (70%) and from Europe (63%) with a median age of 43 years. Within a 12-month period, adults with OI reported visiting a wide range of healthcare professionals. Two-thirds (66%) of adults visited a hospital, and one-third (33%) visited the emergency department. The mean total number of diagnostic tests undergone by adults within these 12 months was 8.0. Adults had undergone a mean total of 11.8 surgeries up to the time point of the survey. The proportions of adults using queried consumables or services over 12 months ranged from 18–82%, depending on the type of consumable or service. Most adults (58%) were in paid employment, of which nearly one-third (29%) reported missing a workday. Of the queried expenses, the mean total out-of-pocket spending in 4 weeks was €191. Respondent characteristics such as female sex, more severe self-reported OI and the experience of fractures were often associated with increased economic burden. Conclusion: IMPACT provides novel insights into the substantial cost of illness associated with OI on individuals, healthcare systems and society at large. Future analyses will provide insights into country-specific economic impact, humanistic impact and the healthcare journey of individuals with OI. [ABSTRACT FROM AUTHOR]

We analyzed mineralogical characteristics, and major as well as rare earth element concentrations, from a cryptotephra layer in sediments of the infilled maar of Auel (Eifel, Germany). The results of detailed geochemical analyses of clinopyroxenes and their glassy rims from the Auel cryptotephra layer showed that they are similar to those from the thick Campanian Ignimbrite tephra occurrence in a loess section at Urluia (Romania). Both tephras show idiomorphic green clinopyroxenes and formation of distorted grains up to millimeter scale. The cryptotephra in the Auel core has a modelled age of around 39,940 yr b2k in the ELSA-20 chronology, almost identical to the latest 40Ar/39Ar dates for the Campanian Ignimbrite/Y-5 (CI/Y-5) eruption. These observations suggest that parts of the CI/Y-5 ash cloud were transported also northwestward into Central Europe, whereas the main branch of the CI/Y-5 ash plume was transported from southern Italy towards the NE, E, and SE. Based on pollen analyses, we conclude there was no direct effect on vegetation from the CI/Y-5 fallout in the Eifel area. Trees, shrubs, and grasses remained at pre-tephra-airfall levels for roughly 240 years, but changed around 39,700 yr b2k when thermophilic woody plants (e.g., Alnus and Carpinus) disappeared and Artemisia spread. This change in vegetation was well after the Laschamp geomagnetic excursion and also after the GI9 interstadial and quite probably represents the onset of the Heinrich Event 4 (H4) cold spell, when climatic conditions over the North Atlantic, and apparently also in Central Europe, deteriorated sharply. [ABSTRACT FROM AUTHOR]

In an effort to improve short-sea shipping in Europe, we present a 3D world interpreter (3DWI) system as part of a robotic container-handling system. The 3DWI is an advanced sensor suite combined with AI-based software and the communication infrastructure to connect to both the crane control and the shore control center. On input of LiDAR data and stereo captures, the 3DWI builds a world model of the operating environment and detects containers. The 3DWI and crane control are the core of an autonomously operating crane that monitors the environment and may trigger an emergency stop while alerting the remote operator of the danger. During container handling, the 3DWI scans for human activity and continuously updates a 3D-Twin model for the operator, enabling situational awareness. The presented methodology includes the sensor suite design, creation of the world model and the 3D-Twin, innovations in AI-detection software, and interaction with the crane and operator. Supporting experiments quantify the performance of the 3DWI, its AI detectors, and safety measures; the detectors reach the top of VisDrone's leaderboard and the pilot tests show the safe autonomous operation of the crane. [ABSTRACT FROM AUTHOR]

The combination of different item formats is found quite often in large scale assessments, and analyses on the dimensionality often indicate multi-dimensionality of tests regarding the task format. In ICILS 2013, three different item types (information-based response tasks, simulation tasks, and authoring tasks) were used to measure computer and information literacy in order to balance technological and information-related aspects of computer and information literacy. The item types differ in the cognitive processes and the type of knowledge they measure and in the strands and aspects of the ICILS 2013 framework they address. In this article, we explored which factor models that assume item type factors or type of knowledge factors fit the data. For the factors of the best fitting models, regression analyses on SES, frequency of computer use, self-efficacy, and gender were computed to work out the different meanings and the convergent and discriminant validity of the factors. The results show that three-dimensional models with correlated factors for item type or type of knowledge fit best. Regression analyses discover substantive implications of between-item and within-item models. The effects are discussed and an outlook is given.

The article stresses the need for comprehensive changes and strategic investments to enhance health emergency preparedness. Topics discussed include the tough lessons taught by the COVID-19 pandemic, the need for more bold and more rapid health systems reform, and the virtuous cycle of targeted investments.

Introduction: The goal of the Health Technology Assessment (HTA) Regulation 2021/2282 is to establish a more harmonized HTA framework, fostering member states cooperation and enabling equal patient access to innovative health technologies in Europe. This research aimed to assess the impact of the regulation on national HTAs, the strategic implications for health technology developers, and its influence on price and reimbursement negotiations. Methods: A scoping literature review encompassing peer-reviewed literature as well as grey literature was conducted. Between February and March 2023, semistructured interviews (n = 20) were performed with stakeholders from Belgian governmental institutions, European institutions, advanced therapy medicinal product developers, academics, and sickness funds. The interviews were analyzed using the framework analysis method. Results: Numerous steps, such as the development of implementing acts and procedural guidelines remain to be taken. At member state level, national/regional HTA bodies and payers must act to adopt the new concepts of Joint Scientific Consultations (JSC) and Joint Clinical Assessments (JCA) within their national legislation, as well as revise their timelines and prepare for interactions at a European level. Compiling a harmonized PICO (Population, Intervention, Comparator, and Outcome), adapting local procedures, and increasing capacity to actively take part in the JSC and JCA are seen as primary barriers by several stakeholders. Training and education will help HTA bodies, payers, and health technology developers to participate in the European processes. Conclusion: While practical and legal challenges were identified, recommendations (such as actively preparing for the upcoming changes and increasing capacity while providing training) were provided to adapt national and European procedures to the needs of the HTA Regulation 2021/2282. The importance of fostering collaborations and aligning local HTA procedures with the new way of working set out by the Regulation was demonstrated with this study. [ABSTRACT FROM AUTHOR]

Investigating past interglacial climatic and environmental changes can enhance our understanding of the natural rates and ranges of climate variability under interglacial boundary conditions. However, comparing past interglacial palaeoclimate records from different regions and archives is often complicated by differing and uncertain chronologies. For instance, the duration of the Last Interglacial in Europe is still controversial as southern European palaeoclimate records suggest a duration of ~16 500–18 000 years, while a length of only ~11 000 years in northern‐central Europe was previously inferred from the analysis of partly annually laminated (varved) palaeolake sediments recovered at Bispingen, northern Germany. To resolve this discrepancy, we here present sediment microfacies, geochemistry and pollen data from a new sediment core from the Bispingen palaeolake sediment succession, covering the entire Last Interglacial (Eemian) and the earliest part of the Last Glacial (Weichselian). In particular, we provide evidence that the duration of the Last Interglacial at Bispingen must have been hitherto underestimated due to the investigation of an incomplete sediment core. Using microscopic varve counting and sedimentation rate estimates for non‐varved sections on the new sediment core, we show that the Eemian in northern‐central Europe probably lasted at least ~15 000 years, about 4000 years longer than previously thought. This new duration estimate is in much better agreement with results from southern European palaeoclimate records, clarifying the enigma of a steep trans‐European vegetation gradient for several millennia at the end of the Last Interglacial. [ABSTRACT FROM AUTHOR]

Millennial-scale climate variations during the last glacial period, such as Dansgaard–Oeschger (DO) cycles and Heinrich events, have been extensively studied using ice core and marine proxy records. However, there is a limited understanding of the magnitude of these temperature fluctuations in continental regions, and questions remain about the seasonal signal of these climate events. This study presents a 60 000-year-long temperature reconstruction based on branched glycerol dialkyl glycerol tetraethers (brGDGTs) extracted from lake sediments from the Eifel Volcanic Field, Germany. brGDGTs are bacterial membrane-spanning lipids that are known to have a strong relationship with temperature, making them suitable for temperature reconstructions. We test several temperature calibration models on modern samples taken from soils and multiple maar lakes. We find a negative bias in brGDGT-based temperature estimates associated with water depth and anoxic conditions that can be corrected for by accounting for a brGDGT isomer that is only produced in anoxic conditions. The corrected temperature reconstruction correlates with proxy and climate model estimates of temperature spanning the same time period, validating the calibration approach we selected. However, millennial-scale variability is significantly dampened in the brGDGT record, and in contrast to other Northern Hemisphere climate records, during several Heinrich stadials, temperatures actually increase. We demonstrate that these apparent discrepancies can be explained by the unique seasonal response of the brGDGT paleothermometer to temperatures of months above freezing (TMAF). Our data support the view that warm-season temperatures in Europe varied minimally during the last glacial period and that abrupt millennial-scale events were defined by colder, longer winters. Our continuous high-resolution temperature reconstruction provides important information about the magnitude of seasonal climate variability during the last glacial period that can be used to test climate models and inform studies of paleoecological change. [ABSTRACT FROM AUTHOR]

Aims: Tricuspid regurgitation (TR) is commonly observed in patients with severe left‐sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population. Methods and results: Among 6883 patients with severe native left‐sided VHD or previous left‐sided valvular intervention enrolled in the EURObservational Research Programme prospective VHD II survey, moderate or severe TR was very frequent in patients with severe mitral VHD (30% when mitral stenosis, 36% when mitral regurgitation [MR]), especially in patients with secondary MR (46%), and rare in patients with severe aortic VHD (4% when aortic stenosis, 3% when aortic regurgitation). An increase in TR grade was associated with a more severe clinical presentation and a poorer 6‐month survival (p < 0.0001). Rates of concomitant tricuspid valve (TV) intervention at the time of left‐sided heart valve surgery were high at the time of mitral valve surgery (50% when mitral stenosis, 41% when MR). Concordance between class I indications (patients with severe TR) for concomitant TV surgery at the time of left‐sided valvular heart surgery according to guidelines and real‐practice decision‐making was very good (88% overall, 95% in patients operated on for MR). Conclusion: In this large international prospective survey among patients with severe left‐sided VHD, moderate/severe TR was frequent in patients with mitral valve disease and was associated with a poorer outcome as TR grade increased. In patients with severe TR, compliance to guidelines for class I indications for concomitant TV surgery at the time of left‐sided heart valve surgery was very good. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios. Methods: A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2. Results: In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer. Conclusion: Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment. [ABSTRACT FROM AUTHOR]

The literature on migrants' self-selection is focused on labour migrants, while little is known about refugees and internally displaced persons (IDPs). We contribute to this scant literature, by (1) examining a broad set of factors that could determine self-selection, (2) contrasting self-selection profiles of refugees and IDPs, and (3) comparing self-selection profiles of refugees across countries. Specifically, we compare the self-selection profiles of Ukrainian refugees and IDPs with stayers in the months directly following the Russian full-scale invasion in February 2022. We draw on unique, cross-nationally comparative data from the OneUA project, which surveyed Ukrainian refugees and displaced persons in Europe as well as those who stayed in Ukraine in the summer of 2022. More than 24,000 Ukrainian women residing in nine countries participated in this survey. We find systematic empirical patterns of self-selection related to people's region of origin, family status, and individual-level characteristics. [ABSTRACT FROM AUTHOR]

As the production of battery cells experiences exponential growth and electric vehicle fleets continue to expand, an escalating number of traction batteries are nearing the conclusion of their operational life for mobility purposes, both presently and in the foreseeable future. Concurrently, the heightened interest in sustainable energy storage solutions has spurred investigations into potential second-life applications for aging traction batteries. Nonetheless, the predominant practice remains the removal of these batteries from electric vehicles, signifying the end of their life cycle, and their subsequent incorporation into recycling processes, with limited consideration for life-extending measures. This study seeks to elucidate the reasons behind the deprioritization of battery repurposing strategies. Therefore, the research team conducted two industry studies with over 20 battery experts from Europe, revealing concerns about the economic viability of repurposing batteries for stationary storage applications. A literature review of studies published since 2016 confirmed the industry's struggles to address this issue theoretically. In conclusion, a research question was formulated, and a solution approach was delineated to assess the economic prospects of aged traction batteries within the industry's landscape in the future. This solution approach encompasses pertinent market analysis, the identification of representative second-life applications, as well as the formulation of a methodology for evaluating the residual value of these batteries. [ABSTRACT FROM AUTHOR]

Electricity generation in Europe is undergoing a fundamental change. The aim is to increase sustainability by reducing emissions. Each country has a different electricity mix, and there is no established method for measuring environmental impacts of electricity production with a single monetary indicator, in a uniform manner, and with country-specific data. To address this gap, a model that measures the costs of 19 environmental externalities (usually, types of emissions) has been developed. Using country-specific technologies, electricity mixes, and external cost rates, the development of external costs of generating electricity in 27 European countries between 2010 and 2030 is assessed and analyzed. The simulation results show that the external costs vary heavily between 2.1 and 22.4 euro cents per kWh in this period. Despite the initiated transformation of the energy systems in many EU countries, external costs per kWh are decreasing in only eight of them. This fact underlines the need for a drastic change in national energy strategies. Overall, the results show that more far-reaching policy measures are needed in order to significantly reduce the external costs of the energy sector in Europe. The article raises the level of granularity of research on the external costs of electricity in Europe by combining extensive country-specific emission data and country-specific external cost rates. [ABSTRACT FROM AUTHOR]

The Upper Triassic-Lower Jurassic succession of the Barents Sea Shelf (BSS) represents one of Europe's most prolific and strategic petroleum systems. This succession reflects various depositional environments and tectonostratigraphic events. Even though these strata are considered largely well-understood, connections with far-field stresses triggered by regional tectonics remain a subject of investigation. This study presents new interpretations that focus on relationships between the stratigraphic succession across the south-central BSS and Triassic-Jurassic Novaya Zemlya compressional tectonics. By applying the "tectophase model," developed in the Appalachian Basin, to analyze this succession, the presence of foreland-basin depozones and associated far-field processes related to compressional tectonics in an adjacent orogen are suggested. This model addresses unconformity development, lithostratigraphic succession, and reactivation of structures. Use of this model suggests far-field tectonostratigraphic responses during two episodes of Novaya Zemlya tectonism, reflected in the coeval BSS stratigraphy. Overall, this tectonostratigraphic study aligns with other research suggesting a Late Triassic inception for Novaya Zemlya compressional tectonism, which influenced larger parts of the BSS through extensive clastic sedimentation, far-field structural reactivation, and flexural responses to deformational loading triggered by tectonics. [ABSTRACT FROM AUTHOR]

• Agricultural intensification affects life history and functional trait diversity of farmland bird communities. • We calculated the functional diversity index and the community-weighted mean for six life history traits and the brood value index of 30 bird species in eight European farmland areas. • Stronger agricultural intensification at the field level (agrochemicals use, ploughing frequency) favors the assembly of shorter-lived communities and bird species with smaller relative brain sizes. Agricultural intensification reduces the taxonomic diversity of bird communities, but its influence on functional diversity has been less studied. Here, we analyze the response of functional diversity of different cereal farmland bird communities across Europe to a gradient of agricultural intensification. We collected bibliographical information on life history traits (i.e. body mass, brain size, age of sexual maturity, clutch size, number of clutches, lifespan) of 30 species of birds recorded during field surveys in eight European countries. The index "brood value" was calculated to know each species' level of reproductive investment per clutch. Intensification gradients at two spatial scales were obtained from field data through PCA, related to management practices at the field scale and the variation in structure and composition of farmland at the landscape scale respectively. We calculated the functional diversity index (FD) and the community-weighted mean (CWM) for each trait and sampling area, and linear mixed models in relation to the two intensification gradients were performed. Results showed that stronger intensification at the field level favors the assembly of shorter-lived communities and bird species with smaller relative brain sizes, also decreasing overall trait diversity. It also restricts the range of strategies for parental investment, reducing the functional diversity of the brood value index. More intensive field management would favor bird communities dominated by generalist and even introduced and/or managed hunting species, while putting at risk those farmland- and grassland-adapted species, typically more associated with the provision of ecosystem services. This highlights the relevance of field management (agrochemicals use, ploughing frequency) for the functional composition of bird communities and the conservation of farmland biodiversity. These findings add to existing knowledge on how species' pace of life and cognitive capacity interact with drivers of global change, such as agricultural intensification. [ABSTRACT FROM AUTHOR]

Short-term adaptive evolution represents one of the primary mechanisms allowing species to persist in the face of global change. Predicting the adaptive response at the species level requires reliable estimates of the evolutionary potential of traits involved in adaptive responses, as well as understanding how evolutionary potential varies across a species' range. Theory suggests that spatial variation in the fitness landscape due to environmental variation will directly impact the evolutionary potential of traits. However, empirical evidence on the link between environmental variation and evolutionary potential across a species range in the wild is lacking. In this study, we estimate multivariate evolutionary potential (via the genetic variance–covariance matrix, or G-matrix) for six morphological and life history traits in 10 wild populations of great tits (Parus major) distributed across Europe. The G-matrix significantly varies in size, shape, and orientation across populations for both types of traits. For life history traits, the differences in G-matrix are larger when populations are more distant in their climatic niche. This suggests that local climates contribute to shaping the evolutionary potential of phenotypic traits that are strongly related to fitness. However, we found no difference in the overall evolutionary potential (i.e. G-matrix size) between populations closer to the core or the edge of the distribution area. This large-scale comparison of G-matrices across wild populations emphasizes that integrating variation in multivariate evolutionary potential is important to understand and predict species' adaptive responses to new selective pressures. [ABSTRACT FROM AUTHOR]

Background: West Nile virus (WNV) outbreaks in birds, humans, and livestock have occurred in multiple areas in Europe and have had a significant impact on animal and human health. The patterns of emergence and spread of WNV in Europe are very different from those in the US and understanding these are important for guiding preparedness activities. Methods: We mapped the evolution and spread history of WNV in Europe by incorporating viral genome sequences and epidemiological data into phylodynamic models. Spatially explicit phylogeographic models were developed to explore the possible contribution of different drivers to viral dispersal direction and velocity. A "skygrid-GLM" approach was used to identify how changes in environments would predict viral genetic diversity variations over time. Findings: Among the six lineages found in Europe, WNV-2a (a sub-lineage of WNV-2) has been predominant (accounting for 73% of all sequences obtained in Europe that have been shared in the public domain) and has spread to at least 14 countries. In the past two decades, WNV-2a has evolved into two major co-circulating clusters, both originating from Central Europe, but with distinct dynamic history and transmission patterns. WNV-2a spreads at a high dispersal velocity (88km/yr–215 km/yr) which is correlated to bird movements. Notably, amongst multiple drivers that could affect the spread of WNV, factors related to land use were found to strongly influence the spread of WNV. Specifically, the intensity of agricultural activities (defined by factors related to crops and livestock production, such as coverage of cropland, pasture, cultivated and managed vegetation, livestock density) were positively associated with both spread direction and velocity. In addition, WNV spread direction was associated with high coverage of wetlands and migratory bird flyways. Conclusion: Our results suggest that—in addition to ecological conditions favouring bird- and mosquito- presence—agricultural land use may be a significant driver of WNV emergence and spread. Our study also identified significant gaps in data and the need to strengthen virological surveillance in countries of Central Europe from where WNV outbreaks are likely seeded. Enhanced monitoring for early detection of further dispersal could be targeted to areas with high agricultural activities and habitats of migratory birds. Author summary: Evidence for the drivers for West Nile virus (WNV) dispersal has been not clear in Europe. Here, we have comprehensively described the dispersal history of the currently predominant WNV lineage in Europe and estimated the contribution of key drivers of spread between and within countries. By fitting several phylodynamic and phylogeographic models, we found that 1) WNV in Europe has a greater lineage diversity than in other regions of the world. 2) Agricultural intensity had the greatest impact on both WNV spread direction and velocity. 3) WNV spread direction was specifically associated with urbanization and bird habitats. 4) Climate change and bio-diversity changes predicted viral genetic diversity over time. Our study revealed that to enhance preparedness for potential outbreaks, it is important to further define these drivers, and increase sampling for WNV in areas that appear to be a source of WNV in other countries in Europe, as well as in regions with known risk factors but where WNV has not yet been detected. [ABSTRACT FROM AUTHOR]

To further elucidate the Late Pleistocene glacial history of mid-elevation mountainous regions in Central Europe, 10Be cosmic-ray exposure (CRE) dating was applied to moraines in the Zastler Tal Valley in the Southern Black Forest. Periods of glacier recession from moraines in this valley began no later than 16 ka, 15 ka, and 13 ka. CRE ages of moraines in this and other parts of the Southern Black Forest cluster around 17–16 ka and 15–14 ka, thus suggesting a common forcing of glacier recession. Equilibrium-line altitudes (ELAs) during moraine formation were calculated for precipitation reconstruction. Observed spatial discrepancies in ELAs at ca. 15–14 ka are explained best by the size of snow-contributing areas. The reconstructed annual precipitation at the ELA for ca. 16 ka and ca. 15 ka is affected by large uncertainties, representing a wide range from ~50% to ~150% of present-day values. Due to various factors, such as drifting snow, the lower bounds of the estimates appear most realistic, thus concurring with the common hypothesis of less precipitation during the last glacial termination than today in Central Europe. Further research is needed before ELAs of small ice masses can be employed for precise precipitation estimates. [ABSTRACT FROM AUTHOR]

Purpose: The digital age requires people of all ages to communicate and organise their lives through digital technologies. The project EQualCare investigates how the growing population of older people living alone is managing this transition, how it shapes their (non-)digital social networks and what changes on a local level need to be brought about. This paper aims to give insight into the process of participatory action research (PAR) with older people in the community across four countries and reflects on experiences made by academic and co-researchers. Design/methodology/approach: Following the emancipatory underpinnings of PAR, which aims to reduce inequalities through collaboration and co-design, EQualCare involved nine teams of co-researchers across Finland, Germany, Latvia and Sweden making older people the centre of policy development. Co-researchers were involved in formulating research aims, collecting data, reflecting on data, formulating and disseminating recommendations for local policy stakeholders. Findings: Co-researchers' motivation to invest considerable time and effort was driven by a desire to create a more equal future for older people living alone. Moreover, they were keen to involve marginalised older people and became frustrated when this proved difficult. Power dynamics played a role throughout the process but became productive as roles and responsibilities were renegotiated. Doing PAR with older people can be emotionally challenging for co-researchers when negative feelings around ageing are encountered. Originality/value: The paper advances understanding on the process of PAR in ageing research by reflecting on the social, cultural and political contexts of doing PAR with diverse sets of older people. [ABSTRACT FROM AUTHOR]

3D-printing of medicines is an innovative manufacturing method that is characterised by a high degree of digitalisation and automation and enables patient-specific care. Its integration into routine healthcare processes currently fails mainly due to the requirements of a digital environment. Our hospital was the first hospital in Europe to introduce a fully comprehensive patient record in 2011 and to digitalise and automate the drug supply process. The aim of our study is to evaluate the integration of a machine-learning assisted 3D printing of medicines into the already existing, fully digital medication process of the hospital (closed-loop medication management, CLMM). Here, the design of this feasibility study and first results of subprojects are presented. First, a suitable and clinically relevant active ingredient (levodopa/carbidopa) was identified in a multistep approach by an interdisciplinary panel of experts using defined evaluation criteria, taking into account galenic, clinical and machine learning aspects. In the next step, a galenic formulation using a suitable printing technology for manufacturing a drug according to pharmaceutical quality criteria in different dosages is to be developed and to be evaluated for compliance with quality criteria according to the European Pharmacopoeia. Furthermore, an IT concept was developed and adapted to the hospital's current IT infrastructure. Likewise, a machine learning algorithm is to be developed to determine the optimal dose for each individual patient using data from smart wearable devices. For this purpose, a clinical trial was set up as a proof-of-principle study for the use of wearables to detect and grade clinical symptoms from Parkinson's Disease. Finally, the process is to be connected to the digital medication process of the hospital taking into account regulatory requirements. Thus, this interdisciplinary feasibility study will provide important insights into the possibilities of integrating patient-specific 3D printing of medicines into everyday clinical practice in the hospital. [ABSTRACT FROM AUTHOR]

Adequate pain management is essential for ethical and scientific reasons in animal experiments and should completely cover the period of expected pain without the need for frequent re-application. However, current depot formulations of Buprenorphine are only available in the USA and have limited duration of action. Recently, a new microparticulate Buprenorphine formulation (BUP-Depot) for sustained release has been developed as a potential future alternative to standard formulations available in Europe. Pharmacokinetics indicate a possible effectiveness for about 72 h. Here, we investigated whether the administration of the BUP-Depot ensures continuous and sufficient analgesia in two mouse fracture models (femoral osteotomy) and could, therefore, serve as a potent alternative to the application of Tramadol via the drinking water. Both protocols were examined for analgesic effectiveness, side effects on experimental readout, and effects on fracture healing outcomes in male and female C57BL/6N mice. The BUP-Depot provided effective analgesia for 72 h, comparable to the effectiveness of Tramadol in the drinking water. Fracture healing outcome was not different between analgesic regimes. The availability of a Buprenorphine depot formulation for rodents in Europe would be a beneficial addition for extended pain relief in mice, thereby increasing animal welfare. [ABSTRACT FROM AUTHOR]

The advancement of sciences and technologies, economic challenges, increasing expectations, and consumerism result in a radical transformation of health and social care around the globe, characterized by foundational organizational, methodological, and technological paradigm changes. The transformation of the health and social care ecosystems aims at ubiquitously providing personalized, preventive, predictive, participative precision (5P) medicine, considering and understanding the individual's health status in a comprehensive context from the elementary particle up to society. For designing and implementing such advanced ecosystems, an understanding and correct representation of the structure, function, and relations of their components is inevitable, thereby including the perspectives, principles, and methodologies of all included disciplines. To guarantee consistent and conformant processes and outcomes, the specifications and principles must be based on international standards. A core standard for representing transformed health ecosystems and managing the integration and interoperability of systems, components, specifications, and artifacts is ISO 23903:2021, therefore playing a central role in this publication. Consequently, ISO/TC 215 and CEN/TC 251, both representing the international standardization on health informatics, declared the deployment of ISO 23903:2021 mandatory for all their projects and standards addressing more than one domain. The paper summarizes and concludes the first author's leading engagement in the evolution of pHealth in Europe and beyond over the last 15 years, discussing the concepts, principles, and standards for designing, implementing, and managing 5P medicine ecosystems. It not only introduces the theoretical foundations of the approach but also exemplifies its deployment in practical projects and solutions regarding interoperability and integration in multi-domain ecosystems. The presented approach enables comprehensive and consistent integration of and interoperability between domains, systems, related actors, specifications, standards, and solutions. That way, it should help overcome the problems and limitations of data-centric approaches, which still dominate projects and products nowadays, and replace them with knowledge-centric, comprehensive, and consistent ones. [ABSTRACT FROM AUTHOR]

With increasing technology and knowledge, the range of methods used to monitor wildlife is growing. As many invasive techniques have been shown to negatively impact study populations, the use of non-invasive methods is increasing. With Eurasian beaver (Castor fiber) reintroductions occurring across much of Europe, monitoring of beavers is becoming increasingly important; however, some frequently used techniques are invasive. We therefore aimed to examine potentially non-invasive methods of identifying and ageing them from the tail. Tails from previously deceased beavers were photographed with a Nikon D3500 DSLR camera across 3 distances: 'close', 'medium' and 'far', and the pattern of the scales were examined by eye to determine accuracy of individual identification. Photographs including a grey standard were used to determine the accuracy of ageing beavers from the colour of the tail. The accuracy of individual identification was 100% across all distances; however, the results from ageing showed the method to be inaccurate. The success of the individual identification shows that this method could be effectively used as a non-invasive method for monitoring beaver populations, especially in captivity. [ABSTRACT FROM AUTHOR]

Background: The head and neck cancers (HNCs) incidence differs between Europe and East Asia. Our objective was to determine whether survival of HNC also differs between European and Asian countries. Methods: We used population-based cancer registry data to calculate 5-year relative survival (RS) for the oral cavity, hypopharynx, larynx, nasal cavity, and major salivary gland in Europe, Taiwan, and Japan. We modeled RS with a generalized linear model adjusting for time since diagnosis, sex, age, subsite, and histological grouping. Analyses were performed using federated learning, which enables analyses without sharing sensitive data. Findings: Five-year RS for HNC varied between geographical areas. For each HNC site, Europe had a lower RS than both Japan and Taiwan. HNC subsites and histologies distribution and survival differed between the three areas. Differences between Europe and both Asian countries persisted even after adjustments for all HNC sites but nasal cavity and paranasal sinuses, when comparing Europe and Taiwan. Interpretation: Survival differences can be attributed to different factors including different period of diagnosis, more advanced stage at diagnosis, or different availability/access of treatment. Cancer registries did not have stage and treatment information to further explore the reasons of the observed survival differences. Our analyses have confirmed federated learning as a feasible approach for data analyses that addresses the challenges of data sharing and urge for further collaborative studies including relevant prognostic factors. [ABSTRACT FROM AUTHOR]

Millennial-scale climate variations during the last glacial period, such as Dansgaard–Oeschger (D/O) cycles and Heinrich events, have been extensively studied using ice core and marine proxy records. However, there is a limited understanding of the magnitude of these temperature fluctuations in continental regions, and questions remain about the seasonal signal of these climate events. This study presents a 60,000-year long temperature reconstruction based on branched glycerol dialkyl glycerol tetraethers (brGDGTs) extracted from lake sediments from the Eifel volcanic field, Germany. brGDGTs are bacterial membrane lipids that are known to have strong relationship with temperature, making them suitable for temperature reconstructions. We test several temperature calibration models on modern samples taken from soils and multiple maar lakes. We find a bias associated with water depth and anoxic conditions that can be corrected for by accounting for a brGDGT isomer that is only produced in anoxic conditions. The corrected temperature reconstruction correlates with proxy and model temperature record spanning the same time period, validating the calibration model. However, millennial-scale variability is significantly dampened in the brGDGT record, and in contrast to other northern hemisphere climate records, during several Heinrich stadials, temperatures actually increase. We demonstrate that these apparent discrepancies can be explained by the unique seasonal response of the brGDGT paleothermometer to temperatures of months above freezing (TMAF). Our data support the view that warm season temperatures in Europe varied minimally during the last glacial period, and that abrupt millennial-scale events were defined by colder, longer winters. Our continuous high-resolution temperature reconstruction provides important information about the magnitude of seasonal climate variability during the last glacial period that can be used to test climate models and inform studies of paleoecological change. [ABSTRACT FROM AUTHOR]

Glucocorticoids reduce disease activity and retard progression of joint damage in rheumatoid arthritis, but current recommendations discourage their use because of drug adverse effects. This study examined the effects of low-dose glucocorticoids on weight gain and hypertension, which are among the more worrisome adverse effects for patients and rheumatologists. Visual Abstract. The Effect of Low-Dose Glucocorticoids Over Two Years on Weight and Blood Pressure in Rheumatoid Arthritis: Individual Patient Data From Five Randomized Trials Glucocorticoids reduce disease activity and retard progression of joint damage in rheumatoid arthritis, but current recommendations discourage their use because of drug adverse effects. This study examined the effects of low-dose glucocorticoids on weight gain and hypertension, which are among the more worrisome adverse effects for patients and rheumatologists. Background: Weight gain and hypertension are well known adverse effects of treatment with high-dose glucocorticoids. Objective: To evaluate the effects of 2 years of low-dose glucocorticoid treatment in rheumatoid arthritis (RA). Design: Pooled analysis of 5 randomized controlled trials with 2-year interventions allowing concomitant treatment with disease-modifying antirheumatic drugs. Setting: 12 countries in Europe. Patients: Early and established RA. Intervention: Glucocorticoids at 7.5 mg or less prednisone equivalent per day. Measurements: Coprimary end points were differences in change from baseline in body weight and mean arterial pressure after 2 years in intention-to-treat analyses. Difference in the change of number of antihypertensive drugs after 2 years was a secondary end point. Subgroup and sensitivity analyses were done to assess the robustness of primary findings. Results: A total of 1112 participants were included (mean age, 61.4 years [SD, 14.5]; 68% women). Both groups gained weight in 2 years, but glucocorticoids led, on average, to 1.1 kg (95% CI, 0.4 to 1.8 kg; P  < 0.001) more weight gain than the control treatment. Mean arterial pressure increased by about 2 mm Hg in both groups, with a between-group difference of −0.4 mm Hg (CI, −3.0 to 2.2 mm Hg; P  = 0.187). These results were consistent in sensitivity and subgroup analyses. Most patients did not change the number of antihypertensive drugs, and there was no evidence of differences between groups. Limitation: Body composition was not assessed, and generalizability to non-European regions may be limited. Conclusion: This study provides robust evidence that low-dose glucocorticoids, received over 2 years for the treatment of RA, increase weight by about 1 kg but do not increase blood pressure. Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

The European Commission has set targets for a reduction in nutrient losses by at least 50% and a reduction in fertiliser use by at least 20% by 2030 while ensuring no deterioration in soil fertility. Within the mandate of the European Joint Programme EJP Soil 'Towards climate‐smart sustainable management of agricultural soils', the objective of this study was to assess current fertilisation practices across Europe and discuss the potential for harmonisation of fertilisation methodologies as a strategy to reduce nutrient loss and overall fertiliser use. A stocktake study of current methods of delivering fertilisation advice took place across 23 European countries. The stocktake was in the form of a questionnaire, comprising 46 questions. Information was gathered on a large range of factors, including soil analysis methods, along with soil, crop and climatic factors taken into consideration within fertilisation calculations. The questionnaire was completed by experts, who are involved in compiling fertilisation recommendations within their country. Substantial differences exist in the content, format and delivery of fertilisation guidelines across Europe. The barriers, constraints and potential benefits of a harmonised approach to fertilisation across Europe are discussed. The general consensus from all participating countries was that harmonisation of fertilisation guidelines should be increased, but it was unclear in what format this could be achieved. Shared learning in the delivery and format of fertilisation guidelines and mechanisms to adhere to environmental legislation were viewed as being beneficial. However, it would be very difficult, if not impossible, to harmonise all soil test data and fertilisation methodologies at EU level due to diverse soil types and agro‐ecosystem influences. Nevertheless, increased future collaboration, especially between neighbouring countries within the same environmental zone, was seen as potentially very beneficial. This study is unique in providing current detail on fertilisation practices across European countries in a side‐by‐side comparison. The gathered data can provide a baseline for the development of scientifically based EU policy targets for nutrient loss and soil fertility evaluation. [ABSTRACT FROM AUTHOR]

BACKGROUND: Upper extremity function (UEF) is often compromised in multiple sclerosis (MS), although its importance is regularly underrecognized relative to ambulation. We explored the concurrent presence of impairment in UEF and ambulation by examining various aspects of UEF across different levels of ambulation. METHODS: The cohort consisted of 247 patients with clinically definite MS or clinically isolated syndrome according to the revised 2010 McDonald criteria. The Nine-Hole Peg Test and the Expanded Disability Status Scale were used to stratify patients into clinically different subgroups. For UEF, cerebellar function (finger-to-nose test), pyramidal function (pronator drift test), and the ability to perform a task of activities of daily living (drinking- from-cup test) were examined. Patient-reported limitations of UEF in daily life were assessed using the Arm Function in Multiple Sclerosis Questionnaire. RESULTS: Patients in more severely impaired ambulation groups displayed poorer performance on all UEF measures. Although most patients had normal to mild (n = 147) or moderate (n = 46) ambulatory impairment, 87.7% exhibited some level of UEF impairment as defined using the Nine-Hole Peg Test. Most patients had mild UEF impairment (n = 174), accounting for the largest proportion in all ambulation groups (51.9%-77.8%). CONCLUSIONS: A distinct pattern of impairment was found for ambulation and multiple aspects of UEF. Independent assessment of multiple aspects of disability may be helpful in treatment decision-making and could support the development of rehabilitation strategies that specifically target UEF impairment [ABSTRACT FROM AUTHOR]

Purpose: Our purpose in this study was to explore relationships between aspects of objective and perceived housing in five European samples of very old adults, as well as to investigate whether cross-national comparable patterns exist. Design and Methods: We utilized data from the first wave of the ENABLE-AGE Survey Study. The five national samples totalled 1,918 individuals aged 75 to 89 years. Objective assessments of the home environment covered the number of environmental barriers as well as the magnitude of accessibility problems (an aspect of person-environment fit). To assess perceptions of housing, we used instruments on usability, meaning of home, and housing satisfaction. We also assessed housing-related control. Results: Overall, the results revealed that the magnitude of accessibility problems, rather than the number of physical environmental barriers, was associated with perceptions of activity-oriented aspects of housing. That is, very old people living in more accessible housing perceived their homes as more useful and meaningful in relation to their routines and everyday activities, and they were less dependent on external control in relation to their housing. The patterns of such relationships were similar in the five national samples. Implications: Objective and perceived aspects of housing have to be considered in order to understand the dynamics of aging in place, and the results can be used in practice contexts that target housing for senior citizens.

Attention is drawn to important themes thought likely to influence the continuing development of group care services for children and young people in the decade ahead. These include a poorly educated workforce, autonomous training, multi-disciplinary approaches, centres of excellence, diversified programs, new trends and issues shaping the future, and group care practice and the law. (Contains 1 note.)

Population size, genetic diversity, and performance have fundamental importance for ecology, evolution, and nature conservation of plant species. Despite well‐studied relationships among environmental, genetic, and intraspecific trait variation (ITV), the influence of population size on these aspects is less understood. To assess the sources of population size variation, but also its impact on genetic, functional trait, and performance aspects, we conducted detailed population size estimations, assessed 23 abiotic and biotic environmental habitat factors, performed population genetic analyses using nine microsatellite markers, and recorded nine functional traits based on 260 Trifolium montanum individuals from 13 semi‐dry grassland locations of Central Europe. Modern statistical analyses based on a multivariate framework (path analysis) with preselected linear regression models revealed that the variation of abiotic factors (in contrast to factors per se) almost completely, significantly explained fluctuations in population size (R2 =.93). In general, abiotic habitat variation (heterogeneity) was not affected by habitat area. Population size significantly explained genetic diversity (NA: R2 =.42, Ho: R2 =.67, He: R2 =.43, and I: R2 =.59), inbreeding (FIS: R2 =.35), and differentiation (GST: R2 =.20). We also found that iFDCV (ITV) was significantly explained by abiotic habitat heterogeneity, and to a lesser extent by genetic diversity He (R2 =.81). Nevertheless, habitat heterogeneity did not statistically affect genetic diversity. This may be due to the use of selectively neutral microsatellite markers, and possibly by insufficient abiotic selective pressures on habitats examined. Small T. montanum populations in nonoptimal habitats were characterized by reduced genetic and functional trait diversity, and elevated genetic inbreeding and differentiation. This indicates reduced adaptability to current and future environmental changes. The long‐term survival of small populations with reduced genetic diversity and beginning inbreeding will be highly dependent on habitat protection and adequate land‐use actions. [ABSTRACT FROM AUTHOR]