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A substantial body of research shows that various types of audiovisual (AV) input such as videos and videos with second language (L2) subtitles can facilitate language learning. However, language teachers' day-to-day practices with regard to multimodal input is less understood. To bridge the gap in language education, this study investigates teachers' perceived use of four types of AV input (video only, video with subtitles, video with captions and video with enhanced captions) and factors influencing teachers' perspectives on these types of input for in-class and out-of-class learning. Questionnaire data were collected from 193 L2 teachers across the globe about their perceived use of AV input. Teachers reported that they use video and captioned video most frequently in both classroom and out-of-class contexts. Logistic regression analyses revealed that teachers' perceived importance and comfort using specific AV input types were the two most important factors explaining teachers' reported use. Complementarily, open-ended responses were analyzed qualitatively to identify teachers' additional reasons for (non)use of such input.

The growing numbers of mobile students over the years made the provision of student services a key topic of interest for higher education institutions. In order to offer a better experience for international students, it is important to be aware of and assess their needs in relation to different sets of support services. The data used in this paper were gathered through the ESNsurvey 2016 project, a research venture focused on the experiences of participants in short-term student mobility in Europe. Responses were collected from 12,365 international students, who have participated in a short-term (3-12 months) study period abroad mostly through Europe's most promoted mobility program called ERASMUS+. For the purpose of this paper, the focus was only on the aspect of host university support services. The comments of 2,012 students about their experiences were analyzed using a probabilistic methodology known as Latent Dirichlet Allocation (LDA). The findings reveal that some international students' concerns are not fully addressed by higher education institutions. The main problem areas identified with respect to host support services were admission, living costs, including accommodation and money concerns, and IT and bank issues. It is strongly recommended that universities address the problematic areas through student support services by assessing international students' opinions and needs.

Out-of-home mobility and social participation have been identified as resources to postpone frailty. We aim to examine the mediating role and specific contribution of social out-of-home activities in frailty prevention. Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) waves six (w6), seven (w7), and eight (w8) were used. Frailty was measured with the SHARE version of the Edmonton Frail Scale (EFS) with frailty states fit, pre-fail and frail. First, a mediation model with 13,456 fit participants aged ≥ 50 years in w6 was specified with social network size, loneliness (UCLA 3-Item Loneliness Scale), and lack of motivation (EURO-D) as predictors and number of performed social out-of-home activities in w7 as mediator variable on EFS-scores in w8. Age, education, gender, cohabitation, widowhood, urban environment, and country served as covariates. Second, we investigated the association of increasing social out-of-home activities from w6 to w7 with change in EFS-score from w6 to w8 using a linear mixed model with 17,439 participants in all frailty states. Direct effects of loneliness (w6) and lack of motivation (w6) on EFS-scores (w8) were partially mediated by social out-of-home activities (loneliness ß = 0.005; 95% CI = 0.003–0.008) and (lack of motivation ß = 0.014; 95% CI = 0.009–0.019). The linear mixed model revealed a significant effect of increasing social out-of-home activities (w6–w7) on reduction of EFS-scores (w8) (ß = − 0.21; 95% CI = − 0.29–0.04; p < 0.001). Social out-of-home activities appear to play a crucial role in frailty prevention, which could be used for future interventions. [ABSTRACT FROM AUTHOR]

A range of different factors drive student decision-making with respect to studying abroad, they are called push and pull factors. They influence in the (non)-mobility experience of students. This paper focuses on the international student experience, predominantly focusing on: credit-degree mobility and bachelor -- master students. The aim of this paper is to identify enablers and obstacles within the process of going abroad according to service provision along the international student lifecycle. By applying an innovative method -- Latent Dirichlet Allocation (LDA) -- to employ new techniques when looking for hidden structures in large numbers of texts (73,715 reviews from international students), we conclude that they exist significant differences between degree and credit mobility students, and not when comparing bachelor and master students. As a result, both groups of students place importance on three main aspects during their international experience: offerings of the city, social life and academics.

Objectives: Dental anthropological investigations into sexual dimorphism have conventionally concentrated on evaluating the dimensions and configuration of the enamel cap of canines. However, the morphology of the crown dentine surface can be closely linked to that of the enamel surface. This link can facilitate examination of crown morphology even when the enamel surface is slightly worn. Here, we determine if the morphology of the enamel‐dentine junction (EDJ) differs within (maxillary vs. mandibular) and between a sample of male (n = 26) and female (n = 21) contemporary human permanent canines from Europe. Methods: The morphological data of the EDJ were gathered employing a template comprising 96 landmarks and sliding semilandmarks. Subsequently, the data underwent analysis through form space principal component analysis following Procrustes registration, utilizing standard 3D geometric morphometric techniques. Results: Significant differences in the morphology of the EDJ were observed between the sexes, particularly concerning the overall shape of the crown, the symmetry of the mesial and distal edges, and the development of the distal accessory ridge. Conclusions: Sex differences in the morphology of the EDJ could relate in part to retention of the canine‐premolar honing complex in males. Our results indicate that analyses of the permanent canine EDJ may potentially provide a novel method for estimating the sex of adult and nonadult skeletons. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to obtain a comprehensive view of the risk of developing cancer in patients with obstructive sleep apnea (OSA) and to compare this risk between patients receiving continuous positive airway pressure (CPAP) therapy versus upper airway surgery (UAS). Methods: We used both local data and a global-scale federated data research network, TriNetX, to access electronic medical records, including those of patients diagnosed with OSA from health-care organizations (HCOs) worldwide. We used propensity score matching and the score-matched analyses of data for 5 years of follow-up, Results: We found that patients who had undergone UAS had a similar risk of developing cancer than those who used CPAP [hazard ratio of 0.767 (95% CI 0.559–1.053; P = 0.100)]. Conclusion: Analysis of the large data sets collected from HCOs in Europe and globally lead us to conclude that in patients with OSA, neither CPAP nor UAS were associated with the development of cancer better than in non-treated patients. [ABSTRACT FROM AUTHOR]

Background After an acute infection, older persons may benefit from geriatric rehabilitation (GR). Objectives This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. Design Multicentre prospective cohort study. Setting 59 GR facilities in 10 European countries. Participants Post-COVID-19 patients admitted to GR between October 2020 and October 2021. Methods Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6 weeks and 6 months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. Results 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0–7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P  < 0.001) points per month and stabilised around 17.0 (quadratic slope: −0.26, SE 0.02, P  < 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P  < 0.001) and stabilised around 0.8 (quadratic slope: −0.014, SE 0.001, P  < 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. Conclusions Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR. [ABSTRACT FROM AUTHOR]

Each year, thousands of migrants enter the EU. Data on drug use in migrant populations are scarce and inconclusive. However, several risk factors make them particularly vulnerable to engaging in problematic drug use. In this perspective, we summarize the limited information that is available on migrants who use drugs and make a case as to why it is essential to improve access to health and social services, including harm reduction services, for this population. With this aim, we call for the co-creation of integrated services that better address the needs of migrants who use drugs in Europe. [ABSTRACT FROM AUTHOR]

Rural-to-urban transformation (RUT) is the process of turning a rural or natural land surface into an urban one, which brings about important modifications in the surface, causing well-known effects like the urban heat island (UHI), reduced wind speeds, and increased boundary layer heights. Moreover, with concentrated human activities, RUT introduces new emission sources which greatly perturb local and regional air pollution. Particulate matter (PM) is one of the key pollutants responsible for the deterioration of urban air quality and is still a major issue in European cities, with frequent exceedances of limit values. Here we introduce a regional chemistry–climate model (regional climate model RegCM coupled offline to chemistry transport model CAMx) study which quantifies how the process of RUT modified the PM concentrations over central Europe including the underlying controlling mechanisms that contribute to the final PM pollution. Apart from the two most studied ones, (i) urban emissions and (ii) urban canopy meteorological forcing (UCMF; i.e. the impact of modified meteorological conditions on air quality), we also analyse two less studied contributors to RUT's impact on air quality: (iii) the impact of modified dry-deposition velocities (DVs) due to urbanized land use and (iv) the impact of modified biogenic emissions due to urbanization-induced vegetation modifications and changes in meteorological conditions which affect these emissions. To calculate the magnitude of each of these RUT contributors, we perform a cascade of simulations, whereby each contributor is added one by one to the reference state, while focus is given on PM 2.5 (particulate matter with diameter less then 2.5 µm). Its primary and secondary components, namely primary elemental carbon (PEC), sulfates (PSO 4), nitrates (PNO 3), ammonium (PNH 4), and secondary organic aerosol (SOA), are analysed too. The validation using surface measurements showed a systematic negative bias for the total PM 2.5 , which is probably caused by underestimated organic aerosol and partly by the negative bias in sulfates and elemental carbon. For ammonium and nitrates, the underestimation is limited to the warm season, while for winter, the model tends to overestimate their concentrations. However, in each case, the annual cycle is reasonably captured. We evaluated the RUT impact on PM 2.5 over a sample of 19 central European cities and found that the total impact of urbanization is about 2–3 and 1–1.5 µgm-3 in winter and summer, respectively. This is mainly driven by the impact of emissions alone causing a slightly higher impact (1.5–3.5 and 1.2–2 µgm-3 in winter and summer), while the effect of UCMF was a decrease at about 0.2–0.5 µgm-3 (in both seasons), which was mainly controlled by enhanced vertical eddy diffusion, while increases were modelled over rural areas. The transformation of rural land use into an urban one caused an increase in dry-deposition velocities by around 30 %–50 %, which alone resulted in a decrease in PM 2.5 by 0.1–0.25 µgm-3 in both seasons. Finally, the impact of biogenic emission modifications due to modified land use and meteorological conditions caused a decrease in summer PM 2.5 of about 0.1 µgm-3 , while the winter effects were negligible. The total impact of urbanization on aerosol components is modelled to be (values indicate winter and summer averages) 0.4 and 0.3 µgm-3 for PEC, 0.05 and 0.02 µgm-3 for PSO 4 , 0.1 and 0.08 µgm-3 for PNO 3 , 0.04 and 0.03 µgm-3 for PNH 4 , and 0 and 0.05 µgm-3 for SOA. The main contributor of each of these components was the impact of emissions, which was usually larger than the total impact due to the fact that UCMF was counteracted with a decrease. For each aerosol component, the impact of modified DV was a clear decrease in concentration, and finally, the modifications of biogenic emissions impacted SOA predominantly, causing a summer decrease, while a very small secondary effect of secondary inorganic aerosol was modelled too (they increased). In summary, we showed that when analysing the impact of urbanization on PM pollution, apart from the impact of emissions and the urban canopy meteorological forcing, one also has to consider the effect of modified land use and its impact on dry deposition. These were shown to be important in both seasons. For the effect of modified biogenic emissions, our calculations showed that they act on PM 2.5 predominantly through SOA modifications, which only turned out to be important during summer. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis is one of the most common diseases in children and an important cause of morbidity and mortality worldwide. No specific treatment is available; therefore, management is exclusively symptomatic. Xyloglucan has been approved in Europe as a class IIa medical device for restoration of the physiological functions of the intestinal wall. Our objective was to assess efficacy and safety of xyloglucan for the treatment of acute gastroenteritis in children. We performed a triple‐blind, randomized placebo‐controlled clinical trial in four primary care centers and one continued care hospital center. The study population comprised children with acute gastroenteritis aged >3 months and <5 years. Our primary endpoint was time (in hours) of resolution of diarrhea, defined as the time to resolution of stool consistency (Bristol Stool Form Scale ≤5 or Amsterdam Stool Form Scale B or C) or time until deposition frequency resumes to normality, whichever occurred first. We also recorded intravenous rehydration, hospitalization, stools per day, Vesikari scale, vomiting, relapse, weight loss, drugs prescribed, and adverse events. Eighty children were included in the intention‐to‐treat population (43 xyloglucan and 37 placebo) and 74 (93%) in the per‐protocol population. Time to resolution of diarrhea was similar in both groups with (median, 95% CI) 24, 17–24 h in the xyloglucan group versus 24, 19–24 h in the placebo group, p =.680. Significant differences were observed for patients with moderate‐to‐severe diarrhea (Vesikari scale ≥9): xyloglucan group (20 [15–24] h) versus placebo group (85 [51–120] h) (p =.04). No other significant differences were found. Xyloglucan can be considered safe and other studies should be performed to confirm the usefulness in patients with moderate‐to‐severe diarrhea. [ABSTRACT FROM AUTHOR]

Subseasonal‐to‐seasonal (S2S) forecasts span the prediction range of weeks to 2–3 months ahead, bridging the gap between medium‐range and seasonal weather forecasts. There has been growing interest in S2S forecasts in recent years, largely because of the many potential uses of forecasts spanning these timescales. However, the skill of S2S forecasts beyond the first 2 weeks or so is poor, potentially limiting the usability of these forecasts. We show in this study that when considering accumulated temperatures, there is in fact good forecasting skill over Europe for accumulation periods up to 30 days ahead. Using a set of S2S hindcasts, we show using both a deterministic and a probabilistic measure of skill that the accumulated 2‐metre temperature forecasts out to 30 days are skilful over most of Europe. In summer, South West Europe has highest skill, while in winter North East Europe has highest skill. As an example application of such forecasts, we also evaluate the skill for summer cooling degree‐days (CDD) and winter heating degree‐days (HDD). For 30‐day winter HDD, there is good skill in all four European regions; for 30‐day summer CDD, the skill is limited in North West Europe, but still good in other regions. [ABSTRACT FROM AUTHOR]

Coastal flooding is recognized as one of the most devastating natural disasters, resulting in significant economic losses. Therefore, hazard assessment is crucial to support preparedness and response to such disasters. Toward this, flood map databases and catalogues are essential for the analysis of flood scenarios, and furthermore they can be integrated into disaster risk reduction studies. In this study and in the context of the European Coastal Flood Awareness System (ECFAS) project (GA 101004211), which aimed to propose the European Copernicus Coastal Flood Awareness System, a catalogue of flood maps was produced. The flood maps were generated from flood models developed with LISFLOOD-FP for defined coastal sectors along the entire European coastline. For each coastal sector, 15 synthetic scenarios were defined focusing on high-frequency events specific to the local area. These scenarios were constructed based on three distinct storm durations and five different total-water-level (TWL) peaks incorporating tide, mean sea level, surge and wave setup components. The flood model method was extensively validated against 12 test cases for which observed data were collated using satellite-derived flood maps and in situ flood markers. Half of the test cases represented well the flooding with hit scores higher than 80 %. The synthetic-scenario approach was assessed by comparing flood maps from real events and their closest identified scenarios, producing a good agreement and global skill scores higher than 70 %. Using the catalogue, flood scenarios across Europe were assessed, and the biggest flooding occurred in well-known low-lying areas. In addition, different sensitivities to the increase in the duration and TWL peak were noted. The storm duration impacts a few limited flood-prone areas such as the Dutch coast, for which the flooded area increases more than twice between 12 and 36 h storm scenarios. The influence of the TWL peak is more global, especially along the Mediterranean coast, for which the relative difference between a 2- and 20-year return period storm is around 80 %. Finally, at a European scale, the expansion of flood areas in relation to increases in TWL peaks demonstrated both positive and negative correlations with the presence of urban and wetland areas, respectively. This observation supports the concept of storm flood mitigation by wetlands. [ABSTRACT FROM AUTHOR]

Extending the shelf life of food products like strawberries (Fragaria ananassa) is one of Europe's main goals to improving food safety and reduce food waste. In this study, a model has been developed to estimate and predict the quality of strawberries. Strawberries appearance and colour parameters has been determined by image analysis and traditional methods. Pictures of strawberries stored at 5-35 ℃ were taken daily for 15 days. In total, 48 images were recorded and analysed. The colour images (RGB images) were processed in the laboratory using a specific image acquisition and analysis program. A linear model has been developed with high accuracy (R²=0.83) to estimate appearance based only in image analysis. This approach allows the use of this technology in the food chain industry. [ABSTRACT FROM AUTHOR]

Background: Pru p 3 and Pru p 7 have been implicated as risk factors for severe peach allergy. This study aimed to establish sensitization patterns to five peach components across Europe and in Japan, to explore their relation to pollen and foods and to predict symptom severity. Methods: In twelve European (EuroPrevall project) and one Japanese outpatient clinic, a standardized clinical evaluation was conducted in 1231 patients who reported symptoms to peach and/or were sensitized to peach. Specific IgE against Pru p 1, 2, 3, 4 and 7 and against Cup s 7 was measured in 474 of them. Univariable and multivariable Lasso regression was applied to identify combinations of parameters predicting severity. Results: Sensitization to Pru p 3 dominated in Southern Europe but was also quite common in Northern and Central Europe. Sensitization to Pru p 7 was low and variable in the European centers but very dominant in Japan. Severity could be predicted by a model combining age of onset of peach allergy, probable mugwort, Parietaria pollen and latex allergy, and sensitization to Japanese cedar pollen, Pru p 4 and Pru p 7 which resulted in an AUC of 0.73 (95% CI 0.73–0.74). Pru p 3 tended to be a risk factor in South Europe only. Conclusions: Pru p 7 was confirmed as a significant risk factor for severe peach allergy in Europe and Japan. Combining outcomes from clinical and demographic background with serology resulted in a model that could better predict severity than CRD alone. [ABSTRACT FROM AUTHOR]

The rural-to-urban transformation (RUT) is the process of turning rural or natural land-surface into urban one which brings important modifications in the surface causing well know effects like the urban heat island (UHI), reduced wind-speeds, increased boundary layer heights and so on. Moreover, with concentrated human activities RUT introduces new emission source which greatly perturbs the local and regional air-pollution. Particulate matter (PM) is one of key pollutants responsible for deterioration of urban air-quality and is still a major issue in European cities with frequent exceedances of limit values. Here we introduce a regional chemistry-climate model (regional climate model RegCM coupled offline to chemistry transport model CAMx) study which quantifies how the process of RUT modified the PM concentrations over central Europe including the underlying controlling mechanisms that contribute to the final PM pollution. Apart from the two most studied ones, i) the urban emissions and ii) the urban canopy meteorological forcing (UCMF, i.e. the impact of modified meteorological conditions on air-quality) we analyze also two less studied contributors to the RUT's impact on air-quality: iii) the impact of modified dry-deposition velocities due to urbanized land-use and iv) the impact of modified biogenic emissions due to urbanization induced vegetation modifications and changes in meteorological conditions which affect these emissions. To calculate the magnitude of each of these RUT contributors, we perform a cascade of simulations were each contributor is added one-by-one to the reference state while focus is given on PM2.5 (particulate matter with diameter less then 2.5 µm). We also look at their primary and secondary components, namely primary elemental carbon (PEC), sulphates (PSO4), nitrates (PNO3), ammonium (PNH4) and secondary organic aerosol (SOA). The validation using surface measurements showed a systematic negative bias for the total PM2.5 which is probably caused by underestimated organic aerosol and partly by the negative bias in sulphates and elemental carbon. For ammonium and nitrate, the underestimation is limited to the warm season while for winter, the model tends to overestimate their concentrations. However, in each case, the annual cycle is reasonably captured. We evaluated the RUT impact on PM2.5 over an ensemble of 19 central European cities and found that the total impact of urbanization is about 2–3 and 1–1.5 µgm−3 in winter and summer, respectively. This is mainly driven by the impact of emissions alone causing a slightly higher impact (1.5–3.5 and 1.2–2 µgm−3 in winter and summer), while the effect of UCMF was a decrease at about 0.2–0.5 µgm−3 (in both seasons) which was mainly controlled by enhanced vertical eddy-diffusion while increases were modelled over rural areas. The transformation of rural land-use into urban one caused an increase of dry-deposition velocities by around 30–50 % which alone resulted in a decrease of PM2.5 by 0.1–0.25 µgm−3 in both seasons. Finally, the impact of biogenic emission modification due to modified land-use and meteorological conditions caused a decrease of summer PM2.5 of about 0.1 µgm−3 while the winter effects were negligible. The total impact of urbanization on aerosol components is modelled to be (values indicate winter and summer averages) 0.4 and 0.3 µgm−3 for PEC, 0.05 and 0.02 µgm−3 for PSO4, 0.1 and 0.08 µgm−3 for PNO3, 0.04 and 0.03 µgm−3 for PNH4 and 0 and 0.05 µgm−3 for SOA. The main contributor of each of these components was the impact of emissions which was usually larger than the total impact due to the fact that UCMF counteracted with a decrease. For each aerosol component the impact of modified DV was a clear decrease of concentration and finally, the modifications of biogenic emissions impacted predominantly SOA causing a summer decrease while a very small secondary effect of secondary inorganic aerosol was modelled too (they increased). In summary, we showed that when analyzing the impact of urbanization on PM pollution, apart from the impact of emissions and the urban canopy meteorological forcing, one has to consider also the effect of modified land-use and its impact on dry-deposition. These were shown to be important in both seasons. For the effect of modified biogenic emissions, our calculations showed that it acts on PM2.5 predominantly trough SOA modifications which turned to be important only during summer. [ABSTRACT FROM AUTHOR]

Simple Summary: (Poly)phenols are bioactive compounds naturally present in plant-based foods, but they have been suggested to increase the prostate cancer risk in retrospective case-control studies. Therefore, our aim was to prospectively evaluate these associations, including clinically relevant subtypes of prostate cancer. We investigated them using the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, a large observational study including 131,425 adult men from seven European countries. During 14 years of follow-up, a total of 6939 incident prostate cancer cases were identified. Overall, no statistically significant associations were observed between the baseline intake of any class and subclass of (poly)phenols and the risk of overall and any subtype of prostate cancer. In conclusion, the consumption of (poly)phenols and (poly)phenol-rich foods does not increase the risk of prostate cancer and can be included as part of a healthy diet. Existing epidemiological evidence regarding the potential role of (poly)phenol intake in prostate cancer (PCa) risk is scarce and, in the case of flavonoids, it has been suggested that their intake may increase PCa risk. We investigated the associations between the intake of the total and individual classes and subclasses of (poly)phenols and the risk of PCa, including clinically relevant subtypes. The European Prospective Investigation into Cancer and Nutrition (EPIC) cohort included 131,425 adult men from seven European countries. (Poly)phenol intake at baseline was assessed by combining validated center/country-specific dietary questionnaires and the Phenol-Explorer database. Multivariable-adjusted Cox proportional hazards models were used to estimate the hazard ratios (HR) and 95% confidence intervals (CI). In total, 6939 incident PCa cases (including 3501 low-grade and 710 high-grade, 2446 localized and 1268 advanced, and 914 fatal Pca cases) were identified during a mean follow-up of 14 years. No associations were observed between the total intake of (poly)phenols and the risk of PCa, either overall (HRlog2 = 0.99, 95% CI 0.94–1.04) or according to PCa subtype. Null associations were also found between all classes (phenolic acids, flavonoids, lignans, and stilbenes) and subclasses of (poly)phenol intake and the risk of PCa, overall and according to PCa subtype. The results of the current large prospective cohort study do not support any association between (poly)phenol intake and PCa incidence. [ABSTRACT FROM AUTHOR]

Summary : This narrative review summarises the recommendations of a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) for the conduct and reporting of real-world evidence studies with a focus on osteoporosis research. Purpose: Vast amounts of data are routinely generated at every healthcare contact and activity, and there is increasing recognition that these real-world data can be analysed to generate scientific evidence. Real-world evidence (RWE) is increasingly used to delineate the natural history of disease, assess real-life drug effectiveness, understand adverse events and in health economic analysis. The aim of this work was to understand the benefits and limitations of this type of data and outline approaches to ensure that transparent and high-quality evidence is generated. Methods: A ESCEO Working Group was convened in December 2022 to discuss the applicability of RWE to osteoporosis research and approaches to best practice. Results: This narrative review summarises the agreed recommendations for the conduct and reporting of RWE studies with a focus on osteoporosis research. Conclusions: It is imperative that research using real-world data is conducted to the highest standards with close attention to limitations and biases of these data, and with transparency at all stages of study design, data acquisition and curation, analysis and reporting to increase the trustworthiness of RWE study findings. [ABSTRACT FROM AUTHOR]

Coastal flooding is recognized as one of the most devastating natural disasters, resulting in significant economic losses. Therefore, hazard assessment is crucial to support preparedness and response to such disasters. Toward this, flood map databases and catalogues are essential for the analysis of flood scenarios, and furthermore can be integrated into disaster risk reduction studies. In this study and in the context of the ECFAS project (GA 101004211), which aimed to propose a European Copernicus Coastal Flood Awareness System, a catalogue of flood maps was produced. The flood maps were generated from flood models developed with LISFLOOD-FP for defined coastal sectors along the entire European coastline. For each coastal sector, fifteen synthetic scenarios were defined focusing on high-frequency events specific to the local area. These scenarios were constructed based on three distinct storm durations and five different Total Water Level (TWL) peaks incorporating tide, mean sea level, surge and wave set-up components. The flood model method was extensively validated against twelve test cases for which observed data were collated using satellite-derived flood maps and in situ flood markers. Half of the test-cases well represented the flooding with hit scores higher than 80 %. The synthetic scenario approach was assessed by comparing flood maps from real events and their closest identified scenarios, producing a good agreement and global skill scores higher than 70 %. Using the catalogue, flood scenarios across Europe were assessed, and the biggest flooding occurred in well-known low-lying areas. In addition, different sensitivities to the increase of the duration and TWL peak were noted. The storm duration impacts a few limited flood prone areas such as the Dutch coast for which the flooded area increases more than twice between a 12 h and 36 h storm scenarios. The influence of the TWL peak is more global, especially along the Mediterranean coast for which the relative difference between a 2- and 20-year return period storm is around 80 %. Finally, at a European scale, the expansion of flood areas in relation to increases in TWL (Total Water Level) peaks demonstrated both positive and negative correlations with the presence of urban and wetland areas, respectively. This observation supports the concept of storm flood mitigation by wetlands. [ABSTRACT FROM AUTHOR]

The GECEM Project Database stands out as a new Digital Humanities solution to accurately order and analyse the new historical Big Data gathered in Chinese and European historical archives. Traditional challenges such as capture, storage, analysis, data curation, searching, sharing, transfer, visualization, querying, updating, and information privacy are being tackled and solved within the design of this new multi-relational database. The implementation of this database has as its main innovative elements the capability of coding and cross-referring historical data in Chinese and Western languages. Thus, we present a new database as a digital solution to solve the long-lasting problem in historical research: the maximization and optimization of data collection when analysing historical sources and how to make use of a large amount of registers and information when developing case studies and work hypotheses for historical research. In this paper, we present a solution for data collection and analysis of probate inventories and trade records which is a relevant source when determining changes in patterns of consumption and global trade through the introduction of Chinese goods into Europe and vice versa during the early modern period. [ABSTRACT FROM AUTHOR]

Wind-blown dust (WBD) emitted by the Earth's surface due to sandblasting can potentially have important effects on both climate and human health via interaction with solar and thermal radiation, reducing air quality. Apart from the main dust "centres" around the world, like deserts, dust can be emitted from partly vegetated mid- and high-latitude areas like Europe if certain conditions are suitable (strong winds, bare soil, reduced soil moisture, etc.). Using a wind-blown dust model (WBDUST) along with a chemical transport model (Comprehensive Air-quality model with Extensions, CAMx) coupled to a regional climate model (Weather Research and Forecasting, WRF), this study is one of the first to provide a model-based estimate of such emissions over Europe as well as the long-term impact of WBD emissions on the total particulate matter (PM) concentrations for the 2007–2016 period. We estimated average WBD emissions of about 0.5 and 1.5 Mgyr-1km-2 in fine and coarse modes. Maximum emissions occur over Germany, where the average seasonal fine- and coarse-mode emission flux can reach 0.5 and 1 gs-1km-2 , respectively. Large variability is seen in the averaged daily emissions with values of up to 2 gs-1km-2 for the coarse-mode aerosol on selected days. The WBD emissions increased the modelled winter PM 2.5 and PM 10 concentrations by up to 10 and 20 µgm-3 , respectively, especially over Germany, where the highest emissions occur. The impact on other seasons is lower. Much higher impacts are modelled, however, on selected days when occasionally the urban PM 2.5 and PM 10 concentrations are increased by more than 50 and 100 µgm-3. The comparison with measurements revealed that if WBD is considered, the summer biases are reduced; however, the winter PM is overestimated even more greatly (so the bias increases). We identified a strong overestimation of the modelled wind speed (the maximum daily wind is almost 2 times higher in WRF than the measured ones) suggesting that WBD emissions are also overestimated – hence the enhanced winter PM biases. Moreover, we investigated the secondary impacts of the crustal composition of fine WBD particles on secondary inorganic aerosol (SIA): sulfates (PSO 4), nitrates (PNO 3) and ammonium (PNH 4). Because the water pH value, and thus the uptake of the gaseous precursors of SIA, is perturbed and because the increased aerosol surface serves as an oxidation site, we modelled seasonal PSO 4 and PNO 3 concentrations increased by up to 0.1 µgm-3 and PNH 4 ones decreased by up to -0.05 µgm-3 , especially during winter. In terms of average daily impact, these numbers can, however, reach much larger values of up to 1–2 µgm-3 for sulfates and nitrates, while the decrease in ammonium due to WBD can reach -1 µgm-3 on selected days. The sensitivity test on the choice of the inorganic equilibrium model (ISORROPIA vs. EQuilibrium Simplified Aerosol Model V4, EQSAM) showed that if EQSAM is used, the impact on SIA is slightly stronger (by a few 10 %) due to larger number of cations considered for water pH in EQSAM. Our results have to be regarded as a first estimate of the long-term WBD emissions and the related effects on PM over Europe. Due to the strong positive wind bias and hence strong WBD emissions, we should consider these results as an upper bound. More sensitivity studies involving the impact of the driving meteorological fields, WBD model choice and the input data used to describe the land surface need to be carried out in future to better constrain these emissions. [ABSTRACT FROM AUTHOR]

Introduction: Ceftazidime–avibactam has proven activity against multidrug-resistant (MDR) bacteria in clinical trials and real-world studies. This study was conducted to describe the patterns of use of ceftazidime–avibactam (including indications and associated antibiotics), and the effectiveness and safety of ceftazidime–avibactam in real-world clinical practice. Methods: This non-interventional medical chart review study was conducted in 11 countries across the European and Latin American (LATAM) regions. Consecutive patients treated in clinical practice with at least one dose of ceftazidime–avibactam for an approved indication per country label since 01 January 2018 (or launch date in the country if posterior) were enrolled. Effectiveness analyses were conducted in patients treated with ceftazidime–avibactam for at least 72 h. Results: Of the 569 eligible patients enrolled, 516 (90.7%) were treated for at least 72 h (354 patients from Europe and 162 patients from LATAM); 390 patients (75.7%) had switched from another antibiotic line for Gram-negative coverage. Infection sources were intra-abdominal, urinary, respiratory, bloodstream infections, and other infections (approximately 20% each). K. pneumoniae was the most common microorganism identified in the latest microbiological evaluation before starting ceftazidime–avibactam (59.3%). Two-thirds of microorganisms tested for susceptibility were MDR, of which 89.3% were carbapenem-resistant. The common MDR mechanisms for K. pneumoniae were carbapenemase (33.9%), oxacillinase 48 (25.2%), extended-spectrum beta-lactamase (21.5%), or metallo-beta-lactamase (14.2%) production. Without prior patient exposure, 17 isolates (mostly K. pneumoniae) were resistant to ceftazidime–avibactam. Treatment success was achieved in 77.3% of patients overall (88.3% among patients with urinary infection), regardless of first or second treatment line. In-hospital mortality rate was 23.1%. Adverse events were reported for six of the 569 patients enrolled. Conclusion: This study provides important real-world evidence on treatment patterns, effectiveness, and safety of ceftazidime–avibactam in clinical practice through its recruitment in the European and LATAM regions. Ceftazidime–avibactam is one of the antibiotics to consider for treatment of MDR bacteria. Trial Registration: ClinicalTrials.gov identifier, NCT03923426. [ABSTRACT FROM AUTHOR]

Rooted in theory of planned behavior (TPB) supplemented with self‐determination theory (SDT), this study explores determinants of willingness to receive and provide resources in Europe's non‐remunerated and remunerated collaborative consumption (CC). The exploration was conducted within a single research model by assessing the role of (a) TPB constructs reflecting attitude towards participation in CC, perceived social pressure to engage, and perceived level of difficulty that engagement requires and (b) SDT constructs of environmental, social, and economic motives for participation. The data were collected through an online questionnaire, and the structural relationships were analyzed using structural equation modeling. Willingness to consume in non‐remunerated and remunerated CC was positively directly influenced by social pressure to engage in CC and participation being perceived as pleasant, negatively by the level of difficulty that engagement requires, as well as positively indirectly influenced by environmental concern and sociability. Additionally, environmental concern had positive direct effect on willingness to consume only in the remunerated context. Willingness to provide in non‐remunerated CC was positively directly influenced by perceiving participation as pleasant and indirectly by environmental concern and sociability. Resource provision in remunerated CC was not explained by any of the determinants. [ABSTRACT FROM AUTHOR]

Air pollution is a major environmental threat to human health. Pollutants can reach extreme levels in the lower atmosphere when weather conditions permit. As pollutant concentrations depend on scales and processes that are not fully represented in current global circulation models (GCMs), and it is often too computationally expensive to run models with atmospheric chemistry and aerosol processes, air stagnation is often used as a proxy for pollution events with particular success in Europe. However, the variables required to identify air stagnation can have biases in GCM output, which adds uncertainty to projected trends in air stagnation. Here, the representation of air stagnation in GCMs is assessed for Europe in the historical period and in end-of-century projections based on a high-emission scenario using three methods for identifying air stagnation. The monthly frequency of stagnation during summer and autumn is projected to increase with climate change when stagnation is identified by a well-established index. However, this increase is not present when air-stagnation frequency is estimated using a statistical model based on the synoptic- to large-scale atmospheric circulation. This implies that the projected increases in air stagnation are not driven by an increase in frequency or severity of large-scale circulation events that are conducive to stagnation. Indeed, projected changes to the atmospheric circulation in GCMs, in particular a reduction in atmospheric block frequency, would suggest a reduction in future air stagnation. Additional analyses indicate that the projected increases in stagnation frequency follow the trend toward more frequent dry days, which is apparently unrelated to the large-scale drivers of air stagnation. [ABSTRACT FROM AUTHOR]

Background: Since the first European-wide evaluation of dystonia management in 2016, several efforts have been made to improve dystonia-care. One of these was the development of the Dystonia Disease Group as a part of the European Reference Network for Rare Neurological Diseases (ERN-RND) that implemented several initiatives based on the recommendations made in 2016. Aim: To evaluate the current state of dystonia management across Europe. Methods: Twenty-four countries were surveyed via 62 dystonia-experts from 44 ERN-RND-related centers. Results: Dystonia-experts for adult patients were available in all surveyed countries. However, almost half of the countries evaluated accessibility as merely 'satisfactory'. Access to genetic and neurophysiological testing was challenging to varying degrees in over half of countries. Main oral medications and botulinum toxin were available in all countries. Deep brain stimulation (DBS) was easily accessible in one-third of the countries. Dystonia research was conducted in 20/24 countries. Trainings on dystonia for general practitioners (GPs) were available in 11/24 countries. However, lack of trainings for other professionals was almost general. For pediatric dystonia, experts and specific training were available in over half of the countries. Conclusions: In this overview, we present the current state of dystonia management within ERN-RND. Management has slightly improved since 2016 in several fields, including diagnostics, availability of DBS, and research. The results highlight that future challenges in dystonia management are accessibility of experts, and diagnostic tools and treatments, education on adult and childhood dystonia, and optimization of referral pathways. These findings are important for improving dystonia care across Europe. [ABSTRACT FROM AUTHOR]

This study explores the uncertainty of future summer warming over Iberia using storylines constructed from climate model simulations of the Climate Model Intercomparison Project Phase 6. Unlike prior storyline approaches focusing on remote drivers and global teleconnections of atmospheric circulation, we use regional factors that directly influence summer temperatures: ridging activity, soil moisture and Mediterranean sea surface temperature. These drivers explain a substantial portion of the observed variability across climate models, with ridging activity and soil moisture showing the strongest influence on Iberian warming. Under a high radiative forcing scenario (SSP5–8.5), the storylines of Iberian warming based on these two drivers range between 7 and 9 °C for the end of the 21st century. The storyline leading to the largest warming is characterised by a drying out of the soil conditions and an increase in the anticyclonic activity over Iberia. We find similar conclusions for simple extreme heat indicators, though the approach struggles with more complex heatwave metrics. We also propose a novel modification of the storyline approach to increase the data sample of climate responses by using different time intervals throughout the 21st century. This modification would allow the application of more complex statistical models, the exploration of non-linear relationships and the identification of other drivers shaping the regional climate projections. • Soil moisture & ridging explain most multi-model spread of Iberian warming (IW). • Storylines of IW range between ∼1.6–2.1 °C per degree of global warming. • The influence of Mediterranean sea surface temperatures on IW is of secondary importance. • Similar findings on extreme temperatures, but complex metrics pose challenges. • Novel modification of the storyline approach: extending data via moving windows. [ABSTRACT FROM AUTHOR]

Background: Methyldibromo glutaronitrile (MDBGN) was one of the most frequent and relevant allergens found in patch testing at the beginning of this century. In 2008, this preservative was banned from cosmetics in Europe and ever since the prevalence of contact allergy to MDBGN has progressively decreased. Despite that gradual decline, MDBGN is still patch‐tested in most baseline series. This study assessed the frequency of MDBGN sensitization, epidemiological characteristics of allergic patients, and the relevance of positive patch tests in a nationwide Spanish registry (REIDAC). Patients and methods: We evaluated consecutively patch‐tested patients in all participating centres. Using these data, we calculated the proportion of patients with positive patch tests to MDBGN from June 2018 to June 2020 and evaluated the relevance of the positive patch tests. Results: One hundred and fourteen out of 5072 (2.24 %) tested patients were sensitized to MDBGN. Clinical current relevance was confirmed in only one case. Conclusion: Although the frequency of contact allergy to MDBGN remains high, no clinical significance was found in most of these patients (5072 tests needed to obtain one relevant positive result). The clinical usefulness of this allergen seems weak and its continued inclusion in the European baseline series is questionable. [ABSTRACT FROM AUTHOR]

This article analyses the integration of economic history into economics using a unique dataset containing 11,143 articles written by 919 economic historians and published between 1980 and 2019 in leading journals; we also analyzed the authors' biographical information. Using a probit regression, we find that since 1980, economic historians have increased their likelihood of publishing in Economics or Finance Journals (EFJs) by 12 points. This integration is more marked in North America than in Europe because North American economic historians are more likely to be trained in the discipline of economics. In contrast, a significant share of scholars in Europe are trained in the discipline of economic history. Network visualizations confirm these regional differences: citations to EFJs are much more central in North American scholars' work. Our findings support Robert Margo's claim that economic history is currently integrated into economics more often in publications in North America than in Europe. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal nematode (GIN) control is traditionally achieved with the use of anthelmintic drugs, however due to regulations in organic farming and the rise in anthelmintic resistance, alternatives are sought after. A promising alternative is the use of bioactive plant feeding due to the presence of plant secondary metabolites (PSMs) such as proanthocyanidins (PAs). This study focussed on the perennial shrub heather (Ericaceae family), a plant rich in PAs, highly abundant across Europe and with previously demonstrated anthelmintic potential. Methods: In vitro assays were used to investigate heather's anthelmintic efficacy against egg hatching and larval motility. Heather samples were collected from five European countries across two seasons, and extracts were tested against two GIN species: Teladorsagia circumcincta and Trichostrongylus colubriformis. Polyphenol group-specific ultraperformance liquid chromatography-tandem mass spectrometry analysis was performed to identify relevant polyphenol subgroups present, including the PA concentration and size and ratio of the subunits. Partial least squares analysis was performed to associate efficacy with variation in PSM composition. Results: Heather extracts reduced egg hatching of both GIN species in a dose-dependent manner by up to 100%, while three extracts at the highest concentration (10 mg/ml) reduced larval motility to levels that were not significantly different from dead larvae controls. PAs, particularly the procyanidin type, and flavonol derivatives were associated with anthelmintic activity, and the particular subgroup of polyphenols associated with the efficacy was dependent on the GIN species and life stage. Conclusions: Our results provide in vitro evidence that heather, a widely available plant often managed as a weed in grazing systems, has anthelmintic properties attributed to various groups of PSMs and could contribute to sustainable GIN control in ruminant production systems across Europe. [ABSTRACT FROM AUTHOR]

Higher milk intake has been associated with a lower stroke risk, but not with risk of CHD. Residual confounding or reverse causation cannot be excluded. Therefore, we estimated the causal association of milk consumption with stroke and CHD risk through instrumental variable (IV) and gene-outcome analyses. IV analysis included 29 328 participants (4611 stroke; 9828 CHD) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD (eight European countries) and European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) case-cohort studies. rs4988235, a lactase persistence (LP) SNP which enables digestion of lactose in adulthood was used as genetic instrument. Intake of milk was first regressed on rs4988235 in a linear regression model. Next, associations of genetically predicted milk consumption with stroke and CHD were estimated using Prentice-weighted Cox regression. Gene-outcome analysis included 777 024 participants (50 804 cases) from MEGASTROKE (including EPIC-CVD), UK Biobank and EPIC-NL for stroke, and 483 966 participants (61 612 cases) from CARDIoGRAM, UK Biobank, EPIC-CVD and EPIC-NL for CHD. In IV analyses, each additional LP allele was associated with a higher intake of milk in EPIC-CVD (β = 13·7 g/d; 95 % CI 8·4, 19·1) and EPIC-NL (36·8 g/d; 95 % CI 20·0, 53·5). Genetically predicted milk intake was not associated with stroke (HR per 25 g/d 1·05; 95 % CI 0·94, 1·16) or CHD (1·02; 95 % CI 0·96, 1·08). In gene-outcome analyses, there was no association of rs4988235 with risk of stroke (OR 1·02; 95 % CI 0·99, 1·05) or CHD (OR 0·99; 95 % CI 0·95, 1·03). Current Mendelian randomisation analysis does not provide evidence for a causal inverse relationship between milk consumption and stroke or CHD risk. [ABSTRACT FROM AUTHOR]

• Most Radiotherapy Departments in Europe have HDR-PDR brachytherapy equipment with Ir-192 or Co-60. • The present GEC-ESTRO ACROP Recommendations provide guidance on the calibration of such sources. • Practical aspects and issues not specifically accounted for in well-accepted societal recommendations are included. • The aim is to provide a European-wide standard in HDR-PDR BT source calibration at the hospital level. The vast majority of radiotherapy departments in Europe using brachytherapy (BT) perform temporary implants of high- or pulsed-dose rate (HDR-PDR) sources with photon energies higher than 50 keV. Such techniques are successfully applied to diverse pathologies and clinical scenarios. These recommendations are the result of Working Package 21 (WP-21) initiated within the BRAchytherapy PHYsics Quality Assurance System (BRAPHYQS) GEC-ESTRO working group with a focus on HDR-PDR source calibration. They provide guidance on the calibration of such sources, including practical aspects and issues not specifically accounted for in well-accepted societal recommendations, complementing the BRAPHYQS WP-18 Report dedicated to low energy BT photon emitting sources (seeds). The aim of this report is to provide a European-wide standard in HDR-PDR BT source calibration at the hospital level to maintain high quality patient treatments. [ABSTRACT FROM AUTHOR]

Background: Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age. Methods: A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA). Results: Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life. Discussion and conclusions: The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle. [ABSTRACT FROM AUTHOR]

Ceratocystis platani (CP), an ascomycetous fungus, is the agent of canker stain, a lethal vascular disease of Platanus species. Ceratocystis platani has been listed as a quarantine pest (EPPO A2 list) due to extensive damage caused in Southern Europe and the Mediterranean region. As traditional diagnostic assays are ineffective, a Real-Time PCR detection method based on EvaGreen, SYBR Green, and Taqman assays was previously developed, validated in-house, and included in the official EPPO standard PM7/14 (2). Here, we describe the results of a test performance study performed by nine European laboratories for the purpose of an interlaboratory validation. Verification of the DNA extracted from biological samples guaranteed the high quality of preparations, and the stability and the homogeneity of the aliquots intended for the laboratories. All of the laboratories reproduced nearly identical standard curves with efficiencies close to 100%. Testing of blind-coded DNA extracted from wood samples revealed that all performance parameters—diagnostic sensitivity, diagnostic specificity, accuracy and reproducibility—were best fit in most cases both at the laboratory and at the assay level. The previously established limit of detection, 3 fg per PCR reaction, was also validated with similar excellent results. The high interlaboratory performance of this Real-Time PCR method confirms its value as a primary tool to safeguard C. platani-free countries by way of an accurate monitoring, and to investigate the resistance level of potentially canker stain-resistant Platanus genotypes. [ABSTRACT FROM AUTHOR]

This paper proposes a set of digitalisation indicators focused on measuring the different digital capabilities and infrastructure of electricity distribution systems, as opposed to previous indicators which have mainly focused on performance and quality of service aspects. The indicators are classified according to the pillars of digitalisation: sensor and actuator, connectivity, data processing, and digital culture. They are use-case-agnostic and do not require a huge amount of information. In addition to this, three possible new applications of these indicators for distribution system operators and regulatory authorities are identified and discussed. The extensive use of these indicators in Europe could allow the development of fruitful collaborations between distribution system operators, allow the identification of cause–effect relations between grid performance and digital infrastructure, and improve the replicability of innovative smart grid solutions. However, this will only be possible if regulators promote the adoption of the proposed indicators and the dissemination of their results. • Smart grid indicators are required by European Directive 2019/944. • Indicators on sensors/actuators, connectivity, data processing, and digital culture. • Indicators to provide an overview of the distribution grid. • Indicators to study relation between performance and digital infrastructure. • Indicators to generate information for the replicability of solutions. [ABSTRACT FROM AUTHOR]

• An approach for identifying and selecting sustainability indicators for assessing technologies at low TRL. • Three distinct screening tools – a framework, a questionnaire for actor priorities, and a list of indicator selection criteria – are developed and employed to select indicators. • From an initial pool of 382 indicators, the study narrows down to a set of 26 representative indicators deemed essential for assessing the considered system at its early stages. • The new approach outlined in the paper is found to be practical to implement and time- and resource-efficient, when no standard set of indicators exists. In Europe, a decrease in the availability of phosphate rock resources has led to the development of emerging technologies for phosphorus recovery, with the purpose of generating products that can be used as fertilisers. An innovative conceptual system dedicated to the phosphorus recovery from dairy wastewater is considered in the paper. New technologies need to be assessed using relevant sustainability indicators. In this study, we developed an approach for identifying and selecting indicators. Based on searches of literature and expert interviews, three different tools were developed: an indicator screening framework, a questionnaire for finding actor priorities, and a list of indicator selection criteria. The new approach was successfully used to narrow down an initial set of 382 indicators identified in the literature to 26 that were considered representative and practicable for the assessment of the considered system. [Display omitted] [ABSTRACT FROM AUTHOR]

To date, few data on how the COVID-19 pandemic and restrictions affected children's physical activity in Europe have been published. This study examined the prevalence and correlates of physical activity and screen time from a large sample of European children during the COVID-19 pandemic to inform strategies and provide adequate mitigation measures. An online survey was conducted using convenience sampling from 15 May to 22 June, 2020. Parents were eligible if they resided in one of the survey countries and their children aged 6–18 years. 8395 children were included (median age [IQR], 13 [10–15] years; 47% boys; 57.6% urban residents; 15.5% in self-isolation). Approximately two-thirds followed structured routines (66.4% [95%CI, 65.4–67.4]), and more than half were active during online P.E. (56.6% [95%CI, 55.5–57.6]). 19.0% (95%CI, 18.2–19.9) met the WHO Global physical activity recommendation. Total screen time in excess of 2 h/day was highly prevalent (weekdays: 69.5% [95%CI, 68.5–70.5]; weekend: 63.8% [95%CI, 62.7–64.8]). Playing outdoors more than 2 h/day, following a daily routine and being active in online P.E. increased the odds of healthy levels of physical activity and screen time, particularly in mildly affected countries. In severely affected countries, online P.E. contributed most to meet screen time recommendation, whereas outdoor play was most important for adequate physical activity. Promoting safe and responsible outdoor activities, safeguarding P.E. lessons during distance learning and setting pre-planned, consistent daily routines are important in helping children maintain healthy active lifestyle in pandemic situation. These factors should be prioritised by policymakers, schools and parents. To our knowledge, our data provide the first multi-national estimates on physical activity and total screen time in European children roughly two months after COVID-19 was declared a global pandemic. Only 1 in 5 children met the WHO Global physical activity recommendations. Under pandemic conditions, parents should set pre-planned, consistent daily routines and integrate at least 2-hours outdoor activities into the daily schedule, preferable on each day. Schools should make P.E. lessons a priority. Decision makers should mandate online P.E. be delivered by schools during distance learning. Closing outdoor facilities for PA should be considered only as the last resort during lockdowns. [ABSTRACT FROM AUTHOR]

Summary: Using a discrete choice experiment, we aimed to assess patients' preferences with regard to adopting lifestyle behaviours to prevent osteoporotic fractures. Overall, the 1042 patients recruited from seven European countries were favourable to some lifestyle behaviours (i.e., engaging in moderate physical activity, taking calcium and vitamin D supplements, reducing their alcohol consumption and ensuring a normal body weight). Introduction: Alongside medical therapy, healthy lifestyle habits are recommended for preventing osteoporotic fractures. In this study, we aimed to assess patients' preferences with regard to adopting lifestyle changes to prevent osteoporotic fractures. Methods: A discrete choice experiment was conducted in seven European countries. Patients with or at risk of osteoporosis were asked to indicate to what extent they would be motivated to adhere to 16 lifestyle packages that differed in various levels of 6 attributes. The attributes and levels proposed were physical activity (levels: not included, moderate or high), calcium and vitamin D status (levels: not included, taking supplements, improving nutrition and assuring a minimal exposure to sunlight daily), smoking (levels: not included, quit smoking), alcohol (levels: not included, moderate consumption), weight reduction (levels: not included, ensure a healthy body weight) and fall prevention (levels: not included, receiving general advice or following a 1-day fall prevention program). A conditional logit model was used to estimate a patient's relative preferences for the various attributes across all participants and per country. Results: In total, 1042 patients completed the questionnaire. Overall, patients were favourable to lifestyle behaviours for preventing osteoporotic fractures. However, among the lifestyle behaviours proposed, patients were consensually not prone to engage in a high level of physical activity. In addition, in Ireland, Belgium, the Netherlands and Switzerland, patients were also not inclined to participate in a 1-day fall prevention program and Belgian, Swiss and Dutch patients were not prone to adhere to a well-balanced nutritional program. Nevertheless, we observed globally that patients felt positively about reducing their alcohol consumption, engaging in moderate physical activity, taking calcium and vitamin D supplements and ensuring a normal body weight, all measures aimed at preventing fractures. Conclusions: In a patient-centred approach, fracture prevention should take these considerations and preferences into account. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has represented a major cause of morbidity/mortality worldwide, overstressing health systems. Multiple myeloma (MM) patients show an increased risk for infections and they are expected to be particularly vulnerable to SARS-CoV-2 infection. Here we have obtained a comprehensive picture of the impact of COVID-19 in MM patients on a local and a global scale using a federated data research network (TriNetX) that provided access to Electronic Medical Records (EMR) from Health Care Organizations (HCO) all over the world. Through propensity score matched analyses we found that the number of new diagnoses of MM was reduced in 2020 compared to 2019 (RR 0.86, 95%CI 0.76–0.96) and the survival of newly diagnosed MM cases decreased similarly (HR 0.61, 0.38–0.81). MM patients showed higher risk of SARS-CoV-2 infection (RR 2.09, 1.58–2.76) and a higher excess mortality in 2020 (difference in excess mortality 9%, 4.4–13.2) than non-MM patients. By interrogating large EMR datasets from HCO in Europe and globally, we confirmed that MM patients have been more severely impacted by COVID-19 pandemic than non-MM patients. This study highlights the necessity of extending preventive measures worlwide to protect vulnerable patients from SARS-CoV-2 infection by promoting social distancing and an intensive vaccination strategies. [ABSTRACT FROM AUTHOR]

Background: Short tandem repeats (STRs) are genetic markers with a greater mutation rate than single nucleotide polymorphisms (SNPs) and are widely used in genetic studies and forensics. However, most studies in pigs have focused only on SNPs or on a limited number of STRs. Results: This study screened 394 deep-sequenced genomes from 22 domesticated pig breeds/populations worldwide, wild boars from both Europe and Asia, and numerous outgroup Suidaes, and identified a set of 878,967 polymorphic STRs (pSTRs), which represents the largest repository of pSTRs in pigs to date. We found multiple lines of evidence that pSTRs in coding regions were affected by purifying selection. The enrichment of trinucleotide pSTRs in coding sequences (CDS), 5′UTR and H3K4me3 regions suggests that trinucleotide STRs serve as important components in the exons and promoters of the corresponding genes. We demonstrated that, compared to SNPs, pSTRs provide comparable or even greater accuracy in determining the breed identity of individuals. We identified pSTRs that showed significant population differentiation between domestic pigs and wild boars in Asia and Europe. We also observed that some pSTRs were significantly associated with environmental variables, such as average annual temperature or altitude of the originating sites of Chinese indigenous breeds, among which we identified loss-of-function and/or expanded STRs overlapping with genes such as AHR, LAS1L and PDK1. Finally, our results revealed that several pSTRs show stronger signals in domestic pig—wild boar differentiation or association with the analysed environmental variables than the flanking SNPs within a 100-kb window. Conclusions: This study provides a genome-wide high-density map of pSTRs in diverse pig populations based on genome sequencing data, enabling a more comprehensive characterization of their roles in evolutionary and environmental adaptation. [ABSTRACT FROM AUTHOR]

Background: Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC).Methods: We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD.Results: There was a lower risk of IHD with a higher intake of fruit and vegetables combined [HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90-0.99, P-trend = 0.009], and with total fruits (per 100 g/day 0.97, 0.95-1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82-0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85-0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91-0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95-1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk.Conclusions: In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear. [ABSTRACT FROM AUTHOR]

Background: There is considerable variability across European patch test centres as to which allergens are included in local and national cosmetics series. Objectives: To propose a standardized, evidence‐based cosmetic series for Europe based on up‐to‐date analysis of relevant contact allergens. Methods: We collated data from the European Surveillance System on Contact Allergies (ESSCA) from 2009 to 2018 to determine which cosmetic allergens produce a high yield of contact allergy. Contact allergens with a prevalence of >0.3% that were considered relevant were included. Rare contact allergens were excluded if deemed no longer relevant or added to a supplemental cosmetic series for further analysis. Results: Sensitization prevalences of 39 cosmetic contact allergens were tabulated. Thirty of these allergens yielded >0.3% positive reactions and are therefore included in our proposed European cosmetic series. Six were considered no longer relevant and therefore excluded. Three were included in a supplementary European cosmetic series. An additional nine allergens were included in either the core or supplemental European cosmetic series following literature review. Conclusion: We have derived a potential European cosmetic series based upon the above methods. This will require ongoing investigation based upon the changing exposure profiles of cosmetic allergens as well as new and evolving substances. [ABSTRACT FROM AUTHOR]

Ionospheric estimation is becoming more and more important for the new multifrequency positioning algorithms, since they can help to improve greatly the convergence time for acquiring a good positioning error. In this paper, an open source tool to estimate precise ionospheric estimates is presented, namely ESA UGI (Unified-GNSS-Ionosphere). The presentation is done jointly with a methodology to test ionospheric model using a modified NeQuick to generate synthetic data. The results with different option of the ESA UGI shows that it has a good performance below 1 TECU (Total Electron Content Units) in vTEC (vertical Total Electron Content) RMS (Root Mean Squared) for European networks, around 2 TECU in a well-covered African region and between 1 and 6 TECU globally with this synthetic data. It shows as well the capability of changing between different ionosphere models (voxel, multilayer and spherical harmonics) and configuration options. Finally, a test with uncombined PPP actual data is presented showing that instantaneous convergence below 30 cm in 3D RMS position error are achievable in a well sounded area in Europe. [ABSTRACT FROM AUTHOR]

Adolescent smoking is a major public health problem. While the socioeconomic status (SES) of the neighbourhood and that of the family are known to play a role in smoking onset and progression, it is not clear whether it modifies the association between parental influences and adolescent behaviour. The purpose of this study is to investigate family correlates of adolescent smoking experimentation and to explore the modifying role of socioeconomic context and European geographical area in a sample of European adolescents. This is a secondary analysis of the baseline survey of the European Drug Addiction Prevention (EU-Dap) trial which took place in seven European countries and involved 7079 students. School SES was used as indicator of socioeconomic context. European countries were aggregated in two geographical areas: North-Central and South. The associations between parental, family factors, and adolescents smoking experimentation were analysed through multilevel mixed-effect logistic regression models, stratified by school SES and European geographical area. Parental smoking, permissiveness towards tobacco, family conflicts, problematic relationships, low connectedness, and low parental control were significantly associated with adolescent smoking experimentation. Paternal smoking was a stronger correlate of adolescent smoking in low SES schools, while maternal smoking in high SES schools. Parental permissiveness was a stronger correlate in low SES schools. Family conflicts and low parental control were correlates only in low SES schools. The associations did not substantially differ between European geographical areas, with the exception of parental smoking that was a stronger correlate in the North, and parental control that was a correlate only in the South of Europe. To reduce inequalities in tobacco-related outcomes, prevention efforts in low socioeconomic contexts appear to be a public health priority. Parental smoking, permissiveness, family relationships, and connectedness should be addressed in preventive programs. [ABSTRACT FROM AUTHOR]

Summary: Strontium ranelate use, compared with oral bisphosphonates, is not associated with increased risk of AMI in patients with no contraindications for SR use. However, current strontium ranelate (compared with current bisphosphonate) appears associated with 25–30% excess risk of VTE and 35% excess risk of CVDeath. Introduction: Evaluate the risk of cardiac and thromboembolic events among new users of SR and oral BPs without contraindications for SR. Methods: We conducted three multi-national, multi-database (Aarhus-Denmark, HSD-Italy, IPCI-Netherlands, SIDIAP-Spain, THIN-UK) case-control studies nested within a cohort of new users of SR/BP. We matched cases of acute myocardial infarction (AMI), venous thromboembolism (VTE), and cardiovascular death (CVDeath), up to 10 controls on gender, year of birth, index date, and country. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) according to current SR vs current BP use and current vs past SR use, adjusting for potential confounders. Data were pooled using random effects meta-analysis. Results: No excess risk of AMI (5477 cases/54,674 controls) was found with current SR vs current BP (OR 0.89 (95%CI 0.70, 1.12)) nor with current vs past SR use (0.71(0.56, 0.91)). For VTE (5614 cases/6036 controls), an excess risk was found with current SR compared with current BP use, 1.24 (0.96, 1.61), and current vs past SR use, 1.30 (1.04, 1.62). For CVDeath (3019 cases/29,871 controls), an increased risk was seen with current SR vs current BP use, 1.35 (1.02, 1.80), but not with current vs past SR use (0.68 (0.48, 0.96)). Conclusion: In patients without contraindications for SR, we found no evidence of an increased risk of AMI but a 25–30% excess risk of VTE and a 35% excess risk of CVDeath with current SR vs current BP users. This is despite a reduction in risk in CVDeath with current vs past SR users. The latter disparity could still be partially explained by cessation of preventative therapies in end-of-life or residual confounding by indication. [ABSTRACT FROM AUTHOR]

Purpose: The evidence from the literature regarding the association of dietary factors and risk of prostate cancer is inconclusive. Methods: A nutrient-wide association study was conducted to systematically and comprehensively evaluate the associations between 92 foods or nutrients and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cox proportional hazard regression models adjusted for total energy intake, smoking status, body mass index, physical activity, diabetes and education were used to estimate hazard ratios and 95% confidence intervals for standardized dietary intakes. As in genome-wide association studies, correction for multiple comparisons was applied using the false discovery rate (FDR < 5%) method and suggested results were replicated in an independent cohort, the Netherlands Cohort Study (NLCS). Results: A total of 5916 and 3842 incident cases of prostate cancer were diagnosed during a mean follow-up of 14 and 20 years in EPIC and NLCS, respectively. None of the dietary factors was associated with the risk of total prostate cancer in EPIC (minimum FDR-corrected P, 0.37). Null associations were also observed by disease stage, grade and fatality, except for positive associations observed for intake of dry cakes/biscuits with low-grade and butter with aggressive prostate cancer, respectively, out of which the intake of dry cakes/biscuits was replicated in the NLCS. Conclusions: Our findings provide little support for an association for the majority of the 92 examined dietary factors and risk of prostate cancer. The association of dry cakes/biscuits with low-grade prostate cancer warrants further replication given the scarcity in the literature. [ABSTRACT FROM AUTHOR]

In the 2017 Annual Report of the ERA-EDTA Registry, hypertension continues to be the second or third most common cause of renal replacement therapy (RRT) in Europe, tied with glomerulonephritis. There is, however, one little issue: hypertension-induced end-stage renal disease (ESRD) might not exist at all as currently understood, that is, as hypertensive nephrosclerosis. In this regard, the incidence of RRT due to hypertensive nephropathy is related to the incidence of other causes of ESRD but not to the burden of hypertension per country. The current definition of hypertensive nephropathy is non-specific, outdated and only allows a delayed diagnosis by exclusion. It is not helpful that 80% of chronic kidney disease patients develop hypertension and kidney biopsy has no findings specific for hypertensive nephropathy. There is an urgent need to redefine the concept of hypertensive nephropathy with a clear and comprehensive set of criteria that at least should indicate how other nephropathies, including familial nephropathies, should be excluded. Correct causality assessment and aetiology-based therapy is a key to the progress of nephrology and it should no longer be accepted that 'hypertensive nephropathy' serves to disguise a suboptimal diagnostic workup. A diagnosis of nephropathy of unknown cause would be more honest when the full range of alternative aetiological diagnoses is not explored. [ABSTRACT FROM AUTHOR]

Purpose: To test the impact of a nudge strategy (dish of the day strategy) and the factors associated with vegetable dish choice, upon food selection by European adolescents in a real foodservice setting. Methods: A cross-sectional quasi-experimental study was implemented in restaurants in four European countries: Denmark, France, Italy and United Kingdom. In total, 360 individuals aged 12–19 years were allocated into control or intervention groups, and asked to select from meat-based, fish-based, or vegetable-based meals. All three dishes were identically presented in appearance (balls with similar size and weight) and with the same sauce (tomato sauce) and side dishes (pasta and salad). In the intervention condition, the vegetable-based option was presented as the "dish of the day" and numbers of dishes chosen by each group were compared using the Pearson chi-square test. Multivariate logistic regression analysis was run to assess associations between choice of vegetable-based dish and its potential associated factors (adherence to Mediterranean diet, food neophobia, attitudes towards nudging for vegetables, food choice questionnaire, human values scale, social norms and self-estimated health, country, gender and belonging to control or intervention groups). All analyses were run in SPSS 22.0. Results: The nudging strategy (dish of the day) did not show a difference on the choice of the vegetable-based option among adolescents tested (p = 0.80 for Denmark and France and p = 0.69 and p = 0.53 for Italy and UK, respectively). However, natural dimension of food choice questionnaire, social norms and attitudes towards vegetable nudging were all positively associated with the choice of the vegetable-based dish. Being male was negatively associated with choosing the vegetable-based dish. Conclusions: The "dish of the day" strategy did not work under the study conditions. Choice of the vegetable-based dish was predicted by natural dimension, social norms, gender and attitudes towards vegetable nudging. An understanding of factors related to choosing vegetable based dishes is necessary for the development and implementation of public policy interventions aiming to increase the consumption of vegetables among adolescents. [ABSTRACT FROM AUTHOR]

Objective: To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. Methods: We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. Results: We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P <.0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend =.0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend =.0047) and a significant decrease in unilobar temporal surgeries (P for trend =.0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo‐electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. Significance: Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures. [ABSTRACT FROM AUTHOR]