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Background: Triptans are migraine-specific acute treatments. A well-accepted definition of triptan failure is needed in clinical practice and for research. The primary aim of the present Consensus was to provide a definition of triptan failure. To develop this definition, we deemed necessary to develop as first a consensus definition of effective treatment of an acute migraine attack and of triptan-responder. Main body: The Consensus process included a preliminary literature review, a Delphi round and a subsequent open discussion. According to the Consensus Panel, effective treatment of a migraine attack is to be defined on patient well-being featured by a) improvement of headache, b) relief of non-pain symptoms and c) absence of adverse events. An attack is considered effectively treated if patient's well-being, as defined above, is restored within 2 hours and for at least 24 hours. An individual with migraine is considered as triptan-responder when the given triptan leads to effective acute attack treatment in at least three out of four migraine attacks. On the other hand, an individual with migraine is considered triptan non-responder in the presence of failure of a single triptan (not matching the definition of triptan-responder). The Consensus Panel defined an individual with migraine as triptan-resistant in the presence of failure of at least 2 triptans; triptan refractory, in the presence of failure to at least 3 triptans, including subcutaneous formulation; triptan ineligibile in the presence of an acknowledged contraindication to triptan use, as specified in the summary of product characteristics. Conclusions: The novel definitions can be useful in clinical practice for the assessment of acute attack treatments patients with migraine. They may be helpful in identifying people not responding to triptans and in need for novel acute migraine treatments. The definitions will also be of help in standardizing research on migraine acute care. [ABSTRACT FROM AUTHOR]

Background: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standardized way. The Consensus proposed well-defined criteria for resistant migraine (i.e., patients who do not respond to some treatment but who have residual therapeutic opportunities) and refractory migraine (i.e., patients who still have debilitating migraine despite maximal treatment efforts). The aim of this study was to better understand the perceived impact of resistant and refractory migraine and the attitude of physicians involved in migraine care toward those conditions. Methods: We conducted a web-questionnaire-based cross-sectional international study involving physicians with interest in headache care. Results: There were 277 questionnaires available for analysis. A relevant proportion of participants reported that patients with resistant and refractory migraine were frequently seen in their clinical practice (49.5% for resistant and 28.9% for refractory migraine); percentages were higher when considering only those working in specialized headache centers (75% and 46% respectively). However, many physicians reported low or moderate confidence in managing resistant (8.1% and 43.3%, respectively) and refractory (20.7% and 48.4%, respectively) migraine patients; confidence in treating resistant and refractory migraine patients was different according to the level of care and to the number of patients visited per week. Patients with resistant and refractory migraine were infrequently referred to more specialized centers (12% and 19%, respectively); also in this case, figures were different according to the level of care. Conclusions: This report highlights the clinical relevance of difficult-to-treat migraine and the presence of unmet needs in this field. There is the need of more evidence regarding the management of those patients and clear guidance referring to the organization of care and available opportunities. [ABSTRACT FROM AUTHOR]

Birds of prey, owls and falcons are widely used as sentinel species in raptor biomonitoring programmes. A major current challenge is to facilitate large-scale biomonitoring by coordinating contaminant monitoring activities and by building capacity across countries. This requires sharing, dissemination and adoption of best practices addressed by the Networking Programme Research and Monitoring for and with Raptors in Europe (EURAPMON) and now being advanced by the ongoing international COST Action European Raptor Biomonitoring Facility. The present perspective introduces a schematic sampling protocol for contaminant monitoring in raptors. We provide guidance on sample collection with a view to increasing sampling capacity across countries, ensuring appropriate quality of samples and facilitating harmonization of procedures to maximize the reliability, comparability and interoperability of data. The here presented protocol can be used by professionals and volunteers as a standard guide to ensure harmonised sampling methods for contaminant monitoring in raptors. [ABSTRACT FROM AUTHOR]

Introduction: Despite advances in the management of headache disorders, some patients with migraine do not experience adequate pain relief with acute and preventive treatments. It is the aim of the present document to provide a definition of those migraines which are difficult-to-treat, to create awareness of existence of this group of patients, to help Healthcare Authorities in understanding the implications, and to create a basis to develop a better pathophysiological understanding and to support further therapeutic advances. Main body: Definitions were established with a consensus process using the Delphi method. Patients with migraine with or without aura or with chronic migraine can be defined as having resistant migraine and refractory migraine according to previous preventative failures. Resistant migraine is defined by having failed at least 3 classes of migraine preventatives and suffer from at least 8 debilitating headache days per month for at least 3 consecutive months without improvement; definition can be based on review of medical charts. Refractory migraine is defined by having failed all of the available preventatives and suffer from at least 8 debilitating headache days per month for at least 6 consecutive months. Drug failure may include lack of efficacy or lack of tolerability. Debilitating headache is defined as headache causing serious impairment to conduct activities of daily living despite the use of pain-relief drugs with established efficacy at the recommended dose and taken early during the attack; failure of at least two different triptans is required. Conclusions: We hope, that the updated EHF definition will be able to solve the conflicts that have limited the use of definitions which have been put forward in the past. Only with a widely accepted definition, progresses in difficult-to-treat migraine can be achieved. This new definition has also the aim to increase the understanding of the impact of the migraine as a disease with all of its social, legal and healthcare implications. It is the hope of the EHF Expert Consensus Group that the proposed criteria will stimulate further clinical, scientific and social attention to patients who suffer from migraine which is difficult-to-treat. [ABSTRACT FROM AUTHOR]

Veterinary Medicinal Products (VMPs) are used in intensive aquaculture production to treat a wide range of bacterial and parasitic infestations. Their release into the environment poses concerns regarding their potential ecotoxicological risks to aquatic ecosystems, which need to be evaluated making use of appropriate Environmental Risk Assessment (ERA) schemes and models. This study presents an overview of the major aquaculture production systems in Europe, the VMPs most commonly used, and the environmental quality standards and regulatory procedures available for their ERA. Furthermore, it describes the state‐of‐the‐art on the development of environmental models capable of assessing the fate, exposure, ecotoxicological effects and risks of VMPs in aquaculture production systems, and discusses their level of development and implementation within European aquaculture. This study shows that the use of environmental models in regulatory ERA is somewhat limited in many European countries. Major efforts have been dedicated to assess the fate and exposure of antiparasitic compounds in salmonid cage systems, particularly in Scotland, while models and scenarios for assessing dispersal of antimicrobials, in general, and antiparasitic compounds in the Mediterranean as well as in Scandinavian regions are less available. On the other hand, the use of ecological models for assessing the effects and risks of VMPs is almost absent. Recommendations are provided to improve the chemical exposure and effect assessments and the ecological realism of the modelling outcomes, paying special attention to the protection goals set for the regulatory ERA of VMPs in Europe. [ABSTRACT FROM AUTHOR]

The article explores what addiction specialists in the United States might learn from Europe regarding their response to problems relating to opioid addiction and overdose. Particular focus is given to the use of illicitly manufactured opioids, which have been a major contributor to the overdose death epidemic in both Europe and the United States. Other topics discussed include methodologies for harm reduction, government regulation of prescription drugs, and how most opioid-related deaths occur in those who are either uninsured, unemployed or have a low income.

In addition to reducing greenhouse gas emissions, societies worldwide have to cope with the potential impacts of climate change. The central question of this paper is to what extent our historically grown institutions enable actors to cope with the new challenges of climate adaptation. We present six qualities of governance institutions that are crucial to allow for, and encourage adaptation, and apply them to the National Adaptation Strategies of the Netherlands, the United Kingdom, Finland and Sweden. We conclude that although the governance institutions involved seem to have the basic qualities required, they face five institutional weaknesses, causing tensions on the long term: (1) lack of openness towards learning and variety; (2) strong one-sided reliance on scientific experts; (3) tension between top-down policy development and bottom-up implementation; (4) distrust in the problem-solving capacity of civil society; and (5) wickedness of reserving funding for long-term action. [ABSTRACT FROM AUTHOR]

Abstract  Since the initial Swiss heroin-assisted treatment (HAT) study conducted in the mid-1990s, several other jurisdictions in Europe and North America have implemented HAT trials. All of these studies embrace the same goal—investigating the utility of medical heroin prescribing for problematic opioid users—yet are distinct in various key details. This paper briefly reviews (initiated or completed) studies and their main parameters, including primary research objectives, design, target populations, outcome measures, current status and—where available—key results. We conclude this overview with some final observations on a decade of intensive HAT research in the jurisdictions examined, including the suggestion that there is a mounting onus on the realm of politics to translate the—largely positive—data from completed HAT science into corresponding policy and programming in order to expand effective treatment options for the high-risk population of illicit opioid users. [ABSTRACT FROM AUTHOR]

Background: In several European countries and in Canada, clinical trials are being conducted in which heroin-addicted patients are treated with pharmaceutically prepared heroin in order to reduce the destructive behaviour that is so often associated with this drug.Objective: To develop an integrated population pharmacokinetic model for heroin (diamorphine) and its pharmacodynamically active metabolites 6-acetylmorphine, morphine, morphine-3-glucuronide and morphine-6-glucuronide. Additionally, the influence on heroin pharmacokinetics of several covariates that are typical for this population was determined.Method: Plasma concentration data from 106 heroin-dependent patients in The Netherlands (74 heroin inhalers and 32 injectors) were obtained. The 'chasing the dragon' technique was used for inhalation, in which the fumes of heroin base, heated on aluminum foil, were inhaled. Heroin doses varied between 66 and 450 mg. Heroin, 6-acetylmorphine and morphine data were fitted simultaneously using sequential two-compartment models. Morphine-3-glucuronide and morphine-6-glucuronide data were fitted separately to one-compartment models. All data analysis was performed using nonlinear mixed-effect modelling.Results: The bioavailability of inhaled heroin was estimated to be 53% (95% CI 43.7, 62.3). The terminal half-lives of heroin and 6-acetylmorphine were estimated to be 7.6 and 21.8 minutes, respectively. The clearances of morphine and the morphine-glucuronides were estimated to be 73.6 L/h (95% CI 62.8, 84.4) and between 6 and 10 L/h, respectively. The terminal half-life of 6-acetylmorphine was 13% lower in cocaine users (p < 0.05). No other significant relationships between covariates and pharmacokinetic parameters were discovered.Conclusions: Pharmacokinetic parameters of heroin and its five major metabolites were assessed simultaneously in one integrated model. Covariate analyses revealed that sex, bodyweight, benzodiazepine use and creatinine clearance (>60 mL/min) do not need to be taken into account in the medical prescription of pharmaceutically prepared heroin for the treatment of heroin dependency. [ABSTRACT FROM AUTHOR]

To investigate in different countries the effects of becoming widowed, duration of widowhood, and household composition of widowed men on disability onset in different disability domains. Longitudinal data from a cohort study collected around 1990, 1995, and 2000. Three cohorts from Finland, the Netherlands, and Italy. Seven hundred thirty-six men, aged 70 and older at baseline. Disability was measured using standardized questionnaire on activities of daily living (ADLs). Three domains were assessed: instrumental ADLs (IADLs), mobility, and basic ADLs (BADLs). Duration of widowhood was divided into less than 5 years and 5 or more years and household composition into living alone and living with family or in an institution. Men who became widowed developed more IADL disabilities (odds ratio (OR)=2.15; 95% confidence interval (CI)=1.22–3.81) and mobility (OR=1.84; 95% CI=1.15–2.96) than men who were still married. Men who had been widowed for less than 5 years developed more IADL disabilities than those who had been widowed for 5 years or more (OR=2.27; 95% CI=1.14–4.54). Widowed men living alone showed fewer disabilities in mobility (OR=0.25; 95% CI=0.09–0.73) and BADLs (OR=0.02; 95% CI=0.001–0.33) than those living with others. The effects on disability onset did not differ between countries. Widowhood in elderly men is a risk factor for dependency in IADLs and mobility. The growth in the number of widowers may lead to higher demands on family care and professional care. [ABSTRACT FROM AUTHOR]

Background: Based on differences in national health care system characteristics such as the gatekeeping role of GPs (at the macrolevel) and on diverging GP and patient characteristics (at the microlevel), communication may differ between countries. Knowledge of the influence of these characteristics on doctor-patient communication will be important for setting European health care policies.Objectives: Our objectives were (i) to compare doctor-patient communication in general practice between European countries; and (ii) to investigate the influence of the gatekeeping system and GP and patient characteristics on doctor-patient communication in general practice.Methods: Fifteen patients per GP (in total 2825 patients) of 190 GPs in six European countries were included. Participating countries were The Netherlands, Spain, the UK (gatekeeping countries), Belgium, Germany and Switzerland (non-gatekeeping countries). Data were collected by means of patient and GP questionnaires and observation of videotaped consultations, and analysed by one-way and multilevel, multivariate analysis.Results: Differences in communication between countries were found in: affective and instrumental behaviour; biomedical and psychosocial talk; GPs' patient-directed gaze; and consultation length. The study showed that GPs' gatekeeping role (with registered patients) was less important for doctor-patient communication than was expected. Patient characteristics such as gender, age, having psychosocial problems, and familiarity between the doctor and the patient were the most important in explaining differences in communication.Conclusion: The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To compare self-reported disability and performance-based limitation and their association in elderly men from three European countries. DESIGN: Cross-sectional data from a cohort study collected around 1990. SETTING: Three cohorts from Finland, the Netherlands, and Italy. PARTICIPANTS: One thousand one hundred sixty-one men aged 70 and older. MEASUREMENTS: Disability and functional limitation were measured in a standardized way in three countries. Self-reported disability was estimated by questionnaire, assessing three domains of activities of daily living: instrumental activities of daily living, mobility, and activities of daily living (score 0–3). Functional limitation was measured by performance tests (score 0–16), with 0 indicated the healthiest score. RESULTS: Self-reported disability and performance-based limitation scores differed between countries. Mean self-reported disability score was worse in Italy (0.72) and the Netherlands (0.70) than in Finland (0.54). Italian men scored worst on the performance-based tests (mean 4.80 vs 4.04 for Finland and 3.74 for the Netherlands). Differences in self-reported disability remained after adjusting for performance scores: Dutch men reported more disabilities (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.23–2.25) than men in Finland (reference group) and Italy (OR = 1.08, 95% CI = 0.77–1.53). Self-reported disability was positively associated with performance-based score (OR = 1.28, 95% CI = 1.21–1.35) and did not differ between countries. CONCLUSION: Cross-cultural variation was noted in self-reported disability adjusted for performance score. These differences may be due to sociocultural and physical environmental factors. Self-reported disability was consistently associated with performance-based limitation in Finland, the Netherlands, and Italy. [ABSTRACT FROM AUTHOR]

1. Information is lacking on how possible future changes in the seasonal occurrence and intensity of precipitation in Europe will affect the arthropod community of arable farmland. 2. We used a novel experimental approach to investigate the responses of farmland arthropods to spring precipitation in a spring-sown legume. Replicated plots were subjected to spring drought (plots shielded from rainfall), actual rainfall (reference) and spring irrigation. Shielding plots extended an existing drought to 58 days. 3. The response of epigeic arthropods was investigated using principal components analysis (PCA) and principal response curves (PRC). Temporal changes in treatment effects at the community level were more clearly displayed by PRC than by PCA, while PRC improved the interpretation of individual species' responses. PRC analysis has potential for wider application in ecological experiments and monitoring. 4. Short-term manipulation of precipitation in May affected the arthropod community for at least 97 days, despite exceptionally high rainfall in June. The effects of drought on the abundance of herbivores, mycophages, omnivores and predators were negative, while those of irrigation were positive. There were no differences in the responses of beneficial and pest taxa. 5. In addition to their intrinsic importance, these findings illustrate that spring weather might affect the availability of arthropod prey for insectivorous wildlife. Food availability has been implicated in the population declines of several insectivorous farmland birds. 6. The difficulty of manipulating rainfall in a temperate climate precludes realistic field studies of how farmland arthropods respond to precipitation. We suggest that automated rain shielding of experimental plots provides a technique for wider application in drought studies. [ABSTRACT FROM AUTHOR]

Solutions to current complex environmental challenges demand the consultation and involvement of various groups in society. In light of the WFD's requirements of public participation, this paper presents an analysis of the establishment and development of nine different multi-actor platforms (MAPs) across Europe set up as arenas for long-term engagements to solve water quality challenges in relation to agriculture. The MAPs represent different histories and legacies of engagement; some are recent initiatives and some are affiliated with previous government-initiated projects, while other MAPs are long-term engagement platforms. A case study approach drawing on insights from the nine engagement processes is used to discuss conditions for enabling long-term multi-actor engagement. The perceived pressure for change and preferred prioritization in complying with mitigating water quality problems vary within and among the MAPs. The results show that governmental and local actors' concern for water quality improvements and focusing on pressure for change are important for establishing meaningful multi-actor engagement when concerns translate into a clear mandate of the MAP. Furthermore, the degree to which the MAPs have been able to establish relationships and networks with other institutions such as water companies, agricultural and environmental authorities, farmers, and civil society organizations influences possibilities for long-term meaningful engagement. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of psychosocial aspects. Design: Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients. Setting: General practices in six European countries. Participants: 190 general practitioners and 3674 patients. Results: In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors' variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor's perception had more influence in this situation than the patient's. Consultation length is influenced by the patients' sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient's age (the older the patient the longer the consultation). As a doctor's workload increased, the length of consultations decreased. The general practitioner's sex or age and patient's level of education were not related to the length of consultation. Conclusion: Consultation length is determined by variables related to the doctor and the... [ABSTRACT FROM AUTHOR]

No abstract available [ABSTRACT FROM AUTHOR]

Abstract: Biomonitoring using raptors as sentinels can provide early warning of the potential impacts of contaminants on humans and the environment and also a means of tracking the success of associated mitigation measures. Examples include detection of heavy metal-induced immune system impairment, PCB-induced altered reproductive impacts, and toxicity associated with lead in shot game. Authorisation of such releases and implementation of mitigation is now increasingly delivered through EU-wide directives but there is little established pan-European monitoring to quantify outcomes. We investigated the potential for EU-wide coordinated contaminant monitoring using raptors as sentinels. We did this using a questionnaire to ascertain the current scale of national activity across 44 European countries. According to this survey, there have been 52 different contaminant monitoring schemes with raptors over the last 50years. There were active schemes in 15 (predominantly western European) countries and 23 schemes have been running for >20years; most monitoring was conducted for >5years. Legacy persistent organic compounds (specifically organochlorine insecticides and PCBs), and metals/metalloids were monitored in most of the 15 countries. Fungicides, flame retardants and anticoagulant rodenticides were also relatively frequently monitored (each in at least 6 countries). Common buzzard (Buteo buteo), common kestrel (Falco tinnunculus), golden eagle (Aquila chrysaetos), white-tailed sea eagle (Haliaeetus albicilla), peregrine falcon (Falco peregrinus), tawny owl (Strix aluco) and barn owl (Tyto alba) were most commonly monitored (each in 6–10 countries). Feathers and eggs were most widely analysed although many schemes also analysed body tissues. Our study reveals an existing capability across multiple European countries for contaminant monitoring using raptors. However, coordination between existing schemes and expansion of monitoring into Eastern Europe is needed. This would enable assessment of the appropriateness of the EU-regulation of substances that are hazardous to humans and the environment, the effectiveness of EU level mitigation policies, and identify pan-European spatial and temporal trends in current and emerging contaminants of concern. [Copyright &y& Elsevier]

Highlights • Cytokine release syndrome (CRS) and neurotoxicity are common after immune effector cell (IEC) therapy. • Neurotoxicity is now termed IEC-associated neurotoxicity syndrome (ICANS). • A consensus grading system for CRS and ICANS has been developed by experts in the field. • The grading system is designed for IEC therapies in clinical trials and commercial use. • Standardized reporting through the Center for International Blood and Marrow Transplant Research will meet commercial Risk Evaluation and Mitigation Strategies requirements. ABSTRACT Chimeric antigen receptor (CAR) T cell therapy is rapidly emerging as one of the most promising therapies for hematologic malignancies. Two CAR T products were recently approved in the United States and Europe for the treatment ofpatients up to age 25years with relapsed or refractory B cell acute lymphoblastic leukemia and/or adults with large B cell lymphoma. Many more CAR T products, as well as other immunotherapies, including various immune cell- and bi-specific antibody-based approaches that function by activation of immune effector cells, are in clinical development for both hematologic and solid tumor malignancies. These therapies are associated with unique toxicities of cytokine release syndrome (CRS) and neurologic toxicity. The assessment and grading of these toxicities vary considerably across clinical trials and across institutions, making it difficult to compare the safety of different products and hindering the ability to develop optimal strategies for management of these toxicities. Moreover, some aspects of these grading systems can be challenging to implement across centers. Therefore, in an effort to harmonize the definitions and grading systems for CRS and neurotoxicity, experts from all aspects of the field met on June 20 and 21, 2018, at a meeting supported by the American Society for Transplantation and Cellular Therapy (ASTCT; formerly American Society for Blood and Marrow Transplantation, ASBMT) in Arlington, VA. Here we report the consensus recommendations of that group and propose new definitions and grading for CRS and neurotoxicity that are objective, easy to apply, and ultimately more accurately categorize the severity of these toxicities. The goal is to provide a uniform consensus grading system for CRS and neurotoxicity associated with immune effector cell therapies, for use across clinical trials and in the postapproval clinical setting. [ABSTRACT FROM AUTHOR]

Harmful use of alcohol is one of the top five risks for burden of disease globally and in Europe; in 2012, 3.3 million net deaths (approximately 6% of all global deaths) were attributable to this risk factor. It is also linked to the development of a wide spectrum of alcohol use disorders, ranging from mild manifestations to a severe disease known as alcohol dependence. Alcohol dependence is a progressive, chronic, and relapsing brain disease resulting from the prolonged effects of alcohol on the brain. Alcohol dependence imposes a significant societal burden, with indirect societal costs reaching up to 0.64% of European countries׳ annual gross domestic product. With these facts in mind, it is important to recognize and manage alcohol dependence. Although the biological mechanisms behind the development of alcohol dependence are not fully known, factors that have been shown to influence its development include genetic predisposition, psychological problems, and social interactions. Alcohol use has also been linked to the development of hypertension, liver cirrhosis, chronic pancreatitis, multiple types of cancer, and psychiatric comorbidities such as depression and anxiety disorders. With such severe effects on both individuals and society, it is important to recognize the characteristic signs and symptoms of alcohol dependence and explore new ways to better manage patients with this brain disease. Effective treatment approaches for alcohol dependence include biological, behavioral, and social components addressing the multiple aspects of this disease. Comprehensive, educational platforms in which to explore the many facets of this disease such as the Progress in Mind: Focus on Alcohol Use Disorders Resource Centre , will provide clinicians with the tools necessary for recognizing patients with alcohol dependence and managing their disease along with related comorbidities. Online Access: http://progressinmind.elsevierresource.com. [ABSTRACT FROM AUTHOR]

In exposure prediction for environmental risk assessment, the transition to more dynamic and realistic modelling approaches and scenarios has been recently identified as a major challenge, since it would allow a more accurate prediction of bioavailable concentrations and their variations in space and time. In this work, an improved version of the multimedia model ChimERA fate, including a phytoplankton compartment and equations to calculate phytoplankton, detritus and dissolved organic matter variations in time, was developed. The model was parameterized to simulate five dynamic scenarios for shallow meso-eutrophic water bodies based on a latitudinal gradient (in Europe); such scenarios include seasonal profiles of water temperature, phytoplankton biomass, detritus, and dissolved organic matter. Model runs were performed for each scenario for 8 hydrophobic chemicals (PCB congeners), with the aim of investigating the influence of scenario characteristics and compound properties on bioavailable concentrations. The key processes were adsorption/uptake by phytoplankton and deposition to sediment of detritus-bound chemicals. The northern scenarios (“Scandinavia” and “UK”) showed the highest bioavailable concentrations, with annual maximum/minimum concentration up to 25; in contrast, for example, maximum concentrations in the “Mediterranean” scenario were lower by a factor of 2 to 9 with respect to the northern ones (depending on chemical hydrophobicity), due to the generally higher biomass and carbon levels, and showed only limited seasonal variability (up to a factor of 4). These results highlight the importance of including biomass and organic carbon dynamics in both modelling approaches and scenarios for the evaluation of exposure concentrations in aquatic environments. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: As part of an RCT in six European sites, the direct mental health care cost for 422 patients with schizophrenia was analysed according to how total and medication costs differed across sites and which variables were likely to predict total or service-specific costs. Method: Service use was recorded continuously during a 12-month follow-up. Prescribed psychotropic medication was recorded at baseline and 12 months later. Service use data were transformed into EURO, log-transformed and analysed using linear regression models. Results: Although samples were homogeneous, large inter-site cost differences were found (annual means ranging from 2958 € in Spain up to 36978 € in Switzerland). Psychopharmacologic costs were much more constant across sites than costs for other services. Total costs were associated more with region or socio-demographic characteristics than with disorder related parameters. Conclusions: The findings confirm remarkable differences in direct costs of patients with schizophrenia across Europe. However, the relative stability of medication costs suggests a need to analyse mechanisms that influence service-specific costs for schizophrenia. [Copyright &y& Elsevier]

Over the last decades, nutrients and pesticides have proved to be a major source of the pollution of drinking water resources in Europe. Extensive legislation has been developed by the EU to protect drinking water resources from agricultural pollution, but the achievement of water quality objectives is still an ongoing challenge throughout Europe. The study aims to identify lessons that can be learnt about the coherence and consistency of the application of EU regulations, and their effects at the local level, using qualitative expert data for 13 local to regional governance arrangements in 11 different European countries. The results show that the complexities and inconsistencies of European legislation drawn up to protect drinking water resources from agricultural pollution come forward most explicitly at local level where cross-sectoral measures have to be taken and effects monitored. At this local level, rather than facilitate, they hamper efforts to achieve water quality objectives. The upcoming revision of the Water Framework Directive (WFD) should strengthen the links between the different directives and how they could be applied at local level. In addition, a more facilitated cross-sectoral approach should be adopted to improve stakeholder networks, between institutional levels and hydrological scales, to attain policy objectives at local level. [Display omitted] • Nitrate and pesticides from agriculture present some of the highest risks to the quality of drinking water resources. • EU legislation on the protection of drinking water resources from agriculture complex to apply consistently and coherently. • Implementation would benefit from more advanced cross-referencing at the EU level. • Implementation requires capacity at the regional-local level for cross-sectoral decision-making. [ABSTRACT FROM AUTHOR]

Land consolidation (LC) is a widespread form of rural planning and is often presented as an important tool for mitigating land degradation. We therefore decided to make a systematic review of the effects of LC projects implemented under different natural and socio-economic conditions. Our results show that there is a major dichotomy in the understanding of LC. Studies from some parts of the world, e.g., Africa and South-east Asia, mostly report on LC projects aimed principally at creating larger fields to facilitate management. Studies from other regions, notably from Europe and China, describe LC as a complex form of planning that includes various types of land management measures. The effects of LC projects on land degradation are strongly linked to the type of project. Within the sample of reviewed studies, the effect of LC projects on land degradation was ambivalent, and projects not including land management measures even tended to contribute to land degradation. Conversely, in studies where LC projects involved specific land management measures, LC had a positive effect on most land degradation types. The results of our study indicate that LC projects can help significantly to mitigate land degradation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)