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The European Open Platform for Prescribing Education (EurOP2E) seeks to improve and harmonize European clinical pharmacology and therapeutics (CPT) education by facilitating international collaboration and sharing problem-based, online, open educational resources. The COVID-19 pandemic forced teachers to switch to virtual modalities, highlighting the need for high-quality online teaching materials. The goal of this study was to establish the online problem-based teaching resources needed to sustain prescribing education during the pandemic and thereafter. A nominal group technique study was conducted with prescribing teachers from 15 European countries. Results were analyzed through thematic analysis. In four meetings, 20 teachers from 15 countries proposed and ranked 35 teaching materials. According to the participants, the most necessary problem-based-online teaching materials related to three overarching themes. Related to learning outcomes for CPT, participants proposed creating prescription scenarios, including materials focusing on background knowledge and resources on personalized medicine and topical/ethical issues such as the prescription's impact on planetary health. Second, related to teaching, they proposed online case discussions, gamification and decision support systems. Finally, in relation to faculty development, they recommend teacher courses, a repository of reusable exam questions and harmonized formularies. Future work will aim to collaboratively produce such materials.

Introduction: Psoriatic arthritis (PsA) is a complex, progressive, and often debilitating disease. Despite recent advances in treatment, numerous unmet needs in patient care persist. Rheumacensus is a multistakeholder, pan-European initiative designed to identify ways to elevate the standard of care (SoC) and treatment ambition for patients with PsA, using the perspectives of three key stakeholder groups: patients, healthcare professionals (HCPs) and payors. Methods: Rheumacensus followed three phases: an insights-gathering workshop to identify current unmet needs in PsA and an area of focus for the project, a modified Delphi process to gain consensus on improvements within the agreed area of focus, and a Consensus Council (CC) meeting which used consensus statements as inspiration to generate 'Calls to Action' (CTA)—practical measures which, if implemented, could elevate the SoC for patients with PsA. Results: The Rheumacensus CC consisted of four patient representatives, four HCPs and four payors. All 12 members completed all three Delphi e-consultations. The shared area of focus that informed the Delphi process was "patient empowerment through education on the disease and treatment options available, to enable patient involvement in management". Four key themes emerged from the Delphi process: patient empowerment, patient knowledge and sources of education, patient–HCP consultations, and optimal initial treatment. Statements within these themes informed 12 overarching CTA, which focus on the need for a multistakeholder approach to implementing a paradigm shift towards patient-centred care and improved outcomes for patients with PsA. Conclusion: Rheumacensus has identified shortcomings in the current SoC for patients with PsA and provides a foundation for change through practical CTA. It is hoped that all stakeholders will now take practical steps towards implementing these CTA across Europe to elevate the SoC for patients with PsA. Plain Language Summary: Inequalities in the care patients with psoriatic arthritis (PsA) receive can be mainly explained by poorly coordinated management due to a lack of disease and treatment knowledge. This report is about a programme called Rheumacensus which has the overall aim of improving the standard of care (SoC) for patients with PsA. Rheumacensus brings together the points of view of three key groups involved in the care of people with PsA: patients, payors and healthcare professionals (HCPs) from across Europe. Together, these three groups agreed to focus on patient empowerment through education on the disease and treatment options as a way to raise the SoC. Through a series of exercises—to agree on the current SoC and what needs to be improved—and group discussions, four themes were established which were used by the groups to help them suggest 'Calls to action' (CTA). The CTAs were ideas of how improvements could be made or what needs to be done to improve the care patients receive. The four themes were (1) patient empowerment, (2) patient knowledge, (3) patient–HCP consultation and (4) optimal initial treatment. In total, 12 CTAs were developed across these themes that provide direction and practical next steps which patients, payors and HCPs could take to drive change and make a real difference to patients by improving their care. [ABSTRACT FROM AUTHOR]

In the Pistoia Nursery-Ornamental Rural District (Italy), a leader in Europe in ornamental nurseries covering over 5200 hectares with over 2500 different species of plant, plant-parasitic nematodes represent a serious concern. The potential efficacy of a pot cultivation system using commercial substrates to control plant-parasitic nematodes was assessed. On two different plant species, two different pot cultivation managements, potted plants, and potted plants previously cultivated in natural soil were compared to plants only cultivated in natural soil. The entire soil nematode structure with and without plants was evaluated. The relationship between soil properties and soil nematode community was investigated. All the studied substrates were free from plant-parasitic nematodes. Regarding free-living nematodes, Peat–Pumice showed nematode assemblage established by colonizer and extreme colonizer bacterial feeders, whereas Peat–Perlite included both bacterial and fungal feeders, and, finally, coconut fiber also included omnivores and predators. In farming, the substrates rich in organic matter such as coconut fiber could still play an important role in suppressing plant-parasitic nematodes because of the abundance of free-living nematodes. In fact, they are of crucial importance in both the mineralization of organic matter and the antagonistic control of plant-parasitic nematodes. Potting systems equally reduce virus-vector nematodes and improve the prey/predator ratio favoring natural control. [ABSTRACT FROM AUTHOR]

Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review is to study the prevalence of chemsex, and the sexualized drug used in Europe, describing both different consumption patterns and other sexual behaviors considered risky and their possible relationship with positivity in diagnoses of sexually transmitted infections, including human immunodeficiency virus. Methods: We conducted a literature review in the main scientific databases (PubMed, Embase, Scopus, Cochrane Library, Web of Science), filtering for articles published between January 2018 and April 2023 that collect information on sexualized drug use and sexual practices conducted in European countries among men who have sex with men, including whether these behaviors can lead to diagnoses of sexually transmitted infections. Results: The definition of drugs included in chemsex is not clearly defined and shows heterogeneity between study publications; the three drugs presented in all manuscripts are mephedrone, GHB/GBL, and crystal methamphetamine. The prevalence of chemsex in Europe is 16% [11–21%] among MSM. The most frequent risky sexual behavior associated with chemsex practice was unprotected sex with a high number of partners. The log risk ratio of STIs was 0.86 (95% CI: 0.49 to 1.23). Conclusions: Adherence to definitions, stringent research methodologies, and focused interventions are needed to tackle the intricate relationship between substance use, sexual behavior, and the risk of HIV/STI transmission in MSM. [ABSTRACT FROM AUTHOR]

Rational prescribing is essential for the quality of health care. However, many final‐year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2‐round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti‐infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country‐specific lists and could be used for the training and assessment of CPT. [ABSTRACT FROM AUTHOR]

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

Objectives Very little is known on the efficacy and safety of drugs for the management of chronic calcium pyrophosphate (CPP) crystal inflammatory arthritis. The objectives of this work were to describe the drugs used in the management of chronic CPP crystal inflammatory arthritis in expert European centres, and to examine treatment retention. Methods This was a retrospective cohort study. Charts from patients with a diagnosis of persistent inflammatory and/or recurrent acute CPP crystal arthritis were reviewed in seven European centres. Baseline characteristics were collected, and visits at months 3, 6, 12 and 24 included an assessment of treatment response and safety. Results One hundred and ninety-four treatments were initiated in 129 patients. Colchicine (used first-line in n  = 73/86), methotrexate (used first-line in n  = 14/36), anakinra (n  = 27) and tocilizumab (n  = 25) were the most prescribed treatments, while long-term corticosteroids, hydroxychloroquine, canakinumab and sarilumab were used occasionally. The 24-month on-drug retention was higher for tocilizumab (40%) than anakinra (18.5%) (P  < 0.05), while the difference between colchicine (29.1%) and methotrexate (44.4%) was not statistically significant (P  = 0.10). Adverse events led to 14.1% of colchicine discontinuations (100% of diarrhoea), 4.3% for methotrexate, 31.8% for anakinra and 20% for tocilizumab; all other discontinuations were related to insufficient response or losses to follow-up. Efficacy outcomes did not differ significantly between treatments throughout follow-up. Conclusion Daily colchicine is the first-line therapy used in chronic CPP crystal inflammatory arthritis, which is considered efficient in a third to half of cases. Second-line treatments include methotrexate and tocilizumab, which have higher retention than anakinra. [ABSTRACT FROM AUTHOR]

The generalist predator Nesidiocoris tenuis, an effective biological control agent of numerous pests of the tomato crops, can also trigger plant defence mechanisms (direct and indirect) due to its phytophagous behaviour. In southern Europe, Nesidiocoris tenuis is frequently released in tomato greenhouses to control the invasive pest Tuta absoluta, sometimes combined with another biocontrol agent, the egg parasitoid Trichogramma achaeae. In this study, using olfactometer bioassays, we showed that the modification of the volatile chemical profile induced by the plant feeding activity of the mirid made tomato plants more attractive to T. achaeae, both in the absence and in the presence of T. absoluta eggs or larvae. This result was discussed in relation to difference observed among the chemical profiles of the volatile organic compounds released by tomato plants punctured by N. tenuis, without or in combination with T. absoluta infestation. We found that a few compounds (e.g.β-pinene and myrcene) could play a role in the foraging behaviour of T. achaeae in this scenario. Overall, our data support the emerging idea of an ecological role of N. tenuis, in addition to its predatory activity, in making tomato crops more resilient against the attack of pests, including T. absoluta. [ABSTRACT FROM AUTHOR]

The research we present concerns the narratives of political and social identity of young adolescents sampled in Northern, Central and Southern Italy. Our qualitative analysis is based on constructivism and aims to enhance narratives by privileging the communication of meanings elaborated by the young people. Consistent with this perspective is our choice of the paradigm of pedagogical personalism, which places the human being as a 'person' at the center of reflection. The diverse universe of youth manifests multifaceted aspects that it is possible to bring out using interaction with deliberative, open, and non-pre-conceptual discussion. The link between semantic cores such as democracy, freedom, rights, interculturalism, and citizenship runs through the analyses of the entire research (based on the study by Ross's work in 2019, Finding Political Identities: Young People in a Changing Europe), examined here specifically in the Italian context. The article presents some contrasting aspects of the way young people living in Europe. They harbor uncertainties and discontinuities from the universe of values inherited from previous generations. However, from the tunnel of doubt young people show that they know how to emerge by outlining the forms of a promise of social commitment containing a hope for change, defined as the design of a future in which alternatives to the current situation can be found. In the background, the theme of democracy shows as an aspiration for something still struggling to be born. [ABSTRACT FROM AUTHOR]

Seed dispersal by frugivores is a fundamental function for plant community dynamics in fragmented landscapes, where forest remnants are typically embedded in a matrix of anthropogenic habitats. Frugivores can mediate both connectivity among forest remnants and plant colonization of the matrix. However, it remains poorly understood how frugivore communities change from forest to matrix due to the loss or replacement of species with traits that are less advantageous in open habitats and whether such changes ultimately influence the composition and traits of dispersed plants via species interactions. Here, we close this gap by using a unique dataset of seed-dispersal networks that were sampled in forest patches and adjacent matrix habitats of seven fragmented landscapes across Europe. We found a similar diversity of frugivores, plants, and interactions contributing to seed dispersal in forest and matrix, but a high turnover (replacement) in all these components. The turnover of dispersed seeds was smaller than that of frugivore communities because different frugivore species provided complementary seed dispersal in forest and matrix. Importantly, the turnover involved functional changes toward larger and more mobile frugivores in the matrix, which dispersed taller, larger-seeded plants with later fruiting periods. Our study provides a trait-based understanding of frugivore-mediated seed dispersal through fragmented landscapes, uncovering nonrandom shifts that can have cascading consequences for the composition of regenerating plant communities. Our findings also highlight the importance of forest remnants and frugivore faunas for ecosystem resilience, demonstrating a high potential for passive forest restoration of unmanaged lands in the matrix. [ABSTRACT FROM AUTHOR]

The analysis of the cultural Cold War in Latin America has experienced a growing interest from disciplinary fields such as cultural history or literary studies. In this line of work, and with the aim of contributing to a transatlantic approach to the problem, the special issue "Cultural ties of socialist and transatlantic friendship: Latin American writers and the Eastern Bloc during the Cold War" emphasizes the study of the interrelationships between Latin American literature and various European socialist countries. For this, it attends to a corpus of a plural nature: from fictional texts or analysis of periodicals to, above all, non-fiction texts that authors of diverse origins (Argentina, Uruguay, Chile, Cuba or Mexico) produced after passing through nations located beyond the Iron Curtain. [ABSTRACT FROM AUTHOR]

During the winters of the 2020–2022 period, several intense North African dust intrusions affected Europe. Some of them displayed a duration never recorded before. They were referred to as exceptional by several international operational and research institutions considering that wintertime is the season with minimum dust activity in the Mediterranean and Europe. These anomalous winter events with origin in North Africa largely affected western Mediterranean. The main objective of the present work is to analyse the atmospheric drivers (synoptic and large-scale environments) of wintertime (from January to March) dust events over the region covering North Africa, the Western Mediterranean and the Euro-Atlantic during the period 2003–2022. Overall, our results indicate large interannual variability over the study period. A dust catalogue of dust events identified by aerosols retrievals from satellite and aerosol reanalysis products shows a very irregular record and large differences between winter months. The analyses demonstrate a positive anomaly in dust concentration and maximum altitude during the dust events of 2020–2022 in comparison with those of previous years (2003–2019). Winter dust events over western Mediterranean are associated with enhanced blocking activity over the Euro-Atlantic sector, which favours the obstruction of the westerlies and the occurrence of cut-off lows at subtropical latitudes. However, these high-pressure systems can exhibit a large variety of configurations, including meridional dipole blocking patterns with poleward shifted jets or Mediterranean subtropical ridges with an intensified mid-latitude jet. The former was more frequent during the reference 2003–2019 period, whereas the latter was relatively common during the anomalous 2020–2022 period. [ABSTRACT FROM AUTHOR]

Introduction: Surveillance of Candida species isolates from blood cultures (BCs) in Europe is considered fragmented, unable to allow the definition of targets of antifungal stewardship recommendations especially during the SARS-CoV-2 pandemic. Methods: We performed a multicentric retrospective study including all consecutive BC Candida isolates from six Southern European tertiary hospitals (1st January 2020 to 31st December 2021). Etiology, antifungal susceptibility patterns, and clinical setting were analyzed and compared. Results: C. albicans was the dominant species (45.1%), while C. auris was undetected. Candida species positive BC events increased significantly in COVID-19 ICUs in 2021 but decreased in other ICUs. Resistance to azole increased significantly and remained very high in C. albicans (fluconazole from 0.7% to 4.5%, p = 0.03) and C. parapsilosis complex (fluconazole up to 24.5% and voriconazole up to 8.9%), respectively. Resistance to caspofungin was remarkable in C. tropicalis (10%) and C. krusei (20%), while resistance to at least one echinocandin increased in 2021, especially in C. parapsilosis complex (from 0.8% to 5.1%, p = 0.05). Although no significant differences were observed over the study period, fluconazole and echinocandin resistance increased in COVID-19 ICUs by up to 14% and 5.8%, respectively, but remained undetected in non-intensive COVID-19 wards. Conclusions: Antifungal stewardship activities aimed at monitoring resistance to echinocandin in C. tropicalis and C. krusei, and against the spread of fluconazole resistant C. parapsilosis complex isolates are highly desirable. In COVID-19 patients, antifungal resistance was mostly present when the illness had a critical course. [ABSTRACT FROM AUTHOR]

Owing to the vulnerability of patients with chronic kidney disease to infectious diseases, the coronavirus disease 2019 (COVID-19) pandemic has been particularly devastating for the nephrology community. Unfortunately, the possibility of future COVID-19 waves or outbreaks of other infectious diseases with pandemic potential cannot be ruled out. The nephrology community made tremendous efforts to contain the consequences of the COVID-19 pandemic. Despite this, the COVID-19 pandemic has highlighted several shortcomings in our response to the pandemic and has taught us important lessons that can be utilized to improve our preparedness for any future health crises of a similar nature. In this article we draw lessons from the European Renal Association COVID-19 Database (ERACODA) project, a pan-European collaboration initiated in March 2020 to understand the prognosis of COVID-19 in patients on kidney function replacement therapy. We discuss the challenges faced in generating timely and robust evidence for informed management of patients with kidney disease and give recommendations for our preparedness for the next pandemic in Europe. Limited collaboration, the absence of common data architecture and the sub-optimal quality of available data posed challenges in our response to COVID-19. Aligning different research initiatives, strengthening electronic health records, and involving experts in study design and data analysis will be important in our response to the next pandemic. The European Renal Association may take a leading role in aligning research initiatives via its engagement with other scientific societies, national registries, administrators and researchers. [ABSTRACT FROM AUTHOR]

Simple Summary: No consensus currently exists on immobilization protocols following shoulder surgery. The aim of this study was to identify patterns and types of sling used by surgeons from the United States and Europe for a variety of shoulder surgical procedures and further to identify factors associated with the variations. Four-hundred and ninety-nine surgeons with a median 15 years of experience responded, with 54.7% from the United States and 45.3% from Europe. United States surgeons reported higher abduction pillow sling use than European surgeons, whereas European surgeons reported more simple sling utilization. Increasing experience was negatively correlated with sling duration, meaning more experienced respondents tended to recommend shorter durations of sling use. Considerable variation exists in the immobilization patterns after a variety of shoulder surgical procedures advocated by surgeons with apparent influence from both geographic location and years of clinical experience. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. Background: There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. Methods: An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher's exact tests and post-hoc tests using Bonferroni-adjusted p-values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman's correlation tests. Results: In total, 499 surgeons with a median of 15 years of experience (IQR = 9–25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, p < 0.0001), Latarjet (53% vs. 12%, p < 0.001), ARCR < 3 cm (80% vs. 42%, p < 0.001) and >3 cm (84% vs. 61%, p < 0.001), aTSA (50% vs. 21%, p < 0.001) and rTSA with subscapularis repair (61% vs. 22%, p < 0.001) and without subscapularis repair (57% vs. 17%, p < 0.001), and isolated BT (18% vs. 7%, p = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, p < 0.001), Latarjet (78% vs. 44%, p < 0.001), ARCR < 3 cm (50% vs. 17%, p < 0.001) and >3 cm (34% vs. 13%, p < 0.001), and aTSA (69% vs. 41%, p < 0.001) and rTSA with subscapularis repair (70% vs. 35%, p < 0.001) and without subscapularis repair (73% vs. 39%, p < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = −0.20, p < 0.001), Latarjet (r = −0.25, p < 0.001), ARCR < 3 cm (r = −0.14, p = 0.014) and >3 cm (r = −0.20, p < 0.002), and aTSA (r = −0.37, p < 0.001), and rTSA with subscapularis repair (r = −0.10, p = 0.049) and without subscapularis repair (r = −0.19, p = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, p < 0.001), Latarjet (4.6 vs. 3.6 weeks, p < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks p < 0.001) and >3 cm (5.9 vs. 5.1 weeks, p < 0.001), aTSA (4.9 vs. 4.3 weeks, p < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, p = 0.031), and isolated BT (3.7 vs. 3.3 weeks, p = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated. Conclusions: There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Identifying the environmental drivers of variation in fitness‐related traits is a central objective in ecology and evolutionary biology. Temporal fluctuations of these environmental drivers are often synchronized at large spatial scales. Yet, whether synchronous environmental conditions can generate spatial synchrony in fitness‐related trait values (i.e., correlated temporal trait fluctuations across populations) is poorly understood. Using data from long‐term monitored populations of blue tits (Cyanistes caeruleus, n = 31), great tits (Parus major, n = 35), and pied flycatchers (Ficedula hypoleuca, n = 20) across Europe, we assessed the influence of two local climatic variables (mean temperature and mean precipitation in February–May) on spatial synchrony in three fitness‐related traits: laying date, clutch size, and fledgling number. We found a high degree of spatial synchrony in laying date but a lower degree in clutch size and fledgling number for each species. Temperature strongly influenced spatial synchrony in laying date for resident blue tits and great tits but not for migratory pied flycatchers. This is a relevant finding in the context of environmental impacts on populations because spatial synchrony in fitness‐related trait values among populations may influence fluctuations in vital rates or population abundances. If environmentally induced spatial synchrony in fitness‐related traits increases the spatial synchrony in vital rates or population abundances, this will ultimately increase the risk of extinction for populations and species. Assessing how environmental conditions influence spatiotemporal variation in trait values improves our mechanistic understanding of environmental impacts on populations. [ABSTRACT FROM AUTHOR]

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Background: Brown trout is one of the most widespread fresh-water fish species in Europe. The evolutionary history of and phylogenetic relationships between brown trout populations are complex, and this is especially true for Italian populations, which are heavily influenced in different ways by stocking practices. The characterization of the genetic structure of Italian brown trout populations may give information on the risk of losing endemic Italian populations due to lack of genetic diversity or to admixture with stocking populations. The identification of signatures of selection, and the information deriving from dense genotyping data will help genotype-informed breeding programs. We used a ddRAD-seq approach to obtain more than 100,000 single nucleotide polymorphisms (SNPs), and to characterize the population structure and signatures of selection in 90 brown trout samples. Results: Italian brown trout populations are genetically differentiated, although the stocking practices have introduced strong admixture in endemic Italian trout, especially with the Atlantic lineage. Most of the analysed populations showed high levels of kinship and inbreeding. We detected putative signatures of selection using different approaches, and investigated if the regions were enriched for functional categories. Several regions putatively under selection and characterized by a reduction in heterozygosity across all the studied populations are enriched for genes involved in the response to viral infections. Conclusions: Our results, which show evidence of admixture with the Atlantic lineage (commonly used for stocking), confirm the need for controlling stocking practices, in order to avoid the erosion of the endemic gene pool; given the apparently high levels of kinship and inbreeding in local populations, our results also show the need to take action for increasing gene diversity. In addition, we used the genetically-distinct lineages to detect signatures of selection and we identified putative signatures of selection in several regions associated with resistance to infectious diseases. These constitute candidate regions for the study of resistance to infections in wild and farmed trout. [ABSTRACT FROM AUTHOR]

Every year in Europe more than 500 thousand injuries that involve the anterior cruciate ligament (ACL) are diagnosed. The ACL is one of the main restraints within the human knee, focused on stabilizing the joint and controlling the relative movement between the tibia and femur under mechanical stress (i.e., laxity). Ligament laxity measurement is clinically valuable for diagnosing ACL injury and comparing possible outcomes of surgical procedures. In general, knee laxity assessment is manually performed and provides information to clinicians which is mainly subjective. Only recently quantitative assessment of knee laxity through instrumental approaches has been introduced and become a fundamental asset in clinical practice. However, the current solutions provide only partial information about either static or dynamic laxity. To support a multiparametric approach using a single device, an innovative smart knee brace for knee laxity evaluation was developed. Equipped with stretchable strain sensors and inertial measurement units (IMUs), the wearable system was designed to provide quantitative information concerning the drawer, Lachman, and pivot shift tests. We specifically characterized IMUs by using a reference sensor. Applying the Bland–Altman method, the limit of agreement was found to be less than 0.06 m/s2 for the accelerometer, 0.06 rad/s for the gyroscope and 0.08 μT for the magnetometer. By using an appropriate characterizing setup, the average gauge factor of the three strain sensors was 2.169. Finally, we realized a pilot study to compare the outcomes with a marker-based optoelectronic stereophotogrammetric system to verify the validity of the designed system. The preliminary findings for the capability of the system to discriminate possible ACL lesions are encouraging; in fact, the smart brace could be an effective support for an objective and quantitative diagnosis of ACL tear by supporting the simultaneous assessment of both rotational and translational laxity. To obtain reliable information about the real effectiveness of the system, further clinical validation is necessary. [ABSTRACT FROM AUTHOR]

The article reports that several doctors take on prescribing responsibilities after they graduate but final-year medical students not only feel insecure about prescribing, but also lack adequate knowledge and skills to prescribe rationally and safely. Topics include considered that to address this public health concern, the European Association for Clinical Pharmacology and Therapeutics (EACPT) recommended that education in clinical pharmacology and therapeutics in Europe should be modernized.

Cannabidiol is a novel antiseizure medication approved in Europe and the US for the treatment of seizures associated with Lennox-Gastaut syndrome, Dravet syndrome and tuberous sclerosis complex. We describe in this article a new and simple liquid chromatography-mass spectrometry method (LC-MS/MS) for the determination of cannabidiol and its active metabolite 7-hydroxy-cannabidiol in microvolumes of serum and saliva (50 μl), to be used as a tool for therapeutic drug monitoring (TDM) and pharmacokinetic studies. After on-line solid phase extraction cannabidiol, 7-hydroxy-cannabidiol and the internal standard cannabidiol- d3 are separated on a monolithic C18 column under gradient conditions. Calibration curves are linear within the validated concentration range (10–1,000 ng/ml for cannabidiol and 5–500 ng/ml for 7-hydroxy-cannabidiol). The method is accurate (intraday and interday accuracy within 94–112% for cannabidiol, 91–109% for 7-hydroxy-cannabidiol), precise (intraday and interday precision <11.6% for cannabidiol and <11.7% for 7- hydroxy-cannabidiol) and sensitive, with a LOQ of 2.5 ng/ml for cannabidiol and 5 ng/ml for 7-hydroxy-cannabidiol. The stability of the analytes was confirmed under different storage conditions. Extraction recoveries were in the range of 81–129% for cannabidiol and 100–113% for 7-hydroxy-cannabidiol. The applicability of the method to TDM was demonstrated by analysis of human serum and saliva samples obtained from patients with epilepsy treated with cannabidiol. [ABSTRACT FROM AUTHOR]

Qualitative studies have found that the use of Information and Communication Technologies is related to an enhanced quality of life for older adults, as these technologies might act as a medium to access social capital regardless of geographical distance. In order to quantitatively study the association between older people's characteristics and the likelihood of having a network of close friends offline and online, we use data from the Survey of Health, Ageing and Retirement in Europe and data from Facebook. Using a novel approach to analyze aggregated and anonymous Facebook data within a regression framework, we show that the associations between having close friends and age, sex, and being a parent are the same offline and online. Migrants who use internet are less likely to have close friends offline, but migrants who are Facebook users are more likely to have close friends online, suggesting that digital relationships may compensate for the potential lack of offline close friendships among older migrants. [ABSTRACT FROM AUTHOR]

The grey wolf (Canis lupus) persists in a variety of human-dominated landscapes and is subjected to various legal management regimes throughout Europe. Our aim was to assess the effects of intrinsic and methodological determinants on the hair cortisol concentration (HCC) of wolves from four European populations under different legal management. We determined HCC by an enzyme-linked immune assay in 259 hair samples of 133 wolves from the Iberian, Alpine, Dinaric-Balkan, and Scandinavian populations. The HCC showed significant differences between body regions. Mean HCC in lumbar guard hair was 11.6 ± 9.7 pg/mg (range 1.6–108.8 pg/mg). Wolves from the Dinaric-Balkan and Scandinavian populations showed significantly higher HCC than Iberian wolves, suggesting that harvest policies could reflected in the level of chronic stress. A significant negative relationship with body size was found. The seasonal, sex and age patterns are consistent with other studies, supporting HCC as a biomarker of chronic stress in wolves for a retrospective time frame of several weeks. Our results highlight the need for standardization of sampling and analytical techniques to ensure the value of HCC in informing management at a continental scale. [ABSTRACT FROM AUTHOR]

Background: The spread of Coronavirus disease-19 (COVID-19) poses unique challenges in the management of people with multiple sclerosis (PwMS). Objectives: To collect data about the impact of COVID-19 emergency on access to care for PwMS and on MS treatment practices. Methods: Between March and July 2020, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) promoted an online survey covering patient access to care, management of relapses and visits, disease-modifying therapy (DMT) and experience with COVID-19. Results: Three-hundred and sixty neurologists from 52 countries (68% from Europe) completed the survey. 98% reported COVID-19-related restrictions. Telemedicine was adopted to overcome the limited access to care and was newly activated (73%) or widely implemented (17%). 70% reported changes in DMT management. Interferons and glatiramer were considered safe. Dimethyl fumarate, teriflunomide and fingolimod were considered safe except for patients developing lymphopenia. No modifications were considered for natalizumab in 64%, cladribine in 24%, anti-CD20 in 22% and alemtuzumab in 17%; 18% (for alemtuzumab and cladribine) and 43% (for anti-CD20) considered postponing treatment. Conclusion: The ECTRIMS survey highlighted the challenges in keeping standards of care in clinical practice. Telemedicine clearly needs to be implemented. Gathering data on DMT safety will remain crucial to inform treatment decisions. [ABSTRACT FROM AUTHOR]

This study examines the prevalence, types of activities, and characteristics of self-employment into digital platform work. Among others, we wonder if self-employment is the natural employment status to perform this type of work, or if this is the case but only for particular activities (i.e., on-location versus on-web), or for specific groups of the working population. Our analysis also addresses the initial motivation for becoming digital platform workers along with their working conditions in order to explore the differences between self-employed workers (workers who are self-employed in their main job), hybrid self-employed workers (workers who are self-employed in their secondary job) and paid-employees. We use data from two waves of the COLLEEM Survey (2017-2018) to estimate discrete choice models. Our results show that the probability of being a digital platform worker is higher for self-employed workers than for paid-employees, but that digital platform work is even more prevailing among hybrid self-employed workers. We also find that digital platform workers among the hybrid self-employed often have a precarious profile of necessity motivations and poor working conditions, whereas among the self-employed, digital platform work is much more associated with voluntary choices and pursuing aspirations related to work autonomy and a varied job. [ABSTRACT FROM AUTHOR]

In the past few decades, boreal summers have been characterized by an increasing number of extreme weather events in the Northern Hemisphere extratropics, including persistent heat waves, droughts and heavy rainfall events with significant social, economic, and environmental impacts. Many of these events have been associated with the presence of anomalous large-scale atmospheric circulation patterns, in particular, persistent blocking situations, i.e., nearly stationary spatial patterns of air pressure. To contribute to a better understanding of the emergence and dynamical properties of such situations, we construct complex networks representing the atmospheric circulation based on Lagrangian trajectory data of passive tracers advected within the atmospheric flow. For these Lagrangian flow networks, we study the spatial patterns of selected node properties prior to, during, and after different atmospheric blocking events in Northern Hemisphere summer. We highlight the specific network characteristics associated with the sequence of strong blocking episodes over Europe during summer 2010 as an illustrative example. Our results demonstrate the ability of the node degree, entropy, and harmonic closeness centrality based on outgoing links to trace important spatiotemporal characteristics of atmospheric blocking events. In particular, all three measures capture the effective separation of the stationary pressure cell forming the blocking high from the normal westerly flow and the deviation of the main atmospheric currents around it. Our results suggest the utility of further exploiting the Lagrangian flow network approach to atmospheric circulation in future targeted diagnostic and prognostic studies. [ABSTRACT FROM AUTHOR]

Purpose: Sharing and developing digital educational resources and open educational resources has been proposed as a way to harmonize and improve clinical pharmacology and therapeutics (CPT) education in European medical schools. Previous research, however, has shown that there are barriers to the adoption and implementation of open educational resources. The aim of this study was to determine perceived opportunities and barriers to the use and creation of open educational resources among European CPT teachers and possible solutions for these barriers. Methods: CPT teachers of British and EU medical schools completed an online survey. Opportunities and challenges were identified by thematic analyses and subsequently discussed in an international consensus meeting. Results: Data from 99 CPT teachers from 95 medical schools were analysed. Thirty teachers (30.3%) shared or collaboratively produced digital educational resources. All teachers foresaw opportunities in the more active use of open educational resources, including improving the quality of their teaching. The challenges reported were language barriers, local differences, lack of time, technological issues, difficulties with quality management, and copyright restrictions. Practical solutions for these challenges were discussed and include a peer review system, clear indexing, and use of copyright licenses that permit adaptation of resources. Conclusion: Key challenges to making greater use of CPT open educational resources are a limited applicability of such resources due to language and local differences and quality concerns. These challenges may be resolved by relatively simple measures, such as allowing adaptation and translation of resources and a peer review system. [ABSTRACT FROM AUTHOR]

Status epilepticus (SE) is a neurological and medical emergency, defined as a condition resulting either from the failure of the mechanisms responsible of seizure self-limitation or from the initiation of mechanisms which lead to atypically prolonged seizures. Further than death, SE can have long-term consequences, including neuronal injury, depending on the type, cause and duration of seizures with severe associated disabilities. In Europe, SE shows an incidence rate ranging about 9 to 40/100,000/y. In adults, mortality of patients with SE is ∼ 30%, and even higher (up to 40%) in refractory status epilepticus. To date, etiology, duration, presence of comorbidity, level of consciousness, semiology and age are the main clinical predictors of SE outcome. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's Disease (AD) impairs the ability to carry out daily activities, reduces independence and quality of life and increases caregiver burden. Our understanding of functional decline has traditionally relied on reports by family and caregivers, which are subjective and vulnerable to recall bias. The Internet of Things (IoT) and wearable sensor technologies promise to provide objective, affordable, and reliable means for monitoring and understanding function. However, human factors for its acceptance are relatively unexplored. Objective: The Public Involvement (PI) activity presented in this paper aims to capture the preferences, priorities and concerns of people with AD and their caregivers for using monitoring wearables. Their feedback will drive device selection for clinical research, starting with the study of the RADAR-AD project. Method: The PI activity involved the Patient Advisory Board (PAB) of the RADAR-AD project, comprised of people with dementia across Europe and their caregivers (11 and 10, respectively). A set of four devices that optimally represent various combinations of aspects and features from the variety of currently available wearables (e.g., weight, size, comfort, battery life, screen types, water-resistance, and metrics) was presented and experienced hands-on. Afterwards, sets of cards were used to rate and rank devices and features and freely discuss preferences. Results: Overall, the PAB was willing to accept and incorporate devices into their daily lives. For the presented devices, the aspects most important to them included comfort, convenience and affordability. For devices in general, the features they prioritized were appearance/style, battery life and water resistance, followed by price, having an emergency button and a screen with metrics. The metrics valuable to them included activity levels and heart rate, followed by respiration rate, sleep quality and distance. Some concerns were the potential complexity, forgetting to charge the device, the potential stigma and data privacy. Conclusions: The PI activity explored the preferences, priorities and concerns of the PAB, a group of people with dementia and caregivers across Europe, regarding devices for monitoring function and decline, after a hands-on experience and explanation. They highlighted some expected aspects, metrics and features (e.g., comfort and convenience), but also some less expected (e.g., screen with metrics). [ABSTRACT FROM AUTHOR]

Purpose: To study age at death (AD) in elderly men as a function of risk factors and morbid conditions in a 25-year follow-up. Materials and methods: Men enrolled in the Seven Countries Study belonging to 8 cohorts in 4 European countries (Finland, The Netherlands, Italy and Serbia) were examined between 1984 and 1989 (aged 65–84 years) with measurement of some cardiovascular risk factors and recording of a few major morbid conditions. AD was measured after 25-year follow-up and used in multiple linear regression (MLR) models as dependent variable; while, risk factors and morbid conditions had the role of independent variables. Results: Out of 2457 men, 2290 died during 25-year follow-up. Overall mean AD was of 82.0 years and slightly different across cohorts, the lowest being recorded in Finland. Age at entry examination and HDL cholesterol were directly associated with AD; while, blood pressure, heart rate, smoking habits and morbid conditions (major cardiovascular diseases, either independently or combined together with diabetes, chronic bronchitis, cancer and silent ECG abnormalities) were inversely related to AD. Body mass index had a parabolic relation with AD with longer survival for levels around 24 units; while, total serum cholesterol was not related to AD. However, only three independent variables were statistically significant when tested in each individual country (age, heart rate and stroke). In a MLR model, where a comorbidity score was entered as independent variable (everything else being equal), the presence of 1 morbid condition was associated with a reduced AD by 1.87 years that increased up to 6.39 years when 4 morbid conditions were present. Conclusion: AD seems a valuable indicator of all-cause mortality when the study population has reached or approached the extinction. [ABSTRACT FROM AUTHOR]

Objective: ADHD remains a largely underdiagnosed disorder in Europe and especially in Italy. Aims of the present study were to assess the prevalence of ADHD and its clinical and demographic correlates in a large sample of Italian outpatients. Method: 634 outpatients accessing psychiatric services were assessed with the Mini-International Neuropsychiatric Interview (MINI) Plus V. 5.0.0 interview and the Adult ADHD self-report Scale Symptoms Checklist (ASRS)-V 1.1 Short Form. Patients positive to the ASRS-V 1.1 were assessed with the Diagnostic Interview for ADHD in Adults (DIVA) 2.0. Results: Of the total patients' sample, 81 (12.8%) were positive on the ASRS-V 1.1. After performing the DIVA 2.0, 44 patients (6.9%) met the criteria for Adult ADHD. Significant clinical and demographic differences between ADHD positive and negative groups were found. Conclusion: The prevalence and correlates of ADHD comorbidity in our outpatient psychiatric population were comparable to those found in other high-income countries. Considering the prevalence of ADHD and its impact on functioning, implementing specific knowledge on this subject is needed. [ABSTRACT FROM AUTHOR]

People with metastatic breast cancer face many challenges and disparities in obtaining optimal cancer care. These challenges are accentuated in underserved patient populations across Europe, who are less likely to receive quality healthcare for reasons including socioeconomic inequalities, educational or cultural status, or geographic location. While there are many local and national initiatives targeted to address these challenges, there remains a need to reduce disparities and improve access to healthcare to improve outcomes, with a focus on multidisciplinary stakeholder engagement. In October 2019, a range of experts in metastatic breast cancer, including healthcare professionals, patient representatives, policymakers and politicians, met to discuss and prioritize the critical needs of underserved patient populations with metastatic breast cancer in Europe. Six key challenges faced by these communities were identified: the need for amplification of the metastatic breast cancer patient voice, better and wider implementation of high-quality guidelines for metastatic breast cancer, more collaboration between stakeholders, tailored support for patients from different cultural and ethnic backgrounds, improved data sharing, and work-related issues. The Expert Panel then conceived and discussed potential actionable goals to address each key challenge. Their conclusions present a set of interrelated approaches to address the different challenges and could serve as the basis for concerted improvement of the lives of patients with metastatic breast cancer in Europe. • A pan-European approach is needed to tackle disparities in metastatic breast cancer treatment. • Multi-stakeholder collaboration may overcome challenges faced by underserved patients. • New interventions integrated with existing initiatives could improve patient care. [ABSTRACT FROM AUTHOR]

The safety of switching between generic products of antiseizure medications (ASMs) continues to be a hot topic in epilepsy management. The main reason for concern relates to the uncertainty on whether, and when, two generics found to be bioequivalent to the same brand (reference) product are bioequivalent to each other, and the risk of a switch between generics resulting in clinically significant changes in plasma ASM concentrations. This article addresses these concerns by discussing the distinction between bioequivalence and statistical testing for significant difference, the importance of intra‐subject variability in interpreting bioequivalence studies, the stricter regulatory bioequivalence requirements applicable to narrow‐therapeutic‐index (NTI) drugs, and the extent by which currently available generic products of ASMs comply with such criteria. Data for 117 oral generic products of second‐generation ASMs approved in Europe by the centralized, mutual recognition or decentralized procedure were analyzed based on a review of publicly accessible regulatory assessment reports. The analysis showed that for 99% of generic products assessed (after exclusion of gabapentin products), the 90% confidence intervals (90% CIs) of geometric mean ratios (test/reference) for AUC (area under the drug concentration vs time curve) were narrow and wholly contained within the acceptance interval (90%–111%) applied to NTI drugs. Intra‐subject variability for AUC was <10% for 53 (88%) of the 60 products for which this measure was reported. Many gabapentin generics showed broader, 90% CIs for bioequivalence estimates, and greater intra‐subject variability, compared with generics of other ASMs. When interpreted within the context of other available data, these results suggest that any risk of non‐bioequivalence between these individual generic products is small, and that switches across these products are not likely to result in clinically relevant changes in plasma drug exposure. The potential for variability in exposure when switching across generics is likely to be greatest for gabapentin. [ABSTRACT FROM AUTHOR]

The MODIFY I/II trials demonstrated that bezlotoxumab, a human monoclonal antibody against Clostridioides difficile toxin B, given during antibiotic treatment for Clostridioides difficile infection (CDI) significantly reduced C. difficile recurrence (rCDI) in adults at high risk for rCDI. Efficacy of CDI-directed intervention may depend on ribotype regional epidemiology, and patient characteristics. This post hoc analysis assessed the efficacy of bezlotoxumab in the subgroup of MODIFY I/II trial participants enrolled in Europe. Data from the bezlotoxumab (10 mg/kg single intravenous infusion) and placebo (0.9% saline) groups from MODIFY I/II were compared to assess initial clinical cure (ICC), rCDI, all-cause, and CDI-associated rehospitalizations within 30 days of discharge, and mortality through 12 weeks post-infusion. Of 1554 worldwide participants, 606 were from Europe (bezlotoxumab n = 313, 51%; placebo n = 292; 48%). Baseline characteristics were generally similar across groups, although there were more immunocompromised participants in the bezlotoxumab group (27.2%) compared with placebo (20.1%). Fifty-five percent of participants were female, and 86% were hospitalized at randomization. The rate of ICC was similar between treatment groups. The rate of rCDI in the bezlotoxumab group was lower compared with placebo among European participants overall, and among those with ≥ 1 risk factor for rCDI. Bezlotoxumab reduced 30-day CDI-associated rehospitalizations compared with placebo. These results are consistent with overall results from the MODIFY trials and demonstrate that bezlotoxumab reduces rCDI and CDI-associated rehospitalizations in European patients with CDI. MODIFY I/II (NCT01241552 and NCT01513239) [ABSTRACT FROM AUTHOR]

This article presents the H-PULSE, a novel semi-passive upper-limb exoskeleton for worker assistance, with motorized tuning of the assistive level. The H-PULSE presents novel design features compared to other passive industrial exoskeletons for the upper limbs, namely joint angle sensors for measuring shoulder flexion/extension and a novel active mechanism for regulating the assistance level. These features could enhance the effectiveness of the system. Along with the presentation of the exoskeleton design, this article reports on the system experimental evaluation with human subjects. The H-PULSE was assessed in prolonged static overhead tasks under different conditions of assistive support. The set of metrics to evaluate the effects of the device included shoulder muscular activity, heart rate, and subjective user feedback. Results show that the exoskeleton can reduce the users’ muscular activity and the heart rate. Subjective questionnaires allowed the assessment of perceived exoskeleton effectiveness. In this study, the H-PULSE exoskeleton was found to be potentially effective in reducing the muscular strain while reducing the global fatigue level during prolonged continuous overhead activities. [ABSTRACT FROM AUTHOR]

This study analyzes the range and content of Social Representations (SRs) about the COVID-19 pandemic in 21 geographical zones from 17 countries in the Americas, Europe and Asia (N = 4430). Based on Social Representations Theory, as well as the psychosocial consequences of pandemics and crises, we evaluate the perceptions of severity and risks, the agreement with different SRs, and participants' Social Dominance Orientation (SDO) and Right-Wing Authoritarianism (RWA). Different sets of beliefs are discussed as SRs, together with their prevalence and association with contextual variables. Results show that severity and risk perceptions were associated with different SRs of the pandemic. Specifically, those focused on Emerging Externalizing zoonotic and ecological factors (the virus is due to Chinese unhygienic habits and the overexploitation of the planet), Polemic Conspiracies (the virus is a weapon), views of Elite and Mass Villains (the elites deceive us and profit with the pandemic), and Personal Responsibility (the neglectful deserves contagion) during the pandemic. Furthermore, most of the SRs are anchored in SDO and, more strongly, in RWA orientations. Additional meta-analyses and multi-level regressions show that the effects are replicated in most geographical areas and that risk perception was a consistent explanatory variable, even after controlling for demographics and 'real risk' (i.e., actual numbers of contagion and death). Results suggest that, while coping with and making sense of the pandemic, authoritarian subjects agree with SR that feed a sense of social control and legitimize outgroup derogation, and support punishment of ingroup lowstatus deviants. [ABSTRACT FROM AUTHOR]

Aim: Nest building is widespread among animals. Nests may provide receptacles for eggs, developing offspring and the parents, and protect them from adverse environmental conditions. Nests may also indicate the quality of the territory and its owner and can be considered as an extended phenotype of its builder(s). Nests may, thus, function as a sexual and social signal. Here, we examined ecological and abiotic factors—temperature, nest predation and interspecific information utilization—shaping geographical variation in a specific nest structure—hair and feather cover of eggs—and its function as an extended phenotype before incubation in great (Parus major) and blue tits (Cyanistes caeruleus) across Europe. We also tested whether egg covering is associated with reproductive success of great tits. Location: Fourteen different study sites and 28 populations across Europe. Taxon: Parus major, Cyanistes caeruleus. Methods: We recorded clutch coverage estimates and collected egg covering nest material from the tit nests. We also measured nest specific breeding parameters and phenotypic measurements on adults. We tested whether mean spring temperatures, nest predation rates and flycatcher (Ficedula spp) densities in the study areas explain the large‐scale geographical variation of clutch coverage and reproductive success of tits. Results: The degree of egg coverage of great tits increased with lower mean spring temperature, higher nest predation rate and higher flycatcher density. We did not find egg covering of blue tits to be associated with any of the ecological or abiotic factors. Moreover, egg covering of great tits was not associated with reproductive success in our cross‐sectional data, yet a rigorous assessment of fitness effects would require long‐term data. Main conclusions: Our findings suggest that, in great tits, egg covering may simultaneously provide thermal insulation against cold temperatures during egg‐laying in spring and also represent a counter‐adaptation to reduce information parasitism by flycatchers and nest predation. Hence, geographical variation in interspecific interactions, and consequently in co‐evolutionary processes, may affect the evolution of nest characteristics besides environmental conditions. [ABSTRACT FROM AUTHOR]

This paper is a contribution to the characterisation by an integrated approach of the species Microterys chalcostomus (Dalman), a parasitoid of mealybugs and apparently a predator of kermesid eggs. Until now, the species, whose type is in good condition, could be identified only by the meagre original description by Dalman and subsequent notes by Graham. Nonetheless, it appears to be extremely common in Europe, hence the need for a thorough morphological and molecular characterisation. Systematic notes on closely related species of Microterys parasitoids of mealybugs are included. [ABSTRACT FROM AUTHOR]

Persian walnut (Juglans regia L.), which is native to Central Asia, has been widely cultivated throughout Europe over millennia as a multipurpose tree. However, only recently the naturalization process outside cultivation has been studied, mostly in temperate Europe, with no information regarding the Mediterranean region. Here we provide the first field investigations about the natural regeneration of walnut in two traditional Mediterranean agroecosystems: an irrigated mixed orchard in suburban areas and a non-irrigated prickly pear (Opuntia ficusindica [L.] Mill.) orchard. The natural regeneration densities were statistically different in the two agroecosystems, ranging from 75 individuals per hectare in the prickly pear orchard to 200 individuals per hectare in the mixed orchard. Crows were frequently observed actively carrying walnuts in both environments. The irrigation practices and the shade provided by larger trees in the mixed orchard, and the potential benefits provided by prickly pear individuals, seemed to be crucial for seedling establishment and development in the two orchards, respectively. On the other hand, climate does not seem to represent a constraint for walnut recruitment, even if the mean annual temperature at the mixed orchard is slightly above the optimal temperature for walnut. Other biotic and abiotic factors that may trigger or hamper the naturalization process are also discussed in this paper, which explores the research needs for better understanding the naturalization potential of the Persian walnut in Mediterranean agroecosystems, as well as the effects of different land uses and future climate change on this process. [ABSTRACT FROM AUTHOR]

Birds are hosts for several zoonotic pathogens. Because of their high mobility, especially of longdistance migrants, birds can disperse these pathogens, affecting their distribution and phylogeography. We focused on Borrelia burgdorferi sensu lato, which includes the causative agents of Lyme borreliosis, as an example for tick‐borne pathogens, to address the role of birds as propagation hosts of zoonotic agents at a large geographical scale. We collected ticks from passerine birds in 11 European countries. B. burgdorferi s.l. prevalence in Ixodes spp. was 37% and increased with latitude. The fieldfare Turdus pilaris and the blackbird T. merula carried ticks with the highest Borrelia prevalence (92 and 58%, respectively), whereas robin Erithacus rubecula ticks were the least infected (3.8%). Borrelia garinii was the most prevalent genospecies (61%), followed by B. valaisiana (24%), B. afzelii (9%), B. turdi (5%) and B. lusitaniae (0.5%). A novel Borrelia genospecies "Candidatus Borrelia aligera" was also detected. Multilocus sequence typing (MLST) analysis of B. garinii isolates together with the global collection of B. garinii genotypes obtained from the BorreliaMLST public database revealed that: (a) there was little overlap among genotypes from different continents, (b) there was no geographical structuring within Europe, and (c) there was no evident association pattern detectable among B. garinii genotypes from ticks feeding on birds, questing ticks or human isolates. These findings strengthen the hypothesis that the population structure and evolutionary biology of tick‐borne pathogens are shaped by their host associations and the movement patterns of these hosts. [ABSTRACT FROM AUTHOR]

Seed transmission is a key point of the CBB disease cycle, favouring both vertical transmission of the pathogen and worldwide distribution of the disease through global seed trade. European Cooperation in Science and Technology (COST) is a funding organization for the creation of research networks, called COST Actions, that provide networking opportunities for researchers and innovators to strengthen Europe's capacity to address scientific, technological, and societal challenges. In addition, we complement this set of pathogens with a Pathogen Profile about cassava-infecting xanthomonads because of their important socioeconomic impact worldwide. [Extracted from the article]

Landscape quality has become a fundamental issue in the development of renewable energy (henceforth abbreviated RE) projects. Rapid technological advances in RE production and distribution, coupled with changing policy frameworks, bring specific challenges during planning in order to avoid degradation of landscape quality. The current work provides a comprehensive review on RE landscapes and the impacts of RE systems on landscape for most European countries. It is based on a review by an interdisciplinary international team of experts of empirical research findings on landscape impacts of RE from thirty-seven countries that have participated in the COST Action TU1401 Renewable Energy and Landscape Quality (RELY). [ABSTRACT FROM AUTHOR]

Objectives: Cholangiocarcinoma is the second most common primary liver tumour with a poor overall prognosis. Percutaneous hepatic perfusion (PHP) is a directed therapy for primary and secondary liver malignancies, and its efficacy and safety have been shown in different entities. The purpose of this study was to prove the safety and efficacy of PHP in patients with unresectable intrahepatic cholangiocarcinoma (iCCA).Patients and Methods: We retrospectively reviewed data from 15 patients with unresectable iCCA treated with PHP in nine different hospitals throughout Europe. Overall response rates (ORR) were assessed according to response evaluation criteria in solid tumours (RECIST1.1). Overall survival (OS), progression-free survival (PFS) and hepatic PFS (hPFS) were analysed using the Kaplan-Meier estimation. Adverse events (AEs) and toxicity were evaluated.Results: Fifteen patients were treated with 26 PHPs. ORR was 20%, disease control was achieved in 53% after the first PHP. Median OS was 26.9 months from initial diagnosis and 7.6 months from first PHP. Median PFS and hPFS were 122 and 131 days, respectively. Patients with liver-only disease had a significantly longer median OS compared to patients with locoregional lymph node metastases (12.9 vs. 4.8 months, respectively; p < 0.01). Haematological toxicity was common, but manageable. No AEs of grade 3 or 4 occurred during the procedures.Discussion: PHP is a standardised and safe procedure that provides promising response rates and survival data in patients with iCCA, especially in non-metastatic disease.Key Points: • Percutaneous hepatic perfusion (PHP) offers an additional locoregional therapy strategy for the treatment of unresectable primary or secondary intrahepatic malignancies. • PHP is a standardised and safe procedure that provides promising response rates and survival data in patients with intrahepatic cholangiocarcinoma (iCCA), especially in non-metastatic disease. • Side effects seem to be tolerable and comparable to other systemic or local treatment strategies. [ABSTRACT FROM AUTHOR]

Drosophila suzukii is native to East Asia and an invasive pest of fruit crops widely established in the Americas and Europe. The lack of effective indigenous parasitoids of D. suzukii in the invaded regions prompted surveys for co-evolved parasitoids in Yunnan Province, China, from 2013 to 2016. From banana-baited traps (2013-2015), 458 parasitoids of drosophilids were reared, comprised of Braconidae (49.56%), Figitidae (37.55%), Diapriidae (7.42%), and Pteromalidae (5.46%). Larval parasitoids included seven braconid species, all Asobara and primarily Asobara mesocauda, and five figitid species, primarily Leptopilina japonica japonica. Pupal parasitoids were the diapriid Trichopria drosophilae and the pteromalid Pachycrepoideus vindemiae. Collections from wild fruits (2016) provided more interesting results. From the puparia of drosophilids collected, comprised of D. suzukii and Drosophila pulchrella, emerged 1354 parasitoids. The larval parasitoids Ganaspis brasiliensis and L. j. japonica were the prevalent species, reaching a fairly high percentage parasitism of fly puparia collected from berries of Rubus foliosus (22.35%), R. niveus (18.81%), Fragaria moupinensis (19.75%), and Sambucus adnata (63.46%). Ganaspis brasiliensis was the dominant species and was collected only from D. suzukii and D. pulchrella-infested fruits and never from banana-baited traps. Molecular analysis showed two G. brasiliensis lineages, which are discussed with respect to previous Japanese collections. Quarantine tests showed that G. brasiliensis developed from D. suzukii and two closely related hosts (Drosophila melanogaster and Drosophila simulans) but did not develop from seven non-target drosophilid species. Our results suggest that G. brasiliensis is a promising classical biocontrol agent for release in invaded regions. [ABSTRACT FROM AUTHOR]

Purpose: Annual rates of knee arthroplasty are increasing in all developed countries, imposing a significant economic and organizational burden; it is crucial to forecast the future need for knee arthroplasty, to assist stakeholders in planning strategies and investments, especially in a country like Italy, with the largest proportion of elderly citizens in Europe. Few epidemiological studies have been performed worldwide to estimate the demand for future knee replacement, and a variety of methods have been proposed.Methods: We investigated the epidemiology of knee arthroplasty performed in Italy in the last 15 years and projected incidence rates up to the year 2050, utilizing, comparing, and adapting the available methodologies.Results: From 2001 to 2016, 812,639 primary TKA were performed in Italy on patients over 40. The total number of surgeries increased by 262% with an average annual growth rate of 6.6%.Conclusions: Adopting the best fitting projection method, an increase of 45% in incidence rate is expected for 2050. [ABSTRACT FROM AUTHOR]

It is stated that farmers need to become more entrepreneurial to compete in modern agriculture. Much of the literature on agricultural entrepreneurship, however, has been focused on established farmers and little is known about what determines this behaviour among new entrants. New entrants may provide a robust answer to the call for entrepreneurialism in agriculture. This paper examines the drivers for entrepreneurialism among 1,877 new entrants in Europe, in particular the effect of human and social capital on new business opportunity identification once they have started their farming activity. The results suggest that new part-time farmers who treat farming as their second job are less likely to identify new business opportunities. By contrast, new farmers with high levels of confidence in their entrepreneurial competencies tend to identify more new business opportunities. Farmers’ weak social ties and a positive attitude in their context towards entrepreneurship increases opportunity identification. The findings contribute to understanding the specifics of new entrants in agriculture and highlight the importance of specific entrepreneurial knowledge and professional networks for this group. This has consequences for tailoring education and training programs as well as for policy measures for this specific group. [ABSTRACT FROM AUTHOR]

Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired. [ABSTRACT FROM AUTHOR]

As heart failure with preserved ejection fraction (HFpEF) rises to epidemic proportions, major steps in patient management and therapeutic development are badly needed. With the current position paper we seek to update our view on HFpEF as a highly complex systemic syndrome, from risk factors and mechanisms to long-term clinical manifestations. We will revise recent advances in animal model development, experimental set-ups and basic and translational science approaches to HFpEF research, highlighting their drawbacks and advantages. Directions are provided for proper model selection as well as for integrative functional evaluation from the in vivo setting to in vitro cell function testing. Additionally, we address new research challenges that require integration of higher-order inter-organ and inter-cell communication to achieve a full systems biology perspective of HFpEF. [ABSTRACT FROM AUTHOR]