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

Decentralized clinical trial (DCT) approaches are clinical trials in which some or all trial activities take place closer to participants' proximities instead of a traditional investigative site. Data from DCTs may be used for clinical and economic evaluations by health technology assessment (HTA) bodies to support reimbursement decision making. This study aimed to explore the opportunities and challenges for DCT approaches from an HTA perspective by interviewing representatives from European HTA bodies. We conducted semistructured interviews with 25 European HTA representatives between September 2022 and February 2023, and transcripts were analyzed after thematic analysis. Two main themes were identified from the data relating to (1) DCT approaches in HTA and (2) trial-level acceptance and relevance. Experience with assessing DCTs was limited and a variety of knowledge about DCTs was observed. The respondents recognized the opportunity of DCTs to reduce recall bias when participant-reported outcome data can be collected more frequently and conveniently from home. Concerns were expressed about the data quality when participants become responsible for data collection. Despite this challenge, the respondents recognized the potential of DCTs to increase the generalizability of results because data can be collected in a setting reflective of the everyday situation potentially from a more diverse participant group. DCTs could generate relevant results for HTA decision making when data are collected in a real-world setting from a diverse participant group. Increased awareness of the opportunities and challenges could help HTA assessors in their appraisal of DCT approaches. • Decentralized clinical trial (DCT) approaches move trial activities from the investigative site to the participants' surroundings, to render either fully decentralized trials or trials with a combination of at-home and in-clinic activities. These approaches have the potential to reduce participation burden, leverage technologies to collect data, and increase participant representativeness. In Europe, regulators are beginning to explore DCT approaches and have issued guidance documents, but the perspective of health technology assessors has not been studied before. • We identified opportunities and challenges for DCT approaches from a health technology assessment (HTA) perspective. The main opportunities relate to a better reflection of the real-world, for example, because participants feel less observed when participating from home and because of expected increased trial access for underserved groups. Identified challenges include the possibility of reduced data quality—when procedures are moved from sites to less controlled settings—and the limited knowledge of DCTs among HTA assessors. • When evaluating DCT approaches, the different ways trials can be decentralized should be recognized—for example, in terms of recruitment procedures, number and type of included digital health technologies, and related trial complexity and accessibility. DCT approaches should be considered to collect participant-reported outcomes for HTA decision making in a convenient way in a real-world setting. An aligned view from the perspective of HTA assessors and regulators could be communicated through guidance. [ABSTRACT FROM AUTHOR]

Simple Summary: Females with PTEN Hamartoma Tumor Syndrome (PHTS) have very high hereditary breast cancer risks up to 76%. The aim of this European cohort study was to the describe the lifestyle in PHTS patients and to assess associations between physical activity, alcohol consumption, tobacco smoking, BMI and breast cancer in female adult PHTS patients. It was observed that of 125 patients who completed the questionnaire, 81% were ≥2 times/week physically active, 86% consumed on average <1 glass of alcohol/day, 78% never smoked and most patients were overweight or obese (72%). In total, 39 developed breast cancer (31%). No indications were found that associations between lifestyle and breast cancer in PHTS patients are different from the general population. These findings suggest that awareness about lifestyle among PHTS patients is important, as a healthier lifestyle could potentially decrease their breast cancer risk in a similar way as for the general population. Females with PTEN Hamartoma Tumor Syndrome (PHTS) have breast cancer risks up to 76%. This study assessed associations between breast cancer and lifestyle in European female adult PHTS patients. Data were collected via patient questionnaires (July 2020–March 2023) and genetic diagnoses from medical files. Associations between lifestyle and breast cancer were calculated using logistic regression corrected for age. Index patients with breast cancer before PHTS diagnosis (breast cancer index) were excluded for ascertainment bias correction. In total, 125 patients were included who completed the questionnaire at a mean age of 44 years (SD = 13). This included 21 breast cancer indexes (17%) and 39 females who developed breast cancer at 43 years (SD = 9). Breast cancer patients performed about 1.1 times less often 0–1 times/week physical activity than ≥2 times (ORtotal-adj = 0.9 (95%CI 0.3–2.6); consumed daily about 1.2–1.8 times more often ≥1 than 0–1 glasses of alcohol (ORtotal-adj = 1.2 (95%CI 0.4–4.0); ORnon-breastcancer-index-adj = 1.8 (95%CI 0.4–6.9); were about 1.04–1.3 times more often smokers than non-smokers (ORtotal-adj = 1.04 (95%CI 0.4–2.8); ORnon-breastcancer-index-adj = 1.3 (95%CI 0.4–4.2)); and overweight or obesity (72%) was about 1.02–1.3 times less common (ORtotal-adj = 0.98 (95%CI 0.4–2.6); ORnon-breastcancer-index-adj = 0.8 (95%CI 0.3–2.7)). Similar associations between lifestyle and breast cancer are suggested for PHTS and the general population. Despite not being statistically significant, results are clinically relevant and suggest that awareness of the effects of lifestyle on patients' breast cancer risk is important. [ABSTRACT FROM AUTHOR]

Cancer pain is a common symptom in patients with cancer and can largely affect their quality of life. Pain management is important to minimize the impact of pain on daily activities. Cancer nurses are significantly involved in all steps of pain management and contribute to the success of therapy through their knowledge and expertise. While they generally play an important role in the screening, assessment, diagnosis, treatment and follow-up of patients and their (pain) symptoms, this varies from country to country in Europe. An important aspect is their role in educating patients and their families about what pain is, what impact it can have, how it can be treated pharmacologically or non-pharmacologically and what effects or problems can occur during treatment. While there is a great discrepancy between education and training opportunities for cancer nurses in different European countries, there is a continued need for education and training in pain management. Cancer is increasingly becoming a chronic disease, and the management of pain in cancer survivors will be crucial to maintain an adequate quality of life. With this, the crucial role of cancer nurses is becoming even more important. [ABSTRACT FROM AUTHOR]

Aims: Insights into the current practice of direct‐to‐participant (DtP) supply of investigational medicinal product (IMP) in the context of clinical trials conducted in Europe are needed, as regulations are unharmonized. This study is set out to explore how DtP IMP supply has been employed in Europe and what the advantages and disadvantages and barriers and facilitators of its implementation are. Methods: We conducted semi‐structured interviews with representatives from sponsor companies, courier services and site study staff involved in the IMP dispensing and delivery process in Europe. Interviews were conducted between May and November 2021, and data were analysed following thematic analysis. Results: Sixteen respondents participated in one of the 12 interviews. Respondents had experience with different models of DtP IMP supply including shipment from the investigative site, a central pharmacy (a depot under the control of a pharmacist) and a local pharmacy—aiming to reduce trial participation burden. The respondents indicated that investigative site‐to‐participant shipment is not affected by regulatory barriers, but could burden site staff. Shipment from central locations was considered most efficient, but possible regulatory barriers related to maintaining participants' privacy and investigator oversight were identified. The respondents indicated that the involvement of local pharmacies to dispense IMP can be considered when the IMP is authorized. Conclusions: Several DtP IMP supply models are implemented in clinical trials conducted in Europe. In this study, three main DtP IMP models were identified, which can be referenced when describing these approaches for regulatory approval. [ABSTRACT FROM AUTHOR]

Background: Using data collected in the prospective observational study CIRSE Registry for SIR-Spheres Therapy, the present study aimed at identifying predictors of adverse events (AEs) following transarterial radioembolization (TARE) with Yttrium-90 resin microspheres for liver tumours. Methods: We analysed 1027 patients enrolled between January 2015 and December 2017 and followed up for 24 months. Four hundred and twenty-two patients with hepatocellular carcinoma (HCC), 120 with intrahepatic carcinoma (ICC), 237 with colorectal liver metastases and 248 with liver metastases from other primaries were included. Prognostic factors were calculated with a univariable analysis by using the overall AEs burden score (AEBS). Results: All-cause AEs were reported in 401/1027 (39.1%) patients, with AEs associated with TARE, such as abdominal pain (16.6%), fatigue (17%), and nausea (11.7%) reported most frequently. Grade 3 or higher AEs were reported in 92/1027 (9%) patients. Reports on grade ≥ 3 gastrointestinal ulcerations (0.4%), gastritis (0.3%), radiation cholecystitis (0.2%) or radioembolization-induced liver disease (0.5%) were uncommon. Univariable analysis showed that in HCC, AEBS increased for Eastern Cooperative Oncology Group (ECOG) 0 (p = 0.0045), 1 tumour nodule (0.0081), > 1 TARE treatment (p = 0.0224), no prophylactic embolization (p = 0.0211), partition model dosimetry (p = 0.0007) and unilobar treatment target (0.0032). For ICC, > 1 TARE treatment was associated with an increase in AEBS (p = 0.0224), and for colorectal liver metastases, ECOG 0 (p = 0.0188), > 2 prior systemic treatments (p = 0.0127), and 1 tumour nodule (p = 0.0155) were associated with an increased AEBS. Conclusion: Our study confirms that TARE is a safe treatment with low toxicity and a minimal impact on quality of life. [ABSTRACT FROM AUTHOR]

The respiratory syncytial virus (RSV) has two main variants with similar impact, a human and a bovine variant. The human respiratory syncytial virus (HRSV) is the most frequent cause of acute respiratory disease (pneumonia) in children, leading to hospitalization and causing premature death. In Europe, lower respiratory tract infections caused by HRSV are responsible for 42–45 percent of hospital admissions in children under two. Likewise, the bovine respiratory syncytial virus (BRSV) is a significant cause of acute viral broncho-pneumonia in calves. To date no licensed HRSV vaccine has been developed, despite the high burden of the disease. In contrast, BRSV vaccines have been on the market since the 1970s, but there is still an articulated unmet need for improved BRSV vaccines with greater efficacy. HRSV/BRSV vaccine development was chosen as a case to assess whether collaboration and knowledge-sharing between human and veterinary fields is taking place, benefiting the development of new vaccines in both fields. The genetic relatedness, comparable pathogeneses, and similar severity of the diseases suggests much can be gained by sharing knowledge and experiences between the human and veterinary fields. We analyzed patent data, as most of pharmaceutical inventions, such as the development of vaccines, are protected by patents. Our results show only little cross-utilization of inventions and no collaborations, as in shared IP as an exchange of knowledge. This suggests that, despite the similarities in the genetics and antigenicity of HRSV and BRSV, each fields follows its own process in developing new vaccines. [ABSTRACT FROM AUTHOR]

Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. Results: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. Conclusions: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care. [ABSTRACT FROM AUTHOR]

Using unique longitudinal data from the Dutch population registers, this study investigates the patterns and drivers of emigration of the Turkish second generation born in the Netherlands between 1983 and 1992. Around 13% of the Turkish second generation in the research population emigrated during early adulthood, as compared to 6% of their peers without immigrant parents. Half of the Turkish second-generation emigrants who reported their destination country moved to Turkey, while the other half moved to other destinations, especially the Dutch neighbouring countries. Among the Turkish second generation, unemployment over the previous year was found to increase the likelihood of emigration for individuals with low or middle levels of education, whereas no support was found that higher educated individuals (either employed or unemployed) are more likely to emigrate. However, if high-skilled unemployed individuals of the Turkish second generation emigrated, they appeared more likely to select Turkey as their destination as compared to other (or unknown) destinations. International migration experiences during childhood, living at the parental home, and residing in neighbourhoods with a high share of co-ethnics were also associated with a higher chance of emigration to Turkey, whereas living in the Dutch border regions was associated with a higher chance of emigration to other destinations. Together, the findings indicate that the Turkish second generation has a higher chance to emigrate than their peers without immigrant parents, and that mechanisms specific to the second generation apply to the migration behaviour of this group. [ABSTRACT FROM AUTHOR]

Background: Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. Methods: The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. Results: The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. Conclusions: To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities. [ABSTRACT FROM AUTHOR]

The role of livestock animals as a putative source of ESBL/pAmpC E. coli for humans is a central issue of research. In a large-scale pan-European surveillance, 2,993 commensal Escherichia spp. isolates were recovered from randomly collected fecal samples of healthy cattle, pigs and chickens in various abattoirs. One-hundred Escherichia spp. isolates (0.5% from cattle, 1.3% pigs, 8.0% chickens) fulfilled the criteria for cefotaxime and ceftazidime non-wildtype (EUCAST). In silico screening of WGS data of 99 isolates (98 E. coli and 1 E. fergusonii) revealed bla SHV–12 (32.3%), bla CTX–M–1 (24.2%), and bla CMY–2 (22.2%) as predominant ESBL/pAmpC types. Other types were bla SHV–2 (1.0%), bla CTX–M–2/–14/–15 (1.0/6.1/1.0%), and bla TEM–52 (5.1%). Six isolates revealed AmpC-promoter mutations (position −42 (C > T) and one carried mcr-1. The majority (91.3%) of ESBL/pAmpC genes were located on plasmids. SHV-12 was mainly (50%) encoded on IncI1α plasmids (pST-3/-26/-95), followed by IncX3 (12.5%) and IncK2 (3.1%). The bla TEM–52 genes were located on IncI1α-pST-36 (60%) and IncX1 plasmids (20%). The dominant plasmid lineage among CTX-M-1 isolates was IncI1α (pST-3/-295/-317) (87.5%), followed by IncN-pST-1 (8.3%). CMY-2 was mostly identified on IncI1α (pST-12/-2) (54.5%) and IncK2 (31.8%) plasmids. Several plasmids revealed high similarity to published plasmids from human and animal Enterobacteriaceae. The isolates were assigned to phylogroups A/C (34.7/7.1%), B1 (27.6%), B2 (3.1%), D/F (9.2/10.2%), E (5.1%), and to E. clades (3.0%). With 51 known and 2 novel MLST types, a wide variety of STs was found, including STs previously observed in human isolates (ST10/38/117/131/648). ESBL/AmpC types or STs were rarely correlated with the geographic origin of the isolates or animal species. Virulence gene typing identified extraintestinal pathogenic E. coli (ExPEC; 2.0%), avian pathogenic E. coli (APEC; 51.5%), and atypical enteropathogenic E. coli (EPEC; 6.1%). In conclusion, the high diversity of STs and phylogenetic groups provides hardly any hint for clonal spread of single lineages but hints toward the dissemination of cephalosporin resistance genes in livestock via distinct, globally successful plasmid lineages. Even though a number of isolates could not be assigned to a distinct pathotype, our finding of combined multidrug-resistance and virulence in this facultative pathogen should be considered an additional threat to public health. [ABSTRACT FROM AUTHOR]

Purpose: To address the lack of prospective data on the real-life clinical application of trans-arterial radioembolization (TARE) in Europe, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) initiated the prospective observational study CIRSE Registry for SIR-Spheres® Therapy (CIRT). Materials and Methods: Patients were enrolled from 1 January 2015 till 31 December 2017. Eligible patients were adult patients treated with TARE with Y90 resin microspheres for primary or metastatic liver tumours. Patients were followed up for 24 months after treatment, whereas data on the clinical context of TARE, overall survival (OS) and safety were collected. Results: Totally, 1027 patients were analysed. 68.2% of the intention of treatment was palliative. Up to half of the patients received systemic therapy and/or locoregional treatments prior to TARE (53.1%; 38.3%). Median overall survival (OS) was reported per cohort and was 16.5 months (95% confidence interval (CI) 14.2–19.3) for hepatocellular carcinoma, 14.6 months (95% CI 10.9–17.9) for intrahepatic cholangiocarcinoma. For liver metastases, median OS for colorectal cancer was 9.8 months (95% CI 8.3–12.9), 5.6 months for pancreatic cancer (95% CI 4.1–6.6), 10.6 months (95% CI 7.3–14.4) for breast cancer, 14.6 months (95% CI 7.3–21.4) for melanoma and 33.1 months (95% CI 22.1–nr) for neuroendocrine tumours. Statistically significant prognostic factors in terms of OS include the presence of ascites, cirrhosis, extra-hepatic disease, patient performance status (Eastern Cooperative Oncology Group), number of chemotherapy lines prior to TARE and tumour burden. Thirty-day mortality rate was 1.0%. 2.5% experienced adverse events grade 3 or 4 within 30 days after TARE. Conclusion: In the real-life clinical setting, TARE is largely considered to be a part of a palliative treatment strategy across indications and provides an excellent safety profile. Level of evidence: Level 3. Trial registration: ClinicalTrials.gov NCT02305459. [ABSTRACT FROM AUTHOR]

• Mechanisms of cardiovascular disease are complex and multifactorial, driven by genetic variants. • Attractive drug targets require a substantial body of mechanistic and clinical evidence. • Drug target discovery in CVD is only possible through multidisciplinary collaboration. • To maximise impact, collaboration between independent research consortia is advised. Research consortia in Europe often compete with each other for skills, human and technical resources and, eventually, recognition of the scientific impact of their work. In response to the same EU Horizon2020 call, we received funding for our research project proposals to identify and validate novel drug targets for cardiovascular disease treatment. Each consortium followed a unique and independent research strategy. However, as coordinators of these consortia we envisioned we could increase impact, outcomes and efficiency by intensifying our interaction. At an agreed stage during our projects we chose to share our knowledge, vision and ideas. In this paper we present what we learned, in the hope that future consortia will see the benefits of this approach. [ABSTRACT FROM AUTHOR]

We examined the cross-lagged relations between reading and spelling in five alphabetic orthographies varying in consistency (English, French, Dutch, German, and Greek). Nine hundred and forty-one children were followed from Grade 1 to Grade 2 and were tested on word and pseudoword reading fluency and on spelling to dictation. Results indicated that the relations across languages were unidirectional: Earlier reading predicted subsequent spelling. However, we also found significant differences between languages in the strength of the effects of earlier reading on subsequent spelling. These findings suggest that, once children master decoding, the observed differences between languages are not related to the direction of the effects but to the strength of the effects from reading to spelling. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

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Background: Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe.Methods: The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007-2017.Results: A total of 908 articles were retrieved. Deletion of duplicates left 531. After screening titles, abstracts and full texts according to pre-defined inclusion and exclusion criteria, 29 articles were included in the review. Overall, quantitative studies showed an underutilization of different types of healthcare services by undocumented migrants. Qualitative studies reported that, even when care was received, it was often inadequate or insufficient, and that many undocumented migrants were unfamiliar with their entitlements and faced barriers in utilizing healthcare services.Conclusions: Although it is difficult to generalize findings from the included studies due to methodological differences, they provide further evidence that undocumented migrants in Europe face particular problems in utilizing healthcare services. [ABSTRACT FROM AUTHOR]

We evaluate here the presence of the mcr-1 -like and mcr-2 genes in Escherichia coli and Salmonella spp. isolated from healthy food-producing animals at slaughter between 2002 and 2014 in Europe. Isolates were retrieved from cattle, pig and chicken from 11 European countries of production. The susceptibility to colistin and antibiotics used in human medicine was determined by agar dilution. Colistin-resistant isolates were PCR-screened for mcr genes. mcr -positive isolates were typed by Pulsed-Field Gel Electrophoresis (PFGE) and Multi-Locus Sequence Typing. Among the 10,206 E. coli and 1774 Salmonella spp. isolated from cattle, pigs and chickens, 148 E. coli and 92 Salmonella spp. isolates were resistant to colistin. We found mcr-1 -like gene in 68 (0.7%) E. coli and 2 (0.1%) Salmonella isolates whereas none of the isolates tested positive for mcr-2 . MCR-1-like-positive E. coli were isolated from 2008 to 2014 in chicken (n = 44, 1.2%) and pigs (n = 24, 0.7%). The presence of mcr-1 -like varied from 0 to 4.0% depending on the year and the animal species. mcr-1 -like-positive isolates came from animals originating from Germany (n = 38), Spain (n = 23), The Netherlands (n = 5), and France (n = 4). They were distributed in 63 different PFGE types and 37 different STs, with ST10 being the most prevalent. The two mcr-1 -like-positive Salmonella spp. were isolated from France and Germany from a pig and a chicken, respectively. mcr-1 -like gene is present in food-producing animals at slaughter in European countries with the highest occurrence in chickens. The high clonal diversity of E. coli underlines the evidence for horizontal transfer of mcr-1- like genes. [ABSTRACT FROM AUTHOR]

VetPath is an ongoing pan-European antimicrobial susceptibility monitoring programme collecting pathogens from diseased cattle, pigs and poultry not recently treated with antibiotics. Non-duplicate milk samples were collected from cows with acute clinical mastitis in nine countries and 934 isolates were obtained during 2009–2012 for subsequent antimicrobial susceptibility testing in a central laboratory. CLSI broth microdilution methodology was used, and where available, MICs were interpreted using CLSI approved veterinary-specific (ceftiofur) otherwise human clinical breakpoints. Among Escherichia coli ( n = 207) and Klebsiella spp., ( n = 87), resistance was moderate to tetracycline and high to cephapirin ( E. coli only) whereas resistance to other β-lactam antibiotics was very low (ceftiofur) to low (amoxicillin/clavulanic acid, cephalexin, cephalonium). The MIC 90 of enrofloxacin and marbofloxacin was 0.03 and 0.06 μg/mL respectively ( E. coli) with 0.5% strains displaying higher MICs. Staphylococcus aureus ( n = 192) and coagulase-negative staphylococci (CNS; n = 165) strains were susceptible to most antibiotics tested except to penicillin (25.0 and 29.1% resistance), respectively. Three S. aureus and seven CNS strains were oxacillin-resistant and harboured mecA . Streptococcus uberis strains ( n = 188) were susceptible to the β-lactam antibiotics although 35.6% were penicillin intermediately susceptible, and 20.2% were resistant to erythromycin, 36.7% to tetracycline. For Streptococcus dysgalactiae ( n = 95) the latter figures were 13.7 and 56.8%, respectively. For most antibiotics, the percentage resistance among E. coli , S. aureus and S. uberis was comparable to that of the VetPath 2002–2006 survey. This current, expanded VetPath study shows that mastitis pathogens were susceptible to most antibiotics with exceptions of staphylococci tested against penicillin and streptococci against erythromycin or tetracycline. This work highlights the high need to set additional clinical breakpoints for antibiotics frequently used to treat mastitis. [ABSTRACT FROM AUTHOR]

Background: Undocumented migrants, in particular pregnant women and their newborns, constitute a particularly vulnerable group of migrants. The aim of this study was to systematically review the academic literature on the use and outcomes of maternal and child healthcare by undocumented migrants in the European Union (EU) and European Free Trade Association (EFTA) countries. Methods: The databases, MEDLINE, Embase, CINAHL Plus, Global Health and Popline were searched for the period 2007 to 2017. Two independent reviewers judged the eligibility of studies. The final number of included studies was 33. Results: The results of quantitative, qualitative and mixed methods studies were analysed separately due to their differences in study design, sample size and quality. Overall, the quantitative studies found that undocumented women underutilised essential maternal and child healthcare services, and experienced worse health outcomes. Qualitative studies supported these results, indicating that undocumented migrants were hesitant to use services due to a lack of knowledge and fear of deportation. Studies included in the review covered 10 of 32 EU or EFTA countries, making a European comparison impossible. Conclusions: Despite major methodological differences between included studies, the results of this review indicate that the status of undocumented migrants exacerbates known health risks and hampers service use. [ABSTRACT FROM AUTHOR]

The paper presents a new model for trade flows in Europe that is integrated with a logistics model for transport chain choice through Logsum variables. Logsums measures accessibility across an entire multi-modal logistical chain, and are calculated from a logistics model that has been estimated on disaggregated micro data and then used as an input variable in the trade model. Using Logsums in a trade model is new in applied large-scale freight models, where previous models have simply relied on the distance (e.g. crow-fly) between zones. This linkage of accessibility to the trade model makes it possible to evaluate how changes in policies on transport costs and changes in multi-modal networks will influence trade patterns. As an example the paper presents outcomes for a European-wide truck tolling scenario, which showcases to which extent trade is influenced by such a policy. The paper discusses how such a complex model can be estimated and considers the choice of mathematical formulation and the link between the trade model and logistics model. In the outcomes for the tolling scenario we decompose the total effects into effects from the trade model and effects from the logistics model. [ABSTRACT FROM AUTHOR]

Several prospective multigenerational studies have shown that crime runs in the family, while empirical research on the biological causes of crime has also established that low heart rate is related to antisocial behavior. This study examines whether the intergenerational transmission of crime is moderated or mediated by a low heart rate of the son. Prospectively collected conviction data on 794 men from three consecutive generations of the Dutch Transfive dataset is used. Heart rates were measured around age 18, during the medical examination prior to the mandatory military service in the Dutch army. All analyses were conducted separately for violent and non-violent crime. Both paternal violence and low heart rate levels are associated with increased violent offending. Intergenerational transmission of violence was only found among families in which the son had a low heart rate, although the degree of transmission did not differ significantly from families in which the son had a high heart rate. No support was found for a mediating influence of low heart rates of criminals' offspring on the intergenerational transmission of crime and violence. The results from this study underline the importance to focus on the interaction between biological risk factors and psychosocial risk factors for criminal behavior. [ABSTRACT FROM AUTHOR]

Background: For better supporting the science-governance interface, the potential of health assessments appears underrated. Aims: To identify what various types of health assessment have in common; how they differ; which assessment(s) to apply for which purpose; and what needs and options there are for future joint development. Methods: This review is based on five types of health assessment: monitoring/surveillance/reporting, assessment of health impact, of health technology, of health systems performance, health-related economic assessment. The approach is exploratory and includes: applying an agreed set of comparative criteria; circulating and supplementing synoptic tables; and interpreting the results. Results: Two of the assessments deal with the question 'Where do we stand?', two others with variants of 'What if' questions. Economic Assessment can take place in combination with any of the others. The assessments involve both overall 'procedures' and a variety of 'methods' which inescapably reflect some subjective assumptions and decisions, e.g. on issue framing. Resources and assistance exist for all these assessments. The paper indicates which type of assessment is appropriate for what purpose. Conclusions: Although scientific soundness of health assessments is not trivial to secure, existing types of health assessment can be interpreted as a useful 'toolkit' for supporting governance. If current traces of 'silo' thinking can be overcome, the attainability of a more unified culture of health assessments increases and such assessments might more widely be recognized as a prime, 'tried and tested' way to voice Public Health knowledge and to support rational governance and policy-making. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. Methods: Data from 21,837 participants aged ≥ 55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. Results: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I² = 0%. Conclusions: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults. [ABSTRACT FROM AUTHOR]

Objectives: To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics.Methods: A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated.Results: Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3-36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm3; p < 0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature.Conclusions: This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population.Key Points: • SSNs in women are significantly more often persistent compared to men. • SSN persistence is not associated with age or prior malignancy. • The majority of (persistent) SSNs are located in the upper lung lobes. • A part-solid nature is associated with future nodule growth. • Progressive solitary SSNs are rare under the age of 50 years. [ABSTRACT FROM AUTHOR]

The introduction of clean intermittent catheterization (CIC) in 1972 and low-dose chemoprophylaxis (LDCP, antibiotic prophylaxis), anticholinergic medication and urological surgery in the mid-1980s has improved the long-term outcome of renal function in children with neurogenic bladder sphincter dysfunction (NBSD) due to spina bifida (SB). We have conducted a European survey of the protocols for diagnosing and treating urinary tract infections (UTIs) in these children, using a web-based questionnaire. The responses from 41 centers in 14 European countries confirm that although most centers have standardized protocols for treating UTIs, there is no consensus among European centers in terms of protocols for preventing, diagnosing and treating UTIs in children with NBSD and for CIC. [ABSTRACT FROM AUTHOR]

Introduction: The differential associations of beer, wine, and spirit consumption on cardiovascular risk found in observational studies may be confounded by diet. We described and compared dietary intake and diet quality according to alcoholic beverage preference in European elderly. Methods: From the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES), seven European cohorts were included, i.e. four sub-cohorts from EPIC-Elderly, the SENECA Study, the Zutphen Elderly Study, and the Rotterdam Study. Harmonized data of 29,423 elderly participants from 14 European countries were analyzed. Baseline data on consumption of beer, wine, and spirits, and dietary intake were collected with questionnaires. Diet quality was assessed using the Healthy Diet Indicator (HDI). Intakes and scores across categories of alcoholic beverage preference (beer, wine, spirit, no preference, non-consumers) were adjusted for age, sex, socio-economic status, self-reported prevalent diseases, and lifestyle factors. Cohort-specific mean intakes and scores were calculated as well as weighted means combining all cohorts. Results: In 5 of 7 cohorts, persons with a wine preference formed the largest group. After multivariate adjustment, persons with a wine preference tended to have a higher HDI score and intake of healthy foods in most cohorts, but differences were small. The weighted estimates of all cohorts combined revealed that non-consumers had the highest fruit and vegetable intake, followed by wine consumers. Non-consumers and persons with no specific preference had a higher HDI score, spirit consumers the lowest. However, overall diet quality as measured by HDI did not differ greatly across alcoholic beverage preference categories. Discussion: This study using harmonized data from ~30,000 elderly from 14 European countries showed that, after multivariate adjustment, dietary habits and diet quality did not differ greatly according to alcoholic beverage preference. [ABSTRACT FROM AUTHOR]

It's easy to remember Salmonella serotypes names, isn't it? Surely, this is because the naming system of Salmonella serotypes is by far the most scientist friendly. Traditionally, most Salmonella serotypes have been named after geographic locations. We decided to explore the geographic locations to which Salmonella serotypes refer and describe some unexpected twists in the naming scheme. We found that 93% (n = 1,475) of the 1,585 serotypes could be categorized as geo-serotypes; that is, the name refers to a geographic location. The 3 countries with the most geo-serotypes are Germany, the United Kingdom, and the United States. Other serotype names refer to the name of a person, animal, tribe, or food item or are a composite of symptoms and host. The Salmonella serotypes naming scheme has had a valuable effect on public health microbiology, and in the current era of fast development of whole-genome sequencing, it should remain a reference. [ABSTRACT FROM AUTHOR]

Aim: To explore antidiabetic medicine prescribing to women before, during and after pregnancy in different regions of Europe. Methods: A common protocol was implemented across seven databases in Denmark, Norway, The Netherlands, Italy (Emilia Romagna/Tuscany), Wales and the rest of the UK. Women with a pregnancy starting and ending between 2004 and 2010, (Denmark, 2004–2009; Norway, 2005–2010; Emilia Romagna, 2008–2010), which ended in a live or stillbirth, were identified. Prescriptions for antidiabetic medicines issued (UK) or dispensed (non-UK) during pregnancy and/or the year before or year after pregnancy were identified. Prescribing patterns were compared across databases and over calendar time. Results: 1,082,673 live/stillbirths were identified. Pregestational insulin prescribing during the year before pregnancy ranged from 0.27% (CI95 0.25–0.30) in Tuscany to 0.45% (CI95 0.43–0.47) in Norway, and increased between 2004 and 2009 in all countries. During pregnancy, insulin prescribing peaked during the third trimester and increased over time; third trimester prescribing was highest in Tuscany (2.2%) and lowest in Denmark (0.5%). Of those prescribed an insulin during pregnancy, between 50.5% in Denmark and 88.8% in the Netherlands received an insulin analogue alone or in combination with human insulin, this proportion increasing over time. Oral products were mainly metformin and prescribing was highest in the 3 months before pregnancy. Metformin use during pregnancy increased in some countries. Conclusion: Pregestational diabetes is increasing in many areas of Europe. There is considerable variation between and within countries in the choice of medication for treating pregestational diabetes in pregnancy, including choice of insulin analogues and oral antidiabetics, and very large variation in the treatment of gestational diabetes despite international guidelines. [ABSTRACT FROM AUTHOR]

Migration management and diversity management are recognised as central paradigms in the context of migration and plural societies. A review of scholarly literature analysing the discourses and practices of migration and diversity management reveal that the two phenomena have been studied in isolation and that research on diversity management has predominantly been published in organisation and management literature rather than being integrated in the field of ethnic and migration studies. This article argues that it is relevant and fruitful to study migration management and diversity management in conjunction, since there are significant thematic and logical convergences, and to incorporate diversity management in the study of migration in order to obtain a deeper understanding of the entanglement of migration and diversity management. Based on a synthesis of scholarship and analysis of European reports, the article proposes to recognise three main convergences between the logic of migration management and diversity management: the presentation of migration and plurality as the ‘new’ norm; optimisation; and technocracy. Finally, I suggest directions for a shared research agenda, and, drawing on the prominence of a Foucauldian governmentality framework in critical studies of migration and diversity management, present this as a potentially useful point of departure. [ABSTRACT FROM AUTHOR]

Conditional marketing authorization (CMA) in the European Union (EU) is an early access pathway for medicines that show promising therapeutic effects, but for which comprehensive data are not available. Using a mixed quantitative-qualitative research design, we evaluated how CMA has been used in marketing authorization of oncology medicines in the period 2006 to 2013. We show that compared to full marketing authorization, CMA is granted based on less comprehensive data. However, this is accompanied by significantly longer assessment times and less consensus among regulators about marketing authorization. Moreover, development time from first-in-human testing to marketing authorization did not differ between full marketing authorization and CMA, but was significantly longer for CMA compared to accelerated approved products in the United States (US). Results indicate that CMA is not used by companies as a prospectively planned pathway to obtain early access, but as a 'rescue option' when submitted data are not strong enough to justify full marketing authorization. [ABSTRACT FROM AUTHOR]

Background: Recent studies suggest that meat intake is associated with diabetes-related phenotypes. However, whether the associations of meat intake and glucose and insulin homeostasis are modified by genes related to glucose and insulin is unknown. Objective: We investigated the associations of meat intake and the interaction of meat with genotype on fasting glucose and insulin concentrations in Caucasians free of diabetes mellitus. Design: Fourteen studies that are part of the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium participated in the analysis. Data were provided for up to 50,345 participants. Using linear regression within studies and a fixed-effects meta-analysis across studies, we examined 1) the associations of processed meat and unprocessed red meat intake with fasting glucose and insulin concentrations; and 2) the interactions of processed meat and unprocessed red meat with genetic risk score related to fasting glucose or insulin resistance on fasting glucose and insulin concentrations. Results: Processed meat was associated with higher fasting glucose, and unprocessed red meat was associated with both higher fasting glucose and fasting insulin concentrations after adjustment for potential confounders [not including body mass index (BMI)]. For every additional 50-g serving of processed meat per day, fasting glucose was 0.021 mmol/L (95% CI: 0.011, 0.030 mmol/L) higher. Every additional 100-g serving of unprocessed red meat per day was associated with a 0.037-mmol/L (95% CI: 0.023, 0.051-mmol/L) higher fasting glucose concentration and a 0.049-ln-pmol/L (95% CI: 0.035, 0.063-ln-pmol/L) higher fasting insulin concentration. After additional adjustment for BMI, observed associations were attenuated and no longer statistically significant. The association of processed meat and fasting insulin did not reach statistical significance after correction for multiple comparisons. Observed associations were not modified by genetic loci known to influence fasting glucose or insulin resistance. Conclusion: The association of higher fasting glucose and insulin concentrations with meat consumption was not modified by an index of glucose- and insulin-related single-nucleotide polymorphisms. Six of the participating studies are registered at clinicaltrials.gov as NCT0000513 (Atherosclerosis Risk in Communities), NCT00149435 (Cardiovascular Health Study), NCT00005136 (Family Heart Study), NCT00005121 (Framingham Heart Study), NCT00083369 (Genetics of Lipid Lowering Drugs and Diet Network), and NCT00005487 (Multi-Ethnic Study of Atherosclerosis). [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly. Objective: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged $60 y. Design: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model. Results: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I2 = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I2 = not applicable). Conclusion: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States. [ABSTRACT FROM AUTHOR]

The neonicotinoid insecticide imidacloprid is among the pesticides that most frequently exceed current water quality standards in Dutch surface waters. Recent research shows that effects of imidacloprid on water organisms occur at concentrations below these standards. Mayflies appear to be particularly sensitive with chronic No Observed Effect Concentrations in the nanogram per liter range. The aim of this study was to derive updated water quality standards in accordance with the methodology of the European Water Framework Directive by evaluating the available recent literature on acute and chronic ecotoxicity of imidacloprid to aquatic organisms in laboratory and semi-field experiments. It is concluded that the standard for long-term exposure should be lowered to 8.3 nanograms per liter; the standard for short-term concentration peaks can be maintained at the current value of 0.2 micrograms per liter. The European Commission set restrictions to the use of imidacloprid-based products to reduce the risks for bees and the Dutch national authorities issued emission reduction measures to protect aquatic life. Future monitoring data will ultimately reveal if these measures are sufficient to meet the newly proposed standards. [ABSTRACT FROM PUBLISHER]

Higher professional education in Europe has changed from teaching-only institutes to hybrids of teaching and research. The purpose of this study was to examine factors that influence the judgements of lecturers about new organisational goals and perceptions of their new research-related competencies. Lecturers’ judgements of new organisational goals and self-efficacy related to newly expected competencies were modelled in a bio-ecological model. Findings show that lecturers’ perceptions of self-efficacy can be influenced by an open organisational culture, while lecturers’ judgements of new organisational goals can be influenced by decision-making systems. The professional development of lecturers through formal education and participation in research influences both self-efficacy and judgements. Hence, direct executive managers have three steering mechanisms by which they can influence lecturers’ perceptions during the implementation of new organisational activities: a) Educational Policy, b) Management Policy and c) Developmental Policy. Implications are discussed. [ABSTRACT FROM AUTHOR]

VetPath is an ongoing pan-European antimicrobial susceptibility monitoring programme collecting pathogens from diseased cattle, pigs and poultry not recently treated with antibiotics. Non-replicate milk samples were collected from cows with acute clinical mastitis in eight countries. Escherichia coli , Staphylococcus aureus and Streptococcus uberis were isolated by standardised methods. Antimicrobial susceptibility was determined in a central laboratory by CLSI broth microdilution methodology; results were interpreted using clinical breakpoints where available. Among E. coli ( n = 280), resistance to tetracycline (14.3%) and cefapirin (11.1%) were most common. Resistance to other β-lactam antibiotics was absent (ceftiofur) or very low (cefalexin, amoxicillin/clavulanic acid). The MIC 90 of enrofloxacin and marbofloxacin was 0.03 and 0.06 μg/mL, respectively, with 0.7% of strains displaying a deviating high MIC. Staphylococcus aureus ( n = 250) were susceptible to most antibiotics tested, although 36.0% were resistant to penicillin G. For other β-lactam antibiotics where a CLSI breakpoint was available, no resistance was detected. Tetracycline resistance was low (5.2%). Streptococcus uberis ( n = 282) were susceptible to all β-lactam antibiotics, although 29.8% were intermediately susceptible to penicillin G; 18.8% of strains were resistant to erythromycin and 28.7% to tetracycline. This European study shows that bacteria associated with acute clinical mastitis are susceptible to most antibiotics with the exception of penicillin G against S. aureus , and erythromycin and tetracycline against S. uberis . The results of this study should serve as a reference baseline. This work also highlights the urgent need to set additional clinical breakpoints for antibiotics frequently used to treat mastitis. [ABSTRACT FROM AUTHOR]

The shift to a knowledge information society has given rise to a need for lifelong learning programmes. Such programmes are especially relevant for public health professionals, whose dynamic field of practice is subject to changes due to rapidly developing technologies, evolving expectations of the labour market and new health treats. Lifelong learning programmes for public health should address topics like planning, organisation, leadership, teamwork and research methods, and schools of public health should introduce innovative educational approaches that enable professionals to learn from the experiences of others. This paper describes the rationale for the development of a European online problem-based course on leadership for public health professionals in Europe, the first pilot evaluation and its impact on the final shape of the course. Problem-based learning (PBL) is an excellent approach for a course focused on lifelong learning, because it stimulates constructive, collaborative, and self-directed learning from authentic problems that are relevant to professional practice, and thereby facilitates the transfer of knowledge. Blended learning, which combines face-to-face and online learning, provides new opportunities for working professionals, enabling participation in international student teams and attendance of lectures by international experts without the need to travel. This makes blended problem-based learning a highly effective and efficient learning strategy for continuing professional development. The paper presents a structure for an online pilot leadership course underpinned by a review of the literature and developed and implemented by an international collaboration of four European universities. The curriculum consisted of eight sessions. Each session was developed and offered by a different university center. Two first sessions were delivered face-to-face and the other sessions were online. The seven-step approach of Maastricht University was suitable for a blended mode of PBL. Twelve public health professionals for NHS took part in the course and final evaluation. They found it difficult to use online communication tools for learning and professional activities. Based on the results of the pilot the leadership course was adapted. The training at the beginning was extended with information on behaviour during online sessions. Online practice sessions were integrated before the course. The problems were reformulated and build around a common theme. Educational institutions who would like to embark on a similar project, should consider complexities related to coordination, development and implementation of such a complex educational practice. [ABSTRACT FROM AUTHOR]

This study presents a proxy-based, quantitative reconstruction of cold-season (mean October to May, TOct–May) air temperatures covering nearly the entire last millennium (AD 1060–2003, some hiatuses). The reconstruction was based on subfossil chrysophyte stomatocyst remains in the varved sediments of high-Alpine Lake Silvaplana, eastern Swiss Alps (46°27’N, 9°48′W, 1791 m a.s.l.). Previous studies have demonstrated the reliability of this proxy by comparison to meteorological data. Cold-season air temperatures could therefore be reconstructed quantitatively, at a high resolution (5-yr) and with high chronological accuracy. Spatial correlation analysis suggests that the reconstruction reflects cold season climate variability over the high- Alpine region and substantial parts of central and western Europe. Cold-season temperatures were characterized by a relatively stable first part of the millennium until AD 1440 (2σ of 5-yr mean values = 0.7 °C) and highly variable TOct–May after that (AD 1440–1900, 2σ of 5-yr mean values = 1.3 °C). Recent decades (AD, 1991-present) were unusually warm in the context of the last millennium (exceeding the 2σ-range of the mean decadal TOct–May) but this warmth was not unprecedented. The coolest decades occurred from AD 1510–1520 and AD 1880–1890. The timing of extremely warm and cold decades is generally in good agreement with documentary data representing Switzerland and central European lowlands. The transition from relatively stable to highly variable TOct–May coincided with large changes in atmospheric circulation patterns in the North Atlantic region. Comparison of reconstructed cold season temperatures to the North Atlantic Oscillation index (NAO) during the past 1000 years showed that the relatively stable and warm conditions at the study site until AD 1440 coincided with a persistent positive mode of the NAO. We propose that the transition to large TOct–May variability around AD 1440 was linked to the subsequent absence of this persistent zonal flow pattern, which would allow other climatic drivers to gain importance in the study area. From AD 1440–1900, the similarity of reconstructed TOct–May to reconstructed air pressure in the Siberian High suggests a relatively strong influence of continental anticyclonic systems on Alpine cold season climate parameters during periods when westerly airflow was subdued. A more continental type of atmospheric circulation thus seems to be characteristic for the Little Ice Age in Europe. Comparison of Toct–May to summer temperature reconstructions from the same study site shows that, as expected, summer and cold season temperature trends and variability differed completely throughout nearly the entire last 1000 years. Since AD 1980, however, summer and cold season temperatures show a simultaneous, strong increase, which is unprecedented in the context of the last millennium. We suggest that the most likely explanation for this recent trend is anthropogenic greenhouse gas (GHG) forcing. [ABSTRACT FROM AUTHOR]

In the context of a European knowledge economy, the Dutch non-university institutions systematically develop research activities at a higher frequency than before. With this development, they have been accused of academic drift, of striving to receive a status comparable to traditional universities. This study considers the perceptions of both managers and lecturers in non-university higher education concerning the organisational aims for research activities. The intention is to add an empirical base to the debate of academic drift, especially to the potential of academic drift on the staff level. The results show a moderate indication of potential for academic drift on the staff level. In addition, managers have more positive perceptions regarding all aims for research than lecturers, but both groups prioritise that the results of research should, first and foremost, be directed towards improving the quality of education. [ABSTRACT FROM AUTHOR]

Abstract: Antimicrobial resistance is a concern both for animal and human health. Veterinary programmes monitoring resistance of animal and zoonotic pathogens are therefore essential. Various European countries have implemented national surveillance programmes, particularly for zoonotic and commensal bacteria, and the European Food Safety Authority (EFSA) is compiling the data. However, harmonisation is identified as a weakness and an essential need in order to compare data across countries. Comparisons of resistance monitoring data among national programmes are hampered by differences between programmes, such as sampling and testing methodology, and different epidemiological cut-off values or clinical breakpoints. Moreover, only very few valid data are available regarding target pathogens both of farm and companion animals. The European Animal Health Study Centre (CEESA) attempts to fill these gaps. The resistance monitoring programmes of CEESA have been a collaboration of veterinary pharmaceutical companies for over a decade and include two different projects: the European Antimicrobial Susceptibility Surveillance in Animals (EASSA) programme, which collects food-borne bacteria at slaughter from healthy animals, and the pathogen programmes that collect first-intention target pathogens from acutely diseased animals. The latter comprises three subprogrammes: VetPath; MycoPath; and ComPath. All CEESA projects include uniform sample collection and bacterial identification to species level in various European Union (EU) member states. A central laboratory conducts quantitative susceptibility testing to antimicrobial agents either important in human medicine or commonly used in veterinary medicine. This ‘methodology harmonisation’ allows easy comparisons among EU member states and makes the CEESA programmes invaluable to address food safety and antibiotic efficacy. [Copyright &y& Elsevier]

BACKGROUND Previous research has shown that living arrangements (independent households of those living alone or as a couple, versus coresident households encompassing adult children) are important determinants of older adults' loneliness. However, little is known about intergenerational support exchanges in these living arrangements and their associations with loneliness. OBJECTIVE Our aim is to contribute to the knowledge on associations between living arrangements and loneliness, by taking into account and differentiating intergenerational support types. METHODS Using data from the Generations and Gender Surveys of three countries in Eastern Europe and two countries in Western Europe, Latent Class Analyses was applied to develop intergenerational support types for (a) co-residing respondents in Eastern Europe, (b) respondents in independent households in Eastern Europe, and (c) respondents in independent households in Western Europe, respectively. Six types resulted, distinguishing patterns of upward support, downward support and get-togethers. Subsequently, we used linear regression analyses to examine differences in loneliness by region, living arrangements and intergenerational support type. RESULTS Findings show higher levels of loneliness in Eastern than in Western Europe. Older adults living alone are most lonely, older adults living with a partner are least lonely. Coresidence provides protection, but not to the same degree as a partner. In both coresident and independent households there is a greater likelihood of being involved in support given to adult children than in support received from adult children. In both East and West European countries, older adults who are primarily on the receiving side are most lonely. CONCLUSIONS A better explanation of older adult loneliness is obtained if the direction of supportive exchanges with adult children is considered than if only living arrangements are considered. [ABSTRACT FROM AUTHOR]

Objective: To study associations between aspirin use and early and late aging macula disorder (AMD). Design: Population-based cross-sectional European Eye Study in 7 centers from northern to southern Europe. Participants: In total, 4691 participants 65 years of age and older, collected by random sampling. Methods: Aspirin intake and possible confounders for AMD were ascertained by a structured questionnaire. Ophthalmic and basic systemic measurements were performed in a standardized way. The study classified AMD according to the modified International Classification System on digitized fundus images at 1 grading center. Nonfasting blood samples were analyzed in a single laboratory. Associations were analyzed by logistic regression. Main Outcome Measures: Odds ratios (ORs) for AMD in aspirin users. Results: Early AMD was present in 36.4% of the participants and late AMD was present in 3.3% of participants. Monthly aspirin use was reported by 1931 (41.2%), at least once weekly by 7%, and daily use by 17.3%. For daily aspirin users, the ORs, adjusted for potential confounders, showed a steady increase with increasing severity of AMD grades. These were: grade 1, 1.26 (95% confidence interval [CI], 1.08–1.46; P<0.001); grade 2, 1.42 (95% CI, 1.18–1.70), and wet late AMD, 2.22 (95% CI, 1.61–3.05). Conclusions: Frequent aspirin use was associated with early AMD and wet late AMD, and the ORs rose with increasing frequency of consumption. This interesting observation warrants further evaluation of the associations between aspirin use and AMD. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

Loneliness concerns the subjective evaluation that the number of relationships is smaller than the individual considers desirable or that the intimacy that the individual wishes for has not been realized. The aim of this study was to assess variations in levels of late-life loneliness and its determinants across Europe. Data came from the SHARE surveys, Wave 2 (Börsch-Supan et al., 2008), encompassing adults aged 50 years and over in Austria, Belgium, the Czech Republic, Denmark, France, Germany, Greece, Ireland, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland (N = 12,248). Loneliness was measured by a single item derived from the CES-D (depression) scale. Using logistic models, the present authors tested several types of explanations for country differences: differences in demographic characteristics, wealth and health, and social networks. Older adults in the southern and central European countries were generally lonelier than their peers in the northern and western European countries. In the southern and central European countries, loneliness was largely attributable to not being married, economic deprivation, and poor health. Frequent contacts with parents and adult children, social participation, and providing support to family members were important in preventing and alleviating loneliness in almost all countries. To combat loneliness among older adults, the findings suggest both (a) generic approaches aimed at improving social embeddedness and (b) country-tailored approaches aimed at improving health and wealth. [ABSTRACT FROM AUTHOR]

Listed companies may be liable to investors for misrepresentation. A causal connection between the investor's alleged harm and the misstatement or omission will need to be established for a successful damage claim. This article addresses causation, specifically the causal connection between the misstatement (or omission) and the investment decision. Proving this causal connection is often problematic, which raises the question how investors can be effectively protected without inviting excessive litigation. Recently, the Dutch Supreme Court has accepted an indirect causal connection as sufficient and has adopted a presumption on behalf of investors on favorable terms in a prospectus liability case. A showing of a material misstatement by investors activates the presumption. The Dutch Supreme Court justifies this by reference to the Prospectus Directive, which it interprets as requiring an effective protection of (potential) investors. The influence of the Prospectus Directive on the law of causation can be relevant for other European jurisdictions as well. The approach to adopt a presumption based on European disclosure directives could extend beyond prospectus liability cases to all lawsuits alleging misrepresentation on the secondary market. These developments are discussed and a comparison is made between the law of the Netherlands, the US and Germany. [ABSTRACT FROM AUTHOR]

Variation in the apolipoprotein E gene (APOE) has been reported to be associated with longevity in humans. The authors assessed the allelic distribution of APOE isoforms ε2, ε3, and ε4 among 10,623 participants from 15 case-control and cohort studies of age-related macular degeneration (AMD) in populations of European ancestry (study dates ranged from 1990 to 2009). The authors included only the 10,623 control subjects from these studies who were classified as having no evidence of AMD, since variation within the APOE gene has previously been associated with AMD. In an analysis stratified by study center, gender, and smoking status, there was a decreasing frequency of the APOE ε4 isoform with increasing age (χ2 for trend = 14.9 (1 df); P = 0.0001), with a concomitant increase in the ε3 isoform (χ2 for trend = 11.3 (1 df); P = 0.001). The association with age was strongest in ε4 homozygotes; the frequency of ε4 homozygosity decreased from 2.7% for participants aged 60 years or less to 0.8% for those over age 85 years, while the proportion of participants with the ε3/ε4 genotype decreased from 26.8% to 17.5% across the same age range. Gender had no significant effect on the isoform frequencies. This study provides strong support for an association of the APOE gene with human longevity. [ABSTRACT FROM AUTHOR]

On the 50th anniversary of the Treaty of Rome, the non-profit organisation Musée de l'Europe staged the exhibition It's our history!. The subject of It's our history! was the history of European integration from 1945 to today. The exhibition was intended to make European citizens aware that - as the exhibition's manifesto stated: 'The History, with a capital H, of European construction is inextricable from our own personal history, that of each European citizen. It is not the reserve of those that govern us. We all shape it, as it shapes us, sometimes unbeknown to us. It's our history!' One of the means that the Musée de l'Europe chose as an illustration of this supposed interrelation of History and history are video testimonies in which 27 European citizens (one from each European member state) tell their own life stories. The present article explores this use of autobiographical accounts as didactic means in It's our history!. The article argues that through the 27 Europeans, an image of European woman/man and European integration is advanced that glosses over internal conflicts in Europe's recent history, leads to the construction of a model European citizen and serves as a symbol for the slogan 'unity in diversity' in which Europe appears as more united than diverse. [ABSTRACT FROM AUTHOR]

- (2011) Journal of Nursing Management , 305-310 This paper outlines research into the causes of congenital anomalies, and introduces a pan-European study. The potential roles of nurses and midwives in this area are illustrated by a case report. Since the thalidomide disaster, use of drugs in pregnancy has been carefully monitored to prevent anything similar happening again. However, monitoring is incomplete and questions remain unanswered. Many medicines are essential for the health of pregnant women. However, drug use in pregnancy requires surveillance. Methods include spontaneous reporting of adverse events, cohort studies and case control studies. It is hoped that a Europe-wide study, combining data from several congenital anomaly registers, will provide a sufficiently large population to assess the impact of selected drugs on congenital anomalies. However, this work depends on the consistency of reporting by nurses and midwives. Drug safety in pregnancy remains undetermined. Collaboration across Europe has the potential to provide a framework for safety evaluation. Prescribers should consider the possibility of pregnancy in women of child-bearing age. Careful review of maternal drug use in early pregnancy is essential. Midwives and nurses should be aware of adverse event drug reporting systems, including congenital anomaly registers. [ABSTRACT FROM AUTHOR]

Most of the publications on isotretinoin, pregnancy and compliance with the pregnancy prevention programme (PPP) originate from North America. Information specific for the European situation is very limited. The aim of this study was to identify publications describing the use of isotretinoin in humans and the compliance with the PPP in Europe, a systematic search in Medline and Embase was conducted using the terms 'isotretinoin, pregnancy (and Europe)'. Furthermore, a manual search in publications was performed. A total of 17 publications were identified. Publications consisted of case reports of exposed pregnancies, surveys among dermatologists or pharmacists and database studies evaluating compliance with the PPP. The studies and surveys dealt with groups of patients exposed to isotretinoin before or during pregnancy and/or compliance with the isotretinoin PPP. Where the information was provided, in 6-26% of cases isotretinoin was prescribed in full accordance with the PPP. Pregnancy incidence was seen in 0·2-1·0 per 1000 women of childbearing age using isotretinoin. Between 65% and 87% of these pregnancies were terminated. This review of studies in Europe performed to date shows failures in the implementation of the PPP. Therefore, the isotretinoin PPP must be scrutinized to identify whether new measures should be taken or whether the failures in the implementation need to be corrected. New measures should take into account the definition of the ultimate goal of a PPP and the acceptable burden. In the meantime, stakeholders could make a start with adjustments in the implementation of the PPP by taking responsibility and enhancing the performance by explicit instructions, monitoring the performance and adjusting, if necessary. [ABSTRACT FROM AUTHOR]