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Ecosystem based management requires assessment of human activities and generated pressures that cause physical disturbance and loss of the seabed within the Mediterranean, also accounting for the strength of their interaction. To support the implementation of Descriptor 6 of the Marine Strategy Framework Directive (MSFD), the present work aimed at testing the applicability of an exposure-effect methodology and harmonizing - across countries sharing the same marine waters - the identification of the MSFD key physical pressures on benthic habitats and their relative importance at different spatial scales (national, subregional, regional) in the Mediterranean Sea. The methodology uses 24 MSFD relevant human activities, five physical pressures, and 13 Broad Habitat Types (BHT). Τhe links between human activities, physical pressures and the different MSFD Broad Habitat Types affected are identified and scored using three criteria; namely Spatial Extent, Frequency of Occurrence, and Degree of Impact. The methodology assesses the risk of pressures in a semi-quantitative way, integrating both quantitative (data) and qualitative (expert judgement) information, where quantitative data is not available, and allows the ranking of the physical pressures affecting the seafloor. The methodology was applied in the marine waters of Italy, Slovenia, Croatia and Greece. Abrasion (e.g., related to fishing or boating) and sealing (e.g., caused by structures) were ranked as top pressures; the former is widespread over different BHTs, in a persistent manner and presents intense impacts; the latter appears locally, at specific sites, and persistently, generating an acute impact. According to the results, the infralittoral and circalittoral habitats are those most affected by physical pressures. The identification of major pressures can assist considerably towards the elimination or mitigation of the impacts through actions on the human activities, as it enables the prioritisation of tailor-made measures to achieve or maintain the Good Environmental Status (GES) in the region. • Screening and assessing physical pressures affecting seafloor integrity. • Testing an exposure-effect methodology relevant to MSFD Descriptor 6. • Addressing key physical pressures on benthic habitats in a harmonised way. • Assisting decision makers in prioritizing management actions for the seafloor. • Ecosystem-based management in the Mediterranean region. [ABSTRACT FROM AUTHOR]

• A formal antimicrobial stewardship programme was present mainly in the Netherlands (91%) and France (84%). • Presence of an antimicrobial stewardship (AMS) team ranged from 42% (France) to 94% (the Netherlands). • Lack of official salary support for AMS teams was an issue in all four countries, ranging from 68% (France) to 12% (Italy). • Countries varied substantially in the use of 'prospective monitoring and advice' as a strategy to improve AMS objectives. • Despite much recent effort to implement AMS at national and international levels, there is still room for improvement. Antimicrobial stewardship programmes (ASPs) are designed to improve antibiotic use. A survey was systematically developed to assess ASP prerequisites, objectives and improvement strategies in hospitals. This study assessed the current state of ASPs in acute-care hospitals throughout Europe. A survey containing 46 questions was disseminated to acute-care hospitals: all Dutch (n = 80) and Slovenian (n = 29), 215 French (25%, random stratified sampling) and 62 Italian (49% of hospitals with an infectious diseases department, convenience sampling) acute-care hospitals, for a Europe-wide assessment. Response rates for the Netherlands (Nl), Slovenia (Slo), France (Fr) and Italy (It) were 80%, 86%, 45% and 66%. There was variation between countries in the prerequisites met and the objectives and improvement strategies chosen. A formal ASP was present mainly in the Netherlands (90%) and France (84%) compared with Slovenia (60%) and Italy (60%). Presence of an antimicrobial stewardship (AMS) team ranged from 42% (Fr) to 94% (Nl). Salary support for AMS teams was provided in 68% (Fr), 51% (Nl), 33% (Slo) and 12% (It) of surveyed hospitals. Quantity of antibiotic use was monitored in the majority of hospitals, ranging from 72% (Nl) to 100% (Slo and Fr) of acute-care hospitals. Participating countries varied substantially in the use of 'prospective monitoring and advice' as a strategy to improve AMS objectives. ASP prerequisites, objectives and improvement activities vary considerably across Europe, with room for improvement. Stimulating appropriate system prerequisites throughout Europe, e.g. by introducing staffing standards and financial support for ASPs, seems a first priority. [ABSTRACT FROM AUTHOR]