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Background: Nuclear medicine has made enormous progress in the past decades. However, there are still significant inequalities in patient access among different countries, which could be mitigated by improving access to and availability of radiopharmaceuticals. Main body: This paper summarises major considerations for a suitable pharmaceutical regulatory framework to facilitate patient access to radiopharmaceuticals. These include the distinct characteristics of radiopharmaceuticals which require dedicated regulations, considering the impact of the variable complexity of radiopharmaceutical preparation, personnel requirements, manufacturing practices and quality assurance, regulatory authority interfaces, communication and training, as well as marketing authorisation procedures to ensure availability of radiopharmaceuticals. Finally, domestic and regional supply to ensure patient access via alternative regulatory pathways, including in-house production of radiopharmaceuticals, is described, and an outlook on regulatory challenges faced by new developments, such as the use of alpha emitters, is provided. Conclusions: All these considerations are an outcome of a dedicated Technical Meeting organised by the IAEA in 2023 and represent the views and opinions of experts in the field, not those of any regulatory authorities.

Nuclear medicine has made enormous progress in the past decades. However, there are still significant inequalities in patient access among different countries, which could be mitigated by a suitable pharmaceutical regulatory framework and associated guidelines. This paper summarizes major considerations for a suitable pharmaceutical regulatory framework to facilitate patient access to radiopharmaceuticals. These include the distinct characteristics of radiopharmaceuticals advocating dedicated regulations, the impact of variable complexity of radiopharmaceutical preparation, personnel requirements, manufacturing practices and quality assurance, regulatory authorities interfaces, communication and training, as well as marketing authorization procedures to ensure availability of radiopharmaceuticals. Finally domestic and regional supply to ensure patient access via alternative regulatory pathways, including in-house production of radiopharmaceuticals, is described and an outlook on regulatory challenges faced by new developments, such as the use of alpha emitters, is provided. All these considerations are an outcome of a dedicated Technical Meeting organized by the IAEA in 2023.

Structural changes in Ti1-xAlxN coated tool inserts used for turning in 316L stainless steel were investigated by XANES, EXAFS, EDS, and STEM. For coarse-grained fcc-structured Ti1-xAlxN coatings, with 0 ≤ x ≤ 0.62, the XANES spectrum changes with Al-content. XANES Ti 1s line-scans across the rake face of the worn samples reveals that TiN-enriched domains have formed during turning in Ti0.47Al0.53N and Ti0.38Al0.62N samples as a result of spinodal decomposition. The XANES spectra reveal the locations on the tool in which the most TiN-rich domains have formed, indicating which part of the tool-chip contact area that experienced the highest temperature during turning. Changes in the pre-edge features in the XANES spectra reveal that structural changes occur also in the w-TiAlN phase in fine-grained Ti0.38Al0.62N during turning. EDS shows that Cr and Fe from the steel adhere to the tool rake face during machining. Cr 1s and Fe 1s XANES show that Cr is oxidized in the end of the contact length while the adhered Fe retains in the same fcc-structure as that of the 316L stainless steel., Funding agencies: Swedish Governmental Agency for Innovation Systems (Vinnova) [2018-04417]; VINNOVA [2016-05156]; Swedish Research council [2018-07152]; Swedish Governmental Agency for Innovation Systems [2018-04969]; Formas [2019-02496]

Citizen perceptions of justice, regarding both processes and outcomes, are closely related to the perceived legitimacy of the authorities involved and are thus significant for trust. This study investigates how a withdrawn driving license due to visual field loss might affect trust in the authorities involved in withdrawal processes and outcomes: the health-care system, the Swedish Transport Agency, and the judicial system. The factors influencing trust were investigated as was whether the withdrawal experience had changed the trust in other authorities not involved in the withdrawal process. Also, the aetiology of the visual field loss and gender were investigated. A survey study was conducted in which 402 Swedish respondents with visual field loss and a withdrawal experience participated. Variance, regression, and content analyses were conducted. The following conceptual factors were used in understanding trust: Benevolence, Openness, Integrity, Ability, and Value Congruence. The results revealed that processes and outcomes affected the overall trust in all three authorities, although the highest trust was in the health-care system (but still low). Diagnosis, but not gender, was important for the experienced trust. Differences in levels of trust in each authority were related to the aetiology of the diagnosis. Benevolence and Ability were the trust factors most important for overall trust in the health-care system and the Swedish Transport Agency. For some respondents (46%), the negative experiences of the withdrawal had worsened their trust in other, not involved authorities, as well. © 2023 The Author(s)

Background: Healthcare professionals’ digital health competence is an important phenomenon to study as healthcare practices are changing globally. Recent research aimed to define this complex phenomenon and identify the current state of healthcare professionals’ competence in digitalisation but did not include an overarching outlook when measuring digital health competence of healthcare professionals. Objectives: The purpose of this study was to develop and psychometrically validate two self-assessed instruments measuring digital health competence and factors associating with it. Methods: The study followed three phases of instrument development and validation: 1) conceptualisation and item pool generation; 2) content validity testing and pilot study; and 3) construct validity and reliability testing. The conceptual background of the instruments was based on individual interviews conducted with healthcare professionals (n = 20) and previous systematic reviews. A total of 17 experts assessed the instrument’s content validity. Face validity was evaluated by a group of healthcare professionals (n = 20). Data collection from 817 professionals took place in spring-summer 2022 in nine organisations. Construct validity was confirmed with exploratory factor analysis. Cronbach’s alpha was used to assess the internal consistency of the instruments. Results: The instrument development and validation process resulted in two instruments: DigiHealthCom and DigiComInf. DigiHealthCom included 42 items in 5 factors related to digital health competence, and DigiComInf included 15 items in 3 factors related to educational and organisational factors associated with digital health competence. The DigiHealthCom instrument explained 68.9 % of the total variance and the factors’ Cronbach alpha values varied between 0.91 and 0.97. The DigiComInf instrument explained 59.6 % of the total variance and the factors’ Cronbach alpha values varied between 0.76 and 0.88. Conclusions: The tw

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In our contemporary European landscape there is an increasing division between the natural and the cultural landscape (agriculture, industry, habitation, …). What little is left of functioning ecosystems is often secured in nature reserves, under very strict legal protection. And rightly so! But the cultural landscape surrounding these natural areas is increasingly devoid of any natural processes or biodiversity and our choices in the cultural landscape have an ever increasing negative impact on the ecosystems in the adjoining natural areas. In the PONC project (2020-2023), where PONC stands for Process Oriented Nature Conservation, we explored the possibilities for allowing natural processes back into the cultural landscape, for the good of both nature ánd humans. There are several options on how to look at the concept of process oriented nature conservation. We used this term, rather than the term ‘rewilding’ because we were aiming at man-made landscapes where man obviously is a part in the equation, compared to vast areas which are ‘re-wilded’ after they were deserted by inhabitants. The overview of natural processes and listing of possible proxies for these natural processes, can help to focus on natural processes rather than focusing on just species or habitats. The PONC score we developed is a tool to measure and visualise the impact of introducing PONC principles on a site. This might help in communicating with stakeholders. PONC is a joint project of Natuurinvest (coordinator, Belgium) and Agentschap voor Natuur en Bos (Belgium); Ark Rewilding Nederland (the Netherlands); Fjällbete (Sweden); Pro Natura (Sweden); Milvus Group (Romania); and Knepp Estate (UK) in England.