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Background Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized. Methods Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded. Results The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician’s self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training. Conclusion This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.

Summary Background & aims Nutrition education is necessary in the training of healthcare professionals, including medical students. However, recent surveys showed that there is a high variability within Medical Schools in different countries. The aim of this ESPEN position paper is to identify a minimum curriculum knowledge in nutrition that serves to improve the training of the future doctors and how to solve the main barriers of its implementation in university centres. Methods In 2017, the ESPEN Executive Committee launched the Nutrition Education in Medical Schools (NEMS) Project and formed a core working group including members of the ESPEN Nutrition Education Study Group (NESG) and representatives of several European Medical Schools. This group met in Brussels, on 19th July 2018 and decided to prepare a position paper on this topic. Results Five main learning objectives and twenty-one topics on human nutrition, within its three domains (basic, applied and clinical nutrition) were identified to be fulfilled at the end of training in all Medical Schools. The experts showed the following key factors for its implementation: establish a nutrition curriculum committee, use different models of integration of the contents in the curriculum (vertical and horizontal), have a multidisciplinary and experienced faculty, incorporate a variety of teaching models, and evaluate the programme periodically. Conclusions Nutrition Education is necessary and should be mandatory in all Medical Schools. This position paper aims at improving this gap knowledge and gives some clues for a successful implementation of the changes in the medical curriculum at university centres.

Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.

The physical demands of daily life in developed countries have decreased remarkably during the last two centuries. General leisure time has increased and the age at retirement has decreased. General health has improved and life expectancy has increased. Most people can expect to live 20-30 years after retirement. By 2050, one in four people in Europe and North America will be aged 65 or over. Furthermore, women live longer than men. Generally, the physical demands on older women will be low. Thus, their physical fitness will decline, which in turn will affect a variety of organ systems and functions, and so impact on mental health, quality of life and independent living. This opinion paper explores exercise strategies for healthy ageing.

It is well recognised that adolescents and young adults (AYA) with cancer have inequitable access to oncology services that provide expert cancer care and consider their unique needs. Subsequently, survival gains in this patient population have improved only modestly compared with older adults and children with cancer. In 2015, the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE) established the joint Cancer in AYA Working Group in order to increase awareness among adult and paediatric oncology communities, enhance knowledge on specific issues in AYA and ultimately improve the standard of care for AYA with cancer across Europe. This manuscript reflects the position of this working group regarding current AYA cancer care, the challenges to be addressed and possible solutions. Key challenges include the lack of specific biological understanding of AYA cancers, the lack of access to specialised centres with age-appropriate multidisciplinary care and the lack of available clinical trials with novel therapeutics. Key recommendations include diversifying interprofessional cooperation in AYA care and specific measures to improve trial accrual, including centralising care where that is the best means to achieve trial accrual. This defines a common vision that can lead to improved outcomes for AYA with cancer in Europe.

More than 150,000 in Europe and 800,000 people worldwide, die every year by suicide (WHO, 2015), accounting for 1·4% of all annual deaths. Suicide is the second, and in some European countries even the first leading cause of death amongst young people aged 15-24 years (WHO, 2015), thus exceeding the number of accidental deaths.The European parliament resolution on Mental Health 2008/2209 (INI) adopted a series of recommendations for European member states. It proposed areas for priority action as defined in the European Pact on Mental Health and Well-Being. Recently, 29 suicide prevention experts from 17 European countries (The Task Force for the European Evidence-Based Suicide Prevention Program, EESPP) performed a systematic review of evidence for the effectiveness of suicide prevention interventions that has been published over the last decade. During three face-to-face meetings, the EESPP group developed a consensus declaration that, based on the findings of the systematic reviews, summarizes the minimal requirements for a national suicide prevention programs and of the strategies to employ.

A sensitive and simple nanomaterial based colorimetric sensor array (NBCSA) was developed for discrimination of monofloral honey from various European countries based on three botanical origins as Acacia, Canola and Honeydew. The NBCSA was designed by spotting gold (AuNPs) and silver (AgNPs) nanoparticles synthesized using six different reducing and/or capping agents. The colour intensity of AuNPs represented differential changes when interacting with volatile organic compounds appeared in the headspace of the honey samples. The color difference maps, which are calculated as the difference between color intensity of the sensor before and after exposing to the sample vapors, were used as a fingerprint to discriminate the honey samples based on botanical origin. Classification was achieved utilizing data pre-processing and chemometrics data analysis. Fitting accuracies of 88% and 86% were obtained by partial least squares discriminant analysis and linear discriminant analysis whereas 100% was achieved using support vector machine.

This bibliometric analysis aims to analyze the high-cited papers (HCPs), those which have received100 citations) on Sarcopenia to provide insight into publication performances and research characteristics of the literature.Global HCPs on Sarcopenia research were identified from the Scopus database from January 1993 to August 2022. VOSviewer, and Biblioshiny software were used to visualize the collaborative interaction among most productive countries, organizations, authors, and keywords. Select bibliometric measures were applied to evaluate the publication productivity and their influence in this area.Out of 6219 publications on Sarcopenia only 398 were HCPs. These HCPs received an average of 271.7 citations per publication (CPP). The most productive organizations were the Università Cattolica del Sacro Cuore, Italy, and Jean Mayer USDA Human Nutrition Center on Aging, USA. The most impactful organizations in terms of CPP and relative citation index were CHU de Toulouse, France, and Università Cattolica del Sacro Cuore, Italy. The most productive authors were Landi F and Morley JE, and Anker SD from Italy and Germany respectively. The most impactful authors were: Cederholm T (Sweden), Cruz JAJ (Spain) and Rolland Y (France). There were few/no HCPs from South America, Africa, South Asia, and USSR.Sarcopenia research has been predominantly done in USA, Europe, and China, and rarely from low and middle-income countries. Further focus of research should be on its etiopathogenesis (especially at the molecular level), prevalence in different communities, methods to diagnose it in early stages, and its cost-effective management.

The Prostate Cancer Programme of the European School of Oncology developed the concept of specialised interdisciplinary and multiprofessional prostate cancer care to be formalized in Prostate Cancer Units (PCU). After the publication in 2011 of the collaborative article "The Requirements of a Specialist Prostate Cancer Unit: A Discussion Paper from the European School of Oncology", in 2012 the PCU Initiative in Europe was launched. A multiprofessional Task Force of internationally recognized opinion leaders, among whom representatives of scientific societies, and patient advocates gathered to set standards for quality comprehensive prostate cancer care and designate care pathways in PCUs. The result was a consensus on 40 mandatory and recommended standards and items, covering several macro-areas, from general requirements to personnel to organization and case management. This position paper describes the relevant, feasible and applicable core criteria for defining PCUs in most European countries delivered by PCU Initiative in Europe Task Force.

The ACR and European Society of Radiology white papers on teleradiology propose best practice guidelines for teleradiology, with each body focusing on its respective local situation, market, and legal regulations. The organizations have common viewpoints, the most important being patient primacy, maintenance of quality, and the "supplementary" position of teleradiology to local services. The major differences between the white papers are related mainly to the market situation, the use of teleradiology, teleradiologist credentialing and certification, the principles of "international" teleradiology, and the need to obtain "informed consent" from patients. The authors describe these similarities and differences by highlighting the background and context of teleradiology in Europe and the United States.

As to the alignment of "Horizon 2020", ir is a more integrated approach to European science policy than expressed in the proposals previously drafted, and specifically considers: (i) promoting excellence in Science, (ii) establishing a sound industrial leadership and (iii) expressing an ambition to address current and future societal challenges. In this respect, the quest for a knowledge-based economy in Europe should result in proposals for industrial and employment policies that will consolidate the major European advantages in the biomedical, healthcare and pharmaceutical sectors. Horizon 2020 also provides the possibility of adopting a more flexible and simplified management route to drive European research through innovation, research and development. What should be additionally considered? Unmet medical needs, under pressure from demographic changes, await the generation of new medicines and health technologies which will evolve into a driver for a unified European policy. We believe that this should be focused on harnessing pharmaceutical knowledge for clinical use, as part of a response to accommodate patient needs and economic growth based on a robust, scientific approach. The bolder ambition for European research is to unlock key bottlenecks currently undermining European competitiveness. The historical lack of an appropriate business/innovation environment with reduced access to adequate risk finance instruments has severed the path for economic growth and industrial development. These issues are of critical importance and a solution is urgently needed to foster translation from the university to the healthcare sector through the generation and support of start-ups, spin-offs, university-industry consortia, and other platforms, which support translational research. The ultimate goal is implementation of holistic programmes: the 'bench to bedside' paradigm of medicines and other healthcare products. The European Research Council supports the basic biomedical research programmes of long term importance for development of medicines; however, fundamental research initiatives on medicines development will not be competitive in such an environment. In order to strengthen the long term outlook, we must foster innovative research within the university sector, EUFEPS proposes that a fund for such research be set up within Horizon 2020, which would be open for individual research groups and which would include Public-Public Partnerships (complementing already existing Public-Private Partnerships). How do we look for implementation? There is an established research agenda for medicines research that is globally focused, and which incorporates a cooperative model between universities and industry, facilitating integration of complex technologies. Regulatory Science will play an important role in this integration. This agenda uses tools arising from systems approaches (including discovery with systems biology and also systems pharmacology) and has the potential for providing better knowledge management, as well as technological innovation (including manufacturing). It also addresses the drive towards personalised medicines and can, with support from both public and private sectors, foster translation of knowledge to new technologies and from that, to new medicinal products and complex integrated systems. This is a part of a strategy capable of solving unmet medical needs, which would increase the quality of life of patients suffering from chronic and debilitating diseases. The instruments to allow the development of a research agenda should strengthen existing partnerships such as the IMI-JU model; allow for the creation of European-network infrastructures that can bring together existing competences with adequate European coordination, thus promoting advanced training and continuous professional development for the pharmaceutical sciences. This will be the cornerstone of a knowledge management strategy, providing education and training for healthcare professionals and scientists. A key role for EUFEPS is to help the research community to embrace these new holistic policies applied to the spectrum of pharmaceutical, medical and cognate sciences.

The prevalence, complexity, clinical importance, heterogeneity and unpredictability of inherited cardiovascular diseases make the development of inherited cardiovascular disease centers an inevitability, with the ultimate goal of reducing the morbidity and mortality associated with these conditions. An inherited cardiovascular disease center may be seen as a subunit of a cardiology department, with health professionals specializing in these types of disorders, organized to provide excellence in all related areas, including diagnosis, treatment, follow-up, prevention, risk stratification and prognosis. Among its objectives are the development of action protocols and the creation of databases that enable patients to be included in national and international research networks. To achieve these objectives these centers should include functional units of clinical and basic sciences, research, training and education, acting in harmony in a holistic approach to patients and their families. As most experience on inherited cardiovascular diseases is based on hypertrophic cardiomyopathy and on “hypertrophic cardiomyopathy centers”, these centers represent an excellent opportunity to learn how to set up inherited cardiovascular disease centers. European centers will differ from country to country, reflecting the heterogeneity of national health systems, but will share a common core, presented in this document. Though we are aware that this ambitious project is not at all easy and may be difficult to implement in its entirety – in fact we consider it a major step – our position is that all the efforts to achieve it are worthwhile, considering that the main goal will always be the well-being of those affected by these particular disorders. Resumo: A prevalência, complexidade, importância clínica, heterogeneidade e imprevisibilidade das doenças cardíacas heredofamiliares torna a criação de Unidades de Doenças Cardíacas Hereditárias uma inevitabilidade, cujo objectivo final é reduzir a morbilidade e a mortalidade relacionadas com estas patologias. Uma Unidade de Doenças Cardíacas Hereditárias é uma subunidade de um departamento de Cardiologia constituída por profissionais de saúde especializados neste tipo de doenças, organizado de forma a proporcionar a excelência em todos as suas áreas, incluindo diagnóstico, tratamento, seguimento, prevenção, estratificação de risco e determinação de prognóstico. Alguns dos seus objectivos são o desenvolvimento de protocolos de actuação e a criação de bases de dados que permitam a inclusão de doentes em registos e redes de investigação nacionais e internacionais. Para atingir estes objectivos estes centros devem integrar Unidades Funcionais (clínica, ciências básicas, investigação, treino e educação), actuando harmonicamente numa abordagem holística de doentes e suas famílias. Como grande parte do conhecimento referente às doenças cardíacas hereditárias se baseia na miocardiopatia hipertrófica e na experiência adquirida com os “centros de miocardiopatia hipertrófica”, estes representam um excelente modelo para aprender como criar e desenvolver as Unidades de Doenças Cardíacas Hereditárias. A nível Europeu, as características destas Unidades serão diferentes de um país para outro, reflectindo a heterogeneidade dos diferentes sistemas e serviços nacionais de saúde, compartilhando no entanto um core comum, apresentado neste documento. Embora conscientes de que este projecto é ambicioso e de que a sua concretização como um todo não será uma tarefa fácil, consideramos a aplicação e divulgação deste conceito a nível nacional e Europeu um passo de grande importância. Assim, a nossa posição é que todos os esforços para atingir esta meta valem a pena, considerando que o principal objectivo será sempre o bem-estar dos doentes afectados por estas patologias. Keywords: Inherited cardiovascular diseases, Inherited cardiovascular disease centers, Hypertrophic cardiomyopathy, Hypertrophic cardiomyopathy centers, Palavras-chave: Doenças cardíacas hereditárias, Unidades de doenças cardíacas hereditárias, Miocardiopatia hipertrófica, Centros de miocardiopatia hipertrófica

The manufacture of paper generates significant quantities of wastewater; as high as 60 m3/tonne of paper produced. The raw wastewaters from paper and board mills can be potentially very polluting. Indeed, a recent survey within the UK industry has found that their chemical oxygen demands can be as high as 11000 mg/l. This paper reviews the processes involved in paper making and examines the effects which they could have on the environment. It also evaluates the treatment processes which are used to minimise these effects. In line with the majority of UK practice, it focuses mainly on aerobic biological treatment and, in particular, on the activated sludge process. This means that there is an in-depth discussion about the problems associated with filamentous bacteria and sludge "bulking". The paper also discusses the way in which anaerobic digestion can be applied to the treatment of liquid wastes from the manufacture of paper.

In this work, a detailed technical-economic analysis of a fluidized bed based waste-to-energy system for disposal of paper manufacturing sludges has been carried out. Specific reference is made to a case study represented by the largest plant in Italy producing recycled paper, with a daily sludge output of about 52 t. The adopted plant has been sized for a nominal capacity of 140 t per day also allowing the progressive elimination of sludges accumulated in a previously utilized landfill, giving a nominal electrical power output of 3.5 MW. The main plant sections have been described and the adopted technical solutions have been outlined. A detailed process and equipment characterization has been carried out leading to a thorough evaluation of capital investment, operating costs and revenues. A differential analysis has been performed with respect to the alternative solution represented by the disposal of untreated sludges in an external landfill in order to highlight the savings obtainable. The economic profitability of the investment has been evaluated regarding several performance indices. The economic evaluation has been completed by a sensitivity and risk analysis in order to assess the effects of uncertainties in the economically significant parameters. Adopting most probable values, the savings obtained with the considered waste-to-energy system are evaluated in the 15–20 million Euro range during the estimated plant life of 15 years with a foreseen pay back time of 4 years. Moreover, many environmental benefits result such as the remediation of existing landfill, the avoidance of new landfills opening and very low air pollutants emissions.

What will be the future of internal medicine in Europe? Because of rapidly growing concerns regarding the position of internal medicine in many European countries, the European Federation of Internal Medicine (EFIM) has established a working group to analyze the situation. Being well aware of the variation in working practices in the different countries, the members of the group used an “all-European” approach to answer the following questions: • Are there problems for internal medicine? If so, what are these problems and why? • Why do the health care systems in the European countries need internal medicine? • Why do patients need internal medicine? • What needs to be done? Internal medicine is the modern, clinical, and scientific medical discipline that is responsible for the care of adult patients with one or more complex, acute, or chronic illnesses. Internal medicine is the cornerstone of an integrated health care delivery service that is needed today. Decision-makers in politics and hospitals, insurers, journalists, and the general public need a better understanding of what internal medicine can offer to the health care system and to the individual patient.

Intersex/disorders of sex development advocacy groups and associated health care professionals question the legitimacy of the Council of Europe issue paper, express their worries about its potentially harmful consequences, and urge the Council of Europe to consult more widely with relevant stakeholders.

Background In 2007, the European Society of Physical and Rehabilitation Medicine (ESPRM) established the European Physical and Rehabilitation Medicine Journal Network (EPRMJN) with a view to increase scientific knowledge among physical and rehabilitation medicine (PRM) specialists and to foster collaboration among the national, regional (multinational) and European PRM journals. In this connection, this paper gives the readers of national and regional, and European PRM journals a complete overview of the European Journal of Physical and Rehabilitation Medicine (EJPRM), the official ESPRM journal, and a review of the papers published in 2008. Methods The evolution of the EJPRM in the last five years was analyzed, and the papers published in 2008 were systematically reviewed and classified by content and discussed. Results The EJPRM is listed in PubMed and Current Contents; at now the unofficial 2008 Impact Factor is 1.14, like the Impact Factor, also the independent SCImago Journal Rate and Cites per Doc (two years) have increased steadily since 2005. The EJPRM published 72 papers in 2008, with a well balanced coverage of different rehabilitation topics. The rejection rate is around 40%; the review and publication times are 1.2 and 10.0 months, respectively. The published papers are presented here by topic, highlighting multi-journal initiatives (such as the EPRMJN and the Euro-American Focus with the American Journal of PRM), monographic Special Sections, systematic Cochrane PRM reviews, original papers and case reports, and other contents including the Internet Bookshelf. Conclusion This paper represents the start of the EPRMJN collaborative efforts to increase scientific knowledge among PRM specialists in Europe, independently of the language in which papers are published.

Aims: Patient-reported outcomes (PROs) have recently gained greater credibility with regulatory bodies aiming to standardise their use and interpretation in RCTs, thereby supporting medicinal product submissions. For this reason, the United States (US) Food and Drug Administration (FDA) and the European Medicines Agency (EMEA) have released guidelines. This review paper provides an overview of the current perspectives and views on these guidelines. Method: To evaluate the FDA and EMEA PRO guidelines, 47 expert responses to the FDA guidance were qualitatively reviewed. Two reviewers independently extracted data from these letters and checked these responses to warrant consistency and agreement in the evaluation process. A PubMed literature review was systematically examined to obtain supporting evidence or related articles for both the guidance documents. Results: Generally, there is agreement between regulatory authorities and the research community on the contents of the FDA and EMEA PRO draft guidance. However, disagreements exist on significant philosophical topics (e.g. the FDA focuses more on conceptual models and symptoms than the EMEA) and design topics (e.g. the FDA is more restrictive on issues of recall bias, blinding of oncology trials and degrees of psychometric validation than researchers and the EMEA). This could influence the approval of PRO claims. Conclusion: PRO guidance from the EMEA and FDA has been valuable, and has raised the profile and active debate of PROs in oncology. However, our review of the current opinion shows that there are controversial aspects of the guidance. Consequently, greater latitude should be given to how the guidance is interpreted and applied. (C) 2008 Elsevier Ltd. All rights reserved.

SummaryIn February, 2020, the European Commission published a white paper on artificial intelligence (AI) as well as an accompanying communication and report. The paper sets out policy options to facilitate a secure and trustworthy development of AI and considers health to be one of its most important areas of application. We illustrate that the European Commission's approach, as applied to medical AI, presents some challenges that can be detrimental if not addressed. In particular, we discuss the issues of European values and European data, the update problem of AI systems, and the challenges of new trade-offs such as privacy, cybersecurity, accuracy, and intellectual property rights. We also outline what we view as the most important next steps in the Commission's iterative process. Although the European Commission has done good work in setting out a European approach for AI, we conclude that this approach will be more difficult to implement in health care. It will require careful balancing of core values, detailed consideration of nuances of health and AI technologies, and a keen eye on the political winds and global competition.

Woodchip bioreactors are widely known as a best management practice to reduce excess nitrate loads that are discharged with agricultural leachates. The aim of this study was to evaluate the performance of citrus woodchip bioreactors for denitrification of brine (electrical conductivity ≈ 17 mS cm−1) from groundwater desalination plants with high nitrate content (NO3−-N ≈ 48 mg L−1) in the Campo de Cartagena agricultural watershed, one of the main providers of horticultural products in Europe. The performance was evaluated relative to seasonal changes in temperature, dissolved organic carbon (DOC) provided by woodchips, hydraulic residence time (HRT) and woodchip aging. Bioreactors (capacity 1 m3) operated for 2.5 years (121 weeks) in batch mode (24 h HRT) with three batches per week. Denitrification efficiency was modulated by DOC concentration, temperature, hydraulic residence time and the drying-rewetting cycles. High salinity of brine did not prevent nitrate removal from occurring. The high DOC availability (>25 mg C L−1) during the first ≈48 weeks resulted in high nitrate removal rate (>75%) and nitrate removal efficiency (until ≈ 25 g N m−3 d−1) regardless of temperature. Moreover, the high DOC contents in the effluents during this period may present environmental drawbacks. Denitrification was still high after 2.5 years (reaching ≈9.3 g N m−3 d−1 in week 121), but dependence on warm temperature became more apparent with woodchips aging from week ≈49 onwards. Nitrate removal efficiency was highest on the first weekly batch, immediately after woodchips had been unsaturated for four days. It was attributable to a flush of DOC produced by aerobic microbial metabolism during drying that stimulated denitrification following re-saturation. Hence, alternance of drying-rewetting cycles is an operation practice that increase bioreactors nitrate removal performance.

The European Marine Board recently published a position paper on linking oceans and human health as a strategic research priority for Europe. With this position paper as a reference, the March 2014 Cornwall Oceans and Human Health Workshop brought together key scientists, policy makers, funders, business, and non governmental organisations from Europe and the US to review the recent interdisciplinary and cutting edge research in oceans and human health specifically the growing evidence of the impacts of oceans and seas on human health and wellbeing (and the effects of humans on the oceans). These impacts are a complex mixture of negative influences (e.g. from climate change and extreme weather to harmful algal blooms and chemical pollution) and beneficial factors (e.g. from natural products including seafood to marine renewable energy and wellbeing from interactions with coastal environments). Integrated approaches across disciplines, institutions, and nations in science and policy are needed to protect both the oceans and human health and wellbeing now and in the future.

Anaerobic digestion of organic waste generated by households, businesses, agriculture, and industry is an important approach as method of waste treatment - especially with regard to its potential as an alternative energy source and its cost-effectiveness. Separate collection of biowaste from households or vegetal waste from public green spaces is already established in some EU-27 countries. The material recovery in composting plants is common for biowaste and vegetal waste. Brewery waste fractions generated by beer production are often used for animal feeding after a suitable preparation. Waste streams from paper industry generated by pulp and paper production such as black liquor or paper sludge are often highly contaminated with toxic substances. Recovery of chemicals and the use in thermal processes like incineration, pyrolysis, and gasification are typical utilization paths. The current utilization of organic waste from households and institutions (without agricultural waste) was investigated for EU-27 countries with Germany as an in-depth example. Besides of biowaste little is known about the suitability of waste streams from brewery and paper industry for anaerobic digestion. Therefore, an evaluation of the most important biogas process parameters for different substrates was carried out, in order to calculate the biogas utilization potential of these waste quantities. Furthermore, a calculation of biogas energy potentials was carried out for defined waste fractions which are most suitable for anaerobic digestion. Up to 1% of the primary energy demand can be covered by the calculated total biogas energy potential. By using a "best-practice-scenario" for separately collected biowaste, the coverage of primary energy demand may be increased above 2% for several countries. By using sector-specific waste streams, for example the German paper industry could cover up to 4.7% and the German brewery industry up to 71.2% of its total energy demand.

Up to 25% of plastic waste in Europe is still disposed of in landfills, despite recycling efforts. The plastic waste in the landfill plot may be exposed both to abiotic and biotic degradation processes, although it is thought that most of the plastic materials tend to be resistant to biodegradation or biodeterioration even after a long time. To verify if polypropylene (PP) can undergo the process of short-term biodegradation and how this process is manifested in a municipal waste landfill, we collected a plastic sample from an already closed landfill plot estimating its age at approximately 5 years. Fourier-Transform Infrared Spectroscopy led to sample identification as PP as well as showed additional bands which are not specific to polymer structure but rather result from microbial metabolism. Differential Scanning Calorimetry was performed to examine the influence of the environmental degradation process on the degree of crystallisation of the tested PP. Moreover, significant changes on the surface of an old PP packaging were observed with Scanning Electron Microscopy (SEM) showing clear signs of PP delamination which resulted in microplastic particles formation (smaller than 5 μm in diameter). Additionally, several round and oval shaped structures were observed with SEM leading to the suspicion of biofilm formation on the PP surface. Indeed, the microorganisms were present in a vast amount on the old PP surface and possibly formed a viable biofilm as it was confirmed with fluorescence microscopy. These data show that plastic waste can be inhabited by microorganisms from the ambient environment which may probably lead to its faster degradation. However, this process should be investigated in more detail in order to shed light upon the possible risk factors of plastic biodegradation in waste landfills to the environment and human health. Even after five years, polypropylene can undergo deterioration/biodegradation in a waste landfill with viable microbial cells on its surface, possibly involved in its degradation.

In many nations industrial scale AD of non-agricultural waste materials (such as MSW) has not yet reached its full potential, often constrained by the lack of secure, inexpensive, high quality AD feedstocks, and markets for the resulting digestate material. We tested the output material of a high throughput novel industrial process to define its potential as an AD feedstock (based on quality and consistency). This process, designed to circumvent the constraints of source segregation while still generating segregated waste streams, resulted in the production of a temporally homogenous fibrous material with: an average moisture content of 44.2 (±2.33)%; C:N ratio of ∼32.9:1 (±3.46:1), C:P ratio of ∼228:1 and gross calorific value of 17.4 (±0.29) MJ/kg(DM). This material provided a CH4 yield of between 201 and 297 m3 CH4/tonne(DM) (271–401 m3 CH4/tonne(vs)) comparable to commonly used AD feedstocks. Material contaminant levels were temporally consistent (P > 0.05), (average values being Cd 0.63 (±0.19), Cu 56.3 (±7.45), Crtot 51.4 (±4.41), Hg < 0.3, Ni 28.9 (±5.17), Pb 79.2 (±23.71), Zn 202 (±44.5), total polyaromatic hydrocarbons (PAH) 2.2 (±0.3), and total polychlorinated biphenyls (PCB) (

Publicado também em: https://repositorio.unifesp.br/handle/11600/56388 e https://repositorio.unifesp.br/handle/11600/56970 NCATS NIH HHS Univ Hosp Magdeburg, Dept Cardiol & Intens Care Med, St Vincenz Hosp Paderborn, Working Grp Mol Electrophysiol, Magdeburg, Germany Univ Melbourne, Royal Melbourne Hosp, Melbourne, Vic 3050, Australia Ctr Privado Cardiol, San Miguel De Tucuman, Argentina Yale Univ, New Haven, CT USA European Univ Quiron Madrid, Madrid, Spain Vet Gen Hosp, Taipei, Taiwan Cedars Sinai Med Ctr, Inst Heart, Los Angeles, CA 90048 USA Univ Parma, Parma, Italy Mt Sinai Sch Med, New York, NY USA Univ Duisburg Essen, Inst Pharmacol, West German Heart & Vasc Ctr, Essen, Germany Univ Fed Sao Paulo, Sao Paulo, Brazil Penn State Univ, Penn State Heart & Vasc Inst, Hershey, PA USA Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, Dept Cardiol,INSERM,UMR S1166,ICAN, Paris, France Boston Univ, Sch Med, Boston Med Ctr, Boston, MA 02118 USA Univ Leipzig, Heart Ctr, Leipzig, Germany Royal Brompton Hosp, London, England Imperial Coll London, London, England UH Case Med Ctr, Cleveland, OH USA Univ Michigan, Ann Arbor, MI 48109 USA Korea Univ, Med Ctr, Seoul, South Korea Univ Birmingham, Birmingham, W Midlands, England Anzhen Hosp, Beijing, Peoples R China Univ Calif San Francisco, San Francisco, CA 94143 USA Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA Univ Tsukuba, Ibaraki, Japan Univ Adelaide, South Australian Hlth & Med Res Inst, Ctr Heart Rhythm Disorders, Adelaide, SA, Australia Royal Adelaide Hosp, Adelaide, SA, Australia UPB, Univ CES, Ctr Especializados San Vicente Fdn & Clin CES, Electrophysiol Deparment, Medellin, Colombia Cleveland Clin, Dept Mol Cardiol, Cleveland, OH 44106 USA Univ Montreal, Montreal Heart Inst, Res Ctr, 5000 Belanger St E, Montreal, PQ H1T 1C8, Canada McGill Univ, Montreal, PQ, Canada Univ Duisburg Essen, Fac Med, Inst Pharmacol, West German Heart & Vasc Ctr, Essen, Germany Univ Fed Sao Paulo, Sao Paulo, Brazil NCATS NIH HHS: UL1 TR001863 Web of Science

Policy-making in the European Union (EU) is a complex process that can appear impenetrable and opaque. This paper examines the ongoing process of mental health policy-making in the EU. In 2005, the Health and Consumer Protectorate Director-General of the European Commission published a Green Paper and launched a consultation process aimed at mental health service-users, advocates, providers, business, social services and governments. While there were varying levels of participation between member states, a range of trans-national, national and infra-national actors made contributions. Based on these consultations, a 'Consultative Platform' was created and made 10 recommendations centered on the principles of partnership; establishing policy competencies; integrating mental health into national policies; involving stakeholders; and protecting human rights. This ongoing process illustrates many features of EU policy-making: (a) the European Commission generates an initiative; (b) policy focuses on EU standardization, with member states remaining central actors in service-delivery; (c) policy focuses on social inclusion; (d) the European Commission coordinates diverse networks of actors; and (e) there is 'multi-level' involvement, with direct interaction between trans-national, national and infra-national actors. An enhanced focus on epidemiological data and 'evidence-based policy' would increase rigor and focus further attention on this relatively neglected policy area.

This paper examines emerging trends in transport policy in the UK, as identified by the 2004 Transport White Paper and the supporting policy guidance to local transport authorities for addressing social exclusion through local transport provision; accessibility planning. It moves on to identify potential barriers to delivery at the local level and more fundamental challenges, risk and policy tensions. In this context, it critiques UK policies to deliver social equity through transport programmes in light of its Climate Change Agenda and the identified need to significantly reduce traffic levels on UK roads.It identifies the potential synergy between these two policy ambitions, but argues that currently there is a serious policy conflict between these agendas within the UK policy framework. In the light of this conclusion, it offers some key recommendations on the best way forward, which it recommends must be based on the synergistic and integrated delivery of policies for social and environmental equity within the transport sector. It concludes by identifying the key challenges this implies for applied research in this area.

Many interesting changes are regularly brought into the methodology of cancer clinical trials. This position paper focuses on three topics which are felt to appear as recurrent problems which deserve more attention from the scientific community. RECIST guidelines were published five yeas ago and have since then been largely implemented and used in clinical trials. Although the criteria were initially designed for screening phase II trials they have been used also in most phase III studies aiming at determining the efficacy of new treatments. Problems have been identified some of which require further clarifications and others deserve further research which is being undertaken. overall RECIST is well accepted and a revised version is being considered for 2007. Interim analysis is also an important issue revealed recently through many large adjuvant or advanced trials being prematurely discontinued at the time of an interim analysis. In most instances trials were stopped because of evidence of superiority of the investigational treatment over the standard treatment. Premature discontinuation of trial poses a number of challenges addressed in this paper. Finally, the consequences of the implementation of the EU clinical trial directive are being discussed. The conclusions are without equivoque. There is much less academic research conducted in Europe, there is a lot of discrepancy and inconsistency in the implementation of the directive across member states and there is no apparent direct benefit for the patients. (c) 2006 Elsevier Ltd. All rights reserved.

Over 258 Mt of solid waste are generated annually in Europe, a large fraction of which is biowaste. Sewage sludge is another major waste fraction. In this study, biowaste and sewage sludge were co-digested in an anaerobic digestion reactor (30% and 70% of total wet weight, respectively). The purpose was to investigate the biogas production and methanogenic archaeal community composition in the anaerobic digestion reactor under meso- (35–37 °C) and thermophilic (55–57 °C) processes and an increasing organic loading rate (OLR, 1–10 kg VS m−3 d−1), and also to find a feasible compromise between waste treatment capacity and biogas production without causing process instability. In summary, more biogas was produced with all OLRs by the thermophilic process. Both processes showed a limited diversity of the methanogenic archaeal community which was dominated by Methanobacteriales and Methanosarcinales (e.g. Methanosarcina) in both meso- and thermophilic processes. Methanothermobacter was detected as an additional dominant genus in the thermophilic process. In addition to operating temperatures, the OLRs, the acetate concentration, and the presence of key substrates like propionate also affected the methanogenic archaeal community composition. A bacterial cell count 6.25 times higher than archaeal cell count was observed throughout the thermophilic process, while the cell count ratio varied between 0.2 and 8.5 in the mesophilic process. This suggests that the thermophilic process is more stable, but also that the relative abundance between bacteria and archaea can vary without seriously affecting biogas production.

More than 40 years ago, Russell and Burch published their views on the implementation of the 'Three Rs' in animal experimentation. Since then, much has been achieved in this area. Recently, the European Science Foundation (ESF) has made a further step forward. In a position paper on the use of animals, ESF has formulated what it sees as prerequisites for the humane use of animals in research, testing and education. In this paper, we briefly report on these ESF guidelines. Also, an overview is presented on European legislative regulations for the (ethical) review of research protocols and for the education and training of persons involved in animal experiments. The great diversity between countries is illustrated with some examples and the need for harmonization is emphasised. The paper ends by highlighting the special role that editorial boards of journals can play in the further implementation of the Three Rs.

In 1998 the UK Government published the first Transport White Paper for over 20 years, A New Deal for Transport; Better for Everyone. The document emphasised the need for joined-up policy thinking and for co-ordinated action across different areas of government, a theme that has been taken up in many subsequent policy documents issued by central government. The paper explores the extent to which ‘joined-up thinking’ is evident in practice, both in the ways in which transport measures are appraised (e.g. do they fully take into account non-transport impacts?), and in appraisals in other policy areas with significant transport impacts. It does so by examining appraisal frameworks in different sectors, and identifies a number of current weaknesses. It then builds on these examples to propose ways in which an integrated policy appraisal framework could be developed. This would aim to identify not only the comparative cost-effectiveness of different transport measures in fulfilling policy objectives, but also the relative contribution that different areas of government could make—including transport—to the delivery of over-arching policy objectives, such as sustainable development, social exclusion and regeneration.

We report a pyrolysis GC–MS method capable of analysing Indigenous Australian and European binders typically used in the manufacture of culturally important painted works. Eleven different traditional European binders and ten different Indigenous Australian binders were examined. The method allows discrimination between highly complex and impure lipid, resin, polysaccharide, wax, and protein-based binders. Each was found to have characteristic pyrolysis products that were unique to the binder material, demonstrating the potential for differentiation of these binders on Australian Aboriginal artworks towards identification and conservation of cultural heritage.

Although coastal eutrophication is generally recognised as a recent phenomenon related to the well-documented increase in riverine nutrient delivery during the last 30 or 40 years, a few historical records paradoxically show that, in some places like the Southern Bight of the North Sea, or the Northern Adriatic, algal proliferation as intense as presently observed was already regularly occurring at the end of the 19th century. Estimated riverine nutrient loads from diffuse sources or from domestic point sources of waste water at that time are too low to account for these observations. We attempted a retrospective evaluation of the possible contribution of industrial activity to nutrient river loading. The figures indicate that, by the end of the last century, large scale use of traditional processes in textile and paper industries, in tanneries, candles factories and others was responsible for a dominant part of the nutrient load carried by rivers in Western Europe and could have caused nutrient inputs to coastal zones similar to the present ones.

Introduction It is well known that the use of MDI (methylene diphenyldiisocyanate) as an alternative for formaldehyde-based resins is seen as a responsible option to reduce formaldehyde emissions for CWP (Composite Wood Products) in buildings. However, there are concerns raised regarding the exposure risk of workers. The purpose of this article is to provide the reader with factual information to demonstrate that the use of MDI compared to other agents used in CWP production processes does not pose increased inhalation exposure risks for workers. Personal and area air measurements were carried out at nine Composite Wood Panel plants throughout Europe to assess potential inhalation exposures to MDI and wood dust as Total Inhalable Particulates (TIP). In total, 446 pairs of samples were collected for MDI and TIP of which 283 pairs were personal samples and the remaining 163 pairs were area samples collected at key locations along the production line. This data together with published formaldehyde exposure data has been used to evaluate the exposure safety margin opposite what are considered relevant occupational exposure limits. Material and methods The methods used for sampling and analysing MDI and TIP are based on internationally accepted methods, i.e. MDHS 25/3 (or ISO 16702) for MDI, and MDHS 14/3 for TIP. Results The job functions with an increased exposure profile for TIP were the cleaners, drying operators and quality control staff, and for MDI, the cleaners and quality control staff. The areas with an increased exposure profile for TIP are the conveyor area from OSB blender to former area and the OSB press infeed, and for MDI the OSB weigh belt and OSB former bin area. Conclusions The exposure safety margin opposite the selected exposure limits can be ranked as MDI > TIP > formaldehyde (high margin of safety to low margin of safety), indicating that the use of MDI also reduces the exposure risks to workers during production of CWP compared to formaldehyde. By reducing the airborne TIP concentrations, a respiratory sensitiser, MDI workplace concentrations in general can be reduced further. This can be achieved by improving design and/or maintenance and testing programmes of existing control measures, which should be in place already to effectively control exposure to TIP and formaldehyde. The airborne concentration of MDI at workstations situated after pressing (curing) is regarded as extremely low and likely mainly constituted by workplace emissions from elsewhere in the plant.

Agrarian biomass as a renewable energy source can contribute to a considerable CO 2 reduction. The overriding goal of the European Union is to cut energy consumption related greenhouse gas emission in the EU by 20% until the year 2020. This publication aims at optimising the methane production from steam-exploded wheat straw and presents a theoretical estimation of the ethanol and methane potential of straw. For this purpose, wheat straw was pretreated by steam explosion using different time/temperature combinations. Specific methane yields were analyzed according to VDI 4630. Pretreatment of wheat straw by steam explosion significantly increased the methane yield from anaerobic digestion by up to 20% or a maximum of 331 l N kg −1 VS compared to untreated wheat straw. Furthermore, the residual anaerobic digestion potential of methane after ethanol fermentation was determined by enzymatic hydrolysis of pretreated wheat straw using cellulase. Based on the resulting glucose concentration the ethanol yield and the residual sugar available for methane production were calculated. The theoretical maximum ethanol yield of wheat straw was estimated to be 0.249 kg kg −1 dry matter. The achievable maximum ethanol yield per kg wheat straw dry matter pretreated by steam explosion and enzymatic hydrolysis was estimated to be 0.200 kg under pretreatment conditions of 200 °C and 10 min corresponding to 80% of the theoretical maximum. The residual methane yield from straw stillage was estimated to be 183 l N kg −1 wheat straw dry matter. Based on the presented experimental data, a concept is proposed that processes wheat straw for ethanol and methane production. The concept of an energy supply system that provides more than two forms of energy is met by (1) upgrading obtained ethanol to fuel-grade quality and providing methane to CHP plants for the production of (2) electric energy and (3) utility steam that in turn can be used to operate distillation columns in the ethanol production process.

In order to further understand the contamination of the citrus pulp pellets (CPP) that were exported to Europe in 1997 we examined both contaminated lime and CPP samples for the distribution of polychlorinated biphenyls (PCBs) and chlorinated benzenes (tri-hexa). Standard isotope dilution techniques were applied for all samples, which were analysed by selected ion monitoring high resolution GC-MS. Lime that is used in the production of CPP product is highly contaminated with PCBs and chlorobenzenes.

The removal of lead from drinking water was investigated to develop a point-of-use water filter that could meet the regulation imposed by the new European Directive 98-83 lowering lead concentration in drinking water below 10 μg L −1 . The objective of this research was to assess the potential of different adsorbents (zeolites, resins, activated carbon, manganese oxides, cellulose powder) to remove lead from tap water with a very short contact time. To begin, the repartition of the lead species in a tap water and a mineral water was computed with the computer model CHESS. It showed that in bicarbonated waters lead is mainly under lead carbonate form, either in the aqueous or in the mineral phase. Batch experiments were then conducted to measure the equilibrium adsorption isotherms of the adsorbents. Then, for five of them, dynamic experiments in micro-columns were carried out to assess the outlet lead concentration level. Three adsorbents gave rise to a leakage concentration lower than 10 μg L −1 and were then selected for prototypes experiments: chabasite, an activated carbon coated with a synthetic zeolite and a natural manganese oxide. The proposed method clearly showed that the measurement of equilibrium isotherms is not sufficient to predict the effectiveness of an adsorbent, and must be coupled with dynamic experiments.

Although a theoretical model for the settlement patterns of Galician Palaeolithic has been proposed in the last decades, it has not been statistically tested. The present paper aims to check whether this previous theoretical model can be verified statistically. For this purpose, a methodology based on the creation of a predictive model has been used in which the main environmental variables were analysed and their suitability for predicting the location of Palaeolithic sites statistically verified. The predictive model shows that the most accurate variables are elevation, slope, cost to potential hydrology, the cost to wetland areas, and visual prominence. The results demonstrated that the theoretical model was fulfilled in some of the variables previously proposed. Thus, we have shown the usefulness of this approach to test hypotheses and the results obtained open new possibilities of analysis in the study of the Palaeolithic sites in NW Iberia This study is part of the research projects Dinámicas poblacionales y tecnológicas durante el Pleistoceno final-Holoceno de las Sierras orientales del Noroeste ibérico (R&D Projects of the Ministry of Science, PID2019-107480 GB-I00), Ocupaciones humanas durante el Pleistoceno en la cuenca media del Miño (HUM2007-63662/HIST) and Poblamiento durante el Pleistoceno Medio/Holoceno en las comarcas orientales de Galicia (HAR2010-21786/HIST). M. Díaz-Rodríguez is part of the CLIOARCH project which has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement 817564); and the NeanderEDGE project which has received funding from the Independent Research Fund Denmark (case number 9062-00027B). We are very grateful to the two anonymous reviewers and the editor, whose comments have contributed significantly and helped improve the initial version of this paper. The analyses of this work have been carried out in the statistical environment R (R Core Team, 2021) SI

Introduction/objective: West Nile virus (WNV) is one of the most widely distributed flaviviruses worldwide. It is considered an endemic and emerging pathogen in different areas of the Europe and Mediterranean countries (MR). Mosquitoes of the genus Culex spp. are the main vectors, and birds its main vertebrate hosts. It can occasionally infect mammals, including humans. Different environmental factors can influence its distribution and transmission through its effects on vector or host populations. Our objective was to determine environmental factors associated with changes in vector distribution and WNV transmission in Europe and MR. Material & methods: Systematic peer review of articles published between 2000 and 2020. We selected studies on WNV, and its vectors carried out in Europe and MR. The search included terms referring to climatic and environmental factors. Results: We included 65 studies, of which 21 (32%) were conducted in Italy. Culex spp. was studied in 26 papers (40%), humans in 19 papers (29%) and host animals (mainly horses) in 16 papers (25%), whereas bird reservoirs were addressed in 5 studies (8%). A significant positive relationship was observed between changes in temperature and precipitation patterns and the epidemiology of WNV, although contrasting results were found among studies. Other factors positively related to WNV dynamics were the normalized difference vegetation index (NDVI] and expansion of anthropized habitats. Conclusion: The epidemiology of WNV seems to be related to climatic factors that are changing globally due to ongoing climate change. Unfortunately, the complete zoonotic cycle was not analyzed in most papers, making it difficult to determine the independent impact of environment on the different components of the transmission cycle. Given the current expansion and endemicity of WNV in the area, it is important to adopt holistic approaches to understand WNV epidemiology and to improve WNV surveillance and control. This research was supported by CIBER -Consorcio Centro de Investigación Biomédica en Red-, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea. ESP22PI05 and EU grant 874850 MOOD and is catalogued as MOOD 000. The contents of this publication are the sole responsibility of the authors and don’t necessarily reflect the views of the European Commission. Sí

Stillbirth definitions vary between countries around the globe. The purpose of this paper was to explore stillbirth definitions used by high income countries around the world, specifically compared to Ireland, their stillbirth and mortality rates and to examine how these rates are influenced by standards of care, especially resuscitation efforts within the delivery room for very preterm infants. A literature review was performed using PubMed, Academic Search Complete, MEDLINE, and CINAHL. These databases were searched with the terms “(stillbirth OR still birth OR stillborn) AND (definition OR registration OR registry)” and “(fetal OR neonatal OR neonate) AND Viability AND Gestational Age” in two separate searches. The database searches returned 1081 results involving stillbirths and 164 results for neonatal viability. After title, abstract, full text review, and reference review 33 papers remained for use in this study. Within the European Union (EU), 59.2 % (n = 16), 14.8 % (n = 4), 11.1 % (n = 3), and 3.7 % (n = 1) countries classify stillbirths at gestational ages of ≥22 weeks, ≥24 weeks, ≥28 weeks, and ≥180 gestational days respectively. The median stillbirth rate in Europe using ≥28 weeks gestational age as a cut-off was 2.7 per 1000 births, but this increased to 3.3 per 1000 births when stillbirths from 24 to 27 weeks gestation were included. Of the thirteen countries whose mortality data was examined, survival rates for liveborn infants ranged from 0–37.3 %, 1.1–64.5 %, 31.0–77.7 %, and 59.1–85.7 % for the gestational ages of 22, 23, 24, and 25 weeks, respectively. In 1995, survival rates for the United Kingdom and Ireland were only 26 % for those born at 24 weeks gestation, however this has almost doubled in Ireland to 56.6 % in 2014–2017. Survival rates have improved to the point that, in 2014–2017, the survival rate of infants born at 23 weeks gestation (32.3 %) was 6 % higher than the rate for those born at 24 weeks gestation in 1995. Due to the improvement in survival rates, multiple international organisations recommend recording stillbirths from 22 weeks gestation and/or 500 g. Based on the findings from this review, and due to improving survival rates for periviable infants, it is recommended the stillbirth definition in Ireland should be updated to ≥22 weeks’ gestation and ≥400 g to comply with improved medical developments.

The influenza A/H1N1 pandemic in 2009 taught us that the monitoring of vaccine benefits and risks in Europe had potential for improvement if different public and private stakeholders would collaborate better (public health institutes (PHIs), regulatory authorities, research institutes, vaccine manufacturers). The Innovative Medicines Initiative (IMI) subsequently issued a competitive call to establish a public-private partnership to build and test a novel system for monitoring vaccine benefits and risks in Europe. The ADVANCE project (Accelerated Development of Vaccine benefit-risk Collaboration in Europe) was created as a result. The objective of this paper is to describe the perspectives of key stakeholder groups of the ADVANCE consortium for vaccine benefit-risk monitoring and their views on how to build a European system addressing the needs and challenges of such monitoring. These perspectives and needs were assessed at the start of the ADVANCE project by the European Medicines Agency together with representatives of the main stakeholders in the field of vaccines within and outside the ADVANCE consortium (i.e. research institutes, public health institutes, medicines regulatory authorities, vaccine manufacturers, patient associations). Although all stakeholder representatives stated they conduct vaccine benefit-risk monitoring according to their own remit, needs and obligations, they are faced with similar challenges and needs for improved collaboration. A robust, rapid system yielding high-quality information on the benefits and risks of vaccines would therefore support their decision making. ADVANCE has developed such a system and has tested its performance in a series of proof of concept (POC) studies. The system, how it was used and the results from the POC studies are described in the papers in this supplementary issue.

Background Different terms are used to refer to postural balance training, but the ontological debate involving the concepts to pursue nomenclature consensus is unusual. Objective The goal of this study was to analyze how often the terms balance, neuromuscular, proprioceptive, functional and sensorimotor training/exercise are used in the literature, and to propose a conceptual critical appraisal to determine the most appropriate terminology to address postural balance exercises. Methods A literature search was conducted in the Scopus electronic database. Eligibility criteria: papers with the selected expressions on the title or keywords, published in English, were included. Results The most used term was balance training (471 of 1105 included papers). Europe, followed by Asia and North America, had the highest number of publications. In the 21st century, the number of publications increased considerably. However, the terms have conceptual differences and controversies regarding its use. Conclusion Despite a large variety of exercise types and divergences, balance training seems to be the most suitable term, given it refers to postural equilibrium exercises.

Introduction Journal clubs are useful for teaching critical appraisal skills and maintaining contemporary knowledge in orthopedics. The didactic format is most common; however, work commitments can pose difficulty in full attendance. Also with the current legislative working time restrictions for residents in Europe and North America, work and training time require separation with times that may not suit all attendees. Online forums such as “Twitter” have recently been used to accommodate various journal clubs. We aimed to establish a journal club using smartphone messaging application “WhatsApp” to discuss key orthopedic papers and teach critical appraisal skills to residents. Design A prospective cohort study including all residents and attendings in the department. A research practice questionnaire, the “Evidence-based Practice Questionnaire” and a 28-question MCQ on research methods from the American Academy of Orthopedic Surgeons resident question database was completed by all participants prior to the study. A paper was uploaded each Friday, and discussed the following Tuesday through Friday for 6 consecutive weeks. The original questionnaire and MCQs were again completed after the 6-week study period. Setting A Trauma & Orthopedic residency unit. Participants All orthopedic residents, from PGY1-4 and attendings. Results An average of 22 questions were asked (min 13, max 28), and 55 responses per week (min 30, max 88). In the EBPQ questionnaire, an example question of “how often you critically appraised a paper you have discovered” improved from an average score of 2.45 to 5.4. Self-rating of research skills improved from a score of 3.27 to 5.9. MCQ scores improved from an average of 48.2% among the group to 69%. Conclusions Residents’ critical appraisal skills were improved while providing adequate time and flexibility to reflect on questions. Subspecialty topic discussions led by attendings, stimulated discussion of clinical pearls of interest to all participants. The simplicity of this method, and its widespread availability potentiates the implementation by any specialty looking to educate its residents.

Highlights: • GVCs in medical industries were subject to intense public controversy and state intervention during the initial phase of the COVID-19 pandemic. • We move beyond simplistic ‘success or failure’ of GVCs by differentiating GVC ‘adaptation’ and ‘effectiveness’ during two phases of the crisis: first, a localized crisis in China, and later, a global systemic crisis. • It shows how different types of state policies, beyond just GVC facilitation, interact with GVCs to produce mixed outcomes of PPE provision. • It advances the literature on the state-GVC nexus by showing deeper ‘mutual constraints’ between states and GVCs, which goes beyond states as external shapers of GVCs. • While states influence GVCs, two structural features of GVCs – geography of production and technological complexity – set limits on state policy, even among ‘strong’ states and during a crisis., Shortages of critical medical supplies during the COVID-19 pandemic have turned global value chains (GVCs) in personal protective equipment (PPE) into a political lightning rod. Some blame excessive outsourcing and foreign dependency for causing shortages, thus urging greater state intervention; others applaud GVCs for their flexibility and scaling up of production, while blaming states for undermining GVC operations. Using policy process-tracing and monthly trade data of seven PPE products across the US, Europe, China and Malaysia, this paper goes beyond the binary debate of either the ‘failure’ or ‘success’ of GVCs to show when and under what conditions states interacted with GVCs to produce mixed outcomes in provisioning countries with PPEs. We identify interactions between the type of state intervention and two key structural features of GVCs – geographic distribution of production and technological attributes of the product. Conceptually, the paper demonstrates the mutual constraints of states and GVCs, and highlights structural factors involved in the relationship. Looking to the future of GVCs, we caution against wholesale declarations that GVCs should be abandoned or maintained, instead concluding that paying attention to GVC structure, states and their interactions are crucial.

This paper builds on the following research questions: 1) How is circular economy imagined in the academic literature in support of sustainability transitions in European cities? 2) How do European cities imagine circular economy as a knowable object of governance? 3) How can the circular economy imaginary be an opportunity for socially inclusive and environmentally desirable urban transitions? We engaged in a three-fold research endeavour to address these questions. Firstly, we conducted an in-depth literature review, mapping the emergence and developments of the circular economy concept in time and space with a specific focus on urban studies. Secondly, we analysed documented translations of the circular economy imaginary in three European metropolitan cities (Amsterdam, Paris and London) to explore the discourses, institutions, representations and social identities underpinning their respective translations, and reflect on how they diverge from each other and how they have the potential to deliver sustainable outcomes. Thirdly, these results were used to outline a research agenda that explores the relationship between the political and the epistemic domain of existing urban translations of circular economy across scales and places, to support future empirical investigations of whether and how circular economy imaginaries can support transformative pathways for socially inclusive and environmentally desirable value creation in cities. In so doing, this paper fosters reflexivity for both theory and practice in order to better understand how theorisations and the application of circular economy could be advanced in support of urban sustainability transitions.