European Database Research Articles

Spatial distribution of tree-related microhabitats in European beech-dominated forests

Tree-related Microhabitats (TreMs) are of prime concern for biodiversity since they host thousands of taxa. TreMs are discrete habitat patches borne by trees and cover a wide range of lifespans, from days to decades to centuries. The taxa associated with such discrete and sometimes highly ephemeral habitat patches are likely to be sensitive to spatial distribution because they need to search for new habitats after the occupied one disappears. Although many studies have recently been dedicated to TreMs, only very few have investigated their spatial distribution. Focusing on European beech-dominated forests, we used a European TreM database with 12,362 trees and 296 plots (ranging from local (0.1–1 ha) to landscape scale (10,000 ha)) to assess TreM spatial distribution patterns in long unmanaged forests. Then, with a TreM sub-database with 6828 trees and 21 plots, we assessed whether and if so, how harvesting changes spatial patterns at the plot scale. In long unmanaged forests, most TreMs showed a regular pattern at the plot scale and an aggregated pattern at larger scales. Tree diameter was the most influential factor for spatial patterns in TreMs. Spatial patterns at the plot scale in harvested forests differed slightly from those observed in unmanaged forests. To favor TreM-dwelling taxa in harvested stands, our results suggest retaining habitat trees in a regular spatial pattern to mimic the natural pattern. However, some TreMs should be conserved in an aggregate pattern; we specify the spatial scale at which this should be done.

Transfer of fourteen pesticides from grapes (Vitis vinifera) into wine – Comparison of spiked grapes with grapes treated in the field

Pesticide residues in grapes are usually transferred into the wine during vinification and thus, contribute to a certain human exposure. The objective of the present study was to explore whether spiked samples could be a suitable alternative to the still mandatory field-treated samples in the processing study set-up. Grapes treated with fluxapyroxad in the vineyard and untreated grapes spiked with fluxapyroxad after harvest were processed into wine to check for differences in residual fluxapyroxad. Additionally, the behavior of 13 further pesticides during winemaking was characterized using spiked samples. Grape, must, pomace, and wine samples were analyzed by LC-MS/MS following a QuEChERS extraction protocol. The transfer of fluxapyroxad into wine from field-treated and spiked samples was found to be similar, with processing factors (PF) of 0.31 and 0.33, respectively. A strong correlation between PF and the octanol-water partition coefficient (logKOW) was identified for 13 of the 14 pesticides present in the spiked samples (R2 = 0.89, p < 0.0001). Determined PF were compared with values from the European database of processing factors for pesticides in food, which originate from field-treated samples. No significant differences were found, indicating that field-treated samples are not an absolute necessity for investigating the transfer of pesticides into wine.

Testing the informativeness of Y-STR and mitochondrial DNA control region markers in an attempt to predict ancestry of World War II victims from Slovenian mass grave.

Identification of human remains is a challenge in forensic genetics without relatives or personal items available. In Slovenia, a Konfin II mass grave from the Second World War (WWII) was found, containing skeletal remains of 65 victims. The archival documents detailing victims' information describe 45 persons of which 33 could be considered Germanic and 12 Slavic. This study aims to check for concordance between the victim list and actual victims found by using uniparental markers to differentiate between Slavic and non-Slavic origin by attempting to infer ancestry by analyzing the control region (CR) of mitochondrial DNA (mtDNA) and Y-chromosomal STRs. Diaphyses of femurs were used as a DNA source. Next Generation Sequencing (NGS) technology was used for mtDNA- namely HID Ion Chef™ Instrument, Precision ID mtDNA Control Region Panel, and Ion GeneStudio™ S5 System. For the Y-chromosome, PowerPlex® Y23 System (Promega) kit and SeqStudio™ for human identification (HID) were used. European DNA Profiling mtDNA Population Database (EMPOP) and Y-Chromosome STR Haplotype Reference Database (YHRD) were searched for haplotype matches. Closest haplogroups were predicted using EMPOP, Y-DNA Haplogroup Predictor- NevGen, and Whit Athey's Haplogroup Predictor. Despite mitotypes being more diverse than Y-haplotypes, the Y-haplotypes had more database matches and more unequivocal differentiation between populations. 16 victims could be considered Slavic, 15 non-Slavic, and the remaining 34 had a rather scarce informativeness- either unclear or not providing any match. To address ancestry inference more comprehensively, analysis of autosomal ancestry informative markers as well as expansion on haploid markers will be conducted in future research.

Oral glucocorticoids for skin fibrosis in early diffuse systemic sclerosis: a target trial emulation study from the European Scleroderma Trials and Research group database.

The objective of this study is to evaluate whether adding oral glucocorticoids to immunosuppressive therapy improves skin scores and ensures safety in patients with early diffuse cutaneous systemic sclerosis (dcSSc). We performed an emulated randomized trial comparing the changes from baseline to 12±3 months of the modified Rodnan skin score (mRSS: primary outcome) in early dcSSc patients receiving either oral glucocorticoids (≤20 mg/day prednisone-equivalent) combined with immunosuppression (treated), or immunosuppression alone (controls), using data from the European Scleroderma Trials and Research Group. Secondary endpoints were the difference occurrence of progressive skin or lung fibrosis, and scleroderma renal crisis. Matching propensity score was used to adjust for baseline imbalance between groups. We matched 208 patients (age 49 years; 33% male; 59% anti-Scl70), 104 in each treatment group, obtaining comparable characteristics at baseline. In the treated group, patients received a median prednisone dose of 5 mg/day. Mean mRSS change at 12±3 months was similar in the two groups (decrease of 2.7 [95% CI 1.4 - 4.0] in treated vs. 3.1 [95% CI 1.9 - 4.4] in control, p = 0.64). Similar results were observed in patients with shorter disease duration (≤ 24 months) or with mRSS ≤22. There was no between-group difference for all prespecified secondary outcomes. A case of scleroderma renal crisis occurred in both groups. We did not find any significant benefit of adding low-dose oral glucocorticoids to immunosuppression for skin fibrosis, and at this dosage, glucocorticoid did not increase the risk of scleroderma renal crisis.

RADT-15. THE ROLE OF STEREOTACTIC RADIOSURGERY IN WHO GRADE II MENINGIOMAS: RESULTS FROM A LARGE EUROPEAN MULTICENTER STUDY

Abstract BACKGROUND This study evaluates the outcomes of WHO grade II meningiomas treated with stereotactic radiosurgery (SRS) using a large, multi-institutional European database. We aim to investigate the long-term tumor control rate and morbidity associated with SRS. METHODS Data from 355 consecutive patients treated between 1992 and 2022 at 16 European radiosurgery centers were retrospectively analyzed. After excluding 40 patients due to loss to follow-up, results from 315 patients were included. Clinical and imaging data were independently collected by each center and uniformly entered into a multicenter database. RESULTS The median age of patients was 56 years, with 54% being female. The median follow-up duration was 46.3 ± 36.9 months. Tumors had prior surgical treatment and biopsy in 99% and 1% of cases, respectively. Tumors received previous radiotherapy or SRS in 27.4% of cases. SRS was performed due to local progression in 89.6% of cases, residual tumor in 6.4%, and distant progression in 4.0%. SRS characteristics included a median target volume of 5.1 cm³ and a median margin dose of 16 Gy (53.5% isodose). The 3-year local control rate was 72.0%, with a progression-free survival rate of 66.6% and an overall survival rate of 89.7%. Transient and permanent morbidity rates were 6.4% and 3.5%, respectively. Multivariate analysis identified previous radiotherapy and age as significant factors influencing these outcomes. CONCLUSIONS This study is the largest to date on SRS in WHO grade II meningiomas. Our data shows that SRS is a viable and safe treatment option for residual and recurrent WHO grade II meningiomas

Biological variation and analytical performance specification study of erythrocyte and related parameters

Objective: To study biological variation (BV) and analytical performance specifications (APS) of 15 erythrocyte and related parameters. Methods: Sixty healthy participants from Beijing Hospital were prospectively recruited for the study, from July to December, 2023, including 30 males [aged (41.3±11.9) years] and 30 females [aged (40.3±12.4) years]. The study was designed based on the Biological Variation Data Critical Appraisal Checklist and the characteristics of erythrocyte detection. Whole blood samples were collected 10 times at 2-week intervals during 20 weeks. All samples were tested in duplicate using Mindray BC-7500 hematology analyzer and its accompanying reagents. Within-subject biological variation (CVI) and between-subject biological variation (CVG) were estimated by the nested ANOVA method. The BV data in this study were compared with the BV data of the European Database of Biological Variation. APS, reference change value (RCV) and index of individuality (II) were calculated. Results: The CVI for 15 parameters ranged from 0.49% to 86.46%, and the CVI data for red cell distribution width (RDW)-CV, RDW-SD, reticulocyte (RET) percentage, RET count, reticulocyte hemoglobin content (RHE), medium fluorescence reticulocyte (MFR) and high fluorescence reticulocyte (HFR) were significantly higher in females than in males (all P<0.05). The CVG ranged from 1.27% to 100.79%, and the CVG data for HFR were significantly different between genders (P<0.05). The CVI data for red blood cell (RBC), hemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and RHE in this study were lower than those recommended by the European database. The derived indicators of most parameters were influenced by gender. The II values for all parameters were<1.4, where the II values of MCHC and HFR were between 0.6 and 1.4; the II values for the remaining 13 parameters were<0.6. Conclusions: A BV study protocol for erythrocyte parameters is designed. When the reference intervals differ between genders, BV data should be calculated separately and the lower BV data are recommended for calculating APS; the RCV should be set separately for each gender.

Museums in Action: How Museums are redefining their Role in European Projects

An innovative and detailed analysis of the role of museums in European Union-funded projects is presented in this article, based on a thorough search of the European CORDIS database. The study explores how museums have transformed from being passive custodians of cultural heritage to becoming dynamic and multifunctional actors in European research and innovation. Through a systematic analysis of European projects funded in the 2007-2022 period, the article highlights the growing participation of museums in various EU programs, the varied roles they assume-from beneficiary partners to associate collaborators-and their impact in key areas such as education, research, digitization and technological innovation. This research provides both quantitative and qualitative insights into museums' involvement in shaping European cultural identity and policy development. The paper is of particular interest to policy makers, museum professionals and cultural heritage researchers, offering a unique perspective on the evolving role of museums in the European context and future opportunities for collaboration and funding.

Inflammatory biomarker analysis confirms reduced disease severity in heterozygous patients with familial Mediterranean fever

IntroductionFamilial Mediterranean fever (FMF) is a genetic disease leading to recurrent episodes of inflammation. Two pathogenic variants are required for classical disease, but the disease can occur in heterozygous patients....

Unpaid overtime and non-standard employment among young people in Europe: do national context and institutions matter?

ABSTRACT This article presents a multilevel analysis of unpaid overtime among young people (aged 15–34) across EU-28 member states. It finds that non-standard employment and the specific characteristics and institutions of Europe’s labour markets are related to unpaid overtime. Use has been made of the European Union Labour Force Survey database for 2019. The econometric analysis shows that a national level and a greater scope of collective bargaining agreements, a higher rate of involuntary part-time employment and lower levels of unemployment expenditure increase the probability of unpaid overtime among young people. Furthermore, our results reveal that how flexibility is boosted in European countries drives unpaid overtime. Temporary employment, working from home and a higher number of hours worked are positively related to unpaid overtime, while part-time employment and temporary work agencies are negatively related. Finally, the older and higher educated young workers have a greater propensity towards unpaid overtime, while there is a negative effect of shift work and no significant one in terms of gender and the degree of protection against dismissal. Policy implications for the implementation of flexibility policies and working time regulations are also discussed.

Machine Learning techniques for predicting inpatient probability and LOS from EU Injury Database

Abstract Background Unlike statistical inference Machine Learning (ML) makes repeatable predictions without prior assumptions about the underlying relationships among variables. The Full Data Set (FDS) of the EU-IDB (European Injury DataBase) consent to explore risk of hospitalization due to injuries using many predictors. The Length Of Stay of patients in hospital (LOS) is a relevant proxy of complexity of treatment and resources consumption. Methods The IDB-FDS provides more than 3.800.000 ED records, in years 2008-19 for 19 Countries. LASSO (Least Absolute Shrinkage and Selection Operator) cross-validated linearized regression technique (linear for LOS) was used for variable selection and parameter regularization. Inpatients are those admitted or transferred to hospital. Days of hospitalization were used for LOS. A cross-validated Generalized Linear Model was performed on 5 folds randomly sampled assigning 80% of records to training and 20% to testing samples. Results The strongest predictors of hospital admission risk, selected by the model were in order of importance: EUROCOST-39 diagnoses categories, Age Group, Intent, Mechanism Of Injury, Activity When Injured, Transport Injury Event, Sex Of Patient, Place Of Occurrence. EUROCOST-39 represents 61,9% of explained variability and age group 19,4%. The strongest predictors of LOS were substantially the same: EUROCOST-39 86,2% of explained variability and age group 8,6%. Conclusions The main part of variability in the ML model is explained by diagnoses reclassified according to a disability standardization method. For instance, in the maximum training sample risk of hospitalization ranges from odd 0,76% for hand/fingers sprain up to 154,02% for brain concussion. In the median sample LOS ranges from 0,45 days for strain of hand/fingers up to 11,65 for multi-trauma. A combination of more disabling injury, older age and mechanism of injury (i.e. threat to breathing) increases enormously the risk of hospitalization and LOS. Key messages • Machine Learning techniques applied on EU-IDB can provide identification of relevant risk factors of hospital admission from injuries for targeting preventive measures and organizing health care. • Artificial Intelligence consents to analyse big amount of data as dimension or analytical detail of information for identifying patterns and predictors of specific indicators for injuries or diseases.

Are prison settings included in national preparedness plans?

Abstract With the aim to explore the extent to which places of detention are considered in national preparedness planning in the WHO European Region, a desktop review was conducted and combined with responses to the Health in Prisons European Database (HIPED) survey from Member States referring to 2020. In both searches, the aim was to identify the existence of: 1) national pandemic preparedness plans written prior to the COVID-19 pandemic; and 2) national pandemic preparedness and response plans specific to the COVID-19 pandemic. Where prisons were included, all aspects of pandemic preparedness relating to prisons were extracted and collated as per the main domains of the WHO checklist for influenza pandemic preparedness plans. The desktop review found that 30 Member States had pandemic plans accessible online, but only seven included any mention of prisons. Responses to the HIPED survey suggested wide dissemination of a COVID-19 preparedness and/or response plan, but only six out of 36 Member States referred to prisons or the vulnerabilities of people living in places of detention. The combined findings suggest that prisons are rarely considered in national planning and that lessons from previous pandemics have not led to a change in recognizing that prisons are high-risk environments for pathogen transmission and that failing to consider them in national planning may lead to impacts that affect the wider community.

Differences and similarities in adolescents accessing emergency care for acute alcohol intoxication in three urban regions in Italy, Belgium, and The Netherlands

Abstract Background Excessive drinking among adolescents in Western Europe is prevalent, posing significant health risks and societal costs. Early initiation of alcohol use and binge drinking are associated with adult alcohol use disorders. Collecting comprehensive data on adolescent drinking patterns is crucial for developing effective prevention strategies. Methods To gain insight into the demographic and clinical characteristics of acute alcohol intoxication (AAI), we analysed emergency department access data of adolescents aged 14-17 years presenting with AAI symptoms from 2015-2023. Three urban regions were included: the Reinier de Graaf Gasthuis in Delft (The Netherlands), eight combined hospitals in Antwerp (Belgium) and the IRCCS San Martino Hospital in Genoa (Italy). Results A total of 1841 patients with symptoms of AAI were included. The mean age of patients in the Netherlands was statistically significant younger than in Italy and Belgium (15.7 compared to 15.9 and 16.0 years old, respectively). Moreover, the blood alcohol concentration was higher in the Netherlands and Belgium compared to Italy (2.0‰ compared to 1.95‰ and 1.8‰ respectively). The distribution of sex was nearly equal in the Netherlands, while statistically significant differences were observed with a higher proportion of males in Italy (54.8%) and Belgium (56.8%). Combined drug use was lower in Belgium with 10.0%, compared to 13.4% in The Netherlands and 14.7% in Italy. The most common reason for admission was ‘reduced consciousness’ in the total population (45.2%). Conclusions This is one of the first international studies which combines data on AAI in minors. In the future, efforts should be made to establish a common European database where records of AAI can be stored and analysed more efficiently for prevention purposes.

Assessing progress towards viral hepatitis B and C elimination in prisons in the European region

Abstract Background In 2016 the WHO launched the global health sector strategy for the elimination of viral hepatitis, alongside a dedicated monitoring&amp;evaluation (M&amp;E) framework to assess progress at national, regional and global levels. Despite being a priority setting for viral hepatitis elimination in Europe, prisons are rarely integrated into national monitoring efforts. Besides, prisons are particular contexts with a high viral hepatitis prevalence, where it is possible to utilize adequate micro-elimination strategies. Objectives We aimed to assess available metrics of viral hepatitis burden and coverage of prevention and control interventions in prison settings in Europe using routine sources of data. Methods We adapted the WHO M&amp;E framework for viral hepatitis elimination to the prison context. The resulting M&amp;E framework has 49 indicators of which 10 are defined as core. Data were sourced from available European prison surveillance systems at European level, namely: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and WHO Health in Prisons European Database (HIPED). Results In total 38 countries in the European region provided data to either data sources for 2020. For WHO-HIPED, among core indicators, 3 out of 10 could be calculated for HCV, and covered prevalence, HCV treatment availability and treatment outcome. Concerning HBV, 3 core indicators out of 10 could be calculated and covered prevalence, screening availability and treatment coverage in prison. With EMCDDA surveillance system we could calculate 4 HCV core indicators and 6 HBV core indicators. Lessons Availability of health data from prison settings is scarce, hampering the current capacity to monitor the progress in the viral hepatitis elimination within prisons contexts strategies and its relative contribution to global health goals achievement. A coordinated and standardised M&amp;E framework tailored to this specific setting is needed to foster data collection and systematic monitoring. Key messages • Micro-elimination strategies in prison context contribute to the global health goals achievement. • A coordinated and standardized M&amp;V framework, adapted to the prison context, is needed to foster data collection and monitoring of the viral hepatitis elimination strategy.

Daytime sleepiness and BMI exhibit gender and age differences in patients with central disorders of hypersomnolence.

The aim of the present study was to examine gender and age-specific effects on subjective daytime sleepiness (as measured by the Epworth Sleepiness Scale), body weight and eating behaviour in patients with central disorders of hypersomnolence. Based on the European Narcolepsy Network database, we compared 1035 patients with narcolepsy type I and 505 patients with other central disorders of hypersomnolence ("narcoleptic borderland"), including narcolepsy type II (N = 308) and idiopathic hypersomnia (N = 174), using logistic regression and general linear models. In the entire study population, the Epworth Sleepiness Scale was higher in women (N = 735, mean age = 30 years, mean Epworth Sleepiness Scale = 16.6 ± SD 3.9) than in men (N = 805, mean age = 32 years, mean Epworth Sleepiness Scale = 15.8 ± SD 4.4). In women with narcolepsy type I (N = 475), both Epworth Sleepiness Scale and body mass index increased in parallel with age. In women of the narcoleptic borderland (N = 260), the Epworth Sleepiness Scale markedly peaked in their early 30s, while body mass index only started to rise at that age. This rise in body mass index following the Epworth Sleepiness Scale peak cannot be explained by sleepiness-induced uncontrolled eating, as self-reported uncontrolled eating was negatively associated with the Epworth Sleepiness Scale in this group. We propose that the narcoleptic borderland harbours a unique cluster of women in their fertile years with an unexplored aetiology requiring further investigation towards tailored interventions.

Life Cycle Assessment of Extraction of Cellulose from Date Palm Biomass Using Natural Deep Eutectic Solvent (NaDES) via Microwave-Assisted Process

This study investigates the extraction of cellulose from Saudi Arabia-based date palm biomass utilizing a natural deep eutectic solvent (NaDES) integrated with a microwave-assisted process. A comprehensive life cycle assessment (LCA) was conducted in accordance with the ISO 14040 standard, encompassing four key stages: goal and scope definition, life cycle inventory analysis (LCI), life cycle impact assessment (LCIA) and interpretation. The analysis was confined to a gate-to-gate boundary in which two impact assessment methods, namely, ReCiPe Midpoint (H) 2016 and ILCD 2011 Midpoint, were used to assess the environmental impacts. The OpenLCA software (version 2.1.1) with the European Life Cycle Database 3.2 (ELCD 3.2) was used in the study. The ReCiPe method identified impact categories such as fossil resource scarcity, terrestrial ecotoxicity, freshwater ecotoxicity, water consumption, human carcinogenic toxicity and marine ecotoxicity. Conversely, the ILCD method identified freshwater ecotoxicity, water resource depletion, mineral, fossil and resource depletion, human toxicity and cancer effects. The results indicate that freshwater ecotoxicity presents the most substantial environmental impact across both assessment methods, surpassing other categories. Fossil resource scarcity, even though originally appearing impactful, demonstrated a relatively lower normalized score compared to freshwater ecotoxicity. Terrestrial ecotoxicity and water consumption were found to be negligible in their impact. Our findings provide important insights into sustainable material science and waste management, affording potential applications for biomass utilization in the Gulf region.

An innovative virtual sensing system for the vehicle-centric evaluation of emissions in the sustainable mobility transition

The objective of the research is to develop a new methodology capable of quantifying the emissions of internal combustion engine cars based not only on their technology but also on the dynamic behavior of the individual vehicle. No complicated exhaust measurement apparatus is needed. Employing just a telematic device equipped with GNSS and an inertial measurement unit, which can be easily attached to the vehicle, we demonstrate how individualised, accurate climate-altering emissions result by using figures extracted from European test databases, appropriately combined with real travelled distances, speeds, and driving style of each individual car. Pollutant emissions are, in this paper, also assessed though in a more general manner, and this represents a starting point for a future complete vehicle-centric emissions evaluation. This research demonstrates that circulating car emissions have to be assessed considering not only the Euro class and type of fuel, but also how the vehicle is driven. In this work a new, implementation oriented methodology is proposed in order to properly merge average European standard emission data with car-based telematic measures to highlight a new paradigm for regulating in a more conscious way the transition of the internal combustion engine car park towards a large scale, sustainable mobility ecosystem. This approach would place greater responsibility on the driver, without leaving anyone behind and without compelling the car scrapping solely based on the Euro class of its engine. The key contribution is ultimately to establish an easy to handle methodology enabling targeted and behavior-based traffic management policies. In fact, through a massive telematics recent dataset, the proposed virtual emission sensing system reveals that an extensive and inefficient use of eco-friendly vehicles produces much more greenhouse gas emissions than older vehicles driven in an environmentally responsible way.

The impact of social status and biological sex on diet at 10th century CE Hungarian sites from stable carbon and nitrogen isotope analyses

Stable isotope analysis is a valuable tool to determine the diet of past societies, as well as the relationship that diet has with biological sex and social class. In this research, we performed stable carbon and nitrogen isotope analyses on individuals from four 10th century CE Hungarian sites (Karos-Eperjesszög, Tiszanána, Bodroghalom, and Üllő-Ilona út) to determine if their diet was affected by their sex or social status. We also compared these sites with Kenézlő-Fazekaszug, our previously published, contemporaneous site. The study yielded some unexpected results, indicating that elevated social status was not a reliable indicator of high animal protein consumption among the residents of the upper class Karos site. Additionally, the results suggested that biological sex was only a factor in animal protein consumption at the putative middle-class sites, such as Tiszanána. With its comprehensive sampling, this research provides new stable isotopic data to the Central and Eastern European database, as well as exciting results about a crucial period in Hungarian history. It may also serve as the impetus for future stable isotope analyses of other 10th century Hungarian sites.

Frequency and Spatial Variability of European Record Floods

AbstractRegional envelope curves (RECs) have been used to characterize the flooding potential of regions worldwide. However, a comprehensive assessment for Europe is still missing. In this study we use the largest European flood database to quantify the magnitude of record floods, their dependence on catchment size, and the amount of available independent information, which is needed for estimatinig the REC's exceedance probability. We propose a framework for estimating REC parameters across large areas, consisting in partitioning the domain according to the observation density and estimating the REC slope through quantile regression. The results show that the REC parameters vary substantially across Europe. The envelope unit flood associated with a catchment area of 1,000 km2 varies between 0.1 and 6 m3s−1 km−2 and is highest in Mediterranean and Alpine areas and lowest in central‐eastern Europe. The slope of the envelope varies between 0 and −1 and is larger in Southern Europe than in Northern Europe. These differences are explained by steeper landscape in mountaineous regions and localized short duration storms producing large floods in small catchments in the Mediterranean, whose intensities are larger than in other parts of Europe. Based on the framework of probabilistic envelope curves we show that, despite the uneven observation density, the obtained RECs are associated with comparable exceedance probabilities.

Environmental impact of dietary patterns in 10 European countries; a cross-sectional analysis of nationally representative dietary surveys.

Changing dietary patterns is essential to reducing the substantial environment impact of agriculture and food production systems. We performed a cross-country comparison of dietary patterns and their associated environmental impact in Europe, including by sociodemographic factors. We analyzed pooled cross-sectional dietary records collected during 2010-18 from 10 European countries using the European Food Safety Authority (EFSA) Comprehensive European Food Database (16 508 adults; aged 18-79 years). Each food consumed was mapped to the corresponding environmental impact data using the SHARP Indicators Database, which provides greenhouse gas emission (GHGE) and land use (LU) values of approximately 900 foods. Total diet-associated environmental impact was calculated for each person and averaged across multiple days. Multivariable linear regression models were used to compare diet-associated GHGE and LU between population subgroups (gender, age, education and diet type) with country-level fixed effects. The mean dietary GHGE and LU per capita ranged from 4.0 kgCO2/day and 5.0 m2*year/day in Spain to 6.5 kgCO2eq/day and 8.2 m2*year/day in France. Diet-related GHGE and LU (per kg/food) were lower among females (2.6 kgCO2eq/day, B = -0.08, P < 0.01; 3.2 m2*year/day, B = -0.11, P < 0.01), older population aged 66-79 (2.6 kgCO2eq/day, B = -0.03, P < 0.01; 3.4 m2*year/day, B = -0.4, P < 0.01), people following vegetarian diets (1.7 kgCO2eq/day, B = -0.07, P < 0.01; 2.0 m2*year/day, B = -0.07, P < 0.01), and higher among individuals with secondary education (2.7 kgCO2eq/day, B = 0.05, P < 0.01; 3.6 m2*year/day, B = -0.05, P < 0.01). Environmental footprints vary substantially across countries, dietary patterns and between different sociodemographic groups in Europe. These findings are crucial for the development of country-specific food policies aimed at promoting environmentally sustainable diets.

Pooled analysis of the MANTICO2 and MONET randomized controlled trials comparing drug efficacy for early treatment of COVID-19 during Omicron waves

BackgroundThe clinical effectiveness of early therapies for mild-to-moderate COVID-19, comparing antivirals and monoclonal antibodies (mAbs) during the Omicron era, has not been conclusively assessed through a post-approval comparative trial. We present a pooled analysis of two randomized clinical trials conducted during Omicron waves. Methods The MANTICO2/MONET trial is a pooled analysis of two multicentric, independent, phase-4, three-arm, superiority, randomized, open-label trials. Nonhospitalized patients with early mild-to-moderate COVID-19 (≤5 days after symptoms’ onset) and at least one risk factor for disease progression were randomized 1:1:1 to receive 500mg of intravenous sotrovimab (SOT) or 600mg of intramuscular tixagevimab/cilgavimab (TGM/CGM) or oral 5-days course of nirmatrelvir/ritonavir (NMV/r) 300/100mg BID. Primary outcome was COVID-19-related hospitalization or death within 29 days after randomization. Fisher’s exact test for pooled data and incidence of failure was reported as overall and by arm with respective 95% CI.Pairwise comparisons across the arms were conducted using unadjusted exact logistic regression. An analysis by means of a doubly robust marginal model using augmented inverse probability weighting (AIPW) was also conducted to estimate the potential outcomes (Pom) in each treatment group and their difference by the average treatment effect (ATE). Analysis of symptom persistence within 30 days after randomization was performed using a 2-level hierarchical mixed-effects logistic model with a random intercept at the patient’s level. Point estimates and 95% confidence intervals were adjusted for age and sex and calculated using ANOVA-like methods for the mixedeffects logistic model. These trials are registred with the European Clinical Trials Database, EudraCT2021-002612-31 (MANTICO2) and EudraCT2021-004188-28 (MONET) and ClinicalTrials.gov, NCT05321394 (MANTICO2) Findings Between March 2022 and February 2023, 991 patients (SOT=332, TGM/CGM =327, NMV/r=332) were enrolled in 15 Italian centersThe overall mean age was 66 years; 482 participants (48.80%) were male and 856 vaccinated with at least a primary course ( 86%). Among the 8/991 hospitalizations observed, one resulted in death. The overall estimate of failure was 0.81% (95%CI; 0.35-1.58%). The odds ratio (OR) for the primary outcome in the NMV/r arm compared to the TGM/CGM and SOT arms was 8.41 (95% CI 1.21 to infinity; p=0.015) and 2.42 (95% CI 0.19 to infinity; p=0.499), respectively. No significant difference was observed between SOT and TGM/CGM (OR 0.32; 95% CI 0.032-1.83; p=0.174). Results were similar when we applied the marginal weighted model accounting for potential residual confounding bias. There was no evidence for a difference in the prevalence of symptoms between treatment groups, except for cough, which was higher in the SOT group compared to the other two groups at the 21-day follow-up (P=0.039) and a higher prevalence of nausea at the 7-day follow-up in the NMV/r group compared to the mAbs group (p=0.036). Interpretation NMV/r was superior to TGM/CGM in reducing hospital admission or death in clinical vulnerable patients with SARS-CoV-2 infection treated within 5 days of symptoms’ onset. No significant difference in symptom prevalence over time across the arms was found. Funding: The trials were funded by the Italian Agency of Drugs (AIFA) in 2021.