European Research Research Articles

A Delphi method approach to consensus - based translation of ‘Second Victim’ definition into German

Abstract Background Healthcare providers involved in unanticipated adverse patient events, unintentional healthcare errors, or patient injuries, and who become negatively impacted, are defined as ‘Second Victims’. The term Second Victim has gained substantial attention since its inception around 2000, yet lacks a standardized definition in the German context. This study addresses this gap by proposing a consensus-based translation of the term into German, aiming to foster understanding and facilitate research comparability. Methods A Delphi method approach was employed, engaging a panel of German-speaking, clinically and scientifically active Second Victim experts. The study was conducted using an online survey and commenced with the reference of the consensus- and evidence-based definition from the European Researchers’ Network Working on Second Victim (ERNST) published in 2022. Results Nine out of eleven invited experts participated in the study, contributing to a robust consensus-building process. Through three Delphi rounds, a consensus rate of 90% was attained for the translation of the international definition of a Second Victim. The resulting definition provides a comprehensive understanding of the term within the German context. Conclusions This Delphi study establishes a formal consensus among recognized experts, delivering a German-language, evidence-based definition of the term Second Victim. It serves as a crucial foundation for understanding and further researching the Second Victim phenomenon within the German-speaking healthcare community. Key messages • Consensus-based German translation of Second Victim enhances clarity in healthcare discourse. • Delphi method with German experts yields unified definition, promoting the coherence of patient safety research.

7.K. Round table: Approaching new public health frontiers: health literacy on a global level

Abstract This workshop will introduce the newly established WHO Collaborating Centre for Health Literacy (WHO CC HL) at TU Munich (TUM) in Germany and reflect on its goals and discuss the potential impact on European public health research, policy, and practice. With the launch of the WHO CC HL, TUM, WHO, and their collaborators, among which are the EUPHA Health Literacy Section, the International Health Literacy Association, and the Global Health Literacy Research Network, jointly aim at systematically developing health literacy as part of the WHO Sustainable Development and Well-being agenda. Health literacy represents the skills and attitudes to find, understand, appraise, and apply health information and services. Low health literacy is prevalent among all population and age groups and it is linked to worse health outcomes and health inequalities. Across the social gradient, people from low socioeconomic backgrounds are more likely to have low health literacy, which is why the European Commission and WHO both highlighted the need to invest in health literacy and, in particular, in school health literacy. Two emerging fields of study include data generation and interventions. Both of which are highly critical to monitoring change and providing evidence-based data on population and system-level health literacy within and between countries. However, there are no health literacy monitoring systems in place on a global scale nor is there robust evaluation data on school-based interventions. These shortcomings will be addressed through the WHO CC HL at TUM. In this round table workshop with five key health literacy and public health experts, the main goal is to present the WHO CC HL and its roadmap for the next four years and critically discuss how the work can influence European and Global public health: Dr. Faten Ben Abdelaziz, WHO; Anastasia Kyoylu, WHO/Europe; Dr Kristine Sorensen, Global Health Literacy Academy; Dr. Charlotte Marchandise, EUPHA; Prof. Dr. Orkan Okan, WHO Collaborating Centre for Health Literacy at Technical University of Munich. First, the chair will provide a short introduction to the WHO CC HL and will, together with the co-chair, facilitate the following panel discussion. The panel members will share a short 2-to-3-minute statement from their point of view in relation to planned activities of the WHO CC HL and highlight synergies to public health and health literacy development. Following the short statement, the chairs will prepare individual questions for each panellist and engage them in a discussion, which shortly after will open towards the audience for them to participate actively with the panellists in a 30-minutes discussion. Key messages • The round table workshop will introduce the newly established WHO CC HL, highlight its goals and impact on public health, and highlight collaboration opportunities. • The key experts will reflect about the WHO CC HL from their unique standpoints and reveal new perspectives on the way forward and how the work can benefit from ongoing public health initiatives. Speakers/Panelists Faten Ben Abdelaziz WHO, Geneva, Switzerland Anastasia Koylyu WHO, Copenhagen, Denmark Kristine Sørensen Global Health Literacy Academy, Risskov, Denmark Charlotte Marchandise EUPHA Orkan Okan Technical University of Munich, Munich, Germany

1.Q. Round table: Primary healthcare workforce crisis in Europe: global policy discourse and national implementation

Abstract Background Primary healthcare (PHC) has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. Recent WHO efforts have underscored the challenges in aligning the global PHC-oriented model with national health systems, highlighting the need for tailored approaches to fulfil diverse needs and contexts. Although significant progress has been made in advancing PHC, some gaps persist, particularly surrounding the integration of PHC and healthcare workforce debates and its prioritisation within national health agendas. These gaps lead to disconnects between PHC policy implementation and workforce considerations, exasperating the existing workforce crisis and obstructing effective service delivery. Objectives This workshop bridges the gap between PHC workforce policy and the ongoing healthcare workforce crisis, focusing on the European region and different types of health systems, socio-economic conditions, health labour markets and workforce compositions. We apply a health system and multi-level governance approach, arguing the need for greater attention to the implementation of global policy concepts and the diverse national and regional conditions, interests, and needs. The workshop begins with an overview of the PHC workforce situation, presenting novel results drawn from European comparative research and nine selected country case studies, followed by a panel discussion. The panellists provide in-depth evidence on various PHC workforce challenges and introduce illustrative examples of policy interventions and good-practice models coming from the case countries. Insights from the WHO Centre for Primary Health Care advance the debate by highlighting strategies and capacity for transformative PHC workforce policies, and the need for further investigation to critically align global and national approaches. The policy recommendations emerging from the panel will be critically reflected in a plenary discussion. The workshop will stimulate debate and improve knowledge exchange across countries, in particular in the WHO European region, as well as between research, policy and practice. It will strengthen both the PHC model and the healthcare workforce, and finally advance the building of resilient health systems. Key messages • Shift the primary healthcare debate from idealistic attributes to actionable implementation strategies, emphasising policy dynamics, political contexts, and diverse stakeholder interests. • Understand the various PHC-oriented models and their dynamics to determine the necessary quantity, competencies, and composition of HCWs and how they can be governed effectively to implement PHC.

Developing an Evidence-Based Primary Cancer Prevention Repository: insights from the PIECES project

Abstract Introduction Up to 40% of cancer cases could be avoided through effective primary prevention. However, cancer prevention tends to be fragmented across Europe, leading to geographical health differences. The dissemination and scale-up of effective primary cancer prevention interventions may address this. Although effective cancer prevention programs exist, finding them and their materials (especially regarding implementation) can be challenging. Repositories of evidence-based interventions provide insight into “what is out there” and can support dissemination within and across national borders. The PIECES project aims to develop and disseminate a repository of evidence-based primary cancer prevention programs adaptable to European contexts, with information to aid adaptation and implementation across countries. Methods The development of the PIECES repository has been informed by established repositories such as NCI’s Evidence-Based Cancer Control Programs. The project team developed a scoring sheet with a selection of items that could be included in the repository. All participants rated each item on relevance and applicability and provided comments and suggestions. A final framework, including a set of minimal requirement items, was agreed upon during three online consensus building meetings. Results We created a repository of evidence-based primary cancer prevention interventions targeting modifiable risk factors suitable for implementation in European healthcare settings. This 22-item repository provides information about an intervention’s logic model, implementation practices, and appraisal of published evidence of effectiveness. Conclusions This repository is innovative as it includes practical information and tools to facilitate implementation. While initially built to serve the PIECES project, the repository is designed to be a valuable tool for European policymakers, researchers, and implementers. Lessons learned from this process will inform future developers. Key messages • A comprehensive cancer prevention intervention repository avoids “reinventing the wheel” and allows for more efficient use of existing interventions by building upon the best available evidence. • The ongoing efforts of the PIECES project represent a significant contribution to reduce cancer prevention disparities and to facilitate the adoption of evidence-based interventions in Europe.

9.Y.1. Breaking down silos: Maximizing the impact of different EU funding schemes in health

Abstract The European Commission (EC) has established various funding schemes to support large health initiatives, such as EU4Health, Horizon Europe, and Digital Europe. These initiatives aim to support research and innovation in order to tackle different health challenges faced by EU member states, improve the health and well-being in European citizens and invest in resilient health systems Funding can come in different forms such as grants, subsidies, loans, prizes, and procurements and is managed by different Directorates General of the European Commission. The EC offers a wealth of financial resources, enabling health scientists to conduct cutting-edge research. However, to make the full potential of the EC funding programmes it is essential to achieve interactions and synergies. Thematic interactions consider the underlying policies of specific actions, striving to connect projects focused on related topics rather than letting them work in isolation, and transferring results from one to another. Implementation interactions involve the sequential or cumulative funding of one or multiple projects. Moreover, the abundance of financial sources poses the possibility for duplication of efforts and redundancy among the various programmes. In addition, complexities in rules and guidelines pose challenges for researchers to fund their long term research projects through cumulative funding. To avoid redundancy and tackle health issues efficiently, it is essential to ensure collaboration and coordination across funding schemes to effectively address both overarching and specific health topics. The aim of this roundtable is to share with the audience the different funding mechanisms provided by the European Commission, explore barriers and challenges to fostering collaborative innovation through the funding programs, and demonstrate best practices for optimizing synergies across different programs. This round table gathers panelists from a variety of backgrounds covering the European Commission, national health institutes, NGOs and SMEs. Key messages • The European Commission provides diverse and rich funding schemes supporting health research and innovation to tackle European health challenges. • Complexities in rules and guidelines pose challenges and combined efforts of both the European Commission and research communities can foster collaborative innovation across the funding schemes. Speakers/Panelists Jinane Ghattas Sciensano, Brussels, Belgium Agnès Mathieu-Mendes HaDEA, EC, Brussels, Belgium Anabela Isidro Agência de Investigação Clínica e Inovação Biomédica, Lisbon, Portugal

Knowledge and attitudes of the Italian population on sharing health data: a cross-sectional study

Abstract Background Healthcare digitization enhances data accessibility but faces data management and privacy challenges. The study sought to explore the Italian public’s understanding and views on storing and sharing health data for treatment and research purposes, as well as factors influencing their attitudes toward health data management and sharing. Methods A cross-sectional questionnaire assessed socio-demographic information, knowledge about health data sharing, and attitudes toward sharing data for treatment and scientific purposes. Descriptive analyses and multivariable logistic regressions were performed to examine the associations between sociodemographic factors and knowledge/attitudes about data storage and sharing. Results A total of 1,389 citizens participated. Most respondents (65.4%) thought that healthcare providers could access personal health data nationwide, while 94% expressed willingness to share personal health data nationwide. A high percentage of respondents (73%) fully agreed that storing and sharing personal health-related data could improve research and quality of care. Males and younger individuals (<41 years) were likelier to have higher data-sharing knowledge (adjusted Odds Ratio [adjOR] 1.50, 95% Confidence Interval (CI) 1.03 - 2.18, and adjOR 1.99, 95% CI 1.29 - 3.08 respectively). Lower educational-level respondents exhibited lower positive attitudes towards sharing health data for treatment and research purposes (adjOR 0.18, 95% CI 0.05-0.58 for high school, and adjOR 0.11, 95% CI 0.03-0.41 for middle school or lower, compared to those with a university degree). Conclusions The findings offer valuable perspectives for European policymakers, healthcare practitioners, and researchers who aim to enhance data handling, foster cooperation, and maximize the benefits of health data for tailored care and scientific progress. Key messages • Italian citizens show strong willingness to share health data nationwide for treatment and research, suggesting a favorable environment for collaborative healthcare initiatives. • Sociodemographic factors such as age and education level influence attitudes towards health data sharing, stressing interventions to ensure equitable access and participation in data-driven healthcare.

Core set of indicators to evaluate healthcare workers support programmes: a consensus-based approach

Abstract Objectives Considering the widespread implementation of support programmes for healthcare workers (HCWs), there is an urgent need to establish a standardised set of indicators for their ongoing assessment. This study seeks to develop a consensus framework for evaluating interventions aimed at supporting HCWs affected by patient safety incidents (PSIs) or other distressing situations, commonly referred to as second victims (SVs). Having a core set of indicators it is crucial for facilitating comparative analyses across different organisations and time periods. Methods A qualitative study was conducted from June 2023 to March 2024. The study involved a multidisciplinary group of members part of the European Researchers Network Working on Second Victims. The consensus-building process utilised insights from a scoping review (phase 0) and a nominal group technique (phase 1) to develop a questionnaire for Delphi Rounds (phase 2). Indicators were rated on a scale of 1-5, with consensus reached if over 70% of participants rated an indicator as both feasible and sensitive scoring above 4. A consensus conference was subsequently organised. Results From an initial pool of 91 indicators, 55 were rated online, with 35 progressing to the Delphi rounds. A total of two Delphi rounds were performed and achieved response rates exceeding 60% and 80% respectively, resulting in consensus on 11 indicators for evaluating SV’ support programmes. These indicators encompass various aspects such as awareness and activation of the programmes, organisational processes and structures, institutional training provisions and assessment of the impact of the programme in the SVs. Conclusions This study endeavors to provide guidance for future SVs’ programs namely in the critical areas of programme’s awareness and activation, structural and process enhancements, and programme’s impact on SVs. Moreover, these indicators are suitable for multiple healthcare contexts and levels of implementation. Key messages • The priorities for evaluation of second victim programmes’ include their impact on healthcare workers, awareness and activation, organisational processes and structures and institutional training. • Utilizing a multidisciplinary consensus approach, we defined a set of indicators that are adaptable to diverse contexts that provide care and varying levels of second victim support implementation.

5.X.2. Improving indoor air quality: a public health challenge

Abstract Indoor air quality (IAQ) may have a profound effect on a person’s physical and mental health and well-being. The Knowledge for Indoor Air Quality and Health (K-HEALTHinAIR) project (grant no 101057693) is an interdisciplinary European research project that brings together 15 partners across 8 countries to study the sources, determinants and health outcomes related to IAQ. We aim to increase knowledge and provide input for more accurate monitoring and interventions, promoting healthy indoor air quality across several public health settings. The main aim of this workshop is to engage the public health community in the relevance of IAQ as a public health concern. We will share the innovative and new methodologies applied in the K-HEALTHinAIR project to study IAQ and health and discuss opportunities as well as challenges in this field of research to support shared learning. This workshop highlights IAQ pollutant sources and determinants, seasonal variation in IAQ, older people’s IAQ and health, and presents the project’s open access platform that is developed to share knowledge. We will zoom in on the evidence available for the sources and determinants of exposure to indoor air pollutants. This activity, a systematic review, was fundamental to identify the gaps of knowledge and guide the preparation of data collection tools. It also depicts the main pollutants present in indoor settings and the respective sources and determinants of exposure. Then, one of the 9 public health scenarios studied in the project is presented. We will focus on the first results regarding (determinants of) IAQ variation in primary schools at several locations in Poland. Next, the pilot study in older people living in senior homes in the Netherlands presents first findings of IAQ and health data in this vulnerable population. Finally, the project will deliver an open-access platform aiming to be the one-stop-shop for IAQ Knowledge. The user-profiles identified are presented. At the end, the workshop participants will be up to date on the project’s activities, its relevance for public health and the open access platform via which all output will be shared. Participants will leave with increased understanding of public health research needed to further study IAQ and its impact on health and well-being. Key messages • Indoor air quality is a public health concern impacting health and well-being, especially in vulnerable populations such as children and older people. • The K-HEALTHinAIR project is a multidisciplinary research project in which innovative methodologies are applied to increase knowledge on indoor air quality and health.

How common is emergency department as a death place in Portugal and who is more likely to die there?

Abstract Background Most people would prefer to die at home but most die in hospitals or other healthcare settings. Some of the latter deaths may have taken place in Emergency Departments (EDs), as EDs are a major hospital gateway. However, EDs have not been consistently categorised as a place of death (PoD) across countries. Portugal is an exception. This study aimed to examine trends in deaths at EDs in Portugal from 2015 to 2021, identifying who is more likely to die at the ED. Methods We obtained national death certificate data on PoD for 2015 to 2021 from the the Portuguese General-Directorate for Health. We analysed the percentage of deaths taking place at the ED by sex, age group (0-17y, 18-49y, 50-69y, 70-79y, ≥80y), underlying cause of death (cancer, dementia, and other causes) and year of death. Results 804.971 people died in Portugal from 2015-2021 (50.1% male; 0.4% aged 0-17y, 58.0% aged ≥80y; 23.3% died from cancer, 5.6% from dementia, and 71.1% from other causes). Of these, 13.2% died at the ED. The percentage of ED deaths was higher in female (13.7% vs. 12.8% in male), in adults (13.3% vs. 9.0% in children), in those dying from dementia (15.7% compared to 9.6% in cancer and 14.3% in other causes). The percentage of ED deaths rose from 10.6% in 2015 to 14.3% in 2021, increasing steadily over time (average 0.6 percentual points per year, representing 1069 additional deaths per year). Conclusions One in every ten deaths in Portugal happens at ED and this is increasing. Patients with non-cancer conditions are more likely to die at the ED, in particular those dying from dementia. To understand if this reality compares with other countries, we are developing a pioneering international classification of place of death which includes the ED. Funding: European Research Council (agreement nr. 948609). Key messages • Emergency department (ED) is a significant PoD in Portugal and has increased from 10.6% to 14.3% (2015-2021). Non-cancer patients, especially those with dementia, more likely to die at ED. • This study highlights the need for an international place of death classification to compare emergency department death trends across countries.

Data Analytics to Support Policy Making for Noncommunicable Diseases: Scoping Review.

There is an emerging need for evidence-based approaches harnessing large amounts of health care data and novel technologies (such as artificial intelligence) to optimize public health policy making. The aim of this review was to explore the data analytics tools designed specifically for policy making in noncommunicable diseases (NCDs) and their implementation. A scoping review was conducted after searching the PubMed and IEEE databases for articles published in the last 10 years. Nine articles that presented 7 data analytics tools designed to inform policy making for NCDs were reviewed. The tools incorporated descriptive and predictive analytics. Some tools were designed to include recommendations for decision support, but no pilot studies applying prescriptive analytics have been published. The tools were piloted with various conditions, with cancer being the least studied condition. Implementation of the tools included use cases, pilots, or evaluation workshops that involved policy makers. However, our findings demonstrate very limited real-world use of analytics by policy makers, which is in line with previous studies. Despite the availability of tools designed for different purposes and conditions, data analytics is not widely used to support policy making for NCDs. However, the review demonstrates the value and potential use of data analytics to support policy making. Based on the findings, we make suggestions for researchers developing digital tools to support public health policy making. The findings will also serve as input for the European Union-funded research project ONCODIR developing a policy analytics dashboard for the prevention of colorectal cancer as part of an integrated platform.

The potential of virtual reality meetings in international research projects for greenhouse gas emission mitigation

PurposeEuropean Union (EU) research projects generally involve international teams based in different countries. This means that researchers need to travel internationally to participate for in-person meetings, which are crucial for facilitating collaboration among research teams and provide a platform for teams to share their progress. Unfortunately, much of the international traveling in EU projects is done by air and therefore it has a significant carbon footprint. One potential solution that has gained attention in recent years is virtual reality (VR) and the metaverse. The aim of this work is to investigate to what degree VR meetings provide a viable alternative to physical meetings in the context of EU research projects and can thus contribute to climate change mitigation.Design/methodology/approachA three-stepped approach was chosen. First, the requirements for VR meetings were determined by collecting all relevant aspects of physical meetings through a questionnaire. Second, a set of VR meeting experiments were designed and executed. Third, carbon footprints for both physical traveling and VR meetings (lifecycle) were calculated.FindingsWe conclude that VR can be a powerful tool which can supplement international projects and mitigate carbon emissions associated with traveling for in-person meetings by an estimated 7–19 times.Originality/valueThis paper explores the suitability of the current generation of VR technology and quantitatively evaluates its effectiveness for greenhouse gas emissions mitigation in the context of a European research project.

Epigenetic aging and fecundability: the Norwegian Mother, Father and Child Cohort Study.

Is there an association between male or female epigenetic age acceleration (EAA) or deceleration (EAD) and fecundability? We do not find compelling evidence of an association between EAA or EAD and fecundability. Prior research has shown that female accelerated epigenetic aging is associated with unfavorable clinical fecundity outcomes and use of in vitro fertilization, and that epigenetic aging in sperm cells is associated with unfavorable sperm parameters. Studies of epigenetic aging and fecundability among individuals who conceive naturally are lacking. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based pregnancy cohort which recruited pregnant couples between 1999 and 2008. We used data from 1657 couples (women and men) with planned naturally conceived pregnancies and available blood samples. Methylation levels were measured in DNA from blood samples taken recruitment (at ∼18 gestational weeks) from pregnant women and their partners using the Illumina Methylation EPIC Array. To obtain a measure of EAA/EAD, we performed a linear regression of each of seven different established epigenetic biomarkers (DNAmAge by Horvath, DNAmAge by Hannum et al., PhenoAge by Levine et al., DunedinPoAm by Belsky et al., DunedinPACE by Belsky et al., DNAmTL by Lu et al., and GrimAge by Lu et al.) against chronological age. We fitted proportional probability regression models to obtain fecundability ratios (FRs) for each standard deviation increase in epigenetic aging, and obtained crude and adjusted (for body mass index, smoking, and education level) estimates. Results were evaluated at a false discovery rate (FDR) of 5%. We evaluated all models for non-linear associations using categories of epigenetic age where appropriate. Although the DunedinPACE clock in males demonstrated slightly increasing fecundability with increasing EAA (adjusted FR 1.05 per one standard deviation increase in EAA, 95% CI 1.00-1.10), this was not robust when evaluated at an FDR of 5%. We found evidence of non-linearity between biological aging and fecundability in two models in females and three models in males, but non-linear associations were weak and conflicting. As MoBa is a pregnancy cohort, our findings may not be generalizable to all couples attempting conception. Fecundability is a couple-level measure, and any impacts of epigenetic aging in each partner may be obscured by effects of the other partner. Our findings contrast with those of prior studies, which have indicated an association between EAA and unfavorable clinical fertility outcomes in populations using fertility treatments, possibly due to less important effects of epigenetic aging among couples who conceive naturally. More research is needed on the association between blood-based EAA and clinical fertility parameters in both sexes. The study was supported by the Research Council of Norway through its Medical Student Research Program funding scheme (project number 271555/F20), its Centres of Excellence funding scheme (project number 262700), and a grant from the Women's Health Program (320656). Co-funding was also received from the Strategic Research Council (SRC), FLUX consortium, decision numbers 345130 and 345131; the National Institute on Aging (R01AG075208); grants to the Max Planck-University of Helsinki Center from the Max Planck Society (decision number 5714240218), Jane and Aatos Erkko Foundation, Faculty of Social Sciences at the University of Helsinki, and Cities of Helsinki, Vantaa, and Espoo; and the European Research Council; and the European Research Council (ERC Synergy, BIOSFER, grant number 101071773, and the Horizon 2020 research and innovation program, grant number 947684). The authors declare no conflicts of interest. N/A.

Youth Education Efforts of the 1940s

My paper aims to present the dance culture of the 1940’s and explore its scientific approach to dance. According to results of my research, the “national-rescue activity” originating in Budapest looked for the promise of demonstrating “cultural-superiority” in youth-education. Movement-artists and newly formed amateur ensembles also played role in this. The initial dance-research followed the European research direction, considered the application of ethnological theories as the basis. When examining the interaction of city and countryside with a cultural-historical anthropological approach, my questions formulated in my writing: Did the village research and Scientific Institute-work in the 1940’s have an impact on the style of dance that also played a representative role, appearing as a result of the youth education efforts in Budapest? How does appear in the source-works that published the research-results of that time? My paper seeks the answers to these questions.

In vitro growth of secondary follicles from cryopreserved-thawed ovarian cortex.

Can secondary follicles be obtained from cultured cryopreserved-thawed human ovarian cortical tissue? We obtained high-quality secondary follicles from cultured cryopreserved-thawed human ovarian cortical tissue from cis female donors (cOVA), but not from trans masculine donors (tOVA) in the same culture conditions. The in vitro growth of oocytes present in unilaminar follicles into metaphase II stage (MII) oocytes has been previously achieved starting from freshly obtained ovarian cortical tissue from adult cis female donors. This involved a multi-step culture protocol and the first step included the transition from unilaminar follicles to multilayered secondary follicles. Given that the ovarian cortex (from both cis female and trans masculine donors) used for fertility preservation is cryopreserved, it is crucial to investigate the potential of unilaminar follicles from cryopreserved-thawed ovarian cortex to grow in culture. Cryopreserved-thawed ovarian cortical tissue from adult trans masculine donors (n = 3) and adult cis female donors (n = 3) was used for in vitro culture following the first culture step described in two published culture protocols (7-8 days and 21 days) and compared to freshly isolated ovarian cortex from trans masculine donors (n = 3) and to ovarian cortex prior to culture. Ovarian cortical tissue was obtained from adult trans masculine donors undergoing gender-affirming surgery while using testosterone, and from adult cis female donors undergoing oophorectomy for fertility preservation purposes before chemotherapy. The ovarian cortex was fixed either prior (day 0) or after the culture period. Follicular survival, growth, and morphology were assessed through histology and immunofluorescence. We quantified the different stages of follicular development (primordial, primary, secondary, and atretic) after culture and observed an increase in the percentage of secondary follicles as well as an increase in COLIV deposition in the stromal compartment regardless of the culture media used. The quality of the secondary follicles obtained from cOVA was comparable to those prior to culture. However, in the same culture conditions, the secondary follicles from tOVA (fresh and cryo) showed low-quality secondary follicles, containing oocytes with small diameter, granulosa cells that expressed abnormal levels of KRT19 and steroidogenic-marker STAR and lacked ACTA2+ theca cells, when compared to tOVA secondary follicles prior to culture. The number of different donors used was limited. Our study revealed that cryopreserved-thawed cOVA can be used to generate high-quality secondary follicles after culture and those can now be further tested to evaluate their potential to generate functional MII oocytes that could be used in the clinic. However, using the same culture protocol on tOVA (fresh and cryo) did not yield high-quality secondary follicles, suggesting that either the testosterone treatment affects follicular quality or adapted culture protocols are necessary to obtain high-quality secondary follicles from tOVA. Importantly, caution must be taken when using tOVA to optimize folliculogenesis in vitro. This research was funded by the European Research Council Consolidator Grant OVOGROWTH (ERC-CoG-2016-725722 to J.S.D.V. and S.M.C.D.S.L.), the Novo Nordisk Foundation (reNEW NNF21CC0073729 to H.C., F.W., J.S.D.V., S.M.C.D.S.L.), and China Scholarship Council (CSC 202008320362 and CSC 202008450034 to H.C. and F.W.), respectively. The authors have no conflicts of interest to declare. N/A.

Particle size analysis of iron hydroxide adipate tartrate (IHAT) in a food supplement: Interlaboratory testing of a dynamic light scattering method

Iron hydroxide adipate tartrate (IHAT) is a nano-scale material with a diameter of less than 5 nm intended for use as iron source in food supplements. It is the first engineered nanomaterial that was authorised as novel food in the European Union in 2022 (Commission Implementing Regulation (EU) 2022/1373) and subsequently added to the European Union list of novel foods. Official control laboratories of EU Member States are required to conduct compliance testing of novel foods, including IHAT, against approved specifications. In the case of IHAT, the authorised specifications include the constituent particle size, referred to in the implementing regulation as ‘primary particle size’. In this study, a method to determine the constituent particle size distribution of IHAT using the volume-based hydrodynamic diameter with dynamic light scattering is proposed and tested in an interlaboratory comparison study involving five experienced European food control and food research laboratories. Three test materials were examined, including an early batch of IHAT without the flow agent, a damaged material unintentionally exposed to water, and the final commercial product that included the flow agent. The results demonstrate that dynamic light scattering can reliably measure the particle size of particles in the low nanometre range if samples are prepared and measured following a robust, easy-to-reproduce, and standardised protocol. The results obtained for the commercial product met the compliance requirements specified in the annex of the Commission Implementing Regulation in all laboratories for the primary particle size distribution (Dv(10/50/90)). The method proposed in this study could represent an initial step towards the full validation of the method.

Priorities and challenges in social and healthcare policies for older people living in the Mediterranean basin: A Delphi panel study

BackgroundRecently, the countries in the Mediterranean basin (which share cultural ties) have been showing a common trend of declining social support for the elderly, with deficiencies in social care models for this demographic. Thus, this Delphi panel study analyzed the gaps in social and integrated care among the participating countries in a European research project.MethodsThis three-round Delphi panel study focused on the European countries of Greece and Spain and the non-European countries of Egypt, Lebanon, and Tunisia. In this project, experts were identified according to their level of expertise in the subject matter, their gender, and their membership in different social groups. Subsequently, they were asked to identify the current situation of social care, set future goals, and locate the gaps regarding the social and healthcare models for older people in the participating countries. The median score (Mdn) and interquartile range (IQR) were calculated to assess the degree of consensus on the different priorities.ResultsAmong the participating countries, there was a lack of state agreements to maintain social care models, a lack of coordination between public and private institutions to provide social care services, territorial inequalities in terms of access and coverage of rights, and job insecurity for professionals. The desired situation was to integrate social and healthcare services with a person-centered social care model, thus promoting autonomy and empowering users and families in participation and decision-making.ConclusionsThis Delphi study reveals significant disparities in social and healthcare policies for older adults across Mediterranean countries, highlighting shared challenges and specific national needs. European nations like Greece and Spain face fragmented systems, while non-European countries such as Lebanon, Egypt, and Tunisia lack specialized geriatric services and social security. All countries urgently need better professional training, social and economic empowerment of older adults, and integrated national strategies. These findings offer key insights for policymakers to develop equitable, sustainable solutions for aging populations.

Improving the Quality of Individual-Level Web Tracking: Challenges of Existing Approaches and Introduction of a New Content and Long-Tail Sensitive Academic Solution

This article evaluates the quality of data collection in individual-level desktop web tracking used in the social sciences and shows that the existing approaches face sampling issues, validity issues due to the lack of content-level data and their disregard for the variety of devices and long-tail consumption patterns as well as transparency and privacy issues. To overcome some of these problems, the article introduces a new academic web tracking solution, WebTrack, an open-source tracking tool maintained by a major European research institution, GESIS. The design logic, the interfaces, and the backend requirements for WebTrack are discussed, followed by a detailed examination of the strengths and weaknesses of the tool. Finally, using data from 1,185 participants, the article empirically illustrates how an improvement in data collection through WebTrack leads to innovative shifts in the use of tracking data. As WebTrack allows for collecting the content people are exposed to beyond the classical news platforms, it can greatly improve the detection of politics-related information consumption in tracking data through automated content analysis compared to traditional approaches that rely on the source-level analysis.

High-resolution observations of the ocean upper layer south of Cape St. Vincent, the western northern margin of the Gulf of Cádiz

Abstract. This article presents an Eulerian physical and biogeochemical dataset from the Iberian Margin Cape St. Vincent Ocean observatory (IbMa-CSV), a facility of the European Multidisciplinary Seafloor and water column Observatory European Research Infrastructure Consortium (EMSO-ERIC), located 10 nautical miles south of Cape St. Vincent (Portugal), the southwest tip of the Iberian Peninsula and western limit of the northern margin of the Gulf of Cádiz (GoC). The observatory was installed on the shelf break, and the data time series spans 4 months for most of the variables. The upper 150 m were sampled intensively with a wave-powered vertical profiler at an average rate of 4.5 profiles per hour recording at 2 Hz when ascending at an approximate velocity of 0.2 m s−1 and 10 Hz when descending at a variable velocity. The vertical resolution was always higher than 0.2 m. Measured channels were conductivity, temperature, pressure, chlorophyll a, dissolved O2 concentration, and turbidity. Derived channels are sea pressure, depth, salinity, speed of sound, specific conductivity, dissolved O2 saturation, density anomaly, spiciness, and Brunt–Väisälä frequency. The acquired dataset includes the flow velocity and direction along the water column, taken from an upward-looking 300 kHz acoustic Doppler current profiler (ADCP) recorded every hour for 3 m depth bins extending the same depth range of the vertical profiler. A standard quality-control scheme was applied to the dataset. The dataset is preserved for multiple use and is accessible in the Sea Open Scientific Data Publication (SEANOE) repository via the following address: https://doi.org/10.17882/94769 (Rautenbach et al., 2022).

Italian winegrowers’ Acceptance of result-based agri-environmental schemes

Abstract As the debate around the cost-effectiveness of agri-environmental schemes (AES) is growing at the European level, researchers and policymakers are exploring the potential of result-based AES. Result-based AES initiate payments only if pre-defined environmental outcomes are achieved, thus increasing risks for farmers. Using a contingent valuation method, we investigated Italian winegrowers’ acceptance and intensity of participation in a result-based AES targeted at pollinators’ conservation in vineyards. We focused on the role of farmers’ behavioural factors and risk attitudes in driving the acceptance. Results show that, among the 222 farmers who completed the survey, 71 per cent of participants are willing to participate in such a scheme. Non-participation is associated with a high perceived bureaucratic burden. Risk also plays a significant role, as the perceived risk of the scheme decreases the likelihood of enrolment, while risk-seeking farmers are more likely to participate. We found no evidence of risk affecting the intensity of participation. In contrast, while a treatment of a randomly assigned rare-species bonus did not affect the scheme's overall acceptance, it positively influenced intensity. Behavioural factors appear to be related to both acceptance and intensity. Considering this, we suggest strategies to encourage farmer participation in result-based AES.

Games in Mathematics Education: Trends and Methodological Approaches in the Context of the Congress of European Research in Mathematics Education (CERME) Review

This study aimed to examine the studies on digital games presented in The Congress of European Research in Mathematics Education (CERME) using a systematic analysis approach in terms of research method, data collection tool, and how they define digital games. Sixteen studies related to games were selected from the proceedings. The findings of the research revealed that the number of studies on games has increased in recent years, and the interest of the mathematics education community in this subject has gradually increased. It was seen that qualitative research approaches were used in most of these studies. As a data collection tool, a semi-structured or clinical interview form was mainly used. To reach more comprehensive results, it is necessary to give importance to quantitative research approaches and even to prefer the use of both approaches together. It was indicated that the tendency towards mathematical reasoning and puzzle games has continued predominantly in recent years. Although it was seen that the number of studies on digital games has increased in the last five years, only six studies in total were presented at the CERME. Moreover, three digital games developed by using the tools in the context of dynamic geometry environments were found. Another significant finding was that most of these studies did not define games. Only a few studies that defined the game considered the game as a tool used to acquire a mathematical concept or knowledge. Based on the findings, it can be argued that digital games are not among the interests of the mathematics education community. Finally, it was observed that mathematical theorems and approaches were central to the studies reviewed. Games were generally defined as tools within these studies. Therefore, future research should particularly consider fundamental game features such as game mechanics to create more integrated research environments with mathematics education.