European Scale Research Articles

Abstract 4124531: Digital Health Intervention to Enhance Optimization of Heart Failure Care: From Reciprocal Innovation using Human-Centered Design to Pilot Study

Introduction: Guideline-directed medical therapy (GDMT) for Heart Failure with reduced ejection fraction (HFrEF) reduces adverse events by 70%, but is underutilized. The Human Centered Design (HCD) methodology can be useful to build a strategy to optimize GDMT centered on patients’ demands and perspectives. We aimed to reciprocally innovate a telephone-based digital health intervention (DHI) from a Brazilian trial to an app co-developed for a US trial and iterate it again to the Brazilian context using HCD. We will evaluate the app’s usability and utility to facilitate HF GDMT optimization, considering barriers of the Brazilian public health system users, such as low literacy and socioeconomic status. Methods: Mixed methods study. Steps were carried out according to HCD method: (1) empathizing and identifying challenges, (2) suggesting solutions, (3) prototype development, (4) ranking features for feasibility and utility (5) engineering work and (6) prototype testing. In stages 1-3, semi-structured interviews were held with 10 HF patients and 2 health professionals. Steps 4 and 5 were done by the research team. In stage 6, we conducted a pilot study with 10 HFrEF patients, with at least one GDMT drug with an optimization gap. The primary outcome was the app’s usability assessed by an engagement score, and the app’s utility at 4 weeks. Secondary outcomes included change in self-care score using the European Self-Care Behavior Scale. After step 6, new interviews were carried out to capture the user experience and identify new iterations. Interviews were recorded and transcribed for content analysis. Results: The average engagement score was 80% (SD 16) and the app’s utility score was 82% (SD 8). The average self-care score increased by 32% (SD 25) at the end of the pilot. The main challenges were lack of knowledge about HF and self-care. Technical difficulties and lack of trust in the app to handle health data were mentioned. In the pilot, patients reported the app was easy to use and contributed to self-care and understanding of HF. Among the DHI components, teleconsultation was best evaluated, followed by the educational videos. The greatest challenge was connecting the blood pressure cuff and scale via Bluetooth. Conclusion: The app was well accepted and considered useful by patients. User contributions were fundamental to create tools that facilitate engagement and utility. The final product will be evaluated in a randomized, multicenter, clinical trial.

Renaissance Self-Fashioning after 44 Years: Hybridity, Conversos, Individuation, and littérature totale

Abstract While Stephen Greenblatt’s 1980 book, Renaissance self-fashioning: from More to Shakespeare, was methodologically innovative within the field of literary criticism, his work also grew from the roots of Jacob Burckhardt’s old cultural history, and his method of new historicism developed alongside the new cultural history. Although certain parts of Burckhardt’s arguments have been discarded, the work of Greenblatt and others has continued to build upon his foundation. Courtiership, anxiety, and the relationship between outward and interior identities, text and context, hybridity, and individuation are all useful concepts for constructing less monolithic understandings of early modern identities. With a European scale, this article traces early modern historiography and literary criticism from the nineteenth century to 2024 and introduces historical examples of identity formation from early modern England, France, Iberia, the Italian peninsula, and the Holy Roman Empire. The article reflects upon early modern examples of self-fashioning in the light of Burckhardt, the Annales, Greenblatt, and others who have contributed to our understanding of agency and identity up to the present day, arguing that these historians and literary scholars have worked together to answer questions that are fundamentally psychological in nature.

Sea Level Rise in Europe: Summary for Policymakers

Abstract. Sea level rise (SLR) is a global concern for low-lying coastal areas, including many European coasts. The European Knowledge Hub on Sea Level Rise (KH-SLR), a collaborative effort by the Joint Programming Initiatives for “Connecting Climate Knowledge for Europe” (JPI Climate) and for “Healthy and Productive Seas and Oceans” (JPI Oceans), has developed the 1st Assessment Report (SLRE1) to address the challenges posed by SLR in Europe. The report's target audience includes national and subnational bodies focused on research and policy advice for coastal management and climate adaptation, as well as European experts who contribute to shaping policy frameworks and collecting information at a pan-European scale. This report, preceded by a series of targeted surveys and workshops with researchers and stakeholders (e.g. coastal decision-makers), has synthesized the current scientific knowledge on SLR drivers, impacts, and policies at local, national, and European basin scales. It provides in-depth and basin-specific analyses on local sea level changes, compared with relevant global assessments of the Intergovernmental Panel on Climate Change (IPCC). In addition, it identified critical knowledge gaps needed to support the development of actionable information. The Summary for Policymakers (SPM) distils the key findings of the SLRE1, presenting information specific to the six European basins: Mediterranean Sea, Black Sea, North Sea, Baltic Sea, Atlantic, and Arctic. The SPM highlights basin-specific trends, vulnerabilities, and potential impacts, while also orienting future requirements.​​​​​​​

10.B. Scientific session: The European Health Data Space (EHDS): A sea of change for health data in Europe

Abstract A wealth of data is generated every day throughout our health systems which, if leveraged well, can underpin the digital solutions and policies that will transform health and care. However, the complexity and divergence of rules, structures and processes within and across European Member States make it difficult to fully harness that potential at European scale. The European Health Data Space will address this challenge by empowering Europeans to access and control their health data and by offering a harmonised and simplified framework for the reuse of health data, including for research, innovation, and policymaking purposes. During the workshop, we will present an overview of the European Health Data Space framework and its implementation phases and discuss its benefits for targeted stakeholders, including citizens, researchers and policymakers in public health. Objectives 1. Emphasise the importance of leveraging health data for research, innovation and policymaking; 2. Present the European Health Data Space regulation and what actions are being undertaken to prepare for its implementation; 3. Discuss how access to their health data can enable patients and individuals play an active role in their own health journey; 4. Discuss what will be the main benefits for policymakers and researchers in public health resulting from enhanced access to health data. Introduction by Chair for presenting the European Health Data Space and the setting the scene for the session. Short presentations by speakers: 1. Implementing the EHDS: lessons from the EHDS2 pilot - Marianne Benderra, Health Data Hub, presenting his experience on developing and piloting the EHDS infrastructure for secondary use of health data, highlighting key project developments; 2. How can the EHDS enable participatory healthcare? - Henrique Martins, ISCTE, xShare project on how the xShare “Yellow Button” will empower individuals with access to and control over their health data and may foster the development of knowledge and tools necessary for prevention and management of their health; 3. What will the EHDS enable for research and policymaking? - Nienke Schutte, Scienciano, bringing the perspective of a leading European public health institute how the benefits the EHDS framework can bring for policymaking, research and innovation. 15 min Q&A session, taking questions from the audience, possibly also through Slido. Possible guiding questions: How can stakeholders contribute more broadly to the development of the EHDS? What support is needed to ensure that data users and data holders are prepared when the EHDS framework becomes operational? Conclusions 2 min by Chair. Speakers/Panelists Marianne Benderra French Health Data Hub, Paris, France Henrique Manuel Martins ISCTE, Lisbon, Portugal Nienke Schutte Sciensano, Brussels, Belgium

Benefits of cross-border access to human genomes at scale for research and healthcare

Abstract Genomics data will soon be routinely generated and integrated into national healthcare systems. To maximise the potential of genomic medicine, data should be accessible for research where possible. This is the remit of ELIXIR, an intergovernmental organisation that brings together life science resources from across Europe. Innovative solutions are needed to ensure the validated research findings for disease or preventative medicine are then integrated into healthcare. To tackle this, the 1+MG initiative, a joint initiative of 25 EU countries, the UK, and Norway, aims to enable secure access to genomics and the corresponding clinical data across Europe for better research, personalised healthcare and health policy making. In the design and scale-up phase (B1MG project), recommendations and guidelines to advance towards the deployment of personalised medicine at a European scale have been produced, adopted by 1+MG and developed into a 1+MG framework. This includes guidance on data governance, standards, quality and infrastructure, recommendations on how to approach citizen engagement and a tool for countries to self-assess implementation into healthcare. The European Genomic Data Infrastructure (GDI) project supports the scale-up and sustainability phase of the 1+MG initiative, to deploy infrastructure across 24 countries to support the overall ambition. Recommendations are being used to promote governance and technical interoperability across European initiatives including the European Health Data Space (EHDS), and European Cancer Image Initiative (EUCAIM). The 1+MG will be established as a European Data Infrastructure Consortia in 2025 and will act as an Authorised Participant in the EHDS providing access to a permanent high-quality federated data collection of genomic and health data that will accelerate research, innovation and policymaking facilitating the deployment of genomic medicine across Europe.

The trajectory of self-care over a 12-month period in patients with heart failure, comparing those with consistently good and poor self-care

Abstract Background Self-care behaviour plays a pivotal role in enhancing the quality of life for patients with heart failure (HF) and reducing mortality and morbidity rates, but many patients struggle with suboptimal self-care behaviours. It is crucial to understand the factors influencing long-term self-care management. Purpose To assess the trajectory of self-care over a 12-month period and assess differences between patients who have constantly good self-care over a 12-month period compared to constantly poor self-care. Method This study use data from a randomised controlled intervention study, called the HF-Wii study. We included patients who had complete data on self-care during on baseline, 3, 6 and 12 months. Self-care was measured with the European Heart Failure Self-care Behaviour scale (EHFSBs). A threshold score of equal or higher than 70 was used to define self-care behaviour as good and a score lower than 70 as poor self-care. Based on literature, the following characteristics (collected from questionnaires and medical records at baseline) were considered in the analysis: age, sex, marital status, education, history of myocardial infarction, duration of HF, New York Heart Association (NYHA) functional class, LVEF, comorbidity. Other factors assessed were Health-related Quality of Life (HrQoL, Minnesota living with HF questionnaire), depressive symptoms (Hospital Anxiety and Depression scale), cognition (Montreal Cognitive Assessment), sleep (Minimal Insomnia Symptom Scale) and level of HF knowledge (Dutch HF knowledge scale). Logistic regression was performed with backwards elimination of the factors considered associated with the differences between patients who have constantly good self-care at baseline, 3, 6 and 12 months compared to constantly poor self-care. Results In total, 407 patients were included in this study. At baseline, the mean self-care was 65±21, with 41% of the patients (n=245) performing good self-care. In total, 126 patients had a constantly good self-care over 12 month (31%), 120 patients had a constantly bad self-care over 12 months (30%) and 161 (39%) fluctuated in their self-care (Figure). In the multivariate analysis, patients that had continuously good self-care over 12-months were of older age (68±10 vs. 64±12, odds ratio (OR) 1.061, P-value<0.001), had higher HF knowledge (score 13±2 vs. 12±2, OR 1.439, P-value<0.001) and had higher HrQoL (score 28±20 vs 36±22, OR 0.984, P-value=0.022). compared to patients with consistently poor self-care. The variance was explained by 20%. Conclusion Younger patients with HF tend to struggle with consistent self-care over a year, underscoring the necessity for tailored interventions for this group. Conversely, patients with greater HF knowledge and higher HrQoL maintained good self-care habits.

Association between self-care behaviour and multiple frailty domains in older patients with heart failure

Abstract Background/Introduction Heart failure (HF) self-care is important for the effective management of HF, reducing clinical events such as all-cause mortality and hospitalizations. HF self-care behaviours encompass comply with a regimen involving medication, diet, and exercise, symptom monitoring, and seeking assistance when symptoms occur. Frailty, prevalent among older patients with HF, involves physical, social, and cognitive domains. Identified factors influencing self-care behaviours in patients with HF include age, social support, and knowledge of the condition. Despite research on the association between self-care behaviours and frailty, there is a notable gap in studies that explore the relationship between self-care behaviour and multiple domains of frailty, particularly with adjustments for clinical characteristics. Purpose The aim of this study was to assess the association between self-care behaviour and multiple domains of frailty in older patients with HF. Methods The study included 182 patients with HF who were aged 65 years or older. Self-care behaviour was assessed 5 months after their discharge using the European Heart Failure Self-Care Behaviour Scale (EHFScBS), a self-report questionnaire. Frailty was assessed using the revised Japanese version of the Cardiovascular Health Study criteria (J-CHS) for physical frailty, and using Makizako’s five items for social frailty, and using Mini-Cog for cognitive decline. We used multiple regression analysis to assess the association between self-care score and multiple frailty domains and the number of frailty domains. The adjusted model was constructed based on age, gender, body mass index, New York Heart Association Classification, left ventricular ejection fraction, log-transformed B-type natriuretic peptide, estimated glomerular filtration rate and history of HF. In addition, we used multiple regression analysis to assess the association between the EHFScBS subitems score complying with regimen, asking for help, and adapting activities and multiple frailty domains and the number of frailty domains. Results According to the results of a multiple regression analysis, poor self-care behaviour was significantly associated with physical and social frailty and the number of frailty domains (all p < 0.05), even after adjusting for clinical characteristics. Poor complying with regimen was also significantly associated with physical and social frailty and the number of frailty domains (all p < 0.05). Poor asking for help was significantly associated with social frailty and the number of frailty domains (all p < 0.05). Conclusion The study indicates that poor self-care behaviour is linked to physical and social frailty, in addition to the cumulative number of frailty domains in older patients with HF, even when clinical characteristics are taken into consideration. This underscores the importance of factoring in the frailty status when guiding patients with HF in disease management.

Supporting inclusion in teaching and learning STEM subjects within the DISCO+ project

Aim. The objectives of DISCO+ (Dropout and Inclusion at SChOol) project are two- fold: to implement an inclusive approach and prevent early school leaving in STEM sub- jects. The participating partner institutions apply cooperative engineering to develop units in mathematics and science subjects that can be implemented in different European educational contexts to meet the project objectives. Within the project (WP2) 16 transna- tional groups of pre- and in- service teachers take part in an eTwinning digital training sessions on the notion of school inclusion in Europe, the implementation of the principle of equality between girls and boys, the development of the critical thinking in learning scientific disciplines. Small group discussions refine each participant’s understanding of the issues involved, and the work carried out makes it possible to go beyond the local character of the definitions and to reach a common and shared understanding of the intercultural nuances present in each country. These exchanges will help build links be- tween participants and create a network of European colleagues. The groups’ experience books will serve as a basis for posters, which will be presented in June 2024. These pres- entations can be filmed and contribute to a 5-hour MOOC, which will be developed at a later phase in the project. Methods. By adopting a methodology which includes collectively designing teach- ing-learning sequences in transnational context, the project applies transnational engi- neering. Each partner involved in the creation of one or more teaching-learning sequenc- es must question the conditions of transferability of its point of view, its analyses and its testimonies in different educational contexts. In other words, the intercultural component of sequences designed jointly by partners from different countries should be ensured by addressing socially relevant issues and enriching their treatment with a variety of cul- tural viewpoints. The design of sequences on a transnational scale from this intercultural perspective will also make it possible to deal with the language issue in subjects such as mathematics and science. This methodology intends to develop a common culture on key issues such as sustainable development, inclusion and gender equality and to contribute to the creation of a European citizenship. Results. The activities will result in several deliverables, which include a round ta- ble, dedicated to the notion of school inclusion on a European scale, a four-month long eTwinning digital training in 16 transnational groups (teacher trainees, practioners) dis- cussing and exchanging ideas on inclusion in European education systems, teaching Sci- ence subjects, equality of girls and boys and developing critical thinking. Group experi- ence notebooks will be published as the result of exchanges between students, and will be dissemminated through the realisation of a poster session allowing the mutualisation of the work of the different working (16 transnational) groups. During the implementa- tion of „cooperative engineering” around inclusion and STEM teaching approaches by deconstructing representations of these objects to identify European variables and in- variants, an „online serious game”, and an accompanying guide is to be developed. The production of at least 4 teaching units (one per transnational team), two of which will be in mathematics and two in earth sciences (at least one unit is taught in the mother tongue and another in a CLIL approach) will be filmed and analysed by each “cooperative en- gineering” group on the eTwinning platform. Several activities will be used to produce resources, which in turn will be scripted into am5-hour MOOC training module to be made available on the platform already developed as part of the DICO+ project. Conclusions. In conclusion, the structure of the DISCO+ project will enable it to ad- dress the entire educational community in each country, including pupils, teachers, fu- ture teachers, trainers of trainers and inspectors.

THE HERITAGE OF VLADIGEROV – THE MUSEUM UP CLOSE

The preservation, scientific processing and presentation of the rich material and musical heritage of the classic Bulgarian composer Pancho Vladigerov are the main goals of the Pancho Vladigerov House Museum – Sofia. In fulfillment of Vladigerov's will and thanks to the donative gesture of his wife, Mrs. Elka Vladigerova, today the composer’s former home houses his archive, painstakingly collected by him throughout his life. The diversity and uniqueness of the collections in the museum's holdings are a prerequisite for the development of thematic documentary exhibitions, educational programs, and multi-genre concerts, as well as many accompanying events that attract young audiences and introduce them to the composer's personality and the recognition he received as a leading figure in Bulgarian musical culture, as well as on a European and global scale. The team’s work is focused on turning the house that has preserved the unique atmosphere of Vladigerov's home in the capital's Lozenets district at 10 Yakubitsa Street into an attractive cultural center.

A measurement scale for material deprivation: A model‐based approach

The prevailing practice of defining classes of material deprivation based on the raw sum of a relatively small number of binary items has obvious advantages in terms of communication and ease of use. Do two people with the same raw score always have the same level of deprivation? This paper examines the methodological foundations of the raw score, comparing classical test theory with model‐based test theory such as Rasch measurement and item response theories. After discussing the merits and limitations of the different approaches, the paper legitimizes the raw score when the assumptions of the Rasch model are met. Based on the analytical procedure of the Rasch model and using the pre‐Covid data from the Survey on Income and Living Conditions, the paper also suggests how to develop a European scale for measuring material deprivation that ensures comparability across European countries.

Arthroscopic treatment for femoroacetabular impingement yields favourable patient-reported outcomes and method survivorship at 10-year follow-up.

To compare the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) preoperatively and at minimum 10-year follow-up using patient-reported outcome measures (PROMs). A total of 128 patients with FAIS were prospectively included. The patients underwent arthroscopic surgery for FAIS between 2011 and 2013 and had a minimum of 10-year follow-up. The International Hip Outcome Tool short version (iHOT-12) was the primary outcome. Secondary outcomes were the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the European Quality visual analogue scale (EQ VAS), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analogue Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. The Wilcoxon signed rank test was used to compare pre- and postoperative PROMs. There was a significant improvement (p < 0.001) of iHOT-12, HAGOS subscales, EQ-5D, EQ VAS and VAS for overall hip function. A total of 83% of the patients were satisfied with their surgery. The survivorship of hip arthroscopy, defined as nonconversion to total hip arthroplasty (THA), at the end of the follow-up period was 77%. Patients undergoing arthroscopic treatment for FAIS reported statistically significant and clinically relevant improved outcomes at 10-year follow-up. Case series, level IV.

Mapping and assessment of ecological vulnerability to wildfires in Europe

BackgroundWildfires play a significant and complex role in ecosystems, influencing various aspects of their functioning and structure. These natural disturbances can positively and negatively impact ecosystems, shaping landscapes, nutrient cycles, biodiversity, and ecological processes. This study focuses on assessing and integrating the different factors that affect the ecological vulnerability to wildfires at the European scale. Our methodology follows three steps. Firstly, ecological values based on biological distinctiveness and conservation status were estimated to understand pre-fire conditions better. Secondly, we obtain vegetation’s coping capacity (or resistance) to the impacts of fire, considering the functional traits of plants and fire characteristics through a fire extreme scenario. Finally, post-fire recovery time was calculated by considering the species-specific recovery time, recovery starting time, growth recovery rate, and the environmental constraints affecting the optimal vegetation response. These three variables were combined using a dynamic model that assumed the change of value due to wildfires integrated throughout the recovery time.ResultsOur results indicate that the tundra biome emerges as the most ecologically vulnerable to fire, primarily due to its high ecological values and long recovery time, which outweigh its moderate coping capacity. Following closely, the temperate conifer forests also exhibit high vulnerability driven by their high recovery time, despite moderate ecological and coping capacity values. The boreal forests rank next, with moderate vulnerability due to their long recovery time and moderate coping capacity. The Mediterranean region, although having moderate ecological values and recovery time, shows a notable vulnerability influenced by lower coping capacity. The temperate broadleaf and mixed forests demonstrate relatively lower vulnerability owing to their balanced ecological values, moderate recovery time, and substantial coping capacity. Lastly, the temperate grasslands, savannas, and shrublands are the least vulnerable, benefiting from lower ecological values and the fastest recovery time, alongside moderate coping capacity, which collectively reduce their overall fire vulnerability.Furthermore, we found that coping capacity is the factor that most influenced ecological vulnerability to wildfires.ConclusionsThe study identifies key zones for European or national policies on fire prevention and post-wildfire regeneration. It offers insights into effective forest management and conservation policies, applicable to current conditions. Additionally, the methods can predict future ecological vulnerability to wildfires based on climatic and socio-economic trends.

A Platform of Serious Video Games Co-built for the General Interest

In a context where training takes place both in initial courses and in lifelong continuing education, the use of games offers a way of promoting effective and sustainable learning: by its very nature, this medium is an open work in which players can become involved and give meaning to their learning. Ikigai - Games for Citizens offers a unique ecosystem for creating serious, expert video games and offering them free of charge to people who want to learn while having fun, as well as producing a set of learning-related data that can be used for research and customizing training courses. By bringing together universities, Grandes Ecoles, research laboratories, associations, and institutions, Ikigai is a collaborative consortium of general interest, implementing the co-construction of videogame services between scientific experts, video game professionals and educational engineers. Together, they are producing a centralized platform of serious games and associated services that can be used by teachers at a moderate cost by pooling resources: the building blocks of each game can be reused in other games developed. The consortium is committed to general interest and popular education by making the games available free of charge to members and the general public. The decentralized infrastructure set up by Ikigai, which respects privacy by design, means that game usage data can now be collected on a national scale, but conceptually it could extend much further. The data collected in compliance with the RGPD will eventually be used to draw up enriched user profiles to offer personalized courses, teaching recommendations and progress monitoring as close as possible to the learner, using AI in particular. Ikigai is also heavily involved in the construction of new digital standards in education, which are needed to ensure the interoperability of data for lifelong monitoring of learners. But also, for the digital education ecosystem, to guarantee a sovereign, efficient, coherent, and sustainable cloud on a European scale.

Generating wildlife density data across Europe in the framework of the European Observatory of Wildlife (EOW)

Abstract The European Observatory of Wildlife EOW, as part of the ENETWILD project, represents a collaborative network that has been operating since 2021 to develop and implement standardized protocols to obtain harmonized data on distribution and density of target mammal species. In so doing, the EOW aims at contributing to improving the quality of data that are available for wildlife management and risk assessment on a European scale. This report describes the activities carried out during the 2023 EOW campaign, which was joined by a total of 30 organizations who committed to collect data in 44 sites across 22 different countries. We present data on the distribution and density of three species – wild boar (Sus scrofa), European roe deer (Capreolus capreolus), and red fox (Vulpes vulpes) – obtained by implementing a camera trapping protocol and by fitting the random encounter model (REM) for density estimation. Camera‐trap images were processed using the Agouti platform and some of its tools specifically designed for the management of camera trapping projects. This includes the use of photogrammetry to obtain parameters for the REM directly from the sequences of images. A total of 24 EOW sites were monitored in past years as well, providing multiannual density estimates and population trends and highlighting an improvement in the precision of the estimates, related to the improved study design and protocol implementation. We also describe the activities of the 2024 campaign, carried out as part of ENETWILD 2.0, where big efforts were made to expand the network, focusing on sites at risk of African Swine Fever, with wild boar/pig interactions and containing wetlands, as potential hubs for Avian Influenza. This effort resulted in the engagement of 40 participants monitoring 64 study sites (27 countries), including 28 study sites located either in infected areas or &lt; 100km from the ASF frontline, and 25 sites with wetland habitats. Furthermore, in at least 20 sites pig farming is practised either intensively, extensively or as backyard farming. Finally, synergies were established with other international initiatives related to wildlife monitoring and disease prevention, with the aim of sharing experiences and sustaining a transnational data collection and harmonization.

Richard Nicolas von Coudenhove-Kalergi’s Pan-Europe”: the relevance of a manifesto from a hundred years ago

This material evokes the main ideas of the „Pan-Europe” manifesto, launched in 1923 by Count Ruchard Nicolas von Coudenhove-Kalergi, in the context in which Europe was divided between Russian Bolshevism, Germany’s dissatisfaction with the Versailles order and new technologies which Western societies were beginning to enjoy. Through his project of pan-European unification, Kalergi aimed to protect from further humanitarian disasters. In order not to force integration processes, he spoke in favor of identifying an optimal relationship between national policies and integration policy at the European scale. Imagining the frontiers of Pan-Europe, his creed was: „Rather than a victorious war, some bad frontiers”. The Romanian Dniester, in Kalergi’s conception, fixed a hundred years ago the Eastern border of Pan-Europe as a space of freedom and democracy.

A Fuzzy PROMETHEE Method for Evaluating Strategies towards a Cross-Country Renewable Energy Cooperation: The Cases of Egypt and Morocco

Recognising the urgency of addressing climate change and the imperative to mitigate its effects, the European Union (EU) has embarked on a transformative journey to reshape its energy landscape, with a pronounced emphasis on harnessing renewable energy sources (RESs) and augmenting their contribution to electricity generation. To propel Europe towards sustainable development through its energy transition, EU member states are encouraged to foster collaborative efforts on a European scale, inviting neighbouring countries to participate in joint ventures aimed at leveraging RESs for electricity generation. Consequently, it becomes imperative to evaluate the potential depth of cooperation among these nations, assessing how such partnerships can align with Europe’s overarching objectives while fostering mutually beneficial conditions. This paper seeks to undertake a thorough analysis and evaluation of the potential impacts of such cooperation, both in advancing RES objectives and in promoting broader cooperation goals concerning the countries involved. The appropriate methodological framework has been developed, utilising and implementing the fuzzy PROMETHEE multicriteria decision analysis method, to address the problem’s multidimensional character, intending to implement an appropriate action plan and promote production from RESs. The methodology has been applied to assess alternative strategies in two case study countries, Morocco and Egypt, while important outcomes have emerged towards the successful implementation of cooperation mechanisms promoting RES.

Urban bryophyte floras of Spain: a meta-analysis

ABSTRACT Introduction Bryophytes constitute an important part of the unmanaged plant diversity of urban areas. They represent, directly and indirectly, an important food, shelter and microhabitat-engineering resource allowing the establishment of other organisms, thereby increasing the biodiversity of urban areas. However, their contribution to urban biodiversity is generally overlooked and poorly understood. Methods In this study, we compared pre-existing data from 23 Spanish urban bryophyte floras and used taxon accumulation curves and ordination analyses to reveal emergent patterns related to urban biodiversity in Spain. Key results The compilation of these 23 floras revealed 286 bryophytes represented in urban areas in peninsular Spain and the Balearic Islands, including 2.80% and 3.50% of taxa considered under some threat category at the European and Iberian scales, respectively. Taxon richness and diversity varied greatly across cities and were strongly affected by climatic characteristics and extension of the studied cities. Ordination analyses showed an alignment of the different floras with the geographical location of the cities. Eurosiberian (Atlantic) and eastern and southern cities showed a higher taxon richness compared with cities from central Spain, which showed taxon assemblies comprising the commonest and widespread taxa. We also found that taxon richness was influenced by methodological factors (i.e. sampling intensity and the time the study was done). Conclusions Our study results suggest a need for adequate sampling of habitat heterogeneity within the urban landscape and point to the contribution of bryological knowledge to our understanding of the biodiversity of urban areas.

Prospects for the Protection of the Stone Heritage of the Małopolska Vistula River Gorge

The aim of this research is to present the abiotic geological environment, morphology and the need to protect geoenvironment and the possibilities of using the geoheritage of mining districts of the region located between Zawichost and Puławy city, within the Geopark. The Geopark is the best example of scientific and educational presentation of Mesozoic and Cenozoic outcrops along the Vistula gorge. The Cretaceous sediments (Middle Albian to Maastrichtian) are especially significant, they are unique on the European scale, showing a record of the evolution of the sea basin - from the Middle Cretaceous transgression and its disappearance at the end of the Cretaceous. The landscape and geomorphological values ​​constituting the heritage of the region are extremely important. An additional circumstance conducive to the creation of the Geopark is the fact that in the area covered by the project, areas of geological heritage protection have been operating for many years and tourist traditions date back to the 18th century.

Health-related quality of life and self-care in heart failure patients under telecare-insights from the randomized, prospective, controlled AMULET trial.

The growing population of heart failure (HF) patients places a burden on the healthcare system. Patient-centered outcomes such as health-related quality of life (HRQoL) and self-care behaviors are key elements of modern HF management programs. Thus, optimized strategies to improve these outcomes are sought. To assess the effects of a new model of medical telecare on HRQoL and self-care in patients with HF (the AMULET study). The study was prospective, randomized, open-label, and controlled with two parallel groups: telecare and standard care. In the telecare group, HF nurses performed patient clinical assessments with telemedical support by a cardiologist and provided education focused on the prevention of HF exacerbation. In the standard care group, patients were followed according to standard practices in the existing healthcare system. At the baseline and at 12 months, HRQoL was assessed using the Short Form 36 (SF-36) questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLwHF). The level of self-care was assessed with the 12-item standardized European Heart Failure Self-care Behavior Scale (EHFScBS-12). In the overall study group, 79% of the subjects were male, the mean age was 67 ± 14 years, and 59% of the subjects were older than 65 years of age. The majority of the subjects (70%) had a left ventricular ejection fraction below 40%. After 12 months, statistically significant increases in physical component of the SF-36 (43.3 vs. 47.4 for telecare vs. 43.4 vs. 46.6 for standard care) and mental component of SF-36 (58.4 vs. 62 for telecare vs. 60.4 vs. 64.2 for standard care) were noted, with no intergroup differences. However, patients receiving telecare showed improvement in specific domains, such as physical functioning, role-physical, bodily pain, vitality, social functioning, role-emotional, and mental health. There was a significant decrease in MLwHF (29 vs. 35.0; lower is better) at follow-up for both groups. Telecare patients had a statistically significant decrease in EHFScBS-12 (lower is better) at 12 months. AMULET outpatient telecare, which is based on nurse-led non-invasive assessments supported by specialist teleconsultations, improved the HRQoL and self-care of HF patients after an episode of acute HF.

Mapping the soil C:N ratio at the European scale by combining multi-year Sentinel radar and optical data via cloud computing

Spatial information on the soil carbon-to-nitrogen (C:N) ratio is essential for sustainable soil use and management. The unprecedented availability of Sentinel optical and radar data on cloud computing platforms, such as the Google Earth Engine (GEE), has created new possibilities for developing soil prediction models from the local scale to the planetary scale. However, there is a paucity of literature on the effects of Sentinel sensor selection and integration and radar data utilization strategies on mapping the C:N ratio. In this study, we explored the use of multiyear Sentinel-1 radar and Sentinel-2 optical data obtained from the GEE platform combined with the digital soil mapping (DSM) technique to map the soil C:N ratio at the European scale. The performance of soil prediction models, which were constructed using two modeling techniques (random forest and support vector machine), derived under multiple scenarios based on optical, radar and commonly used auxiliary data (climatic and topographic variables) combined with the LUCAS 2018 soil dataset, was evaluated by a cross-validation technique. The results showed that the modeling performance varied with the selection and integration of Sentinel observations, as well as the configuration of the radar data. Models based on single polarization performed the worst across all scenarios related to Sentinel-1, with cross-polarization performing better than copolarization. Models that utilized Sentinel-1 data from ascending orbits outperformed those that utilized data from descending orbits. The application of Sentinel-1 backscatter information derived from different orbits and polarization modes resulted in improved prediction accuracy. Our study also demonstrated the potential of integrating multiyear Sentinel satellite data via the GEE to map the continental-scale C:N ratio. The model based on Sentinel-1 data outperformed the one built on Sentinel-2 data, whereas combining Sentinel-2 optical data with Sentinel-1 radar data led to more accurate predictions. The variable importance results indicated that optical data and backscattering information from Sentinel observations are the most important groups of variables for soil C:N ratio mapping compared to the other variable groups (terrain and climate data). The digital soil maps generated under the different scenarios exhibited detailed patterns with significant spatial variation, with similar overall trends but slightly different details.