European System Research Articles

Soil pollution in the European Union – An outlook

Soil pollution in the European Union (EU) is poorly quantified, because of several years of reduced attention and limited funding on soil research and monitoring. Moreover, issues such as different monitoring methodologies within Member States (MS), and quantification methods focused on pseudototal rather than the available fraction of pollutants, has been limiting our understanding of risk under soil pollution. Despite that, thanks to efforts from the scientific community, it was possible to achieve some progress, which is by far insufficient for the problem at hand. In the anticipation of future policy demands and towards a common strategy for tackling soil pollution in the EU, it seemed relevant to describe the limited knowledge and main uncertainties. Such analysis should provide evidence for the development of efficient policies, as well as updating current ones to better tackle the interdisciplinary of soil. This perspective provides our view on current knowledge on soil pollution at EU scale, by compiling the most updated assessments made at EU scale, identifying soil pollution drivers, impacts on health and the environment, and evaluating current state of knowledge. Allowing us to infer about current level of uncertainties and knowledge gaps and identify solutions through future research and policies. Our suggestions are in line with an increasing investment on research and innovation, but also more frequent updates of current legislation already tackling pollution and welcoming the new proposal for a Soil Monitoring Law as an important driver for soil knowledge development and implementation of a European monitoring system.

Early archaeological evidence of wheat and cotton from medieval Ile-Ife, Nigeria

This study reports the earliest directly dated occurrence of archaeological wheat and cotton in the humid forests of West Africa. These are the first archaeobotanical results from the medieval urban center of Ile-Ife, southwestern Nigeria, best known for its famous artworks. Both wheat and cotton likely spread through trans-Saharan trade networks that laid the foundation for later European trade systems. Forty-eight (48) grains of free-threshing wheat (Triticum aestivum/durum) represent the largest assemblage of wheat recovered in sub-Saharan West Africa, which is surprising given that wheat cannot be cultivated locally. Larger quantities of cotton (Gossypium sp.) recovered from late 12th- to early 13th-century CE contexts suggest earlier and more widespread use than wheat. Cotton may have been cultivated and manufactured into cloth locally. The quick adoption of these exotic crops illustrates the active negotiation of prestige through culinary and adornment practices, as well as a high degree of agricultural experimentation.

The value of acr, european, korean and ATA ultrasound risk stratification systems combined with ras mutations for detecting thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules

The value of acr, european, korean and ATA ultrasound risk stratification systems combined with ras mutations for detecting thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules

Russia, Ukraine and the climate crisis: Transforming circuits of power

The paper addresses a history of the present, doing so in relation to UN Sustainable Development Goal #13, that of taking urgent action to combat climate change. It uses key concepts from the circuits of power framework (Clegg 1989; 2023) to do so; notably the idea of social and system integration, adapted from Lockwood (1964). The focus is on the impact of the Russian invasion of Ukraine on European system integration that is dependent on trade in fossils fuels. The paper begins by a backwards glance at how the Soviet Union disintegrated to become Putin’s Russia, via Gorbachev’s attempts at reforming the basis for social integration (Brown, 1997). It contrasts the social integration of Russia with that of the Western democracies. All of this discussion is preparatory to a consideration of Putin’s paradoxes in invading Ukraine and how the unanticipated consequences of this strategic choice point to an undermining of the basis of Putin’s power. The cost inflation and limiting of gas supplies to Europe by supply chain disruption that have been a consequence of Russia’s invasion of Ukraine provide a massive stimulus for the greening of the global economy’s energy sources, thus undermining the resource based power on which the Russian economy is founded.

Impact of different CO2 price paths on the development of the European electricity system

In energy system transformation studies, the assumption of linearly rising CO2 prices is common and based on the decreasing issued European allowances (EUA). The actual auction price for allowances is influenced by market dynamics, resulting in non-linear variations in CO2 prices due to the possibility of banking allowances. This study explores the impact of non-linear CO2 price trajectories on the European electricity market. Various scenarios, such as increasing prices with the market interest rate, early price peaks, collapse, or fluctuations, are examined until 2030. The study quantifies the effects on power plant investments, profitability, consumer costs, and government revenues. The findings reveal that early and high price signals lead to an earlier transition with 7 % more wind power plants but at 4 % higher costs. Conversely, lower initial prices delay power plant investments in wind power plants by 6 % and result in 21 % higher emissions. Compensation for climate impact costs can yield a positive cost-benefit analysis in scenarios with early and high price signals when emissions are avoided through mechanisms like the Market Stability Reserve (MSR).

The impact of the European Union emissions trading system on carbon dioxide emissions: a matrix completion analysis

Despite the negative externalities on the environment and human health, today’s economies still produce excessive carbon dioxide emissions. As a result, governments are trying to shift production and consumption to more sustainable models that reduce the environmental impact of carbon dioxide emissions. The European Union, in particular, has implemented an innovative policy to reduce carbon dioxide emissions by creating a market for emission rights, the emissions trading system. The objective of this paper is to perform a counterfactual analysis to measure the impact of the emissions trading system on the reduction of carbon dioxide emissions. For this purpose, a recently-developed statistical machine learning method called matrix completion with fixed effects estimation is used and compared to traditional econometric techniques. We apply matrix completion with fixed effects estimation to the prediction of missing counterfactual entries of a carbon dioxide emissions matrix whose elements (indexed row-wise by country and column-wise by year) represent emissions without the emissions trading system for country-year pairs. The results obtained, confirmed by robust diagnostic tests, show a significant effect of the emissions trading system on the reduction of carbon dioxide emissions: the majority of European Union countries included in our analysis reduced their total carbon dioxide emissions (associated with selected industries) by about 15.4% during the emissions trading system treatment period 2005–2020, compared to the total carbon dioxide emissions (associated with the same industries) that would have been achieved in the absence of the emissions trading system policy. Finally, several managerial/practical implications of the study are discussed, together with its possible extensions.

Les Identitaires’ Impact on French Foreign Policy During the 2015 Crisis of the European Asylum System

ABSTRACT In 2015, the Common European Asylum System and the Schengen regime were placed under unparalleled strain by the mass arrival of 1.2 million asylum seekers. This event was followed by the failure of the EU Commission to promote a common approach. Within this context, this in-depth investigation explores the impact of the far-right social movement Les Identitaires on French foreign policy in the mid-2010s. Since the Front National contains clear roots in far-right social movements, Les Identitaires’ impact is closely entangled with Marine Le Pen’s party. Whereas past research concluded that the far right failed to directly influence key decisions in foreign policy, this study suggests that the French far right’s indirect impact fostered President Hollande’s unwillingness to welcome the refugees and France’s inactivity at the EU level. Thus, France’s cooperation with Germany foundered to unprecedented levels following President Hollande’s U-turn, with significant repercussions on EU integration on migration policy.

The Court’s Correcting Mechanism: ‘General Measures’ as a Judicial Remedy to Address Legislative Inaction?

Abstract Citizens confronted with a domestic legislator remaining inactive in contravention of its human rights obligations may turn to the European Court of Human Rights (ECtHR or Court). Having already passed legal challenges at the ‘heads’ end of the European system of human rights, the question arises whether they can find redress at the ‘tail’. When the ECtHR establishes a violation due to a lack of regulatory framework, it may decide to indicate general measures in Article 46 and pilot judgments. Based on an analysis of case law, this paper elaborates on how the Court goes about its remedial practice in legislative inactivity cases. The observations relate to addressing the domestic legislator directly, and the frequency, legal status, content, and deadline of the measures. They can, at least in part, be explained by the Court’s adherence to the principle of subsidiarity. Still, many uncertainties concerning the Court’s practice remain.

Impact of multiple comorbidities on long-term mortality in older patients following transcatheter aortic valve replacement

BackgroundOlder candidates for transcatheter aortic valve replacement (TAVR) frequently present with both cardiac and noncardiac comorbidities. There are few risk scores that evaluate a wide range of comorbidities. MethodsPatients who underwent TAVR for severe aortic stenosis were retrospectively evaluated. A new prediction model (Cardiac and nonCardiac Comorbidities risk score: 3C score) was determined based on coefficient in the multivariate Cox regression analysis for two-year all-cause mortality. C-statistics were assessed to compare the predictive abilities of the 3C score, the Charlson Comorbidities Index (CCI) score, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, and the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score. ResultsThe present study included 226 patients (age, 86 ± 5 years; males, 38 %). The values of the CCI score, EuroSCORE II, and MELD-XI score were 2 (1–3), 3.36 (2.12–4.58), and 5.35 (3.05–8.55), respectively. Multivariate Cox regression analysis identified two cardiac (left ventricular ejection fraction [LVEF] <40 % [2 points]; pulmonary hypertension [1 point]) and three noncardiac comorbidities (hepatobiliary system impairment [3 points]; estimated glomerular filtration rate <30 ml/min/1.73 m2 [1 point]; cachexia [1 point]). The C-statistics of the 3C score, EuroSCORE II, MELD-XI score, and CCI score were 0.767 (0.666–0.867), 0.610 (0.491–0.729), 0.580 (0.465–0.696), and 0.476 (0.356–0.596), respectively (p < 0.001). ConclusionsAmong cardiac and noncardiac comorbidities, special attention should be given to hepatobiliary system impairment and reduced LVEF in older patients following TAVR. The 3C score may contribute to the risk stratification.

Techno-Economic Analysis of Electrofuel as a Shipping Fuel

Abstract In this study, we aim to evaluate the technical and economic requirements of electrofuel production through Fischer–Tropsch synthesis using green hydrogen and CO2. We find that a plant with a 1000-barrel/day capacity necessitates 60 tH2 and 424 tCO2 daily, achieving a 36% hydrogen-to-electrofuel conversion rate. The initial capital expenditure (CAPEX) is projected at 295 million USD, with an additional 139 million USD for electrolyzer replacement. The hydrogen production unit accounts for 61% of the CAPEX, followed by the direct air capture unit at 22%. The annual operating expense (OPEX) is estimated at 49.3 million USD, with hydrogen production and direct air capture constituting 58% and 25% of this expense, respectively, largely due to substantial electricity requirements. The synthesis and refining units comprise 17% of the OPEX. The levelized cost of electrofuel is calculated at 1881 USD/t, which is 2.5 times the cost of marine gas oil and 3.8 times that of very low sulfur fuel oil. However, electrofuels emission factor is found to be significantly lower, nearly 14 times less carbon-intensive than traditional fuels. We conclude that electrofuels cost competitiveness with fossil fuels depends on favorable conditions such as low electricity costs, low discount rates, and high carbon prices. While the European Union's emission trading system inclusion for maritime transport will lessen the cost disparity, it is unlikely to make electrofuels cost-competitive given the current carbon prices.

Habitat Suitability of European Land Systems for Terrestrial Vertebrates

ABSTRACTMotivationAccurate estimates of species distributions are crucial for biogeography, spatial conservation, and for assessing the impacts of human activities on species. However, existing approaches to estimate species distributions have typically neglected the influence of land use intensity, potentially overlooking the negative impacts of high‐intensity land uses on biodiversity. Here, we build a dataset documenting the habitat suitability of European land systems for terrestrial vertebrate species, based on a novel land system map of Europe that factors in land use intensity. Our database offers refined and up‐to‐date information on terrestrial vertebrate distributions in Europe by explicitly considering land use intensity.Main Types of Variables ContainedWe created a table defining the suitability of land use classes as habitats for each species. We then built Area of Habitat (AOH) maps for each species by filtering out unsuitable habitat from the latest available estimates of species ranges. AOH maps were then compared with occurrence records from the Global Biodiversity Information Facility (GBIF). Processed datasets and R scripts are publicly available online, facilitating the use of our approach to refine expert‐based distributions for other taxa, land system classifications and regions worldwide.Spatial Location and GrainThe AOH maps cover the spatial extent of the European Union (EU) with the United Kingdom, Norway, Switzerland, and the Western Balkans. The AOH maps are at a 1 km2 resolution.Time Period and GrainThe dataset uses information published during the last 10 years.Major Taxa and Level of MeasurementHabitat suitability was documented for 1155 terrestrial vertebrate species known to occur in Europe: 279 mammals, 520 birds, 251 reptiles and 104 amphibians.Software FormatWe provide the habitat suitability table in a comma‐separated values (csv) format. The AOH maps are available as raster files. R scripts are publicly accessible on GitHub.

Legal regulation of the asylum granting and ensuring of the refugees’ rights in the European Union

The article is devoted to the study of the legal regulation of the asylum granting and ensuring of the refugees’ rights in the European Union. Within the framework of the article, the legal basis of the Common European Asylum System functioning, the creation of which is laid down in the constituent treaties of the European Union, is investigated. In particular, it is determined that the purpose of such a common system is to establish unified standards for determining the criteria for admissibility of applications for asylum or international protection, a similar procedure for considering such applications and the grounds for refusing or suspending the status of a refugee or a person seeking temporary protection, as well as determining the state, responsible for providing asylum, uniform standards for ensuring the rights of refugees, as well as common principles of cooperation between the Member States and partner states that are not members of the Union. The key provisions of the Directive on qualification criteria, on the procedure for granting asylum and international protection, on the conditions of reception and rights of refugees, as well as the Dublin Regulation and the Eurodac Regulation were analyzed. The authors put an emphasis on the fact that because of the full-scale invasion and emergence of the war on the territory of Ukraine, significant changes were made to the process and procedures for granting refugee status and providing asylum within the framework of the legislation of the European Union. The latest Pact on Migration and Asylum was analyzed, especially regarding changes in ensuring border security, quick and effective procedures for considering and obtaining the status of a refugee or a person seeking international protection, solidarity and responsibility among countries that are obliged to provide asylum, as well as strengthening international cooperation in the field of migration. The authors express their support for those concerns regarding alleged violations that may occur after the entry into force of the Pact, in connection with the threat of violations of fundamental human rights. It was concluded that ensuring dignity and respect for human rights is a priority, considering that refugees are recognized as persons who have already suffered violations and were forced to leave their homes.

Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial

BackgroundUndifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction. This was a sensitivity analysis of a drug (tetracosactide; TCS10) targeting melanocortin receptors (MCRs) in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.MethodsSensitivity analysis was based on a randomized, two-arm, multicenter, double-blind, controlled trial. The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs-outputs in 100 consecutive cases (from August to September 2013 from Emilia Romagna region, Italy). Patients included an agent-based TCS10 group (10 mg, single intravenous bolus before surgery; n = 56) and control group (n = 44) and the association with cytokines, lactate, and bleeding-blood transfusion episodes with the prior-risk log-odds for mortality rate in time-to-event was analyzed.ResultsThirty-day mortality was significantly improved in the TCS10 group vs. control group (0 vs. 8 deaths, P < 0.0001). Baseline levels of interleukin (IL)-6, IL-10, and lactate were associated with bleeding episodes, independent of TCS10 treatment [odds ratio (OR) = 1.90, 95% confidence interval (CI) 1.39–2.79; OR = 1.53, 95%CI 1.17–2.12; and OR = 2.92, 95%CI 1.40–6.66, respectively], while baseline level of Fms-like tyrosine kinase 3 ligand (Flt3L) was associated with lower bleeding rates in TCS10-treated patients (OR = 0.31, 95%CI 0.11–0.90, P = 0.03). For every 8 TCS10-treated patients, 1 bleeding case was avoided. Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group (OR = 0.32, 95%CI 0.14–0.73, P = 0.01). For every 4 TCS10-treated patients, 1 transfusion case was avoided.ConclusionsSensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care. To introduce the technology readiness level in real-life critically ill patients, further large-scale studies are required.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials Database (EudraCT Number: 2007-006445-41).

Technological catch-up, nonmonotonicity, and convergence: Parametric evidence from the BRICS and European banking systems

IT-driven productivity growth offers banks an intriguing opportunity to differentiate their offerings in a monopolistic market, introduce attractive products, enhance customer service, streamline back-office processes, and ultimately achieve the twin goals of cost minimization and profit maximization. However, there has been no convincing explanation for the observed divergence in the IT-productivity literature, raising doubts about whether IT can significantly improve performance in contemporary banking markets. The article examines the role of IT-led productivity growth in governing the direction and magnitude of intra-industry and inter-country convergence by investigating the potential nonmonotonicity of IT in influencing frontier-based efficiency of the BRICS and European banking markets. Findings reveal U-shaped associations between IT and cost (profit) efficiency, suggesting that excessive investment in IT may explain the productivity conundrum for BRICS nations. IT capital is not a significant driver of cost efficiency for European nations. Nevertheless, R&D spending significantly influences frontier efficiency, reinforcing that European banks can achieve frontier-level performance by investing in innovative solutions. Inter-regional comparisons reveal that BRICS banks are converging with their European counterparts by leveraging IT solutions, while diminishing marginal benefits for the latter reinforces the presence of a catch-up effect. Intra-industry comparisons reveal that size, age, and R&D intensity drive technological catch-up and convergence.

Comparison of ultrasound findings of papillary thyroid carcinoma subtypes based on the 2022 WHO classification of thyroid neoplasms.

The present study aimed to analyze and compare sonographic features of papillary thyroid carcinoma (PTC) subtypes to determine whether ultrasound (US) may aid in differentiating particular subtypes. This retrospective study enrolled 133 patients diagnosed with 142 histopathologically proven PTCs as per the fifth edition of the World Health Organization classification of thyroid neoplasms between January 2013 and May 2023. US features based on the American College of Radiology and European Thyroid Imaging and Reporting Data Systems (TIRADS), and histopathological characteristics of nodules were assessed and compared. Histopathological analysis yielded 55 (38.7%) classic PTC, 32 (22.5%) invasive encapsulated follicular variant (IEFV) PTC, 20 (14.1%) oncocytic subtype, 14 (9.9%) non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 11 (7.8%) infiltrative follicular subtype, 7 (4.9%) tall cell subtype, 2 (1.4%) solid subtype, and 1 (0.7%) diffuse sclerosing subtype. The US findings indicating malignancy, such as taller-than-wide shape, irregular margins, echogenic foci, and higher TIRADS categories, were more frequently demonstrated in nodules with classic PTC and the tall cell subtype, in line with their histopathological features. Conversely, IEFV-PTC and NIFTP rarely exhibited these high-risk sonographic features. US appearance of the oncocytic subtype more frequently overlapped with IEFV-PTC, yet hypo/very hypoechoic nodules with larger nodular diameters and higher TIRADS scores may favor the diagnosis of this subtype. US features of certain subtypes may guide the differential diagnosis regarding shape, margin, echogenic foci, and TIRADS category of nodules; however, definitive subtyping is not yet possible using US images alone.

Co-creation in partnerships contributing to the sustainability of food systems: insights from 52 case studies in Europe

Institutions worldwide call for joint actions of multiple actors in partnerships to accelerate the transitions towards sustainable food systems and reach food security for everybody, allways. This requires insights into co-creating processes. Here, 52 European food system cases are analyzed. A methodology based on the game structure is used that permits standardizing data collection and extracting generic and cases-specific findings. Game building blocks correspond with key elements of co-creation processes, like defining mutually accepted objectives, engaging in types of activities, and efficient use of resources, boundary conditions, timings, and scales of operations. Results further indicate that different types of inclusive partnerships emerge, in which especially innovative private, including smallholders, and academic actors co-create value, all contributing to sustainability. The public and civil society actors emerge as important initiators, enablers, and organizers of scales of interaction, allowing generating snowball effects. Findings lead to an adapted concept for co-creating partnerships in food systems and recommendations for the European Partnership on sustainable food systems.

The role and accountability of the state as a news media owner in the contemporary media landscape

Drawing on critical capitalism theory and the social responsibility theory of media, this paper explores the role of the state as a news media owner in contemporary European media systems and the capitalist context. It focuses on accountability and the relationships between the state, state-owned media outlets, and the public. Academic research to date has predominantly examined public service media (PSM) and the dichotomy of private versus public media, thereby overlooking other models of state ownership. The lack of clear regulations on the state's accountability as a media owner outside PSM at the EU level, along with uncertainties in national regulatory frameworks (such as those seen in Slovenia, and the recent reinstatement of state ownership of media in Serbia) raise concerns about the potential for abuse of power. These issues are particularly relevant in the current context of illiberal and authoritarian tendencies within modern European capitalist societies.

Applying life cycle assessment to European high nature value farming systems: Environmental impacts and biodiversity

CONTEXTLife Cycle Assessment (LCA) remains a method of choice for assessing the environmental performance of agricultural systems. However, it is rarely applied to multifunctional extensive production systems, in which livestock use, apart from animal production, maintains a continuous disturbance that sustains the diversity of habitats and species. OBJECTIVEThis study aims to assess the environmental impact and biodiversity of extensive ruminant production on semi-natural grasslands (SNG), that is, High Nature Value (HNV) farming across Europe. We collected data from a total of 41 HNV farms in five countries (Finland, Estonia, Spain, Greece, and France) that produce beef, sheep, and goats, and that incorporate (to a varied degree) semi-natural and permanent pastures into production. METHODSWe used LCA to assess the potential environmental impact of HNV farms according to global warming potential (GWP100), fossil resource scarcity (FRS), water scarcity (WS) and land use (LU), by using the Solagro Carbon Calculator and OpenLCA software. We assessed biodiversity based on the expert scoring system of SALCA-BD. We compared impacts on per area and per product basis across the farms, and related them to the productivity. RESULTS AND CONCLUSIONSResults revealed a considerable variation in all environmental impacts among HNV farms, explained mostly by the type of ruminants, main product (meat or milk) and the production level. GWP100 per unit in beef product in France was almost twice as high as that in boreal and 3 times more than in Spain, while sheep systems in Greece varied 7-fold for meat. Sheep systems consistently had the highest GWP100, while goat systems used the most land, fossil fuel and water. Small ruminant production in Spain had both the highest land occupation and biodiversity values. Biodiversity was at its highest on farms utilising only SNG for production, which, however, related negatively to the farms' production output. Enteric fermentation accounted for 32% of overall emissions. SIGNIFICANCEThis study makes a novel contribution towards a better understanding of the environmental performance and production capacity of HNV farming systems that are often used as examples of multifunctional and sustainable ruminant-based production.

Development and pilot implementation of a novel protocol to assess capacity and readiness of health systems to adopt HPV detection-based cervical cancer screening in Europe

BackgroundCervical cancer remains a significant public health concern in Europe. Effective introduction and scaling up of human papillomavirus (HPV) detection-based cervical cancer screening (CCS) requires a systematic assessment of health systems capacity. However, there is no validated capacity assessment methodology for CCS programmes, especially in European contexts. Addressing this gap, our study introduces an innovative and adaptable protocol for evaluating the capacity of CCS programmes across varying European health system settings.MethodsOur research team developed a three-step capacity assessment framework, incorporating a health policy review checklist, a facility visit survey, and key informants’ interview guide followed by a strengths, weaknesses, opportunities and threats (SWOT) analysis. Piloting this comprehensive approach, we explored the CCS capacity in three countries: Estonia, Portugal and Romania. These countries were selected due to their contrasting healthcare structures and resources, providing a diverse overview of the European context.ResultsConducted over a period of 9 months, the capacity assessment covered multiple resources, 27 screening centres, 16 colposcopy and treatment centres and 15 key informant interviews. Our analysis highlighted both shared and country-specific challenges. A key common issue was ensuring high compliance to follow-up and management of screen-positive women. We identified considerable heterogeneity in resources and organization across the three countries, underscoring the need for tailored, rather than one-size-fits-all, solutions.ConclusionsOur study’s novelty lies in the successful development of this capacity assessment methodology implementable within a relatively short time frame, proving its feasibility for use in various contexts and countries. The resulting set of materials, adaptable to different cancer types, is a ready-to-use toolkit to improve cancer screening processes and outcomes. This research marks a significant stride towards comprehensive capacity assessment for CCS programmes in Europe. Future directions include deploying these tools in other countries and cancer types, thereby contributing to the global fight against cancer.

Evaluation of university and training standards in clinical perfusion, an European-wide survey.

Adequate theoretical and practical training of prospective clinical perfusionists is essential for maintaining clinical standards and ensuring patient safety during cardiac surgery procedures. Perfusion schools play a crucial role in establishing and maintaining higher education and training standards in clinical perfusion. The aim of this study is to obtain a comprehensive overview of European training standards in clinical perfusion in 2023. For this study, 53 perfusion schools in Europe were found and contacted, of which 30 (56.6%) responded, giving a sample size of n = 30, which were then included in the data analysis. The quantitative data of the survey are analysed using descriptive methods. The university and training standards in clinical perfusion in Europe vary in many respects. Starting with the entry criterion for studies (most frequently a required bachelor's degree 36.7% or 2nd most common an university entrance qualification 30%), the duration [from <12 months (13.3%) up to 36 months (13.3%)] and regarding the content of the teaching in clinical perfusion [<30 European Credit Transfer System (ECTS) (33.3%) and more than 180 ECTS (6.7%)]. The mean value for teaching in clinical perfusion content is 62.63 ECTS credits. The obtained results show important differences between countries and schools. As such, they form a valuable database for future discussions establishing a common European curriculum and training standards for perfusionists. For the generalizability of the results, further evaluations and larger samples are needed.