Heart failure management programmes in Europe

Background The ESC guidelines recommend that an organised system of specialist heart failure (HF) care should be established to improve outcomes of HF patients. The aim of this study was therefore to identify the number and the content of HF management programmes in Europe. Method A two-phase descriptive study was conducted: an initial screening to identify the existence of HF management programmes; and a survey to describe the content in countries where at least 30% of the hospitals had a programme. Results Of the 43 European countries approached, 26 (60%) estimated the percentage of HF management programmes. Seven countries reported that they had such programmes in more than 30% of their hospitals. Of the 673 hospitals responding to the questionnaire, 426 (63%) had a HF management programme. Half of the programmes (n = 205) were located in an outpatient clinic. In the UK a combination of hospital and home-based programmes was common (75%). The most programmes included physical examination, telephone consultation, patient education, drug titration and diagnostic testing. Most (89%) programmes involved nurses and physicians. Multi-disciplinary teams were active in 56% of the HF programmes. The most prominent differences between the 7 countries were the degree of collaboration with home care and GP's, the role in palliative care and the funding. Conclusion Only a few European countries have a large number of organised programmes for HF care and follow up. To improve outcomes of HF patients throughout Europe more effort should be taken to increase the number of these programmes in all countries.

Transforming the eastern neighbourhood: the security implications of European Union Activity in Ukraine 2000-2006

This thesis examines the external activities of the European Union conducted in the wider Europe against the backdrop of eastern enlargement. It focuses on the technical aspects of EU diplomacy, using qualitative research methodology to study the programmes and initiatives launched since the year 2000 in the countries lying along the Union’s new border to the east. Drawing on evidence from Ukraine, it hypothesises that the EU is an agent of transformation in the eastern neighbourhood and that this transformation has important implications for the regional order in the post-Soviet space. The thesis constitutes an investigation into the transformational activities engaged by the EU in Ukraine conducted with an eye to their strategic implications. It documents and analyses three instances of EU intervention in Ukraine’s internal processes that relate to management of cross-border traffic in the Ukrainian-Russian borderland, restructuring of the country’s energy sector, and conduct of its contentious presidential election in 2004. It is argued that while these interventions have explicitly sought to advance the Union’s security with respect to certain twenty-first century transnational threats, they have at the same time served to confer important strategic advantages on the EU that include giving the bloc greater knowledge and control over developments in Ukraine and that contribute to the dismantling of infrastructural, institutional and other ties between Kiev and the other Soviet successor states, notably Russia. The effect of the European Union’s actions in the region, whether intended or not, has thus been to undermine any competing regional initiatives that cut across its own functions, and thereby to assert itself as the primary integration project in Europe. By showing how technical interventions in the politics, economics and administration of Ukraine can yield important geopolitical dividends, this thesis demonstrates that, in the context of EU external relations, high and low politics are interlinked.

The European Community and innovation policy : reorienting towards diffusion

This study aims to explore the position of diffusion oriented support mechanisms in European Community (EC) innovation policy. With the shift from the traditional linear model towards an integrative approach to innovation, the role of diffusion of technologies and knowledge, achieved greater weight. This shift in both the thinking of academic experts, and of national policy makers, induced EC policy makers to appeal for similar changes in Community innovation policy. From the mid-1980s, the Commission of the European Communities, the key actor in EC policy making, thought to move its innovation policy away from the traditional science push approach. This study shows that in the implementation of programmes for research, technology and innovation, the traditional linear model is still dominant. The core research and technological development programmes still operate from a science push concept of innovation, mainly due to their pre-competitive nature. The case of SPRINT illustrates that policy programmes with an integrated innovation perspective can be successful at Community level. However the programme operates in a relatively isolated position from overall research and technological development policy. The case of BRITE-EURAM illustrates the difficulties of collaborative research programmes, the bulk of EC support mechanisms, to move away from the traditional model. The study shows how conflicting policy objectives arising from the different policy networks that shape EC policy making, in combination with a lack of co-ordination in those policy domains, hinder the emergence of the integrated approach. Consequently EC diffusion policy, implemented from the perspective of the linear model, will have a sub-optimal impact on the competitiveness of European industries.

Change in third sector organisations: the impact of European Union funding in cross-national perspectives

This is a study of third sector organisations and organisational change resulting from European Union funding. While there is a growing body of research which shows how governmental funding can contribute to the organisational challenges that third sector organisations encounter, research on how European Union funding affects third sector organisations is limited. This thesis contributes towards closing this gap in knowledge by identifying a number of organisational changes which can be attributed to the use of European Union funding. A qualitative approach was taken to explore organisational change resulting from the use of URBAN II funding in nine third sector organisations which were studied in the context of the URBAN II programmes of Belfast, Berlin and Bristol. The conceptual framework for this study draws on organisation theory and resource dependence theory, together with concepts of co-production and multi-level governance. URBAN II funding was found to have affected organisational structures, processes, services, goals and participants, as well as the interactions of organisations with their external environment. In contrast to earlier research however, the findings from this study suggest that many of these organisational changes improved the capacity of third sector organisations to carry out their work. The cross-national comparison of the findings further showed that organisational impacts resulting from the use of URBAN II funding can vary significantly between different countries. Programme Managers were found to have played a critically important' role in enabling third sector organisations to obtain benefits from URBAN II funding. Many positive organisational changes arose from a close collaboration between Programme Managers and third sector organisations. Conversely, many negative organisational impacts were found to be due, not to the regulations associated with European funding, but primarily to the approach adopted by the Programme Managers and Local Development Partnerships towards engaging third sector organisations in programme delivery.

MINERVA – the Ministerial Network for Valorising Activities in Digitisation Towards an Agreed European Platform for Digitisation of Cultural and Scientific Heritage

MINERVA is a project funded by the European Commission IST Programme within the 5th Framework Programme. It created a network of EU Ministries and other agencies in charge of cultural policies and programmes, which is open to enlargement to new countries and new sectors of the civil society. The network discusses, correlates and harmonises the activities carried out in the field of digitisation of cultural and scientific heritage, aiming at creating a common European platform made up of agreed recommendations, guidelines, standards. The network acts also to foster collaboration between European Commission and Member States, to ensure awareness of European policies at national level, to exchange good practice, to coordinate national programmes in order to embed in national digitisation activities the technical results achieved by the network. Some main outcomes of the activities are presented.

The East-Central European new donors:mapping capacity building and remaining challenges

In the past decade, the East-Central European countries were provided significant external capacity building assistance to help their emergence as donors of foreign aid. This paper aims to map these capacity development programmes and identify where they have helped and what challenges remain for the new donors. The main conclusion is that although capacity building has been instrumental in building organisational structures, working procedures and training staff, deeper underlying problems such as low levels of financing, lacking political will, the need for visibility and low staff numbers continue to hinder the new international development policies. Copyright © 2013 John Wiley & Sons, Ltd.

Fiscal adjustment and economic growth in the European Union

The current world economic crisis induced countries to launch wide-scale spending programmes all over the world. Member states of the European Union have not been an exception to this trend. While deficit spending may increase the aggregate demand, it can also accelerate indebtedness and make the required spending cuts politically risky later on. However, deficit financing is not a new phenomenon in the EU; it has been widely practiced in the last couple of decades. As the crisis seems to come to an end, countries with huge deficits should adopt exit strategies now, thereby reducing deficit and debt and reintroducing fiscal discipline, a requirement laid down in the Stability and Growth Pact. Nevertheless, former adjustment processes can provide ample evidence for successful and politically viable fiscal consolidations. In certain cases, even economic activity started to accelerate as a response to the welldesigned adjustment measures. Based on the previous experiences of EU states, the aim of this paper is, therefore, to identify the conditions that may determine a fiscal consolidation to be successful in terms of a reduced debt ratio and a positive economic growth.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Distribution, occurrence and biotoxin composition of the main shellfish toxin producing microalgae within European waters: A comparison of methods of analysis.

Harmful algal blooms (HABs) are a natural global phenomena emerging in severity and extent. Incidents have many economic, ecological and human health impacts. Monitoring and providing early warning of toxic HABs are critical for protecting public health. Current monitoring programmes include measuring the number of toxic phytoplankton cells in the water and biotoxin levels in shellfish tissue. As these efforts are demanding and labour intensive, methods which improve the efficiency are essential. This study compares the utilisation of a multitoxin surface plasmon resonance (multitoxin SPR) biosensor with enzyme-linked immunosorbent assay (ELISA) and analytical methods such as high performance liquid chromatography with fluorescence detection (HPLC-FLD) and liquid chromatography–tandem mass spectrometry (LC–MS/MS) for toxic HAB monitoring efforts in Europe. Seawater samples (n = 256) from European waters, collected 2009–2011, were analysed for biotoxins: saxitoxin and analogues, okadaic acid and dinophysistoxins 1/2 (DTX1/DTX2) and domoic acid responsible for paralytic shellfish poisoning (PSP), diarrheic shellfish poisoning (DSP) and amnesic shellfish poisoning (ASP), respectively. Biotoxins were detected mainly in samples from Spain and Ireland. France and Norway appeared to have the lowest number of toxic samples. Both the multitoxin SPR biosensor and the RNA microarray were more sensitive at detecting toxic HABs than standard light microscopy phytoplankton monitoring. Correlations between each of the detection methods were performed with the overall agreement, based on statistical 2 × 2 comparison tables, between each testing platform ranging between 32% and 74% for all three toxin families illustrating that one individual testing method may not be an ideal solution. An efficient early warning monitoring system for the detection of toxic HABs could therefore be achieved by combining both the multitoxin SPR biosensor and RNA microarray.

Building a 'Repository of Science': the importance of integrating Biobanks within molecular pathology programmes

Repositories containing high quality human biospecimens linked with robust and relevant clinical and pathological information are required for the discovery and validation of biomarkers for disease diagnosis, progression and response to treatment. Current molecular based discovery projects using either low or high throughput technologies rely heavily on ready access to such sample collections. It is imperative that modern biobanks align with molecular diagnostic pathology practices not only to provide the type of samples needed for discovery projects but also to ensure requirements for ongoing sample collections and the future needs of researchers are adequately addressed. Biobanks within comprehensive molecular pathology programmes are perfectly positioned to offer more than just tumour derived biospecimens; for example, they have the ability to facilitate researchers gaining access to sample metadata such as digitised scans of tissue samples annotated prior to macrodissection for molecular diagnostics or pseudoanonymised clinical outcome data or research results retrieved from other users utilising the same or overlapping cohorts of samples. Furthermore, biobanks can work with molecular diagnostic laboratories to develop standardized methodologies for the acquisition and storage of samples required for new approaches to research such as ‘liquid biopsies’ which will ultimately feed into the test validations required in large prospective clinical studies in order to implement liquid biopsy approaches for routine clinical practice. We draw on our experience in Northern Ireland to discuss how this harmonised approach of biobanks working synergistically with molecular pathology programmes is key for the future success of precision medicine.

European student mobility and intercultural learning at a portuguese university

The purpose of this study is to understand, impact and evaluate the development of intercultural communicative competencies among European credit-seeking exchange students and other sojourners through purposeful intercultural pedagogy. This pedagogy encompasses intentional intercultural- educational approaches which aim to support and enhance sojourners’ intercultural learning throughout the study abroad cycle (pre-departure, in-country and reentry phases). To test and validate these pedagogies a 20-hour intervention was designed and implemented among two cohorts of 31 sojourners during the in-country phase of their sojourn in Portugal. The process to develop and validate the intercultural intervention was driven by a mixed-methods methodology which combined quantitative and qualitative data to triangulate, complement and expand research results from a pragmatic stance. The mixed methods research design adopted is multi-phased and encompasses a multi-case study and an evaluative component. The multi-case component is embodied by sojourner cohorts: (1) the primary case study involves 19 incoming students at the University of Aveiro (Portugal) as participants in the European exchange program Campus Europae; (2) the second case study comprises three incoming Erasmus students and nine highly skilled immigrants at the same university. All 31 sojourners attended two intermediate Portuguese as Foreign Language classrooms where the intervention was employed. Data collection was extensive and involved collecting, analyzing and mixing quantitative and qualitative strands across four research phases. These phases refer to the: (1) development, (2) implementation and (3) evaluation of the intervention, as well as to (4) a stakeholder analysis of the external value of the intervention and of the Campus Europae program. Data collection instruments included pre and posttest questionnaires and semi-structured interviews. Results confirm the intercultural effectiveness of the intervention and the positive impact upon research participants’ intercultural gains. This impact was, however, greater in case study 2. Among explanatory variables, three stand out: (1) participant meaning-making abilities, (2) host language proficiency and related variables, and (3) type of sojourn or exchange programs. Implications for further research highlight the need to systematize purposeful intercultural pedagogy in sojourner populations in general, and in European credit student mobility in particular. In the latter case, these pedagogies should be part of the design and delivery of credit-bearing exchange programs in pre- departure, in-country and re-entry phases. Implications for practice point to the urge to improve intercultural practices in: macro (higher education institutions), mezzo (exchange programs) and micro (sojourner language classrooms) contexts where this research took place, and wider social scenarios they represent.

Rapport de mission sur la conférence mondiale sur l'aquaculture, organisée conjointement par la World Aquaculture Society et la European Aquaculture Society. Florence, Italie, 9-13 mai 2006

Ce congrès était organisé conjointement par les deux grandes associations de développement de l'aquaculture dans le monde: la World Aquaculture Society (WAS, 2300 membres) et la European Aquaculture Society (EAS, 550 membres). Le précédent s'était tenu à Nice, en mai 2000. Il a rassemblé pendant 5 jours plus de 3000 chercheurs et responsables institutionnels de 95 nationalités. Environ 600 communications orales étaient réparties sur 67 sessions suivant un système de 11 salles en parallèle. Entre les salles de conférence étaient présentés les panneaux des 460 posters. Sur le site, l'exposition commerciale accueillait 135 entreprises et organismes; elle a reçu la visite d'environ 2000 visiteurs dont la moitié d'Italiens (source: EAS). Le thème général du congrès était le lien entre la tradition et la technologie. L'objectif était de montrer que les technologies, dont l'image est ambivalente, constituent un outil remarquable de développement de l'aquaculture, y compris en tenant compte des contraintes de durabilité. En effet, les attentes du citoyen, comme du consommateur, restent centrées autour des notions de qualité, sécurité alimentaire, bien-être et santé animale. Les travaux portaient sur les disciplines classiques de l'aquaculture (nutrition, physiologie, génétique, etc) et leur relation avec les biotechnologies. Il faut souligner l'émergence de thèmes de plus en plus liés la démonstration que l'aquaculture peut s'intégrer dans détruire (capacité de charge d'un écosystème, animaux échappés, etc) et à la perception de la société (perception du consommateur, aquaculture et société, position des ONG écologistes, etc). L'U.E. était très présente avec 5 représentants et une implication marquée dans de plusieurs sessions. Sous différentes formes, ses représentants ont rappelé la volonté de l'UE de continuer à soutenir l'aquaculture, avec l'objectif de poursuivre le développement de ce secteur (4 % de croissance moyenne par an). L'aquaculture devrait générer 8 à 10 000 emplois nouveaux sur les 15 prochaines années, notamment dans la conchyliculture et la pisciculture marine au large avec comme mot clef l'intégration dans l'environnement, dans le tissu socio-économique côtier et dans l'imaginaire des gens, touristes, consommateurs, élus, etc. Ce congrès à vocation mondiale a attiré des représentants de régions habituellement peu représentées comme le Moyen Orient et la Chine, présente à de nombreuses sessions. Il a été aussi le lieu de multiples réunions satellites impliquant presque toujours des chercheurs français: grands programmes européens en cours comme SeaFood+, ASEM (coop. Europe - Asie) ou Consensus, assemblée générale de l'EAS, groupe de travail de l'UICN, etc. Ce type de réunion confirme l'importance des contacts personnels directs pour 1. Evaluer les grandes tendances mondiales du secteur 2. Etablir des contacts directs avec des chercheurs seniors des grandes équipes de recherche et des décideurs au niveau européen et extra-européen 3. Tester des idées et des projets de collaboration et de partenariat Il constitue un forum exceptionnel de diffusion de connaissances, d'informations et de messages. Il offre un espace de perception et de reconnaissance d'Ifremer par de nombreux acteurs de la communauté de recherche en aquaculture. Grâce à la variété thématique des sessions où des chercheurs d'Ifremer sont actifs, l'institut renforce sa notoriété notamment dans la dimension pluridisciplinaire. Cette capacité d'ensemblier est la qualité la plus demandée dans les conclusions d'ateliers et la plus rare dans les instituts présents. Le congrès révèle bien l'évolution de l'aquaculture mondiale: il y a 10 ans, la production de masse était au Sud et la technologie et les marchés au Nord (USA, Europe, Japon). Aujourd'hui, la progression économique et scientifique rapide des pays du Sud, surtout en Asie, crée des marchés locaux .solvables pour l'aquaculture (Chine, Inde) et fait émerger une capacité de recherche « de masse». Cette situation exige que la recherche occidentale évolue pour rester compétitive. Pour préserver un secteur important, qui concourt à la sécurité alimentaire en protéines de manière croissante (4% par an, record de toutes les productions alimentaires), la recherche européenne en aquaculture doit maintenir son effort afin de garder une longueur d'avance, surtout dans les secteurs qui seront vitaux dans la décennie: relations avec l'environnement naturel (durabilité dont la maîtrise des coûts énergétiques), qualité des produits, sécurité alimentaire, intégration socio-économique dans des espaces de plus en plus convoités, maîtrise de l'image de l'espèce « cultivée» (industrielle mais contrôlée) par rapport à l'image de l'espèce « sauvage» (naturelle mais polluée et surexploitée). En conséquence, l'UE conserve tout son potentiel de développement car l'essentiel de la valeur ajoutée sera de moins en moins dans la production en quantité mais dans sa maîtrise de la qualité. Cette évolution donne toute sa valeur à la recherche menée par Ifremer et ce d'autant plus que l'institut sera capable d'anticiper les besoins et les attentes des entreprises, des consommateurs, des associations comme des organisations internationales. Dans cette vision, réactivité, capacité d'ensemblier et réflexion prospective sont les qualités à développer pour que l'lfremer puisse donner toute sa mesure notamment dans la recherche en aquaculture. Ces enjeux sont à l'échelle internationale et Ifremer fait partie du petit nombre d'instituts capables de les traiter en large partenariat, en accord complet avec la politique souhaitée par l'UE

Portugal at the cross road of international chronic respiratory programmes

July 1-4, 2015 two meetings will be held with the Directorate General of Health in Lisbon, Portugal to discuss chronic respiratory programmes of the WHO Global Alliance against Chronic Respiratory Diseases (GARD)1,2 and European Innovation Partnership on Active and Healthy Ageing (EIP on AHA)3 (AIRWAYS ICPs: Integrated Care Pathways for airway diseases).4 The goals of these meetings will be to make an update of these two international actions and to strengthen the WHO noncommunicable disease (NCD) action plan (2013---2020).

Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study

BACKGROUND:Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. METHODS: This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6-8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann-Whitney U test and Pearson's chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. RESULTS: Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. CONCLUSIONS: Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied.

Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems

BACKGROUND: Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. METHODS: This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). RESULTS: The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided. CONCLUSION: The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.