Promoting palliative care in the community: production of the primary palliative care toolkit by the European Association of Palliative Care Taskforce in primary palliative care

BACKGROUND A multidisciplinary European Association of Palliative Care Taskforce was established to scope the extent of and learn what facilitates and hinders the development of palliative care in the community across Europe. AIM To document the barriers and facilitators for palliative care in the community and to produce a resource toolkit that palliative care specialists, primary care health professionals or policymakers, service developers, educationalists and national groups more generally could use to facilitate the development of palliative care in their own country. DESIGN (1) A survey instrument was sent to general practitioners with knowledge of palliative care services in the community in a diverse sample of European countries. We also conducted an international systematic review of tools used to identify people for palliative care in the community. (2) A draft toolkit was then constructed suggesting how individual countries might best address these issues, and an online survey was then set up for general practitioners and specialists to make comments. Iterations of the toolkit were then presented at international palliative care and primary care conferences. RESULTS Being unable to identify appropriate patients for palliative care in the community was a major barrier internationally. The systematic review identified tools that might be used to help address this. Various facilitators such as national strategies were identified. A primary palliative care toolkit has been produced and refined, together with associated guidance. CONCLUSION Many barriers and facilitators were identified. The primary palliative care toolkit can help community-based palliative care services to be established nationally.

The Political Candidacy of EU Migrants in their European Countries of Residence. The Case of British and Romanians Standing in Spanish Local Elections

What explains the variation in how European citizens of diverse origins are politically incorporated in the member states of residence? This paper argues that immigrant groups’ status in the host society plays an important role in political party responses to immigrants’ political participation. Drawing on the case of Romanian and British candidacies in the Spanish local elections from 2011, the paper finds that the level of competition between parties is the key mechanism for incorporating candidates from a positively/neutrally perceived group. Instead, a greater level of ethnic diversity encourages the incorporation of candidates from the negatively perceived group. To demonstrate this, the paper uses an original data-set with the Romanian and British candidates in a large number of Spanish localities.

Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology

CONTEXT Most patients with neuro-urological disorders require life-long medical care. The European Association of Urology (EAU) regularly updates guidelines for the diagnosis and treatment of these patients. OBJECTIVE To provide a summary of the 2015 updated EAU Guidelines on Neuro-Urology. EVIDENCE ACQUISITION Structured literature searches in several databases were carried out to update the 2014 guidelines. Levels of evidence and grades of recommendation were assigned where possible. EVIDENCE SYNTHESIS Neurological disorders often cause urinary tract, sexual, and bowel dysfunction. Most neuro-urological patients need life-long care for optimal life expectancy and quality of life. Timely diagnosis and treatment are essential to prevent upper and lower urinary tract deterioration. Clinical assessment should be comprehensive and usually includes a urodynamic investigation. The neuro-urological management must be tailored to the needs of the individual patient and may require a multidisciplinary approach. Sexuality and fertility issues should not be ignored. Numerous conservative and noninvasive possibilities of management are available and should be considered before a surgical approach is chosen. Neuro-urological patients require life-long follow-up and particular attention has to be paid to this aspect of management. CONCLUSIONS The current EAU Guidelines on Neuro-Urology provide an up-to-date overview of the available evidence for adequate diagnosis, treatment, and follow-up of neuro-urological patients. PATIENT SUMMARY Patients with a neurological disorder often suffer from urinary tract, sexual, and bowel dysfunction and life-long care is usually necessary. The update of the EAU Guidelines on Neuro-Urology, summarized in this paper, enables caregivers to provide optimal support to neuro-urological patients. Conservative, noninvasive, or minimally invasive approaches are often possible.

Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.

BACKGROUND Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012. FACTOR Racial background. OUTCOMES & MEASUREMENTS Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence. RESULTS 868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups. LIMITATIONS No data for socioeconomic status, blood group, and HLA profile. CONCLUSIONS We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.

Abortion Funding: a Matter of Justice

Ibis Reproductive Health

Mineral composition of 0.1-0.05 mm grain size fraction from the surface layer of bottom sediments in the West European province of the Atlantic Ocean

Rock material sampled from the Mir manned deep-sea submersibles and by dradges, grabs, and sediment cores over a vast area of the North Atlantic was analyzed to show that this material is of continental origin, unlike original rocks of the ocean floor. It is proved to be related to iceberg rafting during Quaternary glaciations. Independent data on distribution and composition of sandy and silty grains in sediment cores also support this relation to the recent glaciation. New criteria for identification of iceberg rock matter in pelagic sediments are presented on the base of analysis of all available data.

Latin American Agricultural Trade: The Role of the WTO in Sustainable Virtual Water Flows, European Association of Agricultural Economists

International agricultural trade has been growing significantly during the last decade. Many countries rely on imports to ensure adequate food supplies to the people. A few are becoming food baskets of the world. This process raises issues about the food security in depending countries and potentially unsustainable land and water use in exporting countries. In this paper, we analyse the impacts of amplified farm trade on natural resources, especially water. Farm exports and imports of five Latin America countries (Brazil, Argentina, Mexico, Peru and Chile) are examined carefully. A preliminary analysis indicates that virtual water imports can save valuable water resources in water-short countries, such as Mexico and Chile. Major exporting countries, including Brazil and Argentina, have become big exporters due to abundant natural resource endowments. The opportunity costs of agricultural production in those countries are identified as being low, because of the predominant green water use. It is concluded that virtual water trade can be a powerful tool to alleviate water stress in semi-arid countries. However, for exporting nations a sustainable water use can only be guaranteed if environmental production costs are fully reflected in the commodity prices. There is no basis for erecting environmental trade tariffs on exporters though. Setting up legal foundations for them in full compliance with WTOs processes would be a daunting task.

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of “learning strategy”. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of ―learning strategy‖. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper.

Markov blanket-based approach for learning multi-dimensional Bayesian network classifiers: An application to predict the European Quality of Life-5 Dimensions (EQ-5D) from the 39-item Parkinson's Disease Questionnaire (PDQ-39)

Multi-dimensional Bayesian network classifiers (MBCs) are probabilistic graphical models recently proposed to deal with multi-dimensional classification problems, where each instance in the data set has to be assigned to more than one class variable. In this paper, we propose a Markov blanket-based approach for learning MBCs from data. Basically, it consists of determining the Markov blanket around each class variable using the HITON algorithm, then specifying the directionality over the MBC subgraphs. Our approach is applied to the prediction problem of the European Quality of Life-5 Dimensions (EQ-5D) from the 39-item Parkinson’s Disease Questionnaire (PDQ-39) in order to estimate the health-related quality of life of Parkinson’s patients. Fivefold cross-validation experiments were carried out on randomly generated synthetic data sets, Yeast data set, as well as on a real-world Parkinson’s disease data set containing 488 patients. The experimental study, including comparison with additional Bayesian network-based approaches, back propagation for multi-label learning, multi-label k-nearest neighbor, multinomial logistic regression, ordinary least squares, and censored least absolute deviations, shows encouraging results in terms of predictive accuracy as well as the identification of dependence relationships among class and feature variables.

INFOBIOMED: European Network of Excellence on Biomedical Informatics to support individualised healthcare

INFOBIOMED is an European Network of Excellence (NoE) funded by the Information Society Directorate-General of the European Commission (EC). A consortium of European organizations from ten different countries is involved within the network. Four pilots, all related to linking clinical and genomic information, are being carried out. From an informatics perspective, various challenges, related to data integration and mining, are included.

The European Resonance of Napoleon’s Defeat in Spain

The military event that sealed the defeat of Napoleon in Spain was the Battle of Vitoria on 21st June 1813, which saw the allied British, Spanish and Portuguese troops led by Wellington gain victory over Joseph Bonaparte's forces. It was the last great battle of what is known in Spain as the Guerra de la Independencia, in the United Kingdom as the Peninsular War and in France as the Guerre d'Espagne. While a sliver of Spanish territory remained under French control and the war itself went on for a few more months, it was the Battle of Vitoria that marked the end of Napoleon's rule on the Iberian Peninsula, as symbolised by the departure from Spain of Joseph Bonaparte, the monarch who had been imposed five years earlier to remove the Bourbons from the Spanish throne.