Les systèmes de santé de l’Union européenne sous influence

À l’origine volontairement très limitées, les compétences de l’Union européenne dans le domaine de la santé se sont développées ces vingt dernières années. Elles restent très marginalement influentes par rapport aux dispositions qui ont créé puis renforcé le marché intérieur. Une nouvelle étape est aujourd’hui franchie dans le cadre de la coordination des politiques macroéconomiques, notamment avec les politiques d’ajustements structurels. Inexistante au début de la création des communautés, l’influence européenne sur les services de santé montre qu’elle sait être très invasive.The European Union competences in the field of health, originally voluntarily limited have developed for the last twenty years. They are rather marginal compared to legal basis of the internal market. A new step has been taken with the macroeconomic policies and in particular with the structural adjustments. Initially absent of healthcare services, the European influence shows it can be very invasive

Data-Driven Collaboration between Hospitals and Other Healthcare Organisations in Europe During the COVID-19 Pandemic: An Explanatory Sequential Mixed-Methods Study among Mid-Level Hospital Managers

Introduction: Data and digital infrastructure drive collaboration and help develop integrated healthcare systems and services. COVID-19 induced changes to collaboration between healthcare organisations, which previously often happened in fragmented and competitive ways. New collaborative practices relied on data and were crucial in managing coordinated responses to the pandemic. In this study, we explored data-driven collaboration between European hospitals and other healthcare organisations in 2021 by identifying common themes, lessons learned and implications going forward. Methods: Study participants were recruited from an existing Europe-wide community of mid-level hospital managers. For data collection, we ran an online survey, conducted multi-case study interviews and organised webinars. Data were analysed using descriptive statistics, thematic analysis and cross-case synthesis. Results: Mid-level hospital managers from 18 European countries reported an increase in data exchange between healthcare organisations during the COVID-19 pandemic. Data-driven collaborative practices were goal-oriented and focused on the optimisation of hospitals’ governance functions, innovation in organisational models and improvements to data infrastructure. This was often made possible by temporarily overcoming system complexities, which would otherwise hinder collaboration and innovation. Sustainability of these developments remains a challenge. Discussion: Mid-level hospital managers form a huge potential of reacting and collaborating when needed, including rapidly setting up novel partnerships and redefining established processes. Major post-COVID unmet medical needs are linked to hospital care provision, including diagnostic and therapeutic backlogs. Tackling these will require rethinking of the position of hospitals within healthcare systems, including their role in care integration. Conclusion: Learning from COVID-19-induced developments in data-driven collaboration between hospitals and other healthcare organisations is important to address systemic barriers, sustain resilience and further build transformative capacity to help build better integrated healthcare systems

Liouville field theory coupled to a critical Ising model: Non-perturbative analysis, duality and applications

Two different kinds of interactions between a ${Z}_{n}$-parafermionic and a Liouville field theory are considered. For generic values of $n$, the effective central charges describing the UV behavior of both models are calculated in the Neveu-Schwarz sector. For $n=2$ exact vacuum expectation values of primary fields of the Liouville field theory, as well as the first descendent fields are proposed. For $n=1$, known results for Sinh-Gordon and Bullough-Dodd models are recovered whereas for $n=2$, exact results for these two integrable coupled Ising-Liouville models are shown to exchange under a weak-strong coupling duality relation. In particular, exact relations between the parameters in the actions and the mass of the particles are obtained. At specific imaginary values of the coupling and $n=2$, we use previous results to obtain exact information about: (a) Integrable coupled models like Ising-${\cal M}_{p/p'}$, homogeneous sine-Gordon model $SU(3)_2$ or the Ising-XY model; (b) Neveu-Schwarz sector of the $\Phi_{13}$ integrable perturbation of N=1 supersymmetric minimal models. Several non-perturbative checks are done, which support the exact results.Comment: 29 pages, 1 fig., LaTeX file with epsfig, amssymb, 3 references added. To appear in Nucl. Phys.

Bratislava Statement: consensus recommendations for improving pancreatic cancer care

Pancreatic cancer is one of the most lethal tumours, and it is the fourth cause of cancer death in Europe. Despite its important public health impact, no effective treatments exist, nor are there high-visibility research efforts to improve care. This alarming situation is emblematic of a larger group of cancer diseases, known as neglected cancers. To address the impact of these diseases, the European Commission-supported Innovative Partnership for Action Against Cancer launched a multi-stakeholder initiative to determine key steps that healthcare systems can rapidly implement to improve their response. A working group comprising 20 representatives from European medical societies, patient associations, cancer plan organisations and other relevant European healthcare stakeholders was organised. A consensus process based on the results of different studies, discussion of research outcomes, and development and endorsement of draft statements resulted in 22 consensus recommendations (the Bratislava Statement). The statement argues that substantial improvements can be achieved in patient outcomes by centralising pancreatic cancer care around state-of-the-art reference centres, staffed by expert multidisciplinary teams capable of providing high-quality care. This organisational model requires a specific care framework encompassing primary, palliative and survivorship care, and a policy environment prioritising the use of quality criteria and performance assessments as well as research investments dedicated to prevention, risk prediction, early detection and diagnosis. In order to address the challenges posed by neglected cancers in general and pancreatic cancer in particular, a specific control strategy tailored to this reality is required

Identifying the environmental drivers of corridors and predicting connectivity between seasonal ranges in multiple populations of Alpine ibex (Capra ibex) as tools for conserving migration

Aim Seasonal migrations, such as those of ungulates, are particularly threatened by habitat transformations and fragmentation, climate and other environmental changes caused by anthropogenic activities. Mountain ungulate migrations are neglected because they are relatively short, although traversing heterogeneous altitudinal gradients particularly exposed to anthropogenic threats. Detecting migration routes of these species and understanding their drivers are therefore of primary importance to predict connectivity and preserve ecosystem functions and services. The populations of Alpine ibex Capra ibex have all been reintroduced from the last remnant source population. Despite a general increase in abundance and overall distribution range, ibex populations are mostly disconnected but display intra-population migrations. Therefore, its conservation is strictly linked to the interplay between external threats and related behavioural responses, including space use and migration. Location Austria, France, Italy and Switzerland. Methods By using 337 migratory tracks from 425 GPS-collared individuals from 15 Alpine ibex populations distributed across their entire range, we (i) identified the environmental drivers of movement corridors in both spring and autumn and (ii) compared the ability of a connectivity modelling algorithm to predict migratory movements between seasonal ranges of the 15 populations, using either population-specific or multipopulation datasets, and three validation procedures. Results Steep, south-facing, snow-free slopes were selected while high elevation changes were avoided. This revealed the importance of favourable resources and an attempt to limit energy expenditures and perceived predation risk. The abilities of the modelling methods we compared to predict migratory connectivity from the results of those movement analyses were similar. Main Conclusions The trade-off between energy expenditure, food and cover was the major driver of migration routes and was overall consistent among populations. Based on these findings, we provided useful connectivity models to inform conservation of Alpine ibex and its habitats, and a framework for future research investigating connectivity in migratory specie

Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis.

OBJECTIVE: To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. DESIGN: A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. PARTICIPANTS: One hundred and fifty-five CEOs and 155 quality managers. SETTING: One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. RESULTS: Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. CONCLUSIONS: Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters

a research protocol for a mixed methods study

Funding Information: This work was supported by the European Union under the Horizon Europe Research and Innovation Programme under the grant agreement no 101057825. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2024 Valli et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. Aim SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. Methods We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. Discussion The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.publishersversionpublishe

Morphology and dynamics of inflated subaqueous basaltic lava flows

International audienceDuring eruptions onto low slopes, basaltic Pahoehoe lava can form thin lobes that progressively coalesce and inflate to many times their original thickness, due to a steady injection of magma beneath brittle and viscoelastic layers of cooled lava that develop sufficient strength to retain the flow. Inflated lava flows forming tumuli and pressure ridges have been reported in different kinds of environments, such as at contemporary subaerial Hawaiian-type volcanoes in Hawaii, La Réunion and Iceland, in continental environments (states of Oregon, Idaho, Washington), and in the deep sea at Juan de Fuca Ridge, the Galapagos spreading center, and at the East Pacific Rise (this study). These lava have all undergone inflation processes, yet they display highly contrasting morphologies that correlate with their depositional environment, the most striking difference being the presence of water. Lava that have inflated in subaerial environments display inflation structures with morphologies that significantly differ from subaqueous lava emplaced in the deep sea, lakes, and rivers. Their height is 2-3 times smaller and their length being 10-15 times shorter. Based on heat diffusion equation, we demonstrate that more efficient cooling of a lava flow in water leads to the rapid development of thicker (by 25%) cooled layer at the flow surface, which has greater yield strength to counteract its internal hydrostatic pressure than in subaerial environments, thus limiting lava breakouts to form new lobes, hence promoting inflation. Buoyancy also increases the ability of a lava to inflate by 60%. Together, these differences can account for the observed variations in the thickness and extent of subaerial and subaqueous inflated lava flows

La réception du modèle graphique de Burgess dans la géographie française des années cinquante aux années soixante-dix

It is common practice nowadays to use the Burgess graphic model to explain intra-urban city's structures. It was built up in the twenties and french geographers came to know about it before the thirties. Its diffusion among the scientific community is due to papers from the french sociologist Maurice Halbwachs and the american geographers Harris and Ullman. We are drawing here a sample of the ways this model was received in french geography. Our intentions remain modest : to throw light on an interessing and unknown research material, to draw up a research question. We analyse the welcoming of the Burgess model as a product of a confrontation between two analysis grids of urban space, both associated with two different epistemological corpus : french geographers have translated, according to their conceptual background, the researchs of this american sociologist, which remained peculiar to them in many ways. Studying the graphic transformations in the concentric model allows to underline this process of intellectual embezzlement

A polar expedition project and project management

International audienc