Health Technology Assessment (HTA) in Europe has undergone significant evolution, culminating in the adoption of Regulation (EU) 2021/2282 on HTA (HTAR) aimed at fostering sustainable collaboration in HTA at the European Union (EU) level. The EUnetHTA 21 project, a 2-year initiative, was commissioned to address key methodological issues and prepare for the implementation of the HTAR. This commentary documents the outcomes of the EUnetHTA 21 project, focusing on Joint Clinical Assessments (JCAs), while analyzing challenges encountered and lessons learned for future collaboration under the HTAR. The EUnetHTA 21 consortium, comprising thirteen European HTA bodies, developed twenty guidance documents and thirteen templates, refining methods and procedures for joint work in HTA at EU level. Pilot JCAs and Joint Scientific Consultations were conducted to test these materials. Lessons learned from this experience emphasize the importance of inclusive consensus building, effective time and resource management, capacity building, and continuous quality improvement. The project’s realization underscores a collective commitment among HTA bodies to continue to collaborate, now under a legal framework. Recommendations from the project, along with experiences gained from previous European Network for HTA (EUnetHTA) Joint Actions, provide a foundation for developing guidance for EU-HTA under the HTAR. Further proactive efforts at national and central levels are essential to coordinate and ensure a sustainable cooperation. The EUnetHTA 21 experience provides valuable insights for advancing cooperation in HTA under the HTAR, aiming to improve the quality of HTA, avoid duplication, and ultimately enhance patient access to safe and effective health technologies in the EU.

Image-processing pipelines require the design of complex workflows combining many different steps that bring the raw acquired data to a final result with biological meaning. In the image-processing domain of cryo-electron microscopy single-particle analysis (cryo-EM SPA), hundreds of steps must be performed to obtain the three-dimensional structure of a biological macromolecule by integrating data spread over thousands of micrographs containing millions of copies of allegedly the same macromolecule. The execution of such complicated workflows demands a specific tool to keep track of all these steps performed. Additionally, due to the extremely low signal-to-noise ratio (SNR), the estimation of any image parameter is heavily affected by noise resulting in a significant fraction of incorrect estimates. Although low SNR and processing millions of images by hundreds of sequential steps requiring substantial computational resources are specific to cryo-EM, these characteristics may be shared by other biological imaging domains. Here, we present Scipion, a Python generic open-source workflow engine specifically adapted for image processing. Its main characteristics are: (a) interoperability, (b) smart object model, (c) gluing operations, (d) comparison operations, (e) wide set of domain-specific operations, (f) execution in streaming, (g) smooth integration in high-performance computing environments, (h) execution with and without graphical capabilities, (i) flexible visualization, (j) user authentication and private access to private data, (k) scripting capabilities, (l) high performance, (m) traceability, (n) reproducibility, (o) self-reporting, (p) reusability, (q) extensibility, (r) software updates, and (s) non-restrictive software licensing.

Inadequate nutrition during a critical period of development – as is the case during gestation and the first days of life, especially in very-low-birth-weight (VLBW) infants, can impact on neurodevelopment and favour co-morbidities. In this study, we evaluate how neurodevelopment may be affected by intra-uterine growth (IUGR) restriction and by an inadequate intake of nutritional energy during the early neonatal period. A longitudinal cohort study was conducted to analyse the nutritional contributions received during the first week of life, among a population of 396 VLBW infants. Motor, cognitive, sensory and behavioural development was assessed at 14, 25, 33 and 50 months. The association between IUGR, postnatal energy restriction and neurodevelopment was examined using multivariate logistic regression techniques. Mild cognitive delay was observed in 35·6 % of neonates with IUGR and in 24 % of those with appropriate birth weight. IUGR is associated with behavioural disorder (OR 2·60; 95 % CI 1·25, 5·40) and delayed cognitive development (OR 2·64; 95 % CI 1·34, 5·20). Energy restriction during the first week of life is associated with visual deficiency (OR 2·96; 95 % CI 1·26, 6·84) and cerebral palsy (OR 3·05; CI 95 % 1·00, 9·54). In VLBW infants, IUGR is associated with behavioural disorder, while postnatal energy restriction is significantly associated with motor disorder, infantile cerebral palsy and sensory disorder.

During menopause, women undergo a series of physiological changes that include a redistribution of fat tissue. This study was designed to investigate the effect of adding 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women daily on body composition. We conducted a 6-month, two-arm randomised, controlled trial. Postmenopausal women (57·2 (sd 3·6) years, n 132) were recruited in primary care clinics. Participants in the control group (CG) did not receive any intervention. Those of the intervention group (IG) received 10 g daily of 99 % cocoa chocolate in addition to their habitual diet for 6 months. This quantity comprises 247 kJ (59 kcal) and 65·4 mg of polyphenols. The primary outcomes were the between-group differences in body composition variables, measured by impendancemetry at the end of the study. The main effect of the intervention showed a favourable reduction in the IG with respect to the CG in body fat mass (–0·63 kg (95 % CI –1·15, –0·11), P = 0·019; Cohen’s d = –0·450) and body fat percentage (–0·79 % (95 % CI –1·31, –0·26), P = 0·004; Cohen’s d = –0·539). A non-significant decrease was also observed in BMI (–0·20 kg/m2 (95 % CI –0·44, 0·03), P = 0·092; Cohen’s d = –0·345). Both the body fat mass and the body fat percentage showed a decrease in the IG for the three body segments analysed (trunk, arms and legs). Daily addition of 10 g of cocoa-rich chocolate to the habitual diet of postmenopausal women reduces their body fat mass and body fat percentage without modifying their weight.

This article argues that the “declarative” parastate of the Sahrawi Arab Democratic Republic (SADR) claiming sovereignty over Western Sahara is better understood as a hybrid between a parastate and a state-in-exile. It relies more on external, “international legal sovereignty,” than on internal, “Westphalian” and “domestic” sovereignty. While its Algerian operational base in the Tindouf refugee camps makes it work as a primarily extraterritorial state-in-exile de facto, the SADR maintains control over one quarter of Western Sahara’s territory proper allowing it to at least partially meet the requirements for declarative statehood de jure. Many case-specific nuances surround the internal sovereignty of the SADR in relation to criteria for statehood: territory, population, and government. However, examining this case in a comparative light reveals similarities with other (secessionist) parastates. The SADR exists within the context of a frozen conflict, where the stalemate has been reinforced by an ineffective internationally brokered peace settlement and the indefinite presence of international peacekeeping forces. Global powers have played a major role in prolonging the conflict’s status quo while the specific resilience of the SADR as a parastate has been ensured by support from Algeria as an external sponsor. The path to sovereignty appears to be blocked in every possible way.

This article proposes a typology of causal mechanisms whereby transnational relations of recognition constitute conflict actors in frozen conflicts. While the agency of an emerging conflict actor manifests itself in ‘struggles for recognition’ motivated by experiences of ‘disrespect’, responses from different significant others vary in terms of motivations and pathways (mechanisms of recognition). Adapting Honneth’s tripartite division, the typology distinguishes between four forms of recognition: thin cognitive recognition, ‘respect’/rights, ‘esteem’/difference, and ‘love’/empathy. Three transnational corrections are made in order to include transnational relations of recognition, non-state actors, and unstructured social-relational forms of international/transnational recognition. The typology is applied to the conflict of Western Sahara, which has been reshaped by the rise of internal Sahrawi pro-independence groups (based inside the territory annexed by Morocco) as an increasingly relevant conflict actor, with their identity shifting from victims to human rights activists to activists involved in an unsolved conflict. This identity and social-status formation has been the product of transnational recognition from three significant others: the annexing state (Morocco), the contested state-in-exile (SADR), and the international community. The overall effect of intermingling recognition processes, including various instrumental initiatives deprived of mutuality, has been increased struggle and conflict complexity rather than ‘recognitional peace’.

On 30 March 2018, protesters in the Gaza Strip engaged in a peaceful demonstration for “Land Day,” a Palestinian commemoration of the expropriation of lands for Israeli settlements in 1976. During the march, Palestinians approached the border with Israel where the Israeli army opened fire with live ammunition and tank shells, killing at least fifteen demonstrators. Dozens of others were wounded. In the weeks and months that followed, Palestinian protesters continued to protest at the Gaza border. As this issue goes to print, the International Committee of the Red Cross reports that at least 116 Palestinians have been killed in protests framed as the “Great March of Return” since 30 March 2018, and as many as thirteen thousand have been injured. This spring's events, coinciding with the seventieth anniversary of the founding of the state of Israel and the US decision to move its embassy to Jerusalem, offer yet another reminder of the violence and dispossession that for decades have characterized Palestinian life under Israeli occupation.

The aim of current research is to analyze the psychometric properties of the Spanish version of the SF–8, overcoming previous shortcomings. A double line of analyses was used: competitive structural equations models to establish factorial validity, and Item Response theory to analyze item psychometric characteristics and information. 593 people aged 60 years or older, attending long life learning programs at the University were surveyed. Their age ranged from 60 to 92 years old. 67.6% were women. The survey included scales on personality dimensions, attitudes, perceptions, and behaviors related to aging. Competitive confirmatory models pointed out two-factors (physical and mental health) as the best representation of the data: χ2(13) = 72.37 (p < .01); CFI = .99; TLI = .98; RMSEA = .08 (.06, .10). Item 5 was removed because of unreliability and cross-loading. Graded response models showed appropriate fit for two-parameter logistic model both the physical and the mental dimensions. Item Information Curves and Test Information Functions pointed out that the SF–8 was more informative for low levels of health. The Spanish SF–8 has adequate psychometric properties, being better represented by two dimensions, once Item 5 is removed. Gathering evidence on patient-reported outcome measures is of crucial importance, as this type of measurement instruments are increasingly used in clinical arena.

Priming has proved to enhance seed germination, but most of the research dealing with this topic has been carried out with cultivated species. The potential applications that this process has on wild species, which can be useful for restoration, are usually overlooked. This study analyses the germination response after natural priming and hydropriming of Penstemon roseus and Castilleja tenuiflora, two perennial herbs growing in a protected area known as ‘Parque Ecológico de la Ciudad de México’. Photoblastism was evaluated for both species. Seeds were exposed to a hydration/dehydration cycle and then placed in germination chambers to determine responses to hydropriming. To identify the effects of natural priming, seeds were buried in natural conditions and then recovered every two months and placed in germination chambers. Germination percentages and rates were then quantified. Both species proved to have permeable seed coats. Penstemon roseus seeds are positive photoblastic whereas C. tenuiflora seeds are indifferent to light. Priming methods increased C. tenuiflora germination rates, but they did not affect germination capacity. For P. roseus, priming methods did not improve germination rates, and germination capacity of recovered seeds decreased after the rainy season, suggesting that P. roseus forms a short-term, transient, seed bank. The germination strategies of these two species allow them to occupy suitable microsites for germination and establishment. These responses can be helpful in developing restoration programmes based on the accelerated establishment of native and characteristic successional species.

A new species of holothurian of the genus Psolus Oken, 1815 is described. Psolus rufus sp. nov. was found in the central Cantabrian slope (Bay of Biscay) at 1500 m depth. The new species is characterized by having: ovoid body, reddish colour in vivo; dorsal area enclosed in a complete test composed of imbricating scales; 10 triangular plates of the same size surrounding mouth; 10 oral tentacles; no dorsal papillae; tube feet in two rows in the ventrolateral radii but one single row in the medial third or the body; ossicles are big dorsal plates and small plates in the sole, which are smooth, irregular and perforated. The molecular study of the COI gene supports the morphological results, grouping P. rufus sp. nov. together with other members of the genus. However, the new species is genetically distinct from the two groups (Antarctic and Canadian) of the available sequenced Psolus species. Furthermore, a key to the Psolus species of the north-eastern Atlantic Ocean is provided.

Burnout is characterized by emotional exhaustion, depersonalization and lack of personal accomplishment (Bakke, Demerouti, & Sanz-Vergel, 2014). Several instruments for its measurement exist, but the most widely used scale for measuring its dimensions, by far, is the Maslach Burnout Inventory (MBI) in its different versions. Among the available versions of the scale, the MBI-General Survey was developed to measure three dimensions of burnout (cynicism, personal accomplishment, and emotional exhaustion) regardless of the type of work. The aim of this research is to offer evidence on the psychometric properties of the MBI-GS for its use in the Dominican Republic and other Caribbean Spanish-speaking countries, using representative sample of Dominican teachers. The factorial validity was studied through confirmatory factor analysis. Several competing models were proved in order to test the dimensionality of the scale. The confirmatory analyses shown that the original three-factor structure had a superior fit, but item eleven was removed in order to get an excellent fit χ2(87) = 211.19, p < .001, CFI = .98, RMSEA = .038 90% CI [.032–.045]. Regarding internal consistency, the CRI´s are well above the cut-off criteria of .7 (CRI’s ranged from .74 to .86). Concerning criterion-related validity, the three factors were correlated in the expected direction. Professional efficacy, a dimension of burnout measured in the opposite direction, was positively correlated with the three factors of work engagement, also as expected. This version was found to be a psychometrically sound measure of the three core dimensions of burnout.

Individuals affected by Muscle Dysmorphia (MD; body image disorder based on the sub estimation of muscle size), practice weightlifting in order to alleviate their muscular dissatisfaction. Although physical activity is associated with increased physical self-perception, we assume that this was not reproduced in full in people with MD. The study sample consisted of 734 weightlifters and bodybuilders, 562 men and 172 women, who completed the Escala de Satisfacción Muscular, the Physical Self-Concept Questionnaire, and from whom measures of body fat and Fat -Free Mass Index (FFMI) were obtained. The results showed that people suffering from MD symptoms, overall, have poorer physical self-concept perceptions (F = 18.46 - 34.77, p < .01).

Objectives: The aim of this study was to identify risk points in the different stages of the smart infusion pump implementation process to prioritize improvement measures.

Methods: Failure modes and effects analysis (FMEA) in the pediatric intensive care unit (PICU) of a General and Teaching Hospital. A multidisciplinary team was comprised of two intensive care pediatricians, two clinical pharmacists and the PICU nurse manager. FMEA was carried out before implementing CareFusion infusion smart pumps and eighteen months after to identify risk points during three different stages of the implementation process: creating a drug library; using the technology during clinical practice and analyzing the data stored using Guardrails® CQI v4.1 Event Reporter software.

Results: Several actions for improvement were taken. These included carrying out periodical reviews of the drug library, developing support documents, and including a training profile in the system so that alarms set off by real programming errors could be distinguished from those caused by incorrect use of the system. Eighteen months after the implementation, these measures had helped to reduce the likelihood of each risk point occurring and increase the likelihood of their detection.

Conclusions: Carrying out an FMEA made it possible to detect risk points in the use of smart pumps, take action to improve the tool, and adapt it to the PICU. Providing user training and support tools and continuously monitoring results helped to improve the usefulness of the drug library, increased users’ compliance with the drug library, and decreased the number of unnecessary alarms.