Wallonie-Bruxelles International

<h3>Background and Importance</h3> A survey of market access experts of the Medical Nutrition International Industry was undertaken to understand the barriers contributing to inequity in optimal nutritional care in Europe. <h3>Aim and Objectives</h3> Disease-related malnutrition (DRM), an underdiagnosed, undertreated public health problem that affects 30–50% of hospital inpatients, results in poor health outcomes and higher costs.¹ Multidisciplinary care, including pharmacists, is essential to ensure optimal nutritional interventions.² Pharmacists are vital to multidisciplinary care coordination. Medical nutrition therapy is cost-effective and improves health outcomes, yet inequity exists in access.¹ This survey was conducted to address the limited insight across countries into the major barriers to implementation of equitable nutritional care beyond health technology assessment. <h3>Material and Methods</h3> An online survey was developed by the MNI, and members (n=6) participated between April and December 2024. Additional responses were included (National Industry Groups n=2; additional MNI members n=2). Results covered Croatia, France, Germany, Italy, Poland, Portugal, Spain, Switzerland, The Netherlands and the United Kingdom. Quantitative data were reported as percentages and qualitative data as key themes. <h3>Results</h3> Although screening for DRM was reported as being available in 80% of countries surveyed, it was mandatory in only 20% and often poorly implemented. Knowledge of nutritional care was described as inconsistent and specialty-dependent, with 56% reporting access to expert nutrition professionals as limited to hospital settings. Barriers identified included lack of funding, limited workforce availability and nutrition seen as a low priority. Although reimbursement of food for special medical purposes (FSMP) (medical nutrition products for oral or enteral nutrition) was reported by 90% of country respondents it varied by healthcare setting, and 50% reported that obtaining FSMP is ‘difficult/not easy’. Awareness of DRM amongst patients was reported as low, with difficulties navigating complex healthcare systems citied by 70% of country respondents as a key contributing factor to inequity. <h3>Conclusion and Relevance</h3> Knowledge of system-level barriers to nutritional care, beyond HTA, highlights actionable gaps within hospital practice. Hospital pharmacists can act as drivers of change. Through their roles in therapeutic committees, and care coordination, they can help embed medical nutrition into hospital standards and reduce access inequities. <h3>References and/or Acknowledgements</h3> 1. WHO-ESPEN 2023. https://www.who.int/europe/publications/i/item/WHO-EURO-2023-8931-48703-72392 2. Cederholm, <i>et al</i>. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27642056 <h3>Conflict of Interest</h3> Corporate sponsored research or other substantive relationships: MNI represents the companies that were surveyed for this exercise.

Conventional pulse-contour analysis estimates cardiac output ( ) from arterial pressure waveforms but often relies on demographic calibration or black-box modeling, which limits physiological interpretability and generalizability. This study aims to develop and validate a structurally identifiable model that simultaneously estimates and vascular parameters from peripheral arterial pressure waveforms. The proposed framework is based on a four-element Windkessel model reformulated through -parameters ( ) that encapsulate arterial compliance, resistive and inertial loads, and pressure decay dynamics. Radial peripheral arterial pressure (pABP) waveforms are preprocessed, smoothed, converted into a periodic representation, and fitted to the Windkessel model to extract -parameters. Combined with biometric covariates, these parameters serve as inputs to a generalized linear model (Gamma distribution, identity link) trained to estimate . The estimated is subsequently reinjected into the -parameter expressions to derive arterial compliance ( ), characteristic impedance ( ), distal resistance ( ), and inertance ( ). Internal validation against the EV1000 pulse-contour reference yields an , negligible bias (- 0.02 ), and a percentage error ( ) of 26.17%, meeting the clinical interchangeability criterion ( < 30%). External evaluation on an independent Vigileo dataset achieves and = 28.41% without retraining, confirming robustness across platforms. The -parameterized Windkessel framework provides a physiologically interpretable, data-efficient, and calibration-free alternative for estimation. Beyond , it simultaneously quantifies , , , and , offering a comprehensive and mechanistically grounded hemodynamic profile from a single peripheral arterial pressure signal, suitable for real-time integration into perioperative and critical care monitoring.

Thestudy aimed to assess theapplicability oftheROSE conceptual framework (Resuscitation, Optimization, Stabilization, Evacuation) for fluid therapy in critically ill pediatric patients, focusing on its distinct phases, prevention offluid accumulation, and clinical outcomes. Aquasi-experimental study was conducted including 122 (retrospective: n = 71; prospective: n = 51) mechanically ventilated and vasoactive-dependent children. Aretrospective cohort was compared with aprospective cohort following structured training on ROSE-guided fluid management. Outcomes included fluid accumulation percentage (FA%), duration ofmechanical ventilation, pediatric intensive care unit (PICU) length ofstay, and need for renal replacement therapy (RRT). Adherence to phase-specific FA% targets was also assessed. FA% was similar between cohorts (retrospective vs. prospective) on PICU days 1, 3, and 10 (median [IQR] 1.8% [0.2-4.3] vs. 1.9% [0.8-3.2], P = 0.934; 5.5% [1.7-10.3] vs. 6.1% [3.8-10.2], P = 0.565; 8.3% [0.8-24.8] vs. 7.2% [2.6-18.7], P = 0.848). By ROSE phase, FA% was comparable in Resuscitation (3.5% [2.0-6.0] vs. 4.7% [2.4-6.9], P = 0.244), Optimization (3.0% [0.1-6.7] vs. 4.2% [1.0-7.9], P = 0.261), and Evacuation (2.5% [-2.6-5.3] vs. 2.4% [-0.0-7.4], P = 0.256), but higher during Stabilization (2.5% [0.0-6.9] vs. 4.2% [2.0-8.9], P = 0.043). Mechanical ventilation, length ofPICU stay, RRT, and fluid elimination were similar. No independent predictors emerged in logistic regression. FA% target adherence rose from 67.9% to 72.4% after ROSE. TheROSE framework in pediatric fluid management is feasible, provides benchmarking for FA% control, and shows promise for individualizing fluid management. Future validation in ROSE-naive centers is warranted.

INTRODUCTION Optimal fluid management in surgical intensive care unit (ICU) patients is a complicated balance between avoiding unnecessary intravenous (IV) fluid administration, which contributes to fluid accumulation syndrome (FAS), and maintaining euvolemia to promote tissue and organ perfusion.,Fluid kinetics and dynamics are influenced by the underlying pathology, shock state, administered drugs, the phase of disease, […]

The energy transition driven by the decentralization and electrification of energy systems significantly impacts electricity distribution and transmission grids. This study, focusing on the distribution level, examines specific policy elements of the regulatory frameworks of five European countries that are crucial for promoting the use of flexibility by distribution system operators (DSOs), as well as solutions that are adopted by them for procuring flexibility. By combining insights from existing literature with interviews with European DSOs, we analyse these barriers and identify those requiring priority action. The paper provides policy guidance with practical recommendations to overcome these barriers, aiming to inform DSOs, policymakers, and field experts. The analysis focuses on the regulatory frameworks of five European countries-Bulgaria, Greece, Spain, Sweden, and Switzerland-highlighting the importance of incorporating the value of flexibility in DSOs' revenue models and mapping solutions for flexibility procurement. The findings underscore the need for regulatory incentives to drive digitalization and ensure efficient grid management, ultimately contributing to the acceleration of the energy transition.

Drawing on data collected during ethnographic fieldwork carried out between 2016 and 2018, this article addresses the role of intermediaries from migrant communities in the implementation of voluntary returns run by the International Organisation for Migration (IOM) from Morocco. The article explores the colonial legacies and contrasting effects of this singular form of intermediation in the context of migration. It develops the concept of “indigenous intermediation” by bringing together empirical data, migration studies, and historical works on colonial intermediation. In so doing, the article questions the “indigeneity” of intermediaries in relation to their target audience. It further sheds light on the conditions of emergence of this form of intermediation, as well as its underlying dynamics of racialised categorisation and identification. Finally, it highlights the diversity of practices resulting from indigenous intermediation.

En construction depuis plus de vingt ans, la politique européenne d’asile et d’immigration semble en panne en dépit d’un alignement des positions allemandes et française sur le sujet. La « crise migratoire » de 2015 a néanmoins souligné la fragilité de l’alliance franco-allemande et la timidité du soutien de la France à l’Allemagne confrontée à une situation exceptionnelle sur son territoire. Le couple franco-allemand éprouve des difficultés à convaincre ou à imposer à ses partenaires européens une ligne politique commune. Cela a amené des pays européens à contourner le cadre institutionnel européen pour faire face aux blocages des négociations sur l’avenir de la politique européenne d’asile et d’immigration. La Commission européenne a relancé ce chantier avec la présentation du pacte européen sur l’asile et l’immigration le 23 septembre 2020. La Commission espérait un accord politique sur les principaux aspects de ce texte sous l’autorité de la présidence allemande du Conseil de l’Union européenne. Néanmoins, cette dernière n’a pas permis d’avancées notables sur cette épineuse question. La France devra reprendre le flambeau en 2022 et tenter de faire progresser les négociations sur ce dossier dans un paysage européen en changement en raison des élections nationales allemandes et françaises.

Les financements européens jouent un rôle important dans le financement de l'économie locale et des territoires, qu'ils proviennent de la politique régionale ou de programmes gérés par la Commission européenne. Or, au niveau européen, comme le montrent les échanges en cours sur le futur cadre financier pluriannuel, l'équation budgétaire est de plus en plus complexe à résoudre – avec, d'un côté, des ressources en attrition (déficits publics, Brexit, etc.) et, d'un autre côté, des besoins en forte croissance (enjeux climatiques, migratoires, stratégiques, etc.). Dans ce contexte, une « nouvelle donne » émerge pour les financements européens au service des territoires dans les prochaines années : en termes de priorités, de modes d'interventions et d'interlocuteurs. Cette nouvelle donne devrait renforcer l'Europe des territoires, en rendant possible une distribution des financements européens au plus près des besoins locaux. Après avoir dressé un panorama des financements européens au service des territoires, nous mettons en évidence les principaux éléments de la « nouvelle donne » liée au futur cadre financier pluriannuel, avant de mettre en évidence le rôle croissant des investisseurs publics de long terme nationaux au service d'une Europe des territoires. Classification JEL : F02, F36, F55, R11 .