Salutogenesis Post-Graduate Education: Experience From the European Perspective on the ETC-PHHP Health Promotion Summer Schools (1991–2020)

In this chapter, the authors, representing The Netherlands, Spain, Germany, Italy, Norway, the United Kingdom and Poland, trace the development of higher education in salutogenesis in Europe, spanning 30 years. At this time, the annual summer schools of the European Training Consortium in Public Health and Health Promotion (ETC-PHHP) have trained more than 700 participants from 60 countries. Perhaps the most distinguished member of the summer school’s faculty – at least from the perspective of advancing salutogenesis as a theory for health promotion – is Aaron Antonovsky, who participated in the 1992 edition of the course in Gothenburg, Sweden.

Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

Background The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. Methods Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. Results The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. Conclusion Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.

First steps towards international competency goals for residency training: a qualitative comparison of 3 regional standards in anesthesiology

Background Competency-based medical education (CBME) has revolutionized approaches to training by making expectations more concrete, visible, and relevant for trainees. Designing, applying, and updating CBME requirements challenges residency programs, which must address many aspects of training simultaneously. This challenge also exists for educational regulatory bodies in creating and adjusting national competencies to standardize training expectations. We propose that an international approach for mapping residency training requirements may provide a baseline for assessing commonalities and differences. This approach allows us to take our first steps towards creating international competency goals to enhance sharing of best practices in education and clinical work. Methods We chose anesthesiology residency training as our example discipline. Using two rounds of content analysis, we qualitatively compared published anesthesiology residency competencies for the European Union (The European Training Requirement), United States (ACGME Milestones), and Canada (CanMEDS Competence By Design), focusing on similarities and differences in representation (round one) and emphasis (round two) to generate hypotheses on practical solutions regarding international educational standards. Results We mapped the similarities and discrepancies between the three repositories. Round one revealed that 93% of competencies were common between the three repositories. Major differences between European Training Requirement, US Milestones, and Competence by Design competencies involved critical emergency medicine. Round two showed that over 30% of competencies were emphasized equally, with notable exceptions that European Training Requirement emphasized Anaesthesia Non-Technical Skills, Competence by Design highlighted more granular competencies within specific anesthesiology situations, and US Milestones emphasized professionalism and behavioral practices. Conclusions This qualitative comparison has identified commonalities and differences in anesthesiology training which may facilitate sharing broader perspectives on diverse high-quality educational, clinical, and research practices to enhance innovative approaches. Determining these overlaps in residency training can prompt international educational societies responsible for creating competencies to collaborate to design future training programs. This approach may be considered as a feasible method to build an international core of residency competency requirements for other disciplines.

Training of Remotely Piloted Aircraft Operators for Border Surveillance in Ukraine based on the European Union Standards

The study reveals the theoretical and practical approaches to building of an all-European training strategy for remotely piloted aircraft systems (RPAS) operators to increase their interoperability in the European Union countries and Ukraine. Nowadays, the border guard agencies both in EU and Ukraine have developed their national courses and training programs related to training of RPAS operators, however, the proposed in this study common approach is based on the Sectoral Qualification Framework in the field of border protection and Common Core Curriculum for border guards in EU and is aimed at expanding the use of small RPAS for a specific task of protecting the border sectors of various types (land, sea, air) in accordance with the Concept of European Integrated Border Management. The research was carried out in the frames of the Grant Program of the European Agency for Border and Coast Protection Frontex "The use of RPAS for border protection - tactics, guidelines, best practices". The study covers the analysis of the theory, market solutions, takes into account practical border protection experience, which resulted in creation of a common curricula for operators of RPAS in the specific sphere – surveillance of the state borders. The developed training course for RPAS operators provides an opportunity to train external crews of unmanned aerial vehicles, which will best meet the objectives and peculiar needs of the state border protection agencies of the European Union and Ukraine. The readiness of future RPAS operators to perform professional duties on border surveillance was diagnosed according to cognitive (knowledge formation) and operational (skills and abilities formation) criteria. Comparison of the values of these criteria before and after the formative stage of the experiment shows that the experimental measures for the application of best European practices in the training of RPAS operators have positively affected the quality of their training. The results of the study will help strengthen the state border security within the European context of border guarding by means of increasing the level of interoperability of RPAS operators in the EU countries and Ukraine.

MEMO2: MEthane goes MObile – MEasurements and MOdelling

&lt;p&gt;MEMO&lt;sup&gt;2&lt;/sup&gt; was a 4-years European Training Network with more than 20 collaborators from 7 countries. The project contributed significantly to the targets of the EU with a focus on methane (CH&lt;sub&gt;4&lt;/sub&gt;). CH&lt;sub&gt;4&lt;/sub&gt; emissions are a major contributor to Europe&amp;#8217;s global warming impact, and the official inventories of emissions and estimates derived from direct atmospheric measurement show significant discrepancies. However, effective emission reduction can only be achieved if sources are properly quantified, and mitigation efforts are verified. MEMO&lt;sup&gt;2&lt;/sup&gt; contributed to advanced combinations of measurement and modelling which are needed to achieve such quantification.&lt;/p&gt;&lt;p&gt;With respect to the recently released&amp;#160;EU methane strategy&amp;#160;and the implementation of independent verification of&amp;#160;emissions by atmospheric measurements, we will present some examples of relevant results from MEMO&lt;sup&gt;2&lt;/sup&gt; up to now:&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Urban CH&lt;sub&gt;4&lt;/sub&gt;&amp;#160;emissions:&lt;/strong&gt;&amp;#160;We can now detect and quantify CH&lt;sub&gt;4&lt;/sub&gt;&amp;#160;leaks in cities at the street-level with mobile nigh precision analysers. Similar studies have been carried out in &gt;10 EU cities and in collaboration with interested network operators those measurements are ready to be rolled out at larger scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Oil and gas production:&lt;/strong&gt;&amp;#160;We carried out a large&amp;#160;study in the oil and gas production region in Romania (ROMEO), with aircraft, drones and vehicles. The final results are close to publication and help to improve the emission verification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Coal mining:&lt;/strong&gt;&amp;#160;In collaboration with&amp;#160;CoMet, another science project, we quantified the CH&lt;sub&gt;4&lt;/sub&gt; emissions from the Upper Silesian coal mining area. The collaboration and its results contribute to the development of an independent and objective emission monitoring system&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Modelling:&lt;/strong&gt; Micro-scale plume modelling is significantly improved. Those models e.g. help to simulate a measurement day as we had during our field campaign in Romania and improve sampling and measurement strategies.&lt;/p&gt;

Leveraging fine-mapping and non-European training data to improve trans-ethnic polygenic risk scores

Polygenic risk scores (PRS) based on European training data suffer reduced accuracy in non-European target populations, exacerbating health disparities. This loss of accuracy predominantly stems from LD differences, MAF differences (including population-specific SNPs), and/or causal effect size differences. Here, we propose PolyPred, a method that improves trans-ethnic polygenic prediction by combining two complementary predictors: a new predictor that leverages functionally informed fine-mapping to estimate causal effects (instead of tagging effects), addressing LD differences; and BOLT-LMM, a published predictor. In the special case where a large training sample is available in the non-European target population (or a closely related population), we propose PolyPred+, which further incorporates the non-European training data, addressing MAF differences and causal effect size differences. We applied PolyPred to 49 diseases and complex traits in 4 UK Biobank populations using UK Biobank British training data (average N=325K), and observed statistically significant average relative improvements in prediction accuracy vs. BOLT-LMM ranging from +7% in South Asians to +32% in Africans (and vs. LD-pruning + P-value thresholding (P+T) ranging from +77% to +164%), consistent with simulations. We applied PolyPred+ to 23 diseases and complex traits in UK Biobank East Asians using both UK Biobank British (average N=325K) and Biobank Japan (average N=124K) training data, and observed statistically significant average relative improvements in prediction accuracy of +24% vs. BOLT-LMM and +12% vs. PolyPred. In conclusion, PolyPred and PolyPred+ improve trans-ethnic polygenic prediction accuracy, ameliorating health disparities.