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STUDY QUESTION: Can human pre-antral follicles isolated enzymatically from surplus medulla tissue survive and grow in vitro during long-term 3D culture? SUMMARY ANSWER: Secondary human follicles can develop to small antral follicles and remain hormonally active in an alginate-encapsulation culture system for more than 30 days. WHAT IS KNOWN ALREADY: Ovarian tissue cryopreservation followed by transplantation is a promising fertility preservation approach for cancer patients. However, transplantation of cryopreserved tissue to patients may carry the risk of re-implanting malignant cells. Grafting of follicles enzymatically isolated from ovarian tissue or developing a method for follicular culture and maturation in vitro may provide fertility to such patients without the risk of reintroducing the malignancy. However, the growth of pre-antral follicles isolated by enzymatic digestion from medulla tissue during long-term culture has received only little attention. STUDY DESIGN, SIZE, DURATION: Two to ten human pre-antral follicles were encapsulated together within an alginate bead and cultured with or without ovarian interstitial tissue for either 7 days or >30 days. Follicles were cultured in either 20% oxygen or 5% oxygen or encapsulated in a lower concentration of alginate together with a lower concentration of FSH in high oxygen. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 395 pre-antral follicles from 16 cancer patients, aged 9-37 years, were co-cultured for either 7 days or >30 days. A proportion of follicle (64) were removed from culture on Day 7 and assessed for viability using confocal fluorescence microscopy following calcein-AM and ethidium homodimer-1 staining or histology. The remaining follicles (331) were continued in culture for >30 days then assessed for survival and growth. Anti-Müllerian hormone (AMH) and estradiol levels were quantified in the medium. MAIN RESULTS AND THE ROLE OF CHANCE: An optimized protocol for isolation of intact healthy pre-antral follicles from ovarian medulla was developed. After 7 days of culture, secondary follicles had a significantly higher survival rates compared with primary and primordial follicles (70 versus <38%). Primordial and primary follicles did not develop into the antral follicle stage. In contrast, secondary follicles continued to develop in all culture conditions examined. Based on growth rate and morphology, four distinct cohorts of surviving follicles, 'fast growth', 'slow growth', 'no growth' and 'extruded oocyte' were identified. From Day 1 to Day 30, the mean diameter of follicles increased from 184 ± 35 to 661 ± 120 μm (significant from Day 18), 145 ± 19 to 318 ± 68 μm and 136 ± 15 to 162 ± 25 μm (mean ± SD) in the 'fast growth', 'slow growth' and 'no growth' patterns, respectively. The fast growth follicles also contained a larger diameter oocyte than other follicle groups. From the pre-antral follicle to antral stage, follicles became steroidogenically active and secretion of AMH and estradiol increased. No significant difference between the follicles cultured with or without ovarian interstitial tissue was observed. LIMITATIONS, REASONS FOR CAUTION: The number of surviving follicles at the end of study was low in each of the culture conditions therefore whether there is a benefit with any of the conditions is difficult to ascertain. Multiple pre-antral follicles were cultured within the same alginate bead which may affect the in vitro development of the secondary follicles. WIDER IMPLICATIONS OF THE FINDINGS: These findings show that pre-antral follicles, isolated enzymatically from surplus medulla tissue that is normally discarded, possess a developmental potential which may be used to devise safer fertility preservation methods for patients who are at high risk of malignant contamination of their ovarian tissue. STUDY FUNDING/COMPETING INTERESTS: The Child Cancer Foundation in Denmark (2012-26) and the EU interregional project ReproHigh are thanked for having funded this study; and the Key Program of Medical Science and Technology Innovation of Nanjing Military Area Command in China (14ZX06; 11Z010). They had no role in the study design, collection and analysis of data, data interpretation or in writing the report. The authors have no conflicts of interest to disclose.

ObjectiveTo describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission.DesignA cross-sectionalStudy designutilizing administrative data.Setting and participantsRandomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey).Main outcome measuresCompleteness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery.ResultsIn general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators.ConclusionsAt present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.

The Acknowledgements section in this Article is incomplete. "The authors thank Camilla Skånstrøm Dall and Tina Maria Estrup Axen for technical assistance. This project was supported by Advokat Bent Thorbergs Fond." should read: "The authors thank Camilla Skånstrøm Dall and Tina Maria Estrup Axen for technical assistance. This project was supported by Advokat Bent Thorbergs Fond. This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 642720."

RESULTS: Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures.CONCLUSIONS: This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.INTRODUCTION AND OBJECTIVE: This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study.DESIGN: DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries.SETTING AND PARTICIPANTS: We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30.MAIN OUTCOME MEASURES: A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure).

[EN] The contribution of small farms to local food supply, food security and food sovereignty is widely acknowledged at a global level. In the particular case of Europe, they often are seen as an alternative to large and specialised farms. Assessing the real role of small farms has been limited by a lack of information, as small farms are frequently omitted from agricultural censuses and national statistics. It is also well acknowledged that small farms differ widely, and are distributed according to different spatial patterns across Europe, fulfilling different roles according to the agriculture and territorial characteristics of each region. This paper presents the result of a novel classification of small farms at NUTS-3 level in Europe, according to the relevance of small farms in the agricultural and territorial context of each region, and based on a typology of small farms considering different dimensions of farm size. The maps presented result from an extensive data collection and variables selected according to European wide expert judgement, analysed with advanced cluster procedures. The results provide a fine grained picture of the role of small farms at the regional level in Europe today, and are expected to support further data analysis and targeted policy intervention. ; This work was supported by the SALSA project (Small farms, small food businesses and sustainable food and nutrition security) (Project ID: 677,363) funded under H2020-EU.3.2. Societal Challenges - Food security, sustainable agriculture and forestry, marine, maritime and inland water research and the bioeconomy; and by FEDER Funds through the Operational Programme for Competitiveness Factors - COMPETE and National Funds through FCT - Foundation for Science and Technology. Helen Sooväli-Sepping was funded by the Estonian Ministry of Education target-financed project IUT3-2 Culturescapes in transformation: towards an integrated theory of meaning making. ; Guiomar, N.; Godinho, S.; Pinto-Correia, T.; Almeida, M.; Bartolini, F.; Bezák, ...

784 798 75 ; S ; [EN] The contribution of small farms to local food supply, food security and food sovereignty is widely acknowledged at a global level. In the particular case of Europe, they often are seen as an alternative to large and specialised farms. Assessing the real role of small farms has been limited by a lack of information, as small farms are frequently omitted from agricultural censuses and national statistics. It is also well acknowledged that small farms differ widely, and are distributed according to different spatial patterns across Europe, fulfilling different roles according to the agriculture and territorial characteristics of each region. This paper presents the result of a novel classification of small farms at NUTS-3 level in Europe, according to the relevance of small farms in the agricultural and territorial context of each region, and based on a typology of small farms considering different dimensions of farm size. The maps presented result from an extensive data collection and variables selected according to European wide expert judgement, analysed with advanced cluster procedures. The results provide a fine grained picture of the role of small farms at the regional level in Europe today, and are expected to support further data analysis and targeted policy intervention. This work was supported by the SALSA project (Small farms, small food businesses and sustainable food and nutrition security) (Project ID: 677,363) funded under H2020-EU.3.2. Societal Challenges - Food security, sustainable agriculture and forestry, marine, maritime and inland water research and the bioeconomy; and by FEDER Funds through the Operational Programme for Competitiveness Factors - COMPETE and National Funds through FCT - Foundation for Science and Technology. Helen Sooväli-Sepping was funded by the Estonian Ministry of Education target-financed project IUT3-2 Culturescapes in transformation: towards an integrated theory of meaning making. Guiomar, N.; Godinho, S.; Pinto-Correia, T.; Almeida, M.; Bartolini, ...