Setting the European standards for training in Physical and Rehabilitation Medicine.

The mission of the European Board of Physical and Rehabilitation Medicine (PRM) is to the ensure a consistent and high-level education for PRM physicians across Europe. An important action to accomplish this mission is the publication and continuous update of the European Training Requirements (ETRs) for the specialty of PRM. The first version of the ETRs for PRM was issued in 2017. The aim was to present the up-to-date training standards for trainees, trainers, and training institutions. The revision of the first ETRs, aiming to reflect the current standards in medical education and clinical advances in the field or PRM, started in 2022 and was completed in 2023. It was based on the Rehabilitation Competency Framework and the "Guide for using a contextualised competency framework to develop rehabilitation programmes and their curricula" published by the WHO in 2021. An important addition in the new version of the ETRs is the integration of Entrustable Professional Activities. In all endeavours of the creation of the ETRs, setting the highest standards of training in PRM was pursued.

Cochrane Rehabilitation: 2020 annual report.

During its fourth year of existence, Cochrane Rehabilitation went on to promote evidence-informed health decision-making in rehabilitation. In 2020, the outbreak of the COVID-19 pandemic has made it necessary to alter priorities. In these challenging times, Cochrane Rehabilitation has firstly changed its internal organisation and established a new relevant project in line with pandemic needs: the REH-COVER (Rehabilitation - COVID-19 evidence-based response) action. The aim was to focus on the timely collection, review and dissemination of summarised and synthesised evidence relating to COVID-19 and rehabilitation. Cochrane Rehabilitation REH-COVER action has included in 2020 five main initiatives: 1) rapid living systematic reviews on rehabilitation and COVID-19; 2) interactive living evidence map on rehabilitation and COVID-19; 3) definition of the research topics on "rehabilitation and COVID-19" in collaboration with the World Health Organization (WHO) rehabilitation programme; 4) Cochrane Library special collection on Coronavirus (COVID-19) rehabilitation; and 5) collaboration with COVID-END for the topics "rehabilitation" and "disability." Furthermore, we are still carrying on five different special projects: Be4rehab; RCTRACK; definition of rehabilitation for research purposes; ebook project; and a prioritization exercise for Cochrane Reviews production. The Review Working Area continued to identify and "tag" the rehabilitation-relevant reviews published in the Cochrane library; the Publication Working Area went on to publish Cochrane Corners, working more closely with the Cochrane Review Groups (CRGs) and Cochrane Networks, particularly with Cochrane Musculoskeletal, Oral, Skin and Sensory Network; the Education Working Area, the most damaged in 2020, tried to continue performing educational activities such as workshops in different online meetings; the Methodology Working Area organized the third and fourth Cochrane Rehabilitation Methodological (CRM) meetings respectively in Milan and Orlando; the Communication Working Area spread rehabilitation evidences through different channels and translated the contents in different languages.

Fostering the highest educational standards in Physical and Rehabilitation Medicine: The European PRM board strategy for ensuring overall quality of rehabilitation education and care.

The harmonization of staff education is a key element for ensuring the highest standard of rehabilitation care across Europe. With this aim, the European Union of Medical Specialists (UEMS) has created a Common Training Framework, which consists of a common set of knowledge, skills and competencies for postgraduate medical training. As a body linked to the Physical and Rehabilitation (PRM) Section of the UEMS, the European PRM Board is committed to promoting the harmonization of PRM physicians qualifications. The European PRM Board accomplishes this mission, not only by determining the theoretical knowledge necessary for the practice of the PRM specialty, and the core competencies (training outcomes) to be achieved at the end of training, but also by ascertaining that a standard level of education is achieved and maintained by PRM physicians, through a medically driven system of certification. This paper provides an overview of the methodology and outcomes of the European PRM Board examination, while showing how the approach to PRM education should be considered as a reference point by scientific societies, higher education institutions, health policymakers, patients associations, and all the other bodies caring for high-quality rehabilitation provision to disabled people, at the national and European level.

Overview and recommendations for regionalized life cycle impact assessment.

PURPOSE: Regionalized life cycle impact assessment (LCIA) has rapidly developed in the past decade, though its widespread application, robustness, and validity still faces multiple challenges. Under the umbrella of UNEP/SETAC Life Cycle Initiative, a dedicated cross-cutting working group on regionalized LCIA aims to provides an overview of the status of regionalization in LCIA methods. We give guidance and recommendations to harmonize and support regionalization in LCIA for developers of LCIA methods, LCI databases, and LCA software. METHOD: A survey of current practice among regionalized LCIA method developers was conducted. The survey included questions on chosen method spatial resolution and scale, the spatial resolution of input parameters, choice of native spatial resolution and limitations, operationalization and alignment with life cycle inventory data, methods for spatial aggregation, the assessment of uncertainty from input parameters and model structure, and variability due to spatial aggregation. Recommendations are formulated based on the survey results and extensive discussion by the authors. RESULTS AND DISCUSSION: Survey results indicate that majority of regionalized LCIA models have global coverage. Native spatial resolutions are generally chosen based on the availability of global input data. Annual modelled or measured elementary flow quantities are mostly used for aggregating characterization factors (CFs) to larger spatial scales, although some use proxies, such as population counts. Aggregated CFs are mostly available at the country level. Although uncertainty due to input parameter, model structure, and spatial aggregation are available for some LCIA methods, they are rarely implemented for LCA studies. So far, there is no agreement if a finer native spatial resolution is the best way to reduce overall uncertainty. When spatially differentiated models CFs are not easily available, archetype models are sometimes developed. CONCLUSIONS: Regionalized LCIA methods should be provided as a transparent and consistent set of data and metadata using standardized data formats. Regionalized CFs should include both uncertainty and variability. In addition to the native-scale CFs, aggregated CFs should always be provided, and should be calculated as the weighted averages of constituent CFs using annual flow quantities as weights whenever available. This paper is an important step forward for increasing transparency, consistency and robustness in the development and application of regionalized LCIA methods.

LCIA framework and cross-cutting issues guidance within the UNEP-SETAC Life Cycle Initiative.

Increasing needs for decision support and advances in scientific knowledge within life cycle assessment (LCA) led to substantial efforts to provide global guidance on environmental life cycle impact assessment (LCIA) indicators under the auspices of the UNEP-SETAC Life Cycle Initiative. As part of these efforts, a dedicated task force focused on addressing several LCIA cross-cutting issues as aspects spanning several impact categories, including spatiotemporal aspects, reference states, normalization and weighting, and uncertainty assessment. Here, findings of the cross-cutting issues task force are presented along with an update of the existing UNEP-SETAC LCIA emission-to-damage framework. Specific recommendations are provided with respect to metrics for human health (Disability Adjusted Life Years, DALY) and ecosystem quality (Potentially Disappeared Fraction of species, PDF). Additionally, we stress the importance of transparent reporting of characterization models, reference states, and assumptions, in order to facilitate cross-comparison between chosen methods and indicators. We recommend developing spatially regionalized characterization models, whenever the nature of impacts shows spatial variability and related spatial data are available. Standard formats should be used for reporting spatially differentiated models, and choices regarding spatiotemporal scales should be clearly communicated. For normalization, we recommend using external normalization references. Over the next two years, the task force will continue its effort with a focus on providing guidance for LCA practitioners on how to use the UNEP-SETAC LCIA framework as well as for method developers on how to consistently extend and further improve this framework.

Reliability of maximal grip strength measurements and grip strength recovery following a stroke.

STUDY DESIGN: Clinical measurement. PURPOSE: The test-retest reliability of maximal grip strength measurements (MGSM) is examined in subjects for 12 weeks post-stroke together with maximal grip strength recovery and the maximal-grip and upper-extremity strength measurements' relationship with capacity and performance test scores. METHODS: A Jamar dynamometer and the Motricity Index (MI) were used for strength measurements. The Chedoke Arm and Hand Activity Inventory and ABILHAND questionnaire for evaluating capacities and performances. RESULTS: MGSM were reliable (Intraclass Correlation Coefficients = 0.97-0.99, Minimal Detectable Differences = 2.73-4.68 kg). Among the 34 participants, 47% did not have a measurable grip strength one week post-stroke but 50% of these recovered some strength within the first eight weeks. The MGSM and MI scores were correlated with scores of tests of capacity and performance (Spearman's Rank Correlation Coefficients = 0.69-0.94). CONCLUSIONS: MGSM are reliable in the first weeks after a stroke. LEVEL OF EVIDENCE: N/A.

Auditory spatial deficits following hemispheric lesions: dissociation of explicit and implicit processing.

Auditory spatial deficits occur frequently after hemispheric damage; a previous case report suggested that the explicit awareness of sound positions, as in sound localisation, can be impaired while the implicit use of auditory cues for the segregation of sound objects in noisy environments remains preserved. By assessing systematically patients with a first hemispheric lesion, we have shown that (1) explicit and/or implicit use can be disturbed; (2) impaired explicit vs. preserved implicit use dissociations occur rather frequently; and (3) different types of sound localisation deficits can be associated with preserved implicit use. Conceptually, the dissociation between the explicit and implicit use may reflect the dual-stream dichotomy of auditory processing. Our results speak in favour of systematic assessments of auditory spatial functions in clinical settings, especially when adaptation to auditory environment is at stake. Further, systematic studies are needed to link deficits of explicit vs. implicit use to disability in everyday activities, to design appropriate rehabilitation strategies, and to ascertain how far the explicit and implicit use of spatial cues can be retrained following brain damage.

Cumulative energy demand as predictor for the environmental burden of commodity production.

Cumulative energy demand has been used as a methodology to assess life cycle environmental impacts of commodity production since the early seventies, but has also been criticized because it focuses on energy only. During the past 30 years there has been much research into the development of more complex single-score life cycle impact assessment methodologies. However, a comprehensive analysis of potential similarities and differences between these methodologies and cumulative energy demand has not been carried out so far. Here we compare the cumulative energy demand of 498 commodities with the results of six frequently applied environmental life cycle impact assessment methodologies. Commodity groups included are metals, glass, paper and cardboard, organic and inorganic chemicals, agricultural products, construction materials, and plastics. We show that all impact assessment methods investigated often provide converging results, in spite of the different philosophies behind these methodologies. Fossil energy use is identified by all methodologies as the most important driver of environmental burden of the majority of the commodities included,with the main exception of agricultural products. We conclude that a wide range of life cycle environmental assessment methodologies point into the same environmental direction for the production of many commodities.

Patterns of recovery following focal hemispheric lesions: relationship between lasting deficit and damage to specialized networks.

PURPOSE: Cognitive deficits that are present in the acute stage of a focal hemispheric lesion tend to be greater and more general than residual deficits, which persist into the chronic stage. We have investigated the patterns of recovery and the relationship between deficits and damage to specialized networks taking as model auditory cognitive functions. Evidence from human psychophysical, activation and neuropsychological studies suggests that sound recognition and sound localization are processed in anatomically and functionally distinct cortical networks, the auditory "What" and "Where" processing streams, that are each present in both hemispheres. Focal left or right hemispheric lesions centred on these networks were found to be associated, in the chronic stage, with the corresponding deficits in sound recognition and/or sound localization. METHODS: We report here on recovery patterns in 24 patients who sustained focal hemispheric lesions and were deficient in sound recognition, sound localization and/or sound motion perception at a first evaluation in the acute (n=9), subacute (n=6) or early chronic stages (n=9). RESULTS: All 24 patients had initially a deficit in sound localization and/or sound motion perception. In the acute stage this deficit occurred without damage to the auditory "Where" stream in almost half of the patients, a situation which was never observed in the early chronic stage. Lack of recovery tended to be associated with damage to the specialized stream plus the persistence of deficits beyond the acute stage, and was only loosely related to the size of the lesion and to the extent of damage to a specialized network. CONCLUSIONS: Our results suggest that different mechanisms underlie deficits and recovery at different time points.

Is cumulative fossil energy demand a useful indicator for the environmental performance of products?

The appropriateness of the fossil Cumulative Energy Demand (CED) as an indicator for the environmental performance of products and processes is explored with a regression analysis between the environmental life-cycle impacts and fossil CEDs of 1218 products, divided into the product categories "energy production", "material production", "transport", and "waste treatment". Our results show that, for all product groups but waste treatment, the fossil CED correlates well with most impact categories, such as global warming, resource depletion, acidification, eutrophication, tropospheric ozone formation, ozone depletion, and human toxicity (explained variance between 46% and 100%). We conclude that the use of fossil fuels is an important driver of several environmental impacts and thereby indicative for many environmental problems. It maytherefore serve as a screening indicatorfor environmental performance. However, the usefulness of fossil CED as a stand-alone indicator for environmental impact is limited by the large uncertainty in the product-specific fossil CED-based impact scores (larger than a factor of 10 for the majority of the impact categories; 95% confidence interval). A major reason for this high uncertainty is nonfossil energy related emissions and land use, such as landfill leachates, radionuclide emissions, and land use in agriculture and forestry.

Unilateral hemispheric lesions disrupt parallel processing within the contralateral intact hemisphere: an auditory fMRI study.

Evidence from activation studies suggests that sound recognition and localization are processed in two distinct cortical networks that are each present in both hemispheres. Sound recognition and/or localization may, however, be disrupted by purely unilateral damage, suggesting that processing within one hemisphere may not be sufficient or may be disturbed by the contralateral lesion. Sound recognition and localization were investigated psychophysically and using fMRI in patients with unilateral right hemisphere lesions. Two patients had a combined deficit in sound recognition and sound localization, two a selective deficit in sound localization, one a selective deficit in sound recognition, and two normal performance in both tasks. The overall level of activation in the intact left hemisphere of the patients was smaller than in normal control subjects, irrespective of whether the patient's performance in the psychophysical tasks was impaired. Despite this overall decrease in activation strength, patients with normal performance still exhibited activation patterns similar to those of the control subjects in the recognition and localization tasks, indicating that the specialized brain networks subserving sound recognition and sound localization in normal subjects were also activated in the patients with normal performance, albeit to an altogether lesser degree. In patients with deficient performance, on the other hand, the activation patterns during the sound recognition and localization tasks were severely reduced, comprising fewer and partly atypical activation foci compared to the normal subjects. This indicates that impaired psychophysical performance correlates with a breakdown of parallel processing within specialized networks in the contralesional hemisphere.

Sound recognition and localization in man: specialized cortical networks and effects of acute circumscribed lesions.

Functional imaging studies have shown that information relevant to sound recognition and sound localization are processed in anatomically distinct cortical networks. We have investigated the functional organization of these specialized networks by evaluating acute effects of circumscribed hemispheric lesions. Thirty patients with a primary unilateral hemispheric lesion, 15 with right-hemispheric damage (RHD) and 15 with left-hemispheric damage (LHD), were evaluated for their capacity to recognise environmental sounds, to localize sounds in space and to perceive sound motion. One patient with RHD and 2 with LHD had a selective deficit in sound recognition; 3 with RHD a selective deficit in sound localization; 2 with LHD a selective deficit in sound motion perception; 4 with RHD and 3 with LHD a combined deficit of sound localization and motion perception; 2 with RHD and 1 with LHD a combined deficit of sound recognition and motion perception; and 1 with LHD a combined deficit of sound recognition, localization and motion perception. Five patients with RHD and 6 with LHD had normal performance in all three domains. Deficient performance in sound recognition, sound localization and/or sound motion perception was always associated with a lesion that involved the shared auditory structures and the specialized What and/or Where networks, while normal performance was associated with lesions within or outside these territories. Thus, damage to regions known to be involved in auditory processing in normal subjects is necessary, but not sufficient for a deficit to occur. Lesions of a specialized network was not always associated with the corresponding deficit. Conversely, specific deficits tended not be associated predominantly with lesions of the corresponding network; e.g. deficits in auditory spatial tasks were observed in patients whose lesions involved to a larger extent the shared auditory structures and the specialized What network than the specialized Where network, and deficits in sound recognition in patients whose lesions involved mostly the shared auditory structures and to a varying degree the specialized What network. The human auditory cortex consists of functionally defined auditory areas, whose intrinsic organization is currently not understood. In particular, areas involved in the What and Where pathways can be conceived as: (1) specialized regions, in which lesions cause dysfunction limited to the damaged part; observed deficits should be then related to the specialization of the damaged region and their magnitude to the extent of the damage; or (2) specialized networks, in which lesions cause dysfunction that may spread over the two specialized networks; observed deficits may then not be related to the damaged region and their magnitude not proportional to the extent of the damage. Our results support strongly the network hypothesis.