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Background European cancer programmes and policies lack a unified health-related quality of life (HRQoL) assessment tool. The European oncology quality of life toolkit (EUonQoL-Kit) is a novel set of HRQoL questionnaires, co-designed with cancer patients and survivors, translated and culturally adapted into 31 European languages, and with both static and dynamic electronic administration modes. The main aim of this study is the psychometric assessment of the static version. Secondary aims include evaluating the EUonQoL-Kit acceptability, cross-validating the administration modes, exploring individual factors potentially affecting HRQoL and HRQoL inequalities between countries. Methods A sample of 4,500 participants, including three groups (active treatment, survivors, and palliative care) from 45 centres in 25 EU Member States and 7 associated countries, will be enrolled in a multicentre observational cross-sectional study. All participants will complete the static EUonQoL-Kit; three subsamples (each 10% of the total sample) will also respectively complete the following: a) dynamic EUonQoL-Kit, based on Item Response Theory (IRT)/Computer Adaptive Testing (CAT), b) FACT-G and EQ-5L-5D, and c) static EUonQoL-Kit (re-test). Psychometric analyses will encompass exploratory and confirmatory factor analyses (measurement model and structural validity), Cronbach's alpha (internal consistency), intraclass correlation coefficient (test–retest reliability), Pearson/Spearman correlation (concurrent validity), comparison of group scores (construct validity), and Differential Item Functioning (cross-country item equivalence). Secondary analyses will evaluate participant response time and rate, and static/dynamic score differences. Regression models will estimate associations between individual factors and HRQoL. Discussion The EUonQoL-Kit will serve to systematically incorporate patient perspectives into European cancer policies and to address HRQoL inequalities across Europe. Trial registration ClinicalTrials.gov Identifier: NCT05947903, 2023–06-28.

Exploring both ecological and political-economic histories sheds light on the long-term effects of social and environmental changes. Wetlands provide an excellent context for examining the re-working of society-nature relations in a landscape over a long duration. Wetland conditions and social-ecological dynamics show changes rapidly and visibly because they are frequently re-engineered to account for changes in both technology and social preferences. Wetlands are subject to multiple, concurrent property and access regimes that have consequences for both management and ecosystem health. We discuss the social-natural history of the Scamandre Marshes in the western part of the Camargue Biosphere Reserve using a historical political ecology approach to analyze the shifting dynamics between power relations under a variety of political-economic arrangements, and the ecology of the marsh environment. The approach highlights how historical political ecology is a means of identifying historical socio-natures and how European or national conservation actors’ constructions of a place as “natural” affect its use, conservation, and management. We show that contemporary ecological dynamics are best explained by past conflicts related to property claims, access to natural resources, and their effects on the flows and composition of water in the marsh. A general model of wetland transformation stresses repeated cycles of stability and upheaval, emphasizing that the lack of historical analysis threatens both wetlands and conflict resolution. No landscape is produced locally or ahistorically. We emphasize here that history is not only a hallmark of political ecology, but a way of understanding ecological changes that can help advance biodiversity conservation science and policy.

The biological carbon pump (BCP), involving photosynthesis at the surface and remineralisation at depth, maintains a significant vertical gradient in dissolved inorganic carbon (DIC), thereby promoting the ocean's ability to absorb atmospheric CO2. Remineralised DIC is a good indicator of the strength of the BCP. It can be estimated from apparent oxygen utilisation (AOU), which measures the deficit of oxygen relative to saturation. AOU is projected to increase under climate change due to changes in remineralisation rates and ventilation. However, the amplitude of the change remains uncertain. Here, we identify linear relationships between trends in AOU and ideal-age in the deep ocean, based on simulations of the contemporary (1982–2013) and future (2015–2099) periods from five Earth system models (ESMs). Our analysis underscores the substantial role of ventilation slowdown in increasing remineralised DIC. Furthermore, the study highlights considerable inter-model variability in their sensitivity of AOU to age changes, with this sensitivity remaining relatively stable over time. With more observational data, refined estimates of age changes from ocean tracers and a larger model ensemble, constraining this variability will become feasible. These insights emphasise both the challenges and opportunities for constraining future BCP projections arising from uncertainties in ventilation.

Background: Patients with cancer often have to make complex decisions about treatment, with the options varying in risk profiles and effects on survival and quality of life. Moreover, inefficient care paths make it hard for patients to participate in shared decision-making. Data-driven decision-support tools have the potential to empower patients, support personalized care, improve health outcomes and promote health equity. However, decision-support tools currently seldom consider quality of life or individual preferences, and their use in clinical practice remains limited, partly because they are not well integrated in patients’ care paths. Aim and objectives: The central aim of the 4D PICTURE project is to redesign patients’ care paths and develop and integrate evidence-based decision-support tools to improve decision-making processes in cancer care delivery. This article presents an overview of this international, interdisciplinary project. Design, methods and analysis: In co-creation with patients and other stakeholders, we will develop data-driven decision-support tools for patients with breast cancer, prostate cancer and melanoma. We will support treatment decisions by using large, high-quality datasets with state-of-the-art prognostic algorithms. We will further develop a conversation tool, the Metaphor Menu, using text mining combined with citizen science techniques and linguistics, incorporating large datasets of patient experiences, values and preferences. We will further develop a promising methodology, MetroMapping, to redesign care paths. We will evaluate MetroMapping and these integrated decision-support tools, and ensure their sustainability using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We will explore the generalizability of MetroMapping and the decision-support tools for other types of cancer and across other EU member states. Ethics: Through an embedded ethics approach, we will address social and ethical issues. Discussion: Improved care paths integrating comprehensive decision-support tools have the potential to empower patients, their significant others and healthcare providers in decision-making and improve outcomes. This project will strengthen health care at the system level by improving its resilience and efficiency. Plain language summary Improving the cancer patient journey and respecting personal preferences: an overview of the 4D PICTURE project The 4D PICTURE project aims to help cancer patients, their families and healthcare providers better undertstand their options. It supports their treatment and care choices, at each stage of disease, by drawing on large amounts of evidence from different types of European data. The project involves experts from many different specialist areas who are based in nine European countries. The overall aim is to improve the cancer patient journey and ensure personal preferences are respected.