While the need for integrating palliative care (PC) services into heart failure (HF) care has been well recognised, as of yet this integration lacks behind, especially when compared to cancer care. Currently, only 5-7% of patients with HF utilise PC services, due to a focus on optimising therapy and an unpredictable disease trajectory with exacerbations which hampers prognosis. As a result, many symptoms and concerns that are not directly related to HF are not recognised and undertreated and patients are often referred to PC services only at the very end of their lives. The RAPHAEL consortium sets out to take the next big step in integrating PC into HF care by integrating the RAPHAEL palliative care approach in existing HF care pathways. This flexible and patient centred approach starts with the identification of multidimensional symptoms and concerns, prioritise needs with patient and informal carer and formulate a proactive care plan. The symptoms and concerns will be monitored by the patient at home using the PAL@HEART application. The app can be used to evaluate interventions, support communication and earl identify new or increasing needs. As a result, the care needs of each individual patient with HF are addressed faster and better, improving their quality of life and autonomy. Moreover, this will lead to a reduction in emergency hospitalisations, unburdening the healthcare system and reducing costs. The RAPHAEL project sets out to adapt the RAPHAEL approach to HF care within a European context and test and validate its (cost-)effectiveness via a feasibility and large-scale evaluation study performed in 7 EU countries, the UK and Switzerland. It brings together experts in palliative care, cardiology, and primary care as well as professional organisations and patient representatives. Together the RAPHAEL consortium is uniquely situated to demonstrate the (cost-)effectiveness of the RAPAHEL approach and launch its implementation in Europe and beyond.

Background Health systems face a time of unprecedented change, with spiraling costs, increasing cultural disparity in access to healthcare and research, and an infrastructure that is decades old. Today, telehealth is a realistic alternative making care and research more accessible and personalised with less burden to better support the most vulnerable and under-served in our society. The ability to test and monitor for illnesses using Patient Centric micro-Sampling (PCmS) is at the centre of this reform. Aim and main objectives This project is designed to build upon existing pilots and knowledge, then collaborate cross-sectorially to co-create and test the logistics, infrastructure and tools required to make PCmS a core healthcare tool and an acceptable alternative to venous blood-draw across Europe. This project aligns with many IHI’s objectives focusing on cross-sectorial collaboration, emphasizing patient and end-user- centric co-design of outputs, harmonised regulatory and data generation approaches enhancing the potential of digital innovations in healthcare, while aiming to reduce the environmental footprint during the project and in final outputs to ensure that the expected long-term impact is a reachable reality that will deliver significant benefit to the community and address unmet public health needs at scale. To achieve our objectives, we bring together a broad group of required expertise, know-how and end-users (i.e., public and patients) to form a public-private-partnership specifically equipped to tackle this challenge. This collaborative approach where the relevant stakeholders such as healthcare professionals, regulatory agencies and patients are involved and integrated to deliver solutions and innovation across healthcare systems and ensure the best chances for success and long-term positive impact from this project. Key deliverables include: 1) An optimized, tested and validated ‘Gold Standard’ infrastructure and workflow for PCmS across Europe as a proven and reliable alternative to venipuncture 2) Harmonised and clear regulatory and HTA pathways, standards and acceptability, measures and cost-benefit models across Europe 3) Documented evidence to draw a citable ‘line in the sand’ for future research to support decisions to integrate PCmS into decentralised trials and care pathways 4) Stakeholder engagement and patient involvement models and research on preferences and acceptability for PCmS 5) Foundation for future: Enable access to the developed PCmS scientific findings, tools and assessment measures for rapid uptake and integration of PCmS approaches into decentralised clinical studies and healthcare Expected impact: - Patient-centric microsampling becomes an accepted alternative to the current standard of care venipuncture and the data gathered can be leveraged in healthcare planning. - Lowered patient burden and lowered barrier to access in situations where blood samples need to be collected, whether as part of diagnosis, care plan, health monitoring etc. - A solution to leverage high amounts of data gathered from increased testing can be explored already in this project so that it can pave the way for future research that can improve health outcomes.

PREVENT improves upscaling of primary interventions for weight control management during childhood and adolescence to reduce cancer risks in adulthood. This relies on current evidence that relates excess body weight with increased cancer risk. Towards this end, PREVENT applies a series of implementation research actions in the following directions. First, it identifies barriers to current interventions and policies preventing them from upscaling to different geographical, socio-economic, and cultural settings. Then, it introduces new multi-actor and context-aware interventions along with new user engagement strategies to face the current upscaling bottlenecks; multi-actor in the sense that they target different types of users (e.g., students, family, educators, policymakers) and context-aware in the sense that PREVENT interventions are tailored to the specific implementation places (class, canteen, sports fields, labs, outside school). The PREVENT new policies are adapted, piloted, and scaled up within the schools’ communities of three European countries facing different epidemiological settings on childhood obesity, geographic, socio-economic and cultural attributes. The pilots are designed to be holistic end-to-end ecosystems, including users, medical professionals, policymakers, public authorities, and civil communities. They focus on the whole school communities of Greece, Sweden, and Spain-Catalonia, that is, PREVENT outreach to more than 3.3 million students, required for guideline provisioning, large-scale implementation, multi-parameter assessment, and scaling-up. Co-creation, active behavioral change, self-evaluation through user empowerment, motivational interviewing, social innovation, digital-assistive engagement, health apps, and multi-domain assessment are implementation research aspects of PREVENT to advance user acceptability and compatibility with existing policies, and thus improve sustainability and upscaling. This action is part of the Cancer Mission cluster of projects on "Prevention and Early Detection".

The END-VOC consortium will support the European and global response to the COVID-19 pandemic and Variants of Concern (VOC) through well characterised cohorts and linked with existing European and international initiatives. END-VOC consists of 19 partners in Europe (UK, Spain, Italy, Germany, Netherlands, Norway, Italy), South America (Brazil and Peru), Africa (Mozambique, South Africa, Nigeria and 13 ANTICOV African countries), Middle East (Palestine) and Asia (India, Pakistan, Philippines) with a focus on countries affected by VOCs and VOIs. We will elucidate the global circulation of the current and emerging SARS-CoV-2 VOCs and their characteristics, including transmissibility, pathogenicity and propensity to cause reinfection, to support best control strategies and the development of diagnostics; evaluate the impact of VOCs on the effectiveness of different vaccines and vaccination strategies; and assess the implications of VOCs on the choice of optimal treatment options. END-VOC will also investigate how VOCs alter long-term post-infection sequelae and where new VOCs emerge within hosts using our clinical cohorts. We will inform future preparedness and response working closely with international and national public health organisations and existing cohort consortia. Specific beyond state-of-the-art components of END-VOC include the use of novel phylogenetic prediction tools and mathematical modelling; generation of powerful cohorts through sentinel surveillance in low and middle income settings and cohorts of travellers to increase our global reach; use of novel predictive modelling of clinical outcomes by VOC and comorbidity/treatment and evaluation of differences in natural and vaccine immunity by VOC; antiviral screening models within cohorts and an artificial intelligence driven tool for the prediction of long COVID.