research and innovation framework programme

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EU framework programmes for research and innovation

Evolution and key data from fp1 to horizon 2020 in view of fp9 : in-depth analysis, publication metadata, available languages and formats, german (de), english (en), french (fr).

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• Published: 2017
• Corporate author(s): Directorate-General for Parliamentary Research Services ( European Parliament )
• Personal author(s): Reillon, Vincent
• Themes: Research policy and organisation
• Subject: EU research policy , Framework Programme for Research and Development , innovation , organisation of research , research budget , research programme
• Released on EU Publications: 2018-02-12

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How researchers see the future of Widening

We analyse the views of 15 groups of stakeholders to see how they want measures designed to close the east – west research performance gap to change in FP10

There is strong support for Widening to be retained in the EU’s next research and innovation framework programme, FP10, with an analysis of 15 position papers showing universities, research organisations and industry groups are in favour of keeping the measures in place.

However, there are diverging opinions on the structure, the instruments, the budget and the purpose of these measures.

Here, we look at the main trends to get an insight into how Europe’s research community imagines the future of Widening.

The Widening participation and spreading excellence scheme, to give it its full name, was first introduced in Horizon 2020 with the goal of helping EU member states with weaker research and innovation systems to catch up to the top performers.

Under Horizon 2020 there was a budget of just under €1 billion that funded three principal instruments: teaming, twinning and European Research Chairs. The aim was to help researchers in Widening countries connect with top performing counterparts elsewhere in Europe, and participate more in the overall Horizon 2020 programme.

Widening was expanded in Horizon Europe, with research ministers agreeing to ring fence 3.3% of the €95.5 billion Horizon Europe budget, or just under €3 billion. Several new instruments were added.

Widening in FP10

As attention turned to the design of the 2028 - 2034 research programme, FP10, Denmark was the first to rock the boat when it put out an FP10 position paper in January calling for Widening to be moved from the framework programme and funded from other sources, for example through European Structural and Investment Funds that are designed to support the EU’s lagging regions.

No other member states or organisations have explicitly backed that stance, but countries are one by one publishing FP10 position papers so there could be more support for this idea in the future.

EARTO, an association of Research and Technology Organisations, listed Widening as “non-performing” and said it needs to be improved or stopped, without specifying a preference.

The only other country to have waded in at this point is Latvia, which, seemingly in direct response to Denmark, called for the Widening budget to be doubled in FP10.

The specific question of the Widening budget is absent from other FP10 position papers. A large number of research organisations and university alliances are calling for FP10’s budget to be raised to €200 billion, over twice that of Horizon Europe. In that scenario, the Widening budget would be likely to increase, since it is worked out as a percentage of the overall budget.

Several organisations also called for national governments of Widening countries to increase spending on R&D to 3% of the overall GDP. All Widening countries are far from this target, with Romania, Malta, Latvia, Cyprus, Bulgaria, and Slovakia all spending under 1%.

Widening structure

There are several suggestions for how Widening should be structured in FP10.

Currently, it sits outside the wider programme’s three pillars, alongside measures to strengthen the European Research Area (ERA).

Denmark has called for Widening to end, while Latvia suggested putting it into pillar one.

LERU, an association of research universities, suggests creating a new “support” section of the programme that would include ERA and Widening, as well as research infrastructures, which currently sits in pillar one. “This part of FP10 would involve different funding streams, all focused on improving and strengthening the conditions for open, accessible, strong and inclusive research and innovation and the implementation of the ERA, ensuring a holistic approach to research and innovation,” LERU says.

Others have focused more on the need to better connect Widening with the rest of the research programme. The Guild, an alliance of research universities, wants Widening to remain a horizontal pillar, but its concept of supporting lagging countries to be better integrated into other parts of the programme. It describes this as “mainstreaming” Widening.

Science organisations belonging to the Initiative for Science in Europe go further, suggesting fully integrating Widening across the three pillars. A main gripe is that having a separate section for Widening countries could confine them to only participating in a small part of the overall programme.

On another note, the Guild and the Stockholm Trio , an alliance of three Swedish universities, have suggested separating Widening calls from ERA calls. This would make it [clearer] and easier for researchers when applying to specific widening action or actions related to the ERA,” the Stockholm Trio says.

A more radical restructuring of Widening is brewing behind the scenes. Some member states are eager for the measures to apply to low performing regions across Europe, not just to specific countries. While the majority of member states, particularly those currently benefiting from Widening, are understood to be against this idea, it could be brought up for debate as FP10 planning progresses.

Instruments

Widening currently consists of eight different instruments. There are the more established instruments, teaming , twinning and ERA chairs that were brought in under Horizon 2020, and newer ones such as the hop-on facility and excellence hubs that have only recently been launched.

One common theme is to have more calls under these instruments directly supporting research and innovation. That would be a change from the current situation where a large number of Widening calls are designed to support networking or collaboration activities.

The European University Association, for example, suggests a new instrument to “enable institutions from widening countries to lead the development of research projects in small research teams comprising researchers from all EU countries.”

There have also been questions about the Centres of Excellence established through teaming projects. LERU is calling for an assessment of whether or not they actually support the research ecosystems in Widening countries. “Teaming centres need to become independent from the university that supported their establishment, creating a possible competitor for research funding instead of strengthening the existing institutions,” LERU says.

Alliance4Life, a partnership of life science institutions and universities from Widening countries, raised questions about the financial sustainability of the centres, which are funded through a combination of European and national funds. In many cases the “ad hoc schemes” set up to finance the centres only last for the duration of the teaming project – up to seven years.

“Establishing a new excellent research centre without strategic coordination between European and national (and ideally also regional) levels leads to limited impact in the long term,” Alliance4Life says.

Several organisations have called for a thorough assessment of existing Widening measures to find which ones are working, need to be improved, or should be stopped. Science|Business’ own analysis showed mixed results.

There is near unanimity among the various organisations and groups about the need to better coordinate different EU funding streams to support research and innovation. This is especially so in the case of combining European Structural and Investment Funds and framework programme funds.

Cesaer, an alliance of science and technology universities, says synergies should be at the heart of FP10. “Crucially, this must be pursued in a way that research organisations are not left with the burden of combining co-financing from instruments with incompatible legal  and administrative requirements,” it says.

The Norwegian University of Science and Technology also suggested integrating European Economic Area and Norway Research Grants into Widening in FP10, maintaining separate participation rules but using the European Commission’s “successful call and grant management structure”.

Change of perception

A final common suggestion is to change perceptions of Widening, which is often associated with a lack of excellence.

Alliance4Life, for example, says that it is about time Widening actions were designed to frame its grantees as leaders, rather than inexperienced partners learning from the excellent western European researchers.

“Current collaborative schemes in Widening (except excellence hubs) use the concept of ‘leaders’ based in non-Widening countries transferring their knowledge and skills to the ‘followers’ from Widening countries,” the alliance says. “The schemes thereby promote the self-identification of researchers in Widening countries as ‘followers’, even though they formally are coordinators,” says Alliance4Life.

Here are links to the papers analysed for this article:

• Alliance4Life
• THE UNIVERSITY ALLIANCE STOCKHOLM TRIO

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• Published: 15 May 2024

Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke

• Helena Teede 1 , 2   na1 ,
• Dominique A. Cadilhac 3 , 4   na1 ,
• Tara Purvis 3 ,
• Monique F. Kilkenny 3 , 4 ,
• Bruce C.V. Campbell 4 , 5 , 6 ,
• Coralie English 7 ,
• Alison Johnson 2 ,
• Emily Callander 1 ,
• Rohan S. Grimley 8 , 9 ,
• Christopher Levi 10 ,
• Sandy Middleton 11 , 12 ,
• Kelvin Hill 13 &
• Joanne Enticott   ORCID: orcid.org/0000-0002-4480-5690 1  

BMC Medicine volume  22 , Article number:  198 ( 2024 ) Cite this article

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In the context of expanding digital health tools, the health system is ready for Learning Health System (LHS) models. These models, with proper governance and stakeholder engagement, enable the integration of digital infrastructure to provide feedback to all relevant parties including clinicians and consumers on performance against best practice standards, as well as fostering innovation and aligning healthcare with patient needs. The LHS literature primarily includes opinion or consensus-based frameworks and lacks validation or evidence of benefit. Our aim was to outline a rigorously codesigned, evidence-based LHS framework and present a national case study of an LHS-aligned national stroke program that has delivered clinical benefit.

Current core components of a LHS involve capturing evidence from communities and stakeholders (quadrant 1), integrating evidence from research findings (quadrant 2), leveraging evidence from data and practice (quadrant 3), and generating evidence from implementation (quadrant 4) for iterative system-level improvement. The Australian Stroke program was selected as the case study as it provides an exemplar of how an iterative LHS works in practice at a national level encompassing and integrating evidence from all four LHS quadrants. Using this case study, we demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare improvement. We emphasize the transition from research as an endpoint, to research as an enabler and a solution for impact in healthcare improvement.

Conclusions

The Australian Stroke program has nationally improved stroke care since 2007, showcasing the value of integrated LHS-aligned approaches for tangible impact on outcomes. This LHS case study is a practical example for other health conditions and settings to follow suit.

Peer Review reports

Internationally, health systems are facing a crisis, driven by an ageing population, increasing complexity, multi-morbidity, rapidly advancing health technology and rising costs that threaten sustainability and mandate transformation and improvement [ 1 , 2 ]. Although research has generated solutions to healthcare challenges, and the advent of big data and digital health holds great promise, entrenched siloes and poor integration of knowledge generation, knowledge implementation and healthcare delivery between stakeholders, curtails momentum towards, and consistent attainment of, evidence-and value-based care [ 3 ]. This is compounded by the short supply of research and innovation leadership within the healthcare sector, and poorly integrated and often inaccessible health data systems, which have crippled the potential to deliver on digital-driven innovation [ 4 ]. Current approaches to healthcare improvement are also often isolated with limited sustainability, scale-up and impact [ 5 ].

Evidence suggests that integration and partnership across academic and healthcare delivery stakeholders are key to progress, including those with lived experience and their families (referred to here as consumers and community), diverse disciplines (both research and clinical), policy makers and funders. Utilization of evidence from research and evidence from practice including data from routine care, supported by implementation research, are key to sustainably embedding improvement and optimising health care and outcomes. A strategy to achieve this integration is through the Learning Health System (LHS) (Fig.  1 ) [ 2 , 6 , 7 , 8 ]. Although there are numerous publications on LHS approaches [ 9 , 10 , 11 , 12 ], many focus on research perspectives and data, most do not demonstrate tangible healthcare improvement or better health outcomes. [ 6 ]

Monash Learning Health System: The Learn Together for Better Health Framework developed by Monash Partners and Monash University (from Enticott et al. 2021 [ 7 ]). Four evidence quadrants: Q1 (orange) is evidence from stakeholders; Q2 (green) is evidence from research; Q3 (light blue) is evidence from data; and, Q4 (dark blue) is evidence from implementation and healthcare improvement

In developed nations, it has been estimated that 60% of care provided aligns with the evidence base, 30% is low value and 10% is potentially harmful [ 13 ]. In some areas, clinical advances have been rapid and research and evidence have paved the way for dramatic improvement in outcomes, mandating rapid implementation of evidence into healthcare (e.g. polio and COVID-19 vaccines). However, healthcare improvement is challenging and slow [ 5 ]. Health systems are highly complex in their design, networks and interacting components, and change is difficult to enact, sustain and scale up. [ 3 ] New effective strategies are needed to meet community needs and deliver evidence-based and value-based care, which reorients care from serving the provider, services and system, towards serving community needs, based on evidence and quality. It goes beyond cost to encompass patient and provider experience, quality care and outcomes, efficiency and sustainability [ 2 , 6 ].

The costs of stroke care are expected to rise rapidly in the next decades, unless improvements in stroke care to reduce the disabling effects of strokes can be successfully developed and implemented [ 14 ]. Here, we briefly describe the Monash LHS framework (Fig.  1 ) [ 2 , 6 , 7 ] and outline an exemplar case in order to demonstrate how to apply evidence-based processes to healthcare improvement and embed real-world research for optimising healthcare. The Australian LHS exemplar in stroke care has driven nationwide improvement in stroke care since 2007.

An evidence-based Learning Health System framework

In Australia, members of this author group (HT, AJ, JE) have rigorously co-developed an evidence-based LHS framework, known simply as the Monash LHS [ 7 ]. The Monash LHS was designed to support sustainable, iterative and continuous robust benefit of improved clinical outcomes. It was created with national engagement in order to be applicable to Australian settings. Through this rigorous approach, core LHS principles and components have been established (Fig.  1 ). Evidence shows that people/workforce, culture, standards, governance and resources were all key to an effective LHS [ 2 , 6 ]. Culture is vital including trust, transparency, partnership and co-design. Key processes include legally compliant data sharing, linkage and governance, resources, and infrastructure [ 4 ]. The Monash LHS integrates disparate and often siloed stakeholders, infrastructure and expertise to ‘Learn Together for Better Health’ [ 7 ] (Fig.  1 ). This integrates (i) evidence from community and stakeholders including priority areas and outcomes; (ii) evidence from research and guidelines; (iii) evidence from practice (from data) with advanced analytics and benchmarking; and (iv) evidence from implementation science and health economics. Importantly, it starts with the problem and priorities of key stakeholders including the community, health professionals and services and creates an iterative learning system to address these. The following case study was chosen as it is an exemplar of how a Monash LHS-aligned national stroke program has delivered clinical benefit.

Australian Stroke Learning Health System

Internationally, the application of LHS approaches in stroke has resulted in improved stroke care and outcomes [ 12 ]. For example, in Canada a sustained decrease in 30-day in-hospital mortality has been found commensurate with an increase in resources to establish the multifactorial stroke system intervention for stroke treatment and prevention [ 15 ]. Arguably, with rapid advances in evidence and in the context of an ageing population with high cost and care burden and substantive impacts on quality of life, stroke is an area with a need for rapid research translation into evidence-based and value-based healthcare improvement. However, a recent systematic review found that the existing literature had few comprehensive examples of LHS adoption [ 12 ]. Although healthcare improvement systems and approaches were described, less is known about patient-clinician and stakeholder engagement, governance and culture, or embedding of data informatics into everyday practice to inform and drive improvement [ 12 ]. For example, in a recent review of quality improvement collaborations, it was found that although clinical processes in stroke care are improved, their short-term nature means there is uncertainty about sustainability and impacts on patient outcomes [ 16 ]. Table  1 provides the main features of the Australian Stroke LHS based on the four core domains and eight elements of the Learning Together for Better Health Framework described in Fig.  1 . The features are further expanded on in the following sections.

Evidence from stakeholders (LHS quadrant 1, Fig.  1 )

Engagement, partners and priorities.

Within the stroke field, there have been various support mechanisms to facilitate an LHS approach including partnership and broad stakeholder engagement that includes clinical networks and policy makers from different jurisdictions. Since 2008, the Australian Stroke Coalition has been co-led by the Stroke Foundation, a charitable consumer advocacy organisation, and Stroke Society of Australasia a professional society with membership covering academics and multidisciplinary clinician networks, that are collectively working to improve stroke care ( https://australianstrokecoalition.org.au/ ). Surveys, focus groups and workshops have been used for identifying priorities from stakeholders. Recent agreed priorities have been to improve stroke care and strengthen the voice for stroke care at a national ( https://strokefoundation.org.au/ ) and international level ( https://www.world-stroke.org/news-and-blog/news/world-stroke-organization-tackle-gaps-in-access-to-quality-stroke-care ), as well as reduce duplication amongst stakeholders. This activity is built on a foundation and culture of research and innovation embedded within the stroke ‘community of practice’. Consumers, as people with lived experience of stroke are important members of the Australian Stroke Coalition, as well as representatives from different clinical colleges. Consumers also provide critical input to a range of LHS activities via the Stroke Foundation Consumer Council, Stroke Living Guidelines committees, and the Australian Stroke Clinical Registry (AuSCR) Steering Committee (described below).

Evidence from research (LHS quadrant 2, Fig.  1 )

Advancement of the evidence for stroke interventions and synthesis into clinical guidelines.

To implement best practice, it is crucial to distil the large volume of scientific and trial literature into actionable recommendations for clinicians to use in practice [ 24 ]. The first Australian clinical guidelines for acute stroke were produced in 2003 following the increasing evidence emerging for prevention interventions (e.g. carotid endarterectomy, blood pressure lowering), acute medical treatments (intravenous thrombolysis, aspirin within 48 h of ischemic stroke), and optimised hospital management (care in dedicated stroke units by a specialised and coordinated multidisciplinary team) [ 25 ]. Importantly, a number of the innovations were developed, researched and proven effective by key opinion leaders embedded in the Australian stroke care community. In 2005, the clinical guidelines for Stroke Rehabilitation and Recovery [ 26 ] were produced, with subsequent merged guidelines periodically updated. However, the traditional process of periodic guideline updates is challenging for end users when new research can render recommendations redundant and this lack of currency erodes stakeholder trust [ 27 ]. In response to this challenge the Stroke Foundation and Cochrane Australia entered a pioneering project to produce the first electronic ‘living’ guidelines globally [ 20 ]. Major shifts in the evidence for reperfusion therapies (e.g. extended time-window intravenous thrombolysis and endovascular clot retrieval), among other advances, were able to be converted into new recommendations, approved by the Australian National Health and Medical Research Council within a few months of publication. Feedback on this process confirmed the increased use and trust in the guidelines by clinicians. The process informed other living guidelines programs, including the successful COVID-19 clinical guidelines [ 28 ].

However, best practice clinical guideline recommendations are necessary but insufficient for healthcare improvement and nesting these within an LHS with stakeholder partnership, enables implementation via a range of proven methods, including audit and feedback strategies [ 29 ].

Evidence from data and practice (LHS quadrant 3, Fig.  1 )

Data systems and benchmarking : revealing the disparities in care between health services. A national system for standardized stroke data collection was established as the National Stroke Audit program in 2007 by the Stroke Foundation [ 30 ] following various state-level programs (e.g. New South Wales Audit) [ 31 ] to identify evidence-practice gaps and prioritise improvement efforts to increase access to stroke units and other acute treatments [ 32 ]. The Audit program alternates each year between acute (commencing in 2007) and rehabilitation in-patient services (commencing in 2008). The Audit program provides a ‘deep dive’ on the majority of recommendations in the clinical guidelines whereby participating hospitals provide audits of up to 40 consecutive patient medical records and respond to a survey about organizational resources to manage stroke. In 2009, the AuSCR was established to provide information on patients managed in acute hospitals based on a small subset of quality processes of care linked to benchmarked reports of performance (Fig.  2 ) [ 33 ]. In this way, the continuous collection of high-priority processes of stroke care could be regularly collected and reviewed to guide improvement to care [ 34 ]. Plus clinical quality registry programs within Australia have shown a meaningful return on investment attributed to enhanced survival, improvements in quality of life and avoided costs of treatment or hospital stay [ 35 ].

Example performance report from the Australian Stroke Clinical Registry: average door-to-needle time in providing intravenous thrombolysis by different hospitals in 2021 [ 36 ]. Each bar in the figure represents a single hospital

The Australian Stroke Coalition endorsed the creation of an integrated technological solution for collecting data through a single portal for multiple programs in 2013. In 2015, the Stroke Foundation, AuSCR consortium, and other relevant groups cooperated to design an integrated data management platform (the Australian Stroke Data Tool) to reduce duplication of effort for hospital staff in the collection of overlapping variables in the same patients [ 19 ]. Importantly, a national data dictionary then provided the common data definitions to facilitate standardized data capture. Another important feature of AuSCR is the collection of patient-reported outcome surveys between 90 and 180 days after stroke, and annual linkage with national death records to ascertain survival status [ 33 ]. To support a LHS approach, hospitals that participate in AuSCR have access to a range of real-time performance reports. In efforts to minimize the burden of data collection in the AuSCR, interoperability approaches to import data directly from hospital or state-level managed stroke databases have been established (Fig.  3 ); however, the application has been variable and 41% of hospitals still manually enter all their data.

Current status of automated data importing solutions in the Australian Stroke Clinical Registry, 2022, with ‘ n ’ representing the number of hospitals. AuSCR, Australian Stroke Clinical Registry; AuSDaT, Australian Stroke Data Tool; API, Application Programming Interface; ICD, International Classification of Diseases; RedCAP, Research Electronic Data Capture; eMR, electronic medical records

For acute stroke care, the Australian Commission on Quality and Safety in Health Care facilitated the co-design (clinicians, academics, consumers) and publication of the national Acute Stroke Clinical Care Standard in 2015 [ 17 ], and subsequent review [ 18 ]. The indicator set for the Acute Stroke Standard then informed the expansion of the minimum dataset for AuSCR so that hospitals could routinely track their performance. The national Audit program enabled hospitals not involved in the AuSCR to assess their performance every two years against the Acute Stroke Standard. Complementing these efforts, the Stroke Foundation, working with the sector, developed the Acute and Rehabilitation Stroke Services Frameworks to outline the principles, essential elements, models of care and staffing recommendations for stroke services ( https://informme.org.au/guidelines/national-stroke-services-frameworks ). The Frameworks are intended to guide where stroke services should be developed, and monitor their uptake with the organizational survey component of the Audit program.

Evidence from implementation and healthcare improvement (LHS quadrant 4, Fig.  1 )

Research to better utilize and augment data from registries through linkage [ 37 , 38 , 39 , 40 ] and to ensure presentation of hospital or service level data are understood by clinicians has ensured advancement in the field for the Australian Stroke LHS [ 41 ]. Importantly, greater insights into whole patient journeys, before and after a stroke, can now enable exploration of value-based care. The LHS and stroke data platform have enabled focused and time-limited projects to create a better understanding of the quality of care in acute or rehabilitation settings [ 22 , 42 , 43 ]. Within stroke, all the elements of an LHS culminate into the ready availability of benchmarked performance data and support for implementation of strategies to address gaps in care.

Implementation research to grow the evidence base for effective improvement interventions has also been a key pillar in the Australian context. These include multi-component implementation interventions to achieve behaviour change for particular aspects of stroke care, [ 22 , 23 , 44 , 45 ] and real-world approaches to augmenting access to hyperacute interventions in stroke through the use of technology and telehealth [ 46 , 47 , 48 , 49 ]. The evidence from these studies feeds into the living guidelines program and the data collection systems, such as the Audit program or AuSCR, which are then amended to ensure data aligns to recommended care. For example, the use of ‘hyperacute aspirin within the first 48 h of ischemic stroke’ was modified to be ‘hyperacute antiplatelet…’ to incorporate new evidence that other medications or combinations are appropriate to use. Additionally, new datasets have been developed to align with evidence such as the Fever, Sugar, and Swallow variables [ 42 ]. Evidence on improvements in access to best practice care from the acute Audit program [ 50 ] and AuSCR is emerging [ 36 ]. For example, between 2007 and 2017, the odds of receiving intravenous thrombolysis after ischemic stroke increased by 16% 9OR 1.06 95% CI 1.13–1.18) and being managed in a stroke unit by 18% (OR 1.18 95% CI 1.17–1.20). Over this period, the median length of hospital stay for all patients decreased from 6.3 days in 2007 to 5.0 days in 2017 [ 51 ]. When considering the number of additional patients who would receive treatment in 2017 in comparison to 2007 it was estimated that without this additional treatment, over 17,000 healthy years of life would be lost in 2017 (17,786 disability-adjusted life years) [ 51 ]. There is evidence on the cost-effectiveness of different system-focussed strategies to augment treatment access for acute ischemic stroke (e.g. Victorian Stroke Telemedicine program [ 52 ] and Melbourne Mobile Stroke Unit ambulance [ 53 ]). Reciprocally, evidence from the national Rehabilitation Audit, where the LHS approach has been less complete or embedded, has shown fewer areas of healthcare improvement over time [ 51 , 54 ].

Within the field of stroke in Australia, there is indirect evidence that the collective efforts that align to establishing the components of a LHS have had an impact. Overall, the age-standardised rate of stroke events has reduced by 27% between 2001 and 2020, from 169 to 124 events per 100,000 population. Substantial declines in mortality rates have been reported since 1980. Commensurate with national clinical guidelines being updated in 2007 and the first National Stroke Audit being undertaken in 2007, the mortality rates for men (37.4 deaths per 100,000) and women (36.1 deaths per 100,0000 has declined to 23.8 and 23.9 per 100,000, respectively in 2021 [ 55 ].

Underpinning the LHS with the integration of the four quadrants of evidence from stakeholders, research and guidelines, practice and implementation, and core LHS principles have been addressed. Leadership and governance have been important, and programs have been established to augment workforce training and capacity building in best practice professional development. Medical practitioners are able to undertake courses and mentoring through the Australasian Stroke Academy ( http://www.strokeacademy.com.au/ ) while nurses (and other health professionals) can access teaching modules in stroke care from the Acute Stroke Nurses Education Network ( https://asnen.org/ ). The Association of Neurovascular Clinicians offers distance-accessible education and certification to develop stroke expertise for interdisciplinary professionals, including advanced stroke co-ordinator certification ( www.anvc.org ). Consumer initiative interventions are also used in the design of the AuSCR Public Summary Annual reports (available at https://auscr.com.au/about/annual-reports/ ) and consumer-related resources related to the Living Guidelines ( https://enableme.org.au/resources ).

The important success factors and lessons from stroke as a national exemplar LHS in Australia include leadership, culture, workforce and resources integrated with (1) established and broad partnerships across the academic-clinical sector divide and stakeholder engagement; (2) the living guidelines program; (3) national data infrastructure, including a national data dictionary that provides the common data framework to support standardized data capture; (4) various implementation strategies including benchmarking and feedback as well as engagement strategies targeting different levels of the health system; and (5) implementation and improvement research to advance stroke systems of care and reduce unwarranted variation in practice (Fig.  1 ). Priority opportunities now include the advancement of interoperability with electronic medical records as an area all clinical quality registry’s programs needs to be addressed, as well as providing more dynamic and interactive data dashboards tailored to the need of clinicians and health service executives.

There is a clear mandate to optimise healthcare improvement with big data offering major opportunities for change. However, we have lacked the approaches to capture evidence from the community and stakeholders, to integrate evidence from research, to capture and leverage data or evidence from practice and to generate and build on evidence from implementation using iterative system-level improvement. The LHS provides this opportunity and is shown to deliver impact. Here, we have outlined the process applied to generate an evidence-based LHS and provide a leading exemplar in stroke care. This highlights the value of moving from single-focus isolated approaches/initiatives to healthcare improvement and the benefit of integration to deliver demonstrable outcomes for our funders and key stakeholders — our community. This work provides insight into strategies that can both apply evidence-based processes to healthcare improvement as well as implementing evidence-based practices into care, moving beyond research as an endpoint, to research as an enabler, underpinning delivery of better healthcare.

Availability of data and materials

Not applicable

Abbreviations

Australian Stroke Clinical Registry

Confidence interval

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Acknowledgements

The following authors hold National Health and Medical Research Council Research Fellowships: HT (#2009326), DAC (#1154273), SM (#1196352), MFK Future Leader Research Fellowship (National Heart Foundation #105737). The Funders of this work did not have any direct role in the design of the study, its execution, analyses, interpretation of the data, or decision to submit results for publication.

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Helena Teede and Dominique A. Cadilhac contributed equally.

Authors and Affiliations

Monash Centre for Health Research and Implementation, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede, Emily Callander & Joanne Enticott

Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, Australia

Helena Teede & Alison Johnson

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 2 Monash University Research, Victorian Heart Hospital, 631 Blackburn Rd, Clayton, VIC, Australia

Dominique A. Cadilhac, Tara Purvis & Monique F. Kilkenny

Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia

Dominique A. Cadilhac, Monique F. Kilkenny & Bruce C.V. Campbell

Department of Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC, Australia

Bruce C.V. Campbell

Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia

School of Health Sciences, Heart and Stroke Program, University of Newcastle, Hunter Medical Research Institute, University Drive, Callaghan, NSW, Australia

Coralie English

School of Medicine and Dentistry, Griffith University, Birtinya, QLD, Australia

Rohan S. Grimley

Clinical Excellence Division, Queensland Health, Brisbane, Australia

John Hunter Hospital, Hunter New England Local Health District and University of Newcastle, Sydney, NSW, Australia

Christopher Levi

School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia

Sandy Middleton

Nursing Research Institute, St Vincent’s Health Network Sydney and and Australian Catholic University, Sydney, NSW, Australia

Stroke Foundation, Level 7, 461 Bourke St, Melbourne, VIC, Australia

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Contributions

HT: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. DAC: conception, design and initial draft, provided essential literature and case study examples, approved the submitted version. TP: revised the manuscript critically for important intellectual content, approved the submitted version. MFK: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. BC: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CE: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. AJ: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. EC: revised the manuscript critically for important intellectual content, approved the submitted version. RSG: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. CL: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. SM: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. KH: revised the manuscript critically for important intellectual content, provided essential literature and case study examples, approved the submitted version. JE: conception, design and initial draft, developed the theoretical formalism for learning health system framework, approved the submitted version. All authors read and approved the final manuscript.

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Teede, H., Cadilhac, D.A., Purvis, T. et al. Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke. BMC Med 22 , 198 (2024). https://doi.org/10.1186/s12916-024-03416-w

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Horizon 2020 EU framework programme for research and innovation

Horizon 2020, the EU framework programme for research and innovation (2014-2020) is aimed at building a society and an economy based on knowledge and innovation across the Union, while contributing to sustainable development. The programme supports the implementation of the Europe 2020 strategy and other Union policies, as well as the achievement and functioning of the European Research Area (ERA). The introduction to this European implementation assessment (EIA) presents basic information on the implementation of Horizon 2020, including policy on gender equality and international cooperation. In addition, the annexes contain the input to the EIA received from external experts, who prepared analyses of the implementation of the three Horizon 2020 priorities: excellent science, industrial leadership, and societal challenges. The implementation of each priority was analysed from two perspectives: a) a research and industry perspective prepared by experts from the Centre for Strategy and Evaluation Services (CSES) and the Centre for Industrial Studies (CSIL); b) economic and financial perspective prepared by experts from the Europe Economics consortium.

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Biden-Harris Administration Announces Third Year of SMART Grants, Funding Transportation Technology and Innovation

WASHINGTON - The U.S. Department of Transportation (USDOT) announced today that it is accepting applications for the third year of its Strengthening Mobility and Revolutionizing Transportation (SMART) Grants Program . The SMART Grants Program was made possible by the Bipartisan Infrastructure Law, signed by President Biden on November 15, 2021. As part of the President’s Investing in America agenda, the program will fund up to $500 million in grants over five years to conduct demonstration projects focused on advanced smart community technologies and systems that improve transportation safety and efficiency. In the first two rounds of SMART Grants, USDOT selected 93 projects in 39 states, plus the District of Columbia and Puerto Rico, totaling $148 million. 

“The SMART Grant program has helped communities, states, and tribes across America deploy new kinds of transportation technology solutions to improve safety and resilience,” said U.S. Transportation Secretary Pete Buttigieg . “As the program enters its third year of funding, we’re excited for even more communities to get funding and support to develop technological solutions to their most pressing transportation challenges.”

Through this SMART Notice of Funding Opportunity (NOFO), USDOT will accept applications for Stage 1 Planning and Prototyping grants. During Stage 1, the SMART program will fund technology demonstrations and prototypes that solve real-world transportation problems and build data and technology capacity for State, local, and Tribal governments. Later this year, recipients of Stage 1 grants will be eligible to expand their projects through the first of several Stage 2 grant opportunities. 

The funding opportunity is open to public sector entities seeking to carry out transportation projects that demonstrate at least one of the following technology areas:

• Coordinated automation
• Connected vehicles
• Systems integration
• Delivery/logistics
• Innovative aviation
• Traffic signals

 “From Alaska to Maine to Puerto Rico, the SMART program has supported locally driven solutions across the country to make communities safer for all users and more connected and accessible. The popularity of this program demonstrates the demand for purpose-driven technology solutions, and we are excited to open the opportunity for another round of applications,” said Dr. Robert C. Hampshire, Deputy Assistant Secretary for Research and Technology and Chief Scientist at USDOT .

Successful projects will create sustainable partnerships across sectors and levels of government, engaging industry, labor, academia, and nonprofits to better meet community transportation needs.

The NOFO is open now and can be found on the SMART Grants Program website . It will also be posted on grants.gov later in the week. There will be a ‘How to Apply’ webinar on May 28th, 2024. Register for the webinar on the SMART Grants Program website. 

Applications must be submitted by 5:00 PM EDT on Friday July 12th, 2024 to the Valid Eval Submission website .

For more information visit https://www.transportation.gov/grants/SMART . 

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“NASA’s Minority University Research and Education Project Institutional Research Opportunity and Established Program to Stimulate Competitive Research awards help institutions raise their technological bar,” said Torry Johnson, deputy associate administrator of STEM Engagement Programs at NASA Headquarters in Washington. “When institutions enhance their capabilities and infrastructure, they become more competitive in their research, which opens doors to valuable experience and opportunities.”

Minority University Research and Education Project Institutional Research Opportunity (MIRO) Awards

Seven minority-serving institutions will receive approximately $5 million each over a five-year period of performance for projects that span a variety of research topics. The institutions and their proposed projects are:

• Alaska Pacific University in Anchorage – Alaska Pacific University Microplastics Research and Education Center
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• New Jersey Institute of Technology in Newark – AI Powered Solar Eruption Center of Excellence in Research and Education
• University of Houston in Houston – NASA MIRO Inflatable Deployable Environment and Adaptive Space Systems Center
• University of Illinois in Chicago – Center for In-Space Manufacturing: Recycling and Regolith Processing

NASA’s MIRO award was established to strengthen and develop research capacity and infrastructure of minority serving institutions in areas of strategic importance and value to NASA missions and national priorities.

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NASA establishes partnerships with government, higher education, and industry to create lasting improvements in research infrastructure and capacity for specific states or regions, while enhancing its national research and development competitiveness. The program is directed at those jurisdictions that have traditionally not participated in competitive aerospace and aerospace-related research activities.

NASA will award 14 institutions up to $750,000 each over the course of a three-year period of performance. The awarded institutions and their projects are:

• University of Mississippi in University – Development of a Lagrangian Stability Analysis Framework for High-Speed Boundary Layers
• University of Alabama in Huntsville – Testing the functionality and performance of a large area detector for STROBE-X
• Louisiana State University in Baton Rouge – Colloidal Assembly: Understanding the Electric Field Driven Assembly of Colloids and its Applications (Science Mission Directorate)
• West Virginia University in Morgantown – Science Mission Directorate: Bringing Gravitational-Wave Astronomy into the Space Age: Next-Generation Waveform Modeling of Black-Hole Binary Coalescences for Laser Intererometer Space Antenna Data Analysis
• University of Puerto Rico in San Juan – NASA EPSCoR: Space Technology Mission Directorate/Jet Propulsion Laboratory: Advancing High-Energy, Cycle-Stable Sulfur-Based Batteries for NASA Space Missions: An Integrated Framework of Density Functional Theory, Machine Learning, and Materials Innovation
• Desert Research Institute, Reno, Nevada – NASA’s Ames Research Center in Silicon Valley, California: Prospecting and Pre-Colonization of the Moon and Mars using Autonomous Robots with Human-In-The-Loop
• Oklahoma State University in Stillwater – A.7.4.2 Biosignature Detection of Solar System Ocean Worlds using Science-Guided Machine Learning
• Iowa State University in Ames – Johnson Space Center, Ames Research Center: Non-GPS Navigation System Using Dual Star/Planetary Cameras for Lunar and Deep-Space CubeSat Missions
• University of Alaska Fairbanks in Fairbanks – NASA’s Glenn Research Center in Cleveland: The Alaska – Venus analog: synthesizing seismic ground motion and wind noise in extreme environments
• University of the Virgin Islands in Charlotte Amalie – University of the Virgin Islands Etelman Observatory in the Era of Time Domain and MultiMessenger Astronomy: Preparing for a New Era of Science Productivity
• University of Hawaii at Manoa in Honolulu – Cubesats for Climate Change Detection of Transient Greenhouse Gas Emissions
• University of Idaho in Moscow – Science Mission Directorate and Goddard Space Flight Center: Improving Global Dryland Streamflow Modeling by Better Characterizing Vegetation Use of Deep-Water Resources Using NASA’s Gravity Recovery and Climate Experiment/Gravity Recovery and Climate Experiment Follow-On, SWOT, and Land Information System
• University of Arkansas in Little Rock – AR- III-Nitride Ultraviolet Laser Diodes for Harsh Environments, Space Based Communications, and Remote Sensing (Space Technology Mission Directorate)
• South Dakota School of Mines and Technology in Rapid City – Science Mission Directorate: High Spatial-Temporal Resolution Soil Moisture Retrieval using Deep Learning Fusion of Multimodal Satellite Datastreams

Both awards were made through NASA’s Office of STEM engagement solicitations. They promote STEM literacy to enhance and sustain the capability of institutions to perform NASA-related research and education, which directly supports the agency’s mission directorates.

For more information about NASA STEM, visit:

https://stem.nasa.gov

Gerelle Dodson Headquarters, Washington 202-358-4637 [email protected]

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B7 2024: Final Communiqué

B7 2024 final communiqué.

May 20, 2024

The below is the executive summary. You may download the full report on this page.

Maximizing the Benefits of AI  

As a major catalyst for the transformation of our era, AI, in synergy with other enabling technologies, can enhance productivity and economic resilience, optimize the functioning of GVCs, and improve infrastructure planning, natural resource management, energy demand forecasting, and climate mitigation. Investing in AI and its applications ethically and inclusively will usher industries into the data economy, expand the labor market, and enhance progress in key sectors such as healthcare and life sciences. More effective public-private partnerships enhance education, skills, risk-based frameworks, interoperability, and capacity building, and make AI applications safer, and more secure and trustworthy.  

Building upon the G7 AI Hiroshima Process, the B7 fully supports the G7 in establishing human-centered principles and standards to monitor and guide its evolution, while fostering innovation and interoperability for the benefit of all.  

Enhancing Global Trade and GVCs’ Resilience  

Critical dependencies should be addressed by coordinating policies, streamlining compliance costs associated with export controls and investment screening regimes, enhancing partnerships with, and investing in Least Developed Countries (LDCs), sharing frameworks to predict supply chain disruptions, and increasing preparedness and security. 

In parallel, the G7 strive for a global level playing field by eliminating unjustified existing barriers and refraining from adopting new ones. The B7 is deeply concerned about the future of the WTO and reiterates its support for a rules-based multilateral trading system. Making the WTO Moratorium on Electronic Transmissions permanent is vital, while a sound reform of the Organization remains the overarching priority. The G7 policymakers should limit policy uncertainty and support businesses’ strategies, investments, and confidence. Delivering on the objectives of the PGII and the Build Back Better World (B3W) is paramount for revamping investments and supporting the sustainable growth of market economies.  

Tackling Energy, Environmental, and Climate Challenges  

The G7 countries’ industrial policies and regulatory frameworks should converge while ensuring energy security, competitiveness, and decarbonization. Investing in sustainable and low-carbon technologies, research and development-oriented projects, and strategic value chains according to the principle of full technological neutrality and enhancing the diversification of cost-efficient transition energy sources’ supplies and carriers would favor the affordability of energy prices during the transition phase. Public-private investment funds, convergent taxonomies and labeling, aligned incentives, and reduced divergencies in carbon markets would support the decarbonization of hard-to-abate industrial sectors, boost circular economy initiatives, energy efficiency, facilities’ reconversions and recycling, and new smart transmission and distribution infrastructures. 

For a just transition, the G7 should make the Loss and Damage Mechanism operational, and promote voluntary cooperation and targeted technological transfer, while preserving intellectual and industrial property rights. It should also take into account that just transition requires the build-out of infrastructure to empower consumers and Micro, Small and Medium Enterprises (MSMEs) beyond the most advanced areas.  

Embracing the Data Economy and Digital Technologies  

The G7 should operationalize Data Free Flow with Trust (DFFT) through the Institutional Arrangement for Partnership (IAP) while promoting a continuous dialogue with the industry to craft regulations for a digital trust framework. Recognized evidence and risk-based standards for data flow transparency and accountability should be established, and incentives to favor trust, privacy, risk mitigation, cybersecurity, intellectual property, and interoperability should be prioritized. Promoting the development of a common G7 quantum computing ecosystem and joint research on post-quantum cryptography will enhance the security and reliability of digital infrastructures and technologies.  

Also, the G7 should promote an ambitious connectivity agenda to further accelerate the take-up of advanced technologies, and enhance digitalization by spreading digital skills across businesses, administrations, and societies, notably by leveraging STEM-based pathways and the use of Digital Identity for G2B, G2C, B2B and B2C transactions. 

Unleashing Talents’ Potential and Enhancing the Resilience of Welfare Systems  

The B7 calls on the G7 to reform the educational systems at all levels to meet emerging job markets’ requirements and new technological trends and to facilitate the transition from education to work. The B7 renews its commitment to bridge between the workforce and employers by identifying labor market gaps, investing in skills development, and funding apprenticeship and mid-career reskilling programs. The B7 urges G7 governments to strengthen active labor market policies, promote entrepreneurship, encourage the social inclusion of underrepresented groups, particularly women and youth, and modernize welfare systems through farsighted fiscal and employment policies providing citizens with long-term equitable access to quality services in healthcare and education and address the old-age dependency. 

Measuring Achievements  

The B7 Italy 2024 introduces the adoption of leading Key Performance Indicators (KPIs) making the G7 and the other owners accountable for measurable outcomes. To track these KPIs over time and measure progress against the related targets, the B7 recommends the establishment of a joint G7-B7 Monitoring Committee. 

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