GreenME aims to identify ways in which effective nature-based therapy and a broader green care framework can be scaled-up to improve adult mental health and wellbeing equity while contributing to multiple socio-ecological co-benefits. To that end, over 4 years, GreenMEs approach is to diagnose, to increase scientific evidence on the mental health and wellbeing benefits of green care and to empower green care actors to, finally, increase the use of nature-based therapy and its integration within a multi-scalar green care framework to ultimately promote just climate resilient and sustainable healthy communities. GreenME understands green care as a three-scale continuum from nature-in-everyday-life (e.g. the existence of green and blue infrastructure for viewing and walks) to nature-based health promotion (the promotion of active interaction with nature such as gardening and conservation) to nature-based therapy (the provision of treatment for individual patients). We will use a transdisciplinary and mixed-methods approach to identify opportunities, barriers, causal pathways and patterns of (in)equitable distribution of mental health and wellbeing benefits from green care in study countries. We will then co-create solutions and guidelines including a EU framework and country-specific schemes for bolstering green care along with an identified community of green care actors, and design a training program for nature-based therapy providers informed by empirical evidence. The evidence generated will offer replicable partnership models and guidelines to design impactful cross-sectorial green care systems, with national healthcare systems and local governments amongst the beneficiaries, leading to a higher uptake of nature-based therapy and a general reframing of the green infrastructure functionality.

Fatigue and sleep disturbances are two common and disabling symptoms that affect patients with neurodegenerative disorders (NDD) and immune-mediated inflammatory diseases (IMID). These symptoms are major predictors of poor quality of life and increased healthcare cost. Current questionnaire-based approaches to measure these symptoms have key limitations preventing them from being used as reliable endpoints in clinical trials to evaluate the effect of therapies. IDEA-FAST aims to address these issues by identifying novel digital endpoints for fatigue and sleep disturbances that will provide more objective, sensitive and reliable measures of the severity and impact of these symptoms in ecological settings. Such digital endpoints will not only help to gain insight into the underpinning mechanisms of fatigue and sleep disturbances, but will also vastly improve the efficiency of clinical trials, ultimately reducing the time and cost to bring new therapies to patients. To identify these digital endpoints, we will follow the recommendations of the Clinical Trials Transformation Initiative (CTTI). We will identify the characteristics that fatigue and sleep disturbances will have impact, then select the digital measures (endpoints) to quantify them, followed by choosing the appropriate digital device/technology accordingly. We will then perform a pilot study to prioritise a few of these candidate digital endpoints for validation. We will test the performance of these digital endpoints in two NDD and four IMID in a large longitudinal study during which extensive relevant clinical data will be collected. If these digital endpoints were validated, we will seek support from EMA/FDA for their qualification. Patient users’ perspective, ethical, data privacy, legal and other regulatory issues will be taken into consideration in all aspects of our proposal. The resultant digital biobank from the longitudinal study will become an invaluable resource for future exploitation.

RES-Q+ will build on the success of RES-Q (REgistry of Stroke Care Quality) - currently, used by many EU countries and 74 worldwide - to improve stroke care quality by collecting and analyzing hospital discharge reports. RES-Q+ will revolutionize these improvements by capturing the whole patient pathway. The solution will combine NLP with a clinically-validated semantic model to automate ingestion of hospital discharge reports in different languages and assist with audit and feedback. This will include creating a standard model for such reports and using AI to impute missing data. Further augmentations include the creation of two novel AI voice assistants, one to help patients provide feedback on their health and the other to help physicians provide high quality care. We will integrate all these tools into RES-Q+. This will be the basis for a European Open Stroke Data Platform, an open research platform for data aggregation, semantic harmonization and interoperability across European countries to promote the use and re-use of health data. We will facilitate efforts to define a standard European Stroke Hospital Discharge Report Exchange Format as a tool for better secondary use of data and healthcare in general. Consortium legal partners will develop a comprehensive legal and ethical toolbox as guidance towards legal compliance. This will boost wider adoption of such novel AI-based solutions by integrating all current and proposed Union legislation. Our clinical partners will provide medical records and steer the development to maximize clinical utility and validate final solutions. RES-Q+ will be deployed globally to solidify our position as European and global leader in quality improvement. Eventually we will guarantee citizens a similar level of quality control during hospitalizations as when flying in a commercial plane.

Every year, 1.3 million Europeans have a stroke and one million ultimately die of stroke. One third of stroke patients remain dependent on the help of others. The annual costs for stroke care in Europe are estimated at € 64.1 billion. Stroke incidence increases almost exponentially with age, and the personal, societal, and economic burden of stroke is therefore largely driven by its frequent occurrence in the elderly. The elderly have been strongly underrepresented in previous stroke trials and treatment guidelines have no recommendations specific to this important group. Elderly patients are at the highest risk of complications after stroke, such as infections, fever, and dysphagia. These complications are strongly and independently associated with a higher risk of death or dependency. We will perform a pragmatic, randomised, open clinical trial with blinded outcome assessment in 3800 patients with acute stroke aged 66 years or older, to assess whether pharmacological prevention of infections and fever, and early management of dysphagia, will reduce the risk of death, poor functional outcome, and poor quality of life, and lead to reductions in the costs of stroke care throughout Europe. Patients will be randomised using a factorial design to preventive treatment for 4 days with ceftriaxone, paracetamol, and/or metoclopramide, or to ‘standard care’ alone. The primary outcome is functional outcome at 3 months, assessed with the modified Rankin Scale (mRS), and analysed with ordinal logistic regression. The study will have 90% power to detect a statistically significant shift towards a favourable outcome, assuming a 5% absolute increase in the proportion of patients with a good outcome (mRS 0 to 2) in the intervention group, compared with controls. This simple, safe, and generally available treatment strategy has the potential to lead to an annual reduction of over 25 000 elderly Europeans being dead or dependent as a result of stroke, at very low costs.