GLORIA aims to prove that the addition of chronic low dose glucocorticoids (GC) to current antirheumatic therapy is highly cost-effective and safe in elderly patients with rheumatoid arthritis (RA). RA is a frequent (affecting > 2% of the elderly population), painful and disabling chronic disease with high societal costs. RA is associated with multiple comorbidities, polypharmacy and adverse events; these problems, together with challenges in compliance (adherence) are dramatically increased in the elderly population. About 50% of patients are chronically treated with low-dose glucocorticoids (GC) in combination with other antirheumatic drugs, but without good evidence on the balance of benefit and harm. Thus, existing guidelines and information on safety and efficacy of GC are inadequate. GLORIA will address these problems by conducting a large pragmatic trial: 800 elderly (>65y) RA patients receiving standard of care will be randomized to additionally receive 5 mg prednisolone daily or placebo for 2 years. Very liberal eligibility criteria will ensure representativeness to the target population, and most data will be collected from routine clinical practice, minimizing patient and physician load, and operating costs. A novel tool will monitor compliance; it can send personalized reminders to a patient’s smart device. The efficacy of this technology will be tested in a nested trial. Compliance and other characteristics will be entered into a model that will allow personalized risk and benefit assessment in the future. Qualitative research in patients and physicians of member states will explore expectations and challenges in guideline implementation. This information and the study results will enable an update to existing guidelines and patient information, in collaboration with guideline committees and regulatory agencies. Networking conferences will improve health technology assessment in the elderly in general.

PUREMIND will deliver the first Integrated Mental Healthcare Ecosystem (IMHE) to predict/early identify Mental Health Disorders (MHD) and create more optimal personalised interventions to prevent MHD and thereby improving wellbeing in children, adolescents, and young adults (0–25 years). The ecosystem will mitigate key challenges associated with MHDs, specifically 1)Detection: 1 in 7 undetected and untreated MHD cases, 2)Efficiency of treatment: lack of tools and guidelines for personalised multidisciplinary interventions that work, 3)Access to Support and Care: long waiting times for care due to lack of trained personnel, 4)Inequality: disparate and inadequate inter- and intra-country mental healthcare services and 5)Modern Cultures and Lifestyle: the increasingly recognised risk factor of digital addiction resulting in sedentary, socially isolated lifestyle contributing to MHD. These will be addressed by PUREMIND’s approach of combining analytical modelling of dynamical systems in the cyber-physical context of a subject’s personal natural environment-gene-gut-brain-MHD interactions process creating a much-needed personalised intervention synthesis framework that will be exploited by an AI engine to deliver optimised personalised intervention, and a unique digital twin educating young people how MHD might develop depending on their environment and lifestyle. These 2 components will be combined in an accessible/ adaptable mobile app MyMind to measure at scale and allow a subject to seamlessly access a 4-tier service architecture involving family, community, clinical and emergency services, to support prediction/early detection of MHD, empowering them to monitor their own mental health at home/educational/community settings and taking preventive actions against MHD. The IMHE will be designed using Implementation Science approach and will be validated in a 12month pilot study in 7 European countries and 2 LMICs covering different socioeconomic and cultural scenarios.

Multimorbidity is a common condition in older age, and can substantially influence individuals’ health and quality of life, making management more difficult. A single-disease approach with fragmented care is still prevalent in current healthcare systems despite multimorbidity representing a heterogeneous spectrum of disease combination(s). On this background, the novel approach underpinning the AFFIRMO project is to focus on clusters of multimorbidity where atrial fibrillation(AF) represents one of the chronic conditions. Improving the management of AF in the context of multimorbidity may benefit individuals on a larger scale, with a holistic approach to optimize clinical management of older AF patients taking into account the multifaceted aspects of individuals’ health, including multimorbidity, polypharmacy, personal preferences, and social context. First, the project aims to identify different clusters of multimorbidity in older patients with AF. Second, AFFIRMO aims to assess the needs of patients, caregivers, and health professionals for the comprehensive management of multimorbidity including AF, and to examine ways of optimizing care and self-management. Third, AFFIRMO will develop, implement and test the effectiveness of a patient-centered approach on older multimorbid AF patients in the clinical practice. We aim to adapt, implement and promote a care pathway, in older patients with multimorbidity. A specific objective will be to develop an interoperable care framework that can facilitate the application of this personalized care pathway, that bridges the continuum between primary and secondary care, with the active involvement of patients with shared decision-making. A further aim will be to model the impact of multimorbidity including AF on healthcare costs and the health economic benefits by the proposed integrated care pathway. Finally, subgroup analyses would assess differences on outcomes of in relation to gender and social inequalities.

The main goal of the proposal is to develop a new generation of bidirectional implantable electrodes connecting the human nervous system with external mechatronic aid devices such as exoskeletons and exoprostheses, thus helping people with arm amputations or leg paralysis regain their motor and sensorial functions. Electrodes will be the primary bidirectional interface to the nerves, followed by the implantable module, comprising an ASIC for signal processing, a microcontroller, an antenna for radio communication, a coil for wireless power charging and a supercapacitor for energy storage. To enable data communication to the mechatronic structures, as well as their power management and control (via AI modules) an embedded system will be designed, fabricated, and tested. This system will then be integrated into the mechatronic structures of exoprosthesis or exoskeletons. Due to the presence of bidirectional implantable electrodes a close loop between the users brain and the devices control system will be created, with the AI module being used to learn and interpret the users synaptic signals. All the components and modules will be designed, fabricated, and tested with demonstration being assured by integrating the neural implantable systems with exoprostheses and exoskeletons into three demonstrators aimed at different categories of patients: with forearm amputation, with lower limbs paralysis and with single leg paralysis. A new generation of exoprostheses and exoskeletons controlled by the patients brain via the nervous system will change the paradigm of support for people with disabilities and will have an important social, economic, medical, and technological impact. The technology advances including miniaturization, wireless communication and power supply, progresses in medical microsurgery tools and methods, new biocompatible materials and technologies will considerably contribute to the project implementation.

One out of six people in the European Union has a disability, usually caused by an acute episode or a chronic disease. Providing a suitable rehabilitation is the main issue for people as they age as it helps people to live independently and enhance their Quality of Life. However, as the rehabilitation period usually last some months, the continuity of care often is interrupted in the transition from the hospital to the home. Virtual Coaches can help these patients to proceed with a personalized rehabilitation that complies to age-related conditions, as the key technology for empowering patients through the enhancement of the adherence to the care plan and the risk prevention. The project “vCare” (Virtual Coaching Activities for Rehabilitation in Elderly) addresses two major shortcomings of the status quo: a participatory design driven by users’ needs and the personalization of the care pathways enabled by technology. In fact that rehabilitation is an ideal setting as “users” (physicians and patients) interact together for a “long” period into the clinic (from two weeks to two months): this is a good opportunity to embed into the knowledge of the system the clinical profiles and the pathways that will drive the behaviour of the virtual coach at home. Well-elaborated services for tele-rehabilitation of former EU projects, such as eWall or Miracolus Life, will be adapted. Therefore, the system will integrate a semantic layer (universAAL) including a reasoning engine that merges all patient-related and context information together. The advanced services of vCare will be deployed on a reference platform of MYSPHERA (FIWARE-based) and implemented in four reference sites, dealing with commonly impacted domains (neurological and cardiological). The results of vCare shall stimulate the European Healthcare & ICT sector for innovations in the field of integrated care. In sum, vCare will contribute to the EU goal to increase healthy life years of Europeans by two until 2020.