Abstract: In a prospective longitudinal study with 218 Parkinson's disease (PD) patients in the discovery cohort and 84 in the validation cohort, we aimed to identify novel blood biomarkers predicting disability milestones in PD. Through Least Absolute Shrinkage and Selection Operator-Cox (Lasso-Cox) regression, developed nomogram predictive model and Linear mixed-effects models, we identified low level of plasma fibronectin (pFN) as one of the best-performing risk markers in predicting disability milestones. A low level of pFN was associated with a short milestone-free survival period in PD. Longitudinal analysis showed an annual decline in the rate of pFN was significantly associated with the annual elevation rate in the Hoehn-Yahr stage. Moreover, pFN level was negatively correlated with phosphorylated α-synuclein, and a low level of pFN was associated with BBB disruption in the striatum on neuroimaging, providing evidence for pFN's role in PD progression. We finally identified pFN as a novel blood biomarker that predicted first-milestone disability in PD.

Abstract: The 30th anniversary of the Journal of Health Communication: International Perspectives occurs at a pivotal moment. In our inaugural issue in 1996, founding editor Scott Ratzan described his vision "to promote global health with effective communication strategies to improve health outcomes and well-being." Since then, JOHC has consistently championed rigorous and forward-thinking research and perspectives that have helped shape today's multi-disciplinary practice. As we mark this milestone and honor the Journal's legacy, we must also confront the pressing challenges that define the current landscape of health communication. We live in an era where scientific reasoning is increasingly questioned by policymakers, patients, and the public alike. The institutions that have traditionally upheld evidence-based practice have lost trust, respect and authority. In this evolving context, health communication cannot remain a static field. In the decades ahead, the Journal must take an active and unapologetic stance-maintaining the highest ethics while driving innovation in digital health communication, scientific methodology, data interpretation and translation for better uptake. Its mission must be to accelerate measurable global health gains by advancing communication strategies that not only inform, but inspire trust, foster agency, and empower individuals and populations to make evidence-based choices they willingly and confidently adopt.

Abstract: We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program funded vaccines, as at 2 April 2023 for children, adolescents and adults, focusing on the calendar year 2022 and on trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs. Fully vaccinated coverage in Australian children in 2022 was 0.6-1.1 percentage points lower than in 2021 at the 12-month (93.3%), 24-month (91.0%) and 60-month (93.4%) age assessment milestones. This follows the 0.6-0.8 percentage point decrease at the 12- and 60-month milestones between the 2020 and 2021 reports, which came after eight years of generally increasing coverage. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2021 and 2022 predominantly reflect vaccinations due in 2020 and 2021, respectively, and therefore reflect impacts of the first two years of the coronavirus disease 2019 (COVID-19) pandemic. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was 1.2-2.2 percentage points lower in 2022 than in 2021 at the 12-month (90.0%), 24-month (87.9%) and 60-month (95.1%) milestones, indicating differential impacts of the pandemic. However, at the 60-month milestone, coverage in Indigenous children was 1.7 percentage points higher than in children overall. There were also clear pandemic impacts on on-time (within 30 days of recommended age) vaccination. On-time coverage of both the second dose of diphtheria-tetanus-pertussis and the first dose of measles-mumps-rubella-containing vaccines decreased progressively from mid-2020 onwards (6 and 12 percentage point falls, respectively) before recovering partially in the second half of 2022, with decreases 1.5-2.3 percentage points greater in Indigenous than non-Indigenous children, from an already close to 10 percentage points lower pre-pandemic baseline. Of adolescents turning 15 years in 2022, a total of 85.3% of girls and 83.1% of boys (83.0% and 78.1% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 0.9-1.3 percentage points lower than in 2021 (2.5-3.1 percentage points for Indigenous adolescents), also reflecting pandemic impacts. It will be important to monitor coverage with the single-dose HPV vaccine schedule - which was implemented from February 2023 - to ensure that it is sustained (ideally, increasing) and equitable, given that coverage in 2022 was 5-6 percentage points lower in adolescents in socioeconomically disadvantaged and remote areas. By 31 December 2022, coverage for an adolescent dose of diphtheria-tetanus-acellular pertussis vaccine in adolescents turning 15 years in 2022 was 86.9% (82.6% for Indigenous adolescents) and coverage for an adolescent dose of meningococcal ACWY vaccine in those turning 17 years was 75.9% (65.6% for Indigenous adolescents). Ongoing adolescent coverage gaps warrant tailored strategies to achieve higher vaccine uptake. Zoster vaccination coverage in 2022 was 41.3% in adults turning 71 years (37.7% in Indigenous adults), 2.6 (3.6) percentage points higher than in 2021, and was highest in adults turning 75 years (54.6% and 54.0%), reflecting a combination of vaccination at 70 years and catch-up at older ages. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) was 33.8% in adults turning 70 years in 2022 (37.7% in Indigenous adults), 9.9 (12.6) percentage points higher than in 2021. These increases may be partly due to more complete reporting following the introduction of mandatory reporting to the AIR in mid-2021. Influenza vaccination coverage in adults in 2022 increased with increasing age, reaching 73.0% in the ≥ 75 years age group. Coverage was higher in 2022 than in 2021 across all adult age groups, with the proportionate increase since 2019 four- to five-fold higher in those aged < 65 years than in those aged ≥ 65 years. This likely reflects increased completeness due to mandatory reporting, with coverage previously substantially underestimated in younger adults. Vaccination coverage in children and adolescents decreased modestly in 2022, reflecting impacts of the COVID-19 pandemic, but remained relatively high in global terms. The decrease in coverage was greater in Indigenous children and adolescents, with timeliness of vaccination an ongoing issue exacerbated by the pandemic. While adult coverage increased in 2022 - likely, in part, due to the introduction of mandatory reporting to AIR resulting in more accurate estimates - it remains suboptimal. Limited evidence suggests the lower coverage in children and adolescents is due to a combination of acceptance and access factors. Particularly given the evidence that these modest declines in coverage have continued into the first half of 2023, further exploration is needed to better understand these factors and to inform approaches to effectively address barriers and increase vaccine uptake.

Abstract: This innovative practice full paper describes a hybrid pedagogical framework for teaching sampling-based path planning, addressing the challenges posed by its algorithmic complexity. Traditional methods like project-based and active learning often struggle to convey these concepts effectively. To address this, we propose a hybrid pedagogical framework that integrates Technological Pedagogical Content Knowledge (ToPCK) with Adaptive Feedback-Driven Ongoing Projects (AFOP). Implemented in an Advanced Robotics course, this method combines structured content delivery with adaptive, hands-on learning experiences. It features a Multi-Practice Exercise-Enabled Method (MPEM), enabling students to explore sampling-based algorithms through code modification and iterative experimentation. AFOP personalizes learning by adjusting project complexity based on individual progress and feedback, promoting selfpaced, outcome-focused learning. To evaluate effectiveness, we use milestone projects, exams, Q&A sessions, and student interviews. Pre- and post-semester self-assessments aligned with ABET standards guide continuous instructional improvement. Results indicate significant gains in engagement and comprehension, with students demonstrating both conceptual understanding and practical problem-solving skills in robotics sampling-based path planning.

Abstract: ABSTRACT Introduction The U.S. Army-Baylor University Doctor of Science in Physician Assistant Studies General Surgery program is an 18-month curriculum consisting of approximately 4,800 hours of training in clinical, procedural, and operative skills. Maximizing efficient use of medical providers will be paramount in future military conflicts with a high number of casualties expected in a resource-limited environment. This study was designed to ensure that fellowship-trained military physician assistants are meeting surgeon expectations in both garrison and deployed environments. Materials and Methods This study used the Delphi method to prioritize skills and establish performance levels for fellowship-trained physician assistants. The initial survey used a 5-point Likert agreement scale to rate whether trained physician assistants should be able to perform that skill in garrison and deployed environments. The second survey also included questions on the competency level that surgeons expect a trained physician assistant to possess upon graduation, using Accreditation Council for Graduate Medical Education Surgery milestone descriptions for “patient evaluation and decision making,” “intraoperative patient care technical skills,” and “postoperative patient care.” Results Consensus was reached on 18 skills in both environments. Using the surgery milestones, the average expected competency level of a trained physician assistant t is 2.7 in “patient evaluation and decision making,” 2.5 for “intraoperative patient care technical skills,” and 2.8 for “postoperative patient care.” Conclusions The expert opinion garnered through this study can focus training and guide competency assessments. By acknowledging military surgeon expectations, our graduates will be better prepared to participate in interprofessional teams during future conflicts.

Abstract: Single-incision robotic surgery (SIRS) has emerged as a progression in minimally invasive practice, enabling complex operations through a single entry point. Modern systems such as the da Vinci SP (Intuitive Surgical, USA) and Versius (CMR Surgical, UK) allow multi-instrument articulation and high-definition visualization through a single port, overcoming the ergonomic and triangulation challenges of traditional laparoscopy. Recent evidence from South Korea, China, the USA, and Turkey demonstrates SIRS's feasibility, safety, and promising clinical outcomes across specialties including urology, gynecology, and general surgery. Studies report lower conversion rates, minimal postoperative pain, and enhanced cosmesis, though cost and learning curve remain limiting factors. As robotic technologies evolve, SIRS is poised to redefine minimally invasive standards through precision, reduced invasiveness, and improved recovery profiles. Rigorous multicenter trials and cost-effectiveness analyses are essential to confirm its broader clinical value.

Abstract: Summary The current buildings of the Medical University of Vienna were mainly constructed between the eighteenth and twentieth centuries and reflect a multigenerational ambition to keeping up with the latest developments in medicine. The current comprehensive structural expansion of the Medical University of Vienna within about a decade represents a significant turning point. Following the construction of the old and the new Vienna General Hospital (AKH), the establishment of modern infrastructure by the preclinical “MedUni Campus Mariannengasse” (MCM), the Center for Translational Medicine (CTM), and Center for Precision Medicine (CPM)/“Eric Kandel Institute” represents another milestone for Austrian medicine and will accompany the next generations of Austrian physicians for many decades.

Abstract: Abstract Background Despite the use of Next-Generation Sequencing (NGS) as the gold standard for the diagnosis of rare diseases, its clinical implementation has been challenging, limiting the cost-effectiveness of NGS and the understanding, control and safety essential for decision-making in clinical applications. Here, we describe a personalized NGS-based strategy integrating precision medicine into a public healthcare system and its implementation in the routine diagnosis process during a five-year pilot program. Methods Our approach involved customized probe designs, the generation of virtual panels and the development of a personalized medicine module (PMM) for variant prioritization. This strategy was applied to 6500 individuals including 6267 index patients and 233 NGS-based carrier screenings. Results Causative variants were identified in 2061 index patients (average 32.9%, ranging from 12 to 62% by condition). Also, 131 autosomal-recessive cases could be partially genetically diagnosed. These results led to over 5000 additional studies including carrier, prenatal and preimplantational tests or pharmacological and gene therapy treatments. Conclusion This strategy has shown promising improvements in the diagnostic rate, facilitating timely diagnosis and gradually expanding our services portfolio for rare diseases. The steps taken towards the integration of clinical and genomic data are opening new possibilities for conducting both retrospective and prospective healthcare studies. Overall, this study represents a major milestone in the ongoing efforts to improve our understanding and clinical management of rare diseases, a crucial area of medical research and care.

Abstract: The Substance Abuse and Men‐tal Health Services Administration (SAMSHA) on July 17 officially discontinued the “Press 3” option on the 988 Suicide & Crisis Lifeline — a specialized feature that connected LGBTQ+ youth with counselors trained to support their unique mental health needs. The decision coincides with the third anniversary of the lifeline's launch on July 15, 2022, and follows the expiration of congressionally allocated funding that had sustained the LGBTQ+ subnetwork. In response to the change, at least one crisis center provider has stated it is prepared to manage a potential increase in calls to the main lifeline.

Abstract: Alzheimer's disease poses intricate challenges, affecting cognition and behavior, notably marked by agitation. The FDA's approval of brexpiprazole, an atypical antipsychotic, stands as a milestone, representing the first treatment for Alzheimer's-related agitation. brexpiprazole's modulation of serotonin-dopamine activity has proven effective in clinical trials, reducing agitation as measured by CMAI scores. Gradual dosage escalation is recommended, with potential side effects including nasopharyngitis, urinary tract infections, dizziness, somnolence, headache, and insomnia. Also useful for schizophrenia and treatment-resistant depression, providing ongoing treatment and potential well-being enhancement by managing agitation and other symptoms.

Abstract: Arsitektur Puri Agung Karangasem menunjukkan adanya capaian penting kemajuan arsitektur dan lintasan makna ornamen memperlihatkan terjadinya akulturasi budaya Bali, Tiongkok, dan Eropa. Peneliti belum menemukan penelitian mengenai milestone dan makna ornamen pada Puri tersebut. Tujuan penelitian ini untuk menjelaskan capaian penting kesejarahan dan makna ornamen arsitektur Puri Agung Karangasem. Metode deskriptif kualitatif diimplementasikan untuk menjelaskan milestone dan makna ornamen arsitektur Puri Agung Karangasem. Teori hermeneutika digunakan sebagai pendekatan untuk mengungkap kesejarahan dan tafsir makna pada ornamen arsitektur Puri. Teknik pengumpulan data dengan observasi, wawancara dan dokumentasi, sedangkan sebagai sumber data adalah ornamen pada arsitektur istana, para ahli budaya, tokoh masyarakat, dan sebagai informan kunci Penglingsir Puri dan Abdi Dalem Puri. Hasil penelitian menunjukkan bahwa arsitektur Puri Agung Karangasem memiliki makna dan capaian yang sangat penting dalam sejarah Bali, terutama dalam konteks kerajaan. Bentuk ornamen yang terdapat di Puri Agung Karangasem dapat dibedakan menjadi tiga yaitu ornamen dengan gaya tradisional Bali, Tiongkok dan Eropa, menghasilkan perpaduan bentuk ornamen khas Puri Agung Karangasem. Dalam perspektif hermeneutika, ornamen tersebut merupakan tanda-tanda yang merujuk pada aspek-aspek tertentu dari kehidupan sosial, agama, dan politik di Bali, khususnya kerajaan Karangasem. Di samping itu penguasa Puri Agung Karangasem pada zaman dahulu memiliki hubungan budaya yang cukup baik dengan orang-orang dari Tiongkok dan Eropa, tercermin dari visualisasi ornamen yang terintegrasi pada arsitektur Puri tersebut.

Abstract: With due thanks to the Intercollegiate Biomathematics Alliance for their unending support, Spora is offering once again another highly respected platform for collaborative research in mathematics, biology, and related fields. Spora's role in disseminating work especially accessible to students makes it a unique platform to expand the body of knowledge in mathematical biology. Spora welcomes submissions related to Ph.D. dissertations, master's theses, and undergraduate research projects as well as original research.

Abstract: Telesurgery, understood as the use of robotic systems to perform remote surgical procedures, is beginning to transform neurosurgery through its initial procedures. Advances in robotics, virtual reality, augmented reality, and high-speed connectivity have enabled the first successful remote surgery experiences, marking a milestone in the history of the specialty. This innovation opens up new possibilities for expanding access to specialized care and optimizing surgical precision in complex environments.
In addition, telesurgery promotes medical training through simulation and remote mentoring, encouraging continuous learning and international collaboration. However, challenges remain in terms of technological infrastructure, digital security, regulation, and costs, which must be resolved to ensure its safe and equitable application.
In its early stages, telesurgery is already demonstrating its ability to transform neurosurgical practice, heralding a future in which distance will no longer be a barrier to surgical excellence.

Abstract: With a core mission to enhance the environmental performance, traceability, and socialacceptance of bioproducts, BioReCer encompasses a comprehensive framework meant toredefine the way biological feedstocks are utilised. At the heart of this endeavour lies theBioReCer ICT Tool, a dynamic ecosystem that gathers cutting-edge technologies to bringforth a new era of bio-based industry practices. This deliverable is a first milestone on howto tackle the technical challenge behind accomplishing such an ambitious project.Therefore, in the overall architecture description part, we focus on how the ETSI NGSI-LDspecifications lay the groundwork for the entire architectural edifice. We describe the NGSI-LD information model, with its foundational concepts of Entity, Relationship, and Property.We also detail its API, exposed by the Stellio context broker, and how it allows us to providereal-time access to contextual information, fostering seamless collaboration amongstakeholders and data sources. The BioReCer ICT tool (BIT), is a digital cornerstone that extends the reach and scope ofthe project. Through its integration, the platform not only bridges the physical gaps butalso empowers stakeholders with real-time access to context-rich information. Thisinterplay between the physical and digital worlds creates a resource for decision-makingand sustainable practices. As we must first establish trust and security, we dive into concepts such as W3C VerifiableCredentials, Decentralized Identifiers (DID) and Distributed Ledger Technology (DLT). Wethen start thinking about how these connect with ISCC certificates, machine learning,artificial intelligence, and monetization. In this deliverable, we delve into the granular intricacies of the BioReCer technical platform.From the conceptual foundations rooted in ETSI NGSI-LD specifications to the data layerthat acts as the bedrock of insights, we describe each component's role and purpose. Wewill go through identified ontologies and data models, foreseen data sources, technicalcomponents, user interfaces and deployment strategies, that compose BioReCer's ICT tool,and that will enable traceability, and acceptance of bioproducts.

Abstract: In 2023, the Winston Salem State University (WSSU) School of Nursing celebrated 70 years of service. Thirty three African American women made history on September 15, 1953, when they became the inaugural class of nursing students at Winston Salem State Teachers College (now WSSU). They were greeted by recently-hired Beverly W. Knight, professor of nursing studies. Knight was a graduate of Spellman College, Lincoln Hospital School of Nursing in New York City, and had earned a Master’s Degree from Columbia University. Together, this group of dedicated, determined, and professional women built a foundation for the outstanding College of Nursing at WSSU today.

Abstract: The Milestone M3.9 “Identify and map critical components of the Training Platform that havesignificant impact on the roles and responsibilities of Training Coordinators and TrP members”shows all the critical components of the Training Platform (TrP) that are either related to theTraining Coordinators (TrC) or the TrP members. This milestone represents an attempt to categorizethem, in order to group them. The document contains links to related information in order to have aspherical view. The objective of the milestone is to help identify the roles and responsibilities of theTrCs and the activities of the TrP members. Effort has been made in order to collect all informationfrom past ELIXIR meetings (monthly, F2F, All Hands, related workshops) and related documentation(public and private, eg. Elixir site, papers, posters, Handbooks, deliverables etc). This is an ongoingprocess with future meetings in order to further discuss and continue the collection of the criticalcomponents.The related document with critical components of the Training Platform has been created. Thedocument has been read, commented and approved from TrCs of all Nodes and also from the otherWPs, related FG and other related Commission Services as seen in the linked document.

Abstract: The EXA4MIND project connects pre-eminent databases and data management systems to supercomputing systems and European Data Spaces as well as the world of FAIR research data. The core purpose of this endeavour is running next-generation Extreme Data workfows, with emphasis on data analytics, Machine Learning / Artifcial Intelligence, or classical simulations. This deliverable reports on the Data and Workfow Management Toolbox provided for this purpose, building upon the successful LEXIS Platform (delivered by the H2020 project, GA 825532). Furthermore, it illustrates the frst workfows run by our application cases at supercomputing centres as a basis for the milestone MS5 First Data-driven Workfows have been Executed using Systems at Supercomputing Centres.

Abstract: The goal of this milestone was originally to present the “Operational version of FAIR-EASE Earth Analytics Lab, fully tested by use-cases, available for external users and referenced as EOSC Core Service”, verified by D3.3. As for the operational version of the service, tested by Use cases and available for external users, all related details and reporting of the results achieved by the FAIR-EASE project are available in deliverable D3.3 and D5.2. Nonetheless, this document completes D3.3 on the introduction of those services as EOSC Core Service. Since the proposal phase the situation around EOSC and its marketplace has changed, and it will be discussed what the new situation is, and how the approach has been updated to the new situation. In the second part of the document a short overview of the pathway towards an integration in the new EOSC context is presented for each of the three EAL implementations that are tested and ready for further uptake.

Abstract: Abstract The Transgender Persons (Protection of Rights) Act, 2019 marks a significant milestone in the journey towards recognizing and protecting the rights of transgender individuals in India. While the Act aims to provide a framework for the welfare and empowerment of transgender persons, it also raises several questions and challenges. This article critically examines the provisions of the Act, highlighting its strengths and weaknesses, and explores the potential impact on the lives of transgender individuals. It also discusses the challenges that lie ahead in implementing the Act and ensuring that the rights of transgender persons are truly protected and respected

Abstract: Since 1873, the Geological Survey of Italy has conducted field research aimed at the realization of the official detailed scale geological map of the country. However, among these maps, the Geological Survey cartographic series also includes the Geological Map of Italy at 1:1,000,000 scale. This map, in addition to its intrinsic scientific significance, also has historical and cultural value; the long time span between the first and the last edition allows us to retrace the evolution of scientific knowledge within Italian geological sciences over 100 years.

Abstract: BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education Neurosurgery Milestones were implemented to advance competency-based training in neurosurgery; however, research on milestones in neurosurgery has been more limited, and there has been no comprehensive study on the milestone ratings and the comparability of Milestones 1.0 and 2.0. The goal of this study was to describe the levels and trends of competency ratings across Milestones 1.0 and 2.0 for neurosurgical residents in the United States over the decade of implementation. Milestones 1.0 and 2.0 cover both nontechnical competencies and critical technical skills. METHODS: We conducted a retrospective analysis of milestone assessments from 2013 to 2023 across 124 US neurosurgery residency programs, encompassing both Milestones 1.0 (2013-2018) and Milestones 2.0 (2018-2023). We used descriptive statistics to examine the distributions of milestone ratings and identify performance trends in milestone ratings across postgraduate year (PGY) levels. RESULTS: The highest average rating across any milestone and all PGY levels in Milestones 1.0 was professionalism (mean = 3.17, SD 1.02) whereas the average resident rating for Patient Care was the lowest (mean = 2.89, SD = 1.03). However, a shift occurred for Milestones 2.0 where Interpersonal and Communication Skills became the highest for early PGY levels and Medical Knowledge for senior residents. Patient Care remained the lowest scoring competency under both systems. Subcompetencies such as Critical Care and Brain Tumor management consistently showed high scores, whereas areas such as Surgical Treatment of Epilepsy, Pain and Peripheral Nerves, and Pediatric Neurosurgery demonstrated lower scores. CONCLUSION: A balance between nontechnical competencies and critical technical skills is necessary to ensure comprehensive neurosurgical training. Established benchmarks can enhance the utility of milestone data and support the development of well-rounded, competent neurosurgeons.

Abstract: In 2023 on recommendation of the IEEE History Committee, the IEEE Board of Directors approved a designation of IEEE Milestone to the achievement First control of a physical object (a robot) using signals emanating from a human brain, which happened in 1988 in Skopje, Macedonia. This keynote paper describes the pioneering events that led to this achievement. The pioneering events described here are divided into three categories: artificial intelligence events, robotics events, and brain-computer interface events. The Artificial Intelligence part includes the first solution of a challenge of reinforcement learning with delayed rewards, the introduction of emotion in neural network learning, and self-learning, learning without eternal rewards. The robotics part includes first control of a robot using concurrent (multitasking) programming and first control of a movement of a robot using spoken commands. The brain-computer interface part includes contingent negative variation (CNV) signal processing and control of a computer buzzer, and alpha rhythm processing including Machine Learning for control of a robot. All that solved the challenge of psychokinesis, moving a physical object with energy emanating from a human brain, which before 1988 was in the realm of the science fiction.

Abstract: Advancing knowledge valorisation to enable transdisciplinary and cross-sector knowledgecirculation is key to upgrading the European research landscape, resulting in economic, digital,ecological, and social benefits. That is why IP4OS advocates for a concerted Intellectual Property(IP) and Open Science (OS) approach: A complementary and supportive link between agile andfitting IP tools and the sharing of Findable, Accessible, Interoperable, and Re-usable (FAIR)research outputs (data, results, codes, etc.). IP4OS aims to empower multi-professionals and theirorganisations with awareness, knowledge, skills, and advocacy to valorise FAIR research outputswith effectively fitting IP tools. The two-day kick-off event (January 8th and 9th, 2025) featured a symposium on Open Science andIntellectual Property and workshops on IP4OS different workstreams (campaign, training, synergyframework, dissemination etc.) and their key challenges.