Search

Using a participatory Bayesian network-based land-use decision model, we simulate future land-use patterns under various scenarios, including changes in vanilla and clove market prices as well as changes in irrigation water availability and potential harvest failures. Findings indicate that specifically the vanilla value chain (compared to the clove value chain) has a major influence on farmers income vulnerability. Abandoning vanilla cultivation may lead to poverty once income from vanilla reaches a certain threshold. By comparing farmer’s income gains from cash crop production with costs for buying rice to cover basic needs, we show that while focusing on cash crop production is more lucrative, it is, however, highly risky with regard to climate change, price volatility and possible crop thefts. Such lock-in-effects in cash crops, like the vanilla ones in northeastern Madagascar, are essential to be considered, when designing policies for a more sustainable development of resource-rich but poverty-prone regions., Journal of Land Use Science, 18 (1), ISSN:1747-4248, ISSN:1747-423X

The siting of large energy facilities is a major challenge in countries where environmental and landscape issues related to outdoor recreation, place attachment, or tourism are publicly discussed, as the choice of the "optimal" location always depends on perspective. To allow informed decisions by policy makers, landscape research should provide data on current and potential future land use, public perceptions of landscapes and energy infrastructure etc. Decision support tools can convey this information to end users and help them to mimic tradeoffs between landscape issues and renewable energy development. However, these trade-offs often focus on techno-economic aspects and ignore environmental and social aspects. In this presentation, an optimization technique (MARXAN) is applied to mimic siting of renewable energy in Switzerland. Each potential energy site has costs in terms of ecosystem services and social preferences. MARXAN optimizes the selection of these sites to produce a given energy output at the lowest cost. It is shown that when focusing on the (often) common techno-economic approach, ecological costs peak while social costs are moderate compared to ecologically and socially oriented siting strategies. When siting incorporates ecosystem service costs, both spatial stress (claimed square kilometers of landscape for renewable energy infrastructure development) and social impacts peak, and when social costs are incorporated, both spatial and ecosystem service impacts turn out to be quite moderate. The results highlight the implications of a potential paradigm shift by showing the impact of integrating ecological and social information to provide informed decision support.

Urban expansion is generating unprecedented homogenization of landscapes across the world. This uniformization of urban forms brings along dramatic environmental, social, and health problems. Reverting such processes requires activating people's sense of place, their feeling of caring for their surroundings, and their community engagement. While emotions are known to have a modulating effect on behavior, their role in urban transformation is unknown. Drawing on large cognitive-psychological experiments in two countries, we demonstrate for the first time that urban homogenization processes lower people's affective bounds to places and ultimately their intentions to engage with their neighbourhoods. The dulled emotional responses in peri-urban areas compared to urban and rural areas can be explained by lower social cohesion and place attachment. The findings highlight the significance of considering emotions in shaping just, equitable, sustainable, and resilient cities., Scientific Reports, 12, ISSN:2045-2322

Economic growth contributes to biodiversity loss and does not necessarily contribute to wellbeing. Thus, when developing biodiversity scenarios, we should explore societal futures where economic growth is not a pre-condition. However, it is not clear how and by whom a degrowth scenario for biodiversity could be developed. This is so because there are different approaches to develop scenarios (some of them nascent) and because degrowth is only loosely connected to biodiversity questions. In this perspective paper we explain how the Nature Futures Framework (NFF) could be used to generate a degrowth scenario for biodiversity, Nature's Contributions to People (NCP) and Good Quality of Life (GQL) based on multiple societal values. We present key methodological avenues of such an endeavour, including: (i) generating degrowth visions for biodiversity, NCP and GQL; (ii) identifying the leverage points and characterizing the transition; (iii) identifying relevant social-ecological feedbacks and selecting indicators; and (iv) modelling biodiversity, NCP and GQL along a degrowth transition. We frame our proposal in current efforts to improve scenario development across the biodiversity and climate communities. We end with a call for collaboration between natural and social sciences, quantitative and qualitative approaches, and northern and southern perspectives. This collaboration could lead to a community of practice that tests and improves the scenario in national and international science-policy interfaces.

Esophageal foregut duplication cysts are a rare congenital anomaly predominantly diagnosed in children. With possible growth foregut duplication cysts may cause compression on thoracic or mediastinal structures, respectively. Due to the presence of ectopic gastric mucosa and its potential malignant alteration resection of foregut duplication cysts is recommended. More recently, the use of a thoracoscopic approach for resection has shown to be an advantageous alternative to a conventional open approach. A case of a complete thoracoscopic resection of an esophageal foregut duplication cyst using a 5-mm stapling device is presented.

Scientists increasingly cross their disciplinary boundaries and connect with local stakeholders to jointly solve complex problems. Working with stakeholders means higher legitimacy and supports practical impact of research. Games provide a tool to achieve such transdisciplinary collaboration. In this paper, we explore the use of a game in a participatory project where scientists and local stakeholders are seeking and defining a joint problem. The literature is clear that this step is essential but remains short on concrete methods. Here, we explore this potential in practice. We conducted parallel participatory processes in two alpine regions considered as socio-ecological system (SES) in Switzerland and France, both vulnerable to global change. Based on these two case studies, we co-constructed a game, integrating scientific concerns about key land use, climate change and socio-economic elements of a mountain SES (tourism, agriculture, housing and demography). With the game, we assessed the existence of joint problems connecting scientific and local interests. The game successfully engaged participants at both sites over 11 game sessions, showing potential of use in other transdisciplinary settings. By covering a wide array of issues, the game created a discussion space for listing problems and identifying where scientist and stakeholder interests overlap. In Switzerland, the game revealed no pressing joint problem to be addressed. In France, game sessions revealed, among other problems, an enduring and complex issue regarding the co-existence of inhabitants and powerful institutions. Having demonstrated the capacity of this game for joint-problem assessment, we believe other participatory research in similar SES could benefit from an early use of such an approach to frame the potential for collaboration. Supplementary Information The online version contains supplementary material available at 10.1007/s11625-021-00983-2.

Agricultural intensification has profoundly changed agricultural landscapes with important biodiversity impacts. There is increasing knowledge on the general effects of landscape structure and management practices on plant and animal species but understanding the role of surrounding landscape structure for patch-scale biodiversity is more complex. While it can be reasonably assumed, that adjacent habitats are more important than more distant ones, the importance of landscape structure has often been tested at the landscape scale but rarely at smaller scales such as patch-surroundings. We assessed the influence and interdependences of landscape composition and configuration (LCC) and land use/land cover (LULC) on bird species richness and abundance through a multi-scale analysis with specific focus on the surrounding patches. In two agricultural regions in Switzerland, we collected point data of birds on 36 transects (500 m) and combined them with detailed spatial data on LULC. Bird richness and abundance were correlated to sets of landscape metrics as proxies for LCC computed at the transect-scale as well as for the patch surroundings. We analysed patch LULC as well as the most important patch-surrounding metrics using generalized linear mixed models. The results illustrate that patch LULC is the most important predictor of bird richness and abundance. Woody structures increase bird richness, followed by extensive management on patch scale. On the transect-scale semi-natural structure and heterogeneous LCCs are beneficial for bird richness and abundance. The effect of patch-surrounding structure LCCs is only small and interacts with patch LULC. Birds in grassland benefit from fallows in the surroundings, while in cropland they tend to respond positively to surrounding extensive grassland. Our results highlight that considering surroundings can help improve patch-based biodiversity assessments, which will then better predict the consequences of farmland management and make the outcome more applicable for practice., Ecological Indicators, 150, ISSN:1470-160X, ISSN:1872-7034

Deforestation is prohibited in Switzerland, as in most European countries. Nevertheless, exemptions from the ban on forest clearing may be granted, mostly for infrastructure purposes. However, surprisingly little is known about the drivers of deforestation outside of the tropics and developing countries. In this paper, we present results from a spatial econometric analysis of the drivers of forest clearances in Switzerland between 2001 and 2017. The analysis is based on a complete data set on forest clearances, which are defined as land-use and not just land-cover changes. We observe that landscape metrics are pertinent predictors of forest clearances in Switzerland. Unlike common findings on drivers of deforestation in the tropics, in Switzerland, (1) variables related to agriculture exhibited no explanatory power, (2) we found a positive effect of altitude on forest clearances in the Alps, and (3) a negative effect of the population density. We close by critically reviewing our results with regard to the use of spatial and non-spatial regression methods used in the analysis., Forest Policy and Economics, 150, ISSN:1389-9341

This work is an experimental contribution to assessing the relationship between place attachment and well-being in urban parks in a mobility and migratory context. Using virtual park visits, we aimed at finding out whether place attachment and familiarity with parks are related to physiological responses, i.e. relaxation/arousal. The experimental study involved bi-cultural residents and locals who were invited to experience two comparable urban parks in an audio-visual laboratory. The virtual visit included a Persian Garden in Iran and a historic park in Switzerland. During the session, subjects’ affective responses were measured via skin conductance activity and a questionnaire was used to collect information on aspects of place attachment/identity and perceptual properties. Statistical analyses show that place attachment and familiarity with the cultural background of a park have a significant influence on the affective responses, particularly relaxation. In addition, we find some experimental evidence that measurable place attachment has developed among bi-cultural migrants in their new place of residence. Results fit well to theories of place attachment that are compiled in the article, Landscape and Urban Planning, 232, ISSN:0169-2046, ISSN:1872-6062

Ecological infrastructure (EI), which is a planned network of high-quality natural and semi-natural elements designed and managed to provide ecosystem services, has the potential to ensure rich and resilient biodiversity. Within the Action Plan for the Swiss Biodiversity Strategy of the Swiss Confederation, the pilot project known as “ValPar.CH – Values of the ecological infrastructure in Swiss parks” aims to analyse the values and benefits of EI at two levels: across Switzerland, and in four parks of national importance (Jurapark Aargau, and Gruyère Pays-d’Enhaut, Pfyn-Finges and Beverin nature parks). The aim is to contribute to reducing biodiversity erosion as currently observed. This objective is met by developing outputs for different stakeholders (scientific papers, recommendations, data, policy tools)., eco.mont: Journal on Protected Mountain Areas Research and Management, 13 (2), ISSN:2073-106X, ISSN:2073-1558

The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001). Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode.

The Predicting Asthma Risk in Children (PARC) tool uses questionnaire-based respiratory symptoms collected from preschool children to predict asthma risk 5 years later. The tool was developed and validated in population cohorts but not validated using a clinical cohort. We aimed to externally validate the PARC tool in a pediatric pulmonology clinic setting.The Swiss Paediatric Airway Cohort (SPAC) is a prospective cohort of children seen in pediatric pulmonology clinics across Switzerland. We included children aged 1-6 years with cough or wheeze at baseline who completed the 2-year follow-up questionnaire. The outcome was defined as current wheeze plus use of asthma medication. We assessed performance using: sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV), area under the curve (AUC), scaled Brier's score, and Nagelkerke's RAmong 346 children included, 125 (36%) reported the outcome after 2 years. At a PARC score of 4: sensitivity was higher (95% vs. 79%), specificity lower (14% vs. 57%), and NPV and PPV comparable (0.84 vs. 0.87 and 0.37 vs. 0.42) in SPAC versus LRC. AUC (0.71 vs. 0.78), RThe PARC tool shows some clinical utility, particularly for ruling out the development of asthma in young children, but performance limitations highlight the need for new prediction tools to be developed specifically for the clinical setting.

OBJECTIVE Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments. DESIGN Observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC). PATIENTS We included children with EIS as main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS. RESULTS The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy. CONCLUSIONS Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonised procedures for children seen for EIS. This article is protected by copyright. All rights reserved.

A profound understanding of actors’ perspectives on issues to be resolved is essential for researchers and practitioners in integrated natural resource management. Existing mental model approaches ...

ZusammenfassungDie vorliegende Fassung der deutschsprachigen AWMF-Leitlinie soll unter Berücksichtigung der vorliegenden Evidenz die medizinische Versorgung von Kindern und Jugendlichen mit ambulant erworbener Pneumonie (pediatric community acquired pneumonia, pCAP) verbessern. In Mitteleuropa steht einer Prävalenz von ca. 300 Fällen pro 100 000 Kinder/Jahr eine sehr geringe Mortalität gegenüber, die Prävention umfasst Hygiene-Maßnahmen und Impfung z. B. gegen Pneumokokken, Hämophilus, Masern und Influenza. Hauptsymptome der pCAP sind Fieber und Tachypnoe, die Diagnosestellung erfolgt primär klinisch durch Anamnese, körperliche Untersuchung und Pulsoxymetrie. Das zusätzliche Vorliegen von Warnsymptomen wie stark reduzierter Allgemeinzustand, Nahrungsverweigerung, Dehydratation, Bewusstseinsstörung oder Krampfanfälle definiert die schwere pCAP in Abgrenzung zur nicht-schweren pCAP. Das Erregerspektrum ist altersabhängig, zur Differenzierung zwischen viraler, bakterieller oder gemischt viral-bakterieller Infektion stehen jedoch keine zuverlässigen Biomarker zur Verfügung. Die meisten Kinder und Jugendlichen mit nicht-schwerer pCAP und O2-Sättigung > 92 % können ohne weitere Röntgen-, Labor- und Erreger-Diagnostik ambulant betreut werden. Der Einsatz von Antiinfektiva ist nicht grundsätzlich indiziert, vor allem bei jungen Kindern, bronchialer Obstruktion und anderen Hinweisen auf virale Genese kann darauf i. d. R. verzichtet werden. Zur kalkulierten Antibiotika-Therapie sind Aminopenicilline Mittel der Wahl, bei gewährleisteter Einnahme und Resorption sind die orale (Amoxicillin) und intravenöse Verabreichung (Ampicillin) von vergleichbarer Wirksamkeit. Nach 48 – 72 Stunden ist eine Verlaufsbeurteilung notwendig, um den Behandlungserfolg und mögliche Komplikationen wie z. B. parapneumonische Ergüsse oder Pleuraempyeme, die eine Erweiterung bzw. Änderung der Therapie erforderlich machen, rechtzeitig zu erfassen.

In this study, we assessed the importance of cytoskeleton organization in the mammalian cells used to produce therapeutic proteins. Two cytoskeletal genes, Actin alpha cardiac muscle 1 (ACTC1) and a guanosine triphosphate GTPase‐activating protein (TAGAP), were found to be upregulated in highly productive therapeutic protein‐expressing Chinese hamster ovary (CHO) cells selected by the deprivation of vitamin B5. We report here that the overexpression of the ACTC1 protein was able to improve significantly recombinant therapeutic production, as well as to decrease the levels of toxic lactate metabolic by‐products. ACTC1 overexpression was accompanied by altered as well as decreased polymerized actin, which was associated with high protein production by CHO cell cultured in suspension. We suggest that the depolymerization of actin and the possible modulation of integrin signaling, as well as changes in basal metabolism, may be driving the increase of protein secretion by CHO cells., Pourcel et al. observed that several cytoskeletal genes are upregulated in highly productive CHO cell clones. Actin alpha overexpression yielded altered cytoskeletal organization, which was accompanied by improved recombinant therapeutic production as well as decreased levels of toxic lactate metabolic by‐products. Cells spontaneously displaying low actin polymerization yielded higher protein production in suspension cultures, highlighting the importance of the cytoskeleton for the efficient production of easy‐ as well as difficult‐to‐express therapeutic proteins.

Despite extensive research conducted to increase protein production from Chinese hamster ovary (CHO) cells, cellular bottlenecks often remain, hindering high yields. In this study, a transcriptomic analysis led to the identification of 32 genes that are consistently upregulated in high producer clones and thus might mediate high productivity. Candidate genes were associated with functions such as signaling, protein folding, cytoskeleton organization, and cell survival. We focused on two engineering targets, Erp27, which binds unfolded proteins and the Erp57 disulfide isomerase in the endoplasmic reticulum, and Foxa1, a pioneering transcription factor involved in organ development. Erp27 moderate overexpression increased production of an easy‐to‐express antibody, whereas Erp27 and Erp57 co‐overexpression increased cell density, viability, and the yield of difficult‐to‐express proteins. Foxa1 overexpression increased cell density, cell viability, and easy‐ and difficult‐to‐express protein yields, whereas it decreased reactive oxygen species late in fed‐batch cultures. Foxa1 overexpression upregulated two other candidate genes that increased the production of difficult‐ and/or easy‐to‐express proteins, namely Ca3, involved in protecting cells from oxidative stress, and Tagap, involved in signaling and cytoskeleton remodeling. Overall, several genes allowing to overcome CHO cell bottlenecks were identified, including Foxa1, which mediated multiple favorable metabolic changes that improve therapeutic protein yields., In this work, the authors performed a transcriptomic analysis to identify genes upregulated in CHO cells producing therapeutic proteins at high levels. Among them, they identified candidate genes whose overexpression could improve the production of easy‐ and difficult‐to‐express therapeutic proteins. This included Erp27, an endoplasmic reticulum‐located protein that binds unfolded proteins and the Erp57 protein disulfide isomerase, and Foxa1, a pioneering transcription factor whose overexpression upregulated the expression of high production‐associated genes.

Forest frontiers worldwide reveal trade-offs that are key in mitigating global change. In the forest frontiers of northeast Madagascar, land-use changes result from decisions made by smallholder fa...

Resume Objectif Le sentiment de vide vecu par des patients souffrant d’un trouble de personnalite borderline est peu decrit dans la litterature. L’objectif de cette etude est donc d’en offrir une description etoffee. Methode Nous avons realise une analyse thematique des descriptions du sentiment de vide de 37 patients souffrant d’un trouble de personnalite borderline. Resultats Nous avons identifie cinq categories faisant reference au theme de l’absence, trois categories relatives au contenu du vide et cinq categories evoquant des experiences etroitement associees au sentiment de vide. Conclusions L’absence represente l’essence de cette experience, avec plusieurs nuances evoquant un concept multidimensionnel. La limite majeure de cette etude est la forte comorbidite avec des troubles de l’humeur unipolaires, le ressenti de ce sentiment etant vraisemblablement dependant de son contexte psychologique.

Background It is unclear if predictors of asthma attacks are the same as those of asthma symptom control in children. We evaluated predictors for these two outcomes in a clinical cohort study. Methods The Swiss Paediatric Airway Cohort (SPAC) is a multicentre prospective clinical cohort of children referred to paediatric pulmonologists. This analysis included 516 children diagnosed with asthma. At baseline, we collected sociodemographic information, symptoms, personal and family history and environmental exposures from a parental baseline questionnaire, and treatment and test results from hospital records. Outcomes were assessed 1 year later by parental questionnaire: asthma control in the last 4 weeks as defined by GINA guidelines, and asthma attacks defined as any unscheduled visit for asthma in the past year. We used logistic regression to identify and compare predictors for suboptimal asthma control and asthma attacks. Results At follow-up, 114/516 children (22%), reported suboptimal asthma control, and 114 (22%) an incident asthma attack. Only 37 (7%) reported both. Suboptimal asthma control was associated with poor symptom control at baseline, wheeze triggered by allergens, colds and exercise, a more intense treatment at baseline, history of preschool and persistent wheeze, and exposure to tobacco smoke. Incident asthma attacks were associated with previous episodes of severe wheeze and asthma attacks, younger age and non-Swiss origin. Lung function, exhaled nitric oxide (FeNO) and allergic sensitization at baseline were not associated with control or attacks. Conclusion Predictors of suboptimal control differ from those of attacks. Prediction tools and preventive efforts should differentiate these two asthma outcomes.

RationaleThe Predicting Asthma Risk in Children (PARC) tool uses questionnaire-based respiratory symptoms collected from preschool children to predict their risk of asthma 5 years later. The tool was originally developed and externally validated in population-based settings and has not yet been validated in a clinical setting.ObjectiveTo externally validate the PARC tool in children seen in paediatric pulmonology clinics.MethodsThe Swiss Paediatric Airway Cohort (SPAC) is a prospective study of children seen in respiratory outpatient clinics across Switzerland. This analysis included children seen at ages 1-6 years for cough or wheeze at baseline and who completed the follow-up questionnaire 2 years later. The outcome was defined as current wheeze plus use of asthma medication. In sensitivity analyses, we explored effects of varied inclusion criteria and outcomes. We assessed performance by describing sensitivity, specificity, negative and positive predictive value (NPV, PPV), area under the curve (AUC), scaled Brier’s score and Nagelkerke’s R2 scores and compared performance in SPAC to that achieved in the original population, the Leicester Respiratory Cohort (LRC).ResultsAmong the 346 children included, 125 (36%) reported the outcome after 2 years. At a PARC score cut-off of 4, sensitivity was higher (95% vs 79%) but specificity lower (14% vs 57%) in SPAC compared to LRC. NPV was comparable (0.84 vs. 0.87) as was PPV (0.37 vs.0.42). Discrimination was lower in SPAC (AUC of 0.71 vs 0.78), as were Nagelkerke’s R2 (0.18 vs 0.28) and scaled Brier’s scores (0.13 vs 0.22). When the outcome was changed to moderately severe asthma (>4 attacks plus use of asthma medication), there were improvements in AUC (0.74), sensitivity (0.97), specificity (0.22) and NPV (0.99), but some deterioration in PPV (0.13), R2 (0.15) and scaled Brier score (0.09).ConclusionWhile the PARC tool performs well in a population-based setting and has some clinical utility, in particular for ruling out the development of asthma, this study highlights the need for new prognostic prediction tools to be developed specifically for the clinical setting.FundingSNSF:320030_182628, SLA2019-03_641670

BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort (SPAC) from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (e.g., asthma) and features (e.g., triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.

Heart transplantation remains the most durable treatment for patients with end-stage heart failure refractory to medical treatment. Central elements of the listing criteria for heart transplantation have remained largely unchanged in the last three decades whereas treatment of heart failure has significantly increased survival and reduced disease-related symptoms. It remains unknown whether the improvement of heart failure therapy changed the profile of heart transplantation candidates or affected post-transplant survival. The study investigated a total of 323 heart transplant recipients of the Lausanne University Hospital with 328 transplant operations between 1987 and 2018. Patients were separated into three groups on the basis of availability of heart failure therapy: period 1 (1987-1998; n = 115) when renin-angiotensin system blockade and diuretic treatment were available; period 2 (1999-2010; n = 106) marked by the addition of beta-blocker and mineralocorticoid receptor antagonist treatment in severe heart failure, and the establishment of cardiac defibrillator and resynchronisation therapy; period 3 (2011-2018; n = 107) characterised by the increasing use of ventricular assist devices for bridge to transplantation. The patient characteristics age (all: 53.4 years), male sex (all: 79%) and body mass index (all: 24.5 kg/m2) did not differ between periods. History of arterial hypertension was less prevalent in period 2 (period 1 vs 2 vs 3: 44 vs 28 vs 43%, p = 0.04) whereas other cardiovascular risk factors were equally distributed. Left ventricular ejection fraction, VO2max, and pulmonary vascular resistance were not different between the three periods. The prevalence of ischaemic cardiomyopathy was higher in periods 1 and 3; dilated non-ischaemic cardiomyopathy was more frequent in period 2. Post-transplant 1-year survival was highest in period 3 (1 vs 2 vs 3: 87.2 ± 3.2% vs 70.8 ± 4.4% vs 93.0 ± 2.6%, p always ≤0.02), and the Kaplan-Meier estimates of survivors of the first year post-transplant were not different between the three periods. In descriptive analysis, early mortality was not associated with acknowledged pretransplant predictors of post-transplant mortality. Availability of different medical heart failure treatments did not result in greatly different pretransplant characteristics of heart transplantation recipients across the three periods. This suggests that the maintained central criteria of listing for heart transplantation still identify end-stage heart failure patients with a similar profile. This finding can explain the unchanged overall mortality on condition of 1-year survival across the three periods, since pretransplant characteristics are relevant for long-term survival after heart transplantation.

The increasing complexity of the dynamics captured in Land Use and Land Cover (LULC) change modelling has made model behaviour less transparent and calibration more extensive. For cellular automata models in particular, this is compounded by the fact that validation is typically performed indirectly, using final simulated change maps; rather than directly considering the probabilistic predictions of transition potential. This study demonstrates that evaluating transition potential predictions provides detail into model behaviour and performance that cannot be obtained from simulated map comparison alone. This is illustrated by modelling LULC transitions in Switzerland using both Logistic Regression and Random Forests. The results emphasize the need for LULC modellers to explicitly consider the performance of individual transition models independently to ensure robust predictions. Additionally, this study highlights the potential for predictor variable selection as a means to improve transition model generalizability and parsimony, which is beneficial for simulating future LULC change., Environmental Modelling & Software, 159, ISSN:1364-8152, ISSN:1873-6726

Background Asthma treatment should be modified according to symptom control and future risk, but there are scarce data on what drives treatment adjustments in routine tertiary care. Objective We studied factors that drive asthma treatment adjustment in pediatric outpatient clinics. Methods We performed a cross-sectional analysis of the Swiss Paediatric Airway Cohort, a clinical cohort of 0- to 16-year-old children seen by pediatric pulmonologists. We collected information on diagnosis, treatment, lung function, and FeNO from hospital records; and on symptoms, sociodemographic, and environmental factors from a parental questionnaire. We used reported symptoms to classify asthma control and categorized treatment according to the 2020 Global Initiative for Asthma guidelines. We used multivariable logistic regression to study factors associated with treatment adjustment (step-up or down vs no change). Results We included 551 children diagnosed with asthma (mean age, 10 years; 37% female). At the clinical visit, most children were prescribed Global Initiative for Asthma step 3 (35%). Compared with previsit treatment, 252 children remained on the same step (47%), 227 were stepped up (42%), and 58 were stepped down (11%). Female sex (adjusted odds ratio [aOR] = 1.61; 95% confidence interval [CI], 1.05-2.47), poor asthma control (aOR = 3.08; 95% CI, 1.72-5.54), and lower FEV1 Z-score (aOR = 0.70; 95% CI, 0.56-0.86 per one Z-score increase) were independently associated with treatment step-up, and low FeNO (aOR = 2.34; 95% CI, 1.23-4.45) was associated with treatment step-down, with marked heterogeneity between clinics. Conclusions In this tertiary care real-life study, we identified main drivers for asthma treatment adjustment. These findings may help improve both asthma management guidelines and clinical practice.

Antibody-mediated rejection (AMR) is a major barrier preventing successful discordant organ xenotransplantation, but it also occurs in allotransplantation due to anti-HLA antibodies. Symptomatic acute AMR is rare after heart allograft but carries a high risk of mortality, especially >1 year after transplant. As complement activation may play a major role in mediating tissue injury in acute AMR, drugs blocking the terminal complement cascade like eculizumab may be useful, particularly since "standards of care" like plasmapheresis are not based on strong evidence. Eculizumab was successfully used to treat early acute kidney AMR, a typical condition of "active AMR," but showed mitigated results in late AMR, where "chronic active" lesions are more prevalent. Here, we report the case of a heart recipient who presented with acute heart failure due to late acute AMR with eight de novo donor-specific anti-HLA antibodies (DSA), and who fully recovered allograft function and completely cleared DSA following plasmapheresis-free upfront eculizumab administration in addition to thymoglobulin, intravenous immunoglobulins (IVIG), and rituximab. Several clinical (acute onset, abrupt and severe loss of graft function), biological (sudden high-level production of DSA), and pathological features (microvascular injury, C4d deposits) of this cardiac recipient are shared with early kidney AMR and may indicate a strong role of complement in the pathogenesis of acute graft injury that may respond to drugs like eculizumab. Terminal complement blockade should be further explored to treat acute AMR in recipients of heart allografts and possibly also in recipients of discordant xenografts in the future.

Frontiers in Environmental Science, 9, ISSN:2296-665X

ObjectiveNewborn screening (NBS) for cystic fibrosis (CF) was introduced in Switzerland in 2011 based on an immunoreactive trypsinogen (IRT)-DNA-IRT protocol. CF diagnosis was confirmed by sweat test and/or genetics but remained inconclusive for some newborns (cystic fibrosis transmembrane conductance regulator related metabolic syndrome (CRMS)/CF screen positive, inconclusive diagnosis (CFSPID)). We aimed to (1) Describe IRT levels in healthy newborns in the first year of life and by gestational age (GA), and (2) Compare IRT at two time points between healthy newborns and newborns with CF and CRMS/CFSPID.DesignRetrospective study.SettingNational NBS database.PatientsAll children with an IRT measurement by heel prick test from 2011 to 2019.InterventionsNone.Main outcome measuresIRT values were extracted from the National NBS Laboratory, and clinical characteristics of positively screened children from the CF-NBS database. Second IRT assessment in positively screened children was usually performed after 18–24 days. We calculated internal IRT Z-Scores and multiples of the median to compare our results across different laboratory tools.ResultsAmong 815 899 children; 232 were diagnosed with CF, of whom 36 had meconium ileus (MI); 27 had CRMS/CFSPID. Among all samples analysed, mean IRT Z-Scores were higher for newborns with GA 0.11) compared with term babies (all Z-Scores ≤0.06). Repeated IRT Z-Scores after a median (IQR) of 19 (17–22) days remained high for infants with CF with or without MI but decreased for infants with CRMS/CFSPID.ConclusionsMeasurement of a second IRT value can help distinguish between children with CRMS/CFSPID and CF, early in life.

No episodes of oxygen desaturation or carbon dioxide retention were observed in this cross-sectional study assessing children with exercise-induced symptoms wearing a surgical facemask during a submaximal treadmill exercise test https://bit.ly/3GuxhvO.