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Simple Summary: The mainstay of soft-tissue-sarcoma treatment remains ablative surgery with complete tumor resection. In this context, reconstructive plastic surgery has become an important aspect of multidisciplinary sarcoma therapy aiming at limb preservation as an alternative to amputations. In this present study, cross-sectional data collected prospectively at 39 study centers across Germany were analyzed, focusing on both the inhouse availability of plastic surgery and external accessibility to plastic surgery in 621 cases. In summary, unplanned and incomplete primary tumor resections carried out at centers with lower degrees of specialization were associated with a significantly increased need for subsequent flap-based defect coverage. In line with this, a readily available team of plastic surgeons was independently associated with successful defect reconstruction, which in turn was associated with significantly higher chances of limb preservation. We conclude that easily accessible plastic surgery and a high degree of expertise in the field of sarcoma treatment are indispensable for limb preservation following sarcoma resection. Plastic and reconstructive surgery therefore plays a vital role in achieving the best possible outcomes in the interdisciplinary treatment of soft-tissue sarcomas. Although the involvement of plastic surgery has been deemed important in the treatment of sarcoma patients to avoid oncological compromises and ameliorate patient outcomes, it is not ubiquitously available. The accessibility of defect reconstruction and its therapeutic impact on sarcoma care is the subject of this analysis. Cross-sectional data from 1309 sarcoma patients were collected electronically at 39 German study centers from 2017 to 2019. A total of 621 patients with surgical treatment for non-visceral soft-tissue sarcomas were included. The associated factors were analyzed exploratively using multifactorial logistic regression to identify independent predictors of successful defect reconstruction, as well Chi-squared and Cochran–Mantel–Haenszel tests to evaluate subgroups, including limb-salvage rates in extremity cases. A total of 76 patients received reconstructive surgery, including 52 local/pedicled versus 24 free flaps. Sarcomas with positive margins upon first resection (OR = 2.3, 95%CI = 1.2–4.4) that were excised at centers with lower degrees of specialization (OR = 2.2, 95%CI = 1.2–4.2) were independently associated with the need for post-oncological defect coverage. In this context, the inhouse availability of plastic surgery (OR = 3.0, 95%CI = 1.6–5.5) was the strongest independent predictor for successful flap-based reconstruction, which in turn was associated with significantly higher limb-salvage rates (OR = 1.4, 95%CI = 1.0–2.1) in cases of extremity sarcomas (n = 366, 59%). In conclusion, consistent referral to specialized interdisciplinary sarcoma centers significantly ameliorates patient outcomes by achieving higher rates of complete resections and offering unrestricted access to plastic surgery. The latter in particular proved indispensable for limb salvage through flap-based defect reconstruction after sarcoma resection. In fact, although there remains a scarcity of readily available reconstructive surgery services within the current sarcoma treatment system in Germany, plastic and reconstructive flap transfer was associated with significantly increased limb-salvage rates in our cohort. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of obesity is high and increasing worldwide. Obesity is generally associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a lifestyle intervention on body weight and other chronic disease risk markers. Methods: A non-randomized controlled trial was conducted, including mostly middle-aged and elderly participants recruited from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme, focussing on four key areas: a largely plant-based diet (strongest emphasis), physical activity, stress management, and community support. Parameters were assessed at baseline, 10 weeks, 6 months, and 1 year. The control group received no intervention. Results: Compared to the control, in the intervention group, significantly lower 1-year trajectories were observed for body weight, body mass index (BMI), waist circumference (WC), total cholesterol, calculated LDL cholesterol, non-HDL cholesterol, remnant cholesterol (REM-C), glucose, HbA1c, and resting heart rate (RHR). However, between-group differences at 1 year were small for glucose, HbA1c, and cholesterol (apart from REM-C). No significant between-group differences were found for 1-year trajectories of measured LDL cholesterol, HDL cholesterol, triglycerides, insulin, blood pressure, and pulse pressure. Conclusion: The intervention successfully reduced body weight, BMI, WC, REM-C, and RHR. However, at 1 year, effectiveness of the intervention regarding other risk markers was either very modest or could not be shown. [ABSTRACT FROM AUTHOR]

Background: The Paris Climate Agreement requires a rapid and efficient shift to renewable energies and a decarbonization of the energy system. Combined heat and power provision from biomass is one way to efficiently provide renewable heat. Despite this, many bioenergy plants in Germany are mainly used to generate electricity and the provision of externally usable heat still has untapped potential. In this study, we investigated gross quantities as well as the economically viable potential of Germany's current bioenergy plant stock in supplying renewable heat. Methods: We used a top-down GIS modeling approach to spatially and explicitly assess the heat demand of three different categories of heat sinks at sub-municipal level. These included residential, commercial, and industrial areas, as well as large individual heat consumers. We then calculated the plant-specific heat sales potential for two different district heating network options. In addition, we developed a method for assessing the economic efficiency of the previously identified technical heat sales volume for a set of 20 different clusters of bioenergy plants. Results: The results show that about 50% of the bioenergy plants have potential heat consumers in their immediate proximity. The overall technical heat sales potential for all three categories totals around 150 TWhth/a. However, this potential is not evenly distributed throughout Germany. Certain regions appear to be more favorable for investing in district heating networks powered by heat from biomass. The economically viable heat sales potential related to electrical energy generation ranges from − 0.128 to 0.160 €/kWhth. Conclusion: We concluded that, under certain conditions such as location or supply and demand structure, German bioenergy plants have the potential to provide a significant share to renewable energies in the heating sector. In addition, the heat sales potential is highly relevant for plant operators as the importance of heat as a business segment is set to increase. Furthermore, bioenergy plants could contribute 2.1% (16.3 TWhth/a) to the total demand for space heating in Germany (765 TWhth/a) when considering certain technical and economic constraints. [ABSTRACT FROM AUTHOR]

Energy storage is one of the key elements within the actual stage of the energy transition, as it is probably one of the most important factors to allow high penetration of fluctuating renewable energies, such as wind or solar, in the existing power systems. Intensive research is being conducted to assess the economic aspects and technical performance of renewable energy-based systems supported by batteries by evaluating different services that batteries can provide to the electric grid or to the end-consumers. In Germany, where the majority of the currently installed 43 GW of PV capacity corresponds to small residential, commercial, or industrial facilities, an interesting market for batteries to enhance local self-consumption and autarky is already booming, with more than 80 000 storage system installations in 2017. In this context, this study presents a comprehensive analysis of the photovoltaic battery model by analyzing the technical and economic consequences that variations on the most relevant system parameters induce. The presented results are based on high resolution data obtained from a representative residential district with an autarky of above 95%. The employed battery model is based on the results obtained through an extensive test campaign and includes electrical and thermal sub-models. The analysis predicts that grid parity of residential PV battery systems can be reached in the upcoming years, with especially great potential of the retrofitting market for those PV installations which run out of the feed-in tariff policy. [ABSTRACT FROM AUTHOR]