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Abstract Recent years have seen a massive development of geospatial sensing systems informing the use of space. However, rarely do these sensing systems inform transformation towards urban sustainability. Drawing on four global urban case examples, we conceptualize how passive and active sensing systems should be harnessed to secure an inclusive, sustainable and resilient urban transformation. We derive principles for stakeholders highlighting the need for an iterative dialogue along a sensing loop, new modes of governance enabling direct feeding of sensed information, an account for data biases in the sensing processes and a commitment to high ethical standards, including open access data sharing.

Scedosporium apiospermum associated endocarditis is extremely rare. We report a case of a disseminated S. apiospermum infection with an invasive right atrial mass in a 52-year-old male, 11 months after heart transplantation, referred to our institution for an endogenous endophthalmitis with a one-month history of diffuse myalgias and fatigue. The patient had been supported two times with extracorporeal membrane oxygenation (ECMO) during the first three postoperative months. The echocardiography on admission revealed a mass in the right atrium attached to a thickened lateral wall. The whole-body [18F]FDG PET/CT revealed systemic dissemination in the lungs, muscles, and subcutaneous tissue. Blood cultures were positive on day three for filamentous fungi later identified as S. apiospermum. The disease was refractory to a 3-week dual antifungal therapy with voriconazole and anidulafungin in addition to reduced immunosuppression, and palliative care was implemented.

Abstract Dynamic process‐based modelling is often proposed as a powerful tool to understand complex socio‐environmental problems and to provide sustainable solutions as it allows disentangling cause and effect of human behaviour and environmental dynamics. However, the impact of such models in decision‐making and to support policy‐making has so far been very limited. In this paper, we want to take a critical look at the reasons behind this situation and propose steps that need to be taken to change it. We investigate a number of good practice examples from fields where models have influenced policy‐making and management to identify the main aspects that promote or impede the application of these models. Specifically, we compare examples that differ in their extent to how explicitly they represent human behaviour as part of the model, ranging from purely environmental systems (including models for river management, honeybee colonies and animal diseases), where modelling techniques have long been established, to coupled socio‐environmental systems (including models for land use, fishery management and sustainable water use). We use these examples to synthesise four key factors for successful modelling for policy and management support in socio‐environmental systems. They cover (a) the specific requirements caused by modelling the human dimension, (b) the importance of data availability and accessibility, (c) essential elements of the partnership between modellers and decision‐makers and (d) insights related to characteristics of the decision process. For each of these aspects, we give recommendations specifically to modellers, decision‐makers or both to make the use of models for practice more effective. We argue that if all parties involved in the modelling and decision‐making process take into account these suggestions during their collaboration, the full potential that socio‐environmental modelling bears can increasingly unfold. A free Plain Language Summary can be found within the Supporting Information of this article.

Although metacommunity theory provides many useful insights for conservation planning, the transfer of this knowledge to practice is hampered due to the difficulty of identifying metacommunities in bioregions. This study aims to identify the spatial extent of metacommunities at bioregional scales using current and historical habitat data, especially because contemporary biodiversity patterns may be a result of time‐lagged responses to historical habitat configurations. Further, this estimation of the metacommunity spatial extent is based on both the habitat structure and the dispersal ability of the species. Focusing on dragonfly and damselfly (odonate) species in the eastern Swiss Plateau, the research uses wetland habitat information spanning over 110 years to create a time series of nine habitat networks between 1899 and 2010. From these networks, we identified the spatial extents of metacommunities based on the year of habitat information as well as on watershed boundaries. To identify the best metacommunity spatial extents, the study investigates whether patch pairs within a metacommunity exhibit greater similarity in species composition (i.e. lower beta‐diversity) than patch pairs between metacommunities. For the different metacommunities, we further investigated correlations between gamma diversity and metacommunity size and compare them to theoretical expectations. In both analyses we found that augmenting spatial metacommunity identification with historical geographical proximity results in stronger associations with biodiversity patterns (beta and gamma diversity) than when using only current‐day habitat or watershed information. [ABSTRACT FROM AUTHOR]

Abstract Aims Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short‐term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short‐term mortality in AHF patients with reduced EF (AHFrEF), mid‐range EF (AHFmrEF), or preserved EF (AHFpEF). Methods and results This mono‐centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all‐cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1–2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age‐adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1–4.2]; P = 0.002). The age‐adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9–57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5–1.8]; P = 0.875). Conclusions Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.

Snow is a sensitive component of the climate system. In many parts of the world, water stored as snow is a vital resource for agriculture, tourism and the energy sector. As uncertainties in climate change assessments are still relatively large, it is important to investigate the interdependencies between internal climate variability and anthropogenic climate change and their impacts on snow cover. We use regional climate model data from a new single-model large ensemble with 50 members (ClimEX LE) as a driver for the physically based snow model SNOWPACK at eight locations across the Swiss Alps. We estimate the contribution of internal climate variability to uncertainties in future snow trends by applying a Mann–Kendall test for consecutive future periods of different lengths (between 30 and 100 years) until the end of the 21st century. Under RCP8.5, we find probabilities between 10 % and 60 % that there will be no significant negative trend in future mean snow depths over a period of 50 years. While it is important to understand the contribution of internal climate variability to uncertainties in future snow trends, it is likely that the variability of snow depth itself changes with anthropogenic forcing. We find that relative to the mean, interannual variability of snow increases in the future. A decrease in future mean snow depths, superimposed by increases in interannual variability, will exacerbate the already existing uncertainties that snow-dependent economies will have to face in the future.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Integrated regional planning aims to achieve sustainable development by considering multiple socio-economic, environmental, and ecological goals. However, determining the synergies and trade-offs between sustainability goals is a challenging task that requires an in depth analysis of the system-level effects of the implementation of planning policies. For example, polycentricity (i.e. multiple urban centres) is a common regional urban planning goal, which has shown to be beneficial for a region’s socio-economic conditions, but may also change the configuration of the settlement network (i.e. settlements connected by roads and traffic). Given the dependency of animal species on well-connected habitat networks, another possible planning goal is to maximise habitat availability (i.e. the total amount of habitat that is accessible for an individual animal). However, changes to a region’s settlement network can have a variety of impacts on the region’s habitat networks. Due to these interactions, it is unclear whether maximising polycentricity and habitat availability are compatible planning goals. To address this question, we developed a mathematical model of interacting settlement and habitat networks in a region of Switzerland. The settlement network model allowed us to predict commuter and traffic flows in our study region under a certain distribution of jobs and people across the municipalities. The level of polycentricity in our region was measured by calculating the hierarchy in the commuter flow network. The traffic flow network was linked to the habitat network, which was used to calculate the mean habitat availability. With multi-objective optimisations, both polycentricity and habitat availability were maximised by changing the distributions of jobs and people. Although both goals could be improved compared to the current situation, there was a trade-off between polycentricity and habitat availability along the Pareto front. Developing the region towards either of the planning goals could be achieved by changing the distribution of jobs and people mainly in mid-sized municipalities and by a strong collaboration between municipalities. Our results increase the understanding of the complex interactions in urban regions and can lead to recommendations for integrated urban and conservation planning.

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.

The concept of ecological infrastructure (EI) as a lens for landscape management has the potential to address environmental challenges, such as biodiversity loss and ecosystem degradation, by instrumentalizing Nature’s Contributions to People (NCP). NCPs stems from the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES) and refers to the various ways in which the natural world provides benefits, values, and services that directly and indirectly contribute to the well-being, livelihoods, and cultural aspects of human societies. This research explores this potential by proposing an archetype analysis of social-ecological-technological systems (SETS) to manage EI. We derived archetypes using machine learning and clustering on a data-driven SETS framework co-produced with experts in EI management. The archetype analysis was conducted by combining K-means with hierarchical clustering on spatial patterns to generate clusters with similar configurations of social, ecological, and technological subsystems. The approach is illustrated for the canton of Geneva, Switzerland, which experiences high urbanization and ecological pressures. The resulting spatially explicit archetypes of SETS facilitate policy recommendations tailored to multifunctional landscapes, which can be used to derive coherent management strategies for EI. In addition, the approach demonstrates that by taking an integrated landscape approach and engaging with diverse stakeholders, it is possible to develop effective landscape-based management recommendations for promoting the sustainable provision of NCPs and biodiversity within the concept of EI.

Background Diagnosis of primary ciliary dyskinesia (PCD) is challenging since there is no gold standard test. The European Respiratory (ERS) and American Thoracic (ATS) Societies developed evidence-based diagnostic guidelines with considerable differences. Objective We aimed to compare the algorithms published by the ERS and the ATS with each other and with our own PCD-UNIBE algorithm in a clinical setting. Our algorithm is similar to the ERS algorithm with additional immunofluorescence staining. Agreement (Cohen's κ) and concordance between the three algorithms were assessed in patients with suspicion of PCD referred to our diagnostic centre. Results In 46 out of 54 patients (85%) the final diagnosis was concordant between all three algorithms (30 PCD negative, 16 PCD positive). In eight patients (15%) PCD diagnosis differed between the algorithms. Five patients (9%) were diagnosed as PCD only by the ATS, one (2%) only by the ERS and PCD-UNIBE, one (2%) only by the ATS and PCD-UNIBE, and one (2%) only by the PCD-UNIBE algorithm. Agreement was substantial between the ERS and the ATS (κ=0.72, 95% CI 0.53–0.92) and the ATS and the PCD-UNIBE (κ=0.73, 95% CI 0.53–0.92) and almost perfect between the ERS and the PCD-UNIBE algorithms (κ=0.92, 95% CI 0.80–1.00). Conclusion The different diagnostic algorithms lead to a contradictory diagnosis in a considerable proportion of patients. Thus, an updated, internationally harmonised and standardised PCD diagnostic algorithm is needed to improve diagnostics for these discordant cases.