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BackgroundPatients with peripheral arterial disease (PAD) are at increased risk for major adverse cardiovascular events (MACE) such as cardiovascular death, myocardial infarction, and stroke as well as major adverse limb events (MALE) such as amputation and acute limb ischemia. Therefore, prevention of thrombotic events is crucial to improve the prognosis of PAD patients. This review article concludes current evidence and guideline recommendations about antithrombotic therapy in PAD patients.Antithrombotic therapy is highly effective to reduce MACE and MALE events in PAD patients. Recently, the concept of dual pathway inhibition (low-dose rivaroxaban plus acetylic salicylic acid (ASA) has been tested in the COMPASS and VOYAGER-PAD trial. Compared to ASA alone dual pathway inhibition was superior to prevent MACE and MALE. After peripheral revascularization, in particular the risk for acute limb ischemia was reduced. In contrast, the risk for major bleeding is increased. Therefore, current guidelines recommend the combination of low-dose rivaroxaban and ASA in PAD patients with low bleeding risk. In patients with high bleeding risk, a single antiplatelet drug (preferable clopidogrel) is indicated. In patients with atherosclerotic vascular disease and indication for oral anticoagulation, no additional antiplatelet drug is necessary, as this would increase the risk of bleeding without improving the prognosis.ConclusionAntithrombotic treatment reduces MACE and MALE and is recommended in all patients with PAD. Individual bleeding risk should always be considered based on the current data situation and an individual benefit-risk assessment must be carried out.

Patients with peripheral arterial disease (PAD) benefit from combination therapy with acetylsalicylic acid (ASA, 100 mg, one time per day) plus low-dose rivaroxaban (2.5 mg, two times per day) compared to ASA monotherapy. In particular, major adverse cardiac and limb events were significantly reduced after peripheral endovascular revascularization (EVR). In this pilot study, the platelet activation status in vivo and platelet reactivity in vitro were longitudinally analyzed by flow cytometric assays and calibrated automated thrombography in platelet-rich plasma (PRP) from 10 patients with PAD receiving ASA (100 mg, one time per day) before EVR, ASA plus clopidogrel (75 mg, one time per day) after EVR, and ASA plus rivaroxaban (2.5 mg, two times per day) during a long-term follow-up. Platelet responsiveness to clopidogrel was compared to additional 10 patients with stable PAD and clopidogrel (75 mg, one time per day) monotherapy. ASA plus rivaroxaban treatment resulted in a significantly decreased thrombin peak in PRP for two triggers, namely, low concentration of tissue factor (TF) and thrombin, compared to ASA monotherapy. TF-controlled thrombin generation was additionally characterized by a significantly prolonged lag time in PRP and platelet-free plasma during ASA plus rivaroxaban combination therapy. In comparison, ASA plus clopidogrel treatment presented a significant reduction of the thrombin peak in PRP, which was less pronounced than during subsequent ASA plus rivaroxaban therapy. Platelet responsiveness to clopidogrel was observed for 60% of patients receiving ASA plus clopidogrel and clopidogrel monotherapy, respectively. Blocking of CD36 on the platelet surface further reduced the thrombin peak in PRP induced by TF for all three therapy regimes. Platelet activation in vivo and in response to the GPVI-agonist convulxin or thrombin in vitro was similar, whereas integrin αIIbβ3 activation and α-granule release induced by the PAR-1 activating peptide TRAP-6 were significantly diminished during ASA plus rivaroxaban treatment compared to ASA monotherapy. In conclusion, the data of this pilot study indicate an inhibitory effect of rivaroxaban on the thrombin propagation phase of CD36-sensitive platelet thrombin formation in patients with PAD treated with ASA plus rivaroxaban combination therapy, which is associated with decreased PAR-1 but not thrombin-mediated platelet activation.

Abstract Background The amount of available data, which can facilitate answering scientific research questions, is growing. However, the different formats of published data are expanding as well, creating a serious challenge when multiple datasets need to be integrated for answering a question. Results This paper presents a semi-automated framework that provides semantic enhancement of biomedical data, specifically gene datasets. The framework involved a concept recognition task using machine learning, in combination with the BioPortal annotator. Compared to using methods which require only the BioPortal annotator for semantic enhancement, the proposed framework achieves the highest results. Conclusions Using concept recognition combined with machine learning techniques and annotation with a biomedical ontology, the proposed framework can provide datasets to reach their full potential of providing meaningful information, which can answer scientific research questions.

This article focuses on the potential role of non-wood forest products (NWFPs) which are so far largely neglected within forest-related bioeconomy research and policy. From an innovation system perspective, we look at the barriers for NWFPs development and propose how they can be supported. We analyse 20 innovation cases in Europe, based on the analysis of documents and semi-structured interviews with experts involved in the cases. Results show that there is no “one” innovation system supporting NWFPs, but support is given rather erratically through certain programmes from various sectoral or regional innovation systems (forestry, agriculture, nature conservation or rural or regional development). There is a pronounced neglection of the institutional system towards NWFPs, resulting in a lack of statistics, research, education and training programmes and focused support structures. However, our results show rich potential of NWFPs in the forest bioeconomy for private forest owners and producers. These activities can range from a collection of NWFPs for subsistence to collectively organized production relevant to rural areas. Most of these are product innovations, some are service or social innovations, while some combine different innovation types. From some successful examples we derive suggestions for how to improve innovation support structures.

The development of societies, including spiritual development, is closely connected to forests. The larger interrelations among changing societies, transforming forest landscapes, and evolving spiritual values related to forests have yet to be extensively considered. Addressing this research gap is important to avoid the neglect of spiritual values in forest policy and management. Our exploratory study investigates spiritual values of forests from European and Asian perspectives, assessing 13 countries. Based on expert knowledge from 18 interdisciplinary experts, we first define forest spiritual values (forest spirituality). We then elaborate on the idea that forest spirituality evolves as societies and landscapes change, and propose a transition hypothesis for forest spirituality. We identify indicators and drivers and portray four stages of such a transition using country-specific examples. We find that during a first stage (“nature is powerful”), forest spirituality is omnipresent through the abundance of sacred natural sites and practices of people who often directly depend on forests for their livelihoods. An alternative form of spirituality is observed in the second stage (“taming of nature”). Connected to increasing transformation of forest landscapes and intensifying land-use practices, “modern” religions guide human–nature interrelations. In a third stage (“rational management of nature”), forest spirituality is overshadowed by planned rational forest management transforming forests into commodities for the economy, often focusing on provisioning ecosystem services. During a fourth stage (“reconnecting with nature”), a revival of forest spirituality (re-spiritualization) can be observed due to factors such as urbanization and individualizing spirituality. Our core contribution is in showing the connections among changing forest perceptions, changing land-use governance and practices, and changing forest spirituality. Increasing the understanding of this relationship holds promise for supporting forest policy-making and management in addressing trade-offs between spiritual values and other aspects of forests.

Non-timber forest products (NTFPs) contribute to local people’s livelihood in many regions around the world. This article investigates the types of NTFPs collected, processed, and traded in the Arasbaran region of Iran, the roles of these products in household economies, and the potential contribution to rural household economies through the collection, processing, and marketing of NTFPs. Data were collected using household and community surveys as well as through secondary sources on the role of NTFPs within Arasbaran forests in Iran. The main NTFPs harvested by local people were fruits. The fruits from 14 woody species, including trees and shrubs, were harvested by local people. The average share of forest-harvested fruit to household income was 27 percent. The mean annual income derived from the harvest and sale of sumac and reddish blackberry in the sample rural household incomes was USD 1822 and USD 142, respectively. In regard to processing efficiency, plum, cornelian cherry, and sumac exhibited the highest processing efficiency. Better policy support would be needed along the whole value chain, starting with the forest management plans, to include fruit species. In addition, measures to support processing facilities as well as to promote trade and marketing beyond the local area would be highly important to develop the potential of forest fruits and other NTFPs. Besides technical and financial support, measures should include regulatory revisions as well as information, training, and awareness raising.

Abstract Previous reports have investigated the impact of age on D-Dimer testing in elderly individuals with suspected deep vein thrombosis (DVT), but data on the age-related diagnostic value of D-dimer in a sample covering a broad age range are limited. The present study determined age-specifically the diagnostic accuracy of D-dimer and compared it to C-reactive protein (CRP), a marker of inflammation, in 500 patients with suspected DVT from the VTEval project (NCT02156401). Sensitivity of D-dimer was lower in patients 0.05). In conclusion, these data outline a clinically-relevant limitation of D-dimer testing among younger patients with suspected DVT indicating a necessity for age-adapted cut-off values. Further research is required to decrypt the role of inflammation in the pathophysiology and diagnosis of venous thrombosis.

ENGLISH: The crusaders who had settled in Jerusalem after its conquest in 1099 soon saw themselves as Orientals (cf. Fulcher of Chartres), which also had positive effects concerning their attitude towards the local residents, in particular concerning the Muslim population (in terms of a policy of balance among the non-Latin population, far-reaching equality among different groups and the ensurance of legal certainty). Proof of these claims can also be found among Muslim writers, such as Usama Ibn Munqidh and Ibn Dschubair. The example of the chancellor and archbishop William of Tyre shows how old Occidental prejudices and stereotypes regarding Muslims as heathens and idolators could indeed be vanquished. It is a fact that Wilhelm himself acknowledged Muslims as faithful and righteous citizens. This change in attitude certainly allows us to draw conclusions that are highly relevant for our present-day religious education. DEUTSCH: Nur wenige Jahre nach der Eroberung Jerusalems 1099 fühlen sich die im Königreich Jerusalem sesshaft gewordenen Kreuzfahrer bereits als Orientalen (vgl. Fulcher von Chartres), was auch positive Folgen im Verhalten gegenüber der einheimischen Bevölkerung, im Besonderen gegenüber den MuslimInnen zeitigt (Politik des Ausgleichs unter den NichtlateinerInnen, weitgehende Gleichbehandlung der verschiedenen Gruppen, Schaffung von Rechtssicherheit). Belege dafür finden sich auch bei muslimischen Autoren (Usama Ibn Munqidh, Ibn Dschubair). Das Beispiel des Kanzlers und Erzbischofs Wilhelm von Tyrus zeigt, wie die alten okzidentalen Feindbilder über die Muslime als Götzendiener und Heiden durchbrochen werden. Wilhelm kann Muslime als Gottgläubige und Gerechte anerkennen. Aus diesen Wandlungsprozessen lassen sich auch Folgerungen für den Religionsunterricht der Gegenwart ableiten.

The role of non-wood forest products (NWFPs) in industrialised country economies has declined in the past, but they are generating renewed interest as business opportunities. In a forest-based bio-economy frame, NWFPs can contribute to human nutrition, renewable materials, and cultural and experiential services, as well as create job and income opportunities in rural areas. Applying a service-dominant logic (SDL) approach to analysis of NWFPs, this article aimed to understand how new goods and services are co-created through networks of public and private actors in specific institutional, social, and cultural contexts. This focus sheds light on the experiences associated with NWFP harvest and use, revealing a fulsome suite of values and economic opportunities that include but are greater than the physical goods themselves. Turning the SDL lens on in-depth case studies from Europe and North America, we show dimensions of forest products that go beyond commercial values but are, at the same time, constituent of commercial activities. SDL provides a new view on customer relations, service provision to businesses, and policy measures for innovation support for non-wood forest products.

A property rights-based approach is proposed in the paper to underline the common characteristics of the forest property rights specification in ten ECE countries, the specific patterns governing the harvesting of timber in private forestry and the role of the forest management planning in determining the content of the property rights. The analysis deals with the private forests of the individuals (non industrial ownership) from ten countries, covering 7.3 million ha and producing yearly some 25 million m3 timber. The study shows that the forest management rights in private forests belong to the State and that the withdrawal rights on timber, yet recognised in the forest management plans, are in reality strongly restricted from an economic viewpoint. The forest management planning is the key instrument of the current forest governance system, based on top-down, hierarchically imposed and enforced set of compulsory rules on timber harvesting. With few exceptions, the forest owners have little influence in the forest planning and harvesting. The rational and State-lead approach of the private forest management has serious implications not only on the economic content of the property rights, but also on the learning and adaptive capacity of private forestry to cope with current challenges such the climate change, the increased industry needs for wood as raw material, or the marketing of innovative non wood forest products and services. The study highlights that understanding and comparing the regime of the forest ownership require a special analysis of the economic rights attached to each forest attribute; and that the evolution towards more participatory decision-making in the local forest governance can not be accurately assessed in ECE region without a proper understanding of the forest management planning process.

A Delphi survey involving experts in forest preference research was carried out to derive scores for the recreational value of 240 forest stand types across Europe. The survey was organized around four regional panels: Great Britain, Nordic Region, Central Europe, and Iberia. In each region, 60 forest stand types were defined according to five forest management alternatives (FMAs) on a continuum of management intensity, four phases of development (establishment, young, medium, and adult), and three tree species types (conifer, broadleaved, and mixed stands of conifer and broadleaved). The resulting scores were examined using conjoint analysis to determine the relative importance of the three structural attributes (FMA, phase of development, and tree species type), and each level or component of the attributes. The findings quantify the extent to which forest visitors prefer a degree of management to unmanaged forest nature reserves across the four regions. Phase of development was shown to make the highest contribution to the recreational value of forests while the contribution of tree species type was shown to be relatively unimportant. While the results are indicative, they provide evidence to support long-term retention and low-impact silviculture in forests where recreation is a primary objective of management.