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Abstract Objectives To present our technique of diagnostic CT-guided ischiofemoral space injection and report on pain response, complications, and associated imaging findings in young patients with ischiofemoral impingement (IFI). Methods Retrospective case series of patients with a clinical diagnosis of IFI that underwent CT-guided IFS injection with local anesthetic in a prone position with the feet in maximum internal rotation between 06/2019 and 04/2021. The response was evaluated using maximum subjective pain evaluation on a 0–10 visual analog scale (VAS) during a standardized pre- and postinterventional clinical examination. Patient charts and radiographic imaging data were reviewed to report associated imaging findings and subsequent surgeries. Results Eleven patients (13 hips, 9 females) with a median age of 31 years (interquartile range; IQR: 25–37 years) were included. Median baseline VAS was 7 points (IQR: 5–8) with a pain reduction of 5 points (IQR: 5–7 points, p = 0.001) after the injection. One patient reported transient ischial nerve paresthesia, otherwise, no complications occurred. Quadratus femoris muscle edema was present in 85% (11 of 13 hips). Excessively high femoral torsion (11/13 hips, 85%) and cam deformities (8/13 hips, 62%) were the most common osseous deformities. Eight of 13 hips (62%) underwent subsequent surgery for IFI. Conclusion CT-guided diagnostic injection of the ischiofemoral space is safe and feasible. In young IFI patients, diagnostic IFS injections have the potential to improve the differential diagnosis of hip pain and to inform decision-making with regard to a possible benefit of joint-preserving hip surgery. Critical relevance statement In young patients with hip pain, diagnosis of IFI can be challenging due to concomitant pathologies. Furthermore, surgical treatment in these patients is controversial. In this context, CT-guided diagnostic infiltrations of the ischiofemoral space may facilitate not only the initial diagnosis of IFI, but could also improve surgical decision-making. Key Points CT-guided diagnostic injection of local anesthetic in the ischiofemoral space is safe. In young patients with IFI, it leads to subjective pain reduction. In young patients with concomitant osseous deformities, it may improve surgical decision-making. Graphical Abstract

Abstract Background Computed tomography (CT) reconstruction algorithms can improve image quality, especially deep learning reconstruction (DLR). We compared DLR, iterative reconstruction (IR), and filtered back projection (FBP) for lesion detection in neck CT. Methods Nine patient-mimicking neck phantoms were examined with a 320-slice scanner at six doses: 0.5, 1, 1.6, 2.1, 3.1, and 5.2 mGy. Each of eight phantoms contained one circular lesion (diameter 1 cm; contrast -30 HU to the background) in the parapharyngeal space; one phantom had no lesions. Reconstruction was made using FBP, IR, and DLR. Thirteen readers were tasked with identifying and localizing lesions in 32 images with a lesion and 20 without lesions for each dose and reconstruction algorithm. Receiver operating characteristic (ROC) and localization ROC (LROC) analysis were performed. Results DLR improved lesion detection with ROC area under the curve (AUC) 0.724 ± 0.023 (mean ± standard error of the mean) using DLR versus 0.696 ± 0.021 using IR (p = 0.037) and 0.671 ± 0.023 using FBP (p

Abstract Background Hip arthroscopy with initial access to the peripheral compartment could reduce the risk of iatrogenic injury to the labrum and cartilage; furthermore, it avoids the need for large capsulotomies with separate portals for peripheral and central (intra-articular) arthroscopy. Clinical results of the peripheral-compartment-first technique remain sparse, in contrast to those of conventional hip arthroscopy starting in the intra-articular central compartment. The purpose of this study was to assess outcome of hip arthroscopy with the peripheral-compartment-first technique, including complication rates, revision rates and patient-reported outcome scores. Materials and methods This outcome study included 704 hips with femoroacetabular impingement. All arthroscopies were performed using the peripheral-compartment-first technique. A joint replacement registry and the institutional database were used to assess the revision and complication rates, while patient-reported outcome measures were used to assess functional outcomes and patient satisfaction. Results In total, 704 hips (615 patients) were followed up for a mean of 6.2 years (range 1 to 9 years). The mean age of the patients was 32.1 ± 9.2 years. During the follow-up period, 26 of 704 (3.7%) hips underwent total hip arthroplasty (THA) after a mean of 1.8 ± 1.2 years, and 18 of the 704 (2.6%) hips required revision hip arthroscopy after a mean of 1.2 ± 2.1 years. 9.8% of the hips had an unsatisfactory patient-reported outcome at final follow-up. Conclusions The results for the peripheral-compartment-first technique were promising. We recommend a well-conducted randomized controlled clinical trial to guide future therapeutic recommendations regarding the most favorable hip arthroscopy technique. Level of evidence: Level IV, therapeutic study. Trial registration: This study was registered at ClinicalTrials.gov (U.S. National Library of Medicine; ID: NCT05310240).

Abstract Objectives To assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim. Methods IRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed. Results One hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p < .001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME (p < .05). Accuracy for predicting QFME was high with an AUC of .89 (95% CI .82–.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance. With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p = .021). Conclusion Hip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion. Critical relevance statement FABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making. Key points • FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter. • Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema. • Foveal excursion was more frequent in hips with quadratus femoris muscle edema. Graphical Abstract

Abstract Social aspects of miscanthus cultivation have been investigated in a limited way in the scientific literature. Adopting existing frameworks for social life‐cycle assessment enables assessments to include numerous social aspects; however, the relevance of these aspects depends on the local context. This study aims to identify the most relevant social aspects from the farmers' perspective using a previously proposed framework for the assessment of the stakeholder ‘farmer’. It is based on a case study for miscanthus production in Sisak Moslavina in Croatia. The existence of abandoned lands in Croatia presents an opportunity for the cultivation of miscanthus as a potential source of biomass for the production of bio‐based materials and fuels. The study seeks to assess the feasibility of cultivating miscanthus in the region, taking into account potential challenges and opportunities, as well as farmers' willingness to adopt the crop, and to understand the reasons behind land abandonment. We conducted a survey among 44 farmers in the region and used a scoring method to identify the most relevant social aspects. The aspects most valued by the farmers were health and safety, access to water, land consolidation and rights, income and local employment, and food security. Responses to the question of whether they would adopt the crop highlight the importance of an established market, good trading conditions and profitability of cultivation. The survey also enabled an understanding of farmers' preferences with respect to the production conditions of crops. The farmers regarded the provision of subsidies as one of the main factors that render a crop attractive. Opportunities for the adoption of the miscanthus cultivation include high yields and low input requirements. Barriers include land conflicts and land availability. Despite the opportunities for miscanthus development in the region, there are important challenges to consider for successful implementation of the crop.

Abstract Demand for sustainably produced biomass is expected to increase with the need to provide renewable commodities, improve resource security and reduce greenhouse gas emissions in line with COP26 commitments. Studies have demonstrated additional environmental benefits of using perennial biomass crops (PBCs), when produced appropriately, as a feedstock for the growing bioeconomy, including utilisation for bioenergy (with or without carbon capture and storage). PBCs can potentially contribute to Common Agricultural Policy (CAP) (2023–27) objectives provided they are carefully integrated into farming systems and landscapes. Despite significant research and development (R&D) investment over decades in herbaceous and coppiced woody PBCs, deployment has largely stagnated due to social, economic and policy uncertainties. This paper identifies the challenges in creating policies that are acceptable to all actors. Development will need to be informed by measurement, reporting and verification (MRV) of greenhouse gas emissions reductions and other environmental, economic and social metrics. It discusses interlinked issues that must be considered in the expansion of PBC production: (i) available land; (ii) yield potential; (iii) integration into farming systems; (iv) R&D requirements; (v) utilisation options; and (vi) market systems and the socio‐economic environment. It makes policy recommendations that would enable greater PBC deployment: (1) incentivise farmers and land managers through specific policy measures, including carbon pricing, to allocate their less productive and less profitable land for uses which deliver demonstrable greenhouse gas reductions; (2) enable greenhouse gas mitigation markets to develop and offer secure contracts for commercial developers of verifiable low‐carbon bioenergy and bioproducts; (3) support innovation in biomass utilisation value chains; and (4) continue long‐term, strategic R&D and education for positive environmental, economic and social sustainability impacts.

Background: Deep learning (DL) accelerated controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-volumetric interpolated breath-hold examination (VIBE), provides high spatial resolution T1-weighted imaging of the upper abdomen. We aimed to investigate whether DL-CAIPIRINHA-VIBE can improve image quality, vessel conspicuity, and lesion detectability compared to a standard CAIPIRINHA-VIBE in renal imaging at 3 Tesla. Methods: In this prospective study, 50 patients with 23 solid and 45 cystic renal lesions underwent MRI with clinical MR sequences, including standard CAIPIRINHA-VIBE and DL-CAIPIRINHA-VIBE sequences in the nephrographic phase at 3 Tesla. Two experienced radiologists independently evaluated both sequences and multiplanar reconstructions (MPR) of the sagittal and coronal planes for image quality with a Likert scale ranging from 1 to 5 (5 =best). Quantitative measurements including the size of the largest lesion and renal lesion contrast ratios were evaluated. Results: DL-CAIPIRINHA-VIBE compared to standard CAIPIRINHA-VIBE showed significantly improved overall image quality, higher scores for renal border delineation, renal sinuses, vessels, adrenal glands, reduced motion artifacts and reduced perceived noise in nephrographic phase images (all p 0.9). Conclusions: DL-CAIPIRINHA-VIBE is well suited for kidney imaging in the nephrographic phase, provides good image quality, improved delineation of anatomic structures and renal lesions.

Abstract Background Perennial C4 grasses from the genus Miscanthus are widely regarded as leading and promising dedicated bioenergy crops due to their high biomass accumulation on marginal land with low environmental impacts and maintenance requirements over its productive life. There is an urgent socio-political and environmental need to ramp up the production of alternative, affordable and green bioenergy sources and to re-direct the net zero carbon emissions trajectory. Hence, up-scaling of Miscanthus cultivation as a source of biomass for renewable energy could play an important role to strategically address sustainable development goals for a growing bio-based economy. Certain Miscanthus sinensis genotypes are particularly interesting for their biomass productivity across a wide range of locations. As the aromatic biomass component lignin exhibits a higher energy density than cell wall polysaccharides and is generally used as an indicator for heating or calorific value, genetic engineering could be a feasible strategy to develop M. sinensis biomass with increased lignin content and thus improving the energetic value of the biomass. Results For this purpose, transgenic M. sinensis were generated by Agrobacterium-mediated transformation for expression of ZmMYB167, a MYB transcription factor known for regulating lignin biosynthesis in C3 and C4 grasses. Four independent transgenic ZmMYB167 Miscanthus lines were obtained. Agronomic traits such as plant height, tillering and above-ground dry weight biomass of the transgenic plants were not different to that of wild-type control plants. Total lignin content of the transgenic plants was ~ 15–24% higher compared with control plants. However, the structural carbohydrates, glucan and xylan, were decreased by ~ 2–7% and ~ 8–10%, respectively, in the transgenic plants. Moreover, expression of ZmMYB167 in transgenic plants did not alter lignin composition, phenolic compounds or enzymatic saccharification efficiency yields but importantly improved total energy levels in Miscanthus biomass, equivalent to 10% higher energy yield per hectare. Conclusions This study highlights ZmMYB167 as a suitable target for genetic lignin bioengineering interventions aimed at advancing and developing lignocellulosic biomass supply chains for sustainable production of renewable bioenergy.

Abstract Two major global challenges related to agriculture are climate change and the unbalanced nitrogen cycle. For both, national and international reduction targets have been defined to catalyse policy support for more sustainable farming systems. Miscanthus cultivation in water protection areas has been proposed as a contribution to achieving these targets. However, a thorough understanding of the underlying system dynamics at various spatial levels is required before recommendations for policy development can be provided. In this study, a model framework was established to provide economic and environmental indicator results at regional and sub‐regional levels. It presents a consequential Life Cycle Assessment coupled with an agro‐economic supply model (Economic Farm Emission Model) that simulates crop and livestock production, and an agricultural hydrology model (DAISY) that assesses effects on the nitrogen cycle. The framework is applied to Baden‐Württemberg, a federal state in southwest Germany with eight agro‐ecological regions. Scenarios investigating the differences between mandatory and voluntary miscanthus cultivation were also explored. While the results show the high potential of miscanthus cultivation for the reduction of greenhouse gas emissions (−16% to −724%), the potential to reduce nitrate leaching (−4% to −44%) is compromised in some sub‐regions and scenarios (+4% to +13%) by substantial effects on the crop rotation. Furthermore, the cultivation of miscanthus reduces gross margins in most sub‐regions (−0.1% to −9.6%) and decreases domestic food production (−1% to −50%). However, in regions with low livestock density and high yields, miscanthus cultivation can maintain or increase farmers' income (0.1%–5.8%) and improve environmental protection. The study shows that the heterogeneity of arable land requires a flexible promotion programme for miscanthus. Voluntary cultivation schemes were identified as most suitable to capture sub‐regional differences. Policies should address the demand for miscanthus, for example, support the development of regional value chains, including farmers, water suppliers and the biobased industry.

Abstract The current geological epoch is characterized by anthropogenic activity that greatly impacts on natural ecosystems and their integrity. The complex networks of ecosystem services (ESs) are often ignored because the provision of natural resources, such as food and industrial crops, is mistakenly viewed as an independent process separate from ecosystems and ignoring the impacts on ecosystems. Recently, research has intensified on how to evaluate and manage ES to minimize environmental impacts, but it remains unclear how to balance anthropogenic activity and ecosystem integrity. This paper reviews the main ESs at farm level including provisioning, regulating, habitat, and cultural services. For these ESs, synergies are outlined and evaluated along with the respective practices (e.g., cover‐ and intercropping) and ES suppliers (e.g., pollinators and biocontrol agents). Further, several farm‐level ES trade‐offs are discussed along with a proposal for their evaluation. Finally, a framework for stakeholder approaches specific to farm‐level ES is put forward, along with an outlook on how existing precision agriculture technologies can be adapted for improved assessment of ES bundles. This is believed to provide a useful framework for both decision makers and stakeholders to facilitate the development of more sustainable and resilient farming systems.

Primary total hip arthroplasty with cementless stems has numerous advantages over cemented total hip arthroplasty in patients with good bone quality. To enhance osseointegration with ingrowth into the implant, various surface treatments have been proposed. Multiple biomechanical studies in animals have shown that bioactive coatings enhance osseointegration and increase construct stability. Bony ingrowth in humans can only be assessed in rare instances of periprosthetic femoral fractures. In this case report, we describe the findings after a periprosthetic fracture mandating stem exchange in a patient who experienced a fall 8 weeks after implantation. The retrieved proximal Bonit (DOT GmbH, Rostock, Germany) coated stem showed substantial macroscopically visible trabecular bone. This finding supports results from animal studies that showed enhanced metaphyseal bone ingrowth with Bonit coating of implants.

Abstract Background Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture. Methods We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D). Results Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p

Abstract Life cycle assessment (LCA) is a widely recognized tool for the assessment of the potential environmental impacts associated with the life cycle of a product or service. The environmental impact category most commonly quantified in LCAs is global warming potential, a measure of greenhouse gas (GHG) emissions. For agricultural products such as miscanthus, the creation of an inventory can be labour‐intensive and is context‐specific. This impairs the transfer of results to comparable but not necessarily similar situations. Farmers and small‐ and medium‐sized enterprises cannot easily dedicate resources for this purpose (in particular when using marginal land) and often lack the expertise to do so. Simplified LCA models could offer a promising solution to this problem. They are simplified versions of more complex models that require only a few critical parameters to calculate representative results. This study develops such a model for the computation of GHG emissions associated with commercial miscanthus cultivation. The model focuses on rhizome‐based propagation and the indirect harvesting method (cutting to swath, swathing, baling). A parametric life cycle inventory (LCI) was established and used to identify the most influential parameters by means of a global sensitivity analysis (GSA). A simplified model for calculating GHG emissions associated with miscanthus cultivation was developed by fixing input parameters with a low relevance at their median impact values. Six of 38 parameters were identified as relevant parameters: soil carbon sequestration, harvestable yield, duration of cultivation period, quantities of nitrogen and potassium fertilizer applied, and distance between field and customer. The simplified model allows practitioners an easy assessment of the GHG emissions associated with the production and supply of miscanthus. It thus provides a wider audience facilitated access to LCA knowledge and promotes its use as a management and reporting tool in bio‐based industries.

Abstract Insulation materials decrease the final energy consumption of buildings. In Germany, fossil and mineral insulations dominate the market despite numerous life cycle assessments (LCAs) showing that bio‐based insulations can offer environmental benefits. Evaluating the results of such LCAs is, however, complex due to a lack of comparability or costs considered. The objective of this study is comparing bio‐based insulations under equal conditions to identify the most environmentally friendly and cost‐efficient material. For this purpose, a comparative LCA and life cycle costing (LCC) were conducted from “cradle to grave” for four bio‐based and two nonrenewable insulations. The bio‐based insulation materials evaluated were wood fiber, hemp fiber, flax, and miscanthus. The nonrenewable insulations were expanded polystyrene (EPS) and stone wool. Key data for the LCA of the bio‐based insulations were obtained from preceding thermal conductivity measurements under ceteris paribus conditions. Eighteen environmental impact categories were assessed, and direct costs were cumulated along the life cycle. Results show that the most environmentally friendly bio‐based insulation materials were wood fiber and miscanthus. A hotspot analysis found that, for agriculturally sourced insulations, cultivation had the largest environmental impact, and for wood fiber insulation, it was manufacturing. The use phase (including installation) constituted a cost hotspot. The environmental impacts of end‐of‐life incineration were strongly influenced by the fossil components of the materials. Overall, bio‐based insulations were more environmentally friendly than EPS and stone wool in 11 impact categories. The LCC found EPS and miscanthus insulation to be most cost‐efficient, yet market integration of the latter is still limited. It can be concluded that miscanthus biomass is an environmentally and economically promising bio‐based insulation material. Comparability of the environmental performance of the bio‐based insulations was increased by applying the same system boundary and functional unit, the same impact assessment methodology, and the preceding ceteris paribus thermal conductivity measurements.

Abstract The combination of bioethanol production and carbon capture and storage technologies (BECCS) is considered an indispensable method for the achievement of the targets set by the Paris agreement. In Croatia, a first‐of‐its‐kind biorefinery project is currently underway that aims to integrate a second‐generation ethanol plant into an existing fossil refinery. The goal is to replace the fossil fuel production by second‐generation ethanol production using miscanthus. In the ethanol fermentation, CO2 is emitted in highly concentrated form and this can be directly compressed, injected and stored in exploited oil reservoirs. This study presents an assessment of the greenhouse gas (GHG) reduction potential of miscanthus ethanol produced in combination with CCS technology, based on data from the planning process of this biorefinery project. The GHG reduction potential is evaluated as part of a full environmental life cycle assessment. This is of particular relevance as a lignocellulosic ethanol industry is currently emerging in the European Union (EU) and LCAs of BECCS systems have, so far, often omitted environmental impacts other than GHG emissions. Overall, the ethanol to be produced in this planned biorefinery project would clearly achieve the EU's global warming potential (GWP) reduction target for biofuels. Depending on the accounting approach applied for the biological carbon storage, reduction potentials between 104% and 138% relative to the fossil comparator are likely. In addition, ethanol can reduce risks to resource availability. As such, the results generated from data based on the intended biorefinery project support the two major rationales for biofuel use. However, these reductions could come at the expense of human health and ecosystem quality impacts associated with the combustion of lignin and biogas. In order to prevent potential environmental trade‐offs, it will be imperative to monitor and manage these emissions from residue combustion, as they represent significant drivers of the overall environmental impacts.

BACKGROUND: In Switzerland, SARS-CoV-2 vaccination campaigns started in early 2021. Vaccine coverage reached 65% of the population in December 2021, mostly with mRNA vaccines from Moderna and Pfizer-BioNtech. Simultaneously, the proportion of vaccinated among COVID-19-related hospitalisations and deaths rose, creating some confusion in the general population. We aimed to assess vaccine effectiveness against severe forms of SARS-CoV-2 infection using routine surveillance data on the vaccination status of COVID-19-related hospitalisations and deaths, and data on vaccine coverage in Switzerland. METHODS: We considered all routine surveillance data on COVID-19-related hospitalisations and deaths received at the Swiss Federal Office of Public Health from 1 July to 1 December 2021. We estimated the relative risk of COVID-19-related hospitalisation or death for not fully vaccinated compared with fully vaccinated individuals, adjusted for the dynamics of vaccine coverage over time, by age and location. We stratified the analysis by age group and by calendar month. We assessed variations in the relative risk of hospitalisation associated with the time since vaccination. RESULTS: We included a total of 5948 COVID-19-related hospitalisations of which 1245 (21%) were fully vaccinated patients, and a total of 739 deaths of which 259 (35%) were fully vaccinated. We found that the relative risk of COVID-19 related hospitalisation was 12.5 (95% confidence interval [CI] 11.7–13.4) times higher for not fully vaccinated than for fully vaccinated individuals. This translates into a vaccine effectiveness against hospitalisation of 92.0% (95% CI 91.4–92.5%). Vaccine effectiveness against death was estimated to be 90.3% (95% CI 88.6–91.8%). Effectiveness appeared to be comparatively lower in age groups over 70 and during the months of October and November 2021. We also found evidence of a decrease in vaccine effectiveness against hospitalisation for individuals vaccinated for 25 weeks or more, but this decrease appeared only in age groups below 70. CONCLUSIONS: The observed proportions of vaccinated among COVD-19-related hospitalisations and deaths in Switzerland were compatible with a high effectiveness of mRNA vaccines from Moderna and Pfizer-BioNtech against hospitalisation and death in all age groups. Effectiveness appears comparatively lower in older age groups, suggesting the importance of booster vaccinations. We found inconclusive evidence that vaccine effectiveness wanes over time. Repeated analyses will be able to better assess waning and the effect of boosters.

Abstract Perennial rhizomatous grasses (PRG), such as miscanthus and switchgrass, are considered promising lignocellulosic feedstocks. Their cultivation is expected to experience a significant increase in the near future, as it offers a wide range of benefits. For instance, when PRG replace typical annual crops, positive biodiversity impacts are usually anticipated. However, to date, there is no solid, statistically strong evidence for this hypothesis. This study aims to evaluate its validity through a meta‐analysis based on an extensive systematic literature review of research comparing biodiversity attributes in PRG and common annual crops. Dynamics of species richness and abundance in response to PRG cultivation were quantitatively evaluated drawing on 220 paired comparisons from 25 studies. This includes data on five taxonomic groups—arthropods, birds, earthworms, mammals and plants—and three PRG—miscanthus, switchgrass and reed canary grass. The results indicate that biodiversity tends to be higher in PRG cultivations relative to the reference crops, but the initial hypothesis of significantly beneficial impacts could not be confirmed. Trends were specific to the individual taxonomic groups: significantly higher biodiversity was found for plants and small mammals. Positive but insignificant trends were observed for arthropods and birds, while earthworm response was neutral and insignificant. More substantial conclusions could not be drawn, which is mainly due to the low number of studies conducting biodiversity assessments in PRG cultivations that included a comparison with annual crops. In addition, a detailed analysis of the observed responses was impaired by poor reporting of the parameters influencing biodiversity in the studies reviewed, such as planting and crop density, as well as yields. For this reason, we conclude with a call for improved data reporting in biodiversity assessments of PRG cultivations and detail requirements for future biodiversity research.

[This corrects the article DOI: 10.1371/journal.pone.0251194.].

Abstract Purpose Arthroplasty registries gained increasing importance to the re‐certification of orthopaedic implants according to the European Union (EU) Medical Device Regulation (MDR) adopted in 2017. Until recently, several European countries only had regional arthroplasty registries. Whether regional registries deliver data quality comparable with national registries remained unclear. Therefore, the purpose of this study was to validate the Austrian Tyrolean Hip Arthroplasty Registry (THAR) and to evaluate if this regional registry showed adequate adherence, completeness and correctness when compared with well‐established national registries. Methods A consecutive series of 1100 primary total hip arthroplasties were identified from our institution’s medical database. Patients were interviewed by phone and completed questionnaires after a mean follow‐up period of 8.05 years and were asked if they had had revision surgeries. The data were compared to the corresponding dataset from the THAR. Results Adherence was 97.91% for primary total hip arthroplasty. Clinical follow‐up identified 10 missing cases, resulting in adherence of 81.48% for revisions. Completeness of patient‐reported outcome measurements was 78.55% before surgery and 84.45% 1 year after surgery. Correctness was 99.7% for demographic data, 99.54% for implant specifications, and 99.35% for mode of fixation. Conclusion The data of this study showed that regional arthroplasty registries can deliver data quality comparable with well‐established national registries. The main reason for unrecorded revision cases and wrongly recoded implants was human error. Further digitalization with more automatic data submission may have the potential to reduce these failure rates in the future. Overall, the THAR represents a valid data source for re‐certification of medical implants according to the EU’s MDR.

The demand for food and renewable energy is increasing significantly, whereas the availability of land for agricultural use is declining. Agrivoltaic systems (AVS), which combine agricultural production with solar energy generation on the same area, are a promising opportunity with the potential to satisfy this demand while avoiding land-use conflicts. In the current study, a Consequential Life-Cycle Assessment (CLCA) was conducted to holistically assess the environmental consequences arising from a shift from single-use agriculture to AVS in Germany. The results of the study show that the environmental consequences of the installation of overhead AVS on agricultural land are positive and reduce the impacts in 15 of the 16 analysed impact categories especially for climate change, eutrophication and fossil resource use, as well as in the single score assessment, mainly due to the substitution of the marginal energy mix. It was demonstrated that, under certain conditions, AVS can contribute to the extension of renewable energy production resources without reducing food production resources. These include maintaining the agricultural yields underneath the photovoltaic (PV) modules, seeking synergies between solar energy generation and crop production and minimising the loss of good agricultural land.

Agroecosystems provide numerous ecosystem services (ESs) such as provisioning, regulating, habitat and cultural services. At the same time, the management of these agroecosystems can cause various negative impacts on the environment such as the generation of greenhouse gas emissions. However, the way humans manage agroecosystems often focuses only on the production of agricultural goods, which yield monetary benefits in the short term but do not include the positive and negative external effects on ESs. In order to enable a holistic assessment of the economic and environmental costs and benefits, the current study combines the production costs, the monetary value of the ESs provided and the monetization of the environmental impacts caused by the management of agroecosystems using the perennial crop miscanthus as an example. Depending on the scenario assessed, the cultivation of miscanthus leads to a net benefit of 140 to 3051 EUR ha−1 yr−1. The monetary value of the ESs provided by the miscanthus cultivation thereby considerably outweighs the internal and external costs. The approach applied allows for a holistic assessment of the benefits and costs of agroecosystems and thus enables management decisions that are not only based on the biomass yield but include the various interactions with the environment.

Computational reproducibility is a corner stone for sound and credible research. Especially in complex statistical analyses-such as the analysis of longitudinal data-reproducing results is far from simple, especially if no source code is available. In this work we aimed to reproduce analyses of longitudinal data of 11 articles published in PLOS ONE. Inclusion criteria were the availability of data and author consent. We investigated the types of methods and software used and whether we were able to reproduce the data analysis using open source software. Most articles provided overview tables and simple visualisations. Generalised Estimating Equations (GEEs) were the most popular statistical models among the selected articles. Only one article used open source software and only one published part of the analysis code. Replication was difficult in most cases and required reverse engineering of results or contacting the authors. For three articles we were not able to reproduce the results, for another two only parts of them. For all but two articles we had to contact the authors to be able to reproduce the results. Our main learning is that reproducing papers is difficult if no code is supplied and leads to a high burden for those conducting the reproductions. Open data policies in journals are good, but to truly boost reproducibility we suggest adding open code policies.

Abstract Carbon neutrality in the transport sector is a key challenge for the growing bioeconomy as the share of biofuels has stagnated over the past decade. This can be attributed to basic economics and a lack of a robust market for these technologies. Consequently, more sustainable biomass supply concepts are required that reduce negative impacts on the environment and at the same time promote environmental services for sustainable agricultural cropping systems including erosion prevention, soil fertility improvement, greenhouse gas mitigation, and carbon sequestration. One promising concept is the cultivation of perennial biomass crops such as Miscanthus (Miscanthus Andersson) as biofuel feedstock. In this study, the multiple environmental services provided by Miscanthus are first explored and subsequently monetized. Then the integration of Miscanthus cultivation for biomass production into European agricultural systems is assessed. One hectare of Miscanthus provides society with environmental services to a value of 1,200 to 4,183 € a−1. These services are even more pronounced when cultivation takes place on marginal agricultural land. The integration of Miscanthus into existing agricultural practices aids both conservation and further optimization of socio‐economic welfare and landscape diversification. As these environmental services are more beneficial to the public than the Miscanthus farmers, subsidies are required to close the gap between biofuels and biodiversity that are calculated based on the provision of environmental services. Similar approaches to that developed in this study may be suitable for the implementation of other biomass cropping systems and therefore help foster the transition to a bioeconomy.

In this introduction to the Special Issue on methods for modelling of infectious disease epidemiology we provide a commentary and overview of the field. We suggest that the field has been through three revolutions that have focussed on specific methodological developments; disease dynamics and heterogeneity, advanced computing and inference, and complexity and application to the real-world. Infectious disease dynamics and heterogeneity dominated until the 1980s where the use of analytical models illustrated fundamental concepts such as herd immunity. The second revolution embraced the integration of data with models and the increased use of computing. From the turn of the century an emergence of novel datasets enabled improved modelling of real-world complexity. The emergence of more complex data that reflect the real-world heterogeneities in transmission resulted in the development of improved inference methods such as particle filtering. Each of these three revolutions have always kept the understanding of infectious disease spread as its motivation but have been developed through the use of new techniques, tools and the availability of data. We conclude by providing a commentary on what the next revoluition in infectious disease modelling may be.

BACKGROUND:Detection of metastases can have a significant impact on therapy. Nevertheless, even in gadoxetate disodium-enhanced MR scans, very small hepatic metastases may be difficult to see. PURPOSE:To investigate the potential of a contrast-optimised (phase-sensitive) inversion recovery MR sequence in gadoxetate disodium-enhanced scans for detection of hepatic metastases. MATERIALS AND METHODS:With institutional review board approval and after written informed consent, 40 patients (18 male, 22 female) with suspected or known hepatic metastases were examined on a 1.5 T MR system. A T1-weighted gradient-echo volumetric-interpolated-breath-hold (VIBE) sequence was acquired as part of the standard imaging protocol 20 minutes after administration of gadoxetate disodium. Additionally, an IR sequence was acquired with an inversion time to suppress native signal from metastases. Overall image quality and delineation of lesions were assessed on VIBE as well as on magnitude-reconstructed (MAG) and phase-sensitive IR (PSIR) sequences. Lesion-to-liver contrast (LLC) was compared between VIBE and MAG images. RESULTS:Overall image quality was high in both VIBE and MAG IR sequences (VIBE 4.275; MAG 4.313), yet significantly lower in PSIR (4.038). Subjective delineation of lesions was higher on MAG and PSIR images compared to VIBE in all size groups with an overall statistically significant difference for VIBE vs. MAG vs. PSIR (p < .001) in the variance analysis. Mean LLC was 0.35±0.01 for VIBE sequences, and 0.73±0.01 for MAG. CONCLUSION:Contrast-optimised PSIR seems to improve imaging characteristics of hepatic metastases in gadoxetate disodium-enhanced scans compared to T1 gradient-echo VIBE sequences.

Non-alcoholic fatty liver disease (NAFLD) was shown to also occur in lean and underweight patients. So far, the prevalence of NAFLD in underweight individuals with and without inflammatory bowel disease (IBD) is insufficiently enlightened. In this cross-sectional age, gender and disease-matched case-control study, underweight patients (BMI0.05). The prevalence of liver steatosis was higher among underweight IBD and non-IBD patients compared to normal weight controls. Also, underweight patients showed slightly increased liver enzymes and liver diameters, hinting at initial metabolic disturbances.

AIM:To compare the potential of a gadoxetate disodium enhanced navigator-triggered 3D T1 magnetic-resonance cholangiography (MRC) sequence with a specific inversion recovery prepulse to T2-weighted MRCP for assessment of the hepatobiliary system. MATERIALS AND METHODS:30 patients (12 male, 18 female) prospectively underwent conventional navigator-triggered 3D turbo spin-echo T2-weighted MRCP and 3D T1 MRC with a specific inversion pulse to minimise signal from the liver 30 minutes after administration of gadoxetate disodium on a 1.5 T MRI system. For qualitative evaluation, biliary duct depiction was assessed segmentally following a 5-point Likert scale. Visualisation of hilar structures as well as image quality was recorded. Additionally, the extrahepatic bile ducts were assessed quantitatively by calculation of signal-to-noise ratios (SNR). RESULTS:The advantages of T1 3D MRC include reduced affection of image quality by bowel movement and robust depiction of the relative position of the extrahepatic bile ducts in relation to the portal vein and the duodenum compared to T2 MRCP. However, overall T1 3D MRC did not significantly (p > 0.05) improve the biliary duct depiction compared to T2 MRCP in all segments: Common bile duct 4.1 vs. 4.4, right hepatic duct 3.6 vs. 4.2, left hepatic duct 3.5 vs. 4.1. Image quality did not differ significantly (p > 0.05) between both sequences (3.6 vs. 3.5). SNR measurements for the hepatobiliary system did not differ significantly (p > 0.05) between navigator-triggered T1 3D MRC and T2 MRCP. CONCLUSIONS:This preliminary study demonstrates that T1 3D MRC of a specific inversion recovery prepulse has potential to complement T2 MRCP, especially for the evaluation of liver structures close to the hilum in the diagnostic work-up of the biliary system in patients receiving gadoxetate disodium.

In recent years, considerable progress has been made in miscanthus research: improvement of management practices, breeding of new genotypes, especially for marginal conditions, and development of novel utilization options. The purpose of the current study was a holistic analysis of the environmental performance of such novel miscanthus-based value chains. In addition, the relevance of the analyzed environmental impact categories was assessed. A Life Cycle Assessment was conducted to analyse the environmental performance of the miscanthus-based value chains in 18 impact categories. In order to include the substitution of a reference product, a system expansion approach was used. In addition, a normalization step was applied. This allowed the relevance of these impact categories to be evaluated for each utilization pathway. The miscanthus was cultivated on six sites in Europe (Aberystwyth, Adana, Moscow, Potash, Stuttgart and Wageningen) and the biomass was utilized in the following six pathways: (1) small-scale combustion (heat)—chips; (2) small-scale combustion (heat)—pellets; (3) large-scale combustion (CHP)—biomass baled for transport and storage; (4) large-scale combustion (CHP)—pellets; (5) medium-scale biogas plant—ensiled miscanthus biomass; and (6) large-scale production of insulation material. Thus, in total, the environmental performance of 36 site × pathway combinations was assessed. The comparatively high normalized results of human toxicity, marine, and freshwater ecotoxicity, and freshwater eutrophication indicate the relevance of these impact categories in the assessment of miscanthus-based value chains. Differences between the six sites can almost entirely be attributed to variations in biomass yield. However, the environmental performance of the utilization pathways analyzed varied widely. The largest differences were shown for freshwater and marine ecotoxicity, and freshwater eutrophication. The production of insulation material had the lowest impact on the environment, with net benefits in all impact categories expect three (marine eutrophication, human toxicity, agricultural land occupation). This performance can be explained by the multiple use of the biomass, first as material and subsequently as an energy carrier, and by the substitution of an emission-intensive reference product. The results of this study emphasize the importance of assessing all environmental impacts when selecting appropriate utilization pathways.

Growth in planted areas of Miscanthus for biomass in Europe has stagnated since 2010 due to technical challenges, economic barriers and environmental concerns. These limitations need to be overcome before biomass production from Miscanthus can expand to several million hectares. In this paper, we consider the economic and environmental effects of introducing seed based hybrids as an alternative to clonal M. x giganteus (Mxg). The impact of seed based propagation and novel agronomy was compared with current Mxg cultivation and used in 10 commercially relevant, field scale experiments planted between 2012 and 2014 in the United Kingdom, Germany, and Ukraine. Economic and greenhouse gas (GHG) emissions costs were quantified for the following production chain: propagation, establishment, harvest, transportation, storage, and fuel preparation (excluding soil carbon changes). The production and utilization efficiency of seed and rhizome propagation were compared. Results show that new hybrid seed propagation significantly reduces establishment cost to below £900 ha-1. Calculated GHG emission costs for the seeds established via plugs, though relatively small, was higher than rhizomes because fossil fuels were assumed to heat glasshouses for raising seedling plugs (5.3 and 1.5 kg CO2 eq. C Mg [dry matter (DM)]-1), respectively. Plastic mulch film reduced establishment time, improving crop economics. The breakeven yield was calculated to be 6 Mg DM ha-1 y-1, which is about half average United Kingdom yield for Mxg; with newer seeded hybrids reaching 16 Mg DM ha-1 in second year United Kingdom trials. These combined improvements will significantly increase crop profitability. The trade-offs between costs of production for the preparation of different feedstock formats show that bales are the best option for direct firing with the lowest transport costs (£0.04 Mg-1 km-1) and easy on-farm storage. However, if pelleted fuel is required then chip harvesting is more economic. We show how current seed based propagation methods can increase the rate at which Miscanthus can be scaled up; ∼×100 those of current rhizome propagation. These rapid ramp rates for biomass production are required to deliver a scalable and economic Miscanthus biomass fuel whose GHG emissions are ∼1/20th those of natural gas per unit of heat.

Delayed harvest can improve the quality of miscanthus biomass for combustion and enhance the long-term sustainability of the crop, despite accompanying yield losses. The aim of this study is to identify the optimal harvesting time, which can deliver improved biomass quality for combustion of novel miscanthus genotypes at various sites across Europe, without high yield losses and without compromising their environmental performance. The relevant field trials were established as part of the European project OPTIMISC with 15 genotypes at six sites across Europe. For this study, the five highest yielding genotypes from each germplasm group and three sites with contrasting climatic conditions (Stuttgart, Germany; Adana, Turkey; and Moscow, Russia) were selected for assessment. The biomass samples were collected between August and March (depending on site) and subjected to mineral and ash content analysis. At Stuttgart, the delay in harvesting time led to a significant variation in combustion quality characteristics, such as N content (0.64–0.21%), ash content (5.15–2.60%), and ash sintering index (1.30–0.20). At Adana, the delay in harvesting time decreased the N content from 0.62 to 0.23%, ash content from 10.63 to 3.84%, and sintering index from 0.54 to 0.07. At Moscow, the impact of delay in harvesting was not significant, except for N, Mg, and ash sintering index. Overall, a delay in harvesting time improved the combustion quality characteristics of each genotype, but at the expense of yield. Yield losses of up to 49% in Stuttgart and Adana and 21% for Moscow were recorded, with variations between genotypes and sites. The harvesting time also affected nutrient offtake, which in turn influences the long-term environmental performance of the crop. The highest N, P, and K offtakes were recorded at Stuttgart for each harvesting time except for final harvest (March), where Moscow had the highest N offtake. This study describes the three criteria (biomass quality, yield losses, nutrient offtake) for determining the ideal harvesting time, which gives the best compromise between dry matter yields and biomass quality characteristics without negatively affecting the environmental performance of the crop.

OBJECTIVES:To determine the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SWMR) for the detection of pineal gland calcifications (PGC) compared to conventional magnetic resonance imaging (MRI) sequences, using computed tomography (CT) as a reference standard. METHODS:384 patients who received a 1.5 Tesla MRI scan including SWMR sequences and a CT scan of the brain between January 2014 and October 2016 were retrospectively evaluated. 346 patients were included in the analysis, of which 214 showed PGC on CT scans. To assess correlation between imaging modalities, the maximum calcification diameter was used. Sensitivity and specificity and intra- and interobserver reliability were calculated for SWMR and conventional MRI sequences. RESULTS:SWMR reached a sensitivity of 95% (95% CI: 91%-97%) and a specificity of 96% (95% CI: 91%-99%) for the detection of PGC, whereas conventional MRI achieved a sensitivity of 43% (95% CI: 36%-50%) and a specificity of 96% (95% CI: 91%-99%). Detection rates for calcifications in SWMR and conventional MRI differed significantly (95% versus 43%, p

The growing bioeconomy will require a greater supply of biomass in the future for both bioenergy and bio-based products. Today, many bioenergy cropping systems (BCS) are suboptimal due to either social-ecological threats or technical limitations. In addition, the competition for land between bioenergy-crop cultivation, food-crop cultivation, and biodiversity conservation is expected to increase as a result of both continuous world population growth and expected severe climate change effects. This study investigates how BCS can become more social-ecologically sustainable in future. It brings together expert opinions from the fields of agronomy, economics, meteorology, and geography. Potential solutions to the following five main requirements for a more holistically sustainable supply of biomass are summarized: (i) bioenergy-crop cultivation should provide a beneficial social-ecological contribution, such as an increase in both biodiversity and landscape aesthetics, (ii) bioenergy crops should be cultivated on marginal agricultural land so as not to compete with food-crop production, (iii) BCS need to be resilient in the face of projected severe climate change effects, (iv) BCS should foster rural development and support the vast number of small-scale family farmers, managing about 80% of agricultural land and natural resources globally, and (v) bioenergy-crop cultivation must be planned and implemented systematically, using holistic approaches. Further research activities and policy incentives should not only consider the economic potential of bioenergy-crop cultivation, but also aspects of biodiversity, soil fertility, and climate change adaptation specific to site conditions and the given social context. This will help to adapt existing agricultural systems in a changing world and foster the development of a more social-ecologically sustainable bioeconomy.

This paper describes the complete findings of the EU-funded research project OPTIMISC, which investigated methods to optimize the production and use of miscanthus biomass. Miscanthus bioenergy and bioproduct chains were investigated by trialing fifteen diverse germplasm types in a range of climatic and soil environments across central Europe, Ukraine, Russia and China. The abiotic stress tolerances of a wider panel of 100 germplasm types to drought, salinity and low temperatures were measured in the laboratory and a field trial in Belgium. A small selection of germplasm types was evaluated for performance in grasslands on marginal sites in Germany and the UK. The growth traits underlying biomass yield and quality were measured to improve regional estimates of feedstock availability. Several potential high-value bioproducts were identified. The combined results provide recommendations to policymakers, growers and industry. The major technical advances in miscanthus production achieved by OPTIMISC include: 1) demonstration that novel hybrids can out-yield the standard commercially grown genotype Miscanthus x giganteus; 2) characterisation of the interactions of physiological growth responses with environmental variation within and between sites; 3) quantification of biomass-quality-relevant traits; 4) abiotic stress tolerances of miscanthus genotypes; 5) selections suitable for production on marginal land; 6) field establishment methods for seeds using plugs; 7) evaluation of harvesting methods; and 8) quantification of energy used in densification (pellet) technologies with a range of hybrids with differences in stem wall properties. End-user needs were addressed by demonstrating the potential of optimizing miscanthus biomass composition for the production of ethanol and biogas as well as for combustion. The costs and life-cycle assessment of seven miscanthus-based value chains, including small- and large-scale heat and power, ethanol, biogas and insulation material production, revealed GHG-emission- and fossil-energy-saving potentials of up to 30.6 t CO2eq C ha-1y-1 and 429 GJ ha-1y-1 , respectively. Transport distance was identified as an important cost factor. Negative carbon mitigation costs of -78 € t-1 CO2eq C were recorded for local biomass use. The OPTIMISC results demonstrate the potential of miscanthus as a crop for marginal sites and provide information and technologies for the commercial implementation of miscanthus-based value chains.

The purpose of the present study was to compare the image quality of spinal magnetic resonance (MR) imaging performed on a high-field horizontal open versus a short-bore MR scanner in a randomized controlled study setup.Altogether, 93 (80% women, mean age 53) consecutive patients underwent spine imaging after random assignement to a 1-T horizontal open MR scanner with a vertical magnetic field or a 1.5-T short-bore MR scanner. This patient subset was part of a larger cohort. Image quality was assessed by determining qualitative parameters, signal-to-noise (SNR) and contrast-to-noise ratios (CNR), and quantitative contour sharpness.The image quality parameters were higher for short-bore MR imaging. Regarding all sequences, the relative differences were 39% for the mean overall qualitative image quality, 53% for the mean SNR values, and 34-37% for the quantitative contour sharpness (P

Claustrophobia is a common problem precluding MR imaging. The purpose of the present study was to assess whether a short-bore or an open magnetic resonance (MR) scanner is superior in alleviating claustrophobia.Institutional review board approval and patient informed consent were obtained to compare short-bore versus open MR. From June 2008 to August 2009, 174 patients (139 women; mean age = 53.1 [SD 12.8]) with an overall mean score of 2.4 (SD 0.7, range 0 to 4) on the Claustrophobia Questionnaire (CLQ) and a clinical indication for imaging, were randomly assigned to receive evaluation by open or by short-bore MR. The primary outcomes were incomplete MR examinations due to a claustrophobic event. Follow-up was conducted 7 months after MR imaging. The primary analysis was performed according to the intention-to-treat strategy.With 33 claustrophobic events in the short-bore group (39% [95% confidence interval [CI] 28% to 50%) versus 23 in the open scanner group (26% [95% CI 18% to 37%]; P = 0.08) the difference was not significant. Patients with an event were in the examination room for 3.8 min (SD 4.4) in the short-bore and for 8.5 min (SD 7) in the open group (P = 0.004). This was due to an earlier occurrence of events in the short-bore group. The CLQ suffocation subscale was significantly associated with the occurrence of claustrophobic events (P = 0.003). New findings that explained symptoms were found in 69% of MR examinations and led to changes in medical treatment in 47% and surgery in 10% of patients. After 7 months, perceived claustrophobia increased in 32% of patients with events versus in only 11% of patients without events (P = 0.004).Even recent MR cannot prevent claustrophobia suggesting that further developments to create a more patient-centered MR scanner environment are needed.ClinicalTrials.gov NCT00715806.