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Laser-scanned point clouds of forests make it possible to extract valuable information for forest management. To consider single trees, a forest point cloud needs to be segmented into individual tree point clouds. Existing segmentation methods are usually based on hand-crafted algorithms, such as identifying trunks and growing trees from them, and face difficulties in dense forests with overlapping tree crowns. In this study, we propose TreeLearn, a deep learning-based approach for tree instance segmentation of forest point clouds. TreeLearn is trained on already segmented point clouds in a data-driven manner, making it less reliant on predefined features and algorithms. Furthermore, TreeLearn is implemented as a fully automatic pipeline and does not rely on extensive hyperparameter tuning, which makes it easy to use. Additionally, we introduce a new manually segmented benchmark forest dataset containing 156 full trees. The data is generated by mobile laser scanning and contributes to create a larger and more diverse data basis for model development and fine-grained instance segmentation evaluation. We trained TreeLearn on forest point clouds of 6665 trees, labeled using the Lidar360 software. An evaluation on the benchmark dataset shows that TreeLearn performs as well as the algorithm used to generate its training data. Furthermore, the performance can be vastly improved by fine-tuning the model using manually annotated datasets. We evaluate TreeLearn on our benchmark dataset and the Wytham Woods dataset, outperforming the recent SegmentAnyTree, ForAINet and TLS2Trees methods. The TreeLearn code and all datasets that were created in the course of this work are made publicly available.

Abstract Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts’ experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

Abstract Current approaches to project spatial biodiversity responses to climate change mainly focus on the direct effects of climate on species while regarding land use and land cover as constant or prescribed by global land‐use scenarios. However, local land‐use decisions are often affected by climate change and biodiversity on top of socioeconomic and policy drivers. To realistically understand and predict climate impacts on biodiversity, it is, therefore, necessary to integrate both direct and indirect effects (via climate‐driven land‐use change) of climate change on biodiversity. In this perspective paper, we outline how biodiversity models could be better integrated with regional, climate‐driven land‐use models. We initially provide a short, non‐exhaustive review of empirical and modelling approaches to land‐use and land‐cover change (LU) and biodiversity (BD) change at regional scales, which forms the base for our perspective about improved integration of LU and BD models. We consider a diversity of approaches, with a special emphasis on mechanistic models. We also look at current levels of integration and at model properties, such as scales, inputs and outputs, to further identify integration challenges and opportunities. We find that LU integration in BD models is more frequent than the other way around and has been achieved at different levels: from overlapping predictions to simultaneously coupled simulations (i.e. bidirectional effects). Of the integrated LU‐BD socio‐ecological models, some studies included climate change effects on LU, but the relative contribution of direct vs. indirect effects of climate change on BD remains a key research challenge. Important research avenues include concerted efforts in harmonizing spatial and temporal resolution, disentangling direct and indirect effects of climate change on biodiversity, explicitly accounting for bidirectional feedbacks, and ultimately feeding socio‐ecological systems back into climate predictions. These avenues can be navigated by matching models, plugins for format and resolution conversion, and increasing the land‐use forecast horizon with adequate uncertainty. Recent developments of coupled models show that such integration is achievable and can lead to novel insights into climate–land use–biodiversity relations. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Introduction Older people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement. Methods The Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty. Results A total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39). Conclusion There is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.

Abstract Recent studies indicate that virtually all global climate models (GCMs) have had difficulty simulating sea surface temperature (SST) trend patterns over the past four decades. GCMs produce enhanced warming in the eastern Equatorial Pacific (EPAC) and Southern Ocean (SO) warming, while observations show intensified warming in the Indo-Pacific Warm Pool (IPWP) and slight cooling in the eastern EPAC and SO. Using Geophysical Fluid Dynamics Laboratory’s latest higher resolution atmospheric model and coupled prediction system, we show the model biases in SST trend pattern have profound implications for near-term projections of high-impact storm statistics, including the frequency of atmospheric rivers (AR), tropical storms (TS) and mesoscale convection systems (MCS), as well as for hydrological and climate sensitivity. If the future SST warming pattern continues to resemble the observed pattern from the past few decades rather than the GCM simulated/predicted patterns, our results suggest (1) a drastically different future projection of high-impact storms and their associated hydroclimate changes, especially over the Western Hemisphere, (2) a stronger global hydrological sensitivity, and (3) substantially less global warming due to stronger negative feedback and lower climate sensitivity. The roles of SST trend patterns over the EPAC, IPWP, SO, and the North Atlantic tropical cyclone Main Development Region (AMDR) are isolated, quantified, and used to understand the simulated differences. Specifically, SST trend patterns in the EPAC and AMDR are crucial for modeled differences in AR and MCS frequency, while those in the IPWP and AMDR are essential for differences in TS frequency over the North Atlantic.

Inter‐alpha‐trypsin inhibitor heavy chain 5 (ITIH5) has been identified as a metastasis suppressor gene in pancreatic cancer. Here, we analyzed ITIH5 promoter methylation and protein expression in The Cancer Genome Atlas (TCGA) dataset and three tissue microarray cohorts (n = 618), respectively. Cellular effects, including cell migration, focal adhesion formation and protein tyrosine kinase activity, induced by forced ITIH5 expression in pancreatic cancer cell lines were studied in stable transfectants. ITIH5 promoter hypermethylation was associated with unfavorable prognosis, while immunohistochemistry demonstrated loss of ITIH5 in the metastatic setting and worsened overall survival. Gain‐of‐function models showed a significant reduction in migration capacity, but no alteration in proliferation. Focal adhesions in cells re‐expressing ITIH5 exhibited a smaller and more rounded phenotype, typical for slow‐moving cells. An impressive increase of acetylated alpha‐tubulin was observed in ITIH5‐positive cells, indicating more stable microtubules. In addition, we found significantly decreased activities of kinases related to focal adhesion. Our results indicate that loss of ITIH5 in pancreatic cancer profoundly affects its molecular profile: ITIH5 potentially interferes with a variety of oncogenic signaling pathways, including the PI3K/AKT pathway. This may lead to altered cell migration and focal adhesion formation. These cellular alterations may contribute to the metastasis‐inhibiting properties of ITIH5 in pancreatic cancer.

In this article, a utility function framework is developed, serving to determine the demand for an upcoming demand responsive transportation system. A linear’public-good game’ (PGG) model is modified in a way that maximizing the consumer surplus is assumed to determine individual decision-making. This modification allows for considering the endowment effect in the function, which is expected to enable for a more precise distinction among customer segments. The purpose of this approach is to create a possibility for including descriptive behavioral economic findings in a normative modeling concept. It shall serve as a theoretical basis for coming empirical investigations.

Abstract Key message A validation convention can be established for forest management optimization models. It consists of (1) the delivery of face validation, (2) performing at least one other validation technique, and (3) an explicit discussion of how the optimization model fulfills the stated purpose. Validation by potential users or external experts is of high importance. Context Optimization modeling has long assisted the management of forest ecosystems, but the credibility of these models has always been debated with criticisms concerning data quality, failures to include relevant processes in the scope of models, and the inclusion of unrealistic assumptions. Validation is widely considered to be crucial to establishing the credibility of models in general, but how to validate optimization models in particular represents a permanent question generally in operations research. Aims We aim to synthesize practical recommendations for the development of validation frameworks in the optimization modeling for forest management. Methods We selected a sample of 46 studies devoted to optimization models to be applied in practice, analysed the contents with respect to validation, and provided a critical review. Results We (1) clarified the meaning and usage of different validation-related terms that are commonly encountered in the literature, (2) identified and categorised the various methods and frameworks that are used to demonstrate model credibility, and (3) derived organizing principles that helped to suggest improvements in validation frameworks. Conclusions A practical validation convention can be established and we suggest the convention to consist of three stages. By providing structured and consistent information about validation processes, researchers in forest management optimization can better demonstrate the credibility of their work to readers and potential users.

Abstract Background Soft tissue sarcomas (STSs) are a heterogeneous group of tumors. Wide surgical resection is standard, often combined with neoadjuvant chemotherapy, radiotherapy, or both. Studies have shown the predictive value of tumor necrosis in bone sarcoma (BS); however, the role of necrosis in STS after neoadjuvant therapies is still unclear. This study aimed to investigate the role of chemo- and radiotherapy in the formation of tumor necrosis and to evaluate the influence of tumor necrosis on overall survival and local recurrence-free survival. Data from BS patients and patients who did not receive neoadjuvant therapy were compared. Methods A total of 779 patients with STS or BS were treated surgically. In all patients, tumor-specific factors such as type, size, or grading and the type of adjuvant therapy were documented. Local recurrence (LR), the diagnosis of metastatic disease, and survival during follow-up were evaluated. Results A total of 565 patients with STS and 214 with BS were investigated. In STS, 24.1% G1 lesions, 34.1% G2 lesions, and 41.8% G3 lesions were observed. Two hundred twenty-four of the patients with STS and neoadjuvant therapy had either radiotherapy (RTx) (n = 80), chemotherapy (CTx) (n = 93), or both (n = 51). Three hundred forty-one had no neoadjuvant therapy at all. In STS, tumor necrosis after neoadjuvant treatment was significantly higher (53.5%) than in patients without neoadjuvant therapy (15.7%) (p

Abstract Background Forests mitigate climate change by reducing atmospheric $$\mathrm {CO_2}$$ CO 2 -concentrations through the carbon sink in the forest and in wood products, and substitution effects when wood products replace carbon-intensive materials and fuels. Quantifying the carbon mitigation potential of forests is highly challenging due to the influence of multiple important factors such as forest age and type, climate change and associated natural disturbances, harvest intensities, wood usage patterns, salvage logging practices, and the carbon-intensity of substituted products. Here, we developed a framework to quantify the impact of these factors through factorial simulation experiments with an ecosystem model at the example of central European (Bavarian) forests. Results Our simulations showed higher mitigation potentials of young forests compared to mature forests, and similar ones in broad-leaved and needle-leaved forests. Long-lived wood products significantly contributed to mitigation, particularly in needle-leaved forests due to their wood product portfolio, and increased material usage of wood showed considerable climate benefits. Consequently, the ongoing conversion of needle-leaved to more broad-leaved forests should be accompanied by the promotion of long-lived products from broad-leaved species to maintain the product sink. Climate change (especially increasing disturbances) and decarbonization were among the most critical factors influencing mitigation potentials and introduced substantial uncertainty. Nevertheless, until 2050 this uncertainty was narrow enough to derive robust findings. For instance, reducing harvest intensities enhanced the carbon sink in our simulations, but diminished substitution effects, leading to a decreased total mitigation potential until 2050. However, when considering longer time horizons (i.e. until 2100), substitution effects became low enough in our simulations due to expected decarbonization such that decreasing harvests often seemed the more favorable solution. Conclusion Our results underscore the need to tailor mitigation strategies to the specific conditions of different forest sites. Furthermore, considering substitution effects, and thoroughly assessing the amount of avoided emissions by using wood products, is critical to determine mitigation potentials. While short-term recommendations are possible, we suggest risk diversification and methodologies like robust optimization to address increasing uncertainties from climate change and decarbonization paces past 2050. Finally, curbing emissions reduces the threat of climate change on forests, safeguarding their carbon sink and ecosystem services.

Abstract Precipitation changes in full response to CO2 increase are widely studied but confidence in future projections remains low. Mechanistic understanding of the direct radiative effect of CO2 on precipitation changes, independent from CO2‐induced SST changes, is therefore necessary. Utilizing global atmospheric models, we identify robust summer precipitation decreases across North America in response to direct CO2 forcing. We find that spatial distribution of CO2 forcing at land surface is likely shaped by climatological distribution of water vapor and clouds. This, coupled with local feedback processes, changes in convection, and moisture supply resulting from CO2‐induced circulation changes, could determine North American hydroclimate changes. In central North America, increasing CO2 may decrease summertime precipitation by warming the surface and inducing dry advection into the region to reduce moisture supply. Meanwhile, for the southwest and the east, CO2‐induced shift of subtropical highs generates wet advection, which might mitigate the drying effect from warming.

This article reflects on the challenge of online teaching from the perspective of media didactics, a perspective that gained prominence during the COVID-19 pandemic. The qualitative-reconstructive study reflects on 65 multidisciplinary papers written during the pandemic. Together, these studies empirically examine the challenges, achievements, and failures of the first large-scale experiment in university teaching during that time and include quantitative empirical studies and qualitative first-hand accounts from university lectures that document how scholars adapted their courses from on-campus teaching to online teaching. Many approaches are innovative and creative, while some are not really new, at least from the perspective of media education. Still, many teachers with limited exposure to media-based or online teaching pre-pandemic broke new ground in their individual teaching. Of course, learning is an individual process. Nevertheless, expectations that university teaching would be fundamentally redesigned were almost inevitably destined for disappointment due to the pandemic’s suddenness, a lack of didactic knowledge, technical and organizational hurdles, and various other individual challenges. It is now clear that the emergency online semesters have permanently changed university teaching. Learning from both successes and failures, this article proposes the design and development of good (online) teaching for post-pandemic times. It bases its proposals on the documented experiences of teachers, on empirical data, and on three practical examples.

Abstract Background Despite several clinical trials, the use of corticosteroid therapy for treating immunoglobulin A nephropathy (IgAN) remains controversial. We aimed to describe the use of corticosteroid therapy combined with supportive therapy in Norwegian patients with IgAN who had progressed to end-stage kidney disease. Methods We conducted a retrospective cohort study using data from the Norwegian Renal Registry. Overall, 143 patients with primary IgAN who progressed to end-stage kidney disease were divided into two groups: the corticosteroid group, who had been treated with corticosteroids and supportive therapy, and the non-corticosteroid group, which had underwent only supportive therapy. The kidney function, time to end-stage kidney disease, and adverse effects were described. The observation period lasted from the diagnostic kidney biopsy until the initiation of kidney replacement therapy. Results Of the 143 included patients, 103 underwent supportive therapy alone, and 40 were treated with corticosteroids. Most patients (94%) were treated with renin-angiotensin-system blockade, and all patients reached end-stage kidney disease after a median of 5 years (interquartile range; 2–9 years). Time from diagnosis until end-stage kidney disease was similar in the two study groups (p = 0.98). During 6 months of corticosteroid therapy, median eGFR declined from 21 (interquartile range; 13–46) mL/min/1.73 m2 to 20 (interquartile range; 12–40) mL/min/1.73 m2, and median proteinuria decreased from 5.5 g/24 h to 3.0 g/24 h. Most patients (87.5%) treated with corticosteroids reported adverse events. In our linear regression analysis investigating the time to ESKD, we found that age (β = -0.079, p = 0.008) and proteinuria at diagnosis (β = -0.50, p = 0.01) exhibited statistically significant associations with a delay in the progression to ESKD. Conclusions In this cohort of Norwegian patients with IgAN, corticosteroid therapy did not affect the time from diagnosis until end-stage kidney disease among a cohort of patients who all reached end-stage kidney disease. The treatment was also associated with adverse effects.

CDC42 controls intestinal epithelial (IEC) stem cell (IESC) division. How aberrant CDC42 initiates intestinal inflammation or neoplasia is unclear. We utilized models of inflammatory bowel diseases (IBD), colorectal cancer, aging, and IESC injury to determine the loss of intestinal Cdc42 upon inflammation and neoplasia. Intestinal specimens were collected to determine the levels of CDC42 in IBD or colorectal cancer. Cdc42 floxed mice were crossed with Villin-Cre, Villin-CreERT2 and/or Lgr5-eGFP-IRES-CreERT2, or Bmi1-CreERT2 mice to generate Cdc42 deficient mice. Irradiation, colitis, aging, and intestinal organoid were used to evaluate CDC42 upon mucosal inflammation, IESC/progenitor regenerative capacity, and IEC repair. Our studies revealed that increased CDC42 in colorectal cancer correlated with lower survival; in contrast, lower levels of CDC42 were found in the inflamed IBD colon. Colonic Cdc42 depletion significantly reduced Lgr5+ IESCs, increased progenitors' hyperplasia, and induced mucosal inflammation, which led to crypt dysplasia. Colonic Cdc42 depletion markedly enhanced irradiation- or chemical-induced colitis. Depletion or inhibition of Cdc42 reduced colonic Lgr5+ IESC regeneration. In conclusion, depletion of Cdc42 reduces the IESC regeneration and IEC repair, leading to prolonged mucosal inflammation. Constitutive monogenic loss of Cdc42 induces mucosal inflammation, which could result in intestinal neoplasia in the context of aging.

Abstract Background The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. Methods A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible. Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I. Results The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited. Conclusion Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence. Trial registration PROSPERO registration (CRD42021279131).

PURPOSEThe aim of this study is to characterize lung cancer treatment clinical trials in Latin America before (January 2001-December 2011) and after (January 2012-December 2021) the organization of major Latin American oncology cooperative groups.MATERIALS AND METHODSInterventional clinical trials were identified in ClinicalTrials.gov using the search terms “lung cancer,” country filters for 20 Latin American countries, and study start dates January 1, 2001-December 31, 2011, and January 1, 2012-December 31, 2021. Clinical trials were categorized as either originating in Latin America (LA) or outside Latin America (non-LA) with participation of Latin American countries. Descriptive statistics, two-sided Z-scores, and chi-square analyses with 95% CIs were calculated.RESULTSOverall, 273 clinical trials involving Latin American countries between 2001 and 2021 were identified. Comparing 2001-2011 with 2012-2021, there was an increase in total clinical trials (100 v 173; P < .001). Only 9% (26 of 273) of all trials were LA trials. There was a marked decrease in the proportion of LA trials (14% v 7%, P = .058) and estimated enrollment to LA trials (3,245 v 1,190 patients; P < .001). Recruiting of patients with EGFR (29% v 7%; P < .01) and KRAS (18% v 2%; P < .01) driver mutations also decreased. Trial participation was highest in Brazil, Mexico, Argentina, Chile, and Peru and increased over time: Brazil (61 v 108; 77% increase), Mexico (40 v 88; 120% increase), Argentina (50 v 78; 56% increase), Chile (25 v 57; 128% increase), and Peru (14 v 37; 164% increase).CONCLUSIONThere was a significant increase in clinical trial participation by Latin American countries, from 2001-2011 to 2012-2021. However, there were few clinical trials which originated in Latin America or focused on patients with driver mutations.

Abstract Intensive ungulate browsing significantly impacts forests worldwide. However, it is usually not single browsing events that lead to sapling mortality, but the little-researched interactions of browsed saplings with their biotic and abiotic environment. (I) Our objective was to assess the impact of ungulate browsing on the growth of young saplings relative to other environmental factors by utilizing their height increment as a sensitive measure of vitality to indicate their status. (II) Furthermore, we aimed to identify factors affecting ungulate browsing at our study sites, assessed as browsing probabilities, and identify effective mitigation measures for browsing impact. We analyzed an extensive sapling dataset of 248 wildlife exclosures, which were erected in 2016 in beech dominated forests across Germany and assessed annually until 2020. (I) Browsing probability and light availability were the most influential parameters for selectively browsed, admixed tree species (e.g., sycamore maple). Height increment showed abrupt setbacks, which caused a permanent collapse of growth when browsing exceeded a certain level. However, light availability enhanced height increment. (II) An increase in deer harvest reduced the browsing probability of selectively browsed species considerably. We conclude that the growth-inhibiting effect of ungulate browsing is a multifactorial phenomenon, which can be mitigated by silvicultural management and efficient hunting strategies.

Olecranon bursitis is the most common form of bursitis. While it can commonly be treated using noninvasive measures, a surgical approach is indicated for cases of recalcitrant olecranon bursitis, which fail such treatment options. Traditionally, recalcitrant olecranon bursitis has been treated with an open bursectomy. Recently, arthroscopy has been proposed as an alternative method. Contraindications for this approach are cases where the bursa is massively enlarged and contains copious amounts of gouty tophi. While a unanimous consensus regarding which surgical approach is optimal has yet to be made, the endoscopic approach could potentially reduce issues inherent to open bursectomies such as improper wound healing and recurrence. This would reduce patient discomfort and allow them to return to activity sooner. We present a technique for treating recalcitrant olecranon bursitis using endoscopic resection.

Kommunikation ist grundlegende Voraussetzung für gesellschaftliche Handlungsfähigkeit. Aufgrund des digitalen Wandels kommunizieren Individuen nicht nur vermehrt mit und innerhalb digitaler Medien, sondern können sich auch zunehmend mittels der Gestaltung medialer und digitaler Artefakte artikulieren. In diesem Beitrag widmen wir uns dem Gestalten von Medien und Technik als erweiterte Form menschlicher Artikulation. Im Rahmen einer medienethnografischen Studie auf Basis des Frankfurt-Dreiecks als Referenzrahmen spürten wir den neuen Artikulationsformen nach, die digitale Medien und Technik anbieten. Die Auswertung zeigt, dass diese neuen Artikulationsformen von den meisten Proband:innen (noch?) nicht umfänglich genutzt werden – zumindest nicht in allen möglichen Dimensionen. Technische Artikulationsfähigkeit als Erweiterung individueller Handlungskompetenz ist offenbar keine ‹angeborene› menschliche Befähigung, sondern eine Kompetenz, die erlernt werden kann – etwa wie eine Sprache oder ein Musikinstrument. Wie auch Medienbildung können technische Artikulationsfähigkeiten pädagogisch gefördert werden – gleichermassen sollten sie es auch. Denn in einer digitalen Welt dient die pädagogisch angeleitete Ausprägung von Artikulationsfähigkeiten nichts Geringerem als dem Erhalt gesellschaftlicher Handlungsfähigkeit. In der praktischen Arbeit in Makerspaces konnten wir beobachten, dass gerade die handlungsorientierten Ansätze Tinkering, Coding, Making oder Hacking zur gezielten Förderung der in diesem Beitrag exemplarisch identifizierten Artikulationsformen beitragen können.

Abstract Inflammation modifies the incidence and progression of Parkinson’s disease (PD). By using 30 inflammatory markers in CSF in 498 people with PD and 67 people with dementia with Lewy bodies (DLB) we show that: (1) levels of ICAM-1, Interleukin-8, MCP-1, MIP-1 beta, SCF and VEGF were associated with clinical scores and neurodegenerative CSF biomarkers (Aβ1-42, t-Tau, p181-Tau, NFL and α-synuclein). (2) PD patients with GBA mutations show similar levels of inflammatory markers compared to PD patients without GBA mutations, even when stratified by mutation severity. (3) PD patients who longitudinally developed cognitive impairment during the study had higher levels of TNF-alpha at baseline compared to patients without the development of cognitive impairment. (4) Higher levels of VEGF and MIP-1 beta were associated with a longer duration until the development of cognitive impairment. We conclude that the majority of inflammatory markers is limited in robustly predicting longitudinal trajectories of developing cognitive impairment.

Abstract Background There is an emerging consensus that point-of-care ultrasound is an essential skill in acute care. This is reflected in recent changes to the Acute Internal Medicine curriculum in the UK. The need to develop and maintain specific ultrasound competencies is now a mandatory component of training. There is a degree of uncertainty as to how existing training infrastructure can best accommodate these changes. Methods Data were obtained from the latest annual Society for Acute Medicine Benchmarking Audit 2021. All Acute Medical Units in the UK are eligible to participate. Data pertaining to the number of ultrasound machines and number of clinicians that regularly use point of care ultrasound were collected. This was used to develop a series of maps demonstrating variation in provision at the national level. Results In total, 123 AMUs responded to the questions related to ultrasound prevalence and numbers of trained clinicians. Of these, 78.9% (97/123) reported having access to at least one ultrasound machine. There was at least one clinician that regularly used ultrasound in 81 responding hospitals (65.9%). There was significant geographic heterogeneity in the use of ultrasound and availability of accredited supervisors. At a regional level, ultrasound expertise is typically concentrated within a relatively small number of hospitals. Conclusion Geographic variation in the use of ultrasound and availability of registered supervisors represents a significant challenge to ultrasound training provision at the national level. Targeted interventions in areas with less developed training infrastructure, such as regional training hubs may be required to ensure more equitable access to training opportunities.

The cerebral cortex has ongoing electrical activities with rich and complex patterns in space and time. Here, the authors use optical voltage imaging in mice and computational methods, relating these complexities to different levels of wakefulness.

Accurate estimation of above-ground biomass (AGB) in forested areas is essential for studying forest ecological functions, surface carbon cycling, and global carbon balance. Over the past decade, models that harness the distinct features of multi-source remote sensing observations for estimating AGB have gained significant popularity. It is worth exploring the differences in model performance by using simple and fused data. Additionally, quantitative estimation of the impact of high-cost laser point clouds on satellite imagery of varying costs remains largely unexplored. To address these challenges, model performance and cost must be considered comprehensively. We propose a comprehensive assessment based on three perspectives (i.e., performance, potential and limitations) for four typical AGB-estimation models. First, different variables are extracted from the multi-source and multi-resolution data. Subsequently, the performance of four regression methods is tested for AGB estimation with diverse indicator combinations. Experimental results prove that the combination of multi-source data provides a highly accurate AGB regression model. The proposed regression and variables rating approaches can flexibly integrate other data sources for modeling. Furthermore, the data cost is discussed against the AGB model performance. Our study demonstrates the potential of using low-cost satellite data to provide a rough AGB estimation for larger areas, which can allow different remote sensing data to meet different needs of forest management decisions.

For over two decades, Florida citrus growers have been heavily using copper sprays to combat citrus canker (Xanthomonas citri subsp. citri; Xcc), but it raises the risk of developing resistant bacterial strains and excessive accumulation in the soil. Alternative methods are needed to reduce copper dependency and better manage Xcc. Therefore, we screened copper-alternative products against canker on young seedlings in the greenhouse and mature trees in a commercial grove in Florida, USA. In the greenhouse, we evaluated the efficacy of single foliar application of new plant defense inducers (PDI), ‘PDI5’, ‘PDI26’, and ‘PDI31’, and a commercially available systemic acquired resistance inducer, Actigard (drench; 2g/tree), applied two days before injection-infiltration with citrus canker bacterium Xcc (104 CFU/ml), on two-year-old Valencia trees. All three PDIs, sprayed at 500 ppm, as well as Actigard (drench), effectively reduced canker severity on the inoculated leaves in the greenhouse (P ≤0.02). In the grove, we tested new antimicrobials, Mastercop ‘MC’ (21.46% copper sulfate pentahydrate; metallic copper equivalent 5.4%) at concentrations of 1.12 kg/ha, 1.68 kg/ha and 2.24 kg/ha, ‘AM’ at 1.68 kg/ha and 2.24 kg/ha, and a nutrient solution (AGRO-MOS) at 1.12 kg/ha for canker suppression on 4–6-year-old Hamlin trees. Kocide 2000 (growers’ standard control; metallic copper equivalent 30%; 3.92 kg/ha) was used as a control check. Although 2021 was not as conducive for citrus canker due to the relatively dry spring months in the field, our results showed that the six sprays of AM (2.24 kg/ha) or MC (1.68 kg/ha, and 2.24 kg/ha), in 2022, provided excellent control of Xcc, with a significant reduction in disease incidence in leaves and fruits, and disease severity in fruits, similar to Kocide 2000. The results indicate that antimicrobials, AM and MC, and plant defense inducers PDI5, PDI26, and PDI31 can be part of an integrated pest management (IPM) program with copper for managing citrus canker. Reducing the frequency and amount of copper applications can help reduce pesticide and application expenses, lower risks of copper buildup in the soil and toxicity for citrus trees and reduce the risk of the emergence of copper-resistant Xcc strains. Further research on these products is needed to assess their long-term effectiveness and potential environmental risks.

BackgroundMild traumatic brain injuries (mTBIs) comprise 80% of all TBI, but conventional MRI techniques are often insensitive to the subtle changes and injuries produced in a concussion. Diffusion tensor imaging (DTI) is one of the most sensitive MRI techniques for mTBI studies with outcome and symptom associations described. The corpus callosum (CC) is one of the most studied fiber tracts in TBI and mTBI, but the comprehensive post-mTBI symptom relationship has not fully been explored.MethodsThis is a retrospective observational study of how quantitative DTI data of the CC and its sub-regions may relate to clinical presentation of symptoms and timing of resolution of symptoms in patients diagnosed with uncomplicated mTBI. DTI and clinical data were obtained retrospectively from 446 (mean age 42 years, range 13–82) civilian patients. From patient medical charts, presentation of the following common post-concussive symptoms was noted: headache, balance issues, cognitive deficits, fatigue, anxiety, depression, and emotional lability. Also recorded was the time between injury and a visit to the physician when improvement or resolution of a particular symptom was reported. FA values from the total CC and 3 subregions of the CC (genu or anterior, mid body, and splenium or posterior) were obtained from hand tracing on the Olea Sphere v3.0 SP12 free-standing workstation. DTI data was obtained from 8 different 3T MRI scanners and harmonized via ComBat harmonization. The statistical models used to explore the association between regional Fractional Anisotropy (FA) values and symptom presentation and time to symptom resolution were logistic regression and interval-censored semi-parametric Cox proportional hazard models, respectively. Subgroups related to age and timing of first scan were also analyzed.ResultsPatients with the highest FA in the total CC (p = 0.01), anterior CC (p < 0.01), and mid-body CC (p = 0.03), but not the posterior CC (p = 0.91) recovered faster from post-concussive cognitive deficits. Patients with the highest FA in the posterior CC recovered faster from depression (p = 0.04) and emotional lability (p = 0.01). There was no evidence that FA in the CC or any of its sub-regions was associated with symptom presentation or with time to resolution of headache, balance issues, fatigue, or anxiety. Patients with mTBI under 40 had higher FA in the CC and the anterior and mid-body subregions (but not the posterior subregion: p = 1.00) compared to patients 40 or over (p ≤ 0.01). There was no evidence for differences in symptom presentation based on loss of consciousness (LOC) or sex (p ≥ 0.18).ConclusionThis study suggests that FA of the CC has diagnostic and prognostic value for clinical assessment of mTBI in a large diverse civilian population, particularly in patients with cognitive symptoms.

Antiglomerular basement membrane (anti-GBM) disease is a rare, small-vessel vasculitis that affects the capillary beds of the kidneys and lungs. Although exceedingly rare, several case reports have described anti-GBM disease with a concurrent cancer diagnosis, suggesting a possible correlation between these 2 conditions. Herein, we describe the first known case to our knowledge of a woman in her early 60s with simultaneous anti-GBM disease and clear cell renal cell carcinoma, in which the tumor was thought to have been the substrate for anti-GBM disease. We believe that renal cell carcinoma may have contributed to the production of anti-GBM autoantibodies and, thus, anti-GBM disease. The concurrence of these 2 conditions complicated the treatment of the patient, who was hemodialysis-dependent at the time of hospital discharge. This report highlights the importance of considering anti-GBM disease as a potential diagnosis in patients with acute kidney failure, and how important it is to identify both clear cell renal cell carcinoma and anti-GBM disease at an early stage to improve outcomes.

Finding the optimal land allocation for providing ecosystem services, conserving biodiversity and maintaining rural livelihoods is a key challenge of agricultural management and land-use planning. Agroforestry has been widely discussed as a sustainable land-use solution and as one strategy to improve the provision of multiple ecological and economic functions in agricultural landscapes. In this study, we use the backdrop of agroforestry research to evaluate a method from the multi-criteria decision analysis toolbox: robust multi-objective optimization. The key feature of this modelling approach is its capacity to integrate uncertain ecological and socio-economic data. We illustrate the optimization model with a case study from eastern Panama, showing how the model can bring together scientific and practical knowledge to provide potentially desirable landscape compositions from the perspective of farmers, a public perspective, and a compromise solution. Example results of our case study show how to assess whether agroforestry is a desirable component in a landscape composition to satisfy multiple objectives of different interest groups. Furthermore, we use the model to demonstrate how different objectives influence the optimal area share and type of agroforestry. Due to its parsimonious nature, the model could be used as a starting point of an interactive co-learning process with decision-makers, researchers and other stakeholders. The model, however, is not yet suitable for an exact prediction of future land-use dynamics, for questions of spatially explicit land-use configuration, studies going beyond the regional scale or for socio-economic interactions of agents. Therefore, we outline future research needs and recommendations for other types of models or hybrid approaches.

This study shows intensification rates of tropical cyclones around the world have significantly increased, and environmental conditions around storms are becoming more favorable. Human-caused climate change is contributing to both trends.

IntroductionNatural products discovered from bacteria provide critically needed therapeutic leads for drug discovery, and myxobacteria are an established source for metabolites with unique chemical scaffolds and biological activities. Myxobacterial genomes accommodate an exceptional number and variety of biosynthetic gene clusters (BGCs) which encode for features involved in specialized metabolism.MethodsIn this study, we describe the collection, sequencing, and genome mining of 20 myxobacteria isolated from rhizospheric soil samples collected in North America.ResultsNine isolates were determined to be novel species of myxobacteria including representatives from the genera Archangium, Myxococcus, Nannocystis, Polyangium, Pyxidicoccus, Sorangium, and Stigmatella. Growth profiles, biochemical assays, and descriptions were provided for all proposed novel species. We assess the BGC content of all isolates and observe differences between Myxococcia and Polyangiia clusters.DiscussionContinued discovery and sequencing of novel myxobacteria from the environment provide BGCs for the genome mining pipeline. Utilizing complete or near-complete genome sequences, we compare the chromosomal organization of BGCs of related myxobacteria from various genera and suggest that the spatial proximity of hybrid, modular clusters contributes to the metabolic adaptability of myxobacteria.

Abstract High‐resolution atmospheric models are powerful tools for hurricane track and intensity predictions. Although using high resolution contributes to better representation of hurricane structure and intensity, its value in the prediction of steering flow and storm tracks is uncertain. Here we present experiments suggesting that biases in the predicted North Atlantic hurricane tracks in a high‐resolution (approximately 3 km grid‐spacing) model originates from the model's explicit simulation of deep convection. Differing behavior of explicit convection leads to changes in the synoptic‐scale pattern and thereby to the steering flow. Our results suggest that optimizing small‐scale convection activity, for example, through the model's horizontal advection scheme, can lead to significantly improved hurricane track prediction (∼10% reduction of mean track error) at lead times beyond 72 hr. This work calls attention to the behavior of explicit convection in high‐resolution models, and its often overlooked role in affecting larger‐scale circulations and hurricane track prediction.

Abstract Background Due to contradictory results in current research, whether age at menopause is increasing or decreasing in Western countries remains an open question, yet worth studying as later ages at menopause are likely to be related to an increased risk of breast cancer. Using data from breast cancer screening programs to study the temporal trend of age at menopause is difficult since especially younger women in the same generational cohort have often not yet reached menopause. Deleting these younger women in a breast cancer risk analyses may bias the results. The aim of this study is therefore to recover missing menopause ages as a covariate by comparing methods for handling missing data. Additionally, the study makes a contribution to understanding the evolution of age at menopause for several generations born in Portugal between 1920 and 1970. Methods Data from a breast cancer screening program in Portugal including 278,282 women aged 45–69 and collected between 1990 and 2010 are used to compare two approaches of imputing age at menopause: (i) a multiple imputation methodology based on a truncated distribution but ignoring the mechanism of missingness; (ii) a copula-based multiple imputation method that simultaneously handles the age at menopause and the missing mechanism. The linear predictors considered in both cases have a semiparametric additive structure accommodating linear and non-linear effects defined via splines or Markov random fields smoothers in the case of spatial variables. Results Both imputation methods unveiled an increasing trend of age at menopause when viewed as a function of the birth year for the youngest generation. This trend is hidden if we model only women with an observed age at menopause. Conclusion When studying age at menopause, missing ages must be recovered with an adequate procedure for incomplete data. Imputing these missing ages avoids excluding the younger generation cohort of the screening program in breast cancer risk analyses and hence reduces the bias stemming from this exclusion. In addition, imputing the not yet observed ages of menopause for mostly younger women is also crucial when studying the time trend of age at menopause otherwise the analysis will be biased.

Lately, behavioral ecotoxicology has flourished because of increasing standardization of analyses of endpoints like movement. However, research tends to focus on a few model species, which limits possibilities of extrapolating and predicting toxicological effects and adverse outcomes at the population and ecosystem level. In this regard, it is recommended to assess critical species-specific behavioral responses in taxa playing key roles in trophic food webs, such as cephalopods. These latter, known as masters of camouflage, display rapid physiological color changes to conceal themselves and adapt to their surrounding environments. The efficiency of this process depends on visual abilities and acuity, information processing, and control of chromatophores dynamics through nervous and hormonal regulation with which many contaminants can interfere. Therefore, the quantitative measurement of color change in cephalopod species could be developed as a powerful endpoint for toxicological risk assessment. Based on a wide body of research having assessed the effect of various environmental stressors (pharmaceutical residues, metals, carbon dioxide, anti-fouling agents) on the camouflage abilities of juvenile common cuttlefish, we discuss the relevance of this species as a toxicological model and address the challenge of color change quantification and standardization through a comparative review of the available measurement techniques.

Objective: Assess discrepancy between estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk and observed 10-year event rates in a rural population participating in cardiovascular health initiative. Methods: The study included a rural sample of individuals participating in the Heart of New Ulm (HONU), a population-based health initiative aimed at reducing ASCVD risk in a rural community. HONU conducted over 100 baseline screening events with 5221 individuals participating in 2009. For this analysis, we included participants who were aged 40–79 years, free of ASCVD at baseline, and had adequate data to calculate 10-year ASCVD risk. Electronic health record data and state death records were used to determine rates of non-fatal myocardial infarction and stroke, and ASCVD death from 2010–2019. ASCVD event rates were compared to estimated 10-year risks calculated using the Pooled Cohort Equations, stratified by sex and clinically relevant risk categories. Results: The sample (n = 2819, mean ± SD age 56.1 ± 9.9 years, 59.6% female) had a low prevalence of tobacco use (8.1% current smokers) and diabetes (6.5%) and a high prevalence of hypertension (44.4%) and hyperlipidemia (56.6%). The median estimated 10-year ASCVD risk for the entire sample was 5.7% (IQR 2.3–13.5%) with an observed 10-year ASCVD event rate of 3.4%. The largest gap between observed and estimated risk was in those at intermediate/high (≥7.5%) ASCVD risk (median 10-year risk 15.8% [IQR 10.4–29.0], observed ASCVD event rate 6.4%). Conclusio: In a sample of rural participants exposed to a multifaceted ASCVD prevention initiative, observed rates of ASCVD were substantially lower compared to estimated ASCVD risk. The potential for significantly lower than predicted ASCVD event rates in certain populations should be included in the clinician-patient risk discussion.

Abstract Background Hyperplasia of the hematopoietic bone marrow in the appendicular skeleton is common. In contrast, focal hematopoietic islands within the axial skeleton are a rare entity and can confuse with osteoblastic metastases. This study aimed to characterize typical MRI and CT findings of hematopoietic islands in distinction from osteoblastic metastases to help both radiologists and clinicians, on the one hand, not to overdiagnose this entity and, on the other hand, to decide on a reasonable work-up. Methods We retrospectively analyzed the imaging findings of 14 hematopoietic islands of the axial skeleton in ten patients (nine females, median age = 65.5 years [range, 49–74]) who received both MRI and CT at initial diagnosis between 2006 and 2020. CT-guided biopsy was performed in five cases to confirm the diagnosis, while the other five patients received long-term MRI follow-up (median follow-up = 28 months [range, 6–96 months]). Diffusion-weighted imaging was available in three, chemical shift imaging respectively 18F- fluorodeoxyglucose PET/CT in two, and Technetium 99 m skeletal scintigraphy in one of the patients. Results All lesions were small (mean size = 1.72 cm2) and showed moderate hypointense signals on T1- and T2-weighted MRI sequences. They appeared isointense to slightly hyperintense on STIR images and slightly enhanced after gadolinium administration. To differentiate this entity from osteoblastic metastases, CT provides important additional information, as hematopoietic islands do not show sclerosis. Conclusions Hematopoietic islands within the axial skeleton can occur and mimic osteoblastic metastases. However, the combination of MRI and CT allows for making the correct diagnosis in most cases.

Abstract Introduction The relationship between nurse staffing levels and patient safety is well recognised. Inadequate provision of nursing staff is associated with increased medical error, as well as higher morbidity and mortality. Defining what constitutes safe nurse staffing levels is complex. A range of guidance and planning tools are available to inform staffing decisions. The Society for Acute Medicine (SAM) recommend a ‘nurse-to-bed‘ratio of greater than 1:6. Whether this standard accurately reflects the pattern and intensity of work on the Acute Medical Unit (AMU) is unclear. Methods Nurse staffing levels in AMUs were explored using the Society for Acute Medicine Benchmarking Audit 2019 (SAMBA19). Data from 122 acute hospitals were analysed. Nurse-to-bed ratios were calculated and compared. Estimates of the total nursing time available within the acute care system were compared to estimates of the time required to perform nursing activities. Results The total number of AMU beds across all 122 units was 4997. The mean daytime nurse-to-bed ratio was 1:4.3 and the mean night time nurse-to-bed ratio was 1:5.2. The SAM standard of a nurse to bed ratio of greater than 1:6 was achieved in 99 units (81.9%) during daytime hours and achieved by 74 units (60.6%) at night. The estimated time required to deliver direct clinical care was 35,698 h. A deficit of 4128 h (11.5% of time required) was estimated, representing the time difference between the total number of nursing hours available with current staffing and the estimated time needed for direct clinical care across all participating units. Conclusion This UK-wide study suggests a significant proportion of AMUs do not meet the recommenced SAM staffing levels, particularly at night. A difference was observed between the total number of nursing hours within the acute care system and the estimated time required to perform direct nursing activities. This suggests a workforce shortage of nurses within acute care at the system level.

Abstract Background Variants in SLC34A2 encoding the sodium-dependent phosphate transport protein 2b (NaPi-IIb) cause the rare lung disease pulmonary alveolar microlithiasis (PAM). PAM is characterised by the deposition of calcium-phosphate concretions in the alveoli usually progressing over time. No effective treatment is available. So far, 30 allelic variants in patients have been reported but only a few have been functionally characterised. This study aimed to determine the impact of selected SLC34A2 variants on transporter expression and phosphate uptake in cellular studies. Methods Two nonsense variants (c.910A > T and c.1456C > T), one frameshift (c.1328delT), and one in-frame deletion (c.1402_1404delACC) previously reported in patients with PAM were selected for investigation. Wild-type and mutant c-Myc-tagged human NaPi-IIb constructs were expressed in Xenopus laevis oocytes. The transport function was investigated with a 32Pi uptake assay. NaPi-IIb protein expression and localisation were determined with immunoblotting and immunohistochemistry, respectively. Results Oocytes injected with the wild-type human NaPi-IIb construct had significant 32Pi transport compared to water-injected oocytes. In addition, the protein had a molecular weight as expected for the glycosylated form, and it was readily detectable in the oocyte membrane. Although the protein from the Thr468del construct was synthesised and expressed in the oocyte membrane, phosphate transport was similar to non-injected control oocytes. All other mutants were non-functional and not expressed in the membrane, consistent with the expected impact of the truncations caused by premature stop codons. Conclusions Of four analysed SLC34A2 variants, only the Thr468del showed similar protein expression as the wild-type cotransporter in the oocyte membrane. All mutant transporters were non-functional, supporting that dysfunction of NaPi-IIb underlies the pathology of PAM.

Sarcomas are a heterogeneous group of rare mesenchymal tumors. The migration of immune cells into these tumors and the prognostic impact of tumor-specific factors determining their interaction with these tumors remain poorly understood. The current risk stratification system is insufficient to provide a precise survival prediction and treatment response. Thus, valid prognostic models are needed to guide treatment. This study analyzed the gene expression and outcome of 980 sarcoma patients from seven public datasets. The abundance of immune cells and the response to immunotherapy was calculated. Immune-related genes (IRGs) were screened through a weighted gene co-expression network analysis (WGCNA). A least absolute shrinkage and selection operator (LASSO) Cox regression was used to establish a powerful IRG signature predicting prognosis. The identified IRG signature incorporated 14 genes and identified high-risk patients in sarcoma cohorts. The 14-IRG signature was identified as an independent risk factor for overall and disease-free survival. Moreover, the IRG signature acted as a potential indicator for immunotherapy. The nomogram based on the risk score was built to provide a more accurate survival prediction. The decision tree with IRG risk score discriminated risk subgroups powerfully. This proposed IRG signature is a robust biomarker to predict outcomes and treatment responses in sarcoma patients.

Progressive respiratory failure is the primary cause of death in patients with COVID-19, but pathologies in other tissues may also occur. Here the authors report that adrenal tropism of SARS-CoV-2 is associated with adrenalitis, reduced adrenal cortisol levels and severe adrenal damage in a post-mortem case series of patients with severe fatal COVID-19.

ABSTRACTFew land-allocation models consider the impact of off-farm income on tropical deforestation. We provide a concept to integrate off-farm income in a mechanistic multiple-objective land-allocation model, while distinguishing between farms with and without re-allocation of on-farm labor to obtain off-farm income. On farms with re-allocation of labor we found that off-farm income reduced farmers’ financial dependency on deforestation-related agricultural income leading to less tropical deforestation. The influence of off-farm income covered two aspects: availability of additional income and re-allocation of on-farm labor to off-farm activities. The labor effect tended to reduce deforestation slightly more than the income effect. On farms without re-allocation of on-farm labor we showed how farmers can use off-farm income to purchase additional labor to accelerate deforestation. Our study highlights the importance of considering off-farm income in land-use models to better understand, model and possibly curb tropical deforestation.

Abstract Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

Abstract Background The incorporation of acute frailty services into the acute care pathway is increasingly common. The prevalence and impact of acute frailty services in the UK are currently unclear. Methods The Society for Acute Medicine Benchmarking Audit (SAMBA) is a day of care survey undertaken annually within the UK. SAMBA 2019 (SAMBA19) took place on Thursday 27th June 2019. A questionnaire was used to collect hospital and patient-level data on the structure and organisation of acute care delivery. SAMBA19 sought to establish the frequency of frailty assessment tool use and describe acute frailty services nationally. Hospitals were classified based on the presence of acute frailty services and metrics of performance compared. Results A total of 3218 patients aged ≥70 admitted to 129 hospitals were recorded in SAMBA19. The use of frailty assessment tools was reported in 80 (62.0%) hospitals. The proportion of patients assessed for the presence of frailty in individual hospitals ranged from 2.2 to 100%. Bedded Acute Frailty Units were reported in 65 (50.3%) hospitals. There was significant variation in admission rates between hospitals. This was not explained by the presence of a frailty screening policy or presence of a dedicated frailty unit. Conclusion Two fifths of participating UK hospitals did not have a routine frailty screening policy: where this existed, rates of assessment for frailty were variable and most at-risk patients were not assessed. Responses to positive results were poorly defined. The provision of acute frailty services is variable throughout the UK. Improvement is needed for the aspirations of national policy to be fully realised.

Abstract Background The degree of contamination of healthy tissue with tumor cells during a biopsy in bone or soft tissue sarcomas is clearly dependant on the type of biopsy. Some studies have confirmed a clinically relevant contamination of the biopsy tract after incisional biopsies, as opposed to core-needle biopsies. The aim of our prospective study was to evaluate the risk of local recurrence depending on the biopsy type in extremity and pelvis sarcomas. Methods We included 162 patients with a minimum follow-up of 6 months after wide resection of extremity sarcomas. All diagnostic and therapeutic procedures were performed at a single, dedicated sarcoma center. The excision of the biopsy tract after an incisional biopsy was performed as a standard with all tumor resections. All patients received their follow-up after the conclusion of therapy at our center by means of regional MRI studies and, at a minimum, CT of the thorax to rule out pulmonary metastatic disease. The aim of the study was the evaluation of the influence of the biopsy type and of several other clinical factors on the rate of local recurrence and on the time of local recurrence-free survival. Results One hundred sixty-two patients with bone or soft tissue tumors of the extremities and the pelvis underwent either an incisional or a core-needle biopsy of their tumor, with 70 sarcomas (43.2%) being located in the bone. 84.6% of all biopsies were performed as core-needle biopsies. The median follow-up time was 55.6 months, and 22 patients (13.6%) developed a local recurrence after a median time of 22.4 months. There were no significant differences between incisional and core-needle biopsy regarding the risk of local recurrence in our subgroup analysis with differentiation by kind of tissue, grading of the sarcoma, and perioperative multimodal therapy. Conclusions In a large and homogenous cohort of extremity and pelvic sarcomas, we did not find significant differences between the groups of incisional and core-needle biopsy regarding the risk of local recurrence. The excision of the biopsy tract after incisional biopsy in the context of the definitive tumor resection seems to be the decisive factor for this result.

Abstract Background The Oxford classification/MEST score is an established histopathologic scoring system for patients with IgA nephropathy (IgAN). The objective of this study was to derive a prognostic model for IgAN based on the MEST score and histopathologic features. Methods A total of 306 patients with biopsy-proven primary IgAN were included. Histopathologic samples were retrieved from the Norwegian Kidney Biopsy Registry and reclassified according to the Oxford classification. The study endpoint was end-stage renal disease (ESRD). Patients were subclassified into three risk models based on histologic features (Model A), a composite score calculated from the adjusted hazard ratio values (Model B), and on quartiles (Model C). Results The mean follow-up time was 16.5 years (range 0.2–28.1). In total, 61 (20%) patients reached ESRD during the study period. Univariate analysis of M, E, S, T and C lesions demonstrated that all types were associated with an increased risk of ESRD; however, a multivariate analysis revealed that only S, T and C lesions were associated with poor outcomes. Statistical analysis of 15-year data demonstrated that Models A and B were as predictive as the MEST score, with an area-under-the-curve at 0.85. The Harrel c index values were 0.81 and 0.80 for the MEST score and Models A and B, respectively. In the present cohort, adding C lesions to the MEST score did not improve the models prognostic value. Conclusions Patients can be divided into risk classes based on their MEST scores. Histopathologic data provide valuable prognostic information at the time of diagnosis. Model B was the most suitable for clinical practice because it was the most user-friendly.

This article introduces an area of interdisciplinary research in the intersection of education science, media studies, communication studies and media psychology. The article views media as learning objects, teaching media and learning tools in a socially networked environment, and examines the relationship between emotions and media in educational practice. The practical examples presented and theoretically analysed in this article also demonstrate how digital media in educational contexts draw on emotions to foster processes of reflection and action-oriented learning. Learners are activated by teaching and learning media which have a connection to their lifeworlds, and by active media work and working methods which are based on interactionist and constructivist theories. These may also contribute to the acquisition of wide-ranging competence experience and support learners' social relatedness and participation.