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Natural salinity gradients are a promising source of so-called blue energy, a renewable energy source that utilizes the free energy of mixing for power generation. One promising blue energy technology that converts these salinity gradients directly into electricity is reverse electrodialysis (RED). Used at its full potential, it could provide a substantial portion of the worlds electricity consumption. Previous theoretical and experimental works have been done on optimizing RED devices, with the latter often focusing on precious and expensive metal electrodes. However, in order to rationally design and apply RED devices, we need to investigate all related transport phenomena─especially the fluidics of salinity gradient mixing and the redox electrolyte at various concentrations, which can have complex intertwined effects─in a fully functioning and scalable system. Here, guided by fundamental electrochemical and fluid dynamics theories, we work with an iron-based redox electrolyte with carbon electrodes in a RED device with tunable microfluidic environments and study the fundamental effects of electrolyte concentration and flow rate on the potential-driven redox activity and power output. We focus on optimizing the net power output, which is the difference between the gross power output generated by the RED device and the pumping power input, needed for salinity gradient mixing and redox electrolyte reactions. We find through this holistic approach that the electrolyte concentration in the electrode rinse solution is crucial for increasing the electrical current, while the pumping power input depends nonlinearly on the membrane separation distance. Finally, from this understanding, we designed a five cell-pair (CP) RED device that achieved a net power density of 224 mW m-2 CP-1, a 60% improvement compared to the nonoptimized case. This study highlights the importance of the electrode rinse solution fluidics and composition when rationally designing RED devices based on scalable carbon-based electrodes.

The increasing number of wolves (Canis lupus) in Central Europe has increased wolf-livestock conflicts. Several studies have analysed the impact of herding styles and the possible influencing factors. However, short analysis periods and focusing on specific influencing factors can lead to ambiguous or contradictory results. This study used long-term data from 2000 to 2019 in the federal state of Saxony (Germany) to evaluate a broad range of potential influencing factors, thereby identifying critical factors that considerably impact the likelihood of livestock attacks or the extent of livestock damage due to wolves. Generalised linear models were used for modelling. Our analyses showed that small livestock were more at risk of wolf attacks when (1) the percentage of woodland in comparison to agricultural land was low, (2) wolf territories were in proximity, and (3) the abundance of red deer was low. In addition, wolf attacks were associated with more livestock damage when (1) sika and red deer were abundant, (2) livestock were held in small herds, and the number of farms was low, (3) protective measures were missing, and (4) packs held juvenile wolves. The information on fencing style, independent of the occurrence of wolf attacks, would significantly improve future research and may help minimise conflicts between wolves, livestock, and humans.

Objectives: To investigate the effectiveness of intravenous immunoglobulin (IVIG) as treatment for COVID-19 in immunocompromised patients. Methods: This retrospective study investigated outcomes for immunocompromised, vaccine non-responsive, patients that between September 2022 and April 2023 received IVIG as treatment for COVID-19 in the region of Västerbotten, Sweden. We analyzed clinical data, viral load, and anti-SARS-CoV-2 IgG binding and neutralization levels of patient serum samples and IVIG production batches. Primary and secondary outcomes were clinical cure and viral clearance, respectively. Results: Sixteen patients were analyzed. After a median COVID-19 duration of 4 weeks, a median 60 g IVIG infusion increased SARS-CoV-2 binding and neutralizing antibody levels, with broad in vitro activity against tested variants. The treatment resulted in abrogation of viremia in all patients and general improvement in 15 survivors that all met the primary endpoint. Thirteen patients met the secondary endpoint at follow-up after a median of four months. Two subjects with persistent SARS-CoV-2 carriage relapsed but were successfully retreated with IVIG. Conclusions: Antibodies in IVIG efficiently neutralized several SARS-CoV-2 variants. Treatment with IVIG was associated with clinical cure and viral clearance in immunocompromised patients. Our data suggests that IVIG could be a novel treatment alternative for COVID-19 for this patient category.

Abstract Since the end of the nineteenth century, socio-economic changes have greatly altered the Central European landscape and the structural and functional quality of habitats. Urban sprawl areas have appeared, a reduction of multiple forest uses has resulted in the densification of forests and agricultural land use has changed fundamentally through specialisation and intensification. Many of these changes affect biodiversity. To determine the important drivers of spatio-temporal dynamics of the population of 28 game species, we first considered a total of 130 potential explanatory variables. Second, we aggregated the main drivers of single-species models for habitat guilds. Third, we evaluated the results to aid in the development and implementation of mitigation measures for different ecoregions. We used harvest data as a surrogate for population density from 1875 to 2014 in South Tyrol, Italy. In generalised linear models, we used environmental characteristics such as climate, landscape diversity and structures, land cover, hunting, wildlife diseases, competition and predation, land-use type, and intensity (including pesticide use) as explanatory variables to predict the spatio-temporal dynamics of game species. The important drivers are land use and management changes (intensification in the agriculturally favourable areas, extensification or abandonment in the unfavourable areas) as well as associated changes in the landscape features, diversity and structure, and hunting management. Climatic variables, interspecific competition and diseases only play a subordinate role. The dynamics of the habitat guilds and their drivers provide concrete indications for measures to maintain or improve the habitat quality for the investigated species. Particularly important are transfer payments to ensure extensive agricultural use, increasingly through the takeover of personnel costs, but also for the installation of an independent body that monitors and evaluates the effectiveness of the measures.

Introduction Participatory research (PF) actively involves people with lived experience (pwle), e.g. for a disease, in research. This improves the relevance, quality and impact of research and can help to raise third-party funds, increase recruitment numbers, select research methods. Pwle can support all stages of the research process, including dissemination. While PF is already standard in other countries, Germany is still lagging behind. Our participatory advisory board aims to create a sustainable structure to involve underrepresented patients. Objectives In the PART advisory board, pwle and researchers should actively cooperate in projects in the field of forensic psychiatry. In preparation to establish the advisory board procedures, key documents and training material were developed. In addition experiences, opinions, ideas and concerns of stakeholders and pwle in relation to PF were collected. Methods Guided interviews were conducted with stakeholders (clinical, research) and focus groups with in-patient pwle from forensic psychiatry. They were asked how they imagine the structure, tasks and goals of a participatory advisory board, what opportunities and obstacles they see. Anticipated framework conditions and support needs for the successful implementation were also asked. The interviews and focus groups were audio-recorded and transcribed. Data was analysed with MAXQDA using thematic analysis. Results In total, 8 expert interviews and 2 focus groups with 15 pwle were conducted in the first half of the year 2023. The analysis so far shows great interest in PF, although the term is mostly unknown and experience seems to be limited. The respondents identified opportunities for participatory research, but also challenges that need to be overcome in terms of its implementation. Both groups emphasise the importance of PF, especially in the field of mental illness, and express ideas for its implementation. Conclusions The results will be incorporated into the structure of the advisory board, so that PF in the field of forensic psychiatry will be more successful and the exchange between researchers and pwle will be facilitated. Detailed results as well as impressions from the first meeting(s) of the advisory board will be presented at the EPA conference. Disclosure of Interest None Declared

Introduction Despite promising research there is still hesitation in implementing peer support work in some hospitals. Especially in forensic hospitals reservations are held against peer support workers. Objectives We aim to give an overview of reviews about the effects of peer support work in psychiatric settings and its implementation. Special emphasis on implications for forensic psychiatric settings shall be given. Methods Five electronic databases and archives of four relevant journals were searched in December 2019 and updated in April 2022. In addition, references of articles were searched and relevant authors were contacted for unpublished data. Results of reviews were clustered by one author and checked by another. Results 22 reviews were identified of which 15 reported on effects of peer support work and six on factors influencing its implementation and one review on both. Several effects of peer support work on clinical, psychosocial, organizational and other outcomes (e.g., cost savings) were described. Psychosocial outcomes were the most promising ones whereas no effects were described in most reviews for clinical, organizational and other outcomes. Factors influencing the implementation of peer support work were described during preparation, recruitment, early employment and further development of the peer support worker’s roles. Most factors, beneficial and challenging, were described for the preparation stage of the implementation process. Conclusions The authors of the reviews often reported concerns about the low quality of the included studies. Therefore, the present results have to be considered as preliminary. Nevertheless, it is clear that peer support has a positive influence on psychosocial factors and thus complements classic therapeutic approaches. To achieve the best possible effect, the implementation of peer support needs to be carefully planned. Further studies are necessary in order to be able to consider the effect of recovery support in a more differentiated way. Disclosure of Interest None Declared

Abstract Lumbar puncture (LP) is recommended in patients with thunderclap headache and negative computed tomography to rule out spontaneous subarachnoid haemorrhage (SAH). Blood contamination of cerebrospinal fluid (CSF) due to traumatic LP poses a diagnostic dilemma. Therefore, routine CSF parameters were investigated to distinguish between SAH and a traumatic LP. CSF red blood cell (RBC), white blood cell (WBC) count, total protein, CSF colour and supernatant were used for group comparisons of patients with SAH and ‘symptomatic controls’. Due to variable time intervals between bleeding onset and LP in SAH patients in contrast to patients with traumatic LP, where blood contamination of CSF occurs at the time of LP, CSF variables were adjusted for decay in time to allow comparability. Logistic regression analysis identified bloody CSF [odds ratio (OR) 32.6], xanthochromic supernatant [OR 15.5] and WBCadjusted [OR 4.5 (per increase of 100/µl)] as predictors of SAH, while age, sex and CSF total proteinadjusted were no predictors. Optimal cut-point of RBCadjusted (determined at day 1 after bleeding) was > 3667/µl to identify SAH patients with a 97% sensitivity and 94% specificity. Combination of low RBC and clear CSF supernatant was found in none of SAH patients. Combined CSF RBC count and CSF supernatant reliably distinguished traumatic LP from SAH.

Abstract Background The use of participatory research approaches in the field of dementia and forensic mental health research has been on the rise. Advisory board structures, involving people with lived experience (PWLE), have frequently been used for guiding and leading research. Yet, there has been limited guidance on the establishment, retention and use of advisory boards in the field of dementia and forensic mental health research. Objective This project outlined in this research protocol will investigate the benefits and challenges of establishing three patient advisory boards, involving PWLE, practitioners and researchers with the purpose to guide research. Data will be used to develop guidelines for best practice in involving PWLE in dementia and forensic mental health research through advisory boards. Methods The research project will be divided into three phases: Phase I will involve two topic-specific systematic reviews on the use of participatory research with PWLE, followed by an initial study exploring PWLE’s, practitioners’ and researchers’ expectations on research involvement. Phase II will consist of the establishment of three advisory boards, one focusing on dementia, one on forensic mental health and one overarching coordinating advisory board, which will involve PWLE from both fields. Phase III, will consist of interviews and focus groups with advisory board members, exploring any challenges and benefits of involving PWLE and practitioners in advisory boards for guiding research. To capture the impact of involving PWLE in different research phases and tasks, interviews and focus groups will be conducted at four different points of time (0, 6, 12, 18 months). Reflexive thematic analysis will be used for the analysis of data. Discussion The project aims to explore the involvement of PWLE and practitioners in guiding research and aims to develop guidelines for best practice in establishing and using patient advisory boards in dementia and forensic mental health research and involving PWLE and practitioners in research.

Abstract Global warming is affecting the phenological cycles of plants and animals, altering the complex synchronization that has co‐evolved over thousands of years between interacting species and trophic levels. Here, we examined how warmer winter conditions affect the timing of budburst in six common European trees and the hatching of a generalist leaf‐feeding insect, the spongy moth Lymantria dispar, whose fitness depends on the synchrony between egg hatch and leaf emergence of the host tree. We applied four different temperature treatments to L. dispar eggs and twig cuttings, that mimicked warmer winters and reduced chilling temperatures that are necessary for insect diapause and bud dormancy release, using heated open‐top chambers (ambient or +3.5°C), and heated greenhouses (maintained at >6°C or >10°C). In addition, we conducted preference and performance tests to determine which tree species the larvae prefer and benefit from the most. Budburst success and twig survival were highest for all tree species at ambient temperature conditions, whereas it declined under elevated winter temperature for Tilia cordata and Acer pseudoplatanus, likely due to a lack of chilling. While L. dispar egg hatch coincided with budburst in most tree species within 10 days under ambient conditions, it coincided with budburst only in Quercus robur, Carpinus betulus, and, to a lesser extent, Ulmus glabra under warmer conditions. With further warming, we, therefore, expect an increasing mismatch in trees with high chilling requirements, such as Fagus sylvatica and A. pseudoplatanus, but still good synchronization with trees having low chilling requirements, such as Q. robur and C. betulus. Surprisingly, first instar larvae preferred and gained weight faster when fed with leaves of F. sylvatica, while Q. robur ranked second. Our results suggest that spongy moth outbreaks are likely to persist in oak and hornbeam forests in western and central Europe.

Abstract Background The purpose of this study was to investigate outcomes and return to sport metrics in recreational athletes who suffered simple elbow dislocations and were treated operatively or nonoperatively. Methods The study included patients between the ages of 16 and 65 who were recreational athletes and had experienced a simple elbow dislocation, with at least 2 years having passed since the injury. Patient-reported outcomes including Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), Oxford Elbow Score (OES) and Visual Analog Scale (VAS) were collected. Return to sport metrics were assessed. Results A total of 44 patients (21 females, mean age 43.8 years [95% CI, 39.1–48.5]) who were recreational athletes before their injury completed follow-up at mean 7.6 years (95% CI, 6.7–8.5). There were 29 patients (65.9%) who were treated operatively. Mean MEPS was 93.3 (95% CI, 90.2–96.4), mean SEV was 94.9 (95% CI, 91.9–97.9) and mean OES was 43.3 (95% CI, 41.3–45.4). A total of 36 (81.8%) patients returned to their pre-injury sport. Mean time to return to sport was 21.7 (95% CI, 16.8–26.5) weeks. There was a significant difference in OES (P = .019) and SEV (P = .030) that favored the nonoperative group; however, no significant differences for MEPS, VAS, satisfaction, arc of motion and return to sport were present between groups. A total of five (11.4%) complications were observed and one (2.3%) required revision. Conclusions Good outcomes and a high return to sport rate can be expected in recreational athletes following operative and nonoperative treatment of simple elbow dislocations. However, as many as one-in-five patients may not return to pre-injury sport.

Abstract Background One of the primary aims of contact restriction measures during the SARS-CoV-2 pandemic has been to protect people at increased risk of severe disease from the virus. Knowledge about the uptake of contact restriction measures in this group is critical for public health decision-making. We analysed data from the German contact survey COVIMOD to assess differences in contact patterns based on risk status, and compared this to pre-pandemic data to establish whether there was a differential response to contact reduction measures. Methods We quantified differences in contact patterns according to risk status by fitting a generalised linear model accounting for within-participant clustering to contact data from 31 COVIMOD survey waves (April 2020-December 2021), and estimated the population-averaged ratio of mean contacts of persons with high risk for a severe COVID-19 outcome due to age or underlying health conditions, to those without. We then compared the results to pre-pandemic data from the contact surveys HaBIDS and POLYMOD. Results Averaged across all analysed waves, COVIMOD participants reported a mean of 3.21 (95% confidence interval (95%CI) 3.14,3.28) daily contacts (truncated at 100), compared to 18.10 (95%CI 17.12,19.06) in POLYMOD and 28.27 (95%CI 26.49,30.15) in HaBIDS. After adjusting for confounders, COVIMOD participants aged 65 or above had 0.83 times (95%CI 0.79,0.87) the number of contacts as younger age groups. In POLYMOD, this ratio was 0.36 (95%CI 0.30,0.43). There was no clear difference in contact patterns due to increased risk from underlying health conditions in either HaBIDS or COVIMOD. We also found that persons in COVIMOD at high risk due to old age increased their non-household contacts less than those not at such risk after strict restriction measures were lifted. Conclusions Over the course of the SARS-CoV-2 pandemic, there was a general reduction in contact numbers in the German population and also a differential response to contact restriction measures based on risk status for severe COVID-19. This differential response needs to be taken into account for parametrisations of mathematical models in a pandemic setting.

IntroductionDespite the prevalence of post-traumatic disorder in internally displaced persons, which is well established, and the fact that respective international organizations are working on the issues, little attention is given in the context of sub-Saharan Africa, This study aims to review the available data about the prevalence and determinants of post-traumatic stress disorders among internally displaced people in sub-Saharan Africa.MethodsStudies published in the English language that have a clear outcome of interest and are available in full text were included. Six electronic databases were searched to identify published studies on the prevalence and determinants of posttraumatic stress disorder among IDPs in sub-Saharan Africa. This includes PubMed/MEDLINE, Scopus, EMBASE, PsychInfo, and the Web of Science. All relevant studies till June, 2023 were assessed. The review was done as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-2009) and registered on PROSPERO (CRD420222997111).ResultsOriginally, 33,138 articles were found in six databases, and finally, eleven studies were reviewed. The prevalence of post-traumatic stress disorder in sub-Saharan African countries was disproportionately presented in this review, ranging from 12.3% in Central Sudan to 85.5% in Nigeria. From a total of 11 studies, eight of them reported more than 50% of the magnitude of post-traumatic stress disorder, pointing to a higher magnitude of the prevalence of post-traumatic stress disorders in the region. The study identified numerous factors that contributed to post-traumatic stress disorder among the internally displaced population. Female gender, depression, anxiety, stress, being single, low level of educational status, experiencing or witnessing traumatic events, and psychological trauma were evidenced for their association with post-traumatic stress disorder.ConclusionThese results demonstrate a higher prevalence of post-traumatic stress disorder compared to other regions of the world. The participants’ socio-demographic characteristics, including age, being single, being female, and a low level of education, were identified as factors contributing to PTSD. Moreover, the review identified that depression, anxiety, and experiencing or witnessing traumatic events were also influencing factors for PTSD among IDPs. The concerned bodies need to reinforce the monitoring and evaluation of the mental health programs of IDPs in the region.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299711, CRD42022299711.