The WERA cancer center matrix: strategic management of patient access to precision oncology in a large and mostly rural area of Germany

Purpose Providing Patient Access to Precision Oncology (PO) is a major challenge of clinical oncologists. Here, we provide an easily transferable model from strategic management science to assess the outreach of a cancer center. Methods As members of the German WERA alliance, the cancer centers in Würzburg, Erlangen, Regensburg and Augsburg merged care data regarding their geographical impact. Specifically, we examined the provenance of patients from WERA´s molecular tumor boards (MTBs) between 2020 and 2022 (n = 2,243). As second dimension, we added the provenance of patients receiving general cancer care by WERA. Clustering our catchment area along these two dimensions set up a four-quadrant matrix consisting of postal code areas with referrals towards WERA. These areas were re-identified on a map of the Federal State of Bavaria. Results The WERA Matrix overlooked an active screening area of 821 postal code areas – representing about 50% of Bavaria´s spatial expansion and more than six million inhabitants. The WERA Matrix identified regions successfully connected to our outreach structures in terms of subsidiarity – with general cancer care mainly performed locally but PO performed in collaboration with WERA. We also detected postal code areas with a potential PO backlog – characterized by high levels of cancer care performed by WERA and low levels or no MTB representation. Conclusions The WERA Matrix provided a transparent portfolio of postal code areas, which helped assessing the geographical impact of our PO program. We believe that its intuitive principle can easily be transferred to other cancer centers

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Effect of plant-plant interactions on niche differentiation and (co)evolution in agricultural systems

Intercropping has been suggested as a sustainable alternative to monocropping practice to enhance crop productivity with less fertiliser, pesticide and water inputs. This positive effect of crop diversity on productivity is mainly due to resource partitioning where intercropped species use available resources differently, and thus occupy distinct realised niches in the niche space of this resource. Due to plasticity, species can also shift resource uptake, and thus the realised niches, in response to interactions with other species. Such plant-plant interactions are important for community structure, and persistent interactions can also have evolutionary consequences. In intercropping studies, such persistent interactions and consequent adaptation resulted in enhanced productivity in mixtures. The underlying mechanisms are the differentiation in niches and the reduction of competition among the coexisting plants. In this thesis, I gained an understanding that plant-plant interactions can influence both ecological and evolutionary processes of plant communities. Such ecological and evolutionary changes are only possible when plants are highly plastic to respond to co-occurring plants. This plasticity enabled plants to shift niches when grown in more diverse communities, which in turn was associated with overyielding in mixtures and thus contributed positively to ecosystem functioning. Furthermore, this high plasticity allowed plants to (co)adapt with coexisting plants, where persistent interactions not only reduced competition especially in mixtures but also enhanced the productivity of the plant community. This thesis demonstrates that plant-plant interactions, which are often overlooked in cropping systems, can influence resource use of crop species but also illustrates that persistent interactions among plants and its evolutionary outcomes can affect ecosystem functioning. Furthermore, this thesis underpins the potential that diversification of current cropping systems could provide a more sustainable crop production. The findings presented here could potentially also be interesting for future breeding programs to enhance productivity in intercropping systems

Crops grown in mixtures show niche partitioning in spatial water uptake

More diverse plant communities are generally more productive than monocultures. This benefit of species diversity is supposed to stem from resource partitioning of species in mixtures where different species use the resources spatially, temporally, or chemically in distinct ways. With respect to water, the simultaneous cultivation of crops with distinct water uptake patterns might reduce niche overlaps and thus result in higher productivity. However, little is known about whether and how spatial water uptake patterns of crop species differ among different planting arrangements and whether these changes result in increased niche partitioning and explain overyielding in mixtures. Stable isotopes of water and a Bayesian model were used to investigate the spatial water uptake patterns of six different crop species and how these patterns change depending on the planting arrangement (monocultures vs mixtures). Niche overlaps and niche widths in spatial water uptake were compared among the different crop diversity levels and linked to productivity. Furthermore, spatial water uptake was related to competition intensity and overyielding in mixtures. We found evidence for increased niche partitioning in spatial water uptake, and therefore complementary spatial root distributions of crop species, and higher expected productivity in mixtures compared to expected productivity in monocultures both due to inherent species-level differences in water uptake and plasticity in the water uptake pattern of species. We also found a significant relationship of competition and overyielding with observed patterns in spatial water uptake. These results suggest that competition was most intense in shallow soil layers and enhanced overyielding was related to a gradual increase of water uptake in deeper soil layers. Thus, overyielding might be related to a more complete spatial exploitation of available water sources. Synthesis. Differences in spatial water uptake and niche partitioning of intercropped species, driven most likely by a complementary spatial root distribution, might explain why mixtures outperform monocultures. These findings underpin the potential of intercropping systems for a more sustainable agriculture with a more efficient use of soil resources and hence reduced input demands.ISSN:0022-047

Transgenerational coexistence history attenuates negative direct interactions and strengthens facilitation

Interactions among species are a fundamental aspect of biodiversity and drive ecosystem functioning and services. Species interactions include direct (pairwise) interactions among two species and indirect interactions that occur when a third species interacts and changes the pairwise direct interaction. In a three-species interaction network, these interactions can be transitive (where one species outperforms all others) or intransitive (where each species outperforms another). Here, we investigate how direct and indirect interactions influence ecosystem functions in crop systems and how diversification and evolutionary adaptation can influence those interactions and therefore ecosystem functions.A common garden experiment was conducted with crop communities in monocultures, 2- and 3-species mixtures that had either a common or no coexistence history (i.e. co-adaptation) for the three previous years. Net, direct and indirect interaction intensities were estimated and compared between the diversity levels and coexistence histories. Furthermore, species interaction networks were inspected for transitive/intransitive interactions.We found evidence for less intense competition in mixtures and for reduced negative direct interaction intensity and enhanced facilitative effects upon co-adaptation. We could further show that indirect interactions were generally less important for co-adaptation than direct interactions. Additionally, we showed that co-adaptation has the potential to shift interactions in the species interaction networks from competitive intransitive into pairwise competitive interactions where interactions occurred mainly between two species.Synthesis. Co-adapted crop species with reduced negative interactions might have the potential to enhance productivity, especially in more diverse cropping systems. This supports the notion that intercropping is a vital part towards a more sustainable agriculture and one with further yield potential when developing cultivars optimised for growth in mixtures.ISSN:0022-047

Crop Diversity Experiment: towards a mechanistic understanding of the benefits of species diversity in annual crop systems

Inspired by grassland biodiversity experiments studying the impact of plant diversity on primary productivity, the Crop Diversity Experiment setup in 2018 aimed at testing whether these biodiversity benefits also hold for annual crop systems and whether crop mixtures also achieved transgressive overyielding, i.e. yield in mixture that was higher than the most productive monoculture. The first 3 years of the experiment demonstrated that crop mixtures do not only increase yield compared with an average monoculture but often also compared with the highest yielding monoculture. The crop diversity effects were stronger under more stressful environmental conditions and were often achieved in mixtures with legume crops. However, we observed transgressive overyielding also under favorable conditions and in mixtures without legumes. With our investigation of the underlying mechanisms of the yield benefits we found both direct complementarities between crop species and indirect effects via other organisms. The former included chemical, spatial and temporal complementarity in N uptake, complementary root distribution leading to complementary water uptake, as well as spatial and temporal complementarity in light use. Among the indirect mechanisms we identified complementary suppression of weeds and more abundant plant growth-promoting microbes in crop mixtures, apart from complementarity in pest and disease suppression not yet studied in the Crop Diversity Experiment but demonstrated elsewhere. In consequence, the Crop Diversity Experiment supports not only the assumption that the ecological processes identified in biodiversity experiments also hold in crop systems, but that diversification of arable crop systems provides a valuable tool to sustainably produce food.作物多样性实验：理解一年生作物系统物种多样性效应的机理 受到草地生物多样性实验研究植物多样性对初级生产力影响的启发，2018年建立的“作物多样性实验”旨在测试自然生态系统生物多样性的效应是否也适用于一年生作物系统，以及作物混合种植(简称作物混作)是否也能实现超产，即作物混作的产量超过作物单作的最高产量。实验的前3年结果表明，作物混作不仅增加了产量，而且通常也比最高产的作物单作产量高。作物多样性效应在环境胁迫下更显著，且通常是在与豆科作物混作时实现超产。然而，我们也观察到在有利条件下和没有豆科植物的混作中，也有超产现象。对产量效应的潜在机制研究发现，作物物种之间存在直接的互补关系和通过其他生物的间接效应。前者包括氮吸收中的化学、空间和时间互补性，水分吸收的根分布互补性，以及光利用的空间和时间互补性。在间接机制中，除了“作物多样性实验”中未研究但在其他研究得到证明的对害虫和疾病的互补抑制之外，我们还证明作物混作中对杂草的互补抑制和植物生长促进微生物的丰度更高。因此，“作物多样性实验”不仅支持了生物多样性实验所证明的生态过程，也支持了作物系统中的生物多样性的生态系统功能假设，而且作物物种多样化的作物系统为可持续生产食物提供了有价值工具。ISSN:1752-9921ISSN:1752-993

Genetic diversity, genetic structure and diet of ancient and contemporary red deer (Cervus elaphus L.) from north-eastern France

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