Folge den Vögeln: Bewegungsmuster und Nahrungszusammensetzung von Küstenvögeln als Indikatoren für charakteristische Lebensräume im Wattenmeer

The Wadden Sea is a complex mosaic of different habitats, formed by the tidal rhythm. To protect this unique ecosystem, the Wadden Sea has to be monitored and the ecological status assessed. However, due to the high dynamics, the monitoring is difficult. Suitable indicators have to be developed. This thesis contributes to an ecological assessment of the habitats “intertidal flats” and “shallow waters”, based on the foraging behaviour of coastal birds. While herring gulls (Larus argentatus) were chosen for intertidal flats, pied avocets (Recurvirostra avosetta) and Eurasian spoonbills (Platalea leucorodia) were used as potential bio-indicators for shallow waters. GPS data and diet analyses were combined to investigate the foraging ecology on an individual and colony level, respectively. Both approaches were merged into a holistic assessment of the foraging habitat. This thesis enhances our knowledge on habitat selection and diet composition of characteristic top predators and demonstrates the suitability of herring gulls, Pied avocets, and Eurasian spoonbills as indicator species for intertidal flats and shallow waters. The combination of tracking and diet data provides new findings about the foraging behaviour and reflect the distribution and ecological status of the associated habitat. Movement data of characteristic shorebirds can improve the monitoring of the Wadden Sea and helps to detect changes in this highly dynamic ecosystem. This strengthens the foundation of scientific conservation management and spatial planning.Das Wattenmeer ist ein komplexes Mosaik verschiedener Habitate, das durch den Gezeitenrhythmus gebildet wird. Um dieses einzigartige Ökosystem zu schützen, muss das Wattenmeer überwacht und der ökologische Zustand bewertet werden. Aufgrund der hohen Dynamik ist ein Monitoring jedoch schwierig. Daher müssen geeignete Indikatoren entwickelt werden. Als mögliche Bio-Indikatoren wurden für die Wattflächen Silbermöwen (Larus argentatus) und für die Flachwasser Säbelschnäbler (Recurvirostra avosetta) und Löffler (Platalea leucorodia) ausgewählt. GPS-Daten und Nahrungsanalysen wurden kombiniert, um die Nahrungsökologie auf individueller bzw. Kolonieebene zu untersuchen. Beide Ansätze wurden zu einer ganzheitlichen Bewertung des Nahrungshabitats zusammengeführt. Diese Arbeit erweitert das Wissen über die Habitat- und Nahrungswahl charakteristischer Top-Prädatoren und zeigt die Eignung von Silbermöwen, Säbelschnäblern und Löfflern als Indikatorarten für Wattflächen und Flachwassergebiete. Die Kombination von GPS- und Nahrungsdaten ermöglicht neue Erkenntnisse zum Nahrungsverhalten und spiegelt die Verteilung und den ökologischen Zustand des zugehörigen Lebensraums wider. Bewegungsdaten charakteristischer Watvögel können die Überwachung des Wattenmeeres verbessern und helfen Veränderungen in diesem hochdynamischen Ökosystem zu erkennen. Dies stärkt die Grundlage für ein wissenschaftliches Naturschutzmanagement und marine Raumplanung

Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014-2019.

Background: Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. Methods: Use of antibiotics from 2014–2019 was analyzed using dispensing data from community pharmacies claimed to the statutory health insurance (SHI) funds. Quality of regional antibiotic use in 2019 was assessed by calculating indicators based on defined daily doses per 1000 SHI-insured persons per day (DID). Oral cephalosporin and fluoroquinolone use was followed by linear regression analyses. Results: The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. In 2019, DID varied from 1.62 in Brandenburg to 3.17 in Rhineland-Palatinate for cephalosporins and from 0.47 in Brandenburg to 0.89 in Saarland for fluoroquinolones. The city-states Hamburg, Bremen, and Berlin showed highest quality with the applied indicator set. From 2014–2019, a significant decrease in utilization of oral cephalosporins was found in all federal states. During 2017–2019, all states showed a significant decline of fluoroquinolone us

The impact of birds on the Wadden Sea food web

The Wadden Sea at the western coasts of Germany, Denmark and the Netherlands is one of the globally most important foraging areas for breeding and migrating birds which act at the same time as indicators for the ecological condition of the ecosystem. However, little is known about how the intense predation pressure of birds influences the Wadden Sea food web. The aim of the interdisciplinary project STopP (From Sediment to Top Predator) is to determine the food web structure in different Wadden Sea habitat types in terms of the interaction between the basis of the food web and birds as top predators. Studied habitat types included the most important foraging areas of birds; mussel banks, cockle beds, sand flats, mud flats, seagrass meadows and beds of the immigrant razor clam Ensis directus a recently preferred prey item of several bird species. Data were analysed using the Ecological Network Analysis (ENA) that reflects trophic structures within the systems and reveals direct and indirect relations between the lower and the upper trophic levels. Preliminary results show that bird predation increases the complexity of the food web due to an increase in connections and a higher total system throughput. On the other hand the predation has also a destabilizing effect due to a high demand of system’s carbon stocks and increased exports out of the tidal system. In addition, analyses show considerable indirect dependencies of birds to lower trophic levels such as sediment POC and phytoplankton. Future scenarios modelled with ENA shall show how changes within the lower trophic levels would affect foraging birds due to anthropogenic or natural impacts. Further analysis will focus on the importance of special habitat types for different bird species and the influence of changes in the biomass of key species for the whole ecosystem food web

Use of fixed-dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia

Background The 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines for the management of hypertension highlight the importance of fxed-dose combinations (FDC) for the treatment of hypertension and recommend initial single-pill combination therapy in almost all patients. However, data on the implementation of these recommendations in clinical practice are scarce. Methods Data from the German Institute for Drug Use Evaluation (DAPI) were analyzed and extrapolated accounting for approximately 88% of Germany’s population (approximately 73.3 million subjects). All antihypertensive (AHT) FDC products available on the German market were included in the analyses. We examined the time course of dispensed packages between January 2016 and December 2020. Results FDCs accounted for 15.4% of all AHT in 2016 and for 10.9% in 2020. While dispensing of all AHT increased slightly from year to year (2016: 143.8 million, 2020: 153.2 million packs), dispensing of FDCs decreased from 22.2 million (2016) to 16.6 million (2020) packs. Dispensing of FDCs containing hydrochlorothiazide (HCT) declined considerably from 2016 to 2020 (Q1 2016: 4.65 million, Q4 2020: 3.13 million packs). Accordingly, the proportion of HCT-containing combinations in all FDCs decreased from 85.3 to 74.2% from Q1 2016 to Q4 2020. Patients younger than 80 years were prescribed FDCs more frequently (14.6% of all AHT, based on the entire evaluation period) than patients 80 years and older (10.0%). In both age groups, this proportion decreased continuously over time. Conclusions Almost 2 years following the release of the 2018 ESC/ESH guidelines, only 10.9% of the prescribed packs of antihypertensive drugs in 2020 were FDC products, documenting underutilization of current guideline recommendations on pharmacotherapy in hypertension. Structured programs to evidence-based decision support are required to improve guideline inertia and patient outcomes, eventually

Impact of angiotensin receptor blocker product recalls on antihypertensive prescribing in Germany.

In Germany, ~8 million patients take angiotensin receptor blockers (ARBs) and 2.25 million of them valsartan. In 2018, contamination of generic ARBs with probable carcinogenic nitrosamines resulted in more than 30 recalls. The impact of such a huge recall has never been explored in Europe. We analyzed the utilization of valsartan, all ARBs, and other alternative antihypertensive drugs in Germany. We used our database of anonymized dispensing data from >80% of community pharmacies at the expense of the statutory health insurance (SHI) funds from January 2017 to December 2019. We analyzed 290.8 million prescriptions, including all oral mono- and fixed-dose combinations of ARBs and plausible alternatives, i.e. ACE inhibitors (ACEi), beta-blockers (BB), and calcium channel blockers (CCB). Utilization was calculated by defined daily doses per 1000 SHI-insured persons per day (DID). Valsartan use decreased substantially after the recalls in July 2018 from 39.0 to 14.2 DID (-64%) in the second quarter of 2019 and to 16.9 DID (-57%) in the fourth quarter of 2019. Simultaneously, the use of alternative ARBs increased from 77.7 DID in the second quarter of 2018 to 121.9 DID (+57%) in the fourth quarter of 2019, mainly due to an increase of candesartan dispensing to 99.8 DID (+73%). There were no changes in the utilization of ACEi, BB, or CCB. The majority of recalled generic valsartan products were replaced by other ARBs, predominantly candesartan, despite documented drug shortages. In contrast to previous safety warnings/recalls, our data do not suggest an under-prescription of antihypertensives during this period

Learnings from Regional Market Dynamics of Originator and Biosimilar Infliximab and Etanercept in Germany.

Drug budget and prescription control measures are implemented regionally in Germany, meaning that the uptake of pharmaceuticals, including biosimilars, can vary by region. We examine regional market dynamics of tumor necrosis factor alpha (TNFα) inhibitor originators and biosimilars in Germany and studied the influence of biosimilar policies on these dynamics. This study is based on: (1) a literature review in which German biosimilar policies are identified, (2) the analysis of dispensing data (2010-2018) for the class of TNFα inhibitors, and (3) ten semi-structured interviews investigating prescribers' and insurers' views on factors potentially influencing biosimilar uptake. The analysis of biosimilar market shares of infliximab and etanercept revealed wide variations across the 17 German Regional Associations of Statutory Health Insurance Accredited Physicians (PA regions). Quantitative analyses indicated that biosimilar market shares for infliximab and etanercept were significantly lower in former East Germany when compared to former West Germany regions. Through qualitative interview analyses, this study showed that the use of infliximab and etanercept biosimilars across Germany is primarily influenced by (1) the regional-level implementation of biosimilar quotas and the presence of monitoring/sanctioning mechanisms to ensure adherence to these quotas, (2) the different insurer-manufacturer discount contracts, and (3) gainsharing arrangements established at the insurer-prescriber level

Do birds influence the structure and functioning of coastal food webs?

The Wadden Sea is one of the most important stop-over sites for 10 to 12 Million migrating birds per year. But little is known about the influence of birds on the entire ecosystem. We conducted Ecological Network Analysis (ENA) in an important resting site in the Wadden Sea to determine the influence of birds on the food web. A large variety of different bird species uses the area for foraging and is included directly or indirectly in most of the pathways. Birds induce a negative impact on their prey items with a positive feedback reaction to the preys’ competitors and food sources. There is also a strong negative impact among the bird compartments probably due to competition between the birds. Changes in the biomass of the birds revealed alterations in the food web structure. With a decline in the avian biomass the system showed a decrease in connectivity and diversity of flows but an increase in recycling. Changes in the bird population could affect the complexity and functioning of the entire ecosystem. Thus, the use of such holistic approaches would facilitate undertaking management measures

Learnings from Regional Market Dynamics of Originator and Biosimilar Infliximab and Etanercept in Germany

Drug budget and prescription control measures are implemented regionally in Germany, meaning that the uptake of pharmaceuticals, including biosimilars, can vary by region. We examine regional market dynamics of tumor necrosis factor alpha (TNFα) inhibitor originators and biosimilars in Germany and studied the influence of biosimilar policies on these dynamics. This study is based on: (1) a literature review in which German biosimilar policies are identified, (2) the analysis of dispensing data (2010–2018) for the class of TNFα inhibitors, and (3) ten semi-structured interviews investigating prescribers’ and insurers’ views on factors potentially influencing biosimilar uptake. The analysis of biosimilar market shares of infliximab and etanercept revealed wide variation

Co‐developing guidance for conservation: An example for seabirds in the North‐East Atlantic in the face of climate change impacts

Conservation guidance—an authoritative source of information and recommendations explicitly supporting decision-making and action regarding nature conservation—represents an important tool to communicate evidence-based advice to conservation actors. Given the rapidly increasing pressure that climate change poses to biodiversity, producing accessible, well-informed guidance on how to best manage the impacts and risks of changing climatic conditions is particularly urgent. Guidance documents should ideally be produced with multistage input from stakeholders who are likely to use and implement such advice; however, this step can be complicated and costly, and remains largely unformalized. Moreover, there is currently little direct evidence synthesized for actions that specifically target climate change and guidance remains largely absent. Here, we introduce a process for co-developing guidance for species conservation in the face of climate change, using seabirds in the North-East Atlantic as a case study. Specifically, we collated evidence on climate change vulnerability and possible conservation actions using literature synthesis, stakeholder surveys, and ecological modeling. This evidence base was then discussed, refined, and expanded using structured stakeholder workshops. We summarize the knowledge gained through stakeholder engagement and provide recommendations for future international efforts to co-produce conservation guidance for managing wildlife, in the context of a rapidly changing climate.info:eu-repo/semantics/publishedVersio