Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Stakeholder Strategies for Sustainability Impact Assessment of Land Use Scenarios: Analytical Framework and Identifying Land Use Claims

Despite scientific progress in operationalizing sustainable development (SD), it is still hampered by methodological challenges at the regional level. We developed a framework to analyse stakeholder based, SD targets for future land use, which are characterized by different impact levels and spatial references. The framework allows for the analysis of land use demands in the context of SD. We identified societal use targets in north-eastern Germany, particularly for the area type’s lowland fens and irrigation fields, represented through strategy documents. We used frame analysis to aggregate and condense the targets into land use claims. Results present a framework for the ex-ante Sustainability Impact Assessment of land use changes at the regional level and the determination and regionalization of the future societal demand for land use functions. For future land use at the regional level, manifold land use claims exist, but on smaller scales, area-specific targets are less apparent. Six key main-use claims and 44 side-use claims were identified at the regional level and for area types. Possible trade-offs among land use claims for land use functions can be identified at each governance level. Implications of the methodological approach are discussed according to moving development targets and SD as multi-sector and multi-level governance issues

Sustainability impact assessment of peatland-use scenarios: Confronting land use supply with demand

Sustainable development of land use is determined by changes of the regional supply of Land Use Functions (LUFs) and the demand of future societal land use claims. LUFs are based on the ecosystem services concept, but more adapted to human land use. In this paper, we assessed two peatland-use scenarios towards sustainable development in Northeast Germany in order to understand their impacts on LUFs and land use claims. For this, we extended an analytical framework designed to confront LUFs with land use claims identified in multi-level stakeholder strategies in a participatory manner. The sustainability assessment was performed with peatlanduse scenarios “Services for services” and “Market determines usage” that favoured environmental and economic land use claims, respectively. Findings revealed possible trade-offs between land use claims for biomass production and regional value creation as well as for peatlands` carbon and nutrient sink, and habitat functions. The core achievement is an extended sustainability assessment framework integrating land use demands of multi-level stakeholder strategies into participatory impact assessment, in a way that land use claims serve as benchmarks for LUFs. This facilitates the understanding of sustainable land use in both supply and demand perspective, and the normative evaluation of ecosystem services

Integrated framework for stakeholder participation: Methods and tools for identifying and addressing human–wildlife conflicts

As wild areas disappear and agricultural lands expand, understanding how people and wildlife can coexist becomes increasingly important. Human–wildlife conflicts (HWCs) are obstacles to coexistence and negatively affect both wildlife populations and the livelihood of people. To facilitate coexistence, a number of frameworks have been developed to both understand the drivers of conflict and then to find solutions that mitigate conflict. However, each framework has different foci and strengths in particular stages of analysis. Here, we propose an integrated framework that leverages the individual strengths of previously fairly isolated methodologies, allowing for holistic HWC analysis. The framework for participatory impact assessment (FoPIA) provides a toolset for developing wildlife scenarios, selecting assessment indicators and assessing the impact of different scenarios. The social-ecological framework of ecosystem services and disservices (SEEDS) analyzes the ecosystem services trade-offs related to scenarios, and the 3i stakeholder analysis approach, supports the identification of stakeholders and provides a mechanism to explore, in detail stakeholders' interests, relative influence, and how outcomes of research are likely to impact different stakeholders. We apply these approaches to eastern Germany, where the increase in several wildlife populations (i.e., wild boar, common crane, gray wolf, and European bison) has contributed to conflict with people. We demonstrate the complementarity of FoPIA, SEEDS, and 3i in identifying stakeholder needs and showing how wildlife dynamics may affect coexistence and create imbalanced ecosystem service and disservice distributions. The integrated framework introduced here provides guidelines for analyzing the multistage process of stakeholder participation and enables a comprehensive approach to the complex challenge of HWCs.Leibniz Centre for Agricultural Landscape ResearchMarianne and Dr. Fritz Walter Fischer‐FoundationPeer Reviewe

UNESCO biosphere reserves show demand for multifunctional agriculture

Sustainable landscape management of protected areas in UNESCO-biosphere reserves (BR) has become an increasingly important topic for academics and environmental practitioners, yet it remains unclear how this can be operationalized in actual regional circumstances. To achieve positive and measurable sustainability impacts, effective BR management on the ground requires supplementary methods to conceive the unique territorial, political, economic and social characteristics of each case while also considering the needs and visions of different stakeholder groups. In this study, we used the Framework for Participatory Impact Assessment (FoPIA) to assess future projections of current land management strategies and possible alternatives in five BR in Germany. The FoPIA method helped identify major differences in the regional BR contexts, including defining the sustainability problem and sustainability challenges. It also proved suitable for fostering stakeholder dialog with regard to current and future sustainable land use management, particularly for the BR transition zones. Our results predict multiple negative impacts resulting from of a continuation of current practices, which are compared against the assessed outcomes of alternative multifunctional pathways. We use these findings to discuss recommendations and challenges for sustainable management of biosphere reserves, the potential of implementing the FoPIA in BR, and perspectives for further research needs

Kenntnisse von deutschsprachigen Urologen zur Häufigkeit der Assoziation des Peniskarzinoms mit dem Humanen Papillomavirus – Survey-Ergebnisse der European PROspective Penile Cancer Study (E-PROPS)

BACKGROUND A recent meta-analysis showed that penile cancer (PeC) is associated with the human papilloma virus (HPV) in 50 % of patients in Europe. It is unknown whether urologists are aware of the impact of viral carcinogenesis. METHODS A (German-language) survey comprising 14 items was created and sent to urologists of 45 clinical centres in Germany (n = 34), Austria (n = 8), Switzerland (n = 2) and Italy/South Tyrol (n = 1) once in Q3/2018. According to a predefined quality standard, a total of 557 surveys were eligible for final data analysis (response rate: 85.7 %). Among other questions, urologists were asked to state the frequency of HPV-associated PeC in Europe. 4 potential answers were provided: (A)-" 50 - 75 %", (D)-"level of association unknown". For the final calculation, a tolerance of ± 50 % was considered acceptable, so B and C were deemed correct answers. Based on a bootstrap-adjusted multivariate logistic regression model, criteria independently predicting a correct answer were identified. RESULTS Categories A-D were selected in 19.2 % (n = 107), 48.8 % (n = 272), 12.9 % (n = 72) and 19 % (n = 106), respectively, representing a rate of 61.8 % of urologists (n = 344) reaching the endpoint (B + C). Autonomous performance of chemotherapy for PeC by urologists within the given centre (OR 1.55, p[Bootstrap] = 0.036) and the centre's number of urological beds (OR 1.02, p[Bootstrap] = 0.025) were the only parameters showing a significant independent impact on the endpoint. In contrast, the status of a university centre (p = 0.143), a leading position of the responding urologist (p = 0.375) and the number of PeC patients treated per year and centre (p = 0.571) did not significantly predict a correct answer. CONCLUSIONS Our results demonstrate insufficient knowledge on the association of PeC and HPV among German-speaking urologists

Kenntnisse von deutschsprachigen Urologen zur Häufigkeit der Assoziation des Peniskarzinoms mit dem Humanen Papillomavirus – Survey-Ergebnisse der European PROspective Penile Cancer Study (E-PROPS)

Background A recent meta-analysis showed that penile cancer (PeC) is associated with the human papilloma virus (HPV) in 50 % of patients in Europe. It is unknown whether urologists are aware of the impact of viral carcinogenesis. Methods A (German-language) survey comprising 14 items was created and sent to urologists of 45 clinical centres in Germany (n = 34), Austria (n = 8), Switzerland (n = 2) and Italy/South Tyrol (n = 1) once in Q3/2018. According to a predefined quality standard, a total of 557 surveys were eligible for final data analysis (response rate: 85.7 %). Among other questions, urologists were asked to state the frequency of HPV-associated PeC in Europe. 4 potential answers were provided: (A)-" 50 - 75 %", (D)-"level of association unknown". For the final calculation, a tolerance of +/- 50 % was considered acceptable, so B and C were deemed correct answers. Based on a bootstrap-adjusted multivariate logistic regression model, criteria independently predicting a correct answer were identified. Results Categories A-D were selected in 19.2 % (n = 107), 48.8 % (n = 272), 12.9 % (n = 72) and 19 % (n = 106), respectively, representing a rate of 61.8 % of urologists (n = 344) reaching the endpoint (B + C). Autonomous performance of chemotherapy for PeC by urologists within the given centre (OR 1.55, p[Bootstrap] = 0.036) and the centre's number of urological beds (OR 1.02, p[Bootstrap] = 0.025) were the only parameters showing a significant independent impact on the endpoint. In contrast, the status of a university centre (p = 0.143), a leading position of the responding urologist (p = 0.375) and the number of PeC patients treated per year and centre (p = 0.571) did not significantly predict a correct answer. Conclusions Our results demonstrate insufficient knowledge on the association of PeC and HPV among German-speaking urologists