Innovative Ansätze der Daseinsvorsorge in ländlichen Räumen - Lernen von Erfahrungen anderer europäischer Länder für Deutschland (InDaLE)

Das Forschungsprojekt InDaLE (Innovative Ansätze der Daseinsvorsorge in ländlichen Räumen – Lernen von Erfahrungen anderer europäischer Länder für Deutschland) untersuchte innovative Ansätze der Daseinsvorsorge in Österreich, Schweden, Schottland sowie Deutschland und prüfte deren Übertragbarkeit bzw. Anwendbarkeit auf ländliche Räume in Deutschland. Die Broschüre enthält kompakte Projektinformationen, die wichtigsten Untersuchungsergebnisse und unsere darauf basierenden Handlungsempfehlungen

Systems thinking : an approach for understanding 'eco-agri-food systems'

The TEEBAgriFood ‘Scientific and Economic Foundations’ report addresses the core theoretical issues and controversies underpinning the evaluation of the nexus between the agri-food sector, biodiversity and ecosystem services and externalities including human health impacts from agriculture on a global scale. It argues the need for a ‘systems thinking‘ approach, draws out issues related to health, nutrition, equity and livelihoods, presents a Framework for evaluation and describes how it can be applied, and identifies theories and pathways for transformational change

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A Proposed Framework for Rural Resilience – How can peripheral village communities in Europe shape change?

Las comunidades rurales y los pueblos de Europa se encuentran hoy en día frente a grandes desafíos impuestos por las transformaciones sociales, ecológicas y económicas del antropoceno. Sin embargo, algunos pueblos son capaces de adaptarse con éxito a los procesos de cambio y desarrollarse de forma positiva, a pesar de estar situados en regiones donde el cambio demográfico o las transformaciones estructurales del sector agrícola auguran un futuro incierto para la población rural. En búsqueda de enfoques explicativos plausibles, tanto en el ámbito técnico de la praxis como el académico se recurre al ambiguo concepto de la resiliencia. ¿Puede el concepto de la resiliencia rural explicar esta asombrosa capacidad adaptativa? ¿Qué atributos posee una comunidad rural o un pueblo resiliente? Este artículo presenta una conceptualización de la resiliencia rural y de los pueblos inspirada en tres disciplinas científicas veteranas en esta área de estudio: la psicología, la ecología social y el desarrollo comunitario. El marco conceptual desarrollado será puesto a prueba por medio de una metodología mixta (mixed methods) combinando cuestionarios, entrevistas y observación participativa en tres pueblos potencialmente resilientes de las siguientes zonas rurales periféricas europea: Rural communities and villages across Europe currently face great challenges imposed by the social, economic and ecological transformations of the Anthropocene. Despite this, some of them successfully adapt to processes of change and develop positively, even though they are situated in regions where demographic change or the structural transformations in the agricultural sector promise an uncertain future for rural population. In search of plausible explanatory approaches, practitioners and academics fall back on the fuzzy concept of resilience. Can the concept of rural resilience explain this surprising adaptive capacity? What attributes does a resilient rural community or village possess? This article presents a conceptualisation of rural and village resilience inspired by three long-standing disciplines in this area of research: psychology, social ecology and community development. The conceptual framework developed will then be tested by means of a mixed-methods approach, combining questionnaires, interviews and participative observation in three potentially resilient villages in the following European peripheral rural areas: Oberndorf (Oste) in the Federal Republic of Germany, Wooler in the United Kingdom and Albarracín in Spain

Innovative Ansätze der Daseinsvorsorge in ländlichen Räumen - Lernen von Erfahrungen anderer europäischer Länder für Deutschland (InDaLE): Projektabschlussbericht: Learning from the experiences of other European countries for Germany (InDaLE)

Das Forschungsprojekt InDaLE (Innovative Ansätze der Daseinsvorsorge in ländlichen Räumen – Lernen von Erfahrungen anderer europäischer Länder für Deutschland) untersuchte innovative Ansätze der Daseinsvorsorge in Österreich, Schweden, Schottland sowie Deutschland und prüfte deren Übertragbarkeit bzw. Anwendbarkeit auf ländliche Räume in Deutschland. Die Analyse von Erfahrungen im europäischen Ausland zur Anpassung von Infrastrukturen wird für die Entwicklung innovativer Ansätze in Deutschland genutzt und kann neue Lösungen bieten.:ABBILDUNGSVERZEICHNIS VII TABELLENVERZEICHNIS VIII VORWORT 9 1 EINLEITUNG 12 1.1 Problemdarstellung und Motivation 12 1.2 Innovationen in der ländlichen Daseinsvorsorge: Forschungsstand 12 1.3 Projektverständnis 14 2 VERSTETIGUNG, ÜBERTRAGBARKEIT UND GOVERNANCE: KONZEPTIONELLE VORÜBERLEGUNGEN 15 2.1 Verstetigung 15 2.2 Übertragbarkeit 23 2.3 Governance von Daseinsvorsorge 28 3 METHODISCHES VORGEHEN: PROJEKTAUSWAHL, DATENERHEBUNGEN UND -ANALYSE 31 3.1 Vorauswahl und Checkliste 31 3.2 Finale Projektauswahl 31 3.3 Datenerhebung zu den Projekten 34 3.4 Datenauswertung der leitfadengestützten Interviews 36 4 RAHMENBEDINGUNGEN IN DEN UNTERSUCHUNGSLÄNDERN 38 4.1 Deutschland 38 4.2 Österreich 41 4.3 Schottland 45 4.4 Schweden 48 5 GOVERNANCE UND HERAUSFORDERUNGEN DER DASEINSVORSORGEBEREICHE IN LÄNDLICHEN RÄUMEN 53 5.1 Nachschulische Bildung 53 5.2 Medizinische Versorgung und Pflege 56 5.3 Nichtpolizeiliche Gefahrenabwehr 60 6 PROJEKTSTECKBRIEFE 67 6.1 Nachschulische Bildung 67 6.2 Medizinische Versorgung und Pflege 74 6.3 Nichtpolizeiliche Gefahrenabwehr 82 7 VERSTETIGUNG INNOVATIVER PROJEKTE: FÖRDERLICHE UND HEMMENDE FAKTOREN 89 7.1 Nachschulische Bildung 89 7.2 Medizinische Versorgung und Pflege 101 7.3 Nichtpolizeiliche Gefahrenabwehr 114 8 VERSTETIGUNG NACH WIRKUNGSBEREICHEN: ÜBERGREIFENDE ERKENNTNISSE AUS DEN BEISPIELPROJEKTEN 123 8.1 Inhaltlicher Wirkungsbereich 123 8.2 Organisationsstruktureller Wirkungsbereich 125 8.3 Politisch-administrativer Wirkungsbereich 126 8.4 Finanzieller Wirkungsbereich 127 9 INNOVATIVE LÖSUNGEN UND ANSÄTZE DER DASEINSVORSORGE IN LÄNDLICHEN RÄUMEN 129 9.1 Thesen zum inhaltlichen Wirkungsbereich 129 9.2 Thesen zum organisationsstrukturellen Wirkungsbereich 132 9.3 Thesen zum politisch-administrativen Wirkungsbereich 135 9.4 Thesen zum finanziellen Wirkungsbereich 139 10 HANDLUNGSEMPFEHLUNGEN 142 10.1 Empfehlungen für die untersuchten Daseinsvorsorgebereiche 142 10.2 Checkliste für Projektträger zur Verstetigung 147 11 ZUSAMMENFASSUNG ZENTRALER ERGEBNISSE 149 11.1 Zentrale Erkenntnisse aus den drei untersuchten Daseinsvorsorgebereichen 149 11.2 Schlussfolgerungen für die Forschung 154 12 LITERATURVERZEICHNIS 157 ANHANG I: PROJEKTBETEILIGTE UND PROJEKTVERANSTALTUNGEN 171 ANHANG II: INDALE-GLOSSAR 173 ANHANG III: INTERVIEWLEITFÄDEN 175The research project InDaLE (Innovative approaches to services of general interest in rural areas - learning from the experiences of other European countries for Germany) analysed innovative approaches to services of general interest in Austria, Sweden, Scotland and Germany and examined their transferability and applicability to rural areas in Germany. The analysis of experiences in other European countries regarding the adaptation of infrastructures is used for the development of innovative approaches in Germany and can offer new solutions.:ABBILDUNGSVERZEICHNIS VII TABELLENVERZEICHNIS VIII VORWORT 9 1 EINLEITUNG 12 1.1 Problemdarstellung und Motivation 12 1.2 Innovationen in der ländlichen Daseinsvorsorge: Forschungsstand 12 1.3 Projektverständnis 14 2 VERSTETIGUNG, ÜBERTRAGBARKEIT UND GOVERNANCE: KONZEPTIONELLE VORÜBERLEGUNGEN 15 2.1 Verstetigung 15 2.2 Übertragbarkeit 23 2.3 Governance von Daseinsvorsorge 28 3 METHODISCHES VORGEHEN: PROJEKTAUSWAHL, DATENERHEBUNGEN UND -ANALYSE 31 3.1 Vorauswahl und Checkliste 31 3.2 Finale Projektauswahl 31 3.3 Datenerhebung zu den Projekten 34 3.4 Datenauswertung der leitfadengestützten Interviews 36 4 RAHMENBEDINGUNGEN IN DEN UNTERSUCHUNGSLÄNDERN 38 4.1 Deutschland 38 4.2 Österreich 41 4.3 Schottland 45 4.4 Schweden 48 5 GOVERNANCE UND HERAUSFORDERUNGEN DER DASEINSVORSORGEBEREICHE IN LÄNDLICHEN RÄUMEN 53 5.1 Nachschulische Bildung 53 5.2 Medizinische Versorgung und Pflege 56 5.3 Nichtpolizeiliche Gefahrenabwehr 60 6 PROJEKTSTECKBRIEFE 67 6.1 Nachschulische Bildung 67 6.2 Medizinische Versorgung und Pflege 74 6.3 Nichtpolizeiliche Gefahrenabwehr 82 7 VERSTETIGUNG INNOVATIVER PROJEKTE: FÖRDERLICHE UND HEMMENDE FAKTOREN 89 7.1 Nachschulische Bildung 89 7.2 Medizinische Versorgung und Pflege 101 7.3 Nichtpolizeiliche Gefahrenabwehr 114 8 VERSTETIGUNG NACH WIRKUNGSBEREICHEN: ÜBERGREIFENDE ERKENNTNISSE AUS DEN BEISPIELPROJEKTEN 123 8.1 Inhaltlicher Wirkungsbereich 123 8.2 Organisationsstruktureller Wirkungsbereich 125 8.3 Politisch-administrativer Wirkungsbereich 126 8.4 Finanzieller Wirkungsbereich 127 9 INNOVATIVE LÖSUNGEN UND ANSÄTZE DER DASEINSVORSORGE IN LÄNDLICHEN RÄUMEN 129 9.1 Thesen zum inhaltlichen Wirkungsbereich 129 9.2 Thesen zum organisationsstrukturellen Wirkungsbereich 132 9.3 Thesen zum politisch-administrativen Wirkungsbereich 135 9.4 Thesen zum finanziellen Wirkungsbereich 139 10 HANDLUNGSEMPFEHLUNGEN 142 10.1 Empfehlungen für die untersuchten Daseinsvorsorgebereiche 142 10.2 Checkliste für Projektträger zur Verstetigung 147 11 ZUSAMMENFASSUNG ZENTRALER ERGEBNISSE 149 11.1 Zentrale Erkenntnisse aus den drei untersuchten Daseinsvorsorgebereichen 149 11.2 Schlussfolgerungen für die Forschung 154 12 LITERATURVERZEICHNIS 157 ANHANG I: PROJEKTBETEILIGTE UND PROJEKTVERANSTALTUNGEN 171 ANHANG II: INDALE-GLOSSAR 173 ANHANG III: INTERVIEWLEITFÄDEN 17

Systems thinking: an approach for understanding ‘eco-agri-food systems’

Chapter 2 makes the case for using systems thinking as a guiding perspective for TEEBAgriFood’s development of a comprehensive Evaluation Framework for the eco-agri-food system. Many dimensions of the eco-agri-food system create complex analytical and policy challenges. Systems thinking allows better understanding and forecasting the outcomes of policy decisions by illuminating how the components of a system are interconnected with one another and how the drivers of change are determined and impacted by feedback loops, delays and non-linear relationships. To establish the building blocks of a theory of change, systems thinking empowers us to move beyond technical analysis and decisiontool toward more integrated approaches that can aid in the forming of a common ground for cultural changes

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p &lt; 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p &lt; 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p &lt; 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease