Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data

Purpose Timely and accurate data on the epidemiology of sepsis are essential to inform policy decisions and research priorities. We aimed to investigate the validity of inpatient administrative health data (IAHD) for surveillance and quality assurance of sepsis care. Methods We conducted a retrospective validation study in a disproportional stratified random sample of 10,334 inpatient cases of age ≥ 15 years treated in 2015–2017 in ten German hospitals. The accuracy of coding of sepsis and risk factors for mortality in IAHD was assessed compared to reference standard diagnoses obtained by a chart review. Hospital-level risk-adjusted mortality of sepsis as calculated from IAHD information was compared to mortality calculated from chart review information. Results ICD-coding of sepsis in IAHD showed high positive predictive value (76.9–85.7% depending on sepsis definition), but low sensitivity (26.8–38%), which led to an underestimation of sepsis incidence (1.4% vs. 3.3% for severe sepsis-1). Not naming sepsis in the chart was strongly associated with under-coding of sepsis. The frequency of correctly naming sepsis and ICD-coding of sepsis varied strongly between hospitals (range of sensitivity of naming: 29–71.7%, of ICD-diagnosis: 10.7–58.5%). Risk-adjusted mortality of sepsis per hospital calculated from coding in IAHD showed no substantial correlation to reference standard risk-adjusted mortality (r = 0.09). Conclusion Due to the under-coding of sepsis in IAHD, previous epidemiological studies underestimated the burden of sepsis in Germany. There is a large variability between hospitals in accuracy of diagnosing and coding of sepsis. Therefore, IAHD alone is not suited to assess quality of sepsis care

Biological Earth observation with animal sensors

Space-based tracking technology using low-cost miniature tags is now delivering data on fine-scale animal movement at near-global scale. Linked with remotely sensed environmental data, this offers a biological lens on habitat integrity and connectivity for conservation and human health; a global network of animal sentinels of environmen-tal change

A River over the Course of Time - Multi-temporal Analyses of Land Surface Dynamics in the Yellow River Basin (China) based on medium Resolution Remote Sensing Data

The Yellow River Basin is one of China’s most densely-populated, fastest growing and most dynamic regions, with abundant natural resources and intense agricultural production. Major land policies have recently resulted in remarkable landscape modifications throughout the basin. The availability of precise regional land cover change information is crucial to better understand the prevailing dynamics and underlying factors influencing the current processes in such a complex system and can additionally serve as a valuable component for modeling and decision making. Such comprehensive and detailed information is lacking for the Yellow River Basin so far. In this study, we derived land cover characteristics and dynamics from the complete last decade based on optical high-temporal MODIS Normalized Differenced Vegetation Index (NDVI) time series for the whole Yellow River Basin. After filtering and smoothing for noise reduction with the use of the adaptive Savitzky–Golay filter, the processed time series was used to derive a large variety of phenological and annual metrics. The final classifications for the basin (2003 and 2013) were based on a random forest classifier, trained by reference samples from very high-resolution imagery. The accuracy assessment for all 18 thematic classes, which was based on a 30% reference data split, yielded an overall accuracy of 87% and 84% for 2003 and 2013, respectively. Major land cover and land use changes during the last decade have occurred on the Loess Plateau, where land and conservation reforms triggered large-scale recovery of grassland and shrubland habitat that had been previously covered by agriculture or sparse vegetation. Agricultural encroachment and urban area expansion are other processes influencing the dynamics in the basin. The necessity for regionally-adapted land cover maps becomes obvious when our land cover products are compared to existing global products, where thematic accuracy remains low, particularly in a heterogeneous landscape, such as the Yellow River Basin. The basin-wide novel land cover and land use products of the Yellow River Basin hold a large potential for climate, hydrology and biodiversity modelers, as well as river basin and regional governmental authorities and will be shared upon request

Social–ecological challenges in the Yellow River basin (China): a review

The human–environment relationship within the Yellow River basin has a long history, because favorable environmental circumstances allowed the early emergence of societies along the river banks, and hence, the Yellow River basin was the birthplace of ancient Chinese civilization. On the other hand, the Yellow River is “China’s sorrow” due to the constant occurrences of flooding events throughout history. In recent decades, the Yellow River basin is facing a spectacular economic boom, but mainly achieved at the expenses of the environment by over-exploiting the natural resources provided within the basin, which causes various challenges on ecology and society. Water scarcity, pollution, and ecosystem degradation accompanied with biodiversity decline have been further aggravated by anthropogenic-induced climate change. To address the pressing socio-ecological challenges, various conservation and management plans and strategies have been issued, often consulted by international bodies. This article is a comprehensive overview of the current state and recent developments that have occurred in the Yellow River basin and presents and discusses current and pressing socio-ecological challenges. Additionally, we address different policy and management instruments that have been launched to ensure a long-term sustainable development within the basin

Multi-faceted land cover and land use change analyses in the Yellow River Basin based on dense Landsat time series: Exemplary analysis in mining, agriculture, forest, and urban areas

The Yellow River Basin is one of China's most dynamic regions, where past and recent anthropogenic land use activities and polices have had a remarkably impact on the basin's surface. Over the past decades, the rapid socio-economic development has increased the pressure on the prevailing water and land resources with various repercussions on the environment and society. Counteracting ecological degradation in the basin, large-scale conservation and restoration plans have been initiated to expand vegetation coverage on deteriorated land, simultaneously fostering rural sustainable agriculture production. In this context, we derived precise spatial thematic products from long-term satellite time-series about high-frequency temporal dynamics. This information, available in a consistent and repeatable fashion is rare and relevant for many regional and local stakeholders and must be monitored annually to capture the rapid rate of change. Such information serves as a valuable base for decision-making processes. In this study, we used all the archived Landsat images between 2000 and 2015 (4520 scenes) to computed annually the spatially continuous spectral-temporal and textual metrics based on dense Landsat time-series to derive annual maps showing the most prominent land-cover change types related to mining, agriculture, forestry, and urbanization in four sub-regions spread over the Yellow River Basin. These novel land cover/use products provide new insights into recent regional and local dynamics. For final classification, we employed random forest classifiers for each thematic focus-region, trained and tested based on a stable-pixels data set. The resulting maps achieved high accuracies and show afforestation on the Loess Plateau and urbanization as the most prominent drivers of land use/cover dynamics. Agricultural land remained stable, showing local small-scale dynamics. Our study highlights the great potential of using consistent spectral-temporal metrics derived from dense Landsat time-series data together with a stable pixels reference set, allowing for local and regional land surface dynamics mapping at high spatial resolution and the prediction of implications of future change for effective and sustainable basin management

Fußball – Spielfeld für Integration oder Ausgrenzung? Diskussion mit Willi Lemke, Nia Künzer und Gunter A. Pilz

Textdokumentation zur Veranstaltung der Osnabrücker Friedensgespräche am 6. Mai 201