Envisioning the future: creating sustainable, healthy and resilient BioCities

Numerous challenges – from population increase to climate change – threaten the sustainable development of cities and call for a fundamental change of urban development and green-blue resource management. Urban forests are vital in this transition, as they provide various ecosystem services and allow to re-shape and re-think cities. Based on a Europe-wide community effort with diverse experts centered around urban forests and urban greening, we propose five key research fields to generate the knowledge required to unlock fundamental changes in urban development and green-blue resource management: circular bioeconomy, climate resilience, governance, social and human environment, and biodiversity. To support the design of greener, cooler, more inclusive and resilient cities, all these research fields require inter- and transdisciplinary collaboration, engaging stakeholders in transforming urban engagement and functioning. We summarise main inter-, trans- und multidisciplinary research paths for each field and the cross-cutting knowledge areas that can help to address the challenges many cities face (e.g., modelling and assessment of the urban microclimate). For transforming cities further knowledge is needed on e.g., urban innovation, transition, participation, and more. Finally, we address how the identified research gaps can be implemented (e.g., international coordinated research effort, interdisciplinary networks)

Vaccines as alternatives to antibiotics for food producing animals. Part 1:challenges and needs

Vaccines and other alternative products can help minimize the need for antibiotics by preventing and controlling infectious diseases in animal populations, and are central to the future success of animal agriculture. To assess scientific advancements related to alternatives to antibiotics and provide actionable strategies to support their development, the United States Department of Agriculture, with support from the World Organisation for Animal Health, organized the second International Symposium on Alternatives to Antibiotics. It focused on six key areas: vaccines; microbial-derived products; non-nutritive phytochemicals; immune-related products; chemicals, enzymes, and innovative drugs; and regulatory pathways to enable the development and licensure of alternatives to antibiotics. This article, part of a two-part series, synthesizes and expands on the expert panel discussions regarding opportunities, challenges and needs for the development of vaccines that may reduce the need for use of antibiotics in animals; new approaches and potential solutions will be discussed in part 2 of this series. Vaccines are widely used to prevent infections in food animals. Various studies have demonstrated that their animal agricultural use can lead to significant reductions in antibiotic consumption, making them promising alternatives to antibiotics. To be widely used in food producing animals, vaccines have to be safe, effective, easy to use, and cost-effective. Many current vaccines fall short in one or more of these respects. Scientific advancements may allow many of these limitations to be overcome, but progress is funding-dependent. Research will have to be prioritized to ensure scarce public resources are dedicated to areas of potentially greatest impact first, and private investments into vaccine development constantly compete with other investment opportunities. Although vaccines have the potential to improve animal health, safeguard agricultural productivity, and reduce antibiotic consumption and resulting resistance risks, targeted research and development investments and concerted efforts by all affected are needed to realize that potential

Envisioning the future—Creating sustainable, healthy and resilient BioCities

Numerous challenges – from population increase to climate change – threaten the sustainable development of cities and call for a fundamental change of urban development and green-blue resource management. Urban forests are vital in this transition, as they provide various ecosystem services and allow to re-shape and re-think cities. Based on a Europe-wide community effort with diverse experts centered around urban forests and urban greening, we propose five key research fields to generate the knowledge required to unlock fundamental changes in urban development and green-blue resource management: circular bioeconomy, climate resilience, governance, social and human environment, and biodiversity. To support the design of greener, cooler, more inclusive and resilient cities, all these research fields require inter- and transdisciplinary collaboration, engaging stakeholders in transforming urban engagement and functioning. We summarise main inter-, trans- and multi-disciplinary research paths for each field and the cross-cutting knowledge areas that can help to address the challenges many cities face (e.g., modelling and assessment of the urban microclimate). For transforming cities further knowledge is needed on e.g., urban innovation, transition, participation, and more. Finally, we address how the identified research gaps can be implemented (e.g., international coordinated research effort, interdisciplinary networks).</p

Research Agenda: Biocities of the future

call for the preparation of a Green Book of Biocities and a Research Agenda for Biocities of the Future. The Research Agenda is intended as a foundational document for further research and initiatives to be undertaken by the new EFI Biocities Facility launched in 2022 in Rome (Italy). A number of conditions, developments and critical notions form the backdrop to this study: • the continuing pattern of migration to cities globally, and related urbanization patterns and processes; • the interrelationships of cities and the urban realm to global problems (and global solutions); • the fact that cities are inherently complex, that the urban issue is multifaceted, and that solutions are by consequence interrelated and demand interdisciplinary attention; • that the cities of tomorrow face an increasing number of challenges, and are of an increasing diversity; • that cities have been, and are expected to remain, crucibles of development and innovation in areas of technology, economics, culture, society and politics; • that forests, greenspace and the natural world can become central to a paradigm shift in understanding, ordering and acting in the (bio)city of the future; • that the notion of a Biocity resonates with similar initiatives such as eco-urbanism, nature-based solutions and green cities, but aims to critically extend and enlarge on these concepts through the involvement of more diverse branches of research and practice, their effective integration and contextualization, and through the exploration of novel cross-cutting perspectives. The overall objective of the agenda is to contribute towards transforming existing cities to Biocities and provide a framework for new urban developments. Biocities can be defined from the perspective of ‘desirable futures’ (based on a vision developed by the parallel work of another project consortium on the Green Book of Biocities). Critical variables that impact future pathways towards Biocities and point towards areas for further action and research include: (i) degrees of political stability; compatibility of political systems to principles; political commitment to principles; flexibility and adaptability of regulatory and legislative systems; degree of inclusion and participation of communities; (ii) volatility of economic conditions internationally, nationally and locally; predisposition of communities and governments to expand value concepts beyond the monetary; (iii) willingness and capacity of urban communities to adapt to systemic changes required of certain principles; awareness of motivations behind transitions to various principles; migration patterns, the future of work, demographic trends; (iv) development of necessary technological innovations; uptake of technology; (v) availability of natural resources; speed of anthropogenic impacts on planetary boundaries. On the basis of these critical variables, scenarios reveal to what extent the Biocity goals may be reached, resulting in a first set of overarching research challenges, which include: reconciling different perceptions by getting and keeping interest groups involved; interoperability between green space management and urban development; funding and implementation; impacting culture and behaviour towards transformation. Learning from these overarching themes, five key topic areas are identified as a framework for elaboration of a research agenda to facilitate the transition to Biocities: (1) circular bioeconomy, (2) climate resilience, (3) governance, (4) social and human environment, and (5) biodiversity. Our results show that various challenges arise from different perspectives in these topic areas, such as life-cycle management, cultural change, prioritisation of sustainable approaches, urban carbon storage, infrastructural adaptation, bio-resilience, participation, cross-sectoral planning, systemic integration of health and wellbeing, and spatial sustainability. Further, several knowledge areas and research gaps emerge that need to be addressed from the social sciences and humanities, as well as from ecology, civil engineering, architecture and spatial planning and design. Examples include: conceptual research on the circular bioeconomy and urban biodiversity; modelling of the urban microclimate, local health impacts and global supply chain effects; methodologies and standards for impact assessment and participatory planning; historical and contextual research on green, blue and grey infrastructure across cities. For the implementation of greener, cooler and more resilient cities, further knowledge is needed on urban innovation, transition, participation, inequality, inclusiveness management, health and human wellbeing, suitable policies and strategies and the science-policy interface. The implementation of the Research Agenda will require five pathways: (i) an international coordinated research effort, (ii) interdisciplinary networks, (iii) integration of other initiatives, (iv) conceptual capacity building and (v) support for emerging disciplines. The implementation of the Research Agenda is expected to contribute to the Sustainable Development Goals in an urban context, as well as to support the Green Deal Strategy of the European Commission and the promotion of One Health

Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial

Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) &lt; 60&nbsp;ml/min/1.73&nbsp;m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72&nbsp;h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7&nbsp;days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7&nbsp;days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P &lt; 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P &lt; 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7&nbsp;days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide