Sustainability indicators - a tool for regional co-operation

Sustainability indicators are more than just numbers. Besides their main function of illustrating the complex vision of sustainability they could support some factors for success of regional co-operation through their development. Today the discussion on indicators and co-operation is mainly separated from each other. Sustainability indicators are developed on all spatial levels from neighbourhoods up to the United Nations. In some cases the indicators are developed but remain unused. Regional co-operations on sustainability are more or less successful. Some fail because of the complexity of the topic and the multitude of people involved in sustainability. Despite the existing problems the necessity of both topics for the implementation of sustainable development is out of question. Some of the problems mentioned could be solved by the linkage of the two topics: indicators are not developed as an end in itself and regional co-operation could become more successful. The improvement of both is possible because important factors for success of co-operation can be supported by the following abilities resulting from the development of indicators: a) consensus building, b) improvement of the quality of basic information, c) definition of quantified aims and priorities, d) comprehensive development of measures, e) recognition of need for action f) evaluation of success. Besides these effects among the co-operating actors indicators development supports the following factors according to the external of the co-operation: g) information on the work of the co-operation (setting up transparency), h) contribution to a new sustainable awareness. Additionally the indicators are enhanced because the people developing and using them have intellectual ownership of them and guarantee that they are more than numbers. Regional co-operation and sustainability indicators become one unit and could be seen as a sustainable regional management system.

Sustainability indicators - a tool for regional co-operation

Sustainability indicators are more than just numbers. Besides their main function of illustrating the complex vision of sustainability they could support some factors for success of regional co-operation through their development. Today the discussion on indicators and co-operation is mainly separated from each other. Sustainability indicators are developed on all spatial levels from neighbourhoods up to the United Nations. In some cases the indicators are developed but remain unused. Regional co-operations on sustainability are more or less successful. Some fail because of the complexity of the topic and the multitude of people involved in sustainability. Despite the existing problems the necessity of both topics for the implementation of sustainable development is out of question. Some of the problems mentioned could be solved by the linkage of the two topics: indicators are not developed as an end in itself and regional co-operation could become more successful. The improvement of both is possible because important factors for success of co-operation can be supported by the following abilities resulting from the development of indicators: a) consensus building, b) improvement of the quality of basic information, c) definition of quantified aims and priorities, d) comprehensive development of measures, e) recognition of need for action f) evaluation of success. Besides these effects among the co-operating actors indicators development supports the following factors according to the external of the co-operation: g) information on the work of the co-operation (setting up transparency), h) contribution to a new sustainable awareness. Additionally the indicators are enhanced because the people developing and using them have intellectual ownership of them and guarantee that they are more than numbers. Regional co-operation and sustainability indicators become one unit and could be seen as a sustainable regional management system

Implementierung und Wirksamkeit klinischer Behandlungspfade:eine systematische Literaturanalyse

Ziel der Untersuchung war es, einen Überblick über Umfang und Form der Literatur zu Klinischen Behandlungspfaden zu erhalten. Unter Erfüllung expliziter Ein- und Ausschlusskriterien wurden relevante Veröffentlichungen der Datenbank PubMed zwischen 1950 und 2007 geprüft und Inhaltspunkte extrahiert. Kern der Literaturanalyse bildete ein selbstständig entwickeltes Analyse-Modell zur Klassifizierung und Bewertung der Publikationen. Aus 1095 im Volltext untersuchten Artikeln konnten 597 Studien identifiziert werden, davon 15 randomisiert klinische Versuche und acht Systematic Reviews mit Aussagen zur Wirksamkeit von Klinischen Behandlungspfaden. Entgegen der Fülle publizierten Expertenwissens ist die Anzahl qualitativ hochwertig wissenschaftlicher Studien mit Effektivitätsnachweisen gering

Advances in the Renin-Angiotensin-Aldosterone System: Relevance to Diabetic Nephropathy

Hypertension is now recognized as a key contributory factor to the development and progression of kidney disease in both type 1 and type 2 diabetes. The renin angiotensin system (RAS) and its effector molecule angiotensin II, in particular, have a range of hemodynamic and nonhemodynamic effects that contribute not only to the development of hypertension, but also to renal disease. As a result, therapeutic inhibition of the RAS with angiotensin-converting enzyme inhibitors and/or selective angiotensin II type 1 receptor blockers has been proposed as a key strategy for reducing kidney damage beyond the expected effects one would observe with blood pressure reduction per se. Although the relationship between the RAS and the progression of diabetic renal disease has been known for many decades, recent advances have revealed a more complex paradigm with the discovery of a number of new components. Thus, further understanding of these new components of the renin angiotensin aldosterone system (RAAS), such as the angiotensin type 2 receptor subtype, angiotensin converting enzyme 2, and the recently cloned renin receptor, is likely to have therapeutic implications for disorders such as diabetic nephropathy, where interruption of the RAAS is widely used

Fully-automated Body Composition Analysis in Routine CT Imaging Using 3D Semantic Segmentation Convolutional Neural Networks

Body tissue composition is a long-known biomarker with high diagnostic and prognostic value in cardiovascular, oncological and orthopaedic diseases, but also in rehabilitation medicine or drug dosage. In this study, the aim was to develop a fully automated, reproducible and quantitative 3D volumetry of body tissue composition from standard CT examinations of the abdomen in order to be able to offer such valuable biomarkers as part of routine clinical imaging. Therefore an in-house dataset of 40 CTs for training and 10 CTs for testing were fully annotated on every fifth axial slice with five different semantic body regions: abdominal cavity, bones, muscle, subcutaneous tissue, and thoracic cavity. Multi-resolution U-Net 3D neural networks were employed for segmenting these body regions, followed by subclassifying adipose tissue and muscle using known hounsfield unit limits. The S{\o}rensen Dice scores averaged over all semantic regions was 0.9553 and the intra-class correlation coefficients for subclassified tissues were above 0.99. Our results show that fully-automated body composition analysis on routine CT imaging can provide stable biomarkers across the whole abdomen and not just on L3 slices, which is historically the reference location for analysing body composition in the clinical routine

Pancreatic pseudocyst eroding into the splenoportal venous confluence and mimicking an arterial aneurysm

We report the case of a 62-year-old man with chronic pancreatitis who presented with increasing abdominal pain. Sonography, magnetic resonance imaging, contrast-enhanced computed tomography, and ultimately catheter angiography demonstrated a pancreatic pseudocyst that had eroded into the splenoportal venous confluence, mimicking an arterial aneurysm. The diagnostic was confirmed at the time of surgical treatment. This case demonstrates the use of imaging to diagnose complications of pancreatitis, and the difficulty of distinguishing an eroding pseudocyst from an arterial aneurysm

SP415EMPAGLIFLOZIN AND PROGRESSION OF CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETES COMPLICATED BY NEPHROTIC-RANGE PROTEINURIA: INSIGHTS FROM THE EMPA-REG OUTCOME® TRIAL

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Empagliflozin and Cardiovascular and Kidney Outcomes across KDIGO Risk Categories: Post Hoc Analysis of a Randomized, Double-Blind, Placebo-Controlled, Multinational Trial

BACKGROUND AND OBJECTIVES: In the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG Outcome), empagliflozin, in addition to standard of care, significantly reduced risk of cardiovascular death by 38%, hospitalization for heart failure by 35%, and incident or worsening nephropathy by 39% compared with placebo in patients with type 2 diabetes and established cardiovascular disease. Using EMPA-REG Outcome data, we assessed whether the Kidney Disease Improving Global Outcomes (KDIGO) CKD classification had an influence on the treatment effect of empagliflozin. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients with type 2 diabetes, established atherosclerotic cardiovascular disease, and eGFR≥30 ml/min per 1.73 m2 at screening were randomized to receive empagliflozin 10 mg, empagliflozin 25 mg, or placebo once daily in addition to standard of care. Post hoc, we analyzed cardiovascular and kidney outcomes, and safety, using the two-dimensional KDIGO classification framework. RESULTS: Of 6952 patients with baseline eGFR and urinary albumin-creatinine ratio values, 47%, 29%, 15%, and 8% were classified into low, moderately increased, high, and very high KDIGO risk categories, respectively. Empagliflozin showed consistent risk reductions across KDIGO categories for cardiovascular outcomes (P values for treatment by subgroup interactions ranged from 0.26 to 0.85) and kidney outcomes (P values for treatment by subgroup interactions ranged from 0.16 to 0.60). In all KDIGO risk categories, placebo and empagliflozin had similar adverse event rates, the notable exception being genital infection events, which were more common with empagliflozin for each category. CONCLUSIONS: The observed effects of empagliflozin versus placebo on cardiovascular and kidney outcomes were consistent across the KDIGO risk categories, indicating that the effect of treatment benefit of empagliflozin was unaffected by baseline CKD status. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: EMPA-REG OUTCOME, NCT01131676

Fully automated preoperative liver volumetry incorporating the anatomical location of the central hepatic vein

The precise preoperative calculation of functional liver volumes is essential prior major liver resections, as well as for the evaluation of a suitable donor for living donor liver transplantation. The aim of this study was to develop a fully automated, reproducible, and quantitative 3D volumetry of the liver from standard CT examinations of the abdomen as part of routine clinical imaging. Therefore, an in-house dataset of 100 venous phase CT examinations for training and 30 venous phase ex-house CT examinations with a slice thickness of 5 mm for testing and validating were fully annotated with right and left liver lobe. Multi-Resolution U-Net 3D neural networks were employed for segmenting these liver regions. The Sorensen-Dice coefficient was greater than 0.9726 +/- 0.0058, 0.9639 +/- 0.0088, and 0.9223 +/- 0.0187 and a mean volume difference of 32.12 +/- 19.40 ml, 22.68 +/- 21.67 ml, and 9.44 +/- 27.08 ml compared to the standard of reference (SoR) liver, right lobe, and left lobe annotation was achieved. Our results show that fully automated 3D volumetry of the liver on routine CT imaging can provide reproducible, quantitative, fast and accurate results without needing any examiner in the preoperative work-up for hepatobiliary surgery and especially for living donor liver transplantation.Projekt DEA