The social & economic implications of alternative land uses involving pastoral farming and forestry in Northland : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Natural Resource and Environmental Economics at Massey University

This thesis is a scenario study which examines the social and economic impacts of different types of forestry being established in an area of pastoral farmland in Northland, New Zealand. Detailed production, income, expenditure, employment and demographic data was collected from 57 of the 59 farms in the study area. This included expenditure direction data. Those businesses and schools which supported, and were in turn supported by, the study area farms were interviewed to find out the importance of these farms to their continued operation. This pastoral farming scenario is then compared with four forestry scenarios - two conventional forestry scenarios, plus a woodlot and finally an agroforestry scenario. In the first conventional forestry scenario all the study area farms (15,000 hectares) are planted in exotics and in the second about 3,000 hectares are planted. With the two farm forestry scenarios about 1,000 hectares are planted. In the first conventional forestry scenario forestry replaces pastoral farming, while in the second and the farm forestry scenarios pastoral farming and forestry are integrated. Variable results resulted from the comparison, with expenditure comparisons very sensitive to the time harvesting commences, the amount cut and the time span of the scenarios. (Thirty-five years.) These comparisons were also sensitive to the locality in which farming and forestry expenditure were being compared. Forestry expenditure would be markedly higher than farming expenditure once harvesting commenced. But farming has higher backward linkage multipliers and unless forestry processing plants are established, the conventional forestry developments in the scenarios imply a relative decline in regional incomes and employment. If forestry processing plants are established, an increase in regional incomes and employment is implied. Woodlot and agroforestry generally imply an increase in expenditure and employment without the drop in agricultural spending associated with conventional forestry activities on former pastoral farmland. Conventional forestry would result in disruption to the existing social structure. It may result in a long term population decline, but it is likely many ex-farm houses would be re-occupied. Woodlot and agroforestry would strengthen the existing social and economic structure. It is concluded that the Northland United Council's interest and concern about the afforestation of pastoral farmland is justified. However, the rural decline, the corporatisation of government departments, plus the impacts of forestry harvesting and wood processing are considered to be of more importance in the establishment of regional planning priorities

Begrüßung durch die Vizepräsidentin der Universität Hamburg

Nach der kampflosen Besetzung Hamburgs durch britische Truppen am 3. Mai 1945 wurde die Hamburger Universität geschlossen, aber bereits am 6. November 1945 – ein halbes Jahr nach Ende des „Dritten Reichs“ und des Zweiten Weltkriegs – mit einem Festakt in der Musikhalle wiedereröffnet. Den 70. Jahrestag dieser Wiedereröffnung am 6. November 2015 nahm die Universität Hamburg zum Anlass, sich erneut öffentlich mit dem schwierigen Übergang der eigenen Institution von der NS-Diktatur in die demokratische Nachkriegszeit auseinanderzusetzen. Dieser Band der „Hamburger Universitätsreden“ dokumentiert die vier am 6. November 2015 im Magdalene-Schoch-Hörsaal im Hauptgebäude der Universität gehaltenen Reden.After the occupation of Hamburg by British troops on May 3rd, 1945, the Hamburg University was closed, but reopened on November 6th, 1945 - half a year after the end of the "Third Reich" and the Second World War. On the occasion of the 70th anniversary of this reopening on 6 November 2015, the University of Hamburg took the opportunity to publicly discuss the difficult transition of its own institution from the Nazi dictatorship into the democratic post-war period. This volume of "Hamburger Universitätsreden" documents the four speeches held on on this occation

What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018

Background The epidemiology of osteomyelitis in Germany is unknown, which makes it difficult to estimate future demands. Therefore, we aimed to analyse how the numbers of cases have developed over the last decade as a function of osteomyelitis subtype, age group, gender, and anatomical localization. Methods Osteomyelitis rates were quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Overall osteomyelitis prevalence increased by 10.44% from 15.5 to 16.7 cases per 100,000 inhabitants between 2008 through 2018. Out of 11,340 cases in 2018, 47.6% were diagnosed as chronic, 33.2% as acute and 19.2% as unspecified osteomyelitis. Men were often affected than women with 63.4% of all cases compared to 36.6%. The largest proportion of patients comprised the age group 60–69 years (22.1%), followed by 70–79 years (21.7%). A trend towards more osteomyelitis diagnoses in older patients was observed. Lower extremities were most frequently infected with 73.8% of all cases in 2018 (+ 10.8% change). Conclusions Osteomyelitis remains a serious problem for orthopedic and trauma surgery. Prevention methods and interdisciplinary approaches are strongly required

The Epidemiology of Osteomyelitis in Children

Pediatric osteomyelitis remains challenging to treat. Detailed epidemiological data are required to estimate future developments. Therefore, we aimed to analyze how the incidence has changed over the last decade depending on age, gender, osteomyelitis subtype, and anatomical localization. Cases were quantified for patients aged 20 years or younger, using yearly reported ICD-10 diagnosis codes from German medical institutions for the time period 2009 to 2019. Incidence rates of osteomyelitis increased by 11.7% from 8.2 cases per 100,000 children in 2009 to 9.2 cases per 100,000 children in 2019. The age-specific incidence rate revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period, followed by the age group 5–10 years (9.7/100,000 children). In 2019, out of all diagnoses, 39.2% were classified as acute, 38.4% as chronic, and 22.4% were unspecified, whereby chronic cases increased by 38.7%. The lower extremity was mainly affected, with 58.9% of osteomyelitis diagnoses in 2019. In conclusion, pediatric osteomyelitis is a serious issue, even in a developed and industrialized country such as Germany. Considering the recent incidence increase, the permanent need for appropriate treatment should let pediatricians and orthopedic surgeons deal with diagnosis and treatment protocols

Comment on Lunz et al. Impact and Modification of the New PJI-TNM Classification for Periprosthetic Joint Infections. J. Clin. Med. 2023, 12, 1262

We read with great interest the article by Lunz et al. [1], in which the authors dealt with the new Periprosthetic Joint Infection (PJI)-TNM classification that was recently published by our group (Table 1) [2–4]. PJI represents one of the most feared complications in the orthopedic field, resulting in impaired quality of life, repeated and prolonged hospital stays, and significant morbidity and mortality in affected patients. Still, there is no commonly used classification system that could facilitate the comparison of treatment strategies and patient outcomes [5,6]. Therefore, we are delighted with the authors’ conclusions that “clinicians and researchers should be familiar with the new PJI-TNM classification and start implementing it into their routine practice” [1]. The work of Lunz et al. [1] retrospectively assessed 80 consecutive PJI patients treated with a two-stage exchange and was the first to correlate the PJI-TNM classification to surgical parameters and some clinical outcome parameters, such as need for revision surgery after stage one surgery, the duration of the interim period, and mortality. In addition, Lunz et al. [1] believed that the initial PJI-TNM publication from our group could be improved through certain modifications to the TNM backbone, resulting in a “pTNM” version. An additional “p-status” (type of prosthesis) was proposed to distinguish between standard implants (p0), revision implants (p1), and megaprostheses (p2). Further suggestions were to add an “x” in front of the “p-status” to indicate a loosened implant and to limit the criteria parameters for p, T, N, and M to only 0 = least serious, 1 = moderate, and 2 = most serious by eliminating the letters for the subclassifications of the 0, 1, and 2 categories of our initially proposed classification. They also proposed the replacement of the CCI for the assessment of patients’ comorbidities with the American Society of Anesthesiologists (ASA) Physical Status Classification System [7]

Gesamtverzeichnis der Hamburger Universitätsreden

Nach der kampflosen Besetzung Hamburgs durch britische Truppen am 3. Mai 1945 wurde die Hamburger Universität geschlossen, aber bereits am 6. November 1945 – ein halbes Jahr nach Ende des „Dritten Reichs“ und des Zweiten Weltkriegs – mit einem Festakt in der Musikhalle wiedereröffnet. Den 70. Jahrestag dieser Wiedereröffnung am 6. November 2015 nahm die Universität Hamburg zum Anlass, sich erneut öffentlich mit dem schwierigen Übergang der eigenen Institution von der NS-Diktatur in die demokratische Nachkriegszeit auseinanderzusetzen. Dieser Band der „Hamburger Universitätsreden“ dokumentiert die vier am 6. November 2015 im Magdalene-Schoch-Hörsaal im Hauptgebäude der Universität gehaltenen Reden.After the occupation of Hamburg by British troops on May 3rd, 1945, the Hamburg University was closed, but reopened on November 6th, 1945 - half a year after the end of the "Third Reich" and the Second World War. On the occasion of the 70th anniversary of this reopening on 6 November 2015, the University of Hamburg took the opportunity to publicly discuss the difficult transition of its own institution from the Nazi dictatorship into the democratic post-war period. This volume of "Hamburger Universitätsreden" documents the four speeches held on on this occation

Emergence delirium in children is not related to intraoperative burst suppression – prospective, observational electrography study

BACKGROUND: Emergence-delirium is the most frequent brain dysfunction in children recovering from general anaesthesia, though the pathophysiological background remains unclear. The presented study analysed an association between emergence delirium and intraoperative Burst Suppression activity in the electroencephalogram, a period of very deep hypnosis during general anaesthesia. METHODS: In this prospective, observational cohort study at the Charité - university hospital in Berlin / Germany children aged 0.5 to 8 years, undergoing planned surgery, were included between September 2015 and February 2017. Intraoperative bi-frontal electroencephalograms were recorded. Occurrence and duration of Burst Suppression periods were visually analysed. Emergence delirium was assessed using the Pediatric Assessment of Emergence Delirium Score. RESULTS: From 97 children being analysed within this study, 40 children developed emergence delirium, and 57 children did not. Overall 52% of the children displayed intraoperative Burst Suppression periods; however, occurrence and duration of Burst Suppression (Emergence delirium group 55% / 261 + 462 s vs. Non-emergence delirium group 49% / 318 + 531 s) did not differ significantly between both groups. CONCLUSIONS: Our data reveal no correlation between the occurrence and duration of intraoperative Burst Suppression activity and the incidence of emergence delirium. Burst Suppression occurrence is frequent; however, it does not seem to have an unfavourable impact on cerebral function at emergence from general anaesthesia in children

Antibiotikaeinsatz zu Prophylaxe und empirischer Therapie von frakturassoziierten Infektionen in Deutschland

Hintergrund Antibiotika (AB) spielen eine wichtige Rolle in der Prophylaxe und Behandlung von Infektionen in der Unfallchirurgie. Dennoch scheint es gerade bei der Infektionsprophylaxe nach offenen Frakturen und auch bei der empirischen Therapie von frakturassoziierten Infektionen (FRI) große Unterschiede zwischen einzelnen Kliniken zu geben. Methodik An deutschen Universitäts- und berufsgenossenschaftlichen Kliniken wurde eine Umfrage zu Prophylaxe und empirischer AB-Therapie von FRI durchgeführt. Die AB-Regime wurden mit dem Resistenzprofil der Erreger bei 86 FRI-Patienten verglichen, um die theoretische Wirksamkeit der jeweiligen Therapien zu ermitteln. Ergebnisse Von 71 Kliniken antworteten insgesamt 44 (62,0 %). Bei geschlossenen Frakturen zeigte sich mit der Verwendung von Cephalosporinen in 95,5 % der Kliniken ein einheitliches Bild. Für offene Frakturen wurden 8 verschiedene AB-Regime berichtet, wobei Aminopenicilline/β-Lactamase-Inhibitor (BLI) (31,8 %) am häufigsten genannt wurden. Für die empirische Therapie der FRI wurden 12 verschiedene AB-Regime angegeben, am häufigsten Aminopenicilline/BLI (31,8 %), Cephalosporine (31,8 %) und Ampicillin/Sulbactam + Vancomycin (9,1 %). Hinsichtlich der empirischen Therapie der FRI zeigten sich niedrige Sensibilitätsraten für Cephalosporine (65,1 %) bzw. Aminopenicillinen/BLI (74,4 %). Für die Kombination Vancomycin + Meropenem ergab sich mit 91,9 % die höchste hypothetische Sensibilität. Diskussion Im Abgleich mit dem vorliegenden, einrichtungsspezifischen Keimspektrum erscheint die Kombinationstherapie Vancomycin + Meropenem für die empirische Therapie sinnvoll, sollte jedoch Patienten mit mehrfachen Revisionseingriffen oder septischen Infektionsverläufen vorbehalten bleiben, um die Selektion hochresistenter Keime zu vermeiden

Treatment of Periprosthetic Joint Infection and Fracture-Related Infection With a Temporary Arthrodesis Made by PMMA-Coated Intramedullary Nails – Evaluation of Technique and Quality of Life in Implant-Free Interval

Background: Antimicrobial coating of intramedullary nails with polymethyl methacrylate (PMMA) bone cement promises infection control and stabilization for subsequent bone healing. However, when removing the implant, bone cement can debond and remain in the medullary cavity of the long bones, representing a nidus for reinfection. This work presents a technique comprising reinforcement of PMMA-coated intramedullary nails with cerclage wire to prevent such problems in patients treated for fracture-related infection (FRI) or knee periprosthetic joint infection (PJI) with a static spacer as temporary arthrodesis allowing weight-bearing in the implant-free interval. Outcomes of this surgical treatment were evaluated in terms of (i) associated complications and (ii) patient-reported quality of life. Methods: In this retrospective case series, 20 patients with PJI (n = 14, 70%) and FRI (n = 6, 30%) treated with PMMA-coated intramedullary nails reinforced with cerclage wire between January 2021 and July 2021 were included. Quality of life during the implant-free interval was evaluated with the EQ-5D, SF-36, and an ICD-10 based psychological symptom rating and compared with previously analyzed cohorts of successfully treated PJI and FRI patients in whom eradication of infection and stable bone consolidation was achieved. Results: Complications during the implant-free interval comprised a broken nail in one case (5.0%) and a reinfection in one case (5.0%). Coating-specific side effects and cement debonding during removal did not occur. The mean physical health component score of SF-36 was 26.1 ± 7.6, and the mean mental health component score reached a value of 47.1 ± 18.6. The mean EQ-5D index value was 0.36 ± 0.32 and the mean EQ-5D visual analogue scale rating was 47.4 ± 19.4. The scores were significantly lower than those in the successfully treated FRI cohort but not in the PJI cohort. The mean ICD-10-based symptom rating scores revealed psychological symptom burden on the depression scale and enhanced levels of anxiety in comparison with healed FRI and PJI patients. Conclusion: Reinforcement of PMMA bone cement-coated implants seems to be a reasonable treatment option to create a temporary arthrodesis, preventing detachment of the bone cement when the implant was removed. Level of Evidence: IV

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

Antibiotic treatment strategies for fracture-related infections (FRI) are often extrapolated from periprosthetic joint infections (PJI), although, in contrast to PJI, detailed analysis of pathogens and their antibiotic resistance is missing. Therefore, this study aimed to investigate antibiotic susceptibility profiles to identify effective empiric antibiotic treatment for early-, delayed-, and late-onset FRI. Patients treated for FRI from 2013 to 2020 were grouped into early (10 weeks) onset of infection. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. In total, 117 patients (early n = 19, delayed n = 60, late n = 38) were enrolled. In early-onset FRI, 100.0% efficacy would be achieved by meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide, ciprofloxacin + glycopeptide and piperacillin/tazobactam + glycopeptide. For patients with delayed FRI, the highest susceptibility was revealed for meropenem + vancomycin, gentamicin + vancomycin and ciprofloxacin + glycopeptide (96.7%). Meropenem + vancomycin was the most effective empiric antimicrobial in patients with late-onset of infection with 92.1% coverage. No subgroup differences in antibiotic sensitivity profiles were observed except for the combination ciprofloxacin + glycopeptide, which was significantly superior in early FRI (F = 3.304, p = 0.04). Across all subgroups meropenem + vancomycin was the most effective empiric treatment in 95.7% of patients with confirmed susceptibility. Meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide are the best therapeutic options for FRI, regardless of the onset of infection. To avoid multidrug resistance, established antibiotic combinations such as co-amoxiclav with a glycopeptide seem to be reasonable as a systemic antibiotic therapy, while vancomycin + gentamicin could be implemented in local antibiotic therapy to reduce adverse events during treatment