Modeling agricultural production risk and the adaptation to climate change

A model that integrates biophysical simulations in an economic model is used to analyze the impact of climate change on crop production. The biophysical model simulates future plant-management-climate relationships and the economic model simulates farmers' adaptation actions to climate change using a nonlinear programming approach. Beyond the development of average yields, special attention is devoted to the impact of climate change on crop yield variability. This study analyzes corn and winter wheat production on the Swiss Plateau with respect to climate change scenarios that cover the period of 2030-2050. In our model, adaptation options such as changes in seeding dates, changes in production intensity and the adoption of irrigation farming are considered. Different scenarios of climate change, output prices and farmers' risk aversion are applied in order to show the sensitivity of adaptation strategies and crop yields, respectively, on these factors. Our results show that adaptation actions, yields and yield variation highly depend on both climate change and output prices. The sensitivity of adaptation options and yields, respectively, to prices and risk aversion for winter wheat is much lower than for corn because of different growing periods. In general, our results show that both corn and winter wheat yields increase in the next decades. In contrast to other studies, we find the coefficient of variation of corn and winter wheat yields to decrease. We therefore conclude that simple adaptation measures are sufficient to take advantage of climate change in Swiss crop farming.climate change, robust estimation, yield variation, corn, winter wheat, market liberalization, Environmental Economics and Policy, Production Economics, Risk and Uncertainty,

Use of Amoxicillin-Clavulanate and Resistance in Escherichia coli Over a 4-Year Period

Abstract Objective: To reduce the use of amoxicillin-clavulanate after high-resistance rates in Escherichia coli were detected. Design: Intervention study; the interventions were introduced successively over a 4-year period while closely monitoring the resistance patterns. Setting: A 260-bed acute-care hospital in Switzerland. Interventions: Introduction of therapeutic guidelines for specific departments or indications, which proposed alternative antibiotics to amoxicillin-clavulanate. The perioperative prophylactic use of amoxicillin-clavulanate was eliminated completely. Results: The absolute amount of amoxicillin-clavulanate consumed decreased by 23%, from 24.8 g per 100 patient days in 1992 to 18.5 g per 100 patient days in 1995. The number of courses, a parameter that takes the prophylactic use into account, decreased by 62% from 2.3 per 100 patient days in 1992 to 0.9 per 100 patient days in 1995. The percentage of sensitive strains increased from 54.9% (n=512) in 1992 and 54.0% (n=506) in 1993 to 72.1% (n=546) in 1994 and 83.1% (n=668) in 1995. No major changes were detected for other antimicrobials, such as cotrimoxazole, tetracycline, or cefuroxime, used in this 4-year period. Conclusions: A decrease in the use of amoxicillin-clavulanate was followed by an increase in susceptibility of E coli to it. It was not possible to prove a causative relationship. Only a temporal association was discovered. The reduction of the use of amoxicillin-clavulanate was achieved through the implementation of treatment guidelines, facilitated through a close collaboration among the clinical pharmacists, the infection control practitioner, the microbiology laboratory, and the physicians in charge of the respective department

Transmural intestinal wall permeability in severe ischemia after enteral protease inhibition.

In intestinal ischemia, inflammatory mediators in the small intestine's lumen such as food byproducts, bacteria, and digestive enzymes leak into the peritoneal space, lymph, and circulation, but the mechanisms by which the intestinal wall permeability initially increases are not well defined. We hypothesize that wall protease activity (independent of luminal proteases) and apoptosis contribute to the increased transmural permeability of the intestine's wall in an acutely ischemic small intestine. To model intestinal ischemia, the proximal jejunum to the distal ileum in the rat was excised, the lumen was rapidly flushed with saline to remove luminal contents, sectioned into equal length segments, and filled with a tracer (fluorescein) in saline, glucose, or protease inhibitors. The transmural fluorescein transport was determined over 2 hours. Villi structure and epithelial junctional proteins were analyzed. After ischemia, there was increased transmural permeability, loss of villi structure, and destruction of epithelial proteins. Supplementation with luminal glucose preserved the epithelium and significantly attenuated permeability and villi damage. Matrix metalloproteinase (MMP) inhibitors (doxycycline, GM 6001), and serine protease inhibitor (tranexamic acid) in the lumen, significantly reduced the fluorescein transport compared to saline for 90 min of ischemia. Based on these results, we tested in an in-vivo model of hemorrhagic shock (90 min 30 mmHg, 3 hours observation) for intestinal lesion formation. Single enteral interventions (saline, glucose, tranexamic acid) did not prevent intestinal lesions, while the combination of enteral glucose and tranexamic acid prevented lesion formation after hemorrhagic shock. The results suggest that apoptotic and protease mediated breakdown cause increased permeability and damage to the intestinal wall. Metabolic support in the lumen of an ischemic intestine with glucose reduces the transport from the lumen across the wall and enteral proteolytic inhibition attenuates tissue breakdown. These combined interventions ameliorate lesion formation in the small intestine after hemorrhagic shock

The development of machine learning in lung surgery: A narrative review.

Background Machine learning reflects an artificial intelligence that allows applications to improve their accuracy to predict outcomes, eliminating the need to conduct explicit programming on them. The medical field has increased its focus on establishing tools for integrating machine learning algorithms in laboratory and clinical settings. Despite their importance, their incorporation is minimal in the medical sector yet. The primary goal of this study is to review the development of machine learning in the field of thoracic surgery, especially lung surgery. Methods This article used the Preferred Reporting Items for Systematic and Meta-analyses (PRISMA). The sources used to gather data are the PubMed, Cochrane, and CINAHL databases and the Google Scholar search engine. Results The study included 19 articles, where ten concentrated on the application of machine learning in especially lung surgery, six focused on the benefits and limitations of machine learning algorithms in lung surgery, and three provided an overview of the future of machine learning in lung surgery. Conclusion The outcome of this study indicates that the field of lung surgery has attempted to integrate machine learning algorithms. However, the implementation rate is low, owing to the newness of the concept and the various challenges it encompasses. Also, this study reveals the absence of sufficient literature discussing the application of machine learning in lung surgery. The necessity for future research on the topic area remains evident

Influence of drugs and comorbidity on serum potassium in 15 000 consecutive hospital admissions

Background. Drug trials often exclude subjects with relevant comorbidity or comedication. Nevertheless, after approval, these drugs will be prescribed to a much broader collective. Our goal was to quantify the impact of drugs and comorbidity on serum potassium in unselected patients admitted to the hospital. Methods. This was a retrospective pharmacoepidemiologic study in 15 000 consecutive patients admitted to the medical department of the Kantonsspital St. Gallen, a 700-bed tertiary hospital in eastern Switzerland. Patients with ‘haemolytic' plasma and patients on dialysis or with an estimated glomerular filtration rate (GFR) <10 mL/min/1.73 m2 were excluded. For the remaining 14 146 patients, drug history on admission, age, sex, body weight, physical findings, comorbidity (ICD-10 diagnoses) and laboratory information (potassium and creatinine) were extracted from electronic sources. Results. Estimated GFR was the strongest predictor of serum potassium (P < 0.0001). Angiotensin-converting enzyme inhibitors, cyclosporine, loop diuretics and potassium-sparing diuretics all showed a significant effect modification with decreasing GFR (P < 0.001). Similarly, in patients with liver cirrhosis a significantly stronger effect on potassium was found for angiotensin receptor blockers, betablockers and loop diuretics (P < 0.01). Several significant drug-drug interactions were identified. Diabetes, male sex, older age, lower blood pressure and higher body weight were all independently associated with higher serum potassium levels (P < 0.001). The model explained 14% of the variation of serum potassium. Conclusions. The effects of various drugs on serum potassium are highly influenced by comorbidity and comedication. Although the presented model cannot be used to predict potassium in individual patients, we demonstrate that clinical databases could evolve as a powerful tool for industry-independent analysis of postmarketing drug safet

Fluoroscopic radiation exposure of the kyphoplasty patient

Kyphoplasty (KP) is a minimally invasive technique for the percutaneous stabilisation of vertebral fractures. As such, this technique is highly dependent upon intraoperative fluoroscopic visualisation. In order to assess the range of radiation doses that patients are typically subjected to, 60 consecutive procedures using simultaneous bilateral fluoroscopy were analysed with respect to exposure time (ET). In a subset of 16 of these patients, a theoretical entrance skin dose (ESD) and effective dose was additionally calculated from intraoperatively measured dose area product. Average fluoroscopy time for single level cases reached 2.2min (range 0.6-4.3) in the lateral plane and 1.6min (range 0.5-3.0) in the anterior-posterior plane. For multiple level cases the corresponding ET per level was 1.7min (range 0.6-2.9) per level in the lateral and 1.1min (range 0.5-2.0) in the anterior-posterior plane. ESD was estimated as an average 0.32Gy (range 0.05-0.86) in the anterior-posterior and 0.68Gy (range 0.10-1.43) in the lateral plane. Effective dose (cumulative from both planes) averaged 4.28mSv (range 0.47-10.14). Safety margins for the development of early transient erythema are respected within the presented fluoroscopy times. Longer ET in the lateral plane may however breach the 2Gy threshold. Use of large c-arms and judiciously operating the exposure is recommended. With regard to effective dose, a single fluoroscopy guided KP performed for osteoporotic or traumatic vertebral fractures is a safe procedur

Krankheitsrepräsentationen bei nicht-kardialem Brustschmerz – eine verhaltensmedizinische Kurzintervention

Illness Perceptions in Noncardiac Chest Pain - A Brief Psychological Intervention Background: Noncardiac chest pain is a frequent condition that is likely to develop a chronic course. Simply reassuring patients about nonpathological diagnostic test results has proved to be insufficient to effectively reduce dysfunctional illness representations and worry. The aim of the study was to develop a brief psychological intervention focussing on subjective illness representations and to evaluate its practicability. Patients and Methods: 57 patients with noncardiac chest pain participated. Illness representations and chest pain characteristics as well as the participants' subjective evaluation of the intervention were assessed. Results: Subjective ratings by the participants were mostly positive, but of all patients eligible for the intervention 42% declined to participate. In comparison to the refusers, the intervention participants were younger and reported stronger dysfunctional illness representations and higher pain intensity. Conclusion: It remains a challenge to affect patients with noncardiac chest pain with early psychological interventions, in particular patients who feel only mildly impaired. Nevertheless, our results show that a low-threshold intervention is applicable and is mainly seen as effective.Hintergrund: Nicht-kardiale Brustschmerzen sind häufig und entwickeln oft einen chronischen Verlauf. Die einfache ärztliche Rückmeldung über unauffällige kardiodiagnostische Befunde hat sich als nicht ausreichend erwiesen, um dysfunktionale Krankheitsrepräsentationen, Ängste und Sorgen der Betroffenen langfristig zu reduzieren. Daher war das Ziel der Studie, eine niederschwellige, auf subjektive Krankheitsrepräsentationen ausgerichtete psychologische Intervention zu entwickeln und hinsichtlich ihrer Anwendbarkeit zu evaluieren. Patienten und Methoden: 57 Patienten mit nicht-kardialem Brustschmerz nahmen randomisiert an unserer Intervention teil und wurden zu Brustschmerzen und subjektiven Krankheitsrepräsentationen sowie zur subjektiven Bewertung der Intervention befragt. Ergebnisse: Die Intervention wurde durch die meisten Teilnehmer sehr positiv eingeschätzt («Erfolg versprechend», «weiterzuempfehlen»). Jedoch lehnten vorab 42% der potenziell geeigneten Patienten eine Teilnahme ab. Die Interventionsgruppe war im Gegensatz zu den Refusern jünger, berichtete ungünstige Krankheitsrepräsentationen und größere Brustschmerzintensität. Schlussfolgerung: Es bleibt eine Herausforderung, Patienten mit nicht-kardialem Brustschmerz mittels verhaltensmedizinischer Interventionen frühzeitig zu erreichen, insbesondere akut weniger beeinträchtigte Personen. Demgegenüber zeigen unsere Ergebnisse, dass eine niederschwellige Intervention realisierbar ist und überwiegend als wirksam eingeschätzt wird

Vom e-Learning zum eCampus - Hamburgs Hochschulen auf dem Weg zu einer integrierten e-Learning- und IT-Dienste-Infrastruktur

e-Learning wird immer mehr zu einem strategischen Thema für die Hochschul­entwicklung. Nicht nur die technologisch-organisatorische Komplexität des digitalen Studierens, sondern auch der Bologna Prozess und veränderte Service-Erwartun­gen der Studierenden erhöhen den Druck auf die Hochschulen, systema­tisch inte­grierte IT-Diensteinfrastrukturen zu entwickeln. Dies setzt ein hohes Maß an Ko­ordi­nation und Kooperationsbereitschaft zwischen Hochschulen voraus. Am Wissen­schaftsstandort Hamburg wurde unter dem Begriff eCampus ein solcher hochschulübergreifender Entwicklungsprozess initiiert. Der Artikel beschreibt Hinter­gründe, Ziele und Struktur dieses Vorhabens und versucht, ein erstes Resüme des bisherigen Projektverlaufs zu ziehen. 25.02.2007 | Stephanie HAUSSNER, Ulrich SCHMID & Martin VOGEL (Hamburg