Awakening the sleeping giant of urban green in times of crisis—coverage, co-creation and practical guidelines for optimizing biodiversity-friendly and health-promoting residential greenery

As multiple crises deepen existing inequalities in urban societies within and between neighborhoods, strategically integrating nature-based solutions into the living environment can help reduce negative impacts and improve public health, social cohesion, and well-being. Compared to public green such as parks, semi-public residential greenery is rarely studied, is regularly overlooked by planners, and often receives step-motherly treatment from architects and housing companies. We approximated the area of residential greenery of modernist multi-story apartment complexes in Berlin, Germany. We surveyed residents’ suggestions for improving their living environments in vulnerable neighborhoods, report on co-creation experiences, and provide a practical guideline for optimizing health-promoting residential green spaces. The semi-public open space on the doorstep of two-thirds of Berlin’s population is highly fragmented and, in total, has a similar area as the public green spaces and a great potential for qualitative development. Just as the suitability of different nature-based solutions to be integrated into the residential greenery depends on building types, resident demands differ between neighborhoods. Residents called for more involvement in design, implementation, and maintenance, frequently proposing that biodiversity-friendly measures be included. As there is no universal solution even for neighborhoods sharing similar structural and socioeconomic parameters, we propose, and have tested, an optimization loop for health-promoting residential greening that involves exploring residents’ needs and co-creating local solutions for urban regeneration processes that can be initiated by different actors using bottom-up and/or top-down approaches in order to unlock this potential for healthy, livable and biodiversity friendly cities.Peer Reviewe

Awakening the sleeping giant of urban green in times of crisis—coverage, co-creation and practical guidelines for optimizing biodiversity-friendly and health-promoting residential greenery

As multiple crises deepen existing inequalities in urban societies within and between neighborhoods, strategically integrating nature-based solutions into the living environment can help reduce negative impacts and improve public health, social cohesion, and well-being. Compared to public green such as parks, semi-public residential greenery is rarely studied, is regularly overlooked by planners, and often receives step-motherly treatment from architects and housing companies. We approximated the area of residential greenery of modernist multi-story apartment complexes in Berlin, Germany. We surveyed residents’ suggestions for improving their living environments in vulnerable neighborhoods, report on co-creation experiences, and provide a practical guideline for optimizing health-promoting residential green spaces. The semi-public open space on the doorstep of two-thirds of Berlin’s population is highly fragmented and, in total, has a similar area as the public green spaces and a great potential for qualitative development. Just as the suitability of different nature-based solutions to be integrated into the residential greenery depends on building types, resident demands differ between neighborhoods. Residents called for more involvement in design, implementation, and maintenance, frequently proposing that biodiversity-friendly measures be included. As there is no universal solution even for neighborhoods sharing similar structural and socioeconomic parameters, we propose, and have tested, an optimization loop for health-promoting residential greening that involves exploring residents’ needs and co-creating local solutions for urban regeneration processes that can be initiated by different actors using bottom-up and/or top-down approaches in order to unlock this potential for healthy, livable and biodiversity friendly cities

Elp3-mediated codon-dependent translation promotes mTORC2 activation and regulates macrophage polarization.

peer reviewedMacrophage polarization is a process whereby macrophages acquire distinct effector states (M1 or M2) to carry out multiple and sometimes opposite functions. We show here that translational reprogramming occurs during macrophage polarization and that this relies on the Elongator complex subunit Elp3, an enzyme that modifies the wobble uridine base U34 in cytosolic tRNAs. Elp3 expression is downregulated by classical M1-activating signals in myeloid cells, where it limits the production of pro-inflammatory cytokines via FoxO1 phosphorylation, and attenuates experimental colitis in mice. In contrast, alternative M2-activating signals upregulate Elp3 expression through a PI3K- and STAT6-dependent signaling pathway. The metabolic reprogramming linked to M2 macrophage polarization relies on Elp3 and the translation of multiple candidates, including the mitochondrial ribosome large subunit proteins Mrpl3, Mrpl13, and Mrpl47. By promoting translation of its activator Ric8b in a codon-dependent manner, Elp3 also regulates mTORC2 activation. Elp3 expression in myeloid cells further promotes Wnt-driven tumor initiation in the intestine by maintaining a pool of tumor-associated macrophages exhibiting M2 features. Collectively, our data establish a functional link between tRNA modifications, mTORC2 activation, and macrophage polarization

Analysis of end-of-life treatment and physician perceptions at a university hospital in Germany

Purpose!#!Providing state-of-the-art palliative care is crucial in all areas of in- and outpatient settings. Studies on the implementation of palliative care standards for dying patients are rare.!##!Methods!#!N = 141 physicians from all internal departments were polled anonymously about the treatment of dying patients using a self-designed questionnaire. Furthermore, we evaluated the terminal care of n = 278 patients who died in internal medicine departments at University Hospital Mannheim between January and June, 2019 based on clinical data of the last 48 h of life. We defined mandatory criteria for good palliative practice both regarding treatment according to patients' records and answers in physicians' survey.!##!Results!#!Fifty-six physicians (40%) reported uncertainties in the treatment of dying patients (p < 0.05). Physicians caring for dying patients regularly stated to use sedatives more frequently and to administer less infusions (p < 0.05, respectively). In multivariate analysis, medical specialization was identified as an independent factor for good palliative practice (p < 0.05). Physicians working with cancer patients regularly were seven times more likely to use good palliative practice (p < 0.05) than physicians who did not. Cancer patients received good palliative practice more often than patients dying from non-malignant diseases (p < 0.05).!##!Conclusion!#!Guideline-based palliative care for dying patients was found to be implemented more likely and consistent within the oncology department. These results point to a potential lack of training of fellows in non-oncological departments in terms of good end-of-life care

Dünndarmschonung bei der IMRT des Rektumkarzinoms: Dosimetrische Studie zur Bauch- und Rückenlagerung

Background: This treatment planning study analyzes dose coverage and dose to organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) of rectal cancer and compares prone vs. supine positioning as well as the effect of dose optimization for the small bowel (SB) by additional dose constraints in the inverse planning process. Patients and methods: Based on the CT datasets of ten male patients in both prone and supine position, a total of four different IMRT plans were created for each patient. OAR were defined as the SB, bladder, and femoral heads. In half of the plans, two additional SB cost functions were used in the inverse planning process. Results: There was a statistically significant dose reduction for the SB in prone position of up to 41% in the high and intermediate dose region, compared with the supine position. Furthermore, the femoral heads showed a significant dose reduction in prone position in the low dose region. Regarding the additional active SB constraints, the dose in the high dose region of the SB was significantly reduced by up to 14% with the additional cost functions. There were no significant differences in the dose distribution of the planning target volume (PTV) and the bladder. Conclusion: Prone positioning can significantly reduce dose to the SB in IMRT for rectal cancer and therefore should not only be used in 3D conformal radiotherapy but also in IMRT of rectal cancer. Further protection of the SB can be achieved by additional dose constraints in inverse planning without jeopardizing the homogeneity of the PTV

Compression Bioreactor-Based Mechanical Loading Induces Mobilization of Human Bone Marrow-Derived Mesenchymal Stromal Cells into Collagen Scaffolds In Vitro

Articular cartilage (AC) is an avascular tissue composed of scattered chondrocytes embedded in a dense extracellular matrix, in which nourishment takes place via the synovial fluid at the surface. AC has a limited intrinsic healing capacity, and thus mainly surgical techniques have been used to relieve pain and improve function. Approaches to promote regeneration remain challenging. The microfracture (MF) approach targets the bone marrow (BM) as a source of factors and progenitor cells to heal chondral defects in situ by opening small holes in the subchondral bone. However, the original function of AC is not obtained yet. We hypothesize that mechanical stimulation can mobilize mesenchymal stromal cells (MSCs) from BM reservoirs upon MF of the subchondral bone. Thus, the aim of this study was to compare the counts of mobilized human BM-MSCs (hBM-MSCs) in alginate-laminin (alginate-Ln) or collagen-I (col-I) scaffolds upon intermittent mechanical loading. The mechanical set up within an established bioreactor consisted of 10% strain, 0.3 Hz, breaks of 10 s every 180 cycles for 24 h. Contrary to previous findings using porcine MSCs, no significant cell count was found for hBM-MSCs into alginate-Ln scaffolds upon mechanical stimulation (8 ± 5 viable cells/mm3 for loaded and 4 ± 2 viable cells/mm3 for unloaded alginate-Ln scaffolds). However, intermittent mechanical stimulation induced the mobilization of hBM-MSCs into col-I scaffolds 10-fold compared to the unloaded col-I controls (245 ± 42 viable cells/mm3 vs. 22 ± 6 viable cells/mm3, respectively; p-value < 0.0001). Cells that mobilized into the scaffolds by mechanical loading did not show morphological changes. This study confirmed that hBM-MSCs can be mobilized in vitro from a reservoir toward col-I but not alginate-Ln scaffolds upon intermittent mechanical loading, against gravity

Zeitmanagement im OP – eine Querschnittstudie zur Bewertung der subjektiven und objektiven Dauer chirurgischer Prozeduren im HNO-Bereich

Background!#!Accurate planning of operating times in surgical clinics is essential. Moreover, high-capacity utilization of operating rooms (ORs) is necessary for economic efficiency.!##!Objective!#!Most planning of operating times is performed by surgeons. Herein, surgeons' estimated times and the objective times for performing surgical procedures were compared to detect sources of error.!##!Materials and methods!#!In a retrospective analysis, the durations of 1809 operations using general anesthesia (22 types of surgery) by 31 surgeons (12 specialists and 19 residents) were compared. Comparisons were analyzed by Mann-Whitney U‑tests.!##!Results!#!The comparison of objective times of surgical action showed significant differences between specialists and residents in 6 of 15 types of surgeries. The post-processing times estimated by specialists deviated from the objective times in 2 out of 22 surgery types, while the post-processing times estimated by residents deviated in 7 of 15 types. Specialists misjudged the incision-to-suture times in 7 of 22 surgery types, and residents misjudged these times in 3 of 15 types. The preparation times estimated by specialists deviated from the objective times in 16 of 22 types of surgeries and in 7 of 15 types estimated by residents.!##!Conclusion!#!A surgeon's routine must be carefully considered in order to estimate operating times. Specialists generally underestimated preparation and post-processing times and overestimated incision-to-suture times, whereas residents underestimated all three. Preparation and post-processing times must be considered in planning and, ideally, determined together with anesthesiologists and surgical assistants