ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Governance of transformations towards sustainable water, food and energy supply systems : facilitating sustainability innovations through multi-level learning processes

A fundamental change in societal values and economic structures is required to address increasing pressures on ecosystems and natural resources. Transition research has developed in the last decades to analyze the co-dynamics of technological, institutional, social and economic elements in the provision of key functions such as energy, water and food supply. This doctoral dissertation provides conceptual and methodological contributions to the pro-active governance of sustainability transitions. Three research gaps are identified that are addressed in this dissertation. First, a comprehensive conceptualization of learning in sustainability transitions is currently missing that comprises learning at multiple societal levels (ranging from individuals to policy-actors). Learning concepts are often not explicitly discussed in transition research even though learning is considered as fundamental for innovation processes, niche formation and development as well as breakthrough and diffusion of innovations. Second, methods for the analysis and design of transition governance processes are lacking that specify case-specific intervention points and roles of actors in the implementation of innovations. Third, participatory modeling approaches are only applied to a limited extent in transition research despite a high potential for supporting communication and learning. The conceptualization of multi-level learning developed in this doctoral research conceptualizes learning at different societal levels as specific learning contexts ranging from individual and group contexts to organizational and policy contexts. The conceptual framework further differentiates between learning processes, intensity, objects, outcomes, subjects and factors, allowing for a more detailed analysis of learning within and across learning contexts. Thus, learning contexts can be linked by processes that involve actors from different learning contexts (e.g., community groups and policy-makers), as well as exchanges of physical aspects, institutions and knowledge (in the form of "learning factors"). This research has also provided a classification of model uses in transition research that supports a purposeful discussion of the opportunities of modeling and promising future research directions. The methodology developed in this doctoral research aims at the analysis and design of transition governance processes by specifying the various opportunities to contribute to sustainability transitions through purposeful action at different societal levels, as well as related roles of stakeholders in implementing such processes of change. The methodology combines different streams of previous research: 1) a participatory modeling approach to identify problem perceptions, case-specific sustainability innovations as well as related implementation barriers, drivers and responsibilities; 2) a systematic review to identify supportive and impeding learning factors from the general literature that can complement case-specific factors; and 3) a method for the analysis and design of case-specific transition governance processes. Three case studies in Canada (topic: sustainable food systems), Cyprus (water-energy-food nexus) and Germany (sustainable heating supply) have been selected to test and iteratively develop the methodology described above. The results for each case study reveal that there are learning objects (i.e., learning requirements) in all learning contexts, which underscores the importance of multi-level learning in sustainability transitions, ranging from the individual to the group, organizational and policy levels. Actors have various opportunities to actively facilitate societal transformations towards sustainable development either directly through actions at their particular societal levels (i.e., context-internal learning) or indirectly through actions that influence learning at other societal levels. In fact, most of the learning factors require cooperation across learning contexts during the implementation process. The comparing of learning factors across case studies underline the importance of several factor categories, such as "physical a disturbance or crisis", "information and knowledge". Of the 206 factors identified by stakeholders, 40 factors are case-specific and not contained in the general, review-based factor list. This underscores the value of participatory research, as general, top-down analyses might have overlooked these case-specific factors. The methodology presented in this dissertation allows for the identification and analysis of case-specific intervention points for sustainability transitions at multiple societal levels. The methodology furthermore permits the analysis of interplay between individual, group, organizational and policy actions, which is a first step towards their coordination. The focus on sustainability innovations links the broad topic of sustainability transitions to a set of opportunities for practical interventions and overcoming their implementation barriers. The methodology presented allows for the analysis and design of these interlinkages between learning contexts. While the methodology cannot provide any "silver bullets" for inducing sustainability transitions, it is flexible enough to identify an appropriate abstraction level for analyzing and designing transition governance processes. The methodology developed in this doctoral research also provides several contributions for the development of participatory modeling methods in transition research. Thus, the participatory method supports an integrated analysis of barriers and drivers of sustainability innovations, and allows application in practice and education. The concepts and methods developed in this research project allow for reflection on transition governance processes from a systemic viewpoint. Experiences in the case studies underline the applicability of the concepts and methods developed for the analysis of case-specific transition governance processes. Despite substantial differences in the geographic location, culture and topics addressed, all case studies include promising sustainability innovations and the engagement of multiple actors in their implementation. The diversity and multitude of initiatives in the case study regions provides an optimistic outlook on future opportunities for large-scale sustainability transitions

Concept of an active access for a minimally invasive robotic system for the inspection of aircraft kerosene tanks

The aim of this thesis was to develop a pool of solution concepts for the design of an active access for a minimally invasive robotic system for the inspection of aircraft kerosene tanks. First a short overview of the overall topic of aircraft fuel tank maintenance and aircraft wing fuel tanks was given. An introduction into the parent project FuTaMa and the motivation of the Access Mechanism followed. The theoretical background given in chapter 2 provides fundamental information about the design methodologies, that were used within this Thesis. According to the conceptual design methods the design process was started with the first step ’Clarification and specification of the problem’ establishing a detailed understanding of the problem and the requirements of the system to be designed. Therefore the aircraft wing fuel tank and the Eeloscope , as well as the process of the visual inspection were analysed by researching literature and by discussing the initial conditions in a group session. Several access ports were analysed in terms of the suitability as an entry port for the Eeloscope . After the analysis the access panel was chosen by elimination as the entry point for the Eeloscope . Then the scope of the system was set according to the task description including the aircraft fuel tank, the Eeloscope , the access and the feeder functionality. Based on the results of the problem analysis the problem description was defined in one short and precise sentence namely: ’Design of a system that establishes a leak tight access of the endoscopic diving robot Eeloscope to an aircraft wing fuel, entering the fuel tank at an access panel and generates a bidirectional feeding motion of the Eeloscope ’. As this problem description did not cover all the requirements and restrictions derived in the problem analysis, a list of requirements was created including requirements and restrictions like explosion proofness, leakage integrity etc.. In the next step of the design process, the different required functions of the Access Mechanism were stated and their structural relations were determined and displayed in an functional tree. For the derived functions, potential principle solutions were found by applying different problem solving methods like ’Analogy review’ or ’Brainstorming’. The collected solution principles were sorted, pre-assessed and added to the ordering scheme ’Morphological box’. In the pre-assessment of the sub-function ’Seal off entry port’ it was observed that no founded solution principle will lead to an satisfactory seal of the entry port. Hence an iterative step was introduced starting with expanding the scope of the system including the storage of the hose batch. After the update of the list of requirements and the functional tree, new solution principles to the additional functions that arose, were found and added to a new ’Morphological box’. Next several solution concepts were derived by combining the solution principles contained in the morphological boxes. Then the concepts were accessed by the ’Weighted Point Scoring’ method with the result of feasible solution concepts. In the last but second step of the design process a final solution concept was derived by selecting the best solution concepts of the sub systems. The final solutions concept consists of a new designed access panel which contains an entry port for the Eeloscope . At the access panel the feeder unit is attached by a Cam-Lock-coupling. The feeding motion is generated by two counter rotating concave rolls. The hose batch is located between the concave rolls. The rolls are driven by an electrical motor and a gear and belt setup. The feeding unit is connected to a hose storage unit by a hose equipped again with Cam-Lock couplings. The hose storage unit consist of a barrel that shall enable a helix-shaped arrangement of the hose batch to store it compactly. Finally the solution concept was evaluated by theoretically executing the future maintenance process and by applying a Failure Mode and Effects Analysis (FMEA). At the end a conclusion about the design process and the resulting solution concept was drawn and an outlook was given

The Need for Policy Coordination in Governing the Water-Energy-Food Nexus

Coordination of policies in different sectors and at multiple levels is a major task for governing the water-energy-food nexus. Nexus governance has to deal with plurality of policies that are in place (e.g., interaction of policies across levels). Based on an overview of governance challenges, this report provides insights into policy instruments and experiences in their application at the global, national, regional and local levels. Institutional innovation is needed to develop democratic and participatory approaches that address the water-energy-food nexus. Another requirement is the development and implementation of binding environmental targets (e.g. water quality standards, land use distribution) which should be set at national or supranational levels. However, context-specific pathways should be established for different regions to achieve those targets. Various examples are provided to illustrate challenges and solutions to the implementation of a nexus governance approach

Use of Participatory System Dynamics Modelling for Collaborative Watershed Management in Québec, Canada

The participation of stakeholders is an important component in integrated and adaptive watershed planning and management. In Québec, Canada watershed organizations are in the process of implementing participatory based watershed planning and management schemes. However, there is a lack of simple and readily implementable frameworks and methods to explicitly involve stakeholders, as well as integrate physical and social processes in watershed planning and management in Québec. The application of the first three stages of a newly proposed five stage stepwise ‘Participatory Model Building’ framework’ is described that was developed to help facilitate the participatory investigation of problems in watershed planning and management through the use of the systems thinking approach (causal loop diagrams). In the Du Chêne watershed in Québec, eight individual stakeholder interviews were conducted in cooperation with the local watershed organization to develop qualitative system dynamics models that represent the main physical and social processes underlying the problem of water pollution. The method was found to be accessible for all the interviewees, and was deemed to be very useful by the watershed organization to develop an overview of the different perspectives of the main stakeholders in the watershed. The results of this study demonstrate the diversity of perspectives regarding the water quality problem in the Du Chêne watershed, and highlight the critical need for participatory approaches to help solve water quality problems. Based on the results generated in this study, stakeholders can jointly discuss diverging points of view, goals and interests by referring to a concrete system structure. This discussion process can again be facilitated by a group-built causal loop diagram and its subsequent conversion into a quantitative system dynamics model (describing the socioeconomic-political components of the watershed)

A Methodological Framework to Initiate and Design Transition Governance Processes

Abstract: Sustainability transitions require societal change at multiple levels ranging from individual behavioral change to community projects, businesses that offer sustainable products as well as policy-makers that set suitable incentive structures. Concepts, methods and tools are currently lacking that help to initiate and design transition governance processes based upon an encompassing understanding of such diverse interactions of actors and intervention points. This article presents a methodological framework for the initiation and design of transition governance processes. Based upon a conceptualization of sustainability transitions as multilevel learning processes, the methodological framework includes participatory modeling, a systematic literature review and governance system analysis to identify social units (learning subjects and contexts), challenges (learning objects) and intervention points (learning factors) relevant for initiating case-specific transition governance processes. A case study on sustainable food systems in Ontario, Canada is provided to exemplify the application of the methodological framework. The results demonstrate the merit of combining stakeholder-based and expert-based methods, as several learning factors identified in the participatory process could not be found in the general literature, and vice versa. The methodological framework allowed for an integrated analysis of the diversity of existing initiatives in the case study region and specific intervention points to support place-based sustainability innovations. Initiators of transition governance processes can use the results by designing targeted interventions to facilitate and coordinate existing initiatives or by setting new impulses through purposeful action

Participatory modeling for transition governance : linking methods to process phases

Participatory modeling - the involvement of stakeholders in the modeling process - can support various objectives, such as stimulating learning processes or promoting mutual understanding of stakeholders. Participatory modeling approaches could therefore be useful for the governance of transitions, but a systematic account of potential application areas of participatory modeling methods in transition governance is still lacking. This article addresses this gap by providing a review of participatory modeling methods and linking them to phases and objectives of transition governance. We reviewed participatory modeling studies in transition research and related fields of social-ecological modeling, integrated assessment and environmental management. We find that participatory modeling methods are mostly used for participatory visioning and goal setting as well as for interactive strategy development. The review shows the potential for extending the application of participatory modeling methods to additional phases of transition governance and for the exchange of experiences between research fields

Integrated and Participatory Design of Sustainable Development Strategies on Multiple Governance Levels

An increasing number of sustainable development strategies (SDS) is being developed for cities, municipalities and countries. The design of such strategies is inherently complex. This is a result from intricate relationships between different SDS on different levels, and a large number of requirements that need to be addressed in strategy implementation. A particular challenge is the integration of strategies across different governance levels (e.g., city, federal, and national levels). Methodologies are currently lacking to systematically design SDS which take the full complexity of the dependencies of the strategies into account. In this article, we propose a participatory requirements analyses approach to support strategy building across governance levels. Experience from systems engineering (SE) has shown, that requirements are the basis for designing systems or strategies. We elicit requirements by applying a participatory modeling approach with causal-loop diagrams in an individual interview setting. To illustrate our approach, we test the developed design approach and focus on the interdependencies between SDS at the city level (i.e., the cities of Berlin and Hamburg) and the German national SDS. The design process reveals critical factors which are needed for the overall success of the strategies. The resulting causal models reveal that despite coordination activities of the regional objectives with the national targets, trade-offs exist between the strategies regarding the underlying conditions for their implementation (e.g., national law, federal and state law). In addition, the level of detail of requirements for certain objectives at the national level and across sectors is too general. This hinders the emergence of system-wide co-benefits of possible solution strategies. Requirements analysis can highlight interdependencies, such as trade-offs and synergies, between strategies at multiple governance levels and, based upon this, can support a more coherent strategy design