Suchergebnisse

Funding: he support of the study in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris Pour la Recherche is greatly appreciated. In Norway, the study was supported by a grant from Health Region West. In addition, EOSCsecretariat.eu provided support and has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Forschungskommission of the Medical Faculty of Heinrich-Heine-University Düsseldorf (grant 2018-32 to GW and grant 2020-21 to RB for a Clinician Scientist Track). The complete list of COVIP collaborators is provided in Multimedia Appendix 10. ; BACKGROUND: The SARS-CoV-2 coronavirus disease (COVID-19) pandemic is challenging health care systems globally. The disease disproportionately affects the elderly population, both in terms of disease severity and mortality risk. OBJECTIVE: This study aimed to evaluate machine-learning based prognostication models for critically ill elderly COVID-19 patients, which dynamically incorporated multifaceted clinical information on the evolution of the disease. METHODS: This multi-centre cohort study obtained patient data from 151 ICUs from 26 countries (COVIP study). Different models based on the Sequential Organ Failure Assessment (SOFA), Logistic Regression (LR), Random Forest (RF) and Extreme Gradient Boosting (XGBoost) were derived as baseline models that included admission variables only. We subsequently included clinical events and time-to-event as additional variables to derive the final models using the same algorithms and compared their performance with the baseline group. Furthermore, we derived baseline and final models on a European patient cohort and externally validated them on a non-European cohort that included Asian, African and American patients. RESULTS: In total, 1,432 elderly (≥70 years) COVID-19 positive patients were admitted to an intensive care unit. Of these 809 (56.5%) patients survived up to 30 days after admission. The average length of stay was 21.6 (±18.2) days. Final models that incorporated clinical events and time-to-event provided superior performance with AUC of 0.81 (95% CI 0.804-0.811), with respect to both, the baseline models that used admission variables only and conventional ICU prediction models (SOFA-score, p<.001). The average precision increased from 0.65 (95% CI 0.650-0.655) to 0.77 (95% CI 0.759-0.770). CONCLUSIONS: Integrating important clinical events and time-to-event information led to a superior accuracy of 30-day mortality prediction compared with models based on the admission information and conventional ICU prediction models. The present study shows that machine-learning models provide additional information and may support complex decision-making in critically ill elderly COVID-19 patients. CLINICALTRIAL: Nct04321265. ; publishersversion ; published

In June-November 2020, SARS-CoV-2-infected mink were detected in 290 of 1,147 Danish mink farms. In North Denmark Region, 30% (324/1,092) of people found connected to mink farms tested SARS-CoV- 2-PCR-positive and approximately 27% (95% confidence interval (CI): 25-30) of SARS-CoV-2-strains from humans in the community were mink-associated. Measures proved insufficient to mitigate spread. On 4 November, the government ordered culling of all Danish mink. Farmed mink constitute a potential virus reservoir challenging pandemic control.

In June–November 2020, SARS-CoV-2-infected mink were detected in 290 of 1,147 Danish mink farms. In North Denmark Region, 30% (324/1,092) of people found connected to mink farms tested SARS-CoV-2-PCR-positive and approximately 27% (95% confidence interval (CI): 25–30) of SARS-CoV-2-strains from humans in the community were mink-associated. Measures proved insufficient to mitigate spread. On 4 November, the government ordered culling of all Danish mink. Farmed mink constitute a potential virus reservoir challenging pandemic control.

Die Konfrontation der politischen Blöcke nach 1945 hatte für Dekaden erhebliche Auswirkungen, nicht zuletzt auf die Jugend, ihre Formen der Vergemeinschaftung und Organisation. In Ost und West gehörten bis zur Perestroika Ende der 1980er Jahre Jugendliche zu einer umkämpften Gruppe, der als Teil der Systemkonkurrenz politisch erhebliche Aufmerksamkeit zukam. Unter dem zunehmenden Einfluss der Massenkultur veränderte sich zudem das Freizeitleben der Jugendlichen. Gleichzeitig etablierten seit den 1960er Jahren Jugendliche innerhalb internationaler Protest-, Ostermarsch- und Friedensbewegungen neue Formen des Protestes. Durch diese neuen Konstellationen verloren die Offerten der Jugendbewegung sowie der klassischen politischen und konfessionellen Jugendorganisationen an Anziehungskraft. Was dies für Jugendliche, Jugendgruppen, Jugendbewegungen und Jugendkulturen in beiden deutschen Staaten hieß, ist Gegenstand dieses Buches, das damit einen Beitrag zur deutsch-deutschen Verflechtungsgeschichte leistet.

Central terms and concepts / Pamela Maseko, H. Ekkehard Wolff and Russell H. Kaschula -- Introduction / Russell H. Kaschula, H. Ekkehard Wolff and Pamela Maseko -- Prologue : the essentialist paradox in intellectual discourse on African languages / H. Ekkehard Wolff -- part one. African language empowerment : concept formation and intellectualisation -- 1. Researching the intellectualisation of African languages, multilingualism and education / Russell H. Kaschula and Pamela Maseko -- 2. Language empowerment and intellectualisation through multilingual higher education in South Africa / Pamela Maseko and H. Ekkehard Wolff -- part two. Language planning, terminology development and dictionaries -- 3. Language planning in South Africa : a history / Gregory Kamwendo and Nobuhle Ndimande-Hlongwa -- 4. Language and terminology development in isiXhosa : a history / Koliswa Moropa and Feziwe Shoba -- 5. Multilingual terminology and cognition in assessment / Bassey E. Antia -- 6. IsiXhosa dictionaries, language learning and intercultural communication / Dion Nkomo -- part three. Language in education -- 7. Managing multilingualism in education : policies and practices / Anneke Potgieter and Christine Anthonissen -- 8. University multilingualism : modelling rationales for language policies / Bassey E. Antia -- 9. Language development and multilingualism at the Cape Peninsula University of Technology / Monwabisi K. Ralarala, Eunice Ivala, Ken Barris, Noleen Leach, Linda Manashe and Zakhile Somlata -- 10. Teacher development : promoting a biliteracy approach to epistemic access / Michael Joseph, Nompumelelo Frans and Esther Ramani -- part four. Language in the professions : law, media, science and language technology -- 11. Language and law : 'cultural translation' of narratives into sworn statements / Monwabisi K. Ralarala -- 12. Language and media : isiXhosa in journalism and media studies at a South African university / Jeanne du Toit and Pamela Maseko -- 13. Using African languages to teach science in higher education / Wanga Gambushe, Dion Nkomo and Pamela Maseko -- 14. The development of language technologies in the South African context / Justus C. Roux -- part five. Language, culture and intercultural communication -- 15. Language policy in South Africa through the Sapir-Whorf 'looking glasses' / Russell H. Kaschula and Andre M. Mostert -- 16. Language, intercultural communication and literature / Nogwaja S. Zulu -- 17. Music, literature and multilingualism in the East Cape Opera Company / Hleze Kunju and Russell H. Kaschula -- 18. Beyond language : German Studies in a South African university context / Undine S. Weber, Rebecca S.C. Domingo and Regine B. Fourie

Funding: This study was endorsed by the ESICM. Free support for running the electronic database was granted from the Department of Epidemiology, Aarhus University, Denmark. The support of the study in France by a grant from 'Fondation Assistance Publique-Hôpitaux de Paris pour la recherche' is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union's Horizon 2020 Framework Programme called H2020-INFRAEOSC-05-2018-2019, Grant Agreement Number 831644. This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf, No. 2018-32 to G.W. and No. 2020-21 to R.R.B. for a Clinician Scientist Track. Open access funding was enabled and organized by Projekt DEAL. No (industry) sponsorship has been received for this investigator-initiated study. ; AIMS: Chronic heart failure (CHF) is a major risk factor for mortality in coronavirus disease 2019 (COVID-19). This prospective international multicentre study investigates the role of pre-existing CHF on clinical outcomes of critically ill old (≥70 years) intensive care patients with COVID-19. METHODS AND RESULTS: Patients with pre-existing CHF were subclassified as having ischaemic or non-ischaemic cardiac disease; patients with a documented ejection fraction (EF) were subclassified according to heart failure EF: reduced (HFrEF, n = 132), mild (HFmrEF, n = 91), or preserved (HFpEF, n = 103). Associations of heart failure characteristics with the 30 day mortality were analysed in univariate and multivariate logistic regression analyses. Pre-existing CHF was reported in 566 of 3917 patients (14%). Patients with CHF were older, frailer, and had significantly higher SOFA scores on admission. CHF patients showed significantly higher crude 30 day mortality [60% vs. 48%, P < 0.001; odds ratio 1.87, 95% confidence interval (CI) 1.5-2.3] and 3 month mortality (69% vs. 56%, P < 0.001). After multivariate adjustment for confounders (SOFA, age, sex, and frailty), no independent association of CHF with mortality remained [adjusted odds ratio (aOR) 1.2, 95% CI 0.5-1.5; P = 0.137]. More patients suffered from pre-existing ischaemic than from non-ischaemic disease [233 vs. 328 patients (n = 5 unknown aetiology)]. There were no differences in baseline characteristics between ischaemic and non-ischaemic disease or between HFrEF, HFmrEF, and HFpEF. Crude 30 day mortality was significantly higher in HFrEF compared with HFpEF (64% vs. 48%, P = 0.042). EF as a continuous variable was not independently associated with 30 day mortality (aOR 0.98, 95% CI 0.9-1.0; P = 0.128). CONCLUSIONS: In critically ill older COVID-19 patients, pre-existing CHF was not independently associated with 30 day mortality. TRIAL REGISTRATION NUMBER: NCT04321265. ; publishersversion ; epub_ahead_of_print

Open Access funding enabled and organized by Projekt DEAL. This study was endorsed by the ESICM. Free support for running the electronic database and was granted from the dep. of Epidemiology, University of Aarhus, Denmark. Bruno et al. Annals of Intensive Care (2022) 12:26 Page 10 of 11 The support of the study in France by a grant from Fondation Assistance Publique-Hôpitaux de Paris pour la recherche is greatly appreciated. In Norway, the study was supported by a grant from the Health Region West. In addition, the study was supported by a grant from the European Open Science Cloud (EOSC). EOSCsecretariat.eu has received funding from the European Union's Horizon Programme call H2020-INFRAEOSC-05-2018-2019, grant agreement number 831644. This work was supported by the Collaborative Research Center SFB 1116 (German Research Foundation, DFG) and by the Forschungskommission of the Medical Faculty of the Heinrich-Heine-University Düsseldorf and No. 2020–21 to RRB for a Clinician Scientist Track. No (industry) sponsorship has been received for this investigator-initiated study. ; PURPOSE: Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group. METHODS: The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders. RESULTS: This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). ...

Deliverable 1.2 is intended to be a guide, a structured interpretation and evaluation of the current knowledge used to collate evidence on intended outcomes and unintended impacts of UF-NBS for urban ecosystem regeneration and human wellbeing. The information reported herein is based on the compilation of a reference-recorded knowledge repository of UF-NBS and their impacts on urban liveability, public health, halting biodiversity loss and re-diversifying UF-NBS structures to enhance urban resilience; specifically, Task 1.2 - Reviewing the knowledge on the importance of UF-NBS for resilient cities - and M1.3 - the Repository on UF-NBS for resilient cities in China and Europe. Sections 2 and 3 of deliverable D1.2a are intended to provide a review of current UF-NBS practices in Europe and China. The in-depth coverage of these UF-NBS case studies is further expanded in Appendix 1 by reviewing the grey literature, i.e. the project and official reports, planning strategies, as well as scientific publications that span the territory of EU Member States and China. This documentation highlights the main goals and methodologies used in UF-NBS research and implementation, policy implications and NBS typology and functions, i.e., ecosystem services, within the frame of Task 1.2, as well as case history templates (Task 1.4). In Section 4, a comparative analysis of case histories provides conclusive insights into common or contrasting aspects in and between these two continents. Final considerations drawn from the comparative analysis of the intended outcomes of UF-NBS implementation include lessons that can be learned and existing knowledge gaps. In Section 5, a Sino-European analysis, in the form of a modelling exercise, was conducted of the selected case histories to explore shared themes, such as connectivity, multifunctionality and social cohesion, and macro-categories (i.e., ecological, engineering, social and economic macro-categories) for urban regeneration and renaturing. The second part, D1.2b, presents a review of ...

Background: Due to the increasing shortage of specialists, disproportionately rising costs and inadequate quality of care, Germany is planning a fundamental hospital reform. The government commission has developed the central principles for this reform. The aim is to achieve a centralization of hospital services in oversupplied metropolitan areas by planning according to groups of services based on defined requirements for structural quality. The economic pressure to increase the number of cases shall be reduced through the introduction of a reserve payment and by dividing hospitals into levels - at least by transparent information for the general public. So far, however, there has been no generic model to determine the significance of specific care providers considering population needs (reachability), capacity of a hospital location, and the number and severity of treated patients. Methods: We developed a generic model to determine the significance of hospital location-related care and the need for the various groups of services. The model may also be used to assess reserve financing. For the model, the groups of services were divided into four categories according to degree of specialization and urgency with limits of reachability of 30, 45, 90 and 180 minutes. Gravity models were used to simulate the population-based significance of care providers for each group of services. In the basic model, the allocation of the significance was based exclusively on the reachability for the population living within the respective reachability corridor. In extended models, the historical number of cases and their case severity were also taken into account in order to account for current care capacities and existing choices of the population regarding, among other things, the quality of care. The model was implemented on the basis of nationwide data provided in accordance with § 21 data (of the German law for hospital remuneration). We then determined the effects of weighting the three influencing variables (i) population, (ii) number of cases and (iii) case severity on the significance of the hospital sites. Using the example of "endoprosthetics of the knee" (service group 14.2 in North Rhine-Westphalia) in the federal state of Saxony, the effect of concentration on the distribution of the reserve budgets and on the accessibility of the population was illustrated. The importance of care determined in this way is contrasted with a key value that reflects the need for hospitals in terms of securing care in rural areas. Results: From the approximately 16.5 million somatic treatment cases in 2021, 98.5% could be assigned to one of the 60 somatic groups of services according to North Rhine-Westphalia model. The simulation models show a differentiated picture for the various service groups. For the majority of service groups, a moderate concentration of services does not lead to relevant restrictions in terms of reachability. Exclusively considering the population to be cared for (basic model) would lead to significant shifts in the financing of running costs, which are, however, very well mitigated by considering the historic number and severity of cases (extended models). As an example, we show the effects for the service group "endoprosthetics of the knee" in the federal state of Saxony compared to the extrapolation at location level. Discussion: The empirically based simulation model proposed here takes into account reachability, patient preference and hospital capacity and offers a scientific way of comparing the regional significance of care providers as well as the necessity of hospital locations for each service group against the background of the state's obligation to provide care and to make economical use of resources. The simulation model is meant to support hospital planning (here: the allocation of groups of services) in the federal states and to guide rational planning. It is also suitable for the management of financial resources in the context of hospital reform. It also enables an impact analysis. The model is not intended to automate planning or otherwise make rigid specifications. The calculations should be regarded as exemplary. The weights of all parameters can be varied. However, the reachability thresholds and the parameterization of the simulation model should be defined jointly by federal and state governments in terms of a common set of objectives.

IntroductionLatinos living with HIV in the Americas share a common ethnic and cultural heritage. In North America, Latinos have a relatively high rate of new HIV infections but lower rates of engagement at all stages of the care continuum, whereas in Latin America antiretroviral therapy (ART) services continue to expand to meet treatment needs. In this analysis, we compare HIV treatment outcomes between Latinos receiving ART in North America versus Latin America.MethodsHIV‐positive adults initiating ART at Caribbean, Central and South America Network for HIV (CCASAnet) sites were compared to Latino patients (based on country of origin or ethnic identity) starting treatment at North American AIDS Cohort Collaboration on Research and Design (NA‐ACCORD) sites in the United States and Canada between 2000 and 2011. Cox proportional hazards models compared mortality, treatment interruption, antiretroviral regimen change, virologic failure and loss to follow‐up between cohorts.ResultsThe study included 8400 CCASAnet and 2786 NA‐ACCORD patients initiating ART. CCASAnet patients were younger (median 35 vs. 37 years), more likely to be female (27% vs. 20%) and had lower nadir CD4 count (median 148 vs. 195 cells/µL, p<0.001 for all). In multivariable analyses, CCASAnet patients had a higher risk of mortality after ART initiation (adjusted hazard ratio (AHR) 1.61; 95% confidence interval (CI): 1.32 to 1.96), particularly during the first year, but a lower hazard of treatment interruption (AHR: 0.46; 95% CI: 0.42 to 0.50), change to second‐line ART (AHR: 0.56; 95% CI: 0.51 to 0.62) and virologic failure (AHR: 0.52; 95% CI: 0.48 to 0.57).ConclusionsHIV‐positive Latinos initiating ART in Latin America have greater continuity of treatment but are at higher risk of death than Latinos in North America. Factors underlying these differences, such as HIV testing, linkage and access to care, warrant further investigation.

Undocumented Migrants (UDM) belong to the most vulnerable groups in times of global emergency situations. COVID-19 does hit hardest the most vulnerable groups and it is important to create an evidence base to guide policy making. The Center for Health and Migration, Vienna, has initiated a stock-taking of national regulations concerning access to health and social care for UDM. The initiative aims to create a landscape of policy frameworks to inform policy making and practice development. National experts on health and migration are contacted and asked to provide information on the respective legal frameworks in the following categories: work, housing, compulsory education, social welfare, and health. A validated template is used for data collection.

How much credit can be given to entrepreneurship for the unprecedented innovation and growth of free-enterprise economies? In this book, some of the world's leading economists tackle this difficult and understudied question, and their responses shed new light on how free-market economies work--and what policies most encourage their growth. The contributors take as their starting point William J. Baumol's 2002 book The Free-Market Innovation Machine (Princeton), which argued that independent entrepreneurs are far more important to growth than economists have traditionally thought, and that an implicit partnership between such entrepreneurs and large corporations is critical to the success of market economies. The contributors include the editors and Robert M. Solow, Kenneth J. Arrow, Michael M. Weinstein, Douglass C. North, Barry R. Weingast, Ying Lowrey, Nathan Rosenberg, Melissa A. Schilling, Corey Phelps, Sylvia Nasar, Boyan Jovanovic, Peter L. Rousseau, Edward N. Wolff, Deepak Somaya, David J. Teece, Naomi R. Lamoreaux, Kenneth L. Sokoloff, Yochanan Shachmurove, Ralph E. Gomory, Jonathan Eaton, Samuel S. Kortum, Alan S. Blinder, Robert J. Shiller, Burton G. Malkiel, and Edmund S. Phelps

Aktuell überschlagen sich Vorschläge, wie auf den Krieg in der Ukraine energiepolitisch zu reagieren ist. Ein Schlüsselprinzip rückt dabei erst langsam ins öffentliche Bewusstsein: Energiesuffizienz. Das bedeutet, den Bedarf an Energie zu senken. Energiesuffizienz senkt Kosten, reduziert den Bedarf an Zukäufen, macht energiepolitisch unabhängiger und ist klimapolitisch hilfreich. Sie muss jetzt zu einem zentralen Prinzip politischen Handelns werden. Eine ergänzende Veröffentlichung zu einer Sammlung verschiedener Materialien zu Maßnahmenvorschlägen und Potenzialabschätzungen zu den Themen Energiesuffizienz, Energieeffizienz und Energieunabhängigkeit ist unter https://doi.org/10.5281/zenodo.6405817 abrufbar.

PURPOSE OF REVIEW: Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities. RECENT FINDINGS: Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered. SUMMARY: Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning ...