Discharge of iodine-containing contrast media into the environment - problem analysis and implementation of measures to reduce discharge by means of separation toilets - experience from a pilot project. / Herausforderung Eintrag jodhaltiger Röntgenkontrastmitteln in die Umwelt ­ Problemanalyse sowie Umsetzung erster Maßnahmen zur Reduktion des Eintrags mittels Trenntoiletten ­ Erfahrungen aus einem Pilotprojekt.

PURPOSE: Environmental aspects and sustainability are becoming increasingly important. In addition to energy consumption, the consumption and environmental discharge of contrast agents pose a particular challenge. Because of their desired stability, X-ray contrast agents (XCAs) are deposited in surface water at a rate of up to 400 tons per year. MATERIALS AND METHODS: In a pilot project, a set of measures (installation of specific separation toilets, the establishment of feedback systems, interviews, questionnaires, and observation) was implemented to sensitize patients and staff to the problem of XCAs during outpatient CT examinations and a retention and recovery system for XCAs was evaluated. RESULTS: In the initial baseline phase, a separation toilet with an additional collection system and a feedback/button system was installed. The built-in feedback system indicated that the separation toilets were used by approx. 16 % of patients without measures. In two subsequent intervention phases, accompanying measures significantly (p < 0.01) increased the use of these separation toilets to 21 % and 25 %, respectively. The measures to reduce the discharge of XCAs were positively assessed by both staff and patients. CONCLUSION: Measures to reduce the discharge of XCAs into the environment have a high acceptance among staff and patients. The subsequent installation of separation toilets is one possibility to achieve on-site retention of XCAs. However, this measure is likely to be of high value only if patients stay on site for a correspondingly long time, as is the case in cardiology, for example. KEY POINTS: · The input of X-ray contrast agents into the environment is relevant in light of the quantity. · Measures to reduce the discharge of X-ray contrast agents into the environment have been investigated in pilot projects. · The (subsequent) installation of separation toilets is possible and allows retention of X-ray contrast agents. · This measure is considered useful by patients and staff. · The financing of these measures needs to be clarified. CITATION FORMAT: · Beer M, Schuler J, Kraus E et al. Discharge of iodine-containing contrast media into the environment - problem analysis and implementation of measures to reduce discharge by means of separation toilets - experience from a pilot project. Fortschr Röntgenstr 2023; 195: 1122 - 1127.

Towards diverse agricultural land uses: socio-ecological implications of European agricultural pathways for a Swiss orchard region.

Diverse agricultural land uses are a typical feature of multifunctional landscapes. The uncertain change in the drivers of global land use, such as climate, market and policy technology and demography, challenges the long-term management of agricultural diversification. As these global drivers also affect smaller scales, it is important to capture the traits of regionally specific farm activities to facilitate adaptation to change. By downscaling European shared socioeconomic pathways (SSPs) for agricultural and food systems, combined with representative concentration pathways (RCP) to regionally specific, alternative socioeconomic and climate scenarios, the present study explores the major impacts of the drivers of global land use on regional agriculture by simulating farm-level decisions and identifies the socio-ecological implications for promoting diverse agricultural landscapes in 2050. A hilly orchard region in northern Switzerland was chosen as a case study to represent the multifunctional nature of Swiss agriculture. Results show that the different regionalised pathways lead to contrasting impacts on orchard meadows, production levels and biodiversity. Increased financial support for ecological measures, adequate farm labour supplies for more labour-intensive farming and consumer preferences that favour local farm produce can offset the negative impacts of climate change and commodity prices and contribute to agricultural diversification and farmland biodiversity. However, these conditions also caused a significant decline in farm production levels. This study suggests that considering a broader set of land use drivers beyond direct payments, while acknowledging potential trade-offs and diverse impacts across different farm types, is required to effectively manage and sustain diversified agricultural landscapes in the long run. Supplementary information: The online version contains supplementary material available at 10.1007/s10113-023-02092-5.

Effects of state-wide implementation of the Los Angeles Motor Scale for triage of stroke patients in clinical practice.

BACKGROUND: The prehospital identification of stroke patients with large-vessel occlusion (LVO), that should be immediately transported to a thrombectomy capable centre is an unsolved problem. Our aim was to determine whether implementation of a state-wide standard operating procedure (SOP) using the Los Angeles Motor Scale (LAMS) is feasible and enables correct triage of stroke patients to hospitals offering (comprehensive stroke centres, CSCs) or not offering (primary stroke centres, PSCs) thrombectomy. METHODS: Prospective study involving all patients with suspected acute stroke treated in a 4-month period in a state-wide network of all stroke-treating hospitals (eight PSCs and two CSCs). Primary endpoint was accuracy of the triage SOP in correctly transferring patients to CSCs or PSCs. Additional endpoints included the number of secondary transfers, the accuracy of the LAMS for detection of LVO, apart from stroke management metrics. RESULTS: In 1123 patients, use of a triage SOP based on the LAMS allowed triage decisions according to LVO status with a sensitivity of 69.2% (95% confidence interval (95%-CI): 59.0-79.5%) and a specificity of 84.9% (95%-CI: 82.6-87.3%). This was more favourable than the conventional approach of transferring every patient to the nearest stroke-treating hospital, as determined by geocoding for each patient (sensitivity, 17.9% (95%-CI: 9.4-26.5%); specificity, 100% (95%-CI: 100-100%)). Secondary transfers were required for 14 of the 78 (17.9%) LVO patients. Regarding the score itself, LAMS detected LVO with a sensitivity of 67.5% (95%-CI: 57.1-78.0%) and a specificity of 83.5% (95%-CI: 81.0-86.0%). CONCLUSIONS: State-wide implementation of a triage SOP requesting use of the LAMS tool is feasible and improves triage decision-making in acute stroke regarding the most appropriate target hospital.

Quantification of myocardial strain assessed by cardiovascular magnetic resonance feature tracking in healthy subjects-influence of segmentation and analysis software.

OBJECTIVES: Quantification of myocardial deformation by feature tracking is of growing interest in cardiovascular magnetic resonance. It allows the assessment of regional myocardial function based on cine images. However, image acquisition, post-processing, and interpretation are not standardized. We aimed to assess the influence of segmentation procedure such as slice selection and different types of analysis software on values and quantification of myocardial strain in healthy adults. METHODS: Healthy volunteers were retrospectively analyzed. Post-processing was performed using CVI42 and TomTec. Longitudinal and radialLong axis (LAX) strain were quantified using 4-chamber-view, 3-chamber-view, and 2-chamber-view. Circumferential and radialShort axis (SAX) strain were assessed in basal, midventricular, and apical short-axis views and using full coverage. Global and segmental strain values were compared to each other regarding their post-processing approach and analysis software package. RESULTS: We screened healthy volunteers studied at 1.5 or 3.0 T and included 67 (age 44.3 ± 16.3 years, 31 females). Circumferential and radialSAX strain values were different between a full coverage approach vs. three short slices (- 17.6 ± 1.8% vs. - 19.2 ± 2.3% and 29.1 ± 4.8% vs. 34.6 ± 7.1%). Different analysis software calculated significantly different strain values. Within the same vendor, different field strengths (- 17.0 ± 2.1% at 1.5 T vs. - 17.0 ± 1.7% at 3 T, p = 0.845) did not influence the calculated global longitudinal strain (GLS), and were similar in gender (- 17.4 ± 2.0% in females vs. - 16.6 ± 1.8% in males, p = 0.098). Circumferential and radial strain were different in females and males (circumferential strain - 18.2 ± 1.7% vs. - 17.1 ± 1.8%, p = 0.029 and radial strain 30.7 ± 4.7% vs. 27.8 ± 4.6%, p = 0.047). CONCLUSIONS: Myocardial deformation assessed by feature tracking depends on segmentation procedure and type of analysis software. CircumferentialSAX and radialSAX depend on the number of slices used for feature tracking analysis. As known from other imaging modalities, GLS seems to be the most stable parameter. During follow-up studies, standardized conditions should be warranted. Trial registration Retrospectively registered KEY POINTS: • Myocardial deformation assessed by feature tracking depends on the segmentation procedure. • Global myocardial strain values differ significantly among vendors. • Standardization in post-processing using CMR feature tracking is essential.

The Effect of Money Priming on Self-Focus in the Imitation-Inhibition Task.

The self-sufficiency hypothesis suggests that priming individuals with money makes them focus more strongly on themselves than on others. However, recently, research supporting this claim has been heavily criticized and some attempts to replicate have failed. A reason for the inconsistent findings in the field may lay in the common use of explicit measures, because they tend to rely on one or just a few items and are thus prone to demand effects and low reliability. In the present research, we administered, in two experiments, the imitation-inhibition task - a robust, unobtrusive, and reliable paradigm that is sensitive to self-other focus on a trial-by-trial basis. A pilot study found an increased focus on the self as compared to others when primed with money. Building on this finding, a preregistered high-powered experiment replicated this effect, suggesting that money primes may indeed increase a focus on the self. An additionally carried out meta-analysis indicates that automatic imitation is modulated by self-other focus and that money primes lead to a smaller focus on the self than conventional methods. Overall, the found effects are rather small and several limitations, such as order effects, call for a cautious interpretation of the findings.

Detection and Monitoring of Acute Myocarditis Applying Quantitative Cardiovascular Magnetic Resonance.

BACKGROUND: Cardiovascular magnetic resonance based on the Lake Louise Criteria is used to make the diagnosis of acute myocarditis. Novel quantitative parametric mapping techniques promise to overcome some of its limitations. We aimed to evaluate quantitative cardiovascular magnetic resonance to detect and monitor acute myocarditis. METHODS AND RESULTS: Eighteen patients with clinical diagnosis of acute myocarditis (25 years [23-38 years]; 78% males) were prospectively enrolled and repeatedly underwent cardiovascular magnetic resonance at 1.5 T seven days (5-10 days) after symptom onset (FU0), after 5 weeks (FU1), and after 6 months (FU2). Eighteen age- and sex-matched healthy subjects served as controls. Cardiovascular magnetic resonance included imaging of edema, hyperemia, necrosis, and fibrosis using semiquantitative T2-weighted spin echo, T2 mapping, and T1 mapping before and 3 and 10 minutes after gadobutrol administration. Extracellular volume for diffuse and late gadolinium enhancement for focal fibrosis were assessed. Compared with controls, patients had significantly higher global T2 times at FU0 (55.1 ms [53.3-57.2 ms] versus 50.2 ms [49.2-52.0 ms]; P<0.001) and at FU1 (52.0 ms [52.0-53.2 ms]; P=0.007), which normalized at FU2 (50.9 ms [49.6-53.3 ms]; P=0.323). Global native T1 times in patients were elevated acutely (1004 ms [988-1048 ms] versus 975 ms [957-1004 ms]; P=0.002) and remained elevated throughout the follow-up (FU1: 998 ms [990-1027 ms]; P=0.014; FU2: 1000 ms [972-1027 ms]; P=0.044). Global extracellular volume fraction was statistically not different between patients and controls (P=0.057). 77.8% (14/18) of patients had focal late gadolinium enhancement. T2 ratio was significantly elevated in patients with myocarditis at FU0 (2.2 [2.0-2.3] versus 1.6 [1.5-1.7]; P<0.001). The difference decreased during follow-up (FU1: 1.9 [1.7-1.9]; P=0.001 and FU2: 1.7 [1.7-1.8]; P=0.053). The diagnostic accuracy to discriminate between patients with acute myocarditis and healthy controls was 86% for T2>52 ms, 78% for native T1>981 ms, 74% for extracellular volume fraction >0.24, and 100% for T2 ratio >1.9. CONCLUSIONS: Although both T2 and T1 mapping reliably detected acute myocarditis, only T2 mapping discriminated between acute and healed stages, underlining the incremental value of T2 mapping.

Prospective, randomized comparison of gadopentetate and gadobutrol to assess chronic myocardial infarction applying cardiovascular magnetic resonance.

BACKGROUND: We hypothesized that the contrast medium gadobutrol is not inferior compared to Gd-DTPA in identifying and quantifying ischemic late gadolinium enhancement (LGE), even by using a lower dose. METHODS: We prospectively enrolled 30 patients with chronic myocardial infarction as visualized by LGE during clinical routine scan at 1.5 T with 0.20 mmol/kg Gd-DTPA. Participants were randomized to either 0.15 mmol/kg gadobutrol (group A) or 0.10 mmol/kg gadobutrol (group B). CMR protocol was identical in both exams. LGE was quantified using a semiautomatic approach. Signal intensities of scar, remote myocardium, blood and air were measured. Signal to noise (SNR) and contrast to noise ratios (CNR) were calculated. RESULTS: Signal intensities were not different between Gd-DTPA and gadobutrol in group A, whereas significant differences were detected in group B. SNR of injured myocardium (53.5+/-21.4 vs. 30.1+/-10.4, p = 0.0001) and CNR between injured and remote myocardium (50.3+/-20.3 vs. 27.3+/-9.3, p < 0.0001) were lower in gadobutrol. Infarct size was lower in both gadobutrol groups compared to Gd-DTPA (group A: 16.8+/-10.2 g vs. 12.8+/-6.8 g, p = 0.03; group B: 18.6+/-12.0 g vs. 14.0+/-9.9 g, p = 0.0016). CONCLUSIONS: Taking application of 0.2 mmol/kg Gd-DTPA as the reference, the delineation of infarct scar was similar with 0.15 mmol/kg gadobutrol, whereas the use 0.10 mmol/kg gadobutrol led to reduced tissue contrast. TRIAL REGISTRATION: The study had been registered under EudraCT Number: 2010-020775-22. Registration date: 2010.08.10.

Adoption potential of conservation agriculture practices in sub-Saharan Africa: results from five case studies.

Despite the reported benefits of conservation agriculture (CA), its wider up-scaling in Sub-Saharan Africa (SSA) has remained fairly limited. This paper shows how a newly developed qualitative expert assessment approach for CA adoption (QAToCA) was applied to determine its adoption potential in SSA. CA adoption potential is not a predictor of observed adoption rates. Instead, our aim was to systematically check relevant factors that may be influencing its adoption. QAToCA delivers an assessment of how suitable conditions "and thus the likelihood for CA adoption" are. Results show that the high CA adoption potentials exhibited by the Malawi and Zambia case relate mostly to positive institutional factors. On the other hand, the low adoption potential of the Zimbabwe case, in spite of observed higher estimates, is attributed mainly to unstable and less secured market conditions for CA. In the case of Southern Burkina Faso, the potential for CA adoption is determined to be high, and this assessment deviates from lower observed figures. This is attributed mainly to strong competition of CA and livestock for residues in this region. Lastly, the high adoption potential found in Northern Burkina Faso is explained mainly by the fact that farmers here have no alternative other than to adopt the locally adapted CA system-Zaï farming. Results of this assessment should help promoters of CA in the given regions to reflect on their activities and to eventually adjust or redesign them based on a more explicit understanding of where problems and opportunities are found.

The economic efficiency of conservation measures for amphibians in organic farming--results from bio-economic modelling.

This paper presents a whole farm bio-economic modelling approach for the assessment and optimisation of amphibian conservation conditions applied at the example of a large scale organic farm in North-Eastern Germany. The assessment focuses mainly on the habitat quality as affected by conservation measures such as through specific adapted crop production activities (CPA) and in-field buffer strips for the European tree frog (Hyla arborea), considering also interrelations with other amphibian species (i.e. common spadefoot toad (Pelobates fuscus), fire-bellied toad (Bombina bombina)). The aim of the approach is to understand, analyse and optimize the relationships between the ecological and economic performance of an organic farming system, based on the expectation that amphibians are differently impacted by different CPAs. The modelling system consists of a set of different sub-models that generate a farm model on the basis of environmentally evaluated CPAs. A crop-rotation sub-model provides a set of agronomically sustainable crop rotations that ensures overall sufficient nitrogen supply and controls weed, pest and disease infestations. An economic sub-model calculates the gross margins for each possible CPA including costs of inputs such as labour and machinery. The conservation effects of the CPAs are assessed with an ecological sub-model evaluates the potential negative or positive effect that each work step of a CPA has on amphibians. A mathematical programming sub-model calculates the optimal farm organization taking into account the limited factors of the farm (e.g. labour, land) as well as ecological improvements. In sequential model runs, the habitat quality is to be improved by the model, while the highest possible gross margin is still to be achieved. The results indicate that the model can be used to show the scope of action that a farmer has to improve habitat quality by reducing damage to amphibian population on its land during agricultural activities. Thereby, depending on the level of habitat quality that is aimed at, different measures may provide the most efficient solution. Lower levels of conservation can be achieved with low-cost adapted CPAs, such as an increased cutting height, reduced sowing density and grubbing instead of ploughing. Higher levels of conservation require e.g. grassland-like managed buffer strips around ponds in sensible areas, which incur much higher on-farm conservation costs.

Regional impact assessment of land use scenarios in developing countries using the FoPIA approach: findings from five case studies.

The impact of land use changes on sustainable development is of increasing interest in many regions of the world. This study aimed to test the transferability of the Framework for Participatory Impact Assessment (FoPIA), which was originally developed in the European context, to developing countries, in which lack of data often prevents the use of data-driven impact assessment methods. The core aspect of FoPIA is the stakeholder-based assessment of alternative land use scenarios. Scenario impacts on regional sustainability are assessed by using a set of nine regional land use functions (LUFs), which equally cover the economic, social and environmental dimensions of sustainability. The cases analysed in this study include (1) the alternative spatial planning policies around the Merapi volcano and surrounding areas of Yogyakarta City, Indonesia; (2) the large-scale afforestation of agricultural areas to reduce soil erosion in Guyuan, China; (3) the expansion of soil and water conservation measures in the Oum Zessar watershed, Tunisia; (4) the agricultural intensification and the potential for organic agriculture in Bijapur, India; and (5) the land degradation and land conflicts resulting from land division and privatisation in Narok, Kenya. All five regions are characterised by population growth, partially combined with considerable economic development, environmental degradation problems and social conflicts. Implications of the regional scenario impacts as well as methodological aspects are discussed. Overall, FoPIA proved to be a useful tool for diagnosing regional human-environment interactions and for supporting the communication and social learning process among different stakeholder groups.

Participatory impact assessment of soil and water conservation scenarios in Oum Zessar watershed, Tunisia.

Environmental threats and progressive degradation of natural resources are considered critical impediments to sustainable development. This paper reports on a participatory impact assessment of alternative soil and water conservation (SWC) scenarios in the Oum Zessar watershed, Tunisia. The first objective was to assess the impact of three SWC scenarios on key social, economic and environmental land use functions. The second objective was to test and evaluate the applicability of the 'Framework for Participatory Impact Assessment (FoPIA)' for assessing scenario impacts in the context of a developing country, in this case Tunisia. The assessed scenarios included: the originally planned SWC policy implementation at 85 % coverage of arable land of the watershed, the current implementation (70 %), and a hypothetical expansion of SWC measures to the entire watershed (100 %). Our results suggest that implementation of the SWC policy at 100 % coverage of arable land achieves the maximum socioeconomic benefit. However, if stakeholders' preferences regarding land use functions are taken into account, and considering the fact that the implementation of SWC measures also implies some negative changes to traditional landscapes and the natural system, SWC implementation at 85 % coverage of arable land might be preferable. The FoPIA approved to be a useful tool for conducting a holistic sustainability impact assessment of SWC scenarios and for studying the most intriguing sustainability problems while providing possible recommendations towards sustainable development. We conclude that participatory impact assessment contributes to an enhanced regional understanding of key linkages between policy effects and sustainable development, which provides the foundation for improved policy decision making.

Towards a planning support system for environmental management and agri-environmental measures--the Colorfields study.

The authors present the beginnings of a planning support system (PSS) for agri-environmental measures exemplified by a virtual implementation of Colorfields and blooming strips on model farms, based on real-world data. This paper starts with an introduction to the Colorfields, a concept for transdisciplinary and sustainable landscape design of set-aside land. Colorfields comprise of blooming strips of flowering annual or biennial plants, which are designed and drilled in pattern on fallow land creating Land Art. The temporary scenic arrangements of the Colorfields combine the advantages of ecological strips, e.g. providing habitats for insects (especially bees), improving soil fertility through the cultivation of intercrops, with improvements of the social recognition of farmers as producers of pleasant landscapes instead of monoculture fields. The prototype of the PSS uses two software tools of different scientific origin, the bio-economic modeling system MODAM and the landscape visualization system Lenné3D, which are linked based on geo-data. The resulting system helps to assess the economic effects and visualizes the effects of the specific landuse patterns under different scenarios. The economic assessment of blooming strips on arable land and of one Colorfield on fallow land shows that these measures prove to be profitable from an economic viewpoint assuming the current area payments for the obligatory European Union set-aside program. Furthermore, the visualizations enable the design to be tested virtually by exploring the resultant scenery. They provide artists, planners and stakeholders including farmers with a tool to virtually wander through landscape scenarios supporting a collaborative design and a shared vision for the community. The results of the two model farms and previous case studies for Colorfields demonstrate how current policy conditions could be used for the improvement of environmental and scenic qualities. Furthermore, the ability of the tools, MODAM and Lenné3D, suggests to support and promote these activities.