Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study.

BACKGROUND: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. OBJECTIVE: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany's largest state. METHODS: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. RESULTS: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system's emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. CONCLUSIONS: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI.

Multi-method analysis of microplastic distribution by flood frequency and local topography in Rhine floodplains.

Rivers are important transport pathways for microplastics into the ocean, but they can also be potential sinks due to microplastic deposition in the sediments of the river bed and adjacent floodplains. In particular, floods can (re)mobilise microplastics from sediments and floodplains, (re)deposit and relocate them depending on the floodplain topography. The knowledge about fluvial microplastic input to floodplains, their spatial distribution and their fate in floodplain soils is limited. To investigate this topic, we sampled soil at a depth of 5-20 cm along three transects in three different Rhine floodplains. We analysed the soil samples in tandem with pyrolysis GC/MS and ATR- & µ-FPA-FTIR for their microplastic abundance and mass concentrations. To study the influence of flood frequency on the microplastic abundance in the three floodplains, we fitted a hydrodynamic flood model (MIKE 21, DHI, Hørsholm, Denmark) and related the results to the respective spatial microplastic distribution. We found similar microplastic distribution patterns in each floodplain. The highest microplastic abundance (8516-70,124 microplastics kg-1) and mass concentration (46.2-141.6 mg kg-1) were consistently found in the farthest transects from the Rhine in a topographical depression. This microplastic distribution pattern is detectable with both, pyrolysis GC/MS and FTIR. The strongest correlation between the results of both methods was found for small, abundant microplastic particles. Our results suggest that the spatial distribution of microplastics in floodplains is related to the combination of flood frequency and local topography, that ought to be explicitly considered in future studies conducted in floodplains. Finally, our results indicate that pyrolysis GC/MS and FTIR data are comparable under certain conditions, which may help in the decision for the analytical method and sampling design in future studies.

Microplastics in the Water Column of the Rhine River Near Basel: 22 Months of Sampling.

Measured microplastic concentrations in river surface waters fluctuate greatly. This variability is affected by season and is codriven by factors, such as sampling methodologies, sampling site, or sampling position within site. Unfortunately, most studies comprise single-instance measurements, whereas extended sampling periods are better suited to assessing the relevance of such factors. Moreover, microplastic concentrations in riverine water column remain underexplored. Similar to the oceans, however, this compartment likely holds significant amounts of microplastics. By representatively sampling the entire Rhine River cross-section near Basel through five sampling points over 22 months, we found a median microplastic (50-3000 µm) concentration of 4.48 n m-3, and estimated a widely ranging load between 4.04 × 102 n s-1 and 3.57 × 105 n s-1. We also show that the microplastic concentration in the water column was not well explained by river discharge. This suggests that although high discharge events as observed here can over short time periods lead to peak microplastic concentrations (e.g., 1.23 × 102 n m-3), microplastic load variance was not dominated by discharge in the study area.

Drought impact on pharmaceuticals in surface waters in Europe: Case study for the Rhine and Elbe basins.

Hydrological droughts are expected to increase in frequency and severity in many regions due to climate change. Over the last two decades, several droughts occurred in Europe, including the 2018-drought, which showed major adverse impacts for nature and different sectoral uses (e.g. irrigation, drinking water). While drought impacts on water quantity are well studied, little understanding exists on the impacts on water quality, particularly regarding pharmaceutical concentrations in surface waters. This study investigates the impact of the 2018-drought on concentrations of four selected pharmaceuticals (carbamazepine, sulfamethoxazole, diclofenac and metoprolol) in surface waters in Europe, with a major focus on the Elbe and Rhine rivers. Monitoring data were analysed for the period of 2010-2020 to estimate the spatiotemporal patterns of pharmaceuticals and assess the concentration responses in rivers during the 2018-drought compared to reference years. Our results indicate an overall deterioration in water quality, which can be attributed to the extremely low flow and higher water temperatures (∼ + 1.5 °C and + 2.0 °C in Elbe and Rhine, respectively) during the 2018-drought. Our results show an increase in the concentrations of carbamazepine, sulfamethoxazole, and metoprolol, but reduced concentrations of diclofenac during the 2018-drought. Significant increases in carbamazepine concentrations (+45 %) were observed at 3/6 monitoring stations in the upstream part of the Elbe, which was mainly attributed to less dilution of chemical loads from wastewater treatment plants under drought conditions. However, reduced diclofenac concentrations could be attributed to increased degradation processes under higher water temperatures (R2 = 0.60). Moreover, the rainfed-dominated Elbe exhibited more severe water quality deterioration than the snowmelt-dominated Rhine river, as the Elbe's reduction in dilution capacity was larger. Our findings highlight the need to account for the impacts of climate change and associated increases in droughts in water quality management plans, to improve the provision of water of good quality for ecosystems and sectoral needs.

Evolution of SARS-CoV-2 in the Rhine-Neckar/Heidelberg Region 01/2021 - 07/2023.

In January 2021, the monitoring of circulating variants of SARS-CoV-2 was initiated in Germany under the Corona Surveillance Act, which was discontinued after July 2023. This initiative aimed to enhance pandemic containment, as specific amino acid changes, particularly in the spike protein, were associated with increased transmission and reduced vaccine efficacy. Our group conducted whole genome sequencing using the ARTIC protocol (currently V4) on Illumina's NextSeq 500 platform (and, starting in May 2023, on the MiSeq DX platform) for SARS-CoV-2 positive specimen from patients at Heidelberg University Hospital, associated hospitals, and the public health office in the Rhine-Neckar/Heidelberg region. In total, we sequenced 26,795 SARS-CoV-2-positive samples between January 2021 and July 2023. Valid sequences, meeting the requirements for upload to the German electronic sequencing data hub (DESH) operated by the Robert Koch Institute (RKI), were determined for 24,852 samples, and the lineage/clade could be identified for 25,912 samples. The year 2021 witnessed significant dynamics in the circulating variants in the Rhine-Neckar/Heidelberg region, including A.27.RN, followed by the emergence of B.1.1.7 (Alpha), subsequently displaced by B.1.617.2 (Delta), and the initial occurrences of B.1.1.529 (Omicron). By January 2022, B.1.1.529 had superseded B.1.617.2, dominating with over 90%. The years 2022 and 2023 were then characterized by the dominance of B.1.1.529 and its sublineages, particularly BA.5 and BA.2, and more recently, the emergence of recombinant variants like XBB.1.5. Since the global dominance of B.1.617.2, the identified variant distribution in our local study, apart from a time delay in the spread of new variants, can be considered largely representative of the global distribution. om a time delay in the spread of new variants, can be considered largely representative of the global distribution.

Reactivation of variably sealed joints and permeability enhancement in geothermal reservoir rocks.

Hydraulic stimulation of enhanced deep geothermal reservoirs commonly targets pre-existing joint networks with the goal of increasing reservoir permeability. Here, we study the permeability and strength of joint-free and jointed Buntsandstein sandstones from the EPS-1 exploratory borehole at the Soultz-sous-Forêts geothermal site (France). The studied jointed samples contain naturally formed fractures that are variably filled with secondary mineralisation. We find that the permeability of these rocks is more sensitive to the presence and orientation of bedding than to the presence of joints at the scale of the samples: permeability is lowest in samples where bedding is oriented perpendicular to the direction of fluid flow. While well-sealed joints can act as barriers to fluid flow, partially filled joints neither inhibit nor promote fluid flow with respect to their joint-free counterparts. These samples were then deformed under triaxial conditions to assess (1) whether deformation reactivates pre-existing joints, and (2) how permeability changes as a result of deformation. We find that the mechanical response of the rocks depends on the extent to which joints are sealed. Well-sealed joints locally increase rock strength and experimentally induced fractures do not exploit pre-existing joint surfaces; partially sealed joints, by contrast, act as planes of weakness that localise strain. Although the permeability of all samples increased during deformation, permeability increase was largest in samples with poorly filled joints. We conclude that hydraulic stimulation operations must carefully consider the extent to which targeted joint networks are filled. Partially sealed joints are ideal targets for stimulation: these features act as planes of weakness within the rock mass and their reactivation can result in significant increases in permeability. By contrast, well-sealed joints may increase rock strength locally and may never reactivate during stimulation, making them poor targets for permeability enhancement. Supplementary Information: The online version contains supplementary material available at 10.1186/s40517-023-00271-5.

Characterizing the long-term occurrence and anthropogenic drivers of per- and polyfluoroalkyl substances in surface water of the Rhine River.

Per- and polyfluoroalkyl substances (PFAS) raise significant concerns due to their persistence, bioaccumulation potential, and toxicity to both ecosystems and human health. However, the long-term trends of PFAS in aquatic environments remain inadequately explored. In this study, we systematically assessed the spatiotemporal distribution, periodic fluctuations, source apportionment, and risk evaluation of 12 PFAS in the Rhine River based on the long-term measuring data collected from 2007 to 2019. The study revealed that the mean concentration and mass flux of total PFAS during this period were 32.83 ng L-1 and 6.36 × 104 µg s-1, declining at an annual rate of 3.70% and 3.82%, respectively. Wavelet analysis demonstrated that the most prominent periodic oscillation of PFAS was 40-60 months. Regarding the sources of PFAS, we employed the self-organizing map (SOM) and the positive matrix factorization (PMF) model for source apportionment. The results indicated that the primary sources of PFAS were agrochemical, pharmaceutical and textile industries, accounting for 38.1% of the total concentration. The contribution from household contamination, tannery industry, and coating materials has increased annually. In contrast, the share of electrochemical fluorination and chemical recycling has shown a continuous decline. The risk quotient (RQ) and hazard quotient (HQ) calculations for three age groups indicated that PFAS exposure did not pose a significant risk to ecological or human health. Implementing source-oriented mitigation strategies is crucial to effectively reduce the ecological and human health risks of PFAS in receiving waters.

Improving an existing proxy-based approach for floodplain denitrification assessment to facilitate decision making on restoration.

Excess nitrogen (N) from agricultural sources is a major contributor to the water pollution of rivers in Europe. Floodplains are of tremendous importance as they can permanently remove nitrate (NO3) from the environment by releasing reactive N to the atmosphere in its gaseous forms (N2O, N2) during denitrification. However, the quantitative assessment of this ecosystem function is still challenging, particularly on the national level. In this study, we modeled the potential of NO3-N removal through microbial denitrification in soils of the active floodplains of the river Elbe and river Rhine in Germany. We combined laboratory measurements of soil denitrification potentials with straightforward modelling data, covering the average inundation duration from six study areas, to improve an existing Germany-wide proxy-based approach (PBAe) on NO3-N retention potential. The PBAe estimates this potential to be 30-150 kg NO3-N ha-1 yr-1. However, with soil pH and Floodplain Status Category identified as essential parameters for the proxies, the improved PBA (PBAi) yields a removal potential of 5-480 kg N ha-1 yr-1. To account for these parameters, we applied scaling factors using a bonus-malus system with a base value of 10-120 N ha-1 yr-1. Upscaling the determined proxies of the PBAi to the entire active floodplains of the river Elbe and river Rhine results in similarly high NO3-N retention sums of ~7000 t yr-1 in spite of very different retention area sizes, strengthening the argument for area availability as the primary objective of restoration efforts. Although PBAs are always subject to uncertainty, the PBAi enables a more differentiated spatial quantification of denitrification because local key controlling parameters are included. Hence, the PBAi is an innovative and robust approach to quantify denitrification in floodplain soils, supporting a better assessment of ecosystem services for decision-making on floodplain restoration.

COVID-19 pandemic response in the Meuse-Rhine Euroregion: methods, participation and recommendations of a longitudinal cross-border study.

BACKGROUND: Comparative data collection in transborder areas can contribute to informed decision making processes when dealing with borderless health threats such as pandemics, and thus help minimize the negative health effects for its citizens. To examine the pandemic response over time and the impact of infectious disease control in a cross-border setting, a prospective longitudinal study was conducted in the border area between Germany, Belgium and the Netherlands. In the spring of 2021, a random sample of 26,925 adult citizens selected from governmental registries was invited to collect a blood sample at home for SARS-CoV-2 antibody testing and to fill in an online questionnaire on attitudes and behaviour towards infection prevention measures, cross-border mobility, social network and support, COVID-19 self-reported infection(s) and symptoms, vaccination, general self-reported health and socio-demographics. In autumn 2021, participants were invited for a follow-up round. An online tool was developed to coordinate fieldwork procedures, real-time monitoring of participation and consultation of antibody test results. Furthermore, a helpdesk in all three languages for participants' support was set up. RESULTS: In the first round, 6,006 citizens in the Meuse-Rhine Euroregion participated. 15.3% of the invited citizens on the Belgian side of the border participated. In the Netherlands and Germany this was respectively 27% and 23.7%. In the follow-up round 4,286 (71.4%) citizens participated for the second time. The participation rate was highest in the age group 50-69 years and lowest in > 80 in all sub regions of the Meuse-Rhine Euroregion. More women participated than men. Overall, more blood samples were returned than completed questionnaires. In total, 3,344 citizens in the Meuse-Rhine Euroregion completed all components of participation in both rounds. CONCLUSIONS: The collection of comparative data can help better assess the pandemic response and the impact of infectious disease control in a cross-border area. Recommendations for a longitudinal cross-border study include a centralized online environment, mapping out potential challenges related to national regulations in the preparation phase and organizing regional coordination centres to create more familiarity and trust towards the involved organisations.

Quantification and characterization of macro- and mesoplastic items in the water column of the river Waal.

Although studies on plastic concentrations mainly focus on the marine environment, recently, an increasing number of studies point out environmental consequences in freshwater environments around the world. However, there still is a paucity of field data on the abundance of riverine plastic items, in particular in the water column. In this study, we provide an overview of macro- and mesoplastic concentrations, categories, ages, and origin over several years in the water column of the river Waal, in the Netherlands. The river water column was passively sampled at two selected locations using a stow net at very low and low discharges (range 537 - 1345 m3.s-1). The most dominant macro- and mesoplastic categories were 'Miscellaneous plastic waste', including "Plastic film 2.5 - 50 cm (soft)" and "Plastic film 0 - 2.5 cm (soft)" as main categories. Macro- and mesoplastic categories were found to show limited variability during several years of monitoring. The mean macroplastic concentration (± SD) ranged between 2.2 × 10-3 ± 0.001 and 7.4 × 10-3 ± 0.003 particles.m-3 for October 2020 and November 2018, respectively. In 2020, the plastic concentrations showed a sharp decrease compared to the previous years, most likely as a consequence of the COVID-19 crisis. The origin of the plastics (e.g., countries) also showed little variability during monitoring. The consistency of several characteristics of the collected plastic suggests that the same sources were responsible for the macro- and mesoplastic input into the river Waal during low discharges and over multiple years. We present the first temporal assessment of macro- and mesoplastic concentrations and composition in the water column of the river Waal. The outcome of the current study can be used to support the development of management measures by decision makers.

Alien species and climate change drive shifts in a riverine fish community and trait compositions over 35 years.

Alien fish substantially impact aquatic communities. However, their effects on trait composition remain poorly understood, especially at large spatiotemporal scales. Here, we used long-term biomonitoring data (1984-2018) from 31 fish communities of the Rhine river in Germany to investigate compositional and functional changes over time. Average total community richness increased by 49 %: it was stable until 2004, then declined until 2010, before increasing until 2018. Average abundance decreased by 9 %. Starting from 198 individuals/m2 in 1984 abundance largely declined to 23 individuals/m2 in 2010 (-88 %), and then consequently increased by 678 % up to 180 individuals/m2 until 2018. Increases in abundance and richness starting around 2010 were mainly driven by the establishment of alien species: while alien species represented 5 % of all species and 0.1 % of total individuals in 1993, it increased to 30 % (7 species) and 32 % of individuals in 2018. Concomitant to the increase in alien species, average native species richness and abundance declined by 26 % and 50 % respectively. We identified increases in temperature, precipitation, abundance and richness of alien fish driving compositional changes after 2010. To get more insights on the impacts of alien species on fish communities, we used 12 biological and 13 ecological traits to compute four trait metrics each. Ecological trait dispersion increased before 2010, probably due to diminishing ecologically similar native species. No changes in trait metrics were measured after 2010, albeit relative shares of expressed trait modalities significantly changing. The observed shift in trait modalities suggested the introduction of new species carrying similar and novel trait modalities. Our results revealed significant changes in taxonomic and trait compositions following alien fish introductions and climatic change. To conclude, our analyses show taxonomic and functional changes in the Rhine river over 35 years, likely indicative of future changes in ecosystem services.

Stable isotope patterns of German rivers with aspects on scales, continuity and network status.

In Germany, river monitoring for tritium started in the early 1970s. Today this monitoring network consists of 50 stations and includes stable isotopes. The stable isotope time series to the end of 2021 are at least four years and for some stations up to 30 years long. Daily river water samples were collected during an extraordinary dry season from October 2018 until end of January 2019 from six selected stations of the Rhine and five stations of the Elbe basin. The most dominating stable isotope effects in river water are the seasonal and altitude effects, but also a continental effect is visible. The isotopes indicate snow and ice melt contributions in the Rhine and Danube during the summer months and a consecutive dilution of these signals by mixing with tributary rivers. Close to the coasts in northern Germany, stable isotope patterns reflect influence of seawater and tides. Daily patterns during the dry season 2018/2019 surprisingly do not exhibit extreme changes but rather trends of enhanced groundwater contribution. Long-term continual data across scales are important for comparing and identifying hydrological processes in German river basins of different size and mean catchment altitudes, and highlight the benefits of a co-organized national network.

The effect of farming environment on asthma; time dependent or universal?

The increasing prevalence of asthma is linked to westernization and urbanization. Farm environments have been associated with a lower risk of asthma development. However, this may not be universal, as the association differs across birth cohorts and farming methods. The aim of this study was to investigate the associations of farm upbringing with asthma in different generations and at different times in history. The study population consisted of three generations: 13,868 subjects participating in the ECRHS in 2010, their 9,638 parents, and their 8,885 offspring participating in RHINESSA in 2013. Information on place of upbringing and self-reported ever asthma was provided via questionnaires. Logistic regression was performed including subgroup analysis stratified by generation and birthyear into ten-year-intervals. The prevalence of asthma increased from 8% among grandparents to 13% among parents and to 18% among offspring. An overall analysis showed an inverse association of farm upbringing on the risk of asthma (OR = 0.64; 95%CI 0.55-0.74). Subgroup analysis stratified into ten-year-intervals showed a tendency towards a more pronounced inverse association between growing up on a farm and asthma among subjects born in the 1940s (0.74; 0.48-1.12), 1950s (0.70; 0.54-0.90) and 1960s (0.70; 0.52-0.93). For subjects born in 1970 and thereafter this association appeared less consistent. While growing up on a farm was associated with a reduced risk of developing asthma in participants born between 1945-1999, this was mainly driven by generations born from 1945 to 1973.

Extreme weather events and farmer adaptation in Zeeland, the Netherlands: A European climate change case study from the Rhine delta.

Global climate change is manifest by local-scale changes in precipitation and temperature patterns, including the frequency of extreme weather events (EWEs). EWEs are associated with a myriad range of adverse environmental and societal consequences, including negative impacts to agriculture and food production. This study focuses on EWEs and their effect on adaptation strategies by potato and onion farmers in Zeeland, a Dutch coastal province in the Rhine delta that can serve as a model for other intensive agricultural landscapes in industrialized nations impacted by extreme weather events. The research approach combines quantitative trend analysis of long-term climatic data (temperature, precipitation) with a formal survey of Zeelandic farmers to statistically test four specific hypotheses regarding the frequency of EWEs in the Netherlands and farmer awareness and adaptation. Trend analyses reveal a strong (statistically significant) increase in extreme heat, a small increase in extreme rainfall and drought, and a strong decrease in frost occurrence. Survey results indicate Zeelandic farmers perceive high risk and awareness of changes to the frequency of EWEs. Many farmers have experienced financial losses from EWEs, particularly between 2017 and 2020. For extreme heat, droughts, and frost, the proportion of farmers that incurred financial damages annually is statistically correlated to the actual occurrence of EWEs. Farmers who incurred more financial losses between 2000 and 2020 due to heat and lack of frost had a higher risk perception of these extremes. Further, almost all farmers have already implemented one or more adaptation strategies. A third of surveyed farmers reduced or stopped with potato and onion cultivation in response to climate change and EWEs. Awareness, exposure to, and risk perception of EWEs contribute to adaptation support by farmers. The high perceived risk of climate change and EWEs among respondents and the high incidence of financial losses from extremes in the past two decades highlights the importance of adaptation in the agricultural sector, including in temperate regions where growing seasons are expanding. Study results support the current 'Rural Development Program' and future 'National Strategic Plan' policies in the Netherlands, both part of the European Union's Common Agricultural Policy (CAP), that provides accessibility to adaptation measures for farmers to avoid financial loss.

Parental Prepuberty Overweight and Offspring Lung Function.

In a recent study we found that fathers' but not mothers' onset of overweight in puberty was associated with asthma in adult offspring. The potential impact on offspring's adult lung function, a key marker of general and respiratory health, has not been studied. We investigated the potential causal effects of parents' overweight on adult offspring's lung function within the paternal and maternal lines. We included 929 offspring (aged 18-54, 54% daughters) of 308 fathers and 388 mothers (aged 40-66). Counterfactual-based multi-group mediation analyses by offspring's sex (potential moderator) were used, with offspring's prepubertal overweight and/or adult height as potential mediators. Unknown confounding was addressed by simulation analyses. Fathers' overweight before puberty had a negative indirect effect, mediated through sons' height, on sons' forced expiratory volume in one second (FEV1) (beta (95% CI): -144 (-272, -23) mL) and forced vital capacity (FVC) (beta (95% CI): -210 (-380, -34) mL), and a negative direct effect on sons' FVC (beta (95% CI): -262 (-501, -9) mL); statistically significant effects on FEV1/FVC were not observed. Mothers' overweight before puberty had neither direct nor indirect effects on offspring's lung function. Fathers' overweight starting before puberty appears to cause lower FEV1 and FVC in their future sons. The effects were partly mediated through sons' adult height but not through sons' prepubertal overweight.

Impacts and Lessons Learned of the First Three COVID-19 Waves on Cross-Border Collaboration in the Field of Emergency Medical Services and Interhospital Transports in the Euregio-Meuse-Rhine: A Qualitative Review of Expert Opinions.

Background: In the Euregio-Meuse-Rhine (EMR), cross-border collaboration is essential for resource-saving and needs-based patient care within the emergency medical service (EMS) systems and interhospital transport (IHT). However, at the onset of the novel coronavirus SARS-COV-2 (COVID-19) pandemic, differing national measures highlighted the fragmentation within the European Union (EU) in its various approaches to combating the pandemic. To assess the consequences of the pandemic in the EMR border area, the aim of this study was to analyze the effects and "lessons learned" regarding cross-border collaboration in EMS and IHT. Method: A qualitative study with 22 semi-structured interviews was carried out. Experts from across the EMR area, including the City of Aachen, the City region of Aachen, the District of Heinsberg (Germany), South Limburg (The Netherlands), and the Province of Limburg, as well as Liège (Belgium), took part. The interviews were coded and analyzed according to changes in cross-border collaboration before and during the pandemic, as well as lessons learned and recommendations. Results: Each EU member country within the EMR area, addressed the pandemic individually with national measures. Cross-border collaboration between regional actors was hardly or not at all addressed at the national level during political decision- or policymaking. Previous direct communication at the personal level was replaced by national procedures, which made regular cross-border collaboration significantly more difficult. The cross-border transfer regulations of patients with COVID-19 proved to be complex and led, among other things, to patients being transported to hospitals far outside the border region. Collaboration continues to be seen as valuable and Euregional emergency services including hospitals work well together, albeit to different degrees. The information and data exchange should, however, be more transparent to use resources more efficiently. Conclusion: Effective Euregional collaboration of emergency services is imperative for public safety in a multi-border region with strong economic, cultural, and social cross-border links. Our findings indicate that existing (pre-pandemic) structures which included regular meetings of senior managerial staff in the region and a number of thematic working groups were helpful to deal with and to compensate for the disruptions during the crisis. Regional cross-border agreements that are currently based on mutual but more or less informal arrangements need to be formalized and better promoted and recognized also at the national and EU level to increase resilience. The continuous determination of synergies and good and best practices are further approaches to support cross-border collaboration especially in preparation for future crises.

Flooding frequency and floodplain topography determine abundance of microplastics in an alluvial Rhine soil.

Rivers are major pathways for the transport of microplastics towards the oceans, and many studies focus on microplastic abundance in fluvial ecosystems. Although flooding strongly affects transport of microplastics, knowledge about the potential input via floodwaters, spatial distribution, and fate of microplastics in adjacent floodplains remains very limited. In this study, we suggest that local topography and flood frequency could influence the abundance of microplastics in floodplains. Based on this concept, we took soil samples in a Rhine River floodplain in two different depths (0-5 cm and 5-20 cm) along three transects with increasing distance to the river and analysed the abundance of microplastics via FTIR spectroscopy. Flood frequency of the transects was estimated by a combination of hydrodynamic modelling with MIKE 21 (DHI, Hørsholm Denmark) and analysis of time series of water levels. Microplastic abundance per kg dry soil varied between 25,502 to 51,119 particles in the top 5 cm and 25,616 to 84,824 particles in the deeper soil (5-20 cm). The results of our study indicate that local topography and resulting flooding patterns are responsible for the amount of microplastics found at the respective transect. Differences in soil properties, vegetation cover and signs of earthworm activity in the soil profile seem to be related to microplastic migration and accumulation in the deeper soil. The interdisciplinary approach we used in our work can be applied to other floodplains to elucidate the respective processes. This information is essentially important both for locating potential microplastic sinks for process-informed sampling designs and to identify areas of increased bioavailability of microplastics for proper ecological risk assessment.

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany.

Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8-11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child's perspective should be given more consideration in the design and maintenance of sanitary facilities.

Angiopoietins as Potential Targets in Management of Retinal Disease.

The Ang/Tie2 pathway complements VEGF-mediated activity in retinal vascular diseases such as DME, AMD, and RVO by decreasing vascular integrity, increasing neovascularization, and increasing inflammatory signaling. Faricimab is a bispecific antibody that has been developed as an inhibitor of both VEGF and Ang2 that has shown positive results in phase I, II and III trials. Recent Year 1 data from phase III clinical trials YOSEMITE, RHINE, TENAYA, and LUCERNE have confirmed the efficacy, safety, durability, and superiority of faricimab in patients with DME and nAMD. Faricimab, if approved, may significantly decrease treatment burden in patients with retinal vascular diseases to a greater extent than would current standard of care anti-VEGF injections.

Development of a Web GIS for small-scale detection and analysis of COVID-19 (SARS-CoV-2) cases based on volunteered geographic information for the city of Cologne, Germany, in July/August 2020.

BACKGROUND: Various applications have been developed worldwide to contain and to combat the coronavirus disease-19 (COVID-19) pandemic. In this context, spatial information is always of great significance. The aim of this study is to describe the development of a Web GIS based on open source products for the collection and analysis of COVID-19 cases and its feasibility in terms of technical implementation and data protection. METHODS: With the help of this Web GIS, data on this issue were collected voluntarily from the Cologne area. Using house perimeters as a data basis, it was possible to check, in conjunction with the Official Topographic Cartographic Information System object type catalog, whether buildings with certain functions, for example residential building with trade and services, have been visited more frequently by infected persons than other types of buildings. In this context, data protection and ethical and legal issues were considered. RESULTS: The results of this study show that the development of a Web GIS for the generation and evaluation of volunteered geographic information (VGI) with the help of open source software is possible. Furthermore, there are numerous data protection and ethical and legal aspects to consider, which not only affect VGI per se but also affect IT security. CONCLUSIONS: From a data protection perspective, more attention needs to be paid to the intervention and post-processing of data. In addition, official data must always be used as a reference for the actual spatial consideration of the number of infections. However, VGI provides added value at a small-scale level, so that valid information can also be reliably derived in the context of health issues. The creation of guidelines for the consideration of data protection, ethical aspects, and legal requirements in the context of VGI-based applications must also be considered. Trial registration The article does not report the results of a health care intervention for human participants.