Use of a novel pressure distribution system for severely ill neonates: a clinical pilot study carried out by the PREPICare consortium.

BACKGROUND: Pressure Injuries are not exclusively an adult phenomenon; various risk factors contribute to a high prevalence rate of 43% in the neonatal and pediatric intensive care population. Effective preventive measures in this population are limited. METHODS: We performed a pilot study to analyze the distribution and localization of support surface interface pressures in neonates in a pediatric intensive care unit (PICU). The hypothesis was that pressure redistribution by a novel air mattress would reduce pressure peaks in critical neonates. The measurements were conducted in a 27-bed level III PICU between November and December 2020. This included measuring pressure distribution and pressure peaks for five neonates positioned on either a state-of-the-art foam mattress or a new prototype air mattress. RESULTS: We confirmed that the pressure peaks were significantly reduced using the prototype air mattress, compared with the state-of-the-art foam mattress. The reduction of mean pressure values was 9-29%, while the reduction of the highest 10% of pressure values was 23-41%. CONCLUSIONS: The journey to an effective, optimal, and approved product for severely ill neonates to reduce Pressure Injuries is challenging. However, a crucial step was completed by this pilot study with the first pressure measurements in a real-world setting and the successful realization of a decrease in pressure peaks obtained using a prototype air mattress.

The choice between business travel and video conferencing after COVID-19 - Insights from a choice experiment among frequent travelers.

COVID-19 has accelerated the substitution of videoconferencing for business travel. However, little research exists about the decision-making behavior of business travelers considering virtual alternatives. We fill this gap by reconceptualizing the decision-making process and investigating the fundamental choice between face-to-face (FtF) and virtual communication (VC) using an adaptive choice-based conjoint analysis. We argue that the process of decision making of business travelers is distinct to that of leisure travelers, as the fundamental decision between FtF and VC occurs prior to subsequent travel decisions. We show that the purpose of the meeting, the character of the message, and the location of the meeting are the decision attributes of greatest importance. Using a novel methodology we present a holistic decision model that increases the theoretical understanding of business traveler decision-making and provide practitioners with comprehensive insights relevant to travel policy development, and executives in the business travel market with guidance with management decisions.

Defining a land boundary for sustainable livestock consumption.

The need for more sustainable production and consumption of animal source food (ASF) is central to the achievement of the sustainable development goals: within this context, wise use of land is a core challenge and concern. A key question in feeding the future world is: how much ASF should we eat? We demonstrate that livestock raised under the circular economy concept could provide a significant, nonnegligible part (9-23 g/per capita) of our daily protein needs (~50-60 g/per capita). This livestock then would not consume human-edible biomass, such as grains, but mainly convert leftovers from arable land and grass resources into valuable food, implying that production of livestock feed is largely decoupled from arable land. The availability of these biomass streams for livestock then determines the boundaries for livestock production and consumption. Under this concept, the competition for land for feed or food would be minimized and compared to no ASF, including some ASF in the human diet could free up about one quarter of global arable land. Our results also demonstrate that restricted growth in consumption of ASF in Africa and Asia would be feasible under these boundary conditions, while reductions in the rest of the world would be necessary to meet land use sustainability criteria. Managing this expansion and contraction of future consumption of ASF is essential for achieving sustainable nutrition security.

Enhanced top soil carbon stocks under organic farming.

It has been suggested that conversion to organic farming contributes to soil carbon sequestration, but until now a comprehensive quantitative assessment has been lacking. Therefore, datasets from 74 studies from pairwise comparisons of organic vs. nonorganic farming systems were subjected to metaanalysis to identify differences in soil organic carbon (SOC). We found significant differences and higher values for organically farmed soils of 0.18 ± 0.06% points (mean ± 95% confidence interval) for SOC concentrations, 3.50 ± 1.08 Mg C ha(-1) for stocks, and 0.45 ± 0.21 Mg C ha(-1) y(-1) for sequestration rates compared with nonorganic management. Metaregression did not deliver clear results on drivers, but differences in external C inputs and crop rotations seemed important. Restricting the analysis to zero net input organic systems and retaining only the datasets with highest data quality (measured soil bulk densities and external C and N inputs), the mean difference in SOC stocks between the farming systems was still significant (1.98 ± 1.50 Mg C ha(-1)), whereas the difference in sequestration rates became insignificant (0.07 ± 0.08 Mg C ha(-1) y(-1)). Analyzing zero net input systems for all data without this quality requirement revealed significant, positive differences in SOC concentrations and stocks (0.13 ± 0.09% points and 2.16 ± 1.65 Mg C ha(-1), respectively) and insignificant differences for sequestration rates (0.27 ± 0.37 Mg C ha(-1) y(-1)). The data mainly cover top soil and temperate zones, whereas only few data from tropical regions and subsoil horizons exist. Summarizing, this study shows that organic farming has the potential to accumulate soil carbon.

The role of multi-target policy instruments in agri-environmental policy mixes.

The Tinbergen Rule has been used to criticise multi-target policy instruments for being inefficient. The aim of this paper is to clarify the role of multi-target policy instruments using the case of agri-environmental policy. Employing an analytical linear optimisation model, this paper demonstrates that there is no general contradiction between multi-target policy instruments and the Tinbergen Rule, if multi-target policy instruments are embedded in a policy-mix with a sufficient number of targeted instruments. We show that the relation between cost-effectiveness of the instruments, related to all policy targets, is the key determinant for an economically sound choice of policy instruments. If economies of scope with respect to achieving policy targets are realised, a higher cost-effectiveness of multi-target policy instruments can be achieved. Using the example of organic farming support policy, we discuss several reasons why economies of scope could be realised by multi-target agri-environmental policy instruments.

Acceptance of meat reduction policies in Switzerland.

The aim of this study was to analyze the acceptance of different policy measures affecting meat consumption in Switzerland. We conducted qualitative interviews with leading stakeholders and elaborated 37 policy measures for reducing meat consumption. In a standardized survey, we analyzed the acceptance of these measures and important preconditions for their implementation. Measures with potentially the biggest direct leverage, such as a VAT increase on meat products, were highly rejected. We found high levels of acceptance for measures that do not directly affect meat consumption but have the potential for significant changes of meat consumption in the longer run - such as research investment and sustainable diet education. Furthermore, some measures with considerable short-term effects were widely accepted (e.g., stricter animal welfare standards, ban of meat advertisements). These measures could be a promising starting point for policy makers aiming at a transformation of the food system toward lower levels of meat consumption.

Averting wildlife-borne infectious disease epidemics requires a focus on socio-ecological drivers and a redesign of the global food system.

A debate has emerged over the potential socio-ecological drivers of wildlife-origin zoonotic disease outbreaks and emerging infectious disease (EID) events. This Review explores the extent to which the incidence of wildlife-origin infectious disease outbreaks, which are likely to include devastating pandemics like HIV/AIDS and COVID-19, may be linked to excessive and increasing rates of tropical deforestation for agricultural food production and wild meat hunting and trade, which are further related to contemporary ecological crises such as global warming and mass species extinction. Here we explore a set of precautionary responses to wildlife-origin zoonosis threat, including: (a) limiting human encroachment into tropical wildlands by promoting a global transition to diets low in livestock source foods; (b) containing tropical wild meat hunting and trade by curbing urban wild meat demand, while securing access for indigenous people and local communities in remote subsistence areas; and (c) improving biosecurity and other strategies to break zoonosis transmission pathways at the wildlife-human interface and along animal source food supply chains.

Significance of developmental meningeal lymphatic dysfunction in experimental post-traumatic injury.

Understanding the pathological mechanisms unfolding after chronic traumatic brain injury (TBI) could reveal new therapeutic entry points. During the post-TBI sequel, the involvement of cerebrospinal fluid drainage through the meningeal lymphatic vessels was proposed. Here, we used K14-VEGFR3-Ig transgenic mice to analyze whether a developmental dysfunction of meningeal lymphatic vessels modifies post-TBI pathology. To this end, a moderate TBI was delivered by controlled cortical injury over the temporal lobe in male transgenic mice or their littermate controls. We performed MRI and a battery of behavioral tests over time to define the post-TBI trajectories. In vivo analyses were integrated by ex-vivo quantitative and morphometric examinations of the cortical lesion and glial cells. In post-TBI K14-VEGFR3-Ig mice, the recovery from motor deficits was protracted compared to littermates. This outcome is coherent with the observed slower hematoma clearance in transgenic mice during the first two weeks post-TBI. No other genotype-related behavioral differences were observed, and the volume of cortical lesions imaged by MRI in vivo, and confirmed by histology ex-vivo, were comparable in both groups. However, at the cellular level, post-TBI K14-VEGFR3-Ig mice exhibited an increased percentage of activated Iba1 microglia in the hippocampus and auditory cortex, areas that are proximal to the lesion. Although not impacting or modifying the structural brain damage and post-TBI behavior, a pre-existing dysfunction of meningeal lymphatic vessels is associated with morphological microglial activation over time, possibly representing a sub-clinical pathological imprint or a vulnerability factor. Our findings suggest that pre-existing mLV deficits could represent a possible risk factor for the overall outcome of TBI pathology.

The compatibility of circularity and national dietary recommendations for animal products in five European countries: a modelling analysis on nutritional feasibility, climate impact, and land use.

BACKGROUND: National food-based dietary guidelines (FBDGs) are generally designed from a human health perspective and often disregard sustainability aspects. Circular food production systems are a promising solution to achieve sustainable healthy diets. In such systems, closing nutrient cycles where possible and minimising external inputs contribute to reducing environmental impacts. This change could be made by limiting livestock feed to available low-opportunity-cost biomass (LOCB). We examined the compatibility of national dietary guidelines for animal products with livestock production on the basis of the feed supplied by available LOCB. METHODS: We investigated whether the national dietary recommendations for animal products for Bulgaria, Malta, the Netherlands, Sweden, and Switzerland could be met with domestically available LOCB. We used an optimisation model that allocates feed resources to different species of farm animals. Of the resulting scenarios, we assessed the nutritional feasibility, climate impact, and land use. FINDINGS: Our results showed the environmental benefits of reducing the recommended animal products in the FBDGs, and that animal products from LOCB could provide between 22% (Netherlands) and 47% (Switzerland) of total protein contributions of the FBDGs. This range covers a substantial part of the nutritional needs of the studied populations. To fully meet these needs, consumption of plant-based food could be increased. INTERPRETATION: Our results contribute to the discussion of what quantities of animal products in dietary guidelines are compatible with circular food systems. Thus, national dietary recommendations for animal products should be revised and recommended quantities lowered. This finding is consistent with recent efforts to include sustainability criteria in dietary guidelines. FUNDING: Swiss National Science Foundation and the Dutch Research Council.

Agroecological practices in combination with healthy diets can help meet EU food system policy targets.

Agroecology has been proposed as a strategy to improve food system sustainability, but has also been criticised for using land inefficiently. We compared five explorative storylines, developed in a stakeholder process, for future food systems in the EU to 2050. We modelled a range of biophysical (e.g., land use and food production), environmental (e.g., greenhouse gas emissions) and social indicators, and potential for regional food self-sufficiency, and investigated the economic policy needed to reach these futures by 2050. Two contrasting storylines for upscaling agroecological practices emerged. In one, agroecology was implemented to produce high-value products serving high-income consumers through trade but, despite 40% of agricultural area being under organic management, only two out of eight EU environmental policy targets were met. As diets followed current trends in this storyline, there were few improvements in environmental indicators compared with the current situation, despite large-scale implementation of agroecological farming practices. This suggests that large-scale implementation of agroecological practices without concurrent changes on the demand side could aggravate existing environmental pressures. However, our second agroecological storyline showed that if large-scale diffusion of agroecological farming practices were implemented alongside drastic dietary change and waste reductions, major improvements on environmental indicators could be achieved and all relevant EU policy targets met. An alternative storyline comprising sustainable intensification in combination with dietary change and waste reductions was efficient in meeting targets related to climate, biodiversity, ammonia emissions, and use of antibiotics, but did not meet targets for reductions in pesticide and fertiliser use. These results confirm the importance of dietary change for food system climate change mitigation. Economic modelling showed a need for drastic changes in consumer preferences towards more plant-based, agroecological and local foods, and for improvements in technology, for these storylines to be realised, as very high taxes and tariffs would otherwise be needed.

Target and suspect screening analysis reveals persistent emerging organic contaminants in soils and sediments.

An approach to identifying persistent organic contaminants in the environment was developed and executed for Switzerland as an example of an industrialized country. First, samples were screened with an in-house list using liquid chromatography high-resolution mass spectrometry (LC-HRMS/MS) and gas chromatography tandem mass spectrometry (GC-MS/MS) in 13 samples from the Swiss National Soil Monitoring Network and three sediment cores of an urban and agricultural contaminated lake. To capture a broader range of organic contaminants, the analysis was extended with a suspect screening analysis by LC-HRMS/MS of >500 halogenated compounds obtained from a Swiss database that includes industrial and household chemicals identified, by means of fugacity modeling, as persistent substances in the selected matrices. In total, the confirmation of 96 compounds with an overlap of 34 in soil and sediment was achieved. The identified compounds consist generally of esters, tertiary amines, trifluoromethyls, organophosphates, azoles and aromatic azines, with azoles and triazines being the most common groups. Newly identified compounds include transformation products, pharmaceuticals such as the flukicide niclofolan, the antimicrobial cloflucarban, and the fungicide mandipropamid. The results indicate that agricultural and urban soils as well as sediments impacted by agriculture and wastewater treatment plants (WWTPs) are the most contaminated sites. The plausibility of this outcome confirms the combination of chemical inventory, modeling of partitioning and persistence, and HRMS-based screening as a successful approach to shed light on less frequently or not yet investigated environmental contaminants and emphasizes the need for more soil and sediment monitoring in the future.

New relevant pesticide transformation products in groundwater detected using target and suspect screening for agricultural and urban micropollutants with LC-HRMS.

Groundwater is a major drinking water resource, but its quality is threatened by a broad variety of anthropogenic micropollutants (MPs), originating from agriculture, industry, or households, and undergoing various transformation processes during subsurface passage. To determine a worst-case impact of pesticide application in agriculture on groundwater quality, a target and suspect screening for more than 300 pesticides and more than 1100 pesticide transformation products (TPs) was performed in 31 Swiss groundwater samples which predominantly originated from areas with intensive agriculture. To assess additional urban contamination sources, more than 250 common urban MPs were quantified. Most of the screened pesticide TPs were experimentally observed by the pesticide producers within the European pesticide registration. To cover very polar pesticide TPs, vacuum-assisted evaporative concentration was used for enrichment, followed by liquid chromatography high-resolution tandem mass spectrometry (LC-HRMS/MS). Based on intensity, isotope pattern, retention time, and in silico fragmentation, the suspect hits were prioritised and verified. We identified 22 suspects unequivocally and five tentatively; 13 TPs are reported here for the first time to be detected in groundwater. In 13 out of 31 groundwater samples, the total concentration of the 20 identified and quantified suspects (1 pesticide and 19 pesticide TPs) exceeded the total concentration of the 519 targets (236 pesticides and TPs; 283 urban MPs) for which we screened. Pesticide TPs had higher concentrations than the parent pesticides, illustrating their importance for groundwater quality. The newly identified very polar chlorothalonil TP R471811 was the only compound detected in all samples with concentrations ranging from 3 to 2700 ng/L. Agricultural MP concentration and detection frequency correlated with agricultural land use in the catchment, except for aquifers, where protective top layers reduced MP transport from the surface. In contrast to agricultural MPs, urban MPs displayed almost no correlation with land use. The dominating entry pathway of urban MPs was river bank filtration.

Eco-efficiency and agricultural innovation systems in developing countries: Evidence from macro-level analysis.

Agricultural innovation is an essential component in the transition to more sustainable and resilient farming systems across the world. Innovations generally emerge from collective intelligence and action, but innovation systems are often poorly understood. This study explores the properties of innovation systems and their contribution to increased eco-efficiency in agriculture. Using aggregate data and econometric methods, the eco-efficiency of 79 countries was computed and a range of factors relating to research, extension, business and policy was examined. Despite data limitations, the analysis produced some interesting insights. For instance public research spending has a positive significant effect for emerging economies, while no statistically significant effect was found for foreign aid for research. However, foreign aid for extension is important in less developed economies. These and other results suggest the importance of context-specific interventions rather than a "one size fits all" approach. Overall, the analysis illustrated the potential of a macro-level diagnostic approach for assessing the role of innovation systems for sustainability in agriculture.

Improving Crop Yield and Nutrient Use Efficiency via Biofertilization-A Global Meta-analysis.

The application of microbial inoculants (biofertilizers) is a promising technology for future sustainable farming systems in view of rapidly decreasing phosphorus stocks and the need to more efficiently use available nitrogen (N). Various microbial taxa are currently used as biofertilizers, based on their capacity to access nutrients from fertilizers and soil stocks, to fix atmospheric nitrogen, to improve water uptake or to act as biocontrol agents. Despite the existence of a considerable knowledge on effects of specific taxa of biofertilizers, a comprehensive quantitative assessment of the performance of biofertilizers with different traits such as phosphorus solubilization and N fixation applied to various crops at a global scale is missing. We conducted a meta-analysis to quantify benefits of biofertilizers in terms of yield increase, nitrogen and phosphorus use efficiency, based on 171 peer reviewed publications that met eligibility criteria. Major findings are: (i) the superiority of biofertilizer performance in dry climates over other climatic regions (yield response: dry climate +20.0 ± 1.7%, tropical climate +14.9 ± 1.2%, oceanic climate +10.0 ± 3.7%, continental climate +8.5 ± 2.4%); (ii) meta-regression analyses revealed that yield response due to biofertilizer application was generally small at low soil P levels; efficacy increased along higher soil P levels in the order arbuscular mycorrhizal fungi (AMF), P solubilizers, and N fixers; (iii) meta-regressions showed that the success of inoculation with AMF was greater at low organic matter content and at neutral pH. Our comprehensive analysis provides a basis and guidance for proper choice and application of biofertilizers.

Strategies for feeding the world more sustainably with organic agriculture.

Organic agriculture is proposed as a promising approach to achieving sustainable food systems, but its feasibility is also contested. We use a food systems model that addresses agronomic characteristics of organic agriculture to analyze the role that organic agriculture could play in sustainable food systems. Here we show that a 100% conversion to organic agriculture needs more land than conventional agriculture but reduces N-surplus and pesticide use. However, in combination with reductions of food wastage and food-competing feed from arable land, with correspondingly reduced production and consumption of animal products, land use under organic agriculture remains below the reference scenario. Other indicators such as greenhouse gas emissions also improve, but adequate nitrogen supply is challenging. Besides focusing on production, sustainable food systems need to address waste, crop-grass-livestock interdependencies and human consumption. None of the corresponding strategies needs full implementation and their combined partial implementation delivers a more sustainable food future.

Impacts of feeding less food-competing feedstuffs to livestock on global food system sustainability.

Increasing efficiency in livestock production and reducing the share of animal products in human consumption are two strategies to curb the adverse environmental impacts of the livestock sector. Here, we explore the room for sustainable livestock production by modelling the impacts and constraints of a third strategy in which livestock feed components that compete with direct human food crop production are reduced. Thus, in the outmost scenario, animals are fed only from grassland and by-products from food production. We show that this strategy could provide sufficient food (equal amounts of human-digestible energy and a similar protein/calorie ratio as in the reference scenario for 2050) and reduce environmental impacts compared with the reference scenario (in the most extreme case of zero human-edible concentrate feed: greenhouse gas emissions -18%; arable land occupation -26%, N-surplus -46%; P-surplus -40%; non-renewable energy use -36%, pesticide use intensity -22%, freshwater use -21%, soil erosion potential -12%). These results occur despite the fact that environmental efficiency of livestock production is reduced compared with the reference scenario, which is the consequence of the grassland-based feed for ruminants and the less optimal feeding rations based on by-products for non-ruminants. This apparent contradiction results from considerable reductions of animal products in human diets (protein intake per capita from livestock products reduced by 71%). We show that such a strategy focusing on feed components which do not compete with direct human food consumption offers a viable complement to strategies focusing on increased efficiency in production or reduced shares of animal products in consumption.

Greenhouse gas fluxes from agricultural soils under organic and non-organic management--a global meta-analysis.

It is anticipated that organic farming systems provide benefits concerning soil conservation and climate protection. A literature search on measured soil-derived greenhouse gas (GHG) (nitrous oxide and methane) fluxes under organic and non-organic management from farming system comparisons was conducted and followed by a meta-analysis. Up to date only 19 studies based on field measurements could be retrieved. Based on 12 studies that cover annual measurements, it appeared with a high significance that area-scaled nitrous oxide emissions from organically managed soils are 492 ± 160 kg CO2 eq. ha(-1) a(-1) lower than from non-organically managed soils. For arable soils the difference amounts to 497 ± 162 kg CO2 eq. ha(-1) a(-1). However, yield-scaled nitrous oxide emissions are higher by 41 ± 34 kg CO2 eq. t(-1) DM under organic management (arable and use). To equalize this mean difference in yield-scaled nitrous oxide emissions between both farming systems, the yield gap has to be less than 17%. Emissions from conventionally managed soils seemed to be influenced mainly by total N inputs, whereas for organically managed soils other variables such as soil characteristics seemed to be more important. This can be explained by the higher bioavailability of the synthetic N fertilisers in non-organic farming systems while the necessary mineralisation of the N sources under organic management leads to lower and retarded availability. Furthermore, a higher methane uptake of 3.2 ± 2.5 kg CO2 eq. ha(-1) a(-1) for arable soils under organic management can be observed. Only one comparative study on rice paddies has been published up to date. All 19 retrieved studies were conducted in the Northern hemisphere under temperate climate. Further GHG flux measurements in farming system comparisons are required to confirm the results and close the existing knowledge gaps.