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The collisionless tearing mode is investigated by means of the delta-f PIC code EUTERPE solving the gyrokinetic equation. In this thesis the first simulations of electromagnetic non-ideal MHD modes in a slab geometry with EUTERPE are presented. Linear simulations are carried out in the cases of vanishing and finite temperature gradients. Both cases are benchmarked using a shooting method showing that EUTERPE simulates the linearly unstable tearing mode to a very high accuracy. In the case of finite diamagnetic effects and values of the linear stability parameter Delta of order unity analytic predictions of the linear dispersion relation are compared with simulation results. The comparison validates the analytic results in this parameter range. Nonlinear single-mode simulations are performed in the small- to medium-Delta range measuring the dependency of the saturated island half width on the equilibrium current width. The results are compared with an analytic prediction obtained with a kinetic electromagnetic model. In this thesis the first simulation results in the regime of fast nonlinear reconnection~(medium- to high-Delta range) are presented using the standard gyrokinetic equation. In this regime a nonlinear critical threshold has been found dividing the saturated mode from the super-exponential phase for medium-Delta values. This critical threshold has been proven to occur in two slab equilibria frequently used for reconnection scenarios. Either changing the width of the equilibrium current or the wave number of the most unstable mode makes the threshold apparent. Extensive parameter studies including the variation of the domain extensions as well as the equilibrium current width are dedicated to a comprehensive overview of the critical threshold in a wide range of parameters. Additionally, a second critical threshold for high-Delta equilibria has been observed. A detailed comparison between a compressible gyrofluid code and EUTERPE is carried out. The two models are compared with each other in the linear regime by measuring growth rates over wave numbers of the most unstable mode for two setups of parameters. Analytical scaling predictions of the dispersion relation relevant to the low-Delta regime are discussed. Employing nonlinear simulations of both codes the saturated island half width and oscillation frequency of the magnetic islands are compared in the small-Delta range. Both models agree very well in the limit of marginal instability and differ slightly with decreasing wave vector. Recently, the full polarisation response in the quasi-neutrality equation was implemented in EUTERPE using the Padé approximation of the full gyrokinetic polarisation term. Linear simulation results including finite ratios of ion to electron temperature are benchmarked with the dispersion relation obtained from a hybrid model. Finite temperature effects influence the saturated island width slightly with increasing ion to electron temperature ratio which has been verified by both models.
This dissertation focusses on the numerical modelling of resonant destabilization of Alfvén eigenmodes by fast ions in fusion plasmas. It especially addresses non-linear simulations of stellarator plasmas in which particle collisions are retained. It is shown that collisions are required for a realistic description of Alfvén waves in plasmas relevant to nuclear fusion.
We start by carefully verifying the implementation of the collision operators into the electromagnetic version of the gyro-kinetic delta-f particle-in-cell code EUTERPE. After these initial benchmarks are completed successfully, the code is in a position to be applied to realistic tokamak and stellarator scenarios.
Since every collision operator needs to fulfil conservation laws, a momentum-conserving version of the pitch-angle scattering operator is implemented. This is in particular important for neoclassical transport simulations aimed at computing flux-surface variations of the electrostatic potential in stellarators.
Using the simplified CKA-EUTERPE model (employing a fixed-mode-structure approximation), we perform non-linear simulations in tokamaks and stellarators. We show that the non-linear dynamics of fast-ion-driven Alfvén eigenmodes is significantly influenced by collisions. They have the potential to enhance the saturation level and to affect the frequency chirping of the modes.
It is thus concluded that collisions play an essential role in determining Alfvén-eigenmode-induced fast-ion transport - an important issue for future fusion devices. In order to address this issue the CKA-EUTERPE model is extended to evolve multiple modes at the same time. First results of this multi-mode version (which enhances the level of realism of the simulations) are shown in the Appendix of the thesis.
Aktuelle Kompendien zu den gutartigen weiblichen Brusttumoren sind zumeist auf nur einen Schwerpunkt ausgerichtet. Daher war das Ziel dieser Promotion die Ausarbeitung eines Kompendiums mit den Schwerpunkten Diagnostik, Pathologie, Therapie und Prognose zu den gutartigen Tumoren der weiblichen Brust. Im weiteren Schritt sollte geprüft werden, ob eine allgemeingültige Empfehlung zur Diagnostik und Therapie der gutartigen Brusttumoren erstellt werden kann. Die Betrachtung der Tumoren erfolgte nach einheitlichen Gesichtspunkten. Dabei wurden zu jedem gutartigen Tumor typische Merkmale, diagnostische Methoden und therapeutische Modalitäten ermittelt. Problematisch gestaltete sich die Erarbeitung der seltenen und sehr seltenen mammären Tumoren aufgrund der nur geringen Anzahl an medizinischen Fachtexten. Bei der Erstellung der Promotion fielen sowohl die kontroversen Empfehlungen bezüglich einer weiteren Abklärung der gutartigen Brusttumoren mittels minimalinvasiver Methoden als auch die unterschiedlichen Empfehlungen hinsichtlich des therapeutischen Vorgehens (Nachsorge vs. operative Entfernung) auf. Mit Berücksichtigung dieser konnte dennoch für die gutartigen Brusttumoren ein allgemeingültiges diagnostisches Vorgehen sowie eine einheitliche Behandlungsempfehlung entwickelt werden.
Hass im Netz findet in Deutschland zunehmend Verbreitung und ist besonders für junge Menschen mittlerweile Teil des Alltags geworden, wobei Hass ausgeübt, erlebt oder beobachtet wird. Unter Hass im Netz lassen sich Phänomene wie Cyberbullying, Hassrede und digitale Gewalt beschreiben. Dieses Gutachten betrachtet zunächst die theoretischen und empirischen Grundlagen dieser Phänomene und benennt zentrale Gemeinsamkeiten und Unterschiede, um davon ausgehend Maßnahmen zu erörtern und deren Evidenzbasierung kritisch zu reflektieren, die zur Prävention sowie zur Intervention und Reaktion bei Hass im Netz zur Verfügung stehen. Aus der Zusammenschau werden dann weiterführende Impulse für Forschung und Praxis abgeleitet. Ein besonderer Fokus der Betrachtung liegt dabei auf der Situation in Niedersachsen.
A G-rich sequence was designed to allow folding into either a stable parallel or hybrid-type topology. With the parent sequence featuring coexisting species, various related sequences with single and double mutations and with a shortened central propeller loop affected the topological equilibrium. Two simple modifications, likewise introduced separately to all sequences, were employed to lock folds into one of the topologies without noticeable structural alterations. The unique combination of sequence mutations, high-resolution NMR structural information, and the thermodynamic stability for both topological competitors identified critical loop residue interactions. In contrast to first loop residues, which are mostly disordered and exposed to solvent in both propeller and lateral loops bridging a narrow groove, the last loop residue in a lateral three-nucleotide loop is engaged in stabilizing stacking interactions. The propensity of single-nucleotide loops to favor all-parallel topologies by enforcing a propeller-like conformation of an additional longer loop is shown to result from their preference in linking two outer tetrads of the same tetrad polarity. Taken together, the present studies contribute to a better structural and thermodynamic understanding of delicate loop interactions in genomic and artificially designed quadruplexes, e.g. when employed as therapeutics or in other biotechnological applications.
Guidelines and Standard Frameworks for AI in Medicine: Protocol for a Systematic Literature Review
(2023)
Background: Applications of artificial intelligence (AI) are pervasive in modern biomedical science. In fact, research results suggesting algorithms and AI models for different target diseases and conditions are continuously increasing. While this situation undoubtedly improves the outcome of AI models, health care providers are increasingly unsure which AI model to use due to multiple alternatives for a specific target and the “black box” nature of AI. Moreover, the fact that studies rarely use guidelines in developing and reporting AI models poses additional challenges in trusting and adapting models for practical implementation.
Objective: This review protocol describes the planned steps and methods for a review of the synthesized evidence regarding the quality of available guidelines and frameworks to facilitate AI applications in medicine.
Methods: We will commence a systematic literature search using medical subject headings terms for medicine, guidelines, and machine learning (ML). All available guidelines, standard frameworks, best practices, checklists, and recommendations will be included, irrespective of the study design. The search will be conducted on web-based repositories such as PubMed, Web of Science, and the EQUATOR (Enhancing the Quality and Transparency of Health Research) network. After removing duplicate results, a preliminary scan for titles will be done by 2 reviewers. After the first scan, the reviewers will rescan the selected literature for abstract review, and any incongruities about whether to include the article for full-text review or not will be resolved by the third and fourth reviewer based on the predefined criteria. A Google Scholar (Google LLC) search will also be performed to identify gray literature. The quality of identified guidelines will be evaluated using the Appraisal of Guidelines, Research, and Evaluation (AGREE II) tool. A descriptive summary and narrative synthesis will be carried out, and the details of critical appraisal and subgroup synthesis findings will be presented.
Results: The results will be reported using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) reporting guidelines. Data analysis is currently underway, and we anticipate finalizing the review by November 2023.
Conclusions: Guidelines and recommended frameworks for developing, reporting, and implementing AI studies have been developed by different experts to facilitate the reliable assessment of validity and consistent interpretation of ML models for medical applications. We postulate that a guideline supports the assessment of an ML model only if the quality and reliability of the guideline are high. Assessing the quality and aspects of available guidelines, recommendations, checklists, and frameworks—as will be done in the proposed review—will provide comprehensive insights into current gaps and help to formulate future research directions.
International Registered Report Identifier (IRRID): DERR1-10.2196/47105
In zwei populationsbasierten randomisierten Studien wurde untersucht, ob telefonische Beratung ein geeignetes Mittel zur Steigerung der Teilnahmequote am Mammographie-Screening-Programm ist. Es wurden die Gründe für eine Nichtteilnahme am Mammographiescreening von Nichtteilnehmerinnen quantitativ erfasst und bestimmt, inwiefern sich diese Gründe durch eine barriere-spezifische Beratung beeinflussen lassen.
Es konnte gezeigt werden, dass die telefonische Beratung ein geeignetes Mittel darstellt, die Teilnahmequote am Mammographie-Screening zu verbessern. Es existieren, außer individuellen Gründen, auch häufige spezifizierbare Gründe die von Nichtteilnehmerinnen genannt werden. Unter diesen ist die Teilnahme am sogenannten „grauen Screening“ der häufigste, der Frauen von einer Teilnahme am Programm abhält. Frauen, die angaben, die Einladung nicht erhalten zu haben oder den in der Einladung angegebenen Termin als unpassend ansahen, konnten am meisten von der telefonischen Beratung profitieren. Die Kenntnis dieser Gründe könnte in Zukunft helfen, im Rahmen der Öffentlichkeitsarbeit spezifische Vorbehalte zu adressieren und im Rahmen des Einladungsverfahrens eine bessere Akzeptanz der Screeninguntersuchung erzeugen. Eine weitere Möglichkeit, die Teilnahmequote zu steigern ist die Reduktion des grauen Screenings, wobei eine individuelle telefonische Beratung hierzu nicht geeignet ist.
Jährlich erkranken in Deutschland mehr als 70 000 Menschen an einem Kolorektalen Karzinom (KRK). Es ist damit einesder häufigsten Malignome in Deutschland. Die Prognose einer am KRK erkrankten Person ist stark abhängig vom Stadium des Tumors zum Zeitpunkt der Entdeckung. Eine frühzeitige Diagnosestellung ist entscheidend für den gesamten weiteren Verlauf. Aufgrund der häufig langen Symptomlosigkeit des KRK sind Früherkennungsuntersuchungen daher von besonderer Bedeutung. Eine Methode, die sich in den letzten Jahren als Goldstandard etabliert hat, ist die Koloskopie. Seit Oktober 2002 gehört sie in Deutschland zu den von den Krankenkassen finanzierten Screeninguntersuchungen. Die besondere Bedeutung der Koloskopie steht im Zusammenhang mit der Pathogenese des KRK. Ein Großteil aller KRK entsteht aus zunächst gutartigen Epitheldysplasien, den Adenomen. Mit Hilfe der Koloskopie können KRK sowie Adenome erkannt und Adenome durch eine in derselben Sitzung mögliche Polypektomie entfernt werden. Das KRK kann so nicht nur frühzeitig diagnostiziert, sondern bereits seine Entstehung verhindert werden. Bis zum Jahr 2007 nahmen rund 2,9 Mio. der Berechtigten eine Screeningkoloskopie in Anspruch. Die kumulierten Teilnahmeraten der Jahre 2002 bis 2007 lagen bei 14,2 % (Männer) bzw. 15,8 % (Frauen).Angesichts dieser nur geringen Teilnahmeraten stellte sich die Frage nach den Ursachen der eingeschränkten Inanspruchnahme. In vorliegender Studie wurden die Gründe und beeinflussenden Faktoren der Nicht-Inanspruchnahme mit Hilfe qualitativer Methodik untersucht. Erhebungsinstrumente waren ein halbstrukturiertes Interview auf Grundlage eines Interviewleitfadens sowie ein ergänzender Fragebogen zu demographischen Merkmalen. Inhaltlich stützte sich der Leitfaden auf den Health Action Process Approach (HAPA)- eines von Ralf Schwarzer entwickelten Modells zur Erklärung von Verhaltensänderungen. Entscheidend für dieses Modell ist die Unterteilung einer Verhaltensänderung in zwei Phasen. In der zunächst ablaufenden Motivationsphase kommt es durch Einflüsse der Risikoerwartung, Selbstwirksamkeitserwartung sowie Handlungsergebniserwartung zur Bildung einer Intention, die in der anschließenden Volitionsphase in die entsprechende Handlung umgesetzt wird. Bei Erstellung des Interviewleitfadens lag ein besonderes Augenmerk auf den beeinflussenden Faktoren der Motivationsphase. Einen Schwerpunkt bildete dabei die Handlungsergebniserwartung mit Erfragung von konkreten Barrieren und Vorteilen. Die Selbstwirksamkeitserwartung wurde außerdem in dem ergänzenden Fragebogen erfasst. Die Befragungen fanden in Hausarztpraxen in der ländlichen Umgebung von Greifswald, im Universitätsklinikums Greifswald sowie in Privathaushalten in der Umgebung von Dresden statt. Insgesamt wurden 60 Personen interviewt, 50 Interviews wurden in die Auswertung einbezogen. Eingeschlossen wurden Personen ab 55 Jahren ohne KRK in der Eigenanamnese, bei denen noch keine Koloskopie durchgeführt worden war. Bis auf eine Person befanden sich alle Interviewteilnehmer bezüglich einer Koloskopieteilnahme in der Motivationsphase oder hatten sich noch nicht mit der Screeningkoloskopie auseinander gesetzt. Die Gründe der geringen Teilnahme sind daher in erster Linie im Zusammenhang mit präintentionalen Faktoren zu suchen. Dabei zeigte sich eine insgesamt hohe allgemeine Selbstwirksamkeitserwartung, während die Risikoerwartung der Interviewteilnehmer gering war. Bei den konkret genannten Barrieren spielten vor allem emotional-kognitive Faktoren eine Rolle. Organisatorische Hindernisse wurden als weniger bedeutsam empfunden. Die mit Abstand am häufigsten erwähnte Barriere war „Symptomlosigkeit“, gefolgt von „Verdrängung“, „unangenehme Untersuchung“, „Sorge/Angst vor dem Ergebnis“ sowie „keine Arztempfehlung“. Vorteile der Untersuchung wurden deutlich weniger genannt, wobei „Beruhigung“ und „Wissen“ im Vordergrund standen. Der Hauptvorteil der Koloskopie, die Verhinderung des KRK durch Polypektomie, wurde von keinem der Befragten erwähnt. Insgesamt wiesen sowohl die konkreten Barrieren als auch die Antworten auf die Fragen zum KRK und der Koloskopie sowie die genannten Vorteile auf einen unzureichenden bzw. falschen Wissensstand hin. Darüber hinaus waren während der Interviews deutliche Verdrängungstendenzen durch eine automatische Assoziation der Koloskopie mit Tabuthemen wie Krankheit und Tod zu verzeichnen. Zusammenfassend findet sich mit der vorliegenden Stichprobe eine Personengruppe mit größtenteils fehlender Intention bezüglich einer Teilnahme an einer Screeningkoloskopie, womit eine wichtige Voraussetzung für eine Handlung nicht gegeben ist. Als Hauptgründe der fehlenden Intentionsbildung sind dabei Faktoren im Zusammenhang mit einem unzureichenden Wissensstand sowie Verdrängungstendenzen zu sehen.
Peatlands are wetland ecosystems covering a relatively small area of the World (~3%), but at the same time storing excessive amounts of carbon for a very long time (equivalent to the four times global annual net primary production). As carbon sinks, peatlands work in spite of their slow growth, absorbing carbon dioxide (CO2) through the photosynthetic activity of the peatland plants and their low growth rates, and because high groundwater table removes oxygen from the soil and slows down the decomposition of the dead plant matter. Because of the relative lack of the oxygen in the peat, especially compared to the mineral soils, methanogen populations in the peatlands are abundant, and releasing methane (CH4), a potent greenhouse gas, to the atmosphere. Therefore, peatlands are generally at the same time significant carbon sinks and stores as well as the methane sources. The balance among the two peatland gass fluxes (CO2 and CH4) will dictate the impact of any given peatland on the global climate and primarily driven by hydrology, in the form of the groundwater table levels.
Because of the slow decomposition rates, and from radiocarbon dating of the peat as well as the subfossil records buried in it, carbon stored in peatlands is locked for a very long time (centuries to millennia). It is, therefore, crucial to gain insights into the development of peatlands and their gas balance through time. One way to get both is by studying peatland hydrology in the form of the groundwater table levels and their historical variations. Unfortunately, intensive monitoring of peatland groundwater table, when available, is an only a recent endeavor. Therefore, we need to employ proxies to reconstruct the past by leveraging the present. In statistics, proxy variables are often used when the observations of the variable of interest, are either missing or too difficult to obtain.
In this thesis, I tested whether we can use the radial growth of the Scots pines growing on peat as proxies to the peatland hydrology. To that end, I studied growth responses of the peatland Scots pines. Other proxies can and are used for the reconstructions of the groundwater table levels, but tree-growth is widely used as one of the proxies to reconstruct past environments which is at the same time annually resolved.
First, I examined the growth ecology of the peatland Scots pines by looking at their intra-annual development and trying to find relationships between it and environmental factors while at the same time comparing it with the Scots pines growing at the forest sites. I first tried with wood anatomy and found that, unfortunately, peatland Scots pines do not form enough wood cells, and consequently do not have high temporal resolution, necessary to investigate the intra-annual patterns of the radial growth. Initial results from wood anatomical investigations were interesting none-the-less, indicating that peatland Scots pines might have smaller cell features than the Scots pines from forests, but might at the same time maintain Early/Latewood ratios of those same features.
After I found that wood anatomical series were not resolved enough I decided to go with dendrometers, linear displacement sensors which constantly monitor the variations of stem radius, to get insights into the intra-annual growth patterns of the peatland Scots pines. Before using dendrometers for ecological investigations, I was involved in implementing routines commonly used in the analysis of the dendrometer signals and bringing them to R in the form of the dendrometeR package.
At one peatland complex, I installed dendrometers on ten trees in total at both peatland and forest sites and compared the pattern of the standardized signal. I inferred from the comparisons and classifications that the signal from two sites was indistinguishable for the dendrometer series shorter than five days. Furthermore, the most important environmental factor driving the radial variation at the peatland site was hydrological, daily relative humidity, indicating further that peatland hydrology might indeed be the driver behind peatland Scots pine growth.
Finally, I looked at the growth responses of peatland Scots pines from central Estonia using dendrochronological methods. Peatland hydrology, in the form of the groundwater table levels, was indeed the environmental factor with the strongest, and also stationary, correlations with the radial growth of the peatland Scots pine. That relationship indicated that peatland Scots pines are indeed possible proxies for reconstructing past levels of the peatland groundwater tables.
My study further indicated that the growth response of the peatland Scots pines was non-linear, further complicating the reconstructions of the past peatland hydrology. However, the strength of the growth response was proportional to the general hydrological regime, expressed as median groundwater table level. As the hydrological regime of the peatland does not vary considerably on the annual scales, but more on decadal it might be more appropriate to find another, independent, proxy to the hydrological regime first, and than use annually resolved radial growth of the peatland Scots pine to reconstruct past levels of the peatland groundwater table.
Human-driven peatland drainage has occurred in Europe for centuries, causing habitat degradation and leading to the emission of greenhouse gases. As such, in the last decades, there has been an increase in policies aiming at restoring these habitats through rewetting. Alder (Alnus glutinosa L.) is a widespread species in temperate forest peatlands with a seemingly high waterlogging tolerance. Yet, little is known about its specific response in growth and wood traits relevant for tree functioning when dealing with changing water table levels. In this study, we investigated the effects of rewetting and extreme flooding on alder growth and wood traits in a peatland forest in northern Germany. We took increment cores from several trees at a drained and a rewetted stand and analyzed changes in ring width, wood density, and xylem anatomical traits related to the hydraulic functioning, growth, and mechanical support for the period 1994–2018. This period included both the rewetting action and an extreme flooding event. We additionally used climate-growth and climate-density correlations to identify the stand-specific responses to climatic conditions. Our results showed that alder growth declined after an extreme flooding in the rewetted stand, whereas the opposite occurred in the drained stand. These changes were accompanied by changes in wood traits related to growth (i.e., number of vessels), but not in wood density and hydraulic-related traits. We found poor climate-growth and climate-density correlations, indicating that water table fluctuations have a stronger effect than climate on alder growth. Our results show detrimental effects on the growth of sudden water table changes leading to permanent waterlogging, but little implications for its wood density and hydraulic architecture. Rewetting actions should thus account for the loss of carbon allocation into wood and ensure suitable conditions for alder growth in temperate peatland forests.
Purpose
Due to the demographic change morbidity raises the demand for medical hospital services as well as a need for medical specialization, while economic and human resources are diminishing. Unlike other industries hospitals do not have sufficient data and adequate models to relate growing demands and increasing performance to growth in staff capacity and to increase in staff competences.
Method
Based on huge medical data sample covering the years from 2010 to 2014 with more than 150,000 operations of the Department for Anesthesiology at the University Hospital Muenster, Germany, comparisons are drawn between the development of medical services and the development of personnel capacity and expertise.
Results
The numbers of surgical operations increased by 21% and “skin incision to closure” time by 17%. Simultaneously, personnel capacity grew by 16% largely resting upon recruiting first-time employees. Expertise measured as “years of professional experience” dwindled from 10 years to 5.4 years on average and staff turnover accelerated.
Conclusion
Static benchmark data collected at fixed reference dates do not sufficiently reflect the nexus between capacity and competence and do not reflect the dynamic changes in a hospital’s requirements for expertise and specialization, at all. Staff turnover leads to a loss of experience, which jeopardizes patient safety and hampers medical specialization. In consequence of the dramatic shortage of medical specialists, drop-off rates must be reduced and retention rates must be increased. To that end, working conditions need to be fundamentally converted for a multigeneration, multicultural, and increasingly female workforce.
Group B streptococci (GBS) cause a range of invasive maternal–fetal diseases during pregnancy and post-partum. However, invasive infections in non-pregnant adults are constantly increasing. These include sepsis and streptococcal toxic shock syndrome, which are often complicated by systemic coagulation and thrombocytopenia. GBS express a hyper-hemolytic ornithine rhamnolipid pigment toxin with cytolytic and coagulatory activity. Here, we investigated the effects of GBS pigment on human platelets. Infections of platelets with pigmented GBS resulted initially in platelet activation, followed by necrotic cell death. Thus, this study shows that GBS pigment kills human platelets.
In der untersuchten Literatur ist der Nutzen einer Osteoporoseprophylaxe mittels Vitamin D und Calcium bei einem vorbestehenden Mangel ausreichend belegt. Unsere Ergebnisse zeigen, dass die kutane Vitamin-D-Synthese über das gesamte Jahr plus die Zufuhr über die Nahrung bei unseren Patienten insgesamt unzureichend ist und bestätigen den ausgeprägten Vitamin-D-Mangel bei unseren Patienten. Dieser Mangel ist bei Patienten mit osteoporosetypischer Fraktur (aktuell oder anamnestisch) signifikant ausgeprägter als in der Vergleichsgruppe. Es konnte bestätigt werden, dass der Vitamin-D-Serumspiegel mit zunehmendem Alter abfällt und auch eine nachlassende Mobilität als Risikofaktor für eine Hypovitaminose D zu werten ist. Prinzipiell ist die zusätzliche Zufuhr jeder einzelnen Vitamin-D-Einheit wünschenswert, der angestrebte Effekt ist aber am besten für eine Dosierung von mindestens 800 bis 2000 IE Vitamin D dokumentiert. Der Mangel ist bei den untersuchten Patienten so weit verbreitet, dass die allgemeine Vitamin-D-Prophylaxe für alle Patienten älter 60 Jahre mit täglich 800 bis 2000 IE Vitamin D empfohlen wird. Die zusätzliche Gabe von 1000 mg Calcium (bei calciumarmer Ernährung) täglich unterstützt die Wirkung und schützt vor der Mobilisation von Calcium aus den Knochen. Ein Nutzen einer Gesamtcalciumzufuhr von über 1500mg ist nicht belegt. Zum Status der Osteoporoseprophylaxe bzw. –therapie lässt sich festhalten, dass die Versorgungssituation in Greifswald zum untersuchten Zeitpunkt als unzureichend bezeichnet werden muss. Insbesondere die Tatsache, dass lediglich 6,5 % der Patienten mit Zustand nach zurückliegender osteoporosetypischer Fraktur bei der stationären Aufnahme in der Abteilung für Unfallchirurgie eine entsprechende Therapie im Vorfeld erhalten haben, ist alarmierend. Die Daten der unfallchirurgischen Patienten bezüglich der Osteoporoseprophylaxe bzw. –therapie konnte durch die Analyse der SHIP 0 Daten eindrucksvoll bestätigt werden. Durch die Miteinbeziehung der Daten der SHIP I- Studie konnte bereits eine deutlich positive Entwicklung in einem 5-Jahreszeitraum aufgezeigt werden. Die vorgelegte Arbeit zieht eine Zwischenbilanz, die alarmierend ist. Die Aufklärung von Ärzteschaft und Patienten unter Einbeziehung der Medien ist obligatorisch; die Osteoporose wird wesentlicher Betrachtungs- und Untersuchungsgegenstand der Versorgungsforschung im jetzigen Dezennium sein.
Over thousands of years, peatlands around the world have accumulated carbon (C) stocks of global importance. Drainage for agriculture, forestry and peat extraction has transformed many peatlands from long-term sinks into strong sources of carbon dioxide (CO2). Peat extraction is worldwide responsible for about ten percent of drained peatlands and is mainly carried out in northern countries and Eastern Europe. In Belarus, 0.3 Mha of peatlands are drained for peat extraction, which is twelve percent of the country's peatland area. From 2006 to 2013, 21,333 ha of this area have been rewetted to protect these peatlands from fire and further degradation, reduce their greenhouse gas (GHG) emissions, turn them back into C sinks and promote biodiversity. A further 260,000 ha are no longer used for peat extraction and their rewetting would be a great benefit for nature conservation and climate protection.
Rewetting of abandoned peat extraction areas usually leads to inundation of large areas where not adapted plants die and new species establish, depending on water level and nutrient conditions. Beavers, of which there are many in Belarus, also play an important role in the rewetting of peatlands. They dam up ditches in drained and rewetted peatlands, thus contributing to water level increases and vegetation changes. The aim of this PhD thesis was to investigate the impact of inundation on vegetation and GHG emissions in formerly extracted fens in Belarus, to determine the role of water level in this process, and to study whether such fens develop back into C sinks with an almost neutral GHG balance within one or two decades after rewetting (Papers II and III). Also the potential of beaver activities for peatland restoration was assessed (Paper III).
Two very different fens, rewetted after peat extraction, were chosen as study areas. The first one, Giel'cykaŭ Kašyl, is a former flood mire and was rewetted with water from the Jasiel'da River in 1985. During the study period 2010–2012 this site was a shallow lake (~ 1 m deep) dominated by very productive, tall reed. Shallower areas along the edges had a partly floating vegetation cover of cattail (Typha latifolia, T. angustifolia) and sedges (Carex elata, C. vesicaria). The second fen, Barcianicha, is fed by groundwater. Rewetting from 1995 onwards resulted in water levels at or slightly above surface and a lower nutrient availability compared to Giel'cykaŭ Kašyl'. This was reflected in the establishment of mesotrophic communities of Eriophorum angustifolium and Carex rostrata. Phragmites australis stands, which were also dominant here, were shorter and less productive than in Giel'cykaŭ Kašyl'. The southern area of Barcianicha was not used for peat extraction and has not been rewetted. Until 2009 vegetation of this part was characterized by forbs (Urtica dioica) and wet meadows (Agrostis stolonifera). From autumn 2009, a beaver dam in the main drainage ditch caused flooding of these areas and led to diverging vegetation development depending on water levels.
Within the framework of this doctoral thesis annual fluxes of CO2, methane (CH4) and nitrous oxide (N2O) and the development of water levels and vegetation were monitored for two years at nine sites and evaluated (Papers II and III). Three of the sites, respectively, were located (a) in Giel’cykaŭ Kašyl’, flooded in 1985, (b) in the central area of Barcianicha, which was rewetted in 1995, and (c) in the southern part of Barcianicha, which was flooded by beavers end of 2009. GHG measurements were carried out with manual chambers from August 2010 to September 2012. Annual net CO2 exchange rates (NEE) were modeled based on light response curves of gross primary production (GPP) and on temperature response curves of ecosystem respiration (Reco), which were determined every third to fourth week by alternating measurements with transparent (cooled) and opaque chambers (both with fan) along the daily amplitude of photosynthetically active radiation (PAR) and temperature. Annual CH4 emissions were calculated mainly based on the temperature response of CH4 fluxes over the course of the year, based on biweekly (in summer) to monthly (in winter) repeated single measurements with opaque chambers (without fan). This was done, although all longer rewetted sites were dominated by aerenchymatic plants whose gas transport during the vegetation period may change over the course of the day and can be influenced by shading. This might apply to the six longer rewetted sites, two of which were dominated by Phragmites australis, and the others by Typha latifolia, Carex elata, Carex rostrata or Eriophorum angustifolium. For these six sites therefore studies on the daily course of CH4 release and the influence of chamber shade were conducted, covering 8–24 hours and lasting at least from sunrise to afternoon. Also the extent to which flux rates were affected by a lack of chamber headspace mixing by fans was investigated in the mentioned studies (Papers I and II).
The daytime course of CH4 emissions showed a pronounced dynamic for Phragmites australis in both fens, with minimum release during the night and maximum during the day (Paper I). The other sites in contrast did not show a significant diurnal CH4 flux dynamic (Paper II). Lack of headspace mixing by fans as compared to chambers with fan resulted in a slight underestimation of CH4 emissions at very high chambers (220 and 250 cm), as used for Phragmites australis in Giel'cykaŭ Kašyl', while there was no difference at lower chambers (≤185 cm), as used for the other sites. Opaque chambers resulted for sites dominated by Typha latifolia and Carex elata in significantly (1.2 times and 1.1 times, respectively) lower CH4 fluxes compared to transparent chambers. For the other sites, opaque chambers did not significantly reduce CH4 emissions. This result was unexpected, especially for Phragmites australis, as PAR out of all parameters tested had the strongest influence on CH4 emissions from both reed sites, and clouds directly led to reduction of their emissions. Presumably the gas flow in the reed shoots located within opaque chambers was maintained by shoots outside the chamber that were connected to the enclosed shoots by rhizomes (Paper I). The investigations showed that single measurements between 9 a.m. and 6 p.m. with opaque chambers without fan, as performed for the determination of annual CH4 fluxes, resulted for Carex rostrata and Eriophorum angustifolium in estimates similar to the daily mean, but for Phragmites australis in estimates that were rather above the daily mean. Annual CH4 fluxes from Phragmites australis could therefore be slightly overestimated. CH4 fluxes from Typha latifolia and Carex elata during the vegetation period were corrected by a factor of 1.2, although darkness inside of opaque chambers matters only at day, not at night. Daily and annual CH4 fluxes from these sites have been therefore most likely slightly overestimated, too.
Water saturation and the establishment of adapted vegetation were the most important conditions for the restoration of C sinks (gaseous CO2 and CH4 fluxes) in the investigated peatlands. The only site with falling water levels in summer and thus temporarily aerated peat was the beaver flooded forbs (Urtica dioica) site at Barcianicha. This site was a very strong CO2 emitter and the only significant N2O source of the entire study (Paper III). All other sites were permanently wet, had much lower CO2 emissions or were even net C sinks (Papers II and III). Establishment of adapted vegetation depended on inundation depth and time since rewetting. For example, within one year the meadow site in Barcianicha shallowly flooded by beaver was colonized by Carex rostrata and other adapted helophytes and developed into a CO2 sink, while the deeper flooded site at the same meadow initially attracted only Chara and some individuals of Alisma plantago aquatica and remained a moderate CO2 source. However, the results of the longer rewetted sites show, that also deeply (~ 1 m) flooded fen areas can become densely populated with mire plants in the course of 25 years and develop into net C sinks. Highest annual C uptake in both fens was achieved by the reed sites. Eriophorum angustifolium and Carex rostrata in mesotrophic Barcianicha were smaller C sinks. Typha latifolia and Carex elata in the eutrophic Giel'cykaŭ Kašyl', on the other hand, released CO2, presumably because the high and fluctuating water levels imposed stress to the plants, and because the large supply of nutrients and dead plant material allowed for strong heterotrophic respiration (Paper II). The simultaneously high CH4 emissions made Typha latifolia and Carex elata major sources of GHG. CH4 emissions from Phragmites australis in Giel'cykaŭ Kašyl' were even higher, but due to extremely high CO2 uptake the site was only a small net GHG source. CH4 emissions in Barcianicha were much lower and comparable to undisturbed sedge fens. The difference between Giel'cykaŭ Kašyl' and Barcianicha was mainly due to the different nutrient supply and the related productivity of the plants. Important conclusions are that stable inundation is an appropriate measure for restoration of the C sink of formerly extracted fens, but nutrient input with water needs to be stopped or reduced in order to decrease CH4 production. If this is not possible, establishment of Phragmites australis and other strong C sinks could help to compensate for the climate impact of high CH4 emissions from eutrophic sites.
The effect of the beaver dam on the development of the southern part of Barcianicha depended not only on the initial situation but mainly on the water level. Under optimal conditions, it led to the rapid establishment of adapted mire plants, the restoration of a C sink and a significant reduction of GHG emissions. However, this situation in the shallowly flooded meadow was achieved by chance. In comparison to planned rewetting measures, which aim to raise the water level evenly over the entire peatland, beavers dam ditches in order to improve their immediate habitat, thus influencing water levels only up to a certain distance, but rarely over the entire peatland. Nevertheless, beaver activity is of high value both for mire conservation projects, where existing dams are supplemented by beaver dams, and for abandoned, drained peatlands, like former peat extraction areas in Belarus, many of which at least partially have been rewetted by beavers.
Abstract
Ecosystems with highly pulsed water supply must be better understood as climate change may increase frequency and severity of intense storms, droughts and floods. Here we collected data over 3 years (2016–2018) in the episodic wetland outflow channel (Aluize), Banhine National Park, in which the system state changed from dry to wet to dry. Field sampling included vegetation records, small‐scale vegetation zoning, the seed bank and water and soil quality. The same main plant species were found in both dry and wet conditions across the riverbed of the outflow channel. We found only very few diaspores of plants in the soil after prolonged drought. In the subsequent flooded state, we examined very dense vegetation on the water surface, which was dominated by the gramineous species Paspalidium obtusifolium. This species formed a compact floating mat that was rooted to the riverbed. The Cyperaceae Bolboschoenus glaucus showed high clonal growth in the form of root tubers, which likely serve as important food reservoir during drought. Soil and water analyses do not indicate a limitation by nutrients. We outline how resident people may change the plant community structure with an increasing practice of setting fire to the meadows in the dried‐up riverbed to facilitate plant regrowth as food for their livestock.
In the PhD-thesis a conditional random field approach and its implementation is presented to predict the interaction sites of protein homo- and heterodimers using the spatial structure of one protein partner from a complex. The method includes a substantially simple edge feature model. A novel node feature class is introduced that is called -change in free energy-. The Online Large-Margin algorithm is adapted in order to train the model parameters given a classified reference set of proteins. A significantly higher prediction accuracy is achieved by combining our new node feature class with the standard node feature class relative accessible surface area. The quality of the predictions is measured by computing the area under the receiver operating characteristic.
A common task in natural sciences is to
describe, characterize, and infer relations between discrete
objects. A set of relations E on a set of objects V can
naturally be expressed as a graph G = (V, E). It is
therefore often convenient to formalize problems in natural
sciences as graph theoretical problems.
In this thesis we will examine a number of problems found in
life sciences in particular, and show how to use graph theoretical
concepts to formalize and solve the presented problems. The
content of the thesis is a collection of papers all
solving separate problems that are relevant to biology
or biochemistry.
The first paper examines problems found in self-assembling
protein design. Designing polypeptides, composed of concatenated
coiled coil units, to fold into polyhedra turns out
to be intimately related to the concept of 1-face embeddings in
graph topology. We show that 1-face embeddings can be
canonicalized in linear time and present algorithms to enumerate
pairwise non-isomorphic 1-face embeddings in orientable surfaces.
The second and third paper examine problems found in evolutionary
biology. In particular, they focus on
inferring gene and species trees directly from sequence data
without any a priori knowledge of the trees topology. The second
paper characterize when gene trees can be inferred from
estimates of orthology, paralogy and xenology relations when only
partial information is available. Using this characterization an
algorithm is presented that constructs a gene tree consistent
with the estimates in polynomial time, if one exists. The
shown algorithm is used to experimentally show that gene trees
can be accurately inferred even in the case that only 20$\%$ of
the relations are known. The third paper explores how to
reconcile a gene tree with a species tree in a biologically
feasible way, when the events of the gene tree are known.
Biologically feasible reconciliations are characterized using
only the topology of the gene and species tree. Using this
characterization an algorithm is shown that constructs a
biologically feasible reconciliation in polynomial time, if one
exists.
The fourth and fifth paper are concerned with with the analysis
of automatically generated reaction networks. The fourth paper
introduces an algorithm to predict thermodynamic properties of
compounds in a chemistry. The algorithm is based on
the well known group contribution methods and will automatically
infer functional groups based on common structural motifs found
in a set of sampled compounds. It is shown experimentally that
the algorithm can be used to accurately
predict a variety of molecular properties such as normal boiling
point, Gibbs free energy, and the minimum free energy of RNA
secondary structures. The fifth and final paper presents a
framework to track atoms through reaction networks generated by a
graph grammar. Using concepts found in semigroup theory, the
paper defines the characteristic monoid of a reaction network. It
goes on to show how natural subsystems of a reaction network organically
emerge from the right Cayley graph of said monoid. The
applicability of the framework is proven by applying it to the
design of isotopic labeling experiments as well as to the
analysis of the TCA cycle.
The main objective of this work is to contribute to the understanding of the grafting of nitrogen and amino surface functional groups on polymers by means of plasmas containing nitrogen and hydrogen. For this purpose, many aspects of plasma surface modification were studied. In the frame of this work, a new, UHV-sealed plasma reactor system was put into operation. The system is special for its clean reaction environment and the possibility to perform quasi in situ XPS measurements. A comparison of the UHV system to a fine vacuum reactor showed that a clean reaction environment is mandatory for reproducible plasma processing and efficient nitrogen and amino functionalisation. A key motivation for the present work was the observation that the non-coating plasma processes reported in literature fail to graft primary amino groups on polymer surfaces with densities that significantly exceed 3 - 4% NH2/C. In order to investigate this phenomenon in detail, this work followed two experimental tracks: On the one hand, a broad systematic study of plasma processing parameters was performed. On the other, the surface diagnostics methods used for the quantification of amino groups were critically reviewed. For this, a numerical algorithm was developed to reconstruct the element depth profile from angle-resolved XPS data. In the scope of the process parameter study, cw and pulsed microwave (MW) plasma excitation was compared to radio-frequency (RF) excitation. The home-built MW source was studied and optimised with respect to ignition behaviour and power efficiency. The performance of the MW and RF plasmas in polymer surface modifications was studied in various gas mixtures containing NH3 and H,, or N2 and H,. Also the differences of glow and afterglow processing of polymers were investigated. Large variations of the nitrogen and primary amino grafting efficiencies were obtained. They triggered a number of new ideas for the underlying reaction mechanisms. Special attendance was devoted to the selectivity of the functionalisation processes for primary amino groups. Nitrogen-containing discharges that were rich in hydrogen achieved selectivities up to 100%. The upper limit of 3 - 4% amino groups on the surface, however, was not passed. Angle-resolved XPS measurements revealed a systematic problem for the definition of a surface density, which is capable of explaining the upper limit for amino groups. It is either due to a limited labelling depth of amino groups by the applied TFBA derivatisation reaction, or to a limited functionalisation depth of the plasma process. One very efficient nitrogen-grafting plasma process that was developed on polystyrene was applied to seven other unfluorinated polymers. The similarity of the resulting functionalisation demonstrated a good transfer-ability of plasma surface functionalisation processes. Plasma treatments of polymer surfaces, especially in hydrogen-containing gases, are known to be generally followed by uncontrollable oxidation phenomena. The properties of plasma-functionalised polymer surfaces were therefore studied in conjunction with ageing effects. Quasi in situ XPS analysis allowed to distinguish the influence of oxygen contamination during the plasma process from post-process oxidation due to contact of plasma-treated samples to atmospheric oxygen. The surface modification experiments were accompanied by several gas phase diagnostic techniques. In the scope of this work, the UHV reactor system was equipped with optical emission spectroscopy (OES), two-photon absorption laser-induced fluorescence (TALIF), and tunable diode laser absorption spectroscopy (TDLAS). A separate plasma source was setup to perform an absolute quantification of the vacuum-ultra-violet (VUV) emission intensity of hydrogen-containing MW-excited plasmas. The techniques were evaluated with respect to their contribution to an understanding of the plasma processing of polymers. The rich experimental data allowed to suggest new reaction mechanisms for the grafting of nitrogen- and amino functional groups. Surface passivation experiments in H, plasmas of nitrogen-functionalised surfaces initiated a re-evaluation and an extension of the mechanism of selective etching [1]. Together with two other new reaction mechanisms, a hypothetical reaction scheme was suggested. It was studied by the help of two numerical models for heterogenous reactions of radicals with the surface. In order to avoid the complexity of the fragmentation process of NH,, the models were restricted to discharges in N, and H9. Despite the sparse information on the composition of the gas phase, the data of two experimental series showed a very particular phenomenology that allowed a first test of the model. The test supports the newly-suggested reaction mechanisms. Especially the role of NH2 attachment to open reaction sites for the grafting of amino groups was emphasised. A more stringent test of the model is left to future experiments with extended gas phase diagnostic means.
Platelets within one individual display heterogeneity in reactivity, size, age, and expression of surface receptors. To investigate the combined intraindividual contribution of platelet size, platelet age, and receptor expression levels on the reactivity of platelets, we studied fractions of large and small platelets from healthy donors separated by using differential centrifugation. Size-separated platelet fractions were perfused over a collagen-coated surface to assess thrombus formation. Multicolor flow cytometry was used to characterize resting and stimulated platelet subpopulations, and platelet age was determined based on RNA and HLA-I labeling. Signal transduction was analyzed by measuring consecutive phosphorylation of serine/threonine-protein kinase Akt. Compared with small platelets, large platelets adhered faster to collagen under flow and formed larger thrombi. Among the large platelets, a highly reactive juvenile platelet subpopulation was identified with high glycoprotein VI (GPVI) expression. Elevated GPVI expression correlated with high HLA-I expression, RNA content, and increased platelet reactivity. There was a stronger difference in Akt phosphorylation and activation upon collagen stimulation between juvenile and older platelets than between large and small platelets. GPVI expression and platelet reactivity decreased throughout platelet storage at 22°C and was better maintained throughout cold storage at 4°C. We further detected higher GPVI expression in platelets of patients with immune thrombocytopenia. Our findings show that high GPVI expression is a feature of highly reactive juvenile platelets, which are predominantly found among the large platelet population, explaining the better performance of large platelets during thrombus formation. These data are important for studies of thrombus formation, platelet storage, and immune thrombocytopenia.
Governance and Management of Tourism in two Biosphere Reserves in Ecuador: Galapagos and Sumaco
(2014)
Tourism is multi-faceted phenomenon and various stakeholders, levels of government, and sectors are closely interlinked. Governmental and non-governmental institutions, local communities, diverse professionals, and different sectors and tourists do show various perspectives about the management of tourism. In this dissertation, a comprehensive analysis on the current situation of tourism in two biosphere reserves (Galapagos and Sumaco) in Ecuador is presented. Tourism is considered as one of the key strategies to promote environmental conservation and socio-economic development of local communities living in these places. UNESCO biosphere reserves are protected areas of extraordinary natural and cultural value, conceived as places for reconciliation between conservation and development. The concept of sustainable tourism can be seen as an umbrella that unites various forms of tourism in these protected areas (e.g. ecotourism, community-based tourism). The primary objective was to evaluate the main factors of success and failure in the management of tourism and its contribution to biodiversity conservation. Thus, a detailed review of the legal, political, and institutional framework of the country and a description of the two biosphere reserves (physical, biogeographic, demographic, socio-economic, institutional and legal elements) was given. Data collection for the case studies (Galapagos and Sumaco) was performed by the combination of qualitative and quantitative methods. As for qualitative tools, in-depth semi-structured interviews with the main stakeholders in both biosphere reserves were applied. Experts and specialists in the management of protected areas, as well as representatives of different sectors directly and indirectly associated with tourism were interviewed. Moreover, surveys were applied to two different target groups. Tourists were surveyed in order to establish their socio-demographic profile, travel preferences, and degree of knowledge about sustainable tourism, as well as their perception of the sustainability of tourism in the destinations visited. Furthermore, residents in both reserves were surveyed in order to find out about their socio-demographic characteristics, their main economic activities for supporting themselves and their attitude towards tourism, their level of knowledge about biosphere reserves, and their perception about advantages or disadvantages of living in a biosphere reserve. In general, although tourism is a concept that could be developed in accordance with the environment in these natural areas, in the case of Galapagos it is one of the main risk factors for the conservation of biodiversity in the archipelago due to the increasing number of tourists. In contrast, in Sumaco tourism could be an important sustainable alternative to mining, oil extraction and hydroelectric projects, which are the current threats to the conservation of the area. From the environmental point of view, there are serious problems in both reserves, mainly linked to the contamination of water resources. Such pollution imposes risks to the health to both, residents and tourists. The lack of freshwater is particularly critical in Galapagos, given its insular habitat. The invasion of exotic species in Galapagos is one of the most serious threats to the conservation, while deforestation in combination with illegal logging and mining activities is the greatest danger in Sumaco. In terms of sociocultural factors, migration processes undoubtedly shape the attitudes and values of the current population in both reserves. In Galapagos most residents are immigrants, whereas in Sumaco a significant portion are Kichwa people who belong to the area’s native population. In general, the inhabitants in both areas have not yet developed a true environmental awareness. The distribution of human population groups is also associated with the different types of tourism. In both reserves, tourist services offered by local communities have low quality standards and are targeted on a market segment consisting of tourists with a low budget. Thus, the community revenues obtained from tourism are generally only a small percentage of the total tourism market. This situation is much more noticeable in Galapagos where large companies that operate luxury cruises and hotels gain most of their revenues from tourism. Many of them have their headquarters in the main cities of Ecuador and abroad, which means that they pay their taxes in those cities and not in the places where they operate. Inequality in the distribution of the economic benefits of tourism leads to a situation of frustration and discontentment among the residents of the regions involved. Despite this situation, tourism is still a profitable business and residents try to make the most of it, no matter the cost impacts. Temporary and illegal tourism activities is often the normal state of the things: unregistered houses that offer rooms for tourists, taxi drivers who offer tours without being in possession of permits, tourist boat owners, tour guides and even large tourist companies that operate without legal licenses. This situation inevitably leads to a decrease of the quality of services, an uncontrolled increase of business, a consequent dumping of prices and the overall decline of the destination. Ultimately, this means fewer tourists, more environmental degradation and less economic benefits for residents. In this context, there is a serious conflict between the local community and large foreign companies. Governance and management of tourism are essential elements to ensure its development in a sustainable way. The country has a large number of laws, rules, regulations, and plans that regulate the development of sustainable tourism legally and institutionally, especially in protected areas. However, monitoring and law enforcement are major constraints for achieving proper management of tourism. This problem is particularly noticeable in small communities such as Galapagos and Sumaco where interpersonal relationships of kinship and friendship are close, which complicates control and regulation. There are some serious limitations regarding the technical and logistical capacity of the institutions responsible for controlling and managing the tourist activity; they consist mainly in the lack of staff and funding. Galapagos, given its special status, has increased the number of funding managers and staff members for controlling and management, but in many cases, these people are not fully qualified for their positions. Sumaco has only few tourism experts who can help to develop the tourism. The coordination and planning among all stakeholders involved in tourism is still a work in progress to ensure proper management of the tourist destinations. In any case, local communities are developing important initiatives in both biosphere reserves. After all, sometimes planning, coordination and local activities do not necessarily coincide with the national agenda. In general, in both biosphere reserves it is necessary to ensure higher standards of education, both formal and informal. Also it is urgent that the government as a regulating entity ensures the equitable participation of local communities in tourism benefits, control, monitoring, and law enforcement. Moreover, there is the need to encourage and ensure integrated planning of tourism in the different levels of government: local, regional, and national. Sustainable tourism means that the protection of cultural heritage and natural resources is granted at least the same level of importance as the involved economic interests. The unique nature that currently attracts tourists to Galapagos and Sumaco should be preserved not only for ensuring the continuity of the tourism activity itself, but also in order to safeguard biodiversity and natural resources for the coming generations. Responsible tourism practices which care about their social and environmental impacts are not necessarily opposed to economic interests. On the contrary, they need each other for a long-term development.