Parks of the future: Protected areas in Europe challenging regional and global change

Climate change, declines in biodiversity, increasing consumption of resources, urbanisation, urban sprawl and demographic change continue to challenge theregions of Europe. In response to these processes of regional and global change, there has been an unmistakeable boom in parks in Europe since the 1990s. Morethan a fifth of the continent is now protected using designations such as regionalnature parks, national parks, UNESCO Biosphere Reserves and World Heritagesites. The responsibilities of these areas are usually diverse and, in addition tonature protection and the conservation of cultural landscapes, increasingly involvethe promotion of sustainable development. In the 22 chapters of this volume, 28 authors from all over Europe analyse and comment on experiences of tackling the challenges of regional and global changein parks. They illustrate discussions with selected case studies and deal with keyissues of current protected area policy: How do parks address the pending challengesand what successes have they had thus far? What pioneering approaches are there in spatial planning and regional development? Which forms of park managementand governance are most promising? This informative and well-illustratedbook also considers which tasks will be assumed by parks in the future and whatroles parks may play in the debate concerning transformations required to promotesustainability in Europe.

Potentials and limitations of coordinated spatial and non-spatial information

Information management and geoinformation systems (GIS) have become indispensable in a large majority of protected areas all over the world. These tools are used for management purposes as well as for research and in recent years have become even more important for visitor information, education and communication. This study is divided into two parts: the first part provides a general overview of GIS and information management in a selected number of national park organizations. The second part lists and evaluates the needs of evolving large protected areas in Switzerland. The results show a wide use of GIS and information management tools in well established protected areas. The more isolated use of singular GIS tools has increasingly been replaced by an integrated geoinformation management. However, interview partners pointed out that human resources for GIS in most parks are limited. The interviews also highlight uneven access to national geodata. The view of integrated geoinformation management is not yet fully developed in the park projects in Switzerland. Short-term needs, such as software and data availability, motivate a large number of responses collected within an exhaustive questionnaire. Nevertheless, the need for coordinated action has been identified and should be followed up. The park organizations in North America show how an effective coordination and cooperation might be organized.

Nötige und unnötige Behandlungen beim Hämorrhoidalleiden: Der Patient bestimmt mit

Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the expense of a higher recurrence rate. These relatively "new" procedures equally qualify for the treatment of grade III and IV hemorrhoids, and, in the case of stapled hemorrhoidopexy, may even be employed in the emergency situation of an acute anal prolapse. While under certain circumstances different treatment options are equivalent, there is a clear specificity with respect to the application of those procedures in other situations. The respective pros and cons need to be discussed separately with every patient. According to their own requirements a treatment strategy has to be defined according to their individual requirements.

Linking Landscape Protection and Nature Conservation: Switzerland’s Experience with Protected Mire Landscapes

Since 1987, Switzerland’s Federal Inventory of Mire Landscapes of Particular Beauty and National Importance has provided an instrument for the integration of nature conservation and landscape protection. Mires and mire landscape protection are strictly regulated. However, research results show that neither the goals of mire protection nor those of mire landscape protection are being achieved. The reasons for this are manifold and, in particular, have to do with a lack of coordination between the various policy areas that shape mire environments and mire landscapes. There are several key challenges involving different political and administrative levels. At the national level, mechanisms must be devised that enable differentiated regional implementation of national sectoral policies. In the context of cantonal structure planning, regional nature conservation and landscape protection priorities should be established based on existing regional potentials vis-à-vis the natural environment and landscapes (including protected biotopes and landscapes). At the regional level (spanning multiple communes), integrated planning instruments and governance structures should be developed so that implementation of national and cantonal sectoral policies may be harmonized under the umbrella of regional and integrated development plans. These adjustments to Switzerland’s institutional system are necessary to enable far-reaching integration of nature conservation and landscape protection when setting regional policy priorities. This would strengthen the protection of mire landscapes and other integrative instruments such as regional nature parks of national importance.

Genome-wide association study of survival from sepsis due to pneumonia: an observational cohort study.

BACKGROUND Sepsis continues to be a major cause of death, disability, and health-care expenditure worldwide. Despite evidence suggesting that host genetics can influence sepsis outcomes, no specific loci have yet been convincingly replicated. The aim of this study was to identify genetic variants that influence sepsis survival. METHODS We did a genome-wide association study in three independent cohorts of white adult patients admitted to intensive care units with sepsis, severe sepsis, or septic shock (as defined by the International Consensus Criteria) due to pneumonia or intra-abdominal infection (cohorts 1-3, n=2534 patients). The primary outcome was 28 day survival. Results for the cohort of patients with sepsis due to pneumonia were combined in a meta-analysis of 1553 patients from all three cohorts, of whom 359 died within 28 days of admission to the intensive-care unit. The most significantly associated single nucleotide polymorphisms (SNPs) were genotyped in a further 538 white patients with sepsis due to pneumonia (cohort 4), of whom 106 died. FINDINGS In the genome-wide meta-analysis of three independent pneumonia cohorts (cohorts 1-3), common variants in the FER gene were strongly associated with survival (p=9·7 × 10(-8)). Further genotyping of the top associated SNP (rs4957796) in the additional cohort (cohort 4) resulted in a combined p value of 5·6 × 10(-8) (odds ratio 0·56, 95% CI 0·45-0·69). In a time-to-event analysis, each allele reduced the mortality over 28 days by 44% (hazard ratio for death 0·56, 95% CI 0·45-0·69; likelihood ratio test p=3·4 × 10(-9), after adjustment for age and stratification by cohort). Mortality was 9·5% in patients carrying the CC genotype, 15·2% in those carrying the TC genotype, and 25·3% in those carrying the TT genotype. No significant genetic associations were identified when patients with sepsis due to pneumonia and intra-abdominal infection were combined. INTERPRETATION We have identified common variants in the FER gene that associate with a reduced risk of death from sepsis due to pneumonia. The FER gene and associated molecular pathways are potential novel targets for therapy or prevention and candidates for the development of biomarkers for risk stratification. FUNDING European Commission and the Wellcome Trust.