A feasibility study for the provision of electronic healthcare tools and services in areas of Greece, Cyprus and Italy

Background Through this paper, we present the initial steps for the creation of an integrated platform for the provision of a series of eHealth tools and services to both citizens and travelers in isolated areas of thesoutheast Mediterranean, and on board ships travelling across it. The platform was created through an INTERREG IIIB ARCHIMED project called INTERMED. Methods The support of primary healthcare, home care and the continuous education of physicians are the three major issues that the proposed platform is trying to facilitate. The proposed system is based on state-of-the-art telemedicine systems and is able to provide the following healthcare services: i) Telecollaboration and teleconsultation services between remotely located healthcare providers, ii) telemedicine services in emergencies, iii) home telecare services for "at risk" citizens such as the elderly and patients with chronic diseases, and iv) eLearning services for the continuous training through seminars of both healthcare personnel (physicians, nurses etc) and persons supporting "at risk" citizens. These systems support data transmission over simple phone lines, internet connections, integrated services digital network/digital subscriber lines, satellite links, mobile networks (GPRS/3G), and wireless local area networks. The data corresponds, among others, to voice, vital biosignals, still medical images, video, and data used by eLearning applications. The proposed platform comprises several systems, each supporting different services. These were integrated using a common data storage and exchange scheme in order to achieve system interoperability in terms of software, language and national characteristics. Results The platform has been installed and evaluated in different rural and urban sites in Greece, Cyprus and Italy. The evaluation was mainly related to technical issues and user satisfaction. The selected sites are, among others, rural health centers, ambulances, homes of "at-risk" citizens, and a ferry. Conclusions The results proved the functionality and utilization of the platform in various rural places in Greece, Cyprus and Italy. However, further actions are needed to enable the local healthcare systems and the different population groups to be familiarized with, and use in their everyday lives, mature technological solutions for the provision of healthcare services.

Effects of Landscape Segregation on Livelihood Vulnerability: Moving From Extensive Shifting Cultivation to Rotational Agriculture and Natural Forests in Northern Laos

This study investigates four decades of socio-economic and environmental change in a shifting cultivation landscape in the northern uplands of Laos. Historical changes in land cover and land use were analyzed using a chronological series of remote sensing data. Impacts of landscape change on local livelihoods were investigated in seven villages through interviews with various stakeholders. The study reveals that the complex mosaics of agriculture and forest patches observed in the study area have long constituted key assets for the resilience of local livelihood systems in the face of environmental and socio-economic risks. However, over the past 20 years, a process of segregating agricultural and forest spaces has increased the vulnerability of local land users. This process is a direct outcome of policies aimed at increasing national forest cover, eradicating shifting cultivation and fostering the emergence of more intensive and commercial agricultural practices. We argue that agriculture-forest segregation should be buffered in such a way that a diversity of livelihood opportunities and economic development pathways can be maintained.

Productive Diversification and Sustainable Use of Complex Social-Ecological Systems: A Comparative Study of Indigenous and Settler Communities in the Bolivian Amazon

Agricultural and forest productive diversification depends on multiple socioeconomic drivers—like knowledge, migration, productive capacity, and market—that shape productive strategies and influence their ecological impacts. Our comparison of indigenous and settlers allows a better understanding of how societies develop different diversification strategies in similar ecological contexts and how the related socioeconomic aspects of diversification are associated with land cover change. Our results suggest that although indigenous people cause less deforestation and diversify more, diversification is not a direct driver of deforestation reduction. A multidimensional approach linking sociocognitive, economic, and ecological patterns of diversification helps explain this contradiction.

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Farming Systems and Resilience Building in a Changing Climate On-Farm Comparisons of Organic and Conventional Cocoa Cultivation in Alto Beni, Bolivia

Resilience research has been applied to socioeconomic as well as for agroecological studies in the last 20 years. It provides a conceptual and methodological approach for a better understanding of interrelations between the performance of ecological and social systems. In the research area Alto Beni, Bolivia, the production of cocoa (Theobroma cacao L.), is one of the main sources of income. Farmers in the region have formed producers’ associations to enhance organic cocoa cultivation and obtain fair prices since the 1980s. In cooperation with the long-term system comparisons by the Research Institute of Organic Agriculture (FiBL) in Alto Beni, aspects of the field trial are applied for the use in on-farm research: a comparison of soil fertility, biomass and crop diversity is combined with qualitative interviews and participatory observation methods. Fieldwork is carried out together with Bolivian students through the Swiss KFPE-programme Echanges Universitaires. For the system comparisons, four different land-use types were classified according to their ecological complexity during a preliminary study in 2009: successional agroforestry systems, simple agroforestry systems (both organically managed and certified), traditional systems and conventional monocultures. The study focuses on interrelations between different ways of cocoa cultivation, livelihoods and the related socio-cultural rationales behind them. In particular this second aspect is innovative as it allows to broaden the biophysical perspective to a more comprehensive evaluation with socio-ecological aspects thereby increasing the relevance of the agronomic field studies for development policy and practice. Moreover, such a socio-ecological baseline allows to assess the potential of organic agriculture regarding resilience-building face to socio-environmental stress factors. Among others, the results of the pre-study illustrate local farmers’ perceptions of climate change and the consequences for the different crop-systems: all interviewees mentioned rising temperatures and/or an extended dry season as negative impacts more with regard to their own working conditions than to their crops. This was the case in particular for conventional monocultures and in plots where slash-and-burn cultivation was practised whereas for organic agroforestry systems the advantage of working in the shade was stressed indicating that their relevance rises in the context of climate change.

[Local treatment of chronic skin wounds in a Swiss out-patient wound centre 2010]

In Switzerland around 30,000 patients suffer from chronic skin wounds. Appropriate topical wound care along with treatment of the causes of the wounds enables to heal a lot of these patients and to avoid secondary disease such as infections. Thereby, the final goal of wound care is stable reepithelisation. Based on experience with chronic leg ulcers mainly in our out-patient wound centre, we give a survey of the wound dressings we actually use and discuss their wound-phase adapted application. Furthermore, we address the two tissue engineering products reimbursed in Switzerland, Apligraf and EpiDex, as well as the biological matrix product Oasis. The crucial question, which treatment options will be offered in future to the wound patients by our health regulatory and insurance systems, is open to debate.

Approaching water stress in the Alps: Transdisciplinary co-production of systems, target and transformation knowledge

There is increasing recognition that transdisciplinary approaches are needed to create suitable knowledge for sustainable water management. However, there is no common understanding of what transdisciplinary research may be and there is very limited debate on potentials and challenges regarding its implementation. Against this background, this paper presents a conceptual framework for transdisciplinary co-production of knowledge in water management projects oriented towards more sustainable use of water. Moreover, first experiences with its implementation are discussed. In so doing, the focus lies on potentials and challenges related to the co-production of systems, target and transformation knowledge by researchers and local stakeholders.

A Systems-Level Approach to Human Epileptic Seizures

Epileptic seizures are due to the pathological collective activity of large cellular assemblies. A better understanding of this collective activity is integral to the development of novel diagnostic and therapeutic procedures. In contrast to reductionist analyses, which focus solely on small-scale characteristics of ictogenesis, here we follow a systems-level approach, which combines both small-scale and larger-scale analyses. Peri-ictal dynamics of epileptic networks are assessed by studying correlation within and between different spatial scales of intracranial electroencephalographic recordings (iEEG) of a heterogeneous group of patients suffering from pharmaco-resistant epilepsy. Epileptiform activity as recorded by a single iEEG electrode is determined objectively by the signal derivative and then subjected to a multivariate analysis of correlation between all iEEG channels. We find that during seizure, synchrony increases on the smallest and largest spatial scales probed by iEEG. In addition, a dynamic reorganization of spatial correlation is observed on intermediate scales, which persists after seizure termination. It is proposed that this reorganization may indicate a balancing mechanism that decreases high local correlation. Our findings are consistent with the hypothesis that during epileptic seizures hypercorrelated and therefore functionally segregated brain areas are re-integrated into more collective brain dynamics. In addition, except for a special sub-group, a highly significant association is found between the location of ictal iEEG activity and the location of areas of relative decrease of localised EEG correlation. The latter could serve as a clinically important quantitative marker of the seizure onset zone (SOZ).

Where the land is greener: Case studies and analysis of soil and water conservation initiatives worldwide

‘where the land is greener’ looks at soil and water conservation from a global perspective. In total, 42 soil and water conservation technologies and 28 approaches are described – each fully illustrated with photographs, graphs and line drawings – as applied in case studies in more than 20 countries around the world. This unique presentation of case studies draws on WOCAT’s extensive database, gathered in over 12 years of field experience. The book is intended as a prototype for national and regional compilations of sustainable land management practices a practical – instrument for making field knowledge available to decision makers. Various land use categories are covered, from crop farming to grazing and forestry. The technologies presented range from terrace-building to agroforestry systems; from rehabilitation of common pastures to conservation agriculture; from Vermiculture to water harvesting. Several of these technologies are already well-established successes – others are innovative, relatively unknown, but full of promise. Descriptions of the various technologies are complemented by studies of the ‘approaches’ that have underpinned their development and dissemination. Some of these approaches were developed specifically for individual projects; others developed and spread spontaneously in fascinating processes that offer a new perspective for development policy. In addition to the case studies, the book includes two analytical sections on the technologies and approaches under study. By identifying common elements of success, these analyses offer hope for productive conservation efforts at the local level with simultaneous global environmental benefits. Policy pointers for decision makers and donors offer a new impetus for further investment – to make the land greener.