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Background: Currently, more than 30,200,000 COVID-19 cases have been diagnosed in Germany alone. However, data regarding prevalence of COVID-19 in children, both in Germany and internationally, are sparse. We sought to evaluate the number of infected children by measuring IgG antibodies. Methods: Oropharyngeal swabs were collected between December 2020 and August 2021 to measure SARS-CoV-2, and capillary blood for the detection of SARS-CoV-2 antibodies (by rapid test NADAL® and filter paper test Euroimmun® ELISA); venous blood was taken for validation (Roche® ECLIA and recomLine Blot) in 365 German children aged 3–16 years from 30 schools and preschools. We used multiple serological tests because the filter paper test Euroimmun® ELISA performs better in terms of sensitivity and specificity than the rapid test NADAL®. The Roche® ECLIA test is used to detect SARS-CoV-2 spike protein, and the recomLine Blot test is used to rule out the possibility of infection by seasonal SARS-viruses and to test for specific SARS-CoV-2 proteins (NP, RBD and S1). In addition, one parent each (n = 336), and 4–5 teachers/caregivers (n = 90) per institution were tested for IgG antibodies from capillary blood samples. The total study duration was 4 months per child, including the first follow-up after 2 months and the second after 4 months. Results: Of 364 children tested at baseline, 3.6% (n = 13) were positive for SARS-CoV-2 IgG antibodies using Euroimmun® ELISA. Seven children reported previously testing positive for SARS-CoV-2; each of these was confirmed by the Roche® Anti-SARS-CoV-2-ECLIA (antibody to spike protein 1) test. SARS-CoV-2 IgG antibodies persisted over a 4-month period, but levels decreased significantly (p = 0.004) within this timeframe. The median IgG values were 192.0 BAU/ml [127.2; 288.2], 123.6 BAU/ml [76.6; 187.7] and 89.9 BAU/ml [57.4; 144.2] at baseline, 2 months and 4 months after baseline, respectively. During the study period, no child tested positive for SARS-CoV-2 by oropharyngeal swab. A total of 4.3% of all parents and 3.7% of teachers/caregivers tested positive for IgG antibodies by Euroimmun® ELISA at baseline. Conclusion: We noted a rather low seroprevalence in children despite an under-reporting of SARS-CoV-2 infections. Measurement of IgG antibodies derived from capillary blood appears to be a valid tool to detect asymptomatic infections in children. However, no asymptomatic active infection was detected during the study period of 4 months in the whole cohort. Further data on SARS-CoV-2 infections in children are needed, especially in the group of <5-year-olds, as there is currently no licensed vaccine for this age group in Germany. The Robert Koch Institute's Standing Commission on Vaccination (STIKO) recommended COVID-19 vaccination for 12–17 and 5–11 year olds in August 2021 and May 2022 respectively. [ABSTRACT FROM AUTHOR]

Recent research in economics and sociology demonstrates the existence of significant occupational segregation by sexual orientation and gender identity and differences in a range of labor market outcomes, such as hiring chances, earnings, and leadership positions. In this paper, we examine one possible cause of these differences that is associated with the disadvantaged position of sexual and gender minorities in the labor market: LGBTQ* individuals' choices aimed at avoiding possible discrimination. This paper examines LGBTQ* people's relative importance of income, time, promotion prospects, an LGBTQ*-friendly work environment, and diversity management in the decision for or against a job. Based on a discrete choice experiment conducted in a large online sample recruited through social media in Germany (N = 4,507), an LGBTQ*-friendly work climate accounted, on average, for 33.8 percent of respondents' decisions which is comparable with the relative importance of income. Overtime, a diversity management on company level and promotion prospects are less important in the job decision process of LGBTQ* people. While the results show only small differences by sexual orientation, they show group-specific preferences by gender identity. An LGBTQ*-friendly work climate is more important for cisgender women of the LGBTQ* community and gender minorities than for cisgender men of the LGBTQ* community. In contrast, income is less important for gender minorities and cisgender women of the LGBTQ* community than for cisgender men of the LGBTQ* community. [ABSTRACT FROM AUTHOR]

With the world population growth, energy consumption and the rapid development of industrial economy, a large amount of carbon emissions has brought destruction and threats to the earth's environment on which human beings depend. The development of low-carbon economy has become the consensus of governments all over the world and has been vigorously advocated & promoted. This paper focuses on the top five global GDP nations in 2022: The United States, China, Japan, Germany, and Britain. A comprehensive evaluation index system of urban low-carbon economic development level is constructed from four dimensions: economic development level, environmental quality, energy consumption emission intensity and social development speed by using literature review and field interview. The evaluation measures are determined using the TOPSIS evaluation method with entropy weight and the grey relational model, providing a comprehensive assessment of the low-carbon economy's development level in these five countries." Judging from the comprehensive evaluation score, the overall development of low-carbon economy in American cities is in good condition and has reached the development standard of low-carbon economy; Germany and Japan rank second and third, and they are low-carbon economies. Britain ranks fourth in comprehensive evaluation, although it belongs to a low-carbon economy country, but there is still a certain gap with Germany and Japan; There is still a big gap between China and the other four countries. Based on the measurement and evaluation outcomes, it presents recommendations and strategies to foster the growth of low-carbon economies, offering valuable insights for the advancement of such economies across different nations. The research results guide countries all over the world to reduce carbon emissions in the process of economic development, protect the earth environment on which human beings depend, and make a better tomorrow for sustainable development. [ABSTRACT FROM AUTHOR]

Status or relative concerns (as in the idiom 'keeping up with the Joneses') can lead to negative feelings such as stress and anxiety. One key question is whether these concerns relate to daily smoking behaviour. The conjecture is that status concerns and the accompanying stress and anxiety might be associated with a higher likelihood of smoking and a higher number of cigarettes smoked, generating a higher instant physical reward and reducing the stress and anxiety. The literature aiming to identify this relationship focuses mostly on a single cross section of individuals, ignoring potential differences in unobserved characteristics of smokers and non-smokers (e.g., genetic factors, personality differences, parental smoking during childhood). This paper investigates the role of unobserved individual characteristics on this relationship, which has not been done in previous studies. Using a long panel data of smoking information in Germany and a variety of panel data model specifications, we show that there is no statistically significant association between relative income concerns and the likelihood of smoking or the number of cigarettes smoked among the overall population. We find a positive and significant relationship only among people who smoked at least one cigarette in the past. A 10% appreciation in the income of comparable other individuals relates to about 3.5 more cigarettes per month among these people. Importantly, failing to allow for the unobserved influences of smoking leads to three times larger estimates than when using models with unobserved factors correlating to the income and smoking behaviour. The results are robust with respect to alternative assumptions and specifications where we use different functional forms of unobserved heterogeneity, definitions of relative concerns, incomes, and reference groups. [ABSTRACT FROM AUTHOR]

In this paper we check whether social capital changes the association of subjective well-being with own income and social comparisons. We use panel data from Germany and publicly available data from three international surveys, for a total of nearly 500,000 respondents from industrial countries. Results show that the association of own income and social comparisons to subjective well-being weakens for individuals with high social capital. This finding holds in a variety of settings, and is robust to various measures of subjective well-being, of social capital, and of social comparisons. We also find evidence indicating that the role of social capital is, at least in part, causal. Finally, our findings support the macro-level implication that income differences are less related to subjective well-being differences in countries with high social capital. [ABSTRACT FROM AUTHOR]

Background: Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. Methods: Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80–20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. Results: For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. Conclusion: The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients. [ABSTRACT FROM AUTHOR]

Background: Retrospective hospital quality indicators can only be useful if they are trustworthy signals of current or future quality. Despite extensive longitudinal quality indicator data and many hospital quality public reporting initiatives, research on quality indicator stability over time is scarce and skepticism about their usefulness widespread. Objective: Based on aggregated, widely available hospital-level quality indicators, this paper sought to determine whether quality indicators are stable over time. Implications for health policy were drawn and the limited methodological foundation for stability assessments of hospital-level quality indicators enhanced. Methods: Two longitudinal datasets (self-reported and routine data), including all hospitals in Germany and covering the period from 2004 to 2017, were analysed. A logistic regression using Generalized Estimating Equations, a time-dependent, graphic quintile representation of risk-adjusted rates and Spearman's rank correlation coefficient were used. Results: For a total of eight German quality indicators significant stability over time was demonstrated. The probability of remaining in the best quality cluster in the future across all hospitals reached from 46.9% (CI: 42.4–51.6%) for hip replacement reoperations to 80.4% (CI: 76.4–83.8%) for decubitus. Furthermore, graphical descriptive analysis showed that the difference in adverse event rates for the 20% top performing compared to the 20% worst performing hospitals in the two following years is on average between 30% for stroke and AMI and 79% for decubitus. Stability over time has been shown to vary strongly between indicators and treatment areas. Conclusion: Quality indicators were found to have sufficient stability over time for public reporting. Potentially, increasing case volumes per hospital, centralisation of medical services and minimum-quantity regulations may lead to more stable and reliable quality of care indicators. Finally, more robust policy interventions such as outcome-based payment, should only be applied to outcome indicators with a higher level of stability over time. This should be subject to future research. [ABSTRACT FROM AUTHOR]

Over the year of 2015, about 800.000 refugees arrived in Germany, a number which equals around one percent of the total population. This migration process was labelled the refugee crisis and was accompanied by a contested debate. On the one hand, there was a widespread willingness to voluntarily help arriving refugees, on the other hand, the number of xenophobic attacks against refugees drastically increased. Our paper will focus on a specific form of xenophobic violence with a strong symbolic meaning: We analyze how arson attacks against collective accommodation facilities spread. Using a comprehensive web chronicle, we collected temporal and spatial data about arson attacks perpetrated on accommodations or facilities for refugees in Germany between 2015 and 2017. We counted 251 attacks, assigned each incident location to its county, merged county characteristics such as population size, proportion of foreigners, right-wing party support, and—going beyond previous research—added geographically coded media data from two digital archives. Besides newspaper contents of a popular nation-wide tabloid, we use a data base that covers local fake news on refugees. Based on these data, we constructed a balanced panel data set with the counties as geographical units and periods of 14 days as the time dimension. Results indicate that social contagion drives the diffusion process of arson attacks. Spatial proximity of previous attacks increased the propensity of attacks in the neighboring counties. Attacks were more likely to occur in counties with larger populations and fewer foreigners. While local newspaper coverage did not impact the diffusion of xenophobic attacks, fake news were relevant–but only in East Germany. We also considered two particularly salient threatening events that received nation-wide media attention, namely Merkel's "border opening" on the 5th of September 2015 and the sexual assaults occurring during New Year's 2015/16 in Cologne. Both were followed by temporary increases in violence. [ABSTRACT FROM AUTHOR]

Background: The international collaboration study PRICOV-19 –Primary Health Care in times of COVID-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on the subjective perceptions of general practitioners on primary health care and the impact of political measures during the second wave of the COVID-19 pandemic. Within this survey, the "open text field" of the questionnaire was utilised remarkably frequently and extensively by the respondents. It became clear that the content that was named needed to be analysed in an exploratory manner. Accordingly, this paper addresses the following question: What preoccupies general practitioners in Germany during COVID-19 that we have not yet asked them enough? Methods: The data collection took place throughout Germany from 01.02.2021 to 28.02.2021with a quantitative online questionnaire consisting of 53 items arranged across six topics as well as an "open text field" for further comments. The questionnaire's open text field was analysed following the premises of the qualitative content analysis. Results: The topics discussed by the respondents were: insufficient support from health policies, not being prioritised and involved in the vaccination strategy, feeling insufficient prepared, that infrastructural changes and financial concerns threatened the practice, and perceiving the own role as important, as well as that health policies affected the wellbeing of the respondents. One of the main points was the way general practitioners were not sufficiently acknowledged for their contribution to ensuring high-quality care during the pandemic. Discussion: German general practitioners perceived their work and role as highly relevant during the COVID-19 pandemic. In controversy with their perception, they described political conditions in which they were the ones who contributed significantly to the fight against the pandemic but were not given enough recognition. [ABSTRACT FROM AUTHOR]

Introduction: Artificial intelligence (AI) has the potential to transform clinical decision-making as we know it. Powered by sophisticated machine learning algorithms, clinical decision support systems (CDSS) can generate unprecedented amounts of predictive information about individuals' health. Yet, despite the potential of these systems to promote proactive decision-making and improve health outcomes, their utility and impact remain poorly understood due to their still rare application in clinical practice. Taking the example of AI-powered CDSS in stroke medicine as a case in point, this paper provides a nuanced account of stroke survivors', family members', and healthcare professionals' expectations and attitudes towards medical AI. Methods: We followed a qualitative research design informed by the sociology of expectations, which recognizes the generative role of individuals' expectations in shaping scientific and technological change. Semi-structured interviews were conducted with stroke survivors, family members, and healthcare professionals specialized in stroke based in Germany and Switzerland. Data was analyzed using a combination of inductive and deductive thematic analysis. Results: Based on the participants' deliberations, we identified four presumed roles that medical AI could play in stroke medicine, including an administrative, assistive, advisory, and autonomous role AI. While most participants held positive attitudes towards medical AI and its potential to increase accuracy, speed, and efficiency in medical decision making, they also cautioned that it is not a stand-alone solution and may even lead to new problems. Participants particularly emphasized the importance of relational aspects and raised questions regarding the impact of AI on roles and responsibilities and patients' rights to information and decision-making. These findings shed light on the potential impact of medical AI on professional identities, role perceptions, and the doctor-patient relationship. Conclusion: Our findings highlight the need for a more differentiated approach to identifying and tackling pertinent ethical and legal issues in the context of medical AI. We advocate for stakeholder and public involvement in the development of AI and AI governance to ensure that medical AI offers solutions to the most pressing challenges patients and clinicians face in clinical care. [ABSTRACT FROM AUTHOR]

In order to shed light on unmeasurable real-world phenomena, we investigate exemplarily the actual number of COVID-19 infections in Germany based on big data. The true occurrence of infections is not visible, since not every infected person is tested. This paper demonstrates that coronavirus-related search queries issued on Google can depict true infection levels appropriately. We find significant correlation between search volume and national as well as federal COVID-19 cases as reported by RKI. Additionally, we discover indications that the queries are indeed causal for infection levels. Finally, this approach can replicate varying dark figures throughout different periods of the pandemic and enables early insights into the true spread of future virus outbreaks. This is of high relevance for society in order to assess and understand the current situation during virus outbreaks and for decision-makers to take adequate and justifiable health measures. [ABSTRACT FROM AUTHOR]

In the Author Contributions, Lukas Broichhaus should be listed as the only author who wrote the paper under 'Writing–original draft.By Lukas Broichhaus; Julian Book; Sven Feddern; Barbara Grüne; Florian Neuhann; Johannes Nießen; Gerhard A. Wiesmüller; Annelene Kossow and Christine JoistenReported by Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

The paper investigates potentials and challenges during the interpretation of prehistoric settlement dynamics based on large archaeological datasets. Exemplarily, this is carried out using a database of 1365 Neolithic sites in the Weiße Elster river catchment in Central Germany located between the southernmost part of the Northern German Plain and the Central Uplands. The recorded sites are systematically pre-processed with regard to their chronology, functional interpretation and spatial delineation. The quality of the dataset is reviewed by analyzing site distributions with respect to field surveys and modern land use. The Random Forests machine learning algorithm is used to examine the impact of terrain covariates on the depth of sites and pottery preservation. Neolithic settlement dynamics are studied using Site Exploitation Territories, and site frequencies per century are used to compare the intensity of land use with adjacent landscapes. The results show that the main trends of the Neolithic settlement dynamics can be derived from the dataset. However, Random Forests analyses indicate poor pottery preservation in the Central Uplands and a superimposition of Neolithic sites in the southernmost part of the Northern German Plain. Throughout the Neolithic the margins between soils on loess and the Weiße Elster floodplain were continuously settled, whereas only Early and Late Neolithic land use also extended into the Central Uplands. These settlement patterns are reflected in the results of the Site Exploitation Territories analyses and explained with environmental economic factors. Similar with adjacent landscapes the Middle Neolithic site frequency is lower compared to earlier and later periods. [ABSTRACT FROM AUTHOR]

Public perceptions of COVID-19 vaccines are critical in reaching protective levels of herd immunity. Vaccine skepticism has always been relatively high in Germany, and surveys suggest that over the course of the pandemic, enthusiasm for the COVID-19 vaccine has dropped. Looking at the period just prior to the approval of the Pfizer/BioNTech and Moderna vaccines in Germany in the latter half of 2020, this paper aims to assess the reasons for and against COVID-19 vaccine uptake among residents of Germany, and to provide in-depth qualitative data to better understand and address concerns surrounding the safety and efficacy of a COVID-19 vaccine. Our findings indicate that there is widespread trust in German institutions and health experts to provide a safe vaccine for those who need it most. However, interviewees also point to the need for more information and the centrality of support from trusted medical authorities in making individual vaccination decisions. We also present the complexity of individual positions on vaccination, and suggest that vaccine hesitancy in relation to COVID-19 needs to be understood as a nuanced, and socially malleable, territory. This indicates that the goal of a vaccination campaign is not only achieving 'herd immunity,' but also a social endorsement of the collaborative effort that is required for a vaccine to be successful. [ABSTRACT FROM AUTHOR]

The rise of digital media has increased the opportunities for individuals to self-select political content online. This development has stimulated empirical research on how people select political information, especially when political beliefs are at stake. In the present paper, we tested a series of theory-derived assumptions about antecedents and consequences of selective exposure to confirmative political information and opinions in the digital arena. We conducted an online survey with German Internet users (N = 897, April 2016) and assessed political attitudes, media use and general beliefs in the context of the so-called "migration crisis". 28% of the participants in our sample reported exposure to a confirmative information environment. They are more likely to hear or read about political opinions on migration and political asylum that are similar to their own compared to cross-cutting content. We found no evidence for the assumption that the technological affordances of the Internet foster this form of selective political exposure. Instead, our analyses indicate that conservatism is a positive predictor of selecting confirmative information environments when it comes to migration and political asylum. We also gathered evidence that this relation is mediated by perceived threat and that selective political exposure is linked to truly false consensus beliefs. Our findings inform supply- and demand-side explanations of selective political exposure online. We discuss the relevance for psychological theories about the motivational underpinnings of selective exposure. [ABSTRACT FROM AUTHOR]

Germany is among the largest countries in the world in terms of total GDP, owing largely to rapid industrialization and expansion of economic activities into several sectors. This paper contributes to the literature on German economic development by investigating the evolution of industry diversification in Germany; particularly focusing on the recent concepts of related (RV) and unrelated variety (UV) in West German regions. It also identifies the statistical and economic determinants of variation in variety over time. Among several industry structure measures; RV is the only measure that reveals a pronounced increasing trend. Since RV is composed of two parts: 1) entropy at five-digit within a two-digit classification, and 2) shares of two-digit sectors in total output, we examined which of the two components dominate. Our findings suggest that the entropy component within two-digit sectoral shares of the RV index is more dominant than the two-digit sectoral shares themselves. We further examined entries and exits of the firms among regions with top and bottom rankings in RV. Findings suggest that both the top and bottom regions experienced an increase in the total number of industries, however, exits were much less pronounced in the bottom regions. It suggests that an increase in variety among top regions is the result of the creative destruction type effect where new industries force inefficient old industries to leave the region. Finally, analysis shows support for the inverse u-shaped relationship between development and diversification. [ABSTRACT FROM AUTHOR]

Governments around the globe use non-pharmaceutical interventions (NPIs) to curb the spread of coronavirus disease 2019 (COVID-19) cases. Making decisions under uncertainty, they all face the same temporal paradox: estimating the impact of NPIs before they have been implemented. Due to the limited variance of empirical cases, researchers could so far not disentangle effects of individual NPIs or their impact on different demographic groups. In this paper, we utilize large-scale agent-based simulations in combination with Susceptible-Exposed-Infectious-Recovered (SEIR) models to investigate the spread of COVID-19 for some of the most affected federal states in Germany. In contrast to other studies, we sample agents from a representative survey. Including more realistic demographic attributes that influence agents' behavior yields accurate predictions of COVID-19 transmissions and allows us to investigate counterfactual what-if scenarios. Results show that quarantining infected people and exploiting industry-specific home office capacities are the most effective NPIs. Disentangling education-related NPIs reveals that each considered institution (kindergarten, school, university) has rather small effects on its own, yet, that combined openings would result in large increases in COVID-19 cases. Representative survey-characteristics of agents also allow us to estimate NPIs' effects on different age groups. For instance, re-opening schools would cause comparatively few infections among the risk-group of people older than 60 years. [ABSTRACT FROM AUTHOR]

Microplastics are a global challenge and a frequently studied environmental issue. Hence, the knowledge body about microplastics within the scientific community is growing fast and challenges an elaborated knowledge transfer from science to the general public. Just as well-informed people are the basis for reducing microplastics' impact on the environment, knowledge of the audience's conceptions is the basis for an accurate and successful dissemination of scientific findings. However, insights into the publics' perceptions of microplastics are still rare. The present study aimed to capture students' conceptions about microplastics based on their individual experiences following qualitative inductive, exploratory research. Therefore, 267 students of a state university in Germany responded to a paper-and-pencil questionnaire containing open and closed questions on microplastic-related conceptual understanding, risk perception, information behavior, sources, and sinks. The inductive classifying of all responses by a qualitative content analysis revealed six basic concepts: 1) Microplastics are mainly understood as small plastic particles. 2) Microplastics are closely associated with its negative consequences. 3) The most labeled source in households is plastic packaging. 4) Compared to other water bodies, microplastics are rarely suspected in groundwater. 5) A high threat awareness exists in classifying microplastics as very dangerous and dangerous. 6) Media such as TV or the Internet are the most crucial information sources while the school has less importance in acquiring information. It is precisely this pattern that indicates the need for profound science communication to establish a joint and scientifically sound knowledge base in society. Knowledge about conceptions of potential "customers" allows tailor-made scientific knowledge transfers to shape public awareness, initiate changes in thoughts and prepare the field for collaborative behavior. [ABSTRACT FROM AUTHOR]

Background: COVID-19 frequently necessitates in-patient treatment and in-patient mortality is high. Less is known about the long-term outcomes in terms of mortality and readmissions following in-patient treatment. Aim: The aim of this paper is to provide a detailed account of hospitalized COVID-19 patients up to 180 days after their initial hospital admission. Methods: An observational study with claims data from the German Local Health Care Funds of adult patients hospitalized in Germany between February 1 and April 30, 2020, with PCR-confirmed COVID-19 and a related principal diagnosis, for whom 6-month all-cause mortality and readmission rates for 180 days after admission or until death were available. A multivariable logistic regression model identified independent risk factors for 180-day all-cause mortality in this cohort. Results: Of the 8,679 patients with a median age of 72 years, 2,161 (24.9%) died during the index hospitalization. The 30-day all-cause mortality rate was 23.9% (2,073/8,679), the 90-day rate was 27.9% (2,425/8,679), and the 180-day rate, 29.6% (2,566/8,679). The latter was 52.3% (1,472/2,817) for patients aged ≥80 years 23.6% (1,621/6,865) if not ventilated during index hospitalization, but 53.0% in case of those ventilated invasively (853/1,608). Risk factors for the 180-day all-cause mortality included coagulopathy, BMI ≥ 40, and age, while the female sex was a protective factor beyond a fewer prevalence of comorbidities. Of the 6,235 patients discharged alive, 1,668 were readmitted a total of 2,551 times within 180 days, resulting in an overall readmission rate of 26.8%. Conclusions: The 180-day follow-up data of hospitalized COVID-19 patients in a nationwide cohort representing almost one-third of the German population show significant long-term, all-cause mortality and readmission rates, especially among patients with coagulopathy, whereas women have a profoundly better and long-lasting clinical outcome compared to men. [ABSTRACT FROM AUTHOR]

Strong public support is a prerequisite for ambitious and thus costly climate change mitigation policy, and strong public concern over climate change is a prerequisite for policy support. Why, then, do most public opinion surveys indicate rather high levels of concern and rather strong policy support, while de facto mitigation efforts in most countries remain far from ambitious? One possibility is that survey measures for public concern fail to fully reveal the true attitudes of citizens due to social desirability bias. In this paper, we implemented list-experiments in representative surveys in Germany and the United States (N = 3620 and 3640 respectively) to assess such potential bias. We find evidence that people systematically misreport, that is, understate their disbelief in human caused climate change. This misreporting is particularly strong amongst politically relevant subgroups. Individuals in the top 20% of the income distribution in the United States and supporters of conservative parties in Germany exhibit significantly higher climate change skepticism according to the list experiment, relative to conventional measures. While this does not definitively mean that climate skepticism is a widespread phenomenon in these countries, it does suggest that future research should reconsider how climate change concern is measured, and what subgroups of the population are more susceptible to misreporting and why. Our findings imply that public support for ambitious climate policy may be weaker than existing survey research suggests. [ABSTRACT FROM AUTHOR]

This paper introduces three new scales to measure left- and right-wing radical as well as general extremist attitudes that can be applied across Western European countries. We therefore propose a thorough conceptualization of extremist attitudes that consists of two dimensions: general extremism, by which we understand attitudes that oppose the constitutional democratic state, and another dimension that differentiates between right- and left-wing radicalism by which we understand people who take far-reaching but often one-sided positions on political issues (e.g., on nationalism or anti-imperialism) by advocating fundamental socio-political change. Based on data from Germany, Great Britain, and the Netherlands (n = 6,201) we created short indices for general extremism and left- and right-wing radicalism. We check for convergence validity by assessing the psychometric properties of the extracted indices, i.e. their internal coherence and the degree to which a scale is able to distinguish strongly extremist and non-extremist individuals. Finally, we correlate the scales with various constructs that are likely related to extremist attitudes in order to assure external or construct validity. The results indicate that the three scales are highly valid and applicable across three Western European countries. Overall, we find that about two to four percent of citizens in each country hold left-wing or right-wing extremist attitudes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jungkunz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

European countries more than ever face shifts towards aging societies with accompanying challenges for health and aged care services. Economic evaluation has mainly relied on health measures such as EQ-5D across populations and conditions. We want to know how well the EQ-5D performs in the target population to avoid bias to the disadvantage of older adults and care-dependents. Therefore, we aim to explore differences and similarities of EQ-5D-3L and EQ-5D-5L in comparison to the old-age specific WHOQOL-OLD instrument in a sample of older adults receiving aged care services. We collected data from n = 329 older adults (≥65 years) receiving aged care services in Germany; the majority was at least 80 years and had varying care needs. We assessed instruments' feasibility, test-retest reliability, instruments' association and sensitivity to known-group differences. In terms of feasibility and test-retest reliability both EQ-5D versions performed better than the WHOQOL-OLD. All measures differentiated well between groups based on aspects of general health and care levels. The analysis of relationship between measures indicated that EQ-5D and WHOQOL-OLD assess partially overlapping, but distinct constructs. We found no clear evidence of superiority of either EQ-5D version over the other. The EQ-5D-5L performed better in terms of test-retest reliability and stronger correlations with WHOQOL-OLD facets. We conclude that using the WHOQOL-OLD alongside EQ-5D in this sample added further information on different aspects of quality of life., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: OM and WG are members of the EuroQol Group and receive or have received research grants from the EuroQol Research Foundation. The views of the authors expressed in this paper do not necessarily reflect the views of the EuroQol Group. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Marten, Greiner. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Occupational skin diseases (OSD) in the form of hand eczema (HE) are a common work-related disease. Illness perceptions as presented in Leventhal's Common-Sense Model (CSM) are important for patients' self-management of diseases. Understanding these illness perceptions is essential for patient communicating. No quantitative or qualitative studies which investigated subjective illness perceptions in patients with occupational HE utilized the CSM as theoretical framework. The Objective of this study is to investigate illness perceptions of patients with occupational hand eczema (HE) using the CSM., Methods: We applied an exploratory qualitative approach and conducted purposive sampling. Thirty-six patients with occupational HE were interviewed using an interview guide based on the dimensions of the CSM, including coherence and emotional representation. All participants participated in a three-week inpatient program at a clinic specialized on occupational dermatology. One interview had to be excluded before analysis, since one participant's diagnosis was retrospectively changed from ICD to tinea and hence did not match the inclusion criteria. Thirty-five interviews were transcribed verbatim and analyzed. Data was analyzed deductively and inductively using qualitative text analysis. MAXQDA 2018 (Verbi, Berlin, Germany), a software for qualitative data analysis, was applied for coding and summarizing of results. All dimensions of the CSM were explored for occupational HE., Results: Several sub-categories could be identified. Participants named a variety of causes in different areas (e. g. external irritants and other hazardous factors, psycho-social factors, allergies, having a 'bad immune system' or lifestyle). The great impact of the disease on the participants' life is shown by the wide range of consequences reported, affecting all areas of life (i. e. psychological, physical, occupational, private). Considering coherence, an ambivalence between comprehensibility and non-comprehensibility of the disease is apparent., Discussion: The complexity of illness perceptions presented in this paper is relevant for those involved in HE patient education and counseling, e. g, health educators, dermatologists, and, occupational physicians. Future research might further investigate specific aspects of illness perceptions in patients with occupational HE, especially considering the complexity of coherence and overlapping dimensions (i. e. emotional representation and psychological consequences)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Buse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The special width approach lane (SWAL) is a newly proposed unconventional design, whereby a wide approach lane is divided into two narrower lanes. The design entails the use of a single lane by two passenger cars or one heavy vehicle. Such design has been applicated at signalized intersections of Karlsruhe, Germany. This paper focuses on the saturation flow rate analysis since most existing studies on such design rely on the default highway capacity manual (HCM) values. Saturation flow rate data was collected at four SWAL design based signalized intersections with procedural steps of the HCM 2010 using the video camera. The two-sample t-test was performed to explore the potential influencing factors, and then the non-linear regression analysis was conducted to estimate the saturation flow rate of SWAL. The proposed model can effectively depict the saturation flow rate with lane marking, presence of cyclists, and rainfall being the influencing factors. The overall accuracy of the proposed model is about 95%. The results indicate that the three influencing factors are independent of each other. The existence of cyclists and rainfall lead to a decrease in the saturation flow rate, while the lane markings can improve the saturation flow rate. Moreover, the SWAL works well in Karlsruhe, Germany. The model predicts a base saturation flow rate value of 1652 pcu/h/ln, which is plausible with comparison of the base saturation flow rate recommended in the German Highway Capacity Manual., Competing Interests: The authors have declared that no competing interests exist.

With the EU Green Deal initiatives, European members seek to launch the first climate neutral continent by 2050. This paper assesses the stochastic convergence of per capita energy consumption series for an illustrative sample of 15 EU countries with memberships prior to the 2004 enlargement, using data spanning the 1970-2018 period. Results from the confidence interval subsampling (asymmetric and equal-tailed) highlight that 11 out of the 15 EU series exhibit a long-run memory behaviour, while a diverging pattern was observed for the UK, Germany, Portugal, and Italy. Finally, per capita energy use series persist but fail to reveal one of the above dynamics for Ireland and Spain. Also, findings from the non-parametric Bayesian application (ANOVA/linear Dependent Dirichlet Process (DDP) mixture model) show how economic growth operates as a converging energy consumption-enabler over the long-run, from which the EU membership cannot be excluded. In particular, we highlight how the nature of energy-GDP hypotheses vary with the stochastic properties of energy use (converging behaviour with temporary shocks, converging pattern with permanent shocks, and diverging dynamic). Finally, our conclusions overcome the well-established development stage argument as we claim that countries with similar energy convergence patterns may need to adopt similar energy policies., Competing Interests: The authors have declared that no competing interests exist.

The main goal of this paper is to examine Nobel Prize data by studying the association among the laureate's country of birth or residence, discipline, time period in which the Nobel Prize was awarded, and gender of the recipient. Multiple correspondence analysis is used as a tool to examine the association between these four categorical variables by cross classifying them in the form of a four-way contingency table. The data that we examine comprise Nobel Prize recipients from 1901 to 2018 (inclusive) from eight-developed countries, with a total sample of 785 Nobel Prize recipients. The countries include Canada, France, Germany, Italy, Japan, Russia, the British Isles, and the USA and the disciplines in which the individuals were awarded the prizes include chemistry, physics, physiology or medicine, literature, economics, and peace., Competing Interests: The authors have declared that no competing interests exist.

The global impact of coronavirus disease 2019 (COVID-19) is unprecedented, and many control and prevention measures have been implemented to test for and trace COVID-19. However, invisible-spreaders, who are associated with nucleic acid detection and asymptomatic infections, have received insufficient attention in the current COVID-19 control efforts. In this paper, we analyze the time series infection data for Italy, Germany, Brazil, India and Sweden since the first wave outbreak to address the following issues through a series of experiments. We conclude that: 1) As of June 1, 2020, the proportion of invisible-spreaders is close to 0.4% in Sweden, 0.8% in early Italy and Germany, and 0.4% in the middle and late stages. However, in Brazil and India, the proportion still shows a gradual upward trend; 2) During the spread of this pandemic, even a slight increase in the proportion of invisible-spreaders could have large implications for the health of the community; and 3) On resuming work, the pandemic intervention measures will be relaxed, and invisible-spreaders will cause a new round of outbreaks., Competing Interests: The authors have declared that no competing interests exist.

A key challenge of environmental planning is to craft recommendations for future sustainable spatial development amid ubiquitous uncertainties. This paper aims to explore how different data uncertainties, usually unknown to the planner, may influence environmental planning recommendations. We apply a case study-based approach, in which we provide three illustrative examples of how data with different kinds and levels of uncertainty affect environmental assessments and, by that, the decision-support provided by environmental planning. The cases stem from different spatial levels in Germany and consider 'Regional soil-based climate change mitigation' in the region of Hannover, 'State-wide habitat conservation siting' in the federal state of Saxony-Anhalt, and 'National renewable energy planning'. Based on the three examples, we discuss implications for planning practice and derive recommendations for further research. The three cases studies illustrate the substantial effects of data uncertainty on environmental assessments and planning recommendations derived from those results. We identify four problem constellations of dealing with data uncertainty in environmental planning that relate to the severeness of uncertainty impacts, the responsibility of the decision-maker, and the kinds of impacts that wrong decisions may have. We close with recommendations for further research, among others to develop robust and pragmatic methods for identifying the uncertainty levels in environmental data and assessment results., Competing Interests: The authors have declared that no competing interests exist.

The development of globalization has separated the production and consumption of products spatially, and the international trade of products has become a carrier of embodied carbon trade. This paper adopted the perspective of value-added trade to calculate the amount of embodied carbon trade of China from 2006 to 2015 and perform a structural decomposition analysis of the changes in China's embodied carbon trade. This study found that: (1) China's embodied carbon exports are much larger than its embodied carbon imports, and there are differences between countries. China imported the largest amount of embodied carbon from South Korea, and it exported the largest amount of embodied carbon to the United States. (2) The structural decomposition analysis shows that changes in the value-added carbon emission coefficient during the study period would have caused China's embodied carbon trade to decrease, and changes in value-added trade would have caused China's embodied carbon trade to increase. Therefore, countries trading with China need to strengthen their cooperation with China in energy conservation, emission reduction, and product trade. In order to accurately reflect China's embodied carbon trade, it is necessary to calculate embodied carbon trade from the perspective of value-added trade., Competing Interests: The authors have declared that no competing interests exist.

When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector., Competing Interests: The authors have declared that no competing interests exist.

Epidemiological simulations as a method are used to better understand and predict the spreading of infectious diseases, for example of COVID-19. This paper presents an approach that combines a well-established approach from transportation modelling that uses person-centric data-driven human mobility modelling with a mechanistic infection model and a person-centric disease progression model. The model includes the consequences of different room sizes, air exchange rates, disease import, changed activity participation rates over time (coming from mobility data), masks, indoors vs. outdoors leisure activities, and of contact tracing. It is validated against the infection dynamics in Berlin (Germany). The model can be used to understand the contributions of different activity types to the infection dynamics over time. It predicts the effects of contact reductions, school closures/vacations, masks, or the effect of moving leisure activities from outdoors to indoors in fall, and is thus able to quantitatively predict the consequences of interventions. It is shown that these effects are best given as additive changes of the reproduction number R. The model also explains why contact reductions have decreasing marginal returns, i.e. the first 50% of contact reductions have considerably more effect than the second 50%. Our work shows that is is possible to build detailed epidemiological simulations from microscopic mobility models relatively quickly. They can be used to investigate mechanical aspects of the dynamics, such as the transmission from political decisions via human behavior to infections, consequences of different lockdown measures, or consequences of wearing masks in certain situations. The results can be used to inform political decisions., Competing Interests: MB and KN own shares of the commercial company senozon. MB and AN are employees of senozon. None of this alters our adherence to PLOS ONE policies on sharing data and materials.

The objective of the paper is to diagnose organisational culture of selected universities and analyse its impact on the innovation processes within them. The subject matter of the study was organisational culture and innovation at universities. The subjects were four selected universities in Poland, Austria, Germany, and Ukraine. The paper provided a definition of organisational culture and its typology. It further discussed the organisational culture of universities and the relationships between organisational culture and innovativeness. The literature review provided foundations for building a model for the formation of a type of organisational culture at universities that is innovation-friendly, which is the added value of the paper. It offers actions worth taking to shape innovation-friendly culture at universities. It is particularly important during difficult time of changing labour market, when universities greatly impact the attitudes of young people. The knowledge of how to shape innovation-friendly organisational culture at universities is necessary for academia to profile future employees in times of continuous changes. To investigate the relationship between organisational culture and the innovativeness of universities, we designed an original survey questionnaire [S1 File]. Organisational culture was diagnosed with the Organizational Culture Assessment Instrument by K.S. Cameron and R.E. Quinn. The analyses were conducted in Dell Statistica v. 13.1 (StatSoft Polska). We normalised data from the Likert rating scale using Kaufman's and Rousseeuw's formula. We used Spearman's correlation coefficient and Kendall's W to calculate correlations. The research shows that the investigated Polish and Austrian universities are dominated by hierarchy and market cultures. On the other hand, the German and Ukrainian universities host all cultures, but clan and adhocracy dominate there. Moreover, the analyses demonstrated that although the adhocracy culture was the least visible in the investigated organisations, it contributes to university innovativeness the most. The conclusions were used to build a model for promoting innovation-friendly organisational culture at universities. The model contains answers to the research questions. In addition, it offers guidelines for shaping organisational culture to bolster innovation at universities. The research identified relationships between organisational culture and university innovativeness and components that create innovation opportunities at universities as its contribution to management theory. When applied in practice, the guidelines can help form the university's organisational culture bottom-up., Competing Interests: The authors have declared that no competing interests exist.

The Psychometric Hepatic Encephalopathy Score (PHES) has previously been standardized in thirteen countries on three continents, confirming its status of gold standard test to detect minimal hepatic encephalopathy (MHE). In the meantime, performance has also been shown to vary with variables such as age, education, and barely sex. The present study aimed at standardizing the PHES in a French population. One hundred and ninety-six French healthy participants completed a French version of the paper-and-pencil PHES, involving five tests and six measures. Importantly, the balance was perfect between all levels of the three controlled factors, which were sex, age (seven decade-levels from 20-29 to 80-89 years), and education (two levels below or above 12 years of education). Raw measures were transformed to fit the normal distribution. ANOVAs on transformed variables showed no effect of sex, but an effect of age on all measures, and of education on five measures. Multiple or simple regressions were completed to build up normograms. Thorough analysis of variability within each test failed to find outliers that may bias the results. Comparison between French and seminal German data showed that they highly fitted though cultural and cognitive style specificities could be observed. This is the first study to standardize the PHES in a French population and to extensively explore the effects of sex, age and education using perfectly balanced samples. Subtle differences between countries of the same continent emphasize the need to build up normative data in each country to get accurate PHES in patients., Competing Interests: OAC was supported by Eumedica (Brussels, Belgium). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Notable cross-country differences exist in the diffusion of the Covid-19 and in its lethality. Contact patterns in populations, and in particular intergenerational contacts, have been argued to be responsible for the most vulnerable, the elderly, getting infected more often and thus driving up mortality in some context, like in the southern European one. This paper asks a simple question: is it between whom contacts occur that matters or is it simply how many contacts people have? Due to the high number of confounding factors, it is extremely difficult to empirically assess the impact of single network features separately. This is why we rely on a simulation exercise in which we counterfactually manipulate single aspects of countries' age distribution and network structures. We disentangle the contributions of the kind and of the number of contacts while holding constant the age structure. More precisely, we isolate the respective effects of inter-age contact patterns, degree distribution and clustering on the virus propagation across age groups. We use survey data on face-to-face contacts for Great Britain, Italy, and Germany, to reconstruct networks that mirror empirical contact patterns in these three countries. It turns out that the number of social contacts (degree distribution) largely accounts for the higher infection rates of the elderly in the Italian context, while differences in inter-age contacts patterns are only responsible for minor differences. This suggests that policies specifically targeting inter-age contacts would be little effective., Competing Interests: The authors have declared that no competing interests exist.

Background: The increased risk of suicidal behaviour among Turkish women living in Europe and Turkey is a serious public health problem. This study compares and synthesises the empirical evidence of demographic, social, psychological and interpersonal characteristics and precipitating factors in the suicides and attempted suicides of Turkish women in Europe and Turkey., Methods: We systematically searched eight databases (PsycINFO, PubMed, Med Line, Web of Science, Smart Cat, Safety Lit, BASE and Ulakbim), using search terms in English, Turkish, German and Dutch, as well as the reference lists of the retrieved papers. We extracted data on countries/regions, population characteristics, sample characteristics, recruitment, method of data collection, type of suicidal behaviour (suicide or attempted suicide) and precipitating factors and characteristics. The results were qualitatively synthesised., Results: We retrieved nine studies on attempted suicide in Europe (from Germany, Switzerland and the Netherlands), 17 studies on attempted suicide in Turkey and 10 studies on suicide in Turkey (36 in total). Overall, we found similar precipitating factors and characteristics of attempted suicide and suicide in Turkey and Europe, including socio-demographic factors (young age and not being enrolled in the labour market), poverty and, to some extent, mental illness. Moreover, conflicts with family or spouses and violence against women, including so-called honour violence, were particularly common for women living in or originating from traditional areas in Turkey., Conclusion: The framework of intersectionality is relevant to understanding our results, because structural inequalities in gender roles, gender role expectations as well as power imbalances among socio-economic classes collectively impact the suicidal behaviour of Turkish women. Moreover, the importance of violence against women points to the cultural continuity of the patriarchal and oppressive structures of Europe and Turkey. Suicide prevention efforts should address cultural attitudes underlying violence against women and girls through community education programmes, cultural and gender-sensitive care provision and jurisdiction., Competing Interests: The authors have declared that no competing interests exist.