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Background: Even now the further training in surgery faces considerable challenges. The planned hospital structural reform will result in new bureaucratic and organizational hurdles, which could lead to a considerable loss of quality in advanced surgical training across all disciplines. Objective: The aim of this position paper is to describe the current and future challenges for advanced surgical training and to identify possible approaches and opportunities for the further development against the background of the planned hospital structural reform. Material and methods: For the development of this position paper a committee of representatives of the Young Forums of the German surgical societies identified and critically discussed current problems and challenges of the present residency training system and formulated a list of demands for a sustainable residency training concept. Results: The planned shift to outpatient treatment and centralization were identified as central challenges for surgical residency training. Surgical training must be considered consistently and from the outset in all political reform efforts. In addition to a transparent and cost-appropriate financing of residency training, we call for the involvement of all German surgical societies in the reform process. Furthermore, the social framework conditions for junior surgeons should be considered. Conclusion: The structural change in the hospital landscape in Germany, which is being forced by politicians, harbors the risk of a further loss of quality and experience in surgical treatment and training. At the same time, the planned hospital reform offers a unique opportunity to address existing problems and challenges in surgical training and to consider them as a starting point for structural changes which are fit for the future. [ABSTRACT FROM AUTHOR]

Background: With reference to the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), a fundamental change in psychiatric care in Germany was proposed in 2019 by Zinkler and von Peter, supported by a legal perspective from Kammeier, which has since led to controversial debates. Essentially, the aim is not only to reduce coercion in psychiatry to a minimum, but also to fundamentally exclude it in a psychiatry that only provides care. The function as an agent of social control is to be returned from psychiatry to state institutions. Psychiatric hospitals will only admit patients with their consent; patients who refuse therapy will not be admitted regardless of their capacity for self-determination and will remain untreated or, if they have committed a criminal offence or threaten to commit a criminal offence, they will be taken into custody or imprisoned in accordance with the legal regulations applicable to all people. There they will receive psychiatric care if they so wish. Aim of the paper: The paper outlines the background of this concept, including international sources, traces the discussion in German specialist literature and takes a critical look at it. Results: The criticism is primarily directed against the fact that responsibility for a relevant proportion of psychiatric patients would be handed over to the police and judiciary and that, as a result, two realities of care would be established that would considerably differ in terms of quality. Conclusion: Arguments are put forward in favor of retaining the function of social control and considerations are suggested as to how caring coercion can be largely minimized. [ABSTRACT FROM AUTHOR]

The present paper is the second of a series of publications that aim at investigating relevant directions to turn the nuclear energy density functional (EDF) method as an effective field theory (EFT). The EDF approach has known numerous successes in nuclear theory over the past decades [1] and is currently the only microscopic technique that can be applied to all atomic nuclei. However, the phenomenological character of the EDF method also comes with important limitations, such as the lack of an explicit connection with quantum chromodynamics (QCD). As was argued in the first paper of this series [2], reformulating the EDF framework as an EFT would enable us to overcome these limitations. In particular, path-integral (PI) techniques are suited to achieve such a purpose as they allow us to design numerous non-perturbative approximations and can take Lagrangians possibly derived from EFTs of QCD as inputs. In our previous paper [2], we have illustrated such technical features for diagrammatic PI techniques in a study of the (0+0)-D O(N)-symmetric φ 4 -theory. In the present work, we consider another class of PI techniques, i.e. functional renormalization group (FRG) approaches, that we apply to the same toy model. Despite our explicit interest for the nuclear many-body problem, the presented study is also directed towards FRG practitioners from various fields: technical details are provided for FRG techniques based on 1-particle-irreducible (1PI), 2-particle-irreducible (2PI) and 2-particle-point-irreducible (2PPI) effective actions, coined respectively as 1PI-, 2PI- and 2PPI-FRGs, and the treatment of the O(N) symmetry is also addressed thoroughly. Connections between these various FRG methods are identified as well. [ABSTRACT FROM AUTHOR]

The political participation literature has documented a long-term trend of the normalization of noninstitutional participation that is often equated with the conventionalization of engagement in protest politics. Less is known on the extent to which noninstitutional forms are differentiated by their mobilization context. Population surveys find it difficult to contextualize individual engagement, and on-site surveys point to effects that are hard to generalize. This study fills this gap by emphasizing differentiation and distinguishing participation according to the issue of engagement. It introduces a conceptual distinction between political insiders and outsiders, defined based on the extent to which they are embedded in the organizational landscape of the dominant cleavage dimension. Using an original survey conducted in Germany during the Covid-19 crisis, the analysis demonstrates that general-population surveys are fit to examine issue-specific participation patterns. The results expose an insider and outsider divide, captured by the effect of attitudinal and behavioral indicators, and demonstrates that the two groups are equally likely to participate in noninstitutional forms. However, insiders engage on the established issues of climate and anti-racism, whereas outsiders engage on the new issues of Covid-19 related economic assistance and civil liberties restrictions. In addition, dynamic models reveal that noninstitutional participation is rooted in volatile issue preferences. Overall, the paper argues that participation during the Covid-19 crisis has furthered the trend towards a differentiated protest arena. [ABSTRACT FROM AUTHOR]

Home delivery services require the attendance of the customer during delivery. Hence, retailers and customers mutually agree on a delivery time window in the booking process. However, when a customer requests a time window, it is not clear how much accepting the ongoing request significantly reduces the availability of time windows for future customers. In this paper, we explore using historical order data to manage scarce delivery capacities efficiently. We propose a sampling-based customer acceptance approach that is fed with different combinations of these data to assess the impact of the current request on route efficiency and the ability to accept future requests. We propose a data-science process to investigate the best use of historical order data in terms of recency and amount of sampling data. We identify features that help to improve the acceptance decision as well as the retailer's revenue. We demonstrate our approach with large amounts of real historical order data from two cities served by an online grocery in Germany. [ABSTRACT FROM AUTHOR]

Background: The healthcare sector is responsible for 5.2% of CO2 emissions in Germany. The prescribing of medicines is a significant contributor. Among the prescribed medicines, metered dose inhalers (MDIs) play a decisive role due to the propellant gases they contain. A relevant reduction in emissions is possible by switching to dry powder inhalation systems (DPI). Aim: The guideline "Climate-conscious prescribing of inhalants" is intended to provide assistance in the prescribing of inhaled medicines by summarising the available evidence on the decision between DPI and MDI and explicitly addressing the aspect of climate damage caused by propellants. It addresses everyone involved in prescribing and counselling those affected. Materials and methods: The S2k guideline was drawn up under the joint leadership of DEGAM (German College of General Practitioners and Family Physicians) and the German Society for Pneumology and Respiratory Medicine (DGP) under moderation of the AWMF (Association of the Scientific Medical Societies in Germany). The main contents from a practical perspective are presented in this paper. Results: Overall, MDIs account for a high proportion of inhaler prescriptions in Germany. The aspects of climate damage should be considered when prescribing MDIs. In order to facilitate implementation in practice, several decision aids were developed. Conclusion: The guideline is the first to address the importance of prescribing a group of medicines in relation to climate change. The degree of implementation of the guideline recommendations can be determined by future analyses of prescription data. A planned practical test is required to check the acceptance of the decision aids. [ABSTRACT FROM AUTHOR]

Between 2016 and 2021, Germany's first total diet study was performed to assess the variety of substances humans are exposed to by dietary intake. On a global scale rather unique, the natural radionuclides lead-210, uranium-234, uranium-238, radium-226, and radium-228 should be investigated in over 200 different food samples within that study. This paper serves as a guide how to successfully determine these natural radionuclides in very low concentrations in a variety of samples. Two independent laboratories were involved for comparison to assure the quality of the presented sample pretreatment and analyzing techniques. [ABSTRACT FROM AUTHOR]

Fire statistics mirror the outcome of fire prevention. Most fire statistics in Germany deal with the loss of life, value, and fire department actions (number of interventions, nozzles used, or alarm category like a false alarm). However, these results also represent the safety level the legislator has set through the prescriptive building regulations. The current statistics cannot evaluate the level of fire safety and the fulfillment or necessity of fire safety precautions. Today, expert judgment from firefighters is necessary to fill this gap. Here, we show the first evaluation of fire prevention and hazard protection measures by evaluating 900 potentially harming fires throughout Germany. In contrast to minor fires, these fires have advanced to the extent that they could potentially violate the protection objectives outlined in building regulations. The fire department association developed a questionnaire to evaluate the fire safety level and possibly reduce unnecessary fire safety regulations. One hundred twenty-three fire departments carried out the questionnaire, which are responsible for 25% of the German population. Fire prevention officers of the fire departments went to the scene after the fire was extinguished, and the fire safety concept of the building could be evaluated. We found a high rate of injuries, smoke spread, need for rescue by firefighters, and higher than expected firefighter response times after arrival at the scene. Surprisingly, smoke spread rates correlated with building height and not with building age. It was even possible to assess the risk of multiple casualties. Overall, the questionnaire results give insight into the current level of fire safety in existing buildings. Ways and rates for smoke and fire spread prove the importance of second escape routes and the influence of human misconduct. According to these results, current building code regulations are sufficient to prevent fire spread. On the other hand, smoke spreading is a severe threat to people's safety. For example, the data shown can be applied in Bayes nets or other risk calculations to optimize individual building designs or even governmental building codes concerning fire safety engineering. Based on our observations, science, and building codes, authorities could in the future establish a performance-based building code instead of the current prescriptive code. This paper presents the first approach in Germany to quantify the expert judgment of fire departments and use it as a source of knowledge for fire prevention. [ABSTRACT FROM AUTHOR]

Increasing residential mobility is said to challenge existing social support systems as mobility raises geographic distances between family members. Since family social support is essential for health and well-being, this study investigates whether residential mobility affects familial social support following changes in proximity to family and kin. By applying a stepwise linear regression on data from the German Socio-Economic Panel study, this paper is looking at variations between different residential mobility trajectories regarding social support provision and spatial proximity to family members in Germany over a 10-year period. Our findings show that people who are moving within Germany are receiving significantly more social support from their family and kin, while internationally mobile respondents receive less compared to non-mobile people. Mediation analyses show that proximity to family and kin are accounting for the negative effect of international mobility on social support but cannot explain the positive effect of internal migration. [ABSTRACT FROM AUTHOR]

Purpose: This paper reports on the first evaluation of infertility counselling in Germany. Methods: Sixty-nine infertility counsellors provided feedback via 524 survey sheets and 182 questionnaires were filled in by clients. Results: The results show a high level of satisfaction on behalf of the clients. They valued the emotional support, information, and exploration of family-building options with and without medical assistance and the counsellors' expertise. During counselling, coping with the emotional burden of infertility was an important issue, but in more than half of all counselling sessions, future parental issues were addressed. The group of clients seeking support can be described to be very heterogeneous, and counselling issues comprise a wide range of aspects. Conclusions: This piece of research suggests that the following issues need to be considered to improve infertility counselling. Better integration of counselling in infertility clinics, more awareness for infertility counselling for other medical and non-medical professions Better funding for counselling so that its uptake is not dependent upon the financial resources of clients Awareness for new groups of clients and counselling issues such as single and transgender individuals, co-parenting families There is a need for more research and the development of counselling concepts. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

Since 2019, a global increase in patients presenting with functional Tourette-like behaviors (FTB) has been observed. This has been related to the exposure of tic-related content in social media, although other factors seem to further fuel this phenomenon. Recently, we, therefore, proposed the term mass social media-induced illness (MSMI) as, in our opinion, this phenomenon constitutes a new type of mass sociogenic illness (MSI) that is in contrast to all recent outbreaks spread solely via social media. In accordance with this hypothesis, we were able to identify the host of the German YouTube channel "Gewitter im Kopf" ("Thunderstorm in the brain") as the initial virtual index case. The purpose of this paper is to present clinical characteristics of a sample of 32 patients diagnosed with MSMI-FTB compared to a large sample of patients with Tourette syndrome (TS) and other chronic tic disorders (CTD) (n = 1032) from the same center in Germany indicating clinical factors helpful to distinguish between tics in TS/CTD and MSMI-FTB. Our main findings were: in patients with MSMI-FTB compared to those with TS/CTD we found (i) a significantly higher age at onset, (ii) a significantly higher rate of females, (iii) a significantly higher rate of obscene and socially inappropriate symptoms, (iv) a significantly lower rate of comorbid ADHD, and (v) a significantly lower rate of OCD/OCB. In contrast, rates of comorbid anxiety and depression as well as reported frequencies of premonitory urges/sensations and suppressibility of symptoms did not differ between groups. [ABSTRACT FROM AUTHOR]

This paper investigates the changes in time use, working conditions and subjective time wealth during the COVID-19 pandemic in Germany. Our analysis draws on panel data collected before and during the first lockdown among 786 employees. It employs a recently developed scale on time wealth which has been suggested as a comprehensive measure to capture the subjective experience of time. We provide separate analyses according to gender and essential occupation. First-difference regressions are applied to examine how changes in time use and changes in working conditions during the lockdown affected subjective time wealth. Our results show a general growth in time wealth during the lockdown which is, among other factors, driven by a decline in work hours and an increase in sleep duration. We also find positive effects on time wealth from decreased time pressure at work, more autonomy in organising one's working day, and an improved reconciliation of work and private life. This study contributes to existing research by identifying key aspects how to improve time wealth among employees. [ABSTRACT FROM AUTHOR]

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, religious organizations increasingly mediatized their activities. Studies examining this process mostly focused on communal offerings, while ignoring how rapid mediatization affected programs geared toward interfaith dialogue. This paper examines the effects and possibilities of this shift to virtual spaces by focusing on frameworks that promote Jewish–Muslim dialogue in Germany. It traces how Jews and Muslims intervene in popular discourse using social media platforms to self-define their respective religions and the relationship between them. In this process, those involved in creating virtual spaces focused on the intersectionality between gender biases and Christonormativity. This paper utilizes a broad methodological approach, including participant observation in dialogue events in virtual spaces, discursive analyses of videos and podcasts, and qualitative interviews with Jews and Muslims involved in the creation of virtual spaces. The first section discusses Jewish–Muslim encounters occurring in organized dialogue events on video communication platforms that are ephemeral in nature (no recordings). The subsequent sections analyze German-language formats that have a representative character and are streamed, recorded, and presented on social media platforms. [ABSTRACT FROM AUTHOR]