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Ingestion of microplastics can lead to deleterious consequences for organisms, as documented by numerous laboratory studies. The current knowledge is based on a multitude of effect studies, conducted with conventional fossil-based and non-degradable plastics. However, there is a lack of information about the acceptance and the effects of novel bio-based and biodegradable plastics. Biodegradable plastics are considered an alternative to conventional plastics and are showing rapidly growing production rates. Biodegradable plastics can disperse into the environment in the same way as conventional plastics do, becoming available to marine organisms. This study aims to provide new insights into the uptake and effects of biodegradable microplastics on marine invertebrates. Rockpool shrimp, Palaemon elegans, were fed with algal flakes coated with polylactic acid (PLA), polyhydroxybutyrate-co-valerate (PHBV) and conventional low-density polyethylene (LDPE) microparticles. Live observations showed that all of the different types of microplastics were ingested. After dissection of the shrimp, less LDPE particles were found in the stomachs than PLA and PHBV particles. This indicates a longer retention time of biodegradable microplastics compared to conventional microplastics. Presumably, less LDPE particles were ingested or evacuated from the stomach, probably by regurgitation. The ingestion of microparticles of all types of plastics induced enzymatic activity of short-chain carboxylesterases in the midgut glands of the shrimp. However, only PLA induced enzymatic activity of medium-chain carboxylesterases. Palaemon elegans showed no oxidative stress response after ingestion of microparticles, irrespective of polymer type. From our results we conclude that biodegradable plastics might have different effects than conventional plastics. The longer retention times of biodegradable plastics might enhance exposure to leaching additives and other harmful substances. Our study provides new insights into how biodegradable plastics might affect aquatic fauna and indicate that the use of biodegradable plastics needs to be reconsidered to some extent.

A promising strategy to counteract the progressing plastic pollution of the environment can involve the replacement of persistent plastics with biodegradable materials. Biodegradable polymers are enzymatically degradable by various hydrolytic enzymes. However, these materials can reach the environment in the same way as conventional plastics. Therefore, they are accessible to terrestrial, freshwater, and marine biota. Once ingested by marine organisms, highly active enzymes in their digestive tracts may break down biodegradable compounds. We incubated microparticles of five different biodegradable plastics, based on polylactictic acid (PLA), polybutylene succinate (PBS), polybutylene adipate terephthalate (PBAT) and polyhydroxybutyrate-co-valerate (PHBV), in-vitro with the gastric fluid of the edible crab Cancer pagurus and evaluated the hydrolysis rates by pH Stat titration. A plastic blend of PLA with PBAT showed the highest hydrolysis rate. The enzymes in the gastric fluid of crabs were separated by anion exchange chromatography. Fractions with carboxylesterase activity were identified using fluorescent methylumbelliferyl (MUF)-derivatives. Pooled fractions with high carboxylesterase activity also hydrolyzed a PLA/PBAT plastic blend. Carboxylesterases showed molecular masses of 40–45 kDa as determined by native gel electrophoresis (SDS-PAGE). Our study demonstrated that digestive carboxylesterases in the gastric fluid of C. pagurus exhibit a high potential for hydrolyzing certain biodegradable plastics. Since esterases are common in the digestive tract of organisms, it seems likely that other invertebrates possess the ability to hydrolyze biodegradable plastics.

Abstract The protective effects of multiple language knowledge on the maintenance of cognitive functions in older adults have been discussed controversially, among others, because of methodological inconsistencies between studies. In a sample of N = 528 German monolinguals and multilinguals (speaking two or more languages) older than 60 years, this study examined (1) whether speaking multiple languages is positively related to performance on tasks of interference suppression, working memory, concept shifting, and phonemic and semantic fluency, and (2) whether language proficiency and age of second language acquisition (AoA) are associated with cognitive performance of multilinguals. Controlling for education and daily activity, we found small cognitive benefits of speaking multiple languages on interference suppression, working memory, and phonemic fluency, but not on concept shifting and semantic fluency. Furthermore, no substantive correlations were found between language proficiency or AoA and cognitive performance. In conclusion, multilingualism appears to have small incremental effects on cognitive performance beyond education and daily activity in older age that are task-specific and widely independent of proficiency and AoA.

Poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) is a promising biodegradable bio-based material, which is designed for a vast range of applications, depending on its composite. This study aims to assess the degradability of a PHBV-based compound under different conditions. The research group followed different methodological approaches and assessed visual and mass changes, mechanical and morphological properties, spectroscopic and structural characterisation, along with thermal behaviour. The Ph-Stat (enzymatic degradation) test and total dry solids (TDS)/total volatile solids (TVS) measurements were carried out. Finally, the team experimentally evaluated the amount of methane and carbon dioxide produced, i.e., the degree of biodegradation under aerobic conditions. According to the results, different types of tests have shown differing effects of environmental conditions on material degradation. In conclusion, this paper provides a summary of the investigations regarding the degradation behaviour of the PHBV-based compound under varying environmental factors.The main strengths of the study lie in its multi-faceted approach, combining assessments of PHBV-based compound degradability under different conditions using various analytical tools, such as visual and mass changes, mechanical and morphological properties, spectroscopic and structural characterization, and thermal behavior. These methods collectively contribute to the robustness and reliability of the undertaken work.

Abstract Background Primary health care in industrialized countries faces major challenges due to demographic changes, an increasing prevalence of chronic diseases and a shortage of primary care physicians. One approach to counteract these developments might be to reduce primary care physicians’ workload supported by the use of health information technology (HIT) and non-physician practice staff. In 2009, the U.S. Commonwealth Fund (CWF) conducted an international survey of primary care physicians which the present secondary descriptive analysis is based on. The aim of this analysis was twofold: First, to explore to what extend German primary care physicians already get support by HIT and non-physician practice staff, and second, to show possible future perspectives. Methods The CWF questionnaire was sent to a representative random sample of 1,500 primary care physicians all over Germany. The data was descriptively analyzed. Group comparisons regarding differences in gender and age groups were made by means of Chi Square Tests for categorical variables. An alpha-level of p < 0.05 was used for statistical significance. Results Altogether 715 primary care physicians answered the questionnaire (response rate 49%). Seventy percent of the physicians use electronic medical records. Technical features such as electronic ordering and access to laboratory parameters are mainly used. However, the majority does not routinely use technical functions for drug prescribing, reminder-systems for guideline-based interventions or recall of patients. Six percent of surveyed physicians are able to transfer prescriptions electronically to a pharmacy, 1% use email communication with patients regularly. Seventy-two percent of primary care physicians get support by non-physician practice staff in patient care, mostly in administrative tasks or routine preventive services. One fourth of physicians is supported in telephone calls to the patient or in patient education and counseling. Conclusion Within this sample the majority of primary care physicians get support by HIT and non-physician practice staff in their daily work. However, the potential has not yet been fully used. Supportive technical functions like electronic alarm functions for medication or electronic prescribing should be improved technically and more adapted to physicians’ needs. To warrant pro-active health care, recall and reminder systems should get refined to encourage their use. Adequately qualified non-physician practice staff could play a more active role in patient care. Reimbursement should not only be linked to doctors’, but also to non-physician practice staff services.

Abstract Background To maintain patients’ quality of life is one of the major goals in palliative home care provided by general practitioners (GPs). GPs need adequate training to care for palliative patients. The paper seeks to evaluate whether a specific training in Germany (PAMINO) has any improving impact on the care of palliative patients and their health-related quality of life. Methods From September 2007 until June 2009, GPs and their palliative care patients with cancer participated in a study to evaluate palliative courses for GPs offered by a regional palliative care initiative (PAMINO). For a period of six months at most or until death, patients were asked monthly to judge their quality of life on the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL) of the European Organization for Research and Treatment of Cancer (EORTC) and on the Palliative Care Outcome Scale (POS). The ‘Overall quality of life’ scale of the QLQ-C15-PAL takes values between 0 and 100 with higher values indicating a higher quality of life. The POS sum scale takes values between 0 and 40 with higher values indicating worse care outcomes. Patients cared for by PAMINO-trained GPs and patients cared for by other GPs (control group) are compared using t-tests for differences in group means. Results One hundred patients participated in the study; 96 patients filled out the questionnaires at least once. On the QLQ-C15-PAL, mean quality of life of the patient groups of PAMINO-trained and other GPs were 37.7 (SD = 25.5) and 39.4 (SD = 26.3) (p = .76), respectively. On the POS, respective mean values of 13.6 (SD = 5.8) and 12.0 (SD = 6.5) (p = .26) were given. Patients cared for by a PAMINO-trained GP did not report better quality of life and care outcomes than patients cared for by other general practitioners. Conclusions Patients cared for by PAMINO-trained and other GPs in our study did not report differences in quality of life. Quality of life and care outcomes of all patients were better than of palliative patients in institutional or specialized care, emphasizing the ability of GPs to provide adequate care for these vulnerable patients. However, conclusions need to be drawn cautiously since the study had a small sample size. Trial registration Current Controlled Trials ISRCTN78021852

Abstract Background The Chronic Care Model (CCM) is an evidence-based approach to improving the structure of care for chronically ill patients with multimorbidity. The Assessment of Chronic Illness Care (ACIC), an instrument commonly used in international research, includes all aspects of the CCM, but cannot be easily extended to the German context. A new instrument called the "Questionnaire of Chronic Illness Care in Primary Care" (QCPC) was developed for use in Germany for this reason. Here, we present the results of the psychometric properties and test-retest reliability of QCPC. Methods A total of 109 family doctors from different German states participated in the validation study. Participating physicians completed the QCPC, which includes items concerning the CCM and practice structure, at baseline (T0) and 3 weeks later (T1). Internal consistency reliability and test-retest reliability were evaluated using Cronbach's alpha and Pearson's r, respectively. Results The QCPC contains five elements of the CCM (decision support, delivery system design, self-management support, clinical information systems, and community linkages). All subscales demonstrated moderate internal consistency and moderate test-retest reliability over a three-week interval. Conclusions The QCPC is an appropriate instrument to assess the structure of chronic illness care. Unlike the ACIC, the QCPC can be used by health care providers without CCM training. The QCPC can detect the actual state of care as well as areas for improvement of care according to the CCM.

Abstract Background Many western countries are facing an existing or imminent shortage of primary care physicians especially in rural areas. In Germany, working in rural areas is often thought to be associated with more working hours, a higher number of patients and a lower income than working in urban areas. These perceptions might be key reasons for the shortage. The aim of this analysis was to explore if working time, number of treated patients per week or proportion of privately insured patients vary between rural and urban areas in Germany using two different definitions of rurality within a sample of primary care physicians including general practitioners, general internists and paediatricians. Methods This is a secondary analysis of pre-collected data raised by a questionnaire that was sent to a representative random sample of 1500 primary care physicians chosen by data of the National Association of Statutory Health Insurance Physicians from all federal states in Germany. We employed two different methods of defining rurality; firstly, level of rurality as rated by physicians themselves (urban area, small town, rural area); secondly, rurality defined according to the Organisation for Economic Co-operation and Development. Results This analysis was based upon questionnaire data from 715 physicians. Primary care physicians in single-handed practices in rural areas worked on average four hours more per week than their urban counterparts (p < 0.05). Physicians' gender, the number of patients treated per week and the type of practice (single/group handed) were significantly related to the number of working hours. Neither the proportion of privately insured patients nor the number of patients seen per week differed significantly between rural and urban areas when applying the self-rated classification of rurality. Conclusion Overall this analysis identified few differences between urban and rural primary care physician working conditions. To counter future misdistribution of primary care, students should receive practical experience in rural areas to get more practical knowledge on working conditions.

Background The co-occurance of multiple medical conditions has a negative impact on health related quality of life (HRQoL) for patients with type 2 diabetes. These patients demand for intensified care programs. Participation in a disease management program (DMP) for type 2 diabetes has shown to counterbalance this effect. However, it remains unclear which dimensions of HRQoL are influenced by the DMP. The aim of this study was to explore the HRQoL dimensions of patients with type 2 diabetes in the German DMP and patients in routine care (RC). Methods This analysis is part of a comparative evaluation of the German DMP for patients with type 2 diabetes. A questionnaire, including the HRQoL measure EQ-5D, was mailed to a random sample of 3,546 patients with type 2 diabetes (59.3% female). The EQ-5D dimensions were analyzed by grouping patients according to their participation in the German DMP for diabetes into DMP and RC. Results Compared to patients in DMP, patients in RC reported more problems for the dimensions mobility (P < 0.05), self care (P < 0.05) and performing usual activities (P < 0.01). Depending on the number of other conditions, remarkable differences for reporting "no problems" exist for patients with six or more comorbid conditions regarding the dimensions mobility (RC = 8.7%, DMP = 32.3%), self care (RC = 43.5%, DMP = 64.5%), usual activities (RC = 13.0%, DMP = 33.9%) and anxiety or depression (RC = 37.0%, DMP = 48.4%). Conclusion Patients participating in the German DMP for type 2 diabetes mellitus show significantly higher ratings of their HRQoL in the dimensions mobility, self care and performing usual activities compared to patients in RC. This difference can also be observed in patients with significant comorbidities. As these dimensions are known to be essential for diabetes care, the German DMP may contribute to improved care even for comorbid diabetes patients.

Abstract Background The Chronic Care Model (CCM) is an evidence based, population based approach to improve care for people with chronic conditions. The Assessment of Chronic Illness Care (ACIC) instrument is widely used to measure to what extent within a healthcare system the CCM is implemented. The aim of this study was to translate and culturally adapt the ACIC Instrument for the German healthcare system. Methods For translating the ACIC instrument, principles of Good Practice for the Translation and Cultural Adaptation Process by the ISPOR Task Force were followed. Focus groups were additionally conducted with general practitioners to adapt the items culturally. Results The ACIC instrument can not be used in the German healthcare system easily due to a multifaceted understanding of words, different levels of knowledge of the CCM and fundamental differences between health systems. Conclusions As following the CCM leads to benefits for patients with chronic illnesses, measuring to which extent it is implemented is of major interest. A new questionnaire using the CCM as its theoretical basis, sensitive to the healthcare systems of the host country has to be created. Knowledge transfer between countries by using an instrument from a different healthcare system can lead to a completely new questionnaire.

Abstract Background In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice. Methods The study was designed as a cross-sectional survey. In 2010, students at the five medical schools in the federal state of Baden-Wuerttemberg (Germany) filled out an online-questionnaire. On 27 items with 5-point Likert scales, the students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to assign their intended medical specialty. Results 1,299 students participated in the survey. Thereof, 1,114 students stated a current choice for a specialty, with 708 students choosing a career in one of the following 6 specialties: internal medicine, surgery, gynaecology and obstetrics, paediatrics, anaesthetics and general practice. Overall, individual aspects ('Personal ambition', 'Future perspective', 'Work-life balance') were rated as more important than occupational aspects (i.e. 'Variety in job', 'Job-related ambition') for career choice. For students favouring a career as a GP individual aspects and the factor 'Patient orientation' among the occupational aspects were significantly more important and 'Job-related ambition' less important compared to students with other specialty choices. Conclusions This study confirms that future GPs differ from students intending to choose other specialties particularly in terms of patient-orientation and individual aspects such as personal ambition, future perspective and work-life balance. Improving job-conditions in terms of family compatibility and work-life balance could help to increase the attractiveness of general practice. Due to the shortage of GPs those factors should be made explicit at an early stage at medical school to increase the number of aspirants for general practice.

Abstract Background Case management is an important component of structured and evidence-based primary care for chronically ill patients. Its effectiveness and efficiency has been evaluated in numerous clinical trials. This protocol describes aims and methods of a systematic review of research on the effectiveness and efficiency of case management in primary care. Methods/Design According to this protocol Medline, Embase, CINAHL, PsychInfo, the Cochrane Central Register of Controlled trials, DARE, NHS EED, Science Citation Index, The Royal College of Nursing Database, Dissertation Abstracts, registers of clinical trials and the reference lists of retrieved articles will be searched to identify reports on randomized and non-randomized controlled trials of case management interventions in a primary care setting without limitations on language or publication date. We will further ask experts in the field to avoid missing relevant evidence. Study inclusion and data extraction will be performed independently by two reviewers. After assessing risk of bias according to predefined standards, included studies will be described qualitatively. Subgroup analyses are planned for different chronic diseases and intervention strategies. If appropriate, a quantitative synthesis of data will be performed to provide conclusive evidence about the effectiveness and efficiency of primary care based case management in chronic care. Review registration Centre for Reviews and Dissemination (University of York): CRD32009100316.

Abstract Background Patients with type 2 diabetes are likely to have comorbid conditions which represent a high burden for patients and a challenge for primary care physicians. The aim of this cross-sectional survey was to assess the impact of additional comorbidities on quality of life within a large sample of patients with type 2 diabetes in primary care. Methods A cross-sectional survey within a large sample (3.546) of patients with type 2 diabetes in primary care was conducted. Quality of life (QoL) was assessed by means of the Medical Outcome Study Short Form (SF-36), self reported presence of comorbid conditions was assessed and groups with single comorbidities were selected. QoL subscales of these groups were compared to diabetes patients with no comorbidities. Group comparisons were made by ANCOVA adjusting for sociodemographic covariates and the presence of depressive disorder. Results Of 3546 questionnaires, 1532 were returned, thereof 1399 could be analysed. The mean number of comorbid conditions was 2.1. 235 patients declared to have only hypertension as comorbid condition, 97 patients declared to have osteoarthritis only. Patients suffering from diabetes and hypertension reached similar scores like diabetic patients with no comorbidities. Patients with diabetes and osteoarthritis reached remarkable lower scores in all subscales. Compared to patients with diabetes alone these differences were statistically significant in the subscales representing pain and physical impairment. Conclusion The impact of osteoarthritis as an often disabling and painful condition on QoL in patients with type 2 diabetes is higher than the impact of hypertension as common but often asymptomatic comorbidity. Individual care of patients with chronic conditions should aim at both improving QoL and controlling risk factors for severe complications.

Abstract Background There has been a marked increase in the use of complementary and alternative medicine (CAM) in recent years worldwide. In Germany, apart from 'Heilpraktiker' (= state-licensed, non-medical CAM practitioners), some general practitioners (GPs) provide CAM in their practices. This paper aims to explore the attitudes of GPs about the role of CAM in Germany, in relation to the healthcare system, quality of care, medical education and research. Furthermore, experiences of GPs integrating CAM in their daily practice were explored. Methods Using a qualitative methodological approach 3 focus groups with a convenience sample of 17 GPs were conducted. The discussions were transcribed verbatim and analysed using qualitative content analysis. Results The majority of the participating GPs had integrated one or more CAM therapies into their every-day practice. Four key themes were identified based on the topics covered in the focus groups: the role of CAM within the German healthcare system, quality of care, education and research. Within the theme 'role of CAM within the healthcare system' there were five categories: integration of CAM, CAM in the Statutory Health Insurance, modernisation of the Statutory Health Insurance Act, individual healthcare services and 'Heilpraktiker'. Regarding quality of care there were two broad groups of GPs: those who thought patients would benefit from standardizing CAM and those who feared that quality control would interfere with the individual approach of CAM. The main issues identified relating to research and education were the need for the development of alternative research strategies and the low quality of existing CAM education respectively. Conclusion The majority of the participating GPs considered CAM as a reasonable complementary approach within primary care. The study increased our understanding of GPs attitudes about the role of CAM within the German healthcare system and the use of 'Heilpraktiker' as a competing CAM-provider. It seems to be a need for increased funding for research, better education and remuneration by the Statutory Health Insurance in order to improve access to 'Integrative medicine' in Germany.

Abstract Background The care of palliative patients challenges the health care system in both quantity and quality. Especially the role of primary care givers needs to be strengthened to provide them with the knowledge and the confidence of applying an appropriate end-of-life care to palliative patients. To improve health care services for palliative patients in primary care, interested physicians in and around Heidelberg, Germany, are enabled to participate in the community-based program 'Palliative Medical Initiative North Baden (PAMINO)' to improve their knowledge in dealing with palliative patients. The impact of this program on patients' health and quality of life remains to be evaluated. Methods/Design The evaluation of PAMINO is a non-randomized, controlled study. Out of the group of primary care physicians who took part in the PAMINO program, a sample of 45 physicians and their palliative patients will be compared to a sample of palliative patients of 45 physicians who did not take part in the program. Every four weeks for 6 months or until death, patients, physicians, and the patients' family caregivers in both groups answer questions to therapy strategies, quality of life (QLQ-C15-PAL, POS), pain (VAS), and burden for family caregivers (BSFC). The inclusion of physicians and patients in the study starts in March 2007. Discussion Although participating physicians value the increase in knowledge they receive from PAMINO, the effects on patients remain unclear. If the evaluation reveals a clear benefit for patients' quality of life, a larger-scale implementation of the program is considered. Trial registration: The study was registered at ‘current controlled trials (CCT)’, registration number: ISRCTN78021852.

As the political arena becomes increasingly polarized, the legal arena is playing a more important role in the creation of education policy in the United States. One critical stage in the legal process for such efforts is at briefing where "amici curiae," or friends-of-the-court, may introduce additional arguments for the court to consider through the filing of "amicus curiae" briefs. To explore the use of extra-legal sources by "amici," we focus on the 2013 U.S. Supreme Court case "Fisher v. University of Texas at Austin" and ask the questions: (1) What are the types, and relative use by "amici," of extra-legal sources cited in the briefs submitted in "Fisher I?"; and (2) What is the relative use of extralegal sources cited in "amicus" briefs by supporting party and by category of "amici?" Our findings reveal the wide-range of extra-legal sources used in "amicus" briefs, and that the type of extra-legal sources incorporated may be associated with who the "amici" are and which party they support. Ultimately, we discuss potential reasons for the differences observed in the use of extra-legal sources and offer recommendations to more effectively engage in the policy briefing process.

Temporal Blind Source Separation (TBSS) is used to obtain the true underlying processes from noisy temporal multivariate data, such as electrocardiograms. TBSS has similarities to Principal Component Analysis (PCA) as it separates the input data into univariate components and is applicable to suitable datasets from various domains, such as medicine, finance, or civil engineering. Despite TBSS’s broad applicability, the involved tasks are not well supported in current tools, which offer only text-based interactions and single static images. Analysts are limited in analyzing and comparing obtained results, which consist of diverse data such as matrices and sets of time series. Additionally, parameter settings have a big impact on separation performance, but as a consequence of improper tooling, analysts currently do not consider the whole parameter space. We propose to solve these problems by applying visual analytics (VA) principles. Our primary contribution is a design study for TBSS, which so far has not been explored by the visualization community. We developed a task abstraction and visualization design in a user-centered design process. Task-specific assembling of well-established visualization techniques and algorithms to gain insights in the TBSS processes is our secondary contribution. We present TBSSvis, an interactive web-based VA prototype, which we evaluated extensively in two interviews with five TBSS experts. Feedback and observations from these interviews show that TBSSvis supports the actual workflow and combination of interactive visualizations that facilitate the tasks involved in analyzing TBSS results.

Abstract Background Non-resectability is common in patients with pancreatic ductal adenocarcinoma (PDAC) due to local invasion or distant metastases. Then, biliary or gastroenteric bypasses or both are often established despite associated morbidity and mortality. The current study explores outcomes after palliative bypass surgery in patients with non-resectable PDAC. Methods From the prospectively maintained German StuDoQ|Pancreas registry, all patients with histopathologically confirmed PDAC who underwent non-resective pancreatic surgery between 2013 and 2018 were retrospectively identified, and the influence of the surgical procedure on morbidity and mortality was analyzed. Results Of 389 included patients, 127 (32.6%) underwent explorative surgery only, and a biliary, gastroenteric or double bypass was established in 92 (23.7%), 65 (16.7%) and 105 (27.0%). After exploration only, patients had a significantly shorter stay in the intensive care unit (mean 0.5 days [SD 1.7] vs. 1.9 [3.6], 2.0 [2.8] or 2.1 [2.8]; P

Among the highly diverse range of biobased polymers, polylactic acid (PLA) received vast attention in recent years due to its versatility for different applications and being the first commercially used polymer produced from renewable sources. Production and application of bio-based, biodegradable plastics will have one of the most crucial roles in tackling worldwide plastic pollution.Methods: This study is based on integrative ecotoxicological assessment of an innovative PLA-based agricultural mulch film (BPE-AMF-PLA), developed under the H2020 EU project “BIO-PLASTICS EUROPE”, towards organisms from different environmental compartments (soil, fresh water and marine) and from different trophic levels. Such comprehensive evaluation has an overarching goal to promote environmentally safe and sustainable use of these PLA-based plastics for agricultural and other potential applications.Results: Low-to-no phytotoxicity was obtained in both single-species standardized bioassays, and in a multi-species microcosms experiment. Earthworm reproduction was negatively affected at the lowest test concentration of 0.1% w/w of PLA-based plastic particles. For freshwater Daphnia, reproduction was found a sensitive endpoint, upon exposure to the leachates of the PLA-based plastic. However, the reported toxicity seemed to be caused by the presence of 2-methylnaphthalene, which can be avoided in the production process. As for the marine organisms, algae growth was inhibited with a LOEC = 25 g L−1, whereas test with brine shrimp only revealed stimulation of lipase upon digestion of micro-sized PLA-based plastics. Marine lugworm ingested pristine and UV pre-treated micro-sized plastics, yet without impact either on biological activity, or on the health of the test individuals.Discussion: The approach used in the present work will contribute to product development, environmental safety and sustainable applications of the PLA-based mulch film BPE-AMF-PLA, in the scope of project BIO-PLASTICS EUROPE. Furthermore, the tools and results obtained in this work are a relevant contribution in the framework development for additional support in the certification of the bio-based polymers, being aligned with European zero waste and non-toxicity strategies, certification, and regulations.

Actions in the real world have immediate sensory consequences. Mimicking these in digital environments is within reach, but technical constraints usually impose a certain latency (delay) between user actions and system responses. It is important to assess the impact of this latency on the users, ideally with measurement techniques that do not interfere with their digital experience. One such unobtrusive technique is electroencephalography (EEG), which can capture the users' brain activity associated with motor responses and sensory events by extracting event-related potentials (ERPs) from the continuous EEG recording. Here we exploit the fact that the amplitude of sensory ERP components (specifically, N1 and P2) reflects the degree to which the sensory event was perceived as an expected consequence of an own action (self-generation effect). Participants (N = 24) elicit auditory events in a virtual-reality (VR) setting by entering codes on virtual keypads to open doors. In a within-participant design, the delay between user input and sound presentation is manipulated across blocks. Occasionally, the virtual keypad is operated by a simulated robot instead, yielding a control condition with externally generated sounds. Results show that N1 (but not P2) amplitude is reduced for self-generated relative to externally generated sounds, and P2 (but not N1) amplitude is modulated by delay of sound presentation in a graded manner. This dissociation between N1 and P2 effects maps back to basic research on self-generation of sounds. We suggest P2 amplitude as a candidate read-out to assess the quality and immersiveness of digital environments with respect to system latency.

Different from more traditional policy-making avenues, the courts provide an antipolitical arena that does not require broad agreement from various constituents for policy enactment. Seeking to guide court decisions on these policy issues, individuals and organizations have filed "amicus" briefs that increasingly include social science to support their arguments. The "Fisher v. University of Texas" at Austin Supreme Court case presents an ideal example to study the use of social science evidence in "amicus" briefs to shape educational policy. Findings from this study identify differences in the use of social science research that suggest many ways in which our current understanding of the efforts of actors to shape educational policy via the highest court in the nation is incomplete. This study also highlights why developing this understanding could be extremely useful to both the creation of educational policy and the use of antipolitical approaches to change such policy.

Visualizing big and complex multivariate data is challenging. To address this challenge, we propose flexible visual analytics (FVA) with the aim to mitigate visual complexity and interaction complexity challenges in visual analytics, while maintaining the strengths of multiple perspectives on the studied data. At the heart of our proposed approach are transitions that fluidly transform data between user-relevant views to offer various perspectives and insights into the data. While smooth display transitions have been already proposed, there has not yet been an interdisciplinary discussion to systematically conceptualize and formalize these ideas. As a call to further action, we argue that future research is necessary to develop a conceptual framework for flexible visual analytics. We discuss preliminary ideas for prioritizing multi-aspect visual representations and multi-aspect transitions between them, and consider the display user for whom such depictions are produced and made available for visual analytics. With this contribution we aim to further facilitate visual analytics on complex data sets for varying data exploration tasks and purposes based on different user characteristics and data use contexts.

BackgroundMobile health (mHealth) interventions for self-management are a promising way to meet the needs of patients with chronic diseases in primary care practices. Therefore, an mHealth intervention, TelePraCMan, was developed and evaluated for patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, high blood pressure, or heart failure in a German primary care setting. TelePraCMan entails a symptom diary, an appointment manager, a manager to document goals, and a warning system. The app should foster the self-management of participating patients. ObjectiveWe aimed to examine the effects of TelePraCMan on patient activation and quality of life and explored the underlying contextual factors, impacts, and degree of implementation. MethodsIn a prospective observational study design, we collected data by using interviews and written questionnaires from participating patients (intervention and control groups) and primary care workers (physicians and practice assistants). The primary outcomes of interest were patient-reported quality of life (12-Item Short Form Survey) and patient activation (patient activation measure). The quantitative analysis focused on differences between patients in the intervention and control groups, as well as before (T0) and after (T1) the intervention. Interviews were analyzed by using qualitative content analysis via MAXQDA (VERBI GmbH). ResultsAt baseline, 25 patients and 24 primary care workers completed the questionnaire, and 18 patients and 21 primary care workers completed the follow-up survey. The patients were predominantly male and, on average, aged 64 (SD 11) years (T0). The primary care workers were mostly female (62%) and, on average, aged 47 (SD 10) years (T0). No differences were observed in the outcomes before and after the intervention or between the intervention and control groups. In the additional interviews, 4 patients and 11 primary care workers were included. The interviewees perceived that the intervention was useful for some patients. However, contextual factors and problems with implementation activities negatively affected the use of the app with patients. The main reasons for the low participation were the COVID-19 pandemic and the target group, which seemed to have less interest in mHealth; the interviewees attributed this to the older age of patients. However, the respondents felt that the app would be better accepted in 5 or 10 years. ConclusionsAlthough the TelePraCMan app was rated as very good and important by the participants, few patients used it. The digital intervention was hardly implemented and had limited impact in the current setting of German primary care. Trial RegistrationGerman Clinical Trials Register DRKS00017320; https://tinyurl.com/4uwrzu85

The progressive substitution of petroleum-based polymers, such as polyethylene, polyvinylchloride, or polyethylene terephtalate, by so-called bioplastics facilitated the development and production of many new materials. The continuously refined properties of bioplastic compounds and their blends enable various applications. With growing production and utilization of bioplastic products, these materials are increasingly discarded into the environment. Although many of these materials are labeled biodegradable, there is limited information about their degradability under environmental conditions. We tested the enzymatic degradability of five bioplastic compounds with the rapid pH-Stat titration assay at environmentally relevant seawater temperatures between 5 and 30°C and pH 8.2. These plastics, issued from the European Horizon 2020 Project ´Bioplastics Europe´, are based on polylactic acid (PLA), polybutylene succinate (PBS), and poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV). Suspensions of microparticles (< 200 µm) were incubated with each of the three hydrolytic enzymes, protease, lipase, and esterase. A PLA-based compound blended with polybutylene adipate terephthalate (PBAT) showed the highest hydrolysis rate of 30 nmol·min-1 when incubated with lipase at 30°C. All other materials showed low hydrolysis rates of less than 10 nmol·min-1. Below 20°C, hydrolysis almost ceased. Plate clearing assays with the same enzymes at 37°C and pH 5 and pH 8, respectively, largely confirmed the results of the pH-Stat titration assays. Our findings indicate that there is a potential degradation of most of the materials with at least one of these hydrolytic enzymes. Nonetheless, the rate of enzymatic degradation under environmentally relevant conditions is low, which indicates only a marginal degradability of bioplastics in the marine environment.

The word ‘pattern’ frequently appears in the visualisation and visual analytics literature, but what do we mean when we talk about patterns? We propose a practicable definition of the concept of a pattern in a data distribution as a combination of multiple interrelated elements of two or more data components that can be represented and treated as a unified whole. Our theoretical model describes how patterns are made by relationships existing between data elements. Knowing the types of these relationships, it is possible to predict what kinds of patterns may exist. We demonstrate how our model underpins and refines the established fundamental principles of visualisation. The model also suggests a range of interactive analytical operations that can support visual analytics workflows where patterns, once discovered, are explicitly involved in further data analysis.

In the application domain of digital humanities network visualization is increasingly being used to conduct research as the main interests of the domain experts lie in exploring and analyzing relationships between entities and their changes over time. Visualizing the dynamics and different perspectives of such data is a non-trivial task but it enables researchers to explore connections between disparate entities and investigate historical narratives that emerge. In this paper we present Circular, an interactive exploration environment to visualize event-based networks and support research in digital humanities through visualization of historical subjects in space and time. Our radial design is the result of iterative collaboration with domain experts, and we discuss the process of collaborative development and exploration of public music festivities in Vienna as an example of immersive development methodology. We validate our approach by means of both domain and visualization expert interviews and show the potential of this approach in supporting the visual exploration of historical subjects. We discuss our design rationales, visual encodings, and interactions as to allow the reproducibility of this approach within a framework of transdisciplinary collaboration with digital humanities.

Heterotrophic bacteria in the ocean initiate biopolymer degradation using extracellular enzymes that yield low molecular weight hydrolysis products in the environment, or by using a selfish uptake mechanism that retains the hydrolysate for the enzyme‐producing cell. The mechanism used affects the availability of hydrolysis products to other bacteria, and thus also potentially the composition and activity of the community. In marine systems, these two mechanisms of substrate processing have been studied in the water column, but to date, have not been investigated in sediments. In surface sediments from an Arctic fjord of Svalbard, we investigated mechanisms of biopolymer hydrolysis using four polysaccharides and mucin, a glycoprotein. Extracellular hydrolysis of all biopolymers was rapid. Moreover, rapid degradation of mucin suggests that it may be a key substrate for benthic microbes. Although selfish uptake is common in ocean waters, only a small fraction (0.5%–2%) of microbes adhering to sediments used this mechanism. Selfish uptake was carried out primarily by Planctomycetota and Verrucomicrobiota. The overall dominance of extracellular hydrolysis in sediments, however, suggests that the bulk of biopolymer processing is carried out by a benthic community relying on the sharing of enzymatic capabilities and scavenging of public goods. [ABSTRACT FROM AUTHOR]

Abstract Background The importance of platelets in the pathogenesis of metastasis formation is increasingly recognized. Although evidence from epidemiologic studies suggests positive effects of aspirin on metastasis formation, there is little clinical data on the perioperative use of this drug in pancreatic cancer patients. Methods From all patients who received curative intent surgery for pancreatic cancer between 2014 and 2016 at our institution, we identified 18 patients that took aspirin at time of admission and continued to throughout the inpatient period. Using propensity score matching, we selected a control group of 64 patients without aspirin intake from our database and assessed the effect of aspirin medication on overall, disease-free, and hematogenous metastasis-free survival intervals as endpoints. Results Aspirin intake proved to be independently associated with improved mean overall survival (OS) (46.5 vs. 24.6 months, *p = 0.006), median disease-free survival (DFS) (26 vs. 10.5 months, *p = 0.001) and mean hematogenous metastasis-free survival (HMFS) (41.9 vs. 16.3 months, *p = 0.005). Three-year survival rates were 61.1% in patients with aspirin intake vs. 26.3% in patients without aspirin intake. Multivariate cox regression showed significant independent association of aspirin with all three survival endpoints with hazard ratios of 0.36 (95% CI 0.15–0.86) for OS (*p = 0.021), 0.32 (95% CI 0.16–0.63) for DFS (**p = 0.001), and 0.36 (95% CI 0.16–0.77) for HMFS (*p = 0.009). Conclusions Patients in our retrospective, propensity-score matched study showed significantly better overall survival when taking aspirin while undergoing curative surgery for pancreatic cancer. This was mainly due to a prolonged metastasis-free interval following surgery.