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Background: Respiratory syncytial virus (RSV) is a common cause for severe lower respiratory tract infections (LRTI) in children < 2 years of age in Germany – though little is known about the clinical and economic burden of RSV in children with and without risk factors per month of life. Methods: In a retrospective health claims analysis, we identified RSV inpatient cases between 2014 and 2019. We assessed incidence rates, mortality rate, healthcare resource utilization, associated direct costs per case and excess costs for 30, 90 and 365 days after hospital admission matched to a control group. The outcomes are reported separately for the first and second year of life (i.e., for infants and toddlers) and were stratified by month of life, preterm and risk status (i.e., presence of underlying disease: chronic respiratory or cardiac disease, immunosuppression, neurological diseases, diabetes, conditions originating in the perinatal period). Results: RSV-attributable hospital incidence rate was higher in infants (30.25/1,000) than toddlers (14.52/1,000), highest in the first three months of life (44.21/1,000), in infants born preterm (64.76/1,000) or with any underlying disease (54.85/1,000). Mortality rate was also higher for infants (0.08/1,000) than toddlers (0.04/1,000). Mean 30-day excess costs ranged from 2,953 € for infants born full-term at no risk, hospitalized for 5 days, to 6,694 € for infants born extremely premature, hospitalized for 7 days. Conclusion: In Germany, the clinical and economic burden of RSV is substantial, especially in the most vulnerable population, that is, very young infants, those born premature and/or those with an underlying disease. [ABSTRACT FROM AUTHOR]

Purpose: There is evidence that lower activity of the RAF/MEK/ERK network is associated with positive outcomes in mild and moderate courses of COVID-19. The effect of this cascade in COVID-19 sepsis is still undetermined. Therefore, we tested the hypothesis that activity of the RAF/MEK/ERK network in COVID-19-induced sepsis is associated with an impact on 30-day survival. Methods: We used biomaterial from 81 prospectively recruited patients from the multicentric CovidDataNet.NRW-study cohort (German clinical trial registry: DRKS00026184) with their collected medical history, vital signs, laboratory parameters, microbiological findings and patient outcome. ERK activity was measured by evaluating ERK phosphorylation using a Proximity Ligation Assay. Results: An increased ERK activity at 4 days after diagnosis of COVID-19-induced sepsis was associated with a more than threefold increased chance of survival in an adjusted Cox regression model. ERK activity was independent of other confounders such as Charlson Comorbidity Index or SOFA score (HR 0.28, 95% CI 0.10–0.84, p = 0.02). Conclusion: High activity of the RAF/MEK/ERK network during the course of COVID-19 sepsis is a protective factor and may indicate recovery of the immune system. Further studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) are at high risk of blood-borne infections, and injection drug use contributes significantly to hepatitis C virus (HCV) transmission. The WHO has therefore set targets of reducing HCV incidence and prevalence among PWID and increasing treatment coverage to eliminate HCV by 2030. The DRUCK study (2011–2014) found high HCV prevalence and low treatment coverage among PWID in Germany. To assess progress in the elimination of HCV among PWID, we conducted a cross-sectional study in two German federal states that piloted a future monitoring. Methods: PWID aged 16 + who injected drugs (previous 12 months) were recruited in low-threshold drug services and opioid agonist treatment (OAT) practices in Berlin and Bavaria between June 2021 and April 2022. Participants completed a questionnaire on sociodemographics, behaviours and access to care, and were tested for hepatitis B virus (HBV) and HCV, and HIV. Data was analysed regarding HCV prevalence, history of treatment, and risk and prevention behaviours. Results were compared with the DRUCK study. Results: A total of 588 PWID, with a median age of 39 (range: 17–66) years and 68% (399/587) male, were included in the analysis. Of the participants, 61% (353/574) reported receiving OAT and 14% (66/469) recent use of shared needles/syringes during the last 30 days. History of imprisonment was reported by 77% (444/577) and history of homelessness by 75% (428/569) of participants. Among anti-HCV positive participants, viraemic HCV infections decreased by 44% from 66% (904/1361) in 2011–2014 to 37% (160/432) in 2021–2022, while those with cleared HCV infection and treatment history increased from 20% (266/1361) to 34% (148/432). Conclusions: Despite a decrease since 2011–2014, viraemic HCV prevalence among PWID in Germany remains high, and treatment coverage is still insufficient. To achieve the WHO targets, universal health coverage and targeted integrated testing and treatment for PWID are needed. PWID receiving OAT and people in prison should be offered testing and treatment at any contact with the medical system. A nationwide monitoring system will help assess successes and remaining gaps, and track progress towards elimination of HCV among PWID in Germany. [ABSTRACT FROM AUTHOR]

Background: Available data suggest that general practitioners (GPs) in Germany use complementary and alternative medicine (CAM) modalities more frequently than GPs in many other countries. We investigated the country differences perceived by general practitioners who have worked in Germany and in one of four other European countries with regard to the role of complementary and alternative treatments in primary care. Methods: In this qualitative study we conducted semi-structured interviews with 12 GPs who had worked both in Germany and Italy, the Netherlands, Norway or the United Kingdom (UK; n = 3 for each of the four countries). Participants were asked how they perceived and experienced country differences regarding health system, relevance of CAM modalities, the role of evidence-based medicine (EBM) and science, and how they handle so-called indeterminate situations. For the analysis, we followed a thematic analysis approach according to Braun and Clarke with focus on themes that cover CAM. Results: Participants unanimously reported that they perceived CAM to be more relevant in general practice in Germany compared to the other countries. We identified four overarching themes in relation to the perceived reasons for these differences. Firstly, physicians with experiences in countries with a strong EBM and science orientation (Netherlands, Norway and the UK) considered the deeply ingrained view in national healthcare systems and GP communities that CAM modalities are not evidence-based as the main reason for the lower use of CAM by GPs. Secondly, extensive training of communication skills was cited as a reason that reduced the need for CAM in the Netherlands, Norway and the UK. Thirdly, differences in patient expectations and demands were perceived as a factor contributing to greater utilisation of CAM by German GPs compared to the other countries. Finally, country-specific reimbursement mechanisms were considered as a factor influencing the role of CAM in general practice. Conclusions: The study results point to major differences between countries with regard to the role of CAM in GP care. Differences in basic attitudes in the discipline of general practice, patient expectations and system conditions appear to play an important role here. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory syncytial virus (RSV) burden in adults is underestimated mainly due to unspecific symptoms and limited standard-of-care testing. We estimated the population-based incidence of hospitalization and mortality attributable to RSV among adults with and without risk factors in Germany. Methods: Weekly counts of hospitalizations and deaths for respiratory, cardiovascular, and cardiorespiratory diseases were obtained (Statutory Health Insurance database, 2015–2019). A quasi-Poisson regression model was fitted to estimate the number of hospitalizations and deaths attributable to RSV as a function of periodic and aperiodic time trends, and viral activity while allowing for potential overdispersion. Weekly counts of RSV and influenza hospitalizations in children < 2 years and adults ≥ 60 years, respectively, were used as viral activity indicators. Models were stratified by age group and risk status (defined as presence of selected comorbidities). Results: Population-based RSV-attributable hospitalization incidence rates were high among adults ≥ 60 years: respiratory hospitalizations (236–363 per 100,000 person-years) and cardiorespiratory hospitalizations (584–912 per 100,000 person-years). RSV accounted for 2–3% of all cardiorespiratory hospitalizations in this age group. The increase in cardiorespiratory hospitalization risk associated with underlying risk factors was greater in 18–44 year old persons (five to sixfold higher) than in ≥ 75 year old persons (two to threefold higher). Conclusions: This is a first model-based study to comprehensively assess adult RSV burden in Germany. Estimated cardiorespiratory RSV hospitalization rates increased with age and were substantially higher in people with risk factors compared to those without risk factors. Our study indicates that RSV, like other respiratory viruses, contributes to both respiratory and cardiovascular hospitalizations. Effective prevention strategies are needed, especially among older adults ≥ 60 years and among adults with underlying risk factors. [ABSTRACT FROM AUTHOR]

Victims of child sexual abuse (CSA) in criminal proceedings face a range of stress factors. In response to this, collaboration between criminal justice and child protection professionals has been established both legally and informally, such as in the newly established Childhood Houses in Germany, which follow the model of the Scandinavian Barnahus to reduce stress and prevent revictimisation. This study intends to identify facilitating and inhibiting factors in the collaboration between the child protection and criminal justice systems in cases of CSA in Germany. Twenty‐eight qualitative interviews with experts from child protection, like counselling centre employees (n = 5), psychosocial court supporters (n = 5) and youth welfare office workers (n = 5), and the criminal justice system, like prosecutors (n = 5), police officers (n = 5) and attorneys (n = 3). The interviews are structured by a questionnaire and analysed using Kuckartz's method of qualitative content analysis (QCA). Findings show that key factors like information flow, assessments of collaboration partners, uncertainties about laws and actors' perspectives on reporting and networking determine the success or failure of interagency collaboration. [ABSTRACT FROM AUTHOR]

Background: Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it. Method: In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically for male patients) over a period of 12 months would be able to increase the percentage of men among patients seeking outpatient cancer counseling (primary endpoint, initial contact; secondary endpoint, all contacts). The intervention effect was quantified by the fitting of generalized linear mixed models to obtain an odds ratio, which was adjusted for cluster structure and for the percentages of first contacts and of all contacts during the 12 months before the start of the intervention. Results: In 12 regions of Germany (6 each in the intervention arm and the control arm), 11986 people had first contacts with outpatient cancer counseling, 6004 of them during the intervention phase. The percentage accounted for by men was 30.7% in the intervention arm and 25.7% in the control arm, corresponding to a statistically insignificant model-based adjusted odds ratio (OR) of 1.2 (95% confidence interval [1.0; 1.4], p =0.08) for the primary endpoint. There were a total of 51842 counseling sessions (both initial contacts and subsequent contacts), 26 651 of them in the intervention phase. The percentage of these that was accounted for by men was 27.6% in the intervention arm and 22.2% in the control arm; the adjusted OR for this secondary endpoint was 1.3 [1.1; 1.6], p =0.01). Conclusion: The targeted implementation of male-specific measures on multiple levels can increase, by a small amount, the percentage of men among persons seeking outpatient cancer counseling. [ABSTRACT FROM AUTHOR]

Purpose: Digitalization plays a critical role and is beginning to impact every part of the patient journey, from drug discovery and data collection to treatment and patient-reported outcomes. We aimed to evaluate the status quo and future directions of digital medicine in the specialty of gynecology and obstetrics in Germany. Methods: An anonymous questionnaire was distributed via the German Society of Gynecology and Obstetrics newsletter in December 2022. The questionnaire covered the domains baseline demographic information, telemedicine, digital health applications (DIGAs), and future expectations. Results: In all, 91 participants completed the survey. Median age was 34 years; 67.4% (60 of 89) were female and 32.6% (29 of 89) were male. About 10% (9 of 88) have prescribed DIGAs to date and 14% (12 of 86) offer telemedical appointments. Among those who do not use digital medicine, very few plan to do so in the near future. Reasons include missing software interfaces, lack of time to try out new things, lack of knowledge, lack of monetary compensation (66.3%), and employee concerns. A majority agreed that digitalization will help to save time and improve patient care and that intelligent algorithms will aid clinicians in providing patient care to women. Conclusions: The status quo and future directions of digital medicine in gynecology and obstetrics in Germany are characterized by contradicting expectations regarding the benefits of digital medicine and its actual implementation in clinical routine. This represents an important call to action to meet the requirements of modern patient care. [ABSTRACT FROM AUTHOR]

Purpose: Hospital information systems (HIS) play a critical role in modern healthcare by facilitating the management and delivery of patient care services. We aimed to evaluate the current landscape of HIS in the specialty of gynecology and obstetrics in Germany. Methods: An anonymous questionnaire was distributed via the German Society of Gynecology and Obstetrics newsletter in December 2022. The questionnaire covered the domains baseline demographic information, satisfaction with daily use, satisfaction with implementation, and degree of digitization. Results: Ninety-one participants completed the survey. Median age was 34 years; 67.4% (60 of 89) were female, and 32.6% (29 of 89) were male. Of the survey participants, 47.7% (42 of 88) were residents, 26.1% (23 of 91) senior physicians, and 9.1% (8 of 88) medical directors. The degree of digitization of clinical documentation is mainly mixed digital and paper-based (64.0%, 57 of 89) while 16.9% (15 of 89) operate mainly paper-based. The current HIS has been in use on average for 9 years. The median number of different software systems used in daily routine is 4. About 33.7% (30 of 89) would likely or very likely recommend their current HIS to a colleague. Conclusions: The current landscape of HIS in gynecology and obstetrics in Germany is characterized by a high heterogeneity of systems with low interoperability and long service life; thus, many healthcare professionals are not satisfied. There is both a need to enhance and an interest in modernizing the technological infrastructure to meet today's requirements for patient care. [ABSTRACT FROM AUTHOR]

Declining public finances and ever increasing national and international competition force state-owned German universities to adapt to an increasingly competitive environment. In a first phase the universities have concentrated their efforts on the optimisation of budgeting processes and on the development of strategies and goals to come to a more efficient way of distributing scarce financial resources. This has been accompanied by a sharpening of their profiles, a process that is still in full flight in a majority of the universities. However, the more dynamic institutions are now entering a second stage of reforms and focusing their efforts on the professionalism of their decision makers as well as their internal management structures in order to become more competitive on an international scale. The greater autonomy from the formerly very rigid system of state control works like an accelerator in this process. In this article, I discuss the framework in which the adaptation of the internationally common system of a professional dean at school level could take place to help the achievement of the strategic goals of the school. The second part of this article analyses the dangers of an unaltered adaptation of this approach in the German system and the steps that should be taken to avoid friction and dysfunctional effects.

Objective: This study aims to identify pathways patients and their relatives take to outpatient psychosocial cancer counselling centres. We had a special interest in how access for men can be eased. Methods: Cancer patients and relatives were purposively sampled in two regions in Germany. Participants were either outpatient cancer counselling centres (OCCCs) users or non‐users and participated in qualitative face‐to‐face interviews. We used different guidelines for users and non‐users. The interviews were analysed using content analysis. Results: One hundred and three people participated in the study. Important pathways to outpatient psychosocial cancer counselling centres for both men and women were: information about the service and its content, easy access (obtaining appointments quickly and without bureaucracy, close to home), and recommendations from another person, in particular from their treating physician. Pathways especially important for men are positive and repeated recommendations from their treating physician and other people they trust, organisation by others on the men's behalf, the Internet, the possibility to talk to a male counsellor, making it a routine in the hospital to refer distressed patients to the counselling services, and the emphasis on information sharing. Women reported more often than men that they discovered and accessed OCCCs via information material. Conclusions: Men in particular need recommendations from others, especially from their treating physician, in order to make use of psychosocial cancer counselling. In addition, stressing the provision of information instead of exploring and expressing emotions can ease access for men to cancer counselling. Key points: Psychosocial services aiming to ease access for men should create gender‐specific information material (flyers, websites, etc.)This information should especially highlight social and social‐legal adviceReferrers, usually general practitioners or oncologists, should be made aware that their recommendation plays a crucial role in male cancer patients' and their relatives' access to outpatient psychosocial cancer counselling [ABSTRACT FROM AUTHOR]

Purpose: In January and February 2021, about 4000 severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positive patients were treated daily in German intensive care units (ICUs). The number of SARS-CoV-2-positive ICU patients with trauma, however, is not known and neither whether the trauma itself or COVID-19 causes the critical illness. Methods: A total of 173 German ICUs, representing 3068 ICU beds, participated in a survey developed by the Trauma Section of the German Interdisciplinary Association of Intensive Care Medicine (DIVI). Results: Participating ICUs reported an overall 1-day prevalence of 20 and an overall 7-day prevalence of 35 SARS-CoV-2-positive trauma patients in the ICU. Critical illness was triggered by trauma alone in 50% of cases and by the combination of trauma and COVID-19 in 49% of cases; 70% of patients were older than 65 years and suffered from a single injury, predominantly proximal femur fractures. The distribution of patients was comparable regarding the level of care of the trauma centre (local, regional, and supra-regional). Conclusion: The proportion of trauma patients of all SARS-CoV-2-positive critically ill patients is small (~ 1%) but relevant. There is no concentration of these patients at Level 1 trauma centres. However, the traumatic insult is the most relevant cause for ICU treatment in most of these patients. Regarding a new wave of the pandemic, adequate trauma dedicated resources and perioperative structures and expertise have to be provided for COVID-19 trauma patients. [ABSTRACT FROM AUTHOR]

Objective: We aimed at investigating the predictors of linguistic barriers among office-based haemato-oncologists during consultation with migrant cancer patients in Germany. Methods: Physicians from haemato-oncological practices were invited to participate in a cross-sectional study. Linguistic barriers and family factors were ascertained using a newly developed online-questionnaire with the scales "Overall linguistic barriers", "Self-perceived linguistic barriers" and "Family factors – antagonistic behaviour". Predictors of linguistic barriers were identified using multivariate ANOVA via step-wise backwards selection. Results: Fifty-five physicians participated in the study. Treating patients from Sub-Saharan Africa predicted higher overall and self-perceived linguistic barriers (F [2,46] = 4.51, p =.04; and F [3,45] = 5.44, p =.02, respectively). Working in an single practice (F [3,45] = 4.19; p =.05) predicted higher self-perceived linguistic barriers. Employees who could act as translators predicted lower barriers in form of antagonistic behaviour from relatives (F [2,48] = 6.12; p =.02). Conclusions: The results indicate that linguistic barriers are affected by the level of linguistic concordance between patients and medical personnel. A temporary solution might be the presence of linguistically competent personnel in the practice. However, the results of this study highlight the need for greater availability of linguistic competent translators for consultations in haemato-oncological practices. [ABSTRACT FROM AUTHOR]

The rising demand for Li, paramount for energy storage, necessitates expanded supply. As the supply is concentrated in a few countries, this poses supply chain risks for Li-ion battery makers. To diversify suppliers, alternative Li ore deposits such as geothermal brines are being explored. However, Li extraction from geothermal brines is challenging due to the unique chemistry and elevated temperatures. Since Li-extraction from geothermal brines is in its infancy, data availability and quality are still poor, hampering life cycle assessments. Hence, this study provides a parametrized life cycle inventory model of Li carbonate production from geothermal brines. The model accounts for site-specific environmental conditions and technological features. Life cycle impacts at the Salton Sea in the US (1686 cases) and the Upper Rhine Graben in Germany (1982 cases) are quantified. The high case numbers are chosen to mitigate the high uncertainties in input parameters. Specifically, the brine chemistry, adsorption yield, drilling required and energy inputs are varied. Climate change impacts of selected cases vary within 18–59 kg CO 2 eq/kg Li carbonate at the Salton Sea and within 5.3–46 kg CO 2 eq/kg Li carbonate at the Upper Rhine Graben, compared to 2.1–11 kg CO 2 eq/kg Li carbonate in existing ecoinvent data sets. The wide range of potential impacts underscore the necessity of early-stage assessments of the technologies. In case of high drilling demand and use of fossil energy, climate change impacts of Li-ion batteries using Li carbonate from geothermal brines can increase by 30–41 % compared to literature values. [Display omitted] • Environmental impacts of lithium from geothermal power plants are assessed. • A parametrized life cycle inventory model for site-specific assessment is created. • Scenarios focusing on brine chemistry, adsorption yield and drilling are analysed. • Literature underestimates environmental impacts of lithium from geothermal brines. [ABSTRACT FROM AUTHOR]

Substantial educational inequalities have been documented in Germany for decades. In this article, we examine whether educational inequalities among children have increased or remained the same since the school closures of spring 2020 due to the COVID-19 pandemic. Our perspective is longitudinal: We compare the amount of time children in secondary schools spent on school-related activities at home before the pandemic, during school closures, and immediately after returning to in-person learning. We operationalize family socio-economic status using the highest parental educational attainment. Based on the theoretical assumption that the pandemic affected everyone equally, we formulate a hypothesis of equalization during the first period of school closures. For the period thereafter, however, we assume that parents with a low level of education had more difficulties bearing the additional burden of supervising and supporting their children's learning activities. Thus, for that period, we postulate an increase in educational inequality. To study our hypotheses, we use data from the 2019 wave of the SOEP and the SOEP-CoV study, both of which are probability samples. The SOEP-CoV study provides a unique database, as it was conducted during the lockdown of spring 2020 and in the following month. For statistical analysis, we use probit regressions at three measurement points (in 2019, in 2020 during the school closures, and in the month after closures). The comparison of these three time points makes our analysis and findings unique in the research on education during the COVID-19 pandemic, in particular with regard to Germany-wide comparisons. Our results confirm the hypothesis of equalization during the first school closures and the hypothesis of an increase in educational in the subsequent period. Our findings have direct policy implications regarding the need to further expand support systems for children. [ABSTRACT FROM AUTHOR]

Objective: To assess the knowledge, opinions and expectations of persons with and without obesity concerning personalised genotype-based nutrition.Design: Questions about nutrition, weight management and personalised genotype-based dietary recommendations were asked via standardised telephone-based interviews. Sociodemographic and anthropometric data were collected. The data were statistically weighted by age, gender, education, domicile and BMI.Setting: Germany.Participants: Representative sample of the German population (n 1003) randomly sampled via a scientific Random Digit dial method plus 354 adults with a BMI ≥ 30·0 kg/m2 to enlarge the sample.Results: Data of 1357 participants were analysed (51·1 % female, age: 50·5 ± 18·5 years, 15·9 % adults with a BMI ≥ 30·0 kg/m2). About 42 % or 19 % of the survey participants stated to know the terms personalised dietary recommendation or genotype-based dietary recommendation, respectively. Of those, 15·8 % indicated to have an experience with a personalised or genotype-based dietary recommendation. Almost 70 % of the survey participants believed that a genotype-based dietary recommendation is a reasonable measure for weight management. About 55 % of the survey participants pointed out that a genotype-based dietary recommendation is an effective concept in general. One-third of the survey participants (34·6 %) indicated to conceive the usage of a genotype-based dietary recommendation.Conclusion: Most of the survey participants did not know the term personalised or genotype-based dietary recommendation. One-third of the study participants are interested to use a genotype-based dietary recommendation. Therefore, more education of the public is necessary to properly help people making informed and serious decisions and assessing commercially available direct-to-consumer genetic tests. [ABSTRACT FROM AUTHOR]

Background: In patients with multiple sclerosis (MS), non-adherence to disease-modifying drug therapy is associated with an increased rate of MS relapses. Early identification of patients at risk of non-adherence would allow provision of timely and individualized support. The aim of the BETAPREDICT study was to investigate potential predictors of adherence in patients with MS in Germany treated with interferon β-1b (IFNβ-1b) using the BETACONNECT® autoinjector. Methods: BETAPREDICT was a national, multi-center, prospective, non-interventional, single-arm, 24-month cohort study of patients with relapsing–remitting MS or clinically isolated syndrome receiving IFNβ-1b via the BETACONNECT® autoinjector (ClinicalTrials.gov: NCT02486640). Injection data were captured by the autoinjector. The primary objective was to determine baseline predictors of compliance, persistence, and adherence to IFNβ-1b treatment after 12- and 24 months using multivariable-adjusted regression. Secondary objectives included evaluation of satisfaction with the autoinjector, injection site pain, vitamin and nutrient supplementation, clinical course, and patient-related outcome measures. Results: Of 165 patients enrolled, 153 were available for analysis (120 with autoinjector data). Seventy-two patients left the study prematurely. Compliance (N = 120), persistence (N = 153), and adherence (N = 120) at 24 months were 89.1, 53.6, and 41.7%, respectively. Compliance at 12- and 24 months was predicted by intake of vitamin D supplements and absence of specific injection site reactions. Positive predictors of persistence included age (at 12- and 24 months) and previous duration of treatment (at 12 months), while intake of vitamins/nutrients other than vitamin D was a negative predictor (at 12 months). Positive predictors of adherence at 24 months were age and being experienced with IFNβ-1b. Higher scores in specific SF-36 subscales were positive predictors of medication-taking behavior at 24 months. Satisfaction with the autoinjector was high at baseline and 24 months (median score: 9 out of 10). Conclusions: Compliance with IFNβ-1b treatment among participants still under observation remained high over a 24-month period, while persistence and adherence continuously declined. Multiple factors affected medication-taking behavior, including patient characteristics, treatment history, injection site reactions, patients' perception of their health and support programs. The importance of these factors may differ among patients according to their individual situation. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive disease requiring maintenance therapy. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy report, bronchodilation with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs), administered via inhalers, is currently the mainstay of COPD treatment. Combined LAMA/LABA therapies have been shown to improve patient health status, lung function and breathlessness. Here, we wanted to report patient satisfaction with the Respimat® Soft Mist™ inhaler (SMI). Methods: This was a pooled analysis of SPIRIT® (NCT02675517) and OTIVACTO® (NCT02719639), two open-label, single-arm, non-interventional studies of physical function in patients with COPD. Patients were treated with tiotropium/olodaterol 5/5 μg for approximately 6 weeks via the SMI. SPIRIT was conducted in Germany; OTIVACTO was conducted in nine European countries. The primary endpoints have been reported previously. Here, we assess patient satisfaction with inhalation and handling, and patient adherence to treatment with the tiotropium/olodaterol SMI in patients with COPD. These were assessed through self-reported questionnaires and physician general assessments. Results: Baseline data were collected from 9180 patients from the SPIRIT and OTIVACTO studies. The majority of patients were GOLD group A (25.59%) or B (46.12%). After 6 weeks of treatment with tiotropium/olodaterol, 85.78% of patients were 'satisfied' or 'very satisfied' with inhaling from the device, and 84.33% of patients were 'satisfied' or 'very satisfied' with the handling of the inhaler. Treating physicians reported patient adherence as 'high' during the study, with 98.57% of patients regularly using the tiotropium/olodaterol SMI. Furthermore, 95.45% of patients expressed a willingness to continue using the tiotropium/olodaterol SMI at the end of the observation period. Conclusion: In this study, over 9000 patients reported satisfaction with respect to inhalation and handling of the Respimat SMI, and patient adherence was high. Trial registration: ClinicalTrials.gov: NCT02675517 (SPIRIT) and NCT02719639 (OTIVACTO). Plain Language Summary: Inhalation devices are the main method of delivering treatments to patients with chronic obstructive pulmonary disease (COPD). However, there are many devices available, which can lead to confusion and poor inhaler technique. To help doctors decide which device to give to their patients, they consider whether the patient would be happy with the device and whether they can use it correctly. This study pooled data from two large real-life studies to assess patient satisfaction with the Respimat® Soft Mist™ inhaler. Patients assessed their satisfaction and willingness to continue using the device at the end of the study period. The pooled data included over 9000 patients on a range of baseline therapies. After 6 weeks of using the trial device, over 85% of patients were satisfied or very satisfied with inhaling from the device, and over 84% were satisfied with the handling of the device. Physicians reported that nearly 99% of patients regularly used their device. Also, over 95% of the patient population reported that they continued using the inhaler at the end of the study. Overall, these results support the view that many patients with COPD across a wide range of severities and baseline characteristics demonstrated satisfaction with the Respimat® Soft Mist™ inhaler to control their disease. [ABSTRACT FROM AUTHOR]

Introduction: Overweight and obesity are thought to be mainly caused by an energy-rich diet and a sedentary lifestyle. The opinions of those with and without obesity about an individual´s and stakeholder´s responsibility for overweight and obesity as well as a healthy diet is rather unclear. Therefore, a survey was conducted to assess the thoughts of persons with and without obesity about the responsibilities for a high body weight and healthy diet. Methods: This telephone-based survey was conducted in Germany. Landline and mobile phone users older than 17 years were quota sampled to represent the German population (n=1,003). Additionally, 354 adults with a body mass index (BMI) ≥ 30 kg/m2 were included in the survey population. Questions on weight management, eating and drinking and anthropometry were asked. Furthermore, the opinions of participants on the responsibility of individuals and stakeholders for obesity and a healthy diet were collected. Data was statistically weighted by age, gender, education, domicile, and BMI. Results: Data of 1,357 persons (51.1% female, age: 50.5 ± 18.5 years, 15.9% with BMI ≥ 30 kg/m2) were analyzed. Participants responded that the general causes of a high body weight were low physical activity (82.7%) and excessive caloric intake (80.5%) followed by a lack of will power (72.1%). Almost 90% of the survey population reported that each individual is responsible for his/her own healthy diet. More than 85% of the survey population agreed that a healthy diet in kindergarten and nutrition education at schools should be the preferred approaches when politics take care of a person´s healthy diet. Sub-analyses revealed that BMI, sex, age, and education are potential confounders. Conclusion: This German survey showed that the majority of participants indicated that the responsibility for a healthy diet lies with the individual and high body weight is caused by self-controlled attitudes. These results suggest that the survey population underestimates societal and environmental factors that contribute to the development of obesity, which could lead to attitudes that facilitate weight-related stigmatization. Furthermore, survey participants indicated that they would support policy-driven measures that promote a healthy diet. [ABSTRACT FROM AUTHOR]

The as yet unknown egg sac and clutch of Paratrachelas maculatus (Thorell, 1875) is described together with new records of the species from Germany and Austria. The flat, lens-like egg sacs contained 5 to 7 eggs, each approximately 0.75 mm in diameter, and were camouflaged with substrate by the female. Based on known records and locations, the species is most probably established in urban regions of Central Europe. [ABSTRACT FROM AUTHOR]

Human activity directly influences ambient air, surface and groundwater temperatures. The most prominent phenomenon is the urban heat island effect, which has been investigated particularly in large and densely populated cities. This study explores the anthropogenic impact on the thermal regime not only in selected urban areas, but on a countrywide scale for mean annual temperature datasets in Germany in three different compartments: measured surface air temperature, measured groundwater temperature, and satellite-derived land surface temperature. Taking nighttime lights as an indicator of rural areas, the anthropogenic heat intensity is introduced. It is applicable to each data set and provides the difference between measured local temperature and median rural background temperature. This concept is analogous to the well-established urban heat island intensity, but applicable to each measurement point or pixel of a large, even global, study area. For all three analyzed temperature datasets, anthropogenic heat intensity grows with increasing nighttime lights and declines with increasing vegetation, whereas population density has only minor effects. While surface anthropogenic heat intensity cannot be linked to specific land cover types in the studied resolution (1 km × 1 km) and classification system, both air and groundwater show increased heat intensities for artificial surfaces. Overall, groundwater temperature appears most vulnerable to human activity, albeit the different compartments are partially influenced through unrelated processes; unlike land surface temperature and surface air temperature, groundwater temperatures are elevated in cultivated areas as well. At the surface of Germany, the highest anthropogenic heat intensity with 4.5 K is found at an open-pit lignite mine near Jülich, followed by three large cities (Munich, Düsseldorf and Nuremberg) with annual mean anthropogenic heat intensities > 4 K. Overall, surface anthropogenic heat intensities > 0 K and therefore urban heat islands are observed in communities down to a population of 5000. [ABSTRACT FROM AUTHOR]

An atypical traffic accident scenario should be investigated directly at the crash site from all concerned professions, especially police men, forensic pathologists and technical experts, to get a personal overview and impression of the situation and the opportunity for interdisciplinary discussion. We present the rare case of a fatal traffic accident on a German motorway which was initially thought to be an accidental discovery of dumping a corpse. Based on autopsy findings, the technical investigation and the accident reconstruction, this case was solved as a spectacular form of a collision between a pedestrian and a bonnet-front car, which was not described elsewhere in scientific literature to the best of our knowledge. The pedestrian was hit in an upright body position, was lifted up by the car, smashed the windscreen and flew over the car with several body rotations. His flight curve ends directly at the roof of the car during brake processing, where the body touched the roof, smashed the rear-window and landed in the trunk. Based on the technical investigation, the driver of the car was not able to hide the accident. However, the pedestrian could have avoided the collision if he did not cross the motorway on foot. [ABSTRACT FROM AUTHOR]

As part of the German Barcode of Life campaign, over 3500 arachnid specimens have been collected and analyzed: ca. 3300 Araneae and 200 Opiliones, belonging to almost 600 species (median: 4 individuals/species). This covers about 60% of the spider fauna and more than 70% of the harvestmen fauna recorded for Germany. The overwhelming majority of species could be readily identified through DNA barcoding: median distances between closest species lay around 9% in spiders and 13% in harvestmen, while in 95% of the cases, intraspecific distances were below 2.5% and 8% respectively, with intraspecific medians at 0.3% and 0.2%. However, almost 20 spider species, most notably in the family Lycosidae, could not be separated through DNA barcoding (although many of them present discrete morphological differences). Conspicuously high interspecific distances were found in even more cases, hinting at cryptic species in some instances. A new program is presented: DiStats calculates the statistics needed to meet DNA barcode release criteria. Furthermore, new generic COI primers useful for a wide range of taxa (also other than arachnids) are introduced. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders are more prevalent in women than in men. Despite this sexual dimorphism, most experimental studies are conducted in male participants, and studies focusing on sex differences are sparse. In addition, the role of hormonal contraceptives and menstrual cycle phase in fear conditioning and extinction processes remain largely unknown. Methods: We investigated sex differences in context-dependent fear acquisition and extinction (day 1) and their retrieval/expression (day 2). Skin conductance responses (SCRs), fear and unconditioned stimulus expectancy ratings were obtained. Results: We included 377 individuals (261 women) in our study. Robust sex differences were observed in all dependent measures. Women generally displayed higher subjective ratings but smaller SCRs than men and showed reduced excitatory/inhibitory conditioned stimulus (CS+/CS-) discrimination in all dependent measures. Furthermore, women using hormonal contraceptives showed reduced SCR CS discrimination on day 2 than men and free-cycling women, while menstrual cycle phase had no effect. Limitations: Possible limitations include the simultaneous testing of up to 4 participants in cubicles, which might have introduced a social component, and not assessing postexperimental contingency awareness. Conclusion: The response pattern in women shows striking similarity to previously reported sex differences in patients with anxiety. Our results suggest that pronounced deficits in associative discrimination learning and subjective expression of safety information (CS- responses) might underlie higher prevalence and higher symptom rates seen in women with anxiety disorders. The data call for consideration of biological sex and hormonal contraceptive use in future studies and may suggest that targeting inhibitory learning during therapy might aid precision medicine. [ABSTRACT FROM AUTHOR]

In Germany a common narrative of the First World War could never be established. In the post-1918 period, explanations of Germany's defeat were highly contested between the political factions of the Weimar Republic. The subsequent Nazi tyranny, the Second World War and the Holocaust came – and continue – to overshadow any other event in German history. During the Cold War, the First World War was largely a forgotten conflict. In recent years, the federal government has remained hesitant about embracing the centenary, but countless exhibitions, seminars, books and other media productions have brought this aspect of history back to public attention from late 2013, and with it has come a renewed public debate on war guilt. 在德国是不会有共同的一战叙事的。1918年以后，对德国战败的解释成为魏玛共和国不同的政治派别的战场。接下来的纳粹独裁、二战以及大屠杀，则让德国历史上的任何其他事件黯然失色。在冷战期间，一战差不多被遗忘了。近些年联邦政府一直对庆祝百年的事犹犹豫豫。不过2013年底以来，无数的展览、研讨会、图书以及其他媒体产品使得这段历史成为公众关注的对象，关于战争的罪孽问题又起纷争。 [ABSTRACT FROM PUBLISHER]

Urban heat islands in the subsurface contain large quantities of energy in the form of elevated groundwater temperatures caused by anthropogenic heat fluxes (AHF S ) into the subsurface. The objective of this study is to quantify these AHF S and the heat flow they generate in two German cities, Karlsruhe and Cologne. Thus, statistical and spatial analytical heat flux models were developed for both cities. The models include the spatial representation of various sources of AHF S : (1) elevated ground surface temperatures, (2) basements, (3) sewage systems, (4) sewage leakage, (5) subway tunnels, and (6) district heating networks. The results show that the district heating networks induce the largest AHF S with values greater than 60 W/m 2 and one order of magnitude higher than fluxes from other sources. A covariance analysis indicates that the spatial distribution of the total flux depends mainly on the thermal gradient in the unsaturated zone. On a citywide scale, basements and elevated ground surface temperatures are the dominant sources of heat flow. Overall, 2.1 PJ/a and 1.0 PJ/a of heat are accumulated on average in Karlsruhe and the western part of Cologne, respectively. Extracting this anthropogenically originated energy could sustainably supply significant parts of the urban heating demand. Furthermore, using this heat could also keep groundwater temperatures from rising further. [ABSTRACT FROM AUTHOR]

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A personal narrative is presented that discusses the author's experiences as a scholar studying the work of theologian Martin Luther, noting the influence of theologian Rudolf Bultmann, the notion of a divine promise in Luther's thought, and the author's study of philosopher Johann Georg Hamann.

Background: The aim was to survey the radiological diagnostics and type of primary radiological examination of polytraumatized patients treated in German hospitals at various levels in the three-tiered system. Material and methods: A questionnaire was sent in October 2007 to every traumatology department registered in the DGU (German Society for Trauma Surgery) databank and forms returned by January 2008 were included in this study. Results: A total of 273 (54.71 %) of forms were returned and were applicable to statistical analysis. In the three-tiered hospital system 35.9 % of returned questionnaires came from third-tier hospitals, 41.02 % from second-tier and 23.08 % from highest tier (maximum care) hospitals. With a higher hospital level of inpatient care more computed tomography (CT) scans were examined by a radiologist during 24 h daily (p = 0.0014) and CT scanners were located closer to the resuscitation room (p < 0.0001). We found significant differences in the ratios of primary whole-body CTs (WBCT) performed depending on the hospital level: third-tier hospitals 44 %, second tier hospitals 67 % and maximum care hospitals 84 % (p < 0.05). Conclusions: Standardized structures regarding radiological diagnostics of polytraumatized patients do not exist at either the same level of the three-tiered hospital system or between levels of care of German hospitals.. [ABSTRACT FROM AUTHOR]

What is already known about this subject? A considerable increase in the prevalence of overweight during the primary school years (7-11 years) has been reported., What this study adds? This reflects lower remission rates of excess body fat (i.e. the proportion of shifts from excess to normal body fat) between the ages of 7 and 11 years as compared with nearly balanced incidence and remission rates of excess body fat between the ages of 3 and 7 years., Objective This study aimed to compare the age-specific balance between incidence and remission of excess body fat between the ages of 3-7 and 7-11 years using the data from a longitudinal study. Design Longitudinal analysis based on the data from the Dortmund Nutritional and Anthropometric Longitudinally Designed ( DONALD) Study, an ongoing, open cohort study in healthy children, conducted in Dortmund, Germany. Excess body fat was defined by the sum of triceps and subscapular skin-fold measurements above the 90th reference percentile of the new German standard; overweight was defined using different national and international standards. The main outcome parameters were incidence and remission rates of excess body fat ( n = 496) and overweight ( n = 518) between the ages of 3 and 7 years and between the ages of 7 and 11 years. Results The incidence rates of excess skin-fold thickness between the ages of 3 and 7 years (4.2 [2.4, 6.2]%) and between the ages of 7 and 11 years (4.3 [2.6, 6.2]%) were almost identical. By contrast, remission rates were significantly lower during the age period of 7-11 years (primary school age) than during the age period of 3-7 years (pre-school age): 37.5 (21.9, 53.1%) compared with 72.3 (59.6, 85.1%). Conclusions These data point to the low remission of excess body fat as an important driving force for the increasing prevalence of excess body fat in children between the ages of 7 and 11 years. Public health initiatives in children should encompass both primary prevention and interventions targeted at children already overweight at school entry. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about the intensity and extension of subsurface urban heat islands (UHI), and the individual role of the driving factors has not been revealed either. In this study, we compare groundwater temperatures in shallow aquifers beneath six German cities of different size (Berlin, Munich, Cologne, Frankfurt, Karlsruhe and Darmstadt). It is revealed that hotspots of up to +20K often exist, which stem from very local heat sources, such as insufficiently insulated power plants, landfills or open geothermal systems. When visualizing the regional conditions in isotherm maps, mostly a concentric picture is found with the highest temperatures in the city centers. This reflects the long-term accumulation of thermal energy over several centuries and the interplay of various factors, particularly in heat loss from basements, elevated ground surface temperatures (GST) and subsurface infrastructure. As a primary indicator to quantify and compare large-scale UHI intensity the 10–90%-quantile range UHII10–90 of the temperature distribution is introduced. The latter reveals, in comparison to annual atmospheric UHI intensities, an even more pronounced heating of the shallow subsurface. [Copyright &y& Elsevier]

In 21 complete denture wearers, six upper and 15 lower denture relines were performed with the open-mouth technique. The centric relation ( CR) was recorded with the Central- Bearing- Point ( CBP) method three times before and three times after the reline. For each registration, the right and left condylar position was recorded in three dimensions using a custom-made measuring device. The average denture displacement from an initial reference position ( CR) was calculated for each registration. An upper denture reline leads to a mean displacement of 2·5 mm, both in the right and left condylar area. With an average of 2·0 mm, this displacement was smaller following a lower denture reline (right and left mean, 1·6 mm). The precision of the CBP-registrations proved 0·5 mm before and 0·3 mm after reline; hence, the measured condylar displacement after reline could not attribute to a methodological bias. This clinical-experimental study demonstrates that relining complete dentures with the open-mouth technique may lead to a substantial denture shift and thus imply inevitably clinically relevant occlusal discrepancies. It is therefore important to carefully check the occlusion at denture delivery and remount the prostheses if necessary. [ABSTRACT FROM AUTHOR]

Discourse particles provide important clues to our understanding of the syntax-to-discourse relation. They are sensitive to sentence types and utterance contexts. As such they seem to contribute to the determination of illocutionary force. After providing some general background information on discourse particles, the present article focuses on the role of discourse particles in German constituent questions. Syntactic evidence is provided which suggests that they are pre-VP functional heads which can to some extent be stacked. It is shown how the particles under consideration can access the force system, and how this access can proceed even in cases in which they occur in embedded clauses. After providing the basic architecture, we investigate the role of these particles in 'special questions', questions which are not interpreted as simple requests for information. The syntactic discussion is then extended to cases in which the discourse particle forms a constituent with a wh-phrase - [wh+Prt] -, as well as to cases in which this constituent interacts with particles in pre-VP position. The [wh+Prt] construction offers important evidence both in favor of the head status of the particles under investigation and in favor of the existence of distinctive syntactic properties of special questions, especially so-called 'surprise-disapproval questions'. Finally, data on surprise-disapproval questions in a Northern Italian dialect as well as in an Indo-Aryan language suggest that the findings about special questions in German are likely to fall under cross-linguistic generalizations. [ABSTRACT FROM AUTHOR]

DNA databases are the most efficient tools in criminal investigations with unknown perpetrators. Due to a significant number of random matches in cross-border DNA profile exchanges, the European Network of Forensic Science Institutes (ENFSI) proposed the addition of further short tandem repeats (STRs) to European DNA databases. Therefore, the new Powerplex® ESX17 and Powerplex® ESI17 kits from Promega comprised the 11 established DNA database STRs and additionally the well-known loci D1S1656 and D12S391, as well as D2S441, D10S1248, and D22S1045. The latter three STRs are thereby established as so-called mini-STRs to fulfill the increasing requirements regarding sensitivity and reproducibility for analysis of minute amounts of DNA. Here, we provide allele frequencies for the five additional STRs from two populations from Germany. A test regarding suitability and robustness of the new kits for routine trace analysis showed that it is more likely to obtain a meaningful profile using Powerplex® ESX17 and Powerplex® ESI17 kits compared to the Powerplex® ES kit. However, for both new kits the range of template DNA amount is rather small, e.g., slightly more DNA than recommended resulted in DNA profiles which could not be reliably evaluated due to allelic drop-in or imbalances and overshoots. In our opinion, the new kits are very promising new tools in forensic trace analysis even though handling and evaluation should yet be carried out with great caution. [ABSTRACT FROM AUTHOR]

Cerebrovascular accidents are responsible for killing or disabling more than half a million Americans every year. They are the third leading cause of death in this country. In Germany, the annual stroke incidence reaches 182 cases per 100,000 inhabitants. Stroke there is the fourth leading cause of death. There is a need of finding cost-effective means of decreasing stroke mortality and morbidity. Instruments for early diagnosis are of great humanitarian and economic importance. All possible clinical findings should be taken into account. It is not the demand of this study to present the panoramic radiograph as a screening test method for early diagnosis of atherosclerosis. The aim is to show the potential of this radiograph used in everyday clinical dental practice by the prevalence of radiopaque findings in the carotid region. This study included panoramic dental radiographs of 2,557 patients older than 30 years of age. Fifty-nine percent of the patients were women and 41% were men. The radiographs were adjudged for signs compatible with carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below the intervertebral space C3-4. Of all these radiographs, 4.8% showed radiopaque findings compatible with atherosclerotic lesions. The proportion of women reached 64.8% and that of men reached 35.2%. In accordance to recent literature, the results of this study show that about 5% of the patients show radiological findings compatible with carotid arterial calcifications. Some of these patients at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph. The suspicion of carotid artery calcifications demands an impetuous referral to an appropriate practitioner who can assist in the control of risk factors and if necessary arrange surgical removal of the carotid arterial plaque. So, the dentist should be aware of this problem and able to make a contribution to stroke prevention. [ABSTRACT FROM AUTHOR]

Aim: The temporal pattern of bone-level alterations in conventionally restored implants is dependent upon healing mode (open or submerged). This study examined the influence of healing on marginal bone levels at implants with a medium-rough surface including the implant collar and a clearance-fit implant-abutment connection restored according to a platform-switching concept. Material and Methods: Two implants were placed in the posterior mandible of 21 test subjects, randomly assigned to open (OH) or submerged (SH) healing. Standardized radiographs were obtained after implant surgery, before re-entry, after crown mounting, 1 and 2 years after implant surgery, and evaluated for implant-bone-level alterations (ΔIBL). Bacterial samples of the implants' inner cavities were analysed by cultivation. Statistics: Brunner-Langer Model, equivalence testings by Wilcoxon's (equivalence range ± 0.4 mm). Results: After 2 years, ΔIBL were -- 0.47 ± 0.46mm (OH) and --0.54 ± 0.38mm (SH). At the 1-year follow-up, all implants were contaminated with bacteria. ΔIBL (p < 0.001) and the amount of bacterial contamination (p < 0.001) significantly depended on time, but not on healing mode. ΔIBL of OH and SH were equivalent at all time points (all p ≤ 0.044). Conclusions: Platform-switched implants showed very limited peri-implant bone-level alterations. The healing-mode neither affected the total amount nor the temporal patterns of ΔIBL. Thus, the results for the tested implants with a non-rigid implant--abutment connection were similar to results reported previously for implants with a rigid implant-abutment connection. [ABSTRACT FROM AUTHOR]