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This paper examines student-faculty communication by email and the lack of clear guidelines that leads to misuse of email in student-faculty interaction, whereby status-incongruent pragmatic markers are employed, resulting in impoliteness and inappropriateness. The main objective is to bridge the gap in research on other than requestive speech acts in this particular type of e-interaction, taking into account various pragmatic markers and cultural determinants of the subjects' email communication styles. The main purpose of the study was to determine whether and to what degree the use of pragmatic markers by students is congruent with the English netiquette in this specific domain. Moreover, the aim was to investigate the relation of the usage of speech acts and pragmatic markers by students to politeness, as well as to cross-culturally compare the data obtained. The research questions were as follows: Which pragmatic markers distinguish students of different nationalities and in different university settings? What are other than requestive purposes for which students deploy email communication? Which pragmatic markers, in general, are associated with student-faculty email? Is there a correlation between the three countries represented in the corpus and (im)politeness based on the data found in all the emails? What are the implications of the study for computer-mediated language learning? The corpus consisted of 1,200 student-faculty emails written in an academic domain by university students from a German university, a Saudi Arabian university, and two Japanese universities (400 emails per country). The research method employed was of mixed qualitative-quantitative nature, with the focus on pragmatic analysis of speech acts with their illocutionary force and functions, as well as on their impact on the receiver (perlocution). It was determined that the impolite acts occurred most frequently in the corpus. This shows that students appear not to be aware of the role their email messages play in creating an impression on faculty and that structured instruction in email writing is required to improve the situation. The lack of pragmatic competence was found in all three groups of students, independent of the proficiency level and seniority; whereby explicit course guidance in email writing and its netiquette had a clear positive effect on the student-faculty interaction in terms of appropriateness and the level of politeness.

In recent years, early childhood education and care have gained increasing public attention. This has led to an expansion of education and care programmes. Yet, little is known about how parents use different options of education and care. Take, for example, kin care, paid caregivers and out-of-kindergarten activities. Drawing on social reproduction theory, we argue that parents organise their children's lives depending on their social class. In addition, we hypothesise that immigrant status plays a role in how parents set up their children's education and care. We use logit regression models to analyse the education and care arrangements of n?=?2400 parents with 3-5?year-olds in Germany. The findings show that parents from the middle and upper classes make more use of "enrichment activities" than lower and working class parents. When it comes to the influence of immigrant status and to informal care arrangements, the findings add to a more complex picture.

Various components of body image were measured to assess body image disturbances in patients with obesity. To overcome limitations of previous studies, a photo distortion technique and a biological motion distortion device were included to assess static and dynamic aspects of body image. Questionnaires assessed cognitive-affective aspects, bodily attitudes, and eating behavior. Patients with obesity and a binge eating disorder (OBE, n = 15) were compared with patients with obesity only (ONB; n = 15), to determine the nature of any differences in body image disturbances. Both groups had high levels of body image disturbances with cognitive-affective deficits. Binge eating disorder (BED) participants also had perceptual difficulties (static only). Both groups reported high importance of weight and shape for self-esteem. There were some significant differences between the groups suggesting that a comorbid BED causes further aggravation. Body image interventions in obesity treatment may be warranted. (Contains 2 tables and 1 figure.)

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease, which is usually type 2-mediated in the western hemisphere, associated with severe therapeutic and socioeconomic challenges. The first targeted systemic treatment option for severe uncontrolled CRSwNP is a human monoclonal antibody against the interleukin-4 receptor α (IL-4Rα) subunit called dupilumab, which was approved for subcutaneous administration in Germany in October 2019. The purpose of this study is to investigate the efficacy of dupilumab in real life in patients treated with dupilumab in label according to license in our department in 2019–2021. Materials and methods: Since October 2019, we have investigated 40 patients (18 men, 22 women) treated with dupilumab in a single-center, retrospective single-arm longitudinal study. The following parameters were collected before treatment (baseline), at 1 month, 4 months, 7 months, 10 months, and 13 months: the Sino-Nasal Outcome Test-22 (SNOT-22), the forced expiratory pressure in 1 s (FEV-1), the olfactometry using Sniffin' Sticks-12 identification test (SSIT), a visual analog scale of the total complaints, the Nasal Polyp Score (NPS), histologic findings as well as total serum IgE, eosinophilic cationic protein in serum and blood eosinophils. Results: The average age was 52.7 years (± 15.3). The follow-up period was 13 months. The SNOT-22 average was 60 points (± 22.2) at the first visit, 28.2 points (± 17.1) after 4 months and 20.8 points (± 17.7) after 13 months. The NPS was 4.3 points (± 1.5), after 4 months 2.1 points (± 1.3) and after 13 months 1.4 points (± 1.1). Olfactometry showed 3.2 points (± 3.7) at the baseline, 7.0 points (± 4.0) after 4 months and 7.8 points (± 3.5) after 13 months. The other parameters also improved. Most parameters showed linear dependence in the slopes under therapy (p < 0.001). Adverse side effects were mostly only mild, and no rescue therapy was needed. Conclusion: There is a clear improvement in the medical condition and symptoms in all categories mentioned under therapy with dupilumab, as well as a reduction in the need for systemic glucocorticoids and revision surgery as rescue treatment. Our results show that dupilumab tends to be an effective therapy alternative for severe CRSwNP. [ABSTRACT FROM AUTHOR]

The article presents the discussion on revised recommendations for celiac disease (CD) screening and biopsy including consideration of a serology-based diagnostic approach. Topics include expanded section on skin disorders showing continuous glucose monitoring (CGM)-related and insulin pump-related skin issues; and screening for thyroid disease by measurement of TSH, anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies.

Background: While there is evidence on the effectiveness of optimized treatment processes for patients receiving hip and knee endoprostheses, feasibility in various settings has not been adequately investigated. The multicenter PROMISE Trial (Process optimization by interdisciplinary and cross-sectoral care using the example of patients with hip and knee prostheses) was set up to fill this gap. Methods: A complex optimized process was implemented in three German hospitals offering different levels of care and five cooperating rehabilitation centers. For the feasibility question, data on 19 parameters characterizing the defined process were collected. The extent of cross-sectoral collaboration was a special focus. Results: The data show, for almost all parameters in all facilities, an implementation rate of more than 80% with missing data below 5%, n = 1887 study participants. A total of 96.8% attended a rehabilitation program, and for 29.2% rehabilitation took place in a PROMISE-collaborating facility. Conclusions: Adherence to the defined and well-documented process was very high in all three organizationally very different hospitals, so that feasibility is given and transferability of the concept can be assumed. An exception was the targeted integration of rehabilitation into the treatment process. The goal of cross-sectoral networking could only be partially achieved. [ABSTRACT FROM AUTHOR]

Invasive lobular carcinoma (ILC) of the breast is known to have typical molecular, clinical, and pathological characteristics that differ from invasive cancer of no special type (NST). In the German mammography screening program (MSP), we evaluated clinical differences between these tumor types at the time of their detection. Clinical features of NSTs (n = 785) and ILCs (n = 141) diagnosed in the MSP between 2009 and 2016 were compared. Compared to NST, ILC was significantly correlated with advanced age (59.1 years versus 60.6 years) and larger tumor size (1.5 cm versus 2.3 cm). ILC was significantly more frequently associated with moderate tumor differentiation (G2), whereas NST was associated with a higher rate of poorly differentiated tumors (p <.001). Furthermore, ILC presented more often as multifocal tumors (36% versus 11%, p <.001), and mastectomies were performed more often in the ILC group (27% versus 12%, p <.001). ILCs and NSTs had different clinical features at the time of detection. The pathological profile of ILC may explain some of these features. Specialists should be aware of the fact that ILC may escape detection by conventional imaging modalities for a long time, and may present later in life as more advanced multifocal disease. [ABSTRACT FROM AUTHOR]

Background: In Germany and the EU, most headwaters are still far from reaching a good chemical and ecological status as it is required by the European Water Framework Directive (WFD), until 2027 the latest. Particularly, in densely populated areas, impacts from municipal and industrial wastewater discharges or diffuse agricultural emissions are still a matter of concern. This also applies to the Nidda River which is considered to be in a moderate to rather poor condition. In our study, we investigated short-term and long-term consequences of anthropogenic pollution on fish health via one monitoring with caged fish (CF) and two field sampling campaigns (FF). In the CF monitoring, rainbow trout (Oncorhynchus mykiss) were caged for seven weeks at four selected sites along the Nidda, whereas in the FF monitoring approach, feral fish, including brown trout (Salmo trutta f. fario), European chub (Leuciscus cephalus) and stone loach (Barbatula barbatula) were caught in June and September 2016. Results: Histopathological analyses of liver and gills were conducted, accompanied by measurements of hepatic 7-ethoxyresorufin-O-deethylase (EROD) activity to assess the cytochrome P450 (CYP1A1) function, and genotoxicity via the micronucleus assay. Caged as well as field-captured fish exhibited impaired health conditions showing lesions particularly in the liver, and a presumably overwhelmed CYP1A1 system, whereas genotoxicity was not induced. The variation between sampling sites and seasons was rather low, but two trends were recognisable: (a) liver condition was poorest around spawning season and (b) tissue integrity and EROD activity were most affected downstream of industrial dischargers. Furthermore, effects were species dependent: the generally highly sensitive S. trutta f. fario proved to be impacted most, whereas L. cephalus with its pelagic lifestyle was affected less than the benthic B. barbatula, indicating a relevant contamination of sediments. Conclusion: Our results confirm the impaired ecological state of the Nidda and emphasise that a sustainable improvement of aquatic ecosystem health needs to include both water quality and sediment contamination to approach the ambitious WFD goal. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany. Methods: Data were extracted from the BARMER sickness fund (2013–2017). Pregnant women (18–45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported. Results: Overall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD (before: 9.0%; during: 5.1%; after: 11.1%) and PSO (before: 3.5%; during: 1.9%; after: 2.7%). Conclusions: A reduction in pharmacological treatment during pregnancy was observed for women with IRD in Germany. Many women with IRD did not return to pre-pregnancy treatments after delivery, despite signs of disease exacerbation, such as hospitalization and initiation of treatment with corticosteroids/biologics, in this period. [ABSTRACT FROM AUTHOR]

This conversation analytic study examines responsive echt ("really"), which is commonly associated with "newsmarks," in co-present German interaction. Across uses, echt-turns are a practice for topicalizing, however briefly, something in another participant's just-prior turn. But this topicalization shapes the response space in systematically different ways: Echt-turns can be taken to (a) invite simple reconfirmation, (b) invite topical elaboration, or (c) solicit an account either to reconcile diverging expectations or to manage problems in acceptability. We demonstrate how both the design of echt-turns and participants' epistemic positioning matter to how echt-turns are treated and shape interactional trajectories. By using the notion of "inviting" a next action, we highlight the importance of conceptualizing response relevance after second-position actions, and specifically after "newsmark-type" responses, as a gradient. Data are taken from everyday and institutional interaction and presented in German with English translations. [ABSTRACT FROM AUTHOR]

Background: Dentists (Ds) and dental assistants (DAs) have a high lifetime prevalence of musculoskeletal disorders (MSDs). In this context, it is assumed that they have an increased intake of substances such as pain medication. Currently, there exist no data on the use of medication among Ds and DAs with MSDs in Germany. Methods: The online questionnaire (i.e., the Nordic Questionnaire) analysed the medical therapies used by 389 Ds (240 f/149 m) and 406 DAs (401 f/5 m) to treat their MSDs. Results: Ds (28.3–11.5%) and DAs (29.4–10.3%) with MSDs took medication depending on the affected body region. A trend between the Ds and DAs in the intake of drug therapy and the frequency was found for the neck region (Ds: 21.1%, DAs: 28.7%). A single medication was taken most frequently (Ds: 60.0–33.3%, DAs: 71.4–27.3%). The frequency of use varied greatly for both occupational groups depending on the region affected. Conclusion: Ds and DAs perceived the need for medical therapies because of their MSDs. Painkillers such as ibuprofen and systemic diclofenac were the medications most frequently taken by both occupational groups. The intake of pain killers, most notably for the neck, should prevent sick leave. [ABSTRACT FROM AUTHOR]

Background: Dental professionals suffer frequently from musculoskeletal disorders (MSD). Dentists and dental assistants work closely with each other in a mutually dependent relationship. To date, MSD in dental assistants have only been marginally investigated and compared to their occurrence in dentists. Therefore, the aim of this study was to compare the prevalence of MSD between dentists and dental assistants by considering occupational factors, physical activity and gender. Methods: This was a cross-sectional observational study. A Germany-wide survey, using a modified version of the Nordic Questionnaire and work-related questions, was applied. In total, 2548 participants took part, of which 389 dentists (240 females and 149 males) and 322 dental assistants (320 females and 2 males) were included in the analysis. Data were collected between May 2018 and May 2019. Differences between the dentists and dental assistants were determined by using the Chi2 test for nominal and the Wilcoxon–Mann–Whitney U test for both ordinal and non-normally distributed metric data. Results: A greater number of dental assistants reported complaints than dentists in all queried body regions. Significant differences in the most affected body regions (neck, shoulders, wrist/hands, upper back, lower back and feet/ankles) were found for the lifetime prevalence, annual prevalence and weekly prevalence. Data from the occupational factors, physical activity and gender analyses revealed significant differences between dentists and dental assistants. Conclusions: Dental assistants appear to be particularly affected by MSD when compared to dentists. This circumstance can be explained only to a limited extent by differences in gender distribution and occupational habits between the occupations. [ABSTRACT FROM AUTHOR]

Background and purpose — Knee and hip replacement are common and increasing procedures, and an optimized care process that could be implemented in different settings would be useful. The PROMISE trial investigates whether a new care process works equally in different German settings and how the results compare with current non-standardized care. Patients and methods — This multi-center prospective mixed-method study includes 2,000 German patients receiving arthritis-related hip or knee endoprostheses. An interdisciplinary and cross-sectoral care process was developed and implemented in 3 German hospitals with different levels of care, and corresponding rehabilitation centers were included to bridge the gap after acute care. Duration and outcome — The PROMISE trial recruited patients between May 2018 and March 2020. Follow-up will end in February 2021. Assessments are performed at: examination on clinical indication, 1 week before surgery, on the day of surgery, at the end of hospitalization, end of the rehabilitation program, and 3 months, 6 months, and 12 months after surgery. Outcomes include patient-reported outcomes, medical examination findings, and routinely collected data regarding the surgery and complications. Guideline-based interviews are conducted with selected patients and care partners. The primary endpoint is the presence of chronic pain at 12 months after surgery. Secondary endpoints are the number of recognized pre-existing conditions, physical activity at 12 months after surgery, use of medical services, quality of life, and interactions between care partners. Trial registration — The trial is registered with the German Clinical Trials Register (; DRKS00013972; March 23, 2018). [ABSTRACT FROM AUTHOR]

Objective: Despite increased physician's awareness and improved diagnostic and serological testing in the recent years, the interval between the initial symptoms and the diagnosis of Systemic lupus erythematosus (SLE) is still very long. Our aim was to study this delay and its association to the outcome of the disease. Methods: Information on demographics, onset of first symptoms, first physicians visit and time of diagnosis was assessed by self-reported questionnaires among SLE patients in Germany (LuLa cohort, n = 585) in the year 2012. Disease activity (Systemic Lupus Activity Questionnaire; SLAQ), disease related damage (Brief Index of Lupus Damage; BILD), health related quality of life (Short Form 12) and fatigue (FSS) were chosen as proxies for outcome. Linear regression analysis was used to analyze the association of the delay in diagnosis to the outcome, adjusted for age, disease duration and sex. Results: Mean duration between the onset of symptoms and the diagnosis of SLE was 47 months (SD 73). The longer the time to diagnosis, the higher the disease activity (β = 0.199, p < 0.0001), the disease-related damage (β = 0.137, p = 0.002) and fatigue (β 0.145, p = 0.003) and the lower the health-related quality of life (physical β = −0.136, p = 0.004, mental β = −0.143, p = 0.004). Conclusion: In systemic lupus erythematosus, longer time to diagnosis was associated with worse outcome. Concepts in care with the intention to shorten the time to diagnosis are needed to improve the long-term outcome of the disease. [ABSTRACT FROM AUTHOR]

Background: Dental professionals are subjected to higher risks for musculoskeletal disorders (MSDs) than other professional groups, especially the hand region. This study aims to investigate the prevalence of hand complaints among dentists (Ds) and dental assistants (DAs) and examines applied therapies. Methods: For this purpose, an online questionnaire analysed 389 Ds (240female/149male) and 406 DAs (401female/5male) working in Germany. The self-reported data of the two occupational groups were compared with regard to the topics examined. The questionnaire was based on the Nordic Questionnaire (self-reported lifetime, 12-month and 7-day MSDs prevalence of the hand, the conducted therapy and its success), additional occupational and sociodemographic questions as well as questions about specific medical conditions. Results: 30.8% of Ds affirmed MSDs in the hand at any time in their lives, 20.3% in the last twelve months and 9.5% in the last seven days. Among DAs, 42.6% reported a prevalence of MSDs in the hand at any time in their lives, 31.8% in the last 12 months and 15.3% in the last seven days. 37.5% of the Ds and 28.3% of the DAs stated that they had certain treatments. For both, Ds and DAs, physiotherapy was the most frequently chosen form of therapy. 89.7% of Ds and 63.3% of DAs who received therapy reported an improvement of MSDs. Conclusion: Although the prevalence of MSDs on the hand is higher among DAs than among Ds, the use of therapeutic options and the success of therapy is lower for DAs compared to Ds. [ABSTRACT FROM AUTHOR]

Background: For loco-regionally advanced, but transorally resectable oropharyngeal cancer (OPSCC), the current standard of care includes surgical resection and risk-adapted adjuvant (chemo) radiotherapy, or definite chemoradiation with or without salvage surgery. While transoral surgery for OPSCC has increased over the last decade for example in the United States due to transoral robotic surgery, this treatment approach has a long history in Germany. In contrast to Anglo-Saxon countries, transoral surgical approaches have been used frequently in Germany to treat patients with oro-, hypopharyngeal and laryngeal cancer. Transoral laser microsurgery (TLM) has had a long tradition since its introduction in the early 70s. To date, the different therapeutic approaches to transorally resectable OPSCC have not been directly compared to each other in a randomized trial concerning disease control and survival. The goal of this study is to compare initial transoral surgery to definitive chemoradiation for resectable OPSCC, especially with regards to local and regional control.Methods: TopROC is a prospective, two-arm, open label, multicenter, randomized, and controlled comparative effectiveness study. Eligible patients are ≥18 years old with treatment-naïve, histologically proven OPSCC (T1, N2a-c, M0; T2, N1-2c, M0; T3, N0-2c, M0 UICC vers. 7) which are amenable to transoral resection. Two hundred eighty patients will be randomly assigned (1:1) to surgical treatment (arm A) or chemoradiation (arm B). Standard of care treatment will be performed according to daily routine practice. Arm A consists of transoral surgical resection with neck dissection followed by risk-adapted adjuvant therapy. Patients treated in arm B receive standard chemoradiation, residual tumor may be subject to salvage surgery. Follow-up visits for 3 years are planned. Primary endpoint is time to local or locoregional failure (LRF). Secondary endpoints include overall and disease free survival, toxicity, and patient reported outcomes. Approximately 20 centers will be involved in Germany. This trial is supported by the German Cancer Aid and accompanied by a scientific support program.Discussion: This study will shed light on an urgently-needed randomized comparison of the strategy of primary chemoradiation vs. primary surgical approach. As a comparative effectiveness trial, it is designed to provide data based on two established regimens in daily clinical routine.Trial Registration: NCT03691441 Registered 1 October 2018 - Retrospectively registered. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders (MSD) are common among dental professionals. The most common areas affected are the trunk, neck, shoulders and wrists. Current evidence suggests that the causes of MSD can be found in the physical demands of the profession. Posture and movement during treatment is influenced by the arrangement of the treatment concept (patient chair, equipment and cabinets). It has not been investigated whether the ergonomic risk differs between the treatment concepts. Methods: To evaluate the prevalence of MSD in dental professionals, 1000 responses will be collected from a nationwide (Germany) online questionnaire (mod. Nordic Questionnaire and mod. Meyer questionnaire). In order to assess the ergonomic risk of the treatment techniques used in the four treatment concepts, 3D movement analyses are carried out with inertial sensors. For this purpose, 20 teams of dentists and dental assistants from four dental fields of specializations (generalists, orthodontists, endodontists and oral surgeons) and a student control group will be recruited. Each team will execute field specific standardized treatments at a dummy head. Measurements are carried out in each of the four treatment concepts. The data will be analyzed using the Rapid Upper Limb Assessment (RULA) which will be modified for the evaluation of objective data. Conclusions: On the basis of these investigations, a substantial gain of knowledge regarding work-related MSD in the field of dentistry and its potential biomechanical causes is possible. For the first time, objective and differentiated comparisons between the four treatment concepts are possible for different fields of dental specialization. Up to now, statically held positions of the trunk and proximal upper extremities, but also the repetitive movements of the hands have been considered a risk for MSD. Since both are included in the RULA, dental activities can be assessed in a detailed but also global manner with regard to ergonomic risks. [ABSTRACT FROM AUTHOR]

The article discusses equal opportunity in rural areas and responsibility of villages in Germany. Topics discusses include future of rural areas as living places; declining numbers of inhabitants in rural areas of Germany; reduced municipal tax revenues from villages causing the reduction or cancellation of voluntary benefits as well as the loss public infrastructures and future design options.

Objective: Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs. Methods: The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients' health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression. Results: Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02-3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97-2.49), a higher age (OR: 1.06; 95% CI: 1.03-1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01-1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82-0.97) was detrimental. Conclusion: A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician-patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome. Lupus (2018) 27, 1652-1660. [ABSTRACT FROM AUTHOR]

Objectives Vaccinations are an important measure to prevent infections in immunocompromised patients. The knowledge of vaccination coverage and reasons for non-vaccination in patients with SLE is scarce. The aim of this study was to assess coverage rates of selected vaccinations in a representative sample of SLE patients and to identify predictors for non-vaccination. Methods In 2013, information on selected vaccinations (coverage, application and reservations) and on demographics, clinical parameters and health beliefs was assessed by means of a self-reported questionnaire among a representative sample of SLE patients in Germany (LuLa cohort). Results Five hundred and seventy-nine patients participated. Vaccination status was primarily checked by their general practitioner (57.3%). Of all the patients, 24.9% did not get their vaccination status checked at all, 16.1% had generally been advised against the use of vaccinations by a physician, and 37.5% stated that they had rejected vaccinations themselves. Their main reasons were fears of developing a lupus flare (21.8%) or adverse events (13.5%). A greater belief by patients in the doctor controlling one’s health and the general benefit of medication prevented the rejection of vaccines. Vaccination coverage was low for all recorded vaccinations (tetanus 65.8%, influenza 45.2%, pneumococcus 32.2% and meningococcus 6.1%). Older age was predictive of receiving influenza and pneumococcal vaccination. The same applies for CSs >7.5 mg for receiving influenza vaccination. Conclusion Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations. Rheumatologists need to recognize patients’ reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their health-care providers. Trial registration German Clinical Trials Register, www.germanctr.de , DRKS00011052. [ABSTRACT FROM AUTHOR]

Response particles manage intersubjectivity. This conversation analytic study describes German eben (“exactly”). With eben, speaker A locally agrees with the immediately prior turn of B (the “confirmable”) and establishes a second indexical link: A relates B’s confirmable to a position A herself had already displayed (the “anchor”). Through claiming temporal priority, eben speakers treat a just-formulated position as self-evident and mark independence. Further evidence for the three-part structure “anchor-confirmable-eben” that eben sets in motion retrospectively comes from instances where eben speakers supply a missing/opaque anchor via a postpositioned display of independent access. Data are in German with English translation. [ABSTRACT FROM AUTHOR]

Background: We examined short- and long-term outcomes of tibial and peroneal venous and heparin-bonded expanded polytetrafluoroethylene bypasses in patients with critical limb ischemia who were unsuitable for endovascular revascularization.Methods: A retrospective analysis was done for all patients who underwent tibial and peroneal bypass surgery in our department between October 2007 and October 2012. Vein was the preferred graft material and used whenever possible.Results: One hundred and ninety-eight crural grafts were included. Indications for the surgery were rest pain (30.3%) or ulcer or gangrene (69.7%). Autologous veins were used in 109 cases (vein group) and heparin-bonded expanded polytetrafluoroethylene grafts were used in 89 cases (heparin-bonded expanded polytetrafluoroethylene group). At three years, primary patency for the vein group was 68.2% versus 34.1% for the heparin-bonded expanded polytetrafluoroethylene group (P = .000) and secondary patency was 69.8% versus 35.5% (P = .001). Limb salvage was 81.8% for the vein group versus 56.5% for the heparin-bonded expanded polytetrafluoroethylene group (P = .000) and survival was 62.8% versus 46.7% (P = .019).Conclusions: The results of our study show that autologous vein grafts are still first choice for tibial and peroneal bypasses in patients with critical limb ischemia. If no adequate vein is available, heparin-bonded expanded polytetrafluoroethylene bypasses are an acceptable alternative to an otherwise impending major amputation. [ABSTRACT FROM AUTHOR]

In Germany the second-most frequent accidents in road traffic are rear-end collisions. For this reason rear-end collisions are quite important for accident research and the development of driving safety systems. To examine the functionality and to design the human–machine-interface of new driving safety systems, especially in the early development phase, subject tests are necessary. Because of the great hazard potential of such safety critical scenarios for the test persons, they are often conducted in a driving simulator (DS). Accordingly, validity is an important qualification to ensure that the findings collected in a simulated test environment can be directly transferred to the real world. This paper regards the question of driving behavior validity of DS in critical situations. There are hardly any validation studies which analyze the driving behavior in a specific collision avoidance situation. The validation study described in this paper aims to evaluate the behavioral validity of a fixed-base simulator in a collision avoidance situation. For this reason a field study from 2007 was replicated in a fixed-base simulator environment. The main questions of this validation study were if the driver can notice an active hazard braking system and if the driving behavior in a static simulator can be valid in such a critical situation. The key finding of the study states that there is no driving behavior validity in a static driving simulator for the tested dynamic scenario. The missing vestibular feedback causes a different behavior of the participants in field and simulator. The resulting absence of comparability leads to non-valid performance indicators. But these indicators are key parameters for analyzing the function and acceptance of active braking systems. So the question arises, which motion performance does a motion base have to provide in order to achieve valid acceleration simulation of such a highly dynamic collision avoidance scenario. The DS’s performance is measured in workspace, velocity and acceleration. [ABSTRACT FROM AUTHOR]

The article presents a report which aims to estimate the prevalence and future number of systemic lupus erythematosus (SLE) in Germany. The study screened data from the statutory health insurance in the country for SLE diagnoses and the gender- and age-specific prevalence of SLF is measured. Results showed that the gender- and age-specific prevalence of SLE will not change substantially, but the number of cases will change until 2034.

Knowledge transfer is a critical factor in ensuring the success of offshore outsourcing software development projects and is, in many cases, neglected. Compared to in-house or co-located projects, however, such globally distributed projects feature far greater complexity. In addition to language barriers, factors such as cultural differences, time zone variance, distinct methods and practices, as well as unique equipment and infrastructure can all lead to problems that negatively impact knowledge transfer, and as a result, a project's overall success. In order to help minimise such risks to knowledge transfer, we conducted a research study based on expert interviews in six projects. Our study used German clients and focused on offshore outsourcing software development projects. We first identified known problems in knowledge transfer that can occur with offshore outsourcing projects. Then we collected best-practice solutions proven to overcome the types of problems described. Afterward, we conducted a follow-up study to evaluate our findings. In this subsequent stage, we presented our findings to a different group of experts in five projects and asked them to evaluate these solutions and recommendations in terms of our original goal, namely to find ways to minimise knowledge-transfer problems in offshore outsourcing software development projects. Thus, the result of our study is a catalog of evaluated solutions and associated recommendations mapped to the identified problem areas. [ABSTRACT FROM AUTHOR]

The article discusses the study on the effectiveness and safety of rituximab in treating systemic lupus erythematosus (SLE) in Germany. It details how the study was conducted, which involved 85 SLE treatment refractory patients with an average disease duration of 9.8 years. The results reportedly revealed that rituximab is an effective treatment option based on the retrospective data collection. It notes that the participants were rated as non-, partial, and complete responders.

The article presents the theoretical premises and preliminary results of a collaborative research project on the socioeconomic aspects of education, known as EDUCARE and hosted at the University of Frankfurt am Main, Germany. Theoretical approaches mentioned include the concept of symbolic capital developed by French sociologist Pierre Bourdieu and discourse analysis following the ideas of French social theorist Michel Foucault. Empirical topics discussed include the health risks of socioeconomically disadvantage children, the effect of poverty on educational opportunity, and political debates about these issues in Germany.

Objective. MMF is teratogenic and needs to be replaced before pregnancy. This change may lead to flares. Our aim was to determine the risk of renal flares in women with LN who switched treatment from MMF to AZA before conception and to evaluate the outcome of their pregnancies.Methods. Medical records of women with LN counselled for pregnancy wish were reviewed. Women receiving treatment with either MMF or AZA (control group), with inactive lupus (SLEDAI &leq; 4) and quiescent LN (serum creatinine <1.5 mg/dl, inactive sediment and proteinuria <1 g/24 h for the preceding 6 months) were eligible for this study.Results. We identified 54 women [23 treated with MMF (group 1) and 31 treated with AZA (group 2)]. MMF dosage was tapered and subsequently transferred to AZA, which was maintained throughout pregnancy. Three (13%) patients (group 1) vs none (group 2) developed a renal flare 3–6 months after transitioning from MMF to AZA (P = 0.14) before pregnancy ensued. The only parameter with a significant difference in those with flare compared with those without was younger age (median 27 vs 30 years; P = 0.03). Risk for adverse outcome within 48 pregnancies (pre-eclampsia 9%, preterm delivery 20.5%) increased with every milligramme of prednisone dosage [odds ratio (OR) 2.03] and every single unit of SLEDAI score (OR 3.92). Renal flares occurred post-partum in two women. No patient developed worsening of renal function.Conclusion. Replacing MMF with AZA in patients with quiescent LN for pregnancy planning rarely leads to renal flares. Pregnancy outcome was favourable. [ABSTRACT FROM PUBLISHER]

Objectives Renal disease is a common and serious complication in HIV-infected patients. Methods A retrospective cohort analysis for the period 1989-2010 was carried out to determine the prevalence, incidence and risk factors for end-stage renal disease ( ESRD). ESRD was defined as initiation of renal replacement therapy. Three time periods were defined: 1989-1996 [pre-highly active antiretroviral therapy ( HAART)], 1997-2003 (early HAART) and 2004-2010 (late HAART). Results Data for 9198 patients [78.2% male; 88.9% Caucasian; cumulative observation time 68 084 patient-years ( PY)] were analysed. ESRD was newly diagnosed in 35 patients (0.38%). Risk factors for ESRD were Black ethnicity [relative risk ( RR) 5.1; 95% confidence interval ( CI) 2.3-10.3; P < 0.0001], injecting drug use ( IDU) ( RR 2.3; 95% CI 1.1-4.6; P = 0.02) and hepatitis C virus ( HCV) coinfection ( RR 2.2; 95% CI 1.1-4.2; P = 0.03). The incidence of ESRD decreased in Black patients over the three time periods [from 788.8 to 130.5 and 164.1 per 100 000 PY of follow-up ( PYFU), respectively], but increased in Caucasian patients (from 29.9 to 41.0 and 43.4 per 100 000 PYFU, respectively). The prevalence of ESRD increased over time and reached 1.9 per 1000 patients in 2010. Mortality for patients with ESRD decreased nonsignificantly from period 1 to 2 ( RR 0.72; P = 0.52), but significantly from period 1 to 3 ( RR 0.24; P = 0.006), whereas for patients without ESRD mortality decreased significantly for all comparisons. ESRD was associated with a high overall mortality ( RR 9.9; 95% CI 6.3-14.5; P < 0.0001). Conclusion As a result of longer survival, the prevalence of ESRD is increasing but remains associated with a high mortality. The incidence of ESRD declined in Black but not in Caucasian patients. IDU and HCV were identified as additional risk factors for the development of ESRD. [ABSTRACT FROM AUTHOR]

This paper describes lightning characteristics as obtained in four sets of lightning measurements during recent field campaigns in different parts of the world from mid-latitudes to the tropics by the novel VLF/LF (very low frequency/low frequency) lightning detection network (LINET). The paper gives a general overview on the approach, and a synopsis of the statistical results for the observation periods as a whole and for one special day in each region. The focus is on the characteristics of lightning which can specifically be observed by this system like intra-cloud and cloud-to-ground stroke statistics, vertical distributions of intra-cloud strokes or peak current distributions. Some conclusions regarding lightning produced NOx are also presented as this was one of the aims of the tropical field campaigns TROCCINOX (Tropical Convection, Cirrus and Nitrogen Oxides Experiment) and TroCCiBras (Tropical Convection and Cirrus Experiment Brazil) in Brazil during January/February 2005, SCOUTO3 (Stratospheric-Climate Links with Emphasis on the Upper Troposphere and Lower Stratosphere) and TWP-ICE (Tropical Warm Pool-International Cloud Experiment) during November/December 2005 and January/February 2006, respectively, in the Darwin area in N-Australia, and of AMMA (African Monsoon Multidisciplinary Analyses) in W-Africa during June-November 2006. [ABSTRACT FROM AUTHOR]

The article provides information on the philosophical contributions of Johann Georg Hamann. According to the article, Hamann became famous in Germany due to his philosophical viewpoints. However, he and his disciples such as Jacobi and Herder were misinterpreted and their views were believed to be against the views of German Enlightenment. On the other hand, there were other philosophers who rendered their support in counterpointing the idea of counter-enlightenment issue of Hamann's views including Georg Wilhelm Friedrich Hegel, Soren Kierkegaard, and Johann Wolfgang von Goethe.

Using conversation analytic methodology, in this article, we examine two prosodic variants of the German response token achja and their use in everyday interaction. Whereas achJA, with prosodic prominence (in form of higher amplitude) on the second syllable, is used to claim remembering of relevant but just now recalled information, ∧achja, with prosodic prominence (in form of a pitch peak) on the first syllable, serves as a placeholder in sequential slots in which the speaker is not in a position to provide the just-now-relevant response. Thus, whereas a speaker may use achJA to establish prior independent access to interactionally relevant information and mark its retrieval, ∧achja displays a significant lack of access to relevant sequential or contextual knowledge. ∧Achja is regularly recognized as an insufficient response by the coparticipant and followed by turn and sequence expansions, whereas achJA is closing relevant. In this article, we also discuss the component tokens ach and ja separately and outline implications for the study of response tokens, translation practices, and of prosody in interaction. [ABSTRACT FROM AUTHOR]

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This paper examines the potential for Domestic Offset Projects (DPs) in climate protection in Germany. DPs are unilateral GHG emissions reduction projects carried out in a country with a binding greenhouse gas emission reduction target under the Kyoto Protocol (Annex I Country). In contrast to the well known project-based mechanisms under the Kyoto protocol — the Clean Development Mechanism (CDM) and Joint Implementation (JI) — Domestic Offset Projects are located in the same country as the investor. Therefore tradable emission reduction certificates for DPs are issued by the investor's domestic authority. This paper presents possible implementation options for DPs based on JI and CDM experience, as well as possible implementation problems. Policy additionaIity seems to be an especially crucial requirement and thus was analysed in more detail. In addition. the emission reduction potential resulting from DPs was estimated for the Federal, state of Baden-Wümemberg, in South-West Germany. Here, it is shown that the scope for DPs is restricted because of the extent of the German climate program. In Baden-Württemberg only some DPs and JI activities fulfil the criterion of policy additionality. For this reason, DPs are probably of more interest in Annex-1 countries with a more limited climate policy mix. [ABSTRACT FROM AUTHOR]

In this study the development of a 13-locus multiplex-PCR system fitting the updated demands for paternity testing in Germany is described. For this purpose an existing multiplex PCR system that allows the simultaneous amplification of eight different STR loci together with the sex-specific locus amelogenin ( genRES MPX-2, Serac, Germany) was extended. Whereas some of the primers were taken from the underlying multiplex system, suitable primer sequences were chosen for the STR loci D19S433, TPOX, TH01, D16S539, D5S818, D2S1338 and FGA. Primers of loci resulting in potentially overlapping fragment sizes were labelled with the fluorescent dyes 6-FAM, JOE and NED. Reaction conditions, such as annealing temperature, concentrations of primers and polymerase or buffer conditions were optimised to obtain a robust amplification and reproducible genotype analysis for various sample sources. Full DNA profiles from single source samples were reliably typed from template DNA amounts of as low as 120 pg, suggesting a potential use of this system also in forensic casework analysis. With a mean exclusion chance (MEC) of 99.9989% and a power of discrimination (P D) of about 1Ö10 14 (Caucasians), the new multiplex PCR system provides a significant and sensitive system for forensic DNA analysis. On the basis of these studies, a commercial kit system is now provided by Serac (Bad Homburg, Germany, genRES MPX-3). [ABSTRACT FROM AUTHOR]

The Parent As A Teacher Inventory (PAA T) was used to assess childrearing attitudes of 155 West German parents and 215 immigrant parents to West Germany from Greece, Italy, and Turkey. Subset comparisons indicate the need for parent-education programs that inform each group about attitude similarities as well as differences and that support family cohesion while integration proceeds. [ABSTRACT FROM AUTHOR]

Investigates the localization of a gene for syndactyly type 1 (SD1) to chromosome 2q34-q36 in Germany. Characterization of the SD1; Analysis on the linkage between polymorphic markers on chromosome and SD1; Recombination of affected individuals between the markers D2s2319 and D2S344.