Search

Educational research often refers to the subjective values assigned to aspects of education. Theoretical frameworks from the related disciplines of psychology and sociology applied to the context of education aim to better describe why some students are more motivated in school than others to understand differences in academic outcomes. In the current study, we followed an interdisciplinary approach that aimed to integrate psychological views regarding domain-specific value beliefs (i.e., intrinsic, attainment, utility, cost) and sociological views regarding domain-general values of education (i.e., stimulation, comfort, status, behavioral confirmation) and to investigate how they relate to academic success in upper secondary education. In a sample of 3,775 upper secondary school students in Germany, we found evidence that combining the two perspectives had incremental effects when predicting domain-specific achievement and GPA. We discuss how integrating interdisciplinary theoretical perspectives could foster communication between scientific disciplines and benefit future research in the field of motivation.

Vocabulary knowledge is one of the most important elements of reading comprehension. Text coverage is the proportion of known words in a given text. We hypothesize that text comprehension increases exponentially with text coverage due to network effects and activation of prior knowledge. In addition, the lexical threshold hypothesis states that text comprehension increases faster above a certain amount of text coverage. The exponential relationship between text coverage and text comprehension, as well as the lexical threshold, are at the heart of text comprehension theory and are of great interest for optimizing language instruction. In this study, we first used vocabulary knowledge to estimate text coverage based on test scores from N = 924 German fourth graders. Second, we compared linear with non-linear models of text coverage and vocabulary knowledge to explain text comprehension. Third, we used a broken-line regression to estimate a lexical threshold. The results showed an exponential relationship between text coverage and text comprehension. Moreover, text coverage explained text comprehension better than vocabulary knowledge, and text comprehension increased more quickly above 56% text coverage. From an instructional perspective, the results suggest that reading activities with text coverage below 56% are too difficult for readers and likely inappropriate for instructional purposes. Further applications of the results, such as for standard setting and readability analyses, are discussed.

The relationship between students' subject-specific academic self-concept and their academic achievement is one of the most widely researched topics in educational psychology. A large proportion of this research has considered cross-lagged panel models (CLPMs), oftentimes synonymously referred to as reciprocal effects models (REMs), as the gold standard for investigating the causal relationships between the two variables and has reported evidence of a reciprocal relationship between self-concept and achievement. However, more recent methodological research has questioned the plausibility of assumptions that need to be satisfied in order to interpret results from traditional CLPMs causally. In this substantive-methodological synergy, we aimed to contrast traditional and more recently developed methods to investigate reciprocal effects of students' academic self-concept and achievement. Specifically, we compared results from CLPMs, full-forward CLPMs (FF-CLPMs), and random intercept CLPMs (RI-CLPMs) with two weighting approaches developed to study causal effects of continuous treatment variables. To estimate these different models, we used rich longitudinal data of N = 3757 students from lower secondary schools in Germany. Results from CLPMs, FF-CLPMs, and weighting methods supported the reciprocal effects model, particularly when math self-concept and grades were considered. Results from the RI-CLPMs were less consistent. Implications from our study for the interpretation of effects from the different models and methods as well as for school motivation theory are discussed.

Students' academic achievement is a key predictor of various life outcomes and is commonly used for selection as well as for educational monitoring and accountability. With regard to achievement indicators, a differentiation has traditionally been drawn between grades and standardized tests. There is initial, albeit inconclusive, evidence that these indicators might differentially reflect students' personality as encapsulated in the Big Five personality traits as well as measures of cognitive abilities. In this article, we propose the personality-achievement saturation hypothesis (PASH) as an overarching model that describes the association between achievement indicators and personality. The PASH suggests that the differentiation between grades and tests is too simplistic and that associations between personality and achievement instead vary across five main features of the achievement measures that are used: level of standardization, relevance for the student, curricular validity, instructional sensitivity, and cognitive ability saturation. On the basis of findings from prior studies, we focused in particular on conscientiousness and openness to test the PASH. We used data from three large-scale studies (total N = 14,953) and aggregated our findings across these studies. In line with the PASH, the Big Five trait of conscientiousness was most strongly related to measures that were less standardized and less saturated with cognitive ability but higher on curriculum validity, relevance, and instructional sensitivity. In addition, openness was most strongly related to measures that were higher on standardization and cognitive ability saturation but lower on relevance, curriculum validity, and instructional sensitivity in English.

Empirically rigorous research on teacher education entry is extremely limited. Evidence on who enters teacher education and why is crucial for identifying undesired gaps in entry and can assist with teacher recruitment. Grounded in prior research, we identified four primary groups of relevant individual-level variables: student/family background, achievement/abilities, personality, and motivation. We empirically tested this conceptual model using rich data from a national cohort of German ninth-graders followed to college/university and their parents. Our study is the first to predict eventual teacher education entry early in secondary school. Although those students who eventually entered teacher education were significantly different from their counterparts across most variables, fewer were conditionally predictive. Social interests, desired working conditions, desire to have children, and students' parents were particularly influential. Implications for research and teacher recruitment are discussed.

Prior research suggests that teachers' positive perceptions of a reform are key when it comes to its successful implementation. The importance of teachers as enactors of change efforts results from their close tie to what is happening in the classroom. This suggests that without persuaded change agents, innovations are unlikely to be implemented coherently, and in turn, likely to fail. In this study, we investigated the relationships between different sets of predictors (specific to the teacher, the school, the reform, or support structures) and teachers' overall rating of a curricular reform. We found that teachers' perceived added value and their perceptions of specific reform aspects predicted overall reform ratings. Furthermore, we identified heterogeneity regarding the importance of specific predictors between different school tracks, which calls for increased attention to school context when considering teachers' perceptions of reforms.

Background/Objectives: This study examines job satisfaction, burnout, and well-being among first-generation migrant physicians in anesthesiology and intensive care medicine in Germany, comparing them to their native German counterparts. Methods: A cross-sectional survey design was utilized, collecting data from 513 physicians, 110 of whom identified as having a migration background. Job satisfaction was measured using the Warr-Cook-Wall (WCW) Job Satisfaction Scale, burnout was assessed with the Copenhagen Burnout Inventory (CBI), and well-being was evaluated using the WHO-5 Well-Being Index. Results: The job satisfaction ratings revealed no significant differences between migrant and German physicians in most dimensions, including physical workload, freedom to choose work methods, satisfaction with colleagues, responsibility, income, skill utilization, and variety in work tasks. However, migrant physicians reported significantly higher satisfaction with recognition received for their work and lower dissatisfaction with working hours. Burnout assessments showed that migrant physicians experienced higher psychological strain, perceiving every work hour as more exhausting and having significantly less energy for family and friends. Migrant physicians reported higher difficulty and frustration in working with patients. Well-being items indicated that migrant physicians felt less energetic and active but found their daily life more filled with interesting activities. Notably, the multivariate analyses of the total scale scores did not show significant associations between migration background and the overall outcome scales. Conclusions: The findings indicate unique challenges faced by migrant physicians, particularly in terms of recognition and patient-related burnout. These results highlight the need for targeted interventions to support migrant physicians, including cultural competence training and flexible working hours to enhance their job satisfaction and overall well-being. Addressing these issues is crucial for maintaining the quality of patient care and the occupational health of migrant physicians in Germany. [ABSTRACT FROM AUTHOR]

Teacher-assigned grades provide important information that is used by universities and colleges to make admission decisions and by employers to make hiring decisions. Besides grades, the results of standardized achievement tests are frequently used for student selection and allocation. However, correlations between the two achievement measures are far from perfect, and researchers have argued that this discrepancy can be at least partially attributed to norm-referenced grading, which is based on the composition of performance in a class. In this study, we investigated the results of a curricular intensification reform, which introduced changes in the distribution of student performance by making enrollment in certain courses mandatory. We investigated whether the reform resulted in changes in the relationship between standardized achievement-test results and teacher-assigned grades. We analyzed cohort control design data from two large representative samples of students from two German states (Baden-Württemberg: N = 5,574; Thuringia: N = 2,202) before and after the reform. Results indicated that students who received a certain grade before the reform (e.g., a grade of A, B, C, or D) differed in their standardized test performance from students who received the same grade after the reform. Furthermore, in math, course-level-specific reform effects on the association between grades and standardized test performance were found to vary between groups of students receiving good and poor grades. Implications for educational policy and school reforms and suggestions for grading are discussed.

In recent decades, several countries have made an effort to increase the enrollment rates and performance of students in science and mathematics by means of mandatory, rigorous course work, which is often referred to as curricular intensification (CI). However, there is a lack of research on intended and unintended effects of CI reforms on achievement and motivation. Using representative data from the National Educational Panel Study, we examined effects of a prototypical CI reform in 1 German state. We compared data from the last student cohort before and the first student cohort after the reform at the end of upper secondary school. There was no statistically significant effect on average achievement. However, we found first evidence for differential effects on English reading and a higher English self-concept of young men after the reform, whereas the reform had a negative effect on young women's math self-concept.

Background: This study focused on Ukrainian refugees and migrants, a population that, with an ongoing war, is expected to grow in Germany. Over 1 million Ukrainians with exceptional legal status and access to public insurance in Germany significantly burden governmental services, especially German healthcare. It is thus essential to facilitate their integration into the healthcare system and ensure its proper usage. Identifying the obstacles Ukrainian refugees and migrants encounter while accessing healthcare services is crucial to ease their integration. Methods: A qualitative study was conducted from February 2023 to April 2023. Thirty semi-structured interviews were performed with Ukrainian migrants and refugees. The interviews were transcribed verbatim, organized, and categorized. Thematic analysis was performed to identify barriers related to the use of German healthcare services. To assess possible differences in the experiences of Ukrainian refugees and migrants, the responses of these two groups for each topic were analysed separately. Results: Ukrainian migrants and refugees experience similar barriers while accessing German healthcare services. Predominantly, language barriers and a lack of understanding of the German healthcare system posed the main barriers in both groups. Additionally, structural challenges, such as differences in referral processes, appointment scheduling, and consultation duration, presented further challenges. Conclusion: This research study emphasizes the importance of addressing cultural and structural barriers to improve healthcare accessibility and utilization for Ukrainian refugees and migrants in Germany to better facilitate their integration into the healthcare system. [ABSTRACT FROM AUTHOR]

Copyright of FinanzRundschau is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Unternehmensbesteuerung (Ubg) is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Math achievement, math self-concept, and vocational interests are critical predictors of STEM careers and are closely linked to high school coursework. Young women are less likely to choose advanced math courses in high school, and encouraging young women to enroll in advanced math courses may therefore bring more women into STEM careers. We looked at a German statewide educational reform that required all students to take advanced math courses and examined differential effects of the reform on young men and women's math achievement, math self-concept, vocational interests, and field of study at university. We compared data from 4,730 students before the reform and 4,715 students after the reform. We specified multiple regression models and tested main effects of gender and cohort as well as the effect of the Cohort × Gender interaction on all outcomes. All outcomes showed clear gender differences favoring young men before the reform. However, the reform was associated with different effects for young men and women: Whereas gender differences in math achievement were smaller after the reform, differences between young men and women in math self-concept and realistic and investigative vocational interests were larger after the reform than before. Gender differences in the field of study at university did not differ between before and after the reform. Results suggest that reducing course choice options in high school does not automatically increase gender equality in STEM fields.

The Omicron variants BA.1, BA.2, and BA.5 caused several waves of SARS-CoV-2 in Germany in 2022. In this comparative study, public health data on SARS-CoV-2 infections from Mecklenburg-Western Pomerania, Germany, between January and October 2022 were examined retrospectively using Pearson's chi-squared tests and Fisher's exact tests for testing for statistical significance. Compared to BA.5 infections, BA.1 and BA.2 infections affected younger individuals aged up to 19 years significantly more often, whereas BA.5 infections occurred significantly more frequently in patients between 40 and 59 years of age when compared to BA.1 and BA.2. Infections with all three variants predominantly caused flu-like symptoms; nevertheless, there were significant differences between the reported symptoms of BA.1, BA.2, and BA.5 infections. Especially, the symptoms of 'fever', 'severe feeling of sickness', 'loss of taste', and 'loss of smell' were significantly more often present in patients with BA.5 infections compared to BA.1 and BA.2 cases. Additionally, BA.2 and BA.5 cases reported significantly more often the symptoms of 'runny nose' and 'cough' than BA.1-infected cases. Our findings indicate remarkable differences in the clinical presentations among the sub-lineages, especially in BA.5 infections. Furthermore, the study demonstrates a powerful tool to link epidemiological data with genetic data in order to investigate their potential impact on public health. [ABSTRACT FROM AUTHOR]

Introduction: Learning English as a foreign language is necessary for many students to actively participate in an increasingly globalized world. This study explores the role of informal English language engagement for students’ reading and listening skills, as well as motivation to learn English. In an era of global interconnectedness, informal learning gains importance as a supplement to formal education. Methods: This study extends the evidence base by analyzing extramural reading and listening activities in a large-scale longitudinal investigation involving secondary school learners (N = 1,994) in Germany. Results: Our results show that frequent informal reading significantly relates to increases in students’ English comprehension skills and their motivation for language learning, reaffirming previous cross-sectional findings. Discussion: The results highlight the relevance of informal language activities for effective language learning and students’ English as a foreign language motivation. Additionally, discrepancies between reading and listening outcomes are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Elderly cancer patients are less likely to be treated in accordance with evidence-based guideline recommendations. This study examines patient-related factors associated with deviations from guideline recommendations. Methods: Using medical documentation and cancer registry data, we investigated the treatment courses of female breast cancer patients aged 50 and older in Germany regarding compliance with German guidelines. Participants completed a questionnaire querying factors hypothesized to be associated with guideline adherence. We conducted univariate analyses to explore the data and select variables for multivariate logistic regression to estimate adjusted odds ratios. Results: Of 1150 participants, 206 (17.9%) were treated in deviation from guideline recommendations. Patients 70 years and older were more likely to be treated deviating from guideline recommendations than patients 50–69 years old (OR: 2.07; 95% CI: 1.52–2.80). Patients aged 50–69 years who reported that quality of life guided their treatment decision were more likely to be treated in deviation from guideline recommendations (AOR: 2.08; 95% CI: 1.11–3.92) than the elderly. In older patients, higher age was associated with an increased chance of receiving guideline-discordant care (AOR: 1.06; 95% CI: 1.01–1.11), as was depression diagnosed prior to cancer (AOR: 1.84; 95% CI: 1.00–3.40). Conclusion: Reasons for deviations from guideline recommendations in breast cancer patients differ by age. In decision-making concerning elderly patients, particular attention should be paid to those with pre-existing depressive disorders. Adequately addressing their needs and concerns could prevent inappropriate deviations from guideline recommendations. [ABSTRACT FROM AUTHOR]

Objective: Although intelligence and personality traits have long been recognized as key predictors of students' academic achievement, little is known about their longitudinal and reciprocal associations. Here, we charted the developmental interplay of intelligence, personality (Big Five) and academic achievement in 3880 German secondary school students, who were assessed four times between the ages 11 and 14 years (i.e., in grades 5, 6, 7, and 8). Method: We fitted random intercept cross‐lagged panel models (RI‐CLPs) to investigate reciprocal within‐person associations between (a) academic achievement and intelligence, (b) academic achievement and personality, as well as (c) intelligence and personality. Results: The results revealed negative within‐person associations between Conscientiousness and Extraversion assessed at the first wave of measurement and intelligence assessed at the second wave. None of the reciprocal personality–achievement associations attained statistical significance. Academic achievement and intelligence showed reciprocal within‐person relations, with the strongest coefficients found for achievement longitudinally predicting intelligence. Conclusions: Our work contributes to developmental theorizing on interrelations between personality, intelligence, and academic achievement, as well as to within‐person conceptualizations in personality research. [ABSTRACT FROM AUTHOR]

Background: Critical infrastructure (CRITIS) in hospitals has become the focus of resilience research due to the impact of the COVID-19 pandemic and also the events in Ukraine. This foundational research examines overall contexts, categorizing and quantifying them. Previous research examined limited scale damage situations with little CRITIS involvement: Worst case studies are missing. The vulnerabilities of the CRITIS of one or more countries will likewise be a prime target for attack in current and future conflicts or criminal extortion, this is especially true in the healthcare sector. Therefore, detailed research with a black swan scenario is necessary in this field. Objective: The aim of the study was to create and validate a categorized and weighted model for the self-assessment of the resilience of critical infrastructure in German hospitals at different levels of care before the exemplary scenario of a prolonged supraregional power blackout. Material and methods: Using an explorative design, experts from 8 hospitals of different care levels performed an expert-based qualitative system analysis to develop, weight and test the model. The resilience index was then calculated using adapted interdependence analyses in a Vester influence matrix. Results: A total of 7 categories and 24 subcategories of hospital CRITIS were identified. There are several key elements: rank 1 of active elements is the emergency power system (E1), and for passive elements, it is the nursing staff (P2). This means that the emergency power system has the greatest impact on all other areas and the nursing staff are most dependent on all others for their work. The most critical elements, because they are most intertwined in the overall system, are the situation center/command staff (Z1) and technical staff (P3), on which the entire system depends. From the weighted individual elements of CRITIS, an overall resilience for a hospital can be calculated (resilience index). The developed model can be used by hospital crisis experts as part of a self-assessment to provide a basis for risk management, financial planning, technical planning, personnel planning or crisis and disaster management. Conclusion: The categorization and quantification of critical infrastructure (CRITIS) in hospitals with the aim of resilience documentation and optimization is possible. The model that has been developed allows rapid adaptation to changing initial situations and increases in resilience that can be realized in the short and medium term. Emergency and crisis preparedness is a dynamic process, which has been combined here with the further development of critical infrastructure. Consequently, there can be no final state to be achieved but only a certain best possible framework within which the hospital as a business enterprise can operate. The classification of the categories in the model must also be constantly further developed and adapted to the current status. Once the explorative and qualitative basic research has been completed, it is necessary in a further step to subject the model, which has been validated by experts, to a broader review. Ideally, this will be done using quantitative methods and a significantly larger sample. [ABSTRACT FROM AUTHOR]

Background: The Borna disease virus (BoDV-1) is an emerging zoonotic virus causing severe and mostly fatal encephalitis in humans. Methods and Results: A local cluster of fatal BoDV-1 encephalitis cases was detected in the same village three years apart affecting two children. While the first case was diagnosed late in the course of disease, a very early diagnosis and treatment attempt facilitated by heightened awareness was achieved in the second case. Therapy started as early as day 12 of disease. Antiviral therapy encompassed favipiravir and ribavirin, and, after bioinformatic modelling, also remdesivir. As the disease is immunopathogenetically mediated, an intensified anti-inflammatory therapy was administered. Following initial impressive clinical improvement, the course was also fatal, although clearly prolonged. Viral RNA was detected by qPCR in tear fluid and saliva, constituting a possible transmission risk for health care professionals. Highest viral loads were found post mortem in the olfactory nerve and the limbic system, possibly reflecting the portal of entry for BoDV-1. Whole exome sequencing in both patients yielded no hint for underlying immunodeficiency. Full virus genomes belonging to the same cluster were obtained in both cases by next-generation sequencing. Sequences were not identical, indicating viral diversity in natural reservoirs. Specific transmission events or a common source of infection were not found by structured interviews. Patients lived 750m apart from each other and on the fringe of the settlement, a recently shown relevant risk factor. Conclusion: Our report highlights the urgent necessity of effective treatment strategies, heightened awareness and early diagnosis. Gaps of knowledge regarding risk factors, transmission events, and tailored prevention methods become apparent. Whether this case cluster reflects endemicity or a geographical hot spot needs further investigation. [ABSTRACT FROM AUTHOR]

Background: HPV vaccination has been recommended and reimbursed for girls in Germany since 2007. In June 2018 the German Standing Committee on Vaccination (STIKO) recommended the gender-neutral vaccination of adolescents aged 9 to 14 years with catch-up through age 17. Objectives of this study were to describe the uptake of vaccination in boys before and during the COVID-19 pandemic. Methods: The study used data from a proprietary electronic medical record database and a database with information on nationally dispensed vaccine doses. The monthly number of first doses of HPV vaccinations in boys and girls aged 9–17 years in the period from 01/2018 to 12/2021 was determined. In addition, for boys the cumulative vaccination rates were calculated for initiated and completed vaccination series. Results: Four months after the introduction of mandatory reimbursement for boys, the monthly numbers of first doses were comparable to that of girls. Compared to the same month in 2019, the number of first doses declined by up to 49% (girls) in 2020 and 71% (boys) in 2021. At the end of 2021, the vaccination rate for 15-year-old boys (2006 birth cohort) reached 44.4% for initiated and 26.4% for completed series. Conclusion: After an initial dynamic increase in HPV vaccinations in boys, the impact of COVID-19 was particularly strong in the second year of the pandemic. At the end of 2021 vaccination rates were still low. Efforts are needed to catch-up on adolescents that missed doses during the pandemic and to increase uptake. [ABSTRACT FROM AUTHOR]

Purpose: For patients with a cancer diagnosis, coping abilities are of high importance. Cancer patients with a high sense of coherence may cope better. The purpose of this study is to learn more about the correlation of sense of coherence and different aspects, such as demographics, psychological factors, lifestyle, complementary and alternative medicine (CAM) and lay aetiology. Methods: A prospective cross-sectional study was performed in ten cancer centres in Germany. The questionnaire consisted of ten sub-items, collecting information about sense of coherence, demographics, general life satisfaction, resilience, spirituality, self-efficacy, physical activity and sports, nutrition, CAM methods and cancer causes. Results: As many as 349 participants were evaluable. The mean sense of coherence score was M = 47.30. Significant associations were shown for sense of coherence and financial situation (r = 0.230, p < 0.001), level of education (r = 0.187, p < 0.001), marital status (η = 0.177, p = 0.026) and time interval since diagnosis (r = − 0.109, p = 0.045). Sense of coherence and resilience correlated on a high level, as well as spirituality, self-efficacy and general life satisfaction (r = 0.563, r = 0.432, r = 0.461, r = 0.306, p's < 0.001). Conclusion: Several aspects, such as demographics and psychological factors, have a great influence on the sense of coherence. To help patients to cope better, physicians should try to strengthen sense of coherence, resilience and self-efficacy and, at the same time, consider patients' individual background such as level of education, financial capacity and emotional support by family members. [ABSTRACT FROM AUTHOR]

Background: Previous studies have already shown that decision aids are a suitable tool for patient decision-making. The aim of this work is to conduct an online search for freely available, German-language patient decision aids (PDAs) for cancer patients, followed by an assessment of their quality. For this purpose, a rating tool that is as manageable as possible was developed on the basis of already existing quality criteria. Methods: A simulated patient online search was conducted via the four most frequently used search engines in Germany. A quality assessment tool was created utilizing international and national guidelines, with a focus on practicality and manageability. Subsequently, the identified PDAs were rated by 4 raters based on the rating tool. Results: The number of German-language oncology PDAs is low (n = 22 of 200 URLs) with limited variability regarding rare cancers. Most originate from non-profit organizations. The overall quality is low, as indicated by an average of 57.52% of the maximum evaluation points of the developed quality assessment tool. Reference values used to assess quality were related to e.g. support/effectiveness, adaptation, layout, etc. No qualitative differences were found regarding different publishers. Quality differed between PDAs of different length, with longer PDAs achieving better results. Conclusion: Overall, the supply and quality of German-language PDAs is not satisfactory. The assessment tool created in this study provides a solid, but more manageable basis, for developing and identifying high-quality PDAs. Practice implications: PDAs should be increasingly used by physicians in practice. For this, a quick qualitative assessment of PDAs in everyday life must be possible. Future research has to investigate especially the aspect of the length of a PDA in more detail. [ABSTRACT FROM AUTHOR]

Copyright of FinanzRundschau is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: COVID-19 has impacted both society and medical care. While Germany entered the first lockdown in spring 2020, the PIKKO study (Patient information, communication and competence empowerment in oncology) was still active. The intervention modules, patient navigator (PN), services of the Saarland Cancer Society (SCS), psycho-social counseling and different courses, and online knowledge database (ODB) continued to be offered, but in an adapted form. It was the aim of this supplementary survey to identify the restrictions and burdens of the pandemic containment strategies on the PIKKO patients and thus on the PIKKO study itself. Furthermore, this work shows how the PIKKO modules were used during the lockdown. Methods: All patients in the PIKKO intervention group (IG) were invited to complete a questionnaire, n = 503. Furthermore, utilization of the SCS and log files of the ODB were analyzed. For socio-demographic data and contacts with the PN, data from the regular PIKKO surveys were used. In addition to descriptive statistics, chi²-tests, F-tests and linear regression analyses were performed. Results: 356 patients participated in this supplemental survey. 37.6% reported restrictions. "Restrictions on accompanying persons", "ban on visits to the wards" and "protective mouth-nose-mask" were reported as the greatest burdens. 39.0% expressed fears that the restrictions would have an impact on the course of their disease. Linear regression analyses showed differences in feelings of burden among age groups (more among < 60-year-olds), gender (more among women), children in the household (more with children), and preexisting financial stress (more with financial worries). In April 2020, there was more patient contact with PNs by phone, more SCS psycho-social counseling by phone, adapted SCS course offering, but with significantly fewer participants, and high activity on the ODB. Conclusion: Cancer patients in the IG reported restrictions from the pandemic containment strategies and feared an impact on their recovery. However, whether a burden is perceived as heavy depends more on gender, age, or pre-existing burdens than on whether the lockdown affects PIKKO or not. The utilization of counseling, courses or the ODB despite lockdown shows the need for such services, especially in times of crisis. Trial registration: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703. [ABSTRACT FROM AUTHOR]

Purpose: Resistance of Staphylococcus aureus to vancomycin includes a general increase of minimal inhibitory concentrations (MIC) within the susceptible range over time (Vancomycin MIC Creep) and the presence of a subset of the bacterial population that expresses resistance (heterogeneous glycopeptide-intermediate S. aureus; hGISA). Increased MICs have been associated with adverse clinical outcomes. However, the vancomycin MIC creep is not a uniform trend suggesting the importance of regional surveys. Methods: We performed a retrospective analysis at a German pediatric tertiary care hospital. Isolates from 2002 to 2017 were selected which were newly identified methicillin-resistant S. aureus (MRSA) or samples from invasive methicillin-susceptible S. aureus (MSSA) or MRSA infections. Vancomycin and oxacillin MICs as well as GISA/hGISA were measured using MIC test strips and resistance was evaluated over time. Results: A total of 540 samples were tested, 200 from the early (2002–2009) and 340 from the later period (2010–2017). All samples were vancomycin susceptible, but the MIC was higher for the earlier samples as compared to the later ones (1.11 vs 0.99; p < 0.001). 14% of the samples were hGISA, GISA strains were not detected. Again, vancomycin resistance decreased over time with 28 vs. 6% hGISA (p < 0.001). There was no significant difference between MRSA and MSSA samples with respect to vancomycin MIC and hGISA prevalence. Conclusion: This study shows a decreasing trend for both MIC values and presence of hGISA strains highlighting the importance of monitoring local susceptibilities. Vancomycin remains a first-line treatment option for suspected severe infection with Gram-positive cocci and proven infection with MRSA. [ABSTRACT FROM AUTHOR]

Theodor Escherich (1857–1911) was one of the key players in early paediatric infectious diseases (PID). In fact, he can be regarded as the first paediatric infectious diseases physician and the founder of this subspecialty. During his long years in service for children, he spent 6 years at the Dr von Hauner children's hospital (1884–1890), laying the foundations for PID clinical care and research in Munich. Walter Marget, founder of this journal and co-founder of the German Society for Infectious Diseases (DGI) graduated from medical school in 1946 and practised in Munich since 1967. His tireless efforts went into establishing close links between clinical paediatrics and microbiological diagnostics culminating in the foundation of the Department of Antimicrobial Therapy and Infection Epidemiology at the Dr von Hauner children's hospital. Walter Marget was a key figure for PID in Germany having trained and supported many clinician scientists who followed in his footsteps. This article gives a brief overview of the history of PID in Munich while commemorating Walter Marget and his achievements in this field and for INFECTION. [ABSTRACT FROM AUTHOR]

Next to the known nosocomial infections, the COVID-19 pandemic was an example for the need for the immediate implementation of functioning hygiene concepts and knowledge transfer. The aim of this study was to evaluate the self-assessment of ehealth literacy in terms of finding, using and critically evaluating health information and theoretical and practical hygiene awareness on a voluntary participation basis at the Jena University Hospital in 2022. The well-established and validated eHEALS and WHO questionnaire on hand hygiene (HH) knowledge for healthcare workers was completely filled by 204 participants (191 medical students; 13 healthcare trainees). In a second step, after the questionnaire, 77 participants completed additional asynchronous, digitally guided self-training using DesiCoach 2Go. In the end, a synchronous hand disinfection was carried out in the hospital using Visirub, by separating it into a group without (n = 191; with and without HH questionnaire) and a group with (n = 31; with HH questionnaire) previously completed self-training. For the eHL, the respondents tended to have a positive self-assessment of finding, using and critically evaluating health information. The voluntary participants of the practical hand disinfection who had received self-training were able to achieve significantly better results (p = 0.0047), resulting in fewer wetting gaps in a subsequent performance with Visirub than those who had not received digital self-training. The survey showed that healthcare-related participants belonging to the "digital native" generation have above-average knowledge on HH and profit by digitally guided self-training. [ABSTRACT FROM AUTHOR]

Background: The onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant. Methods: Patients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother–child bonding were administered at T1 (delivery stay) and T2 (3–6 months postpartum). Results: In total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic. Conclusion: Obstetric patients' concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother–child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic. Clinical trial registration DRKS00022506 Plain Language Summary: The global pandemic of COVID-19 (coronavirus induced disease 2019) is challenging our society in many ways. Especially pregnant women are facing extraordinary conditions and worries, like uncertain risks for mother and fetus in case of infection, restricted prenatal classes or restricted visitor regulations in hospitals. Particularly it is known that pregnancy and the postnatal period are presenting a more psychologically vulnerable time in a woman's life. Developing the GeZeCO study, we aimed to focus on the pandemic's effects on mental health of pregnant women during this time. Women giving birth in the department of obstetrics of the University Hospital Würzburg were asked to participate in the study. In total, 94 women completed several questionnaires concerning their mental health postpartum and again after 3 to 6 months. Further, we took blood samples of the women during the delivery stay and registered sociodemographic and obstetric data. Our results showed, that the women's concern relating to COVID-19, as well as the level of depression and anxiety raised during the pandemic. In addition, the self-efficacy of the mothers was affected by the restriction measures. Despite this, the women had at large a good mother–child-bonding and their competence of active coping increased during time. In summary, we did find that the mental health of obstetric patients is impaired by the COVID-19 pandemic. This points out the importance of not only attending to physical health but also taking care of psychological stress and mental health problems of obstetric patients during this exceptional time. [ABSTRACT FROM AUTHOR]

Knowledge on differences in the severity and symptoms of infections with the SARS-CoV-2 Omicron variants BA.2 (Pango lineage B.1.529.2) and BA.5 (Pango lineage B.1.529.5) is still scarce. We investigated epidemiological data available from the public health authorities in Mecklenburg-Western Pomerania, Northeast Germany, between April and July 2022 retrospectively. Comparative analyses revealed significant differences between recorded symptoms of BA.2 and BA.5 infected individuals and found strong correlations of associations between symptoms. In particular, the symptoms 'chills or sweating', 'freeze' and 'runny nose' were more frequently reported in BA.2 infections. In contrast, 'other clinical symptoms' appeared more frequently in Omicron infections with BA.5. However, the results obtained in this study provide no evidence that BA.5 has a higher pathogenicity or causes a more severe course of infection than BA.2. To our knowledge, this is the first report on clinical differences between the current Omicron variants BA.2 and BA.5 using public health data. Our study highlights the value of timely investigations of data collected by public health authorities to gather detailed information on the clinical presentation of different SARS-CoV-2 subvariants at an early stage. [ABSTRACT FROM AUTHOR]

We analyzed symptoms and comorbidities as predictors of hospitalization in 710 outpatients in North-East Germany with PCR-confirmed SARS-CoV-2 infection. During the first 3 days of infection, commonly reported symptoms were fatigue (71.8%), arthralgia/myalgia (56.8%), headache (55.1%), and dry cough (51.8%). Loss of smell (anosmia), loss of taste (ageusia), dyspnea, and productive cough were reported with an onset of 4 days. Anosmia or ageusia were reported by only 18% of the participants at day one, but up to 49% between days 7 and 9. Not all participants who reported ageusia also reported anosmia. Individuals suffering from ageusia without anosmia were at highest risk of hospitalization (OR 6.8, 95% CI 2.5–18.1). They also experienced more commonly dyspnea and nausea (OR of 3.0, 2.9, respectively) suggesting pathophysiological connections between these symptoms. Other symptoms significantly associated with increased risk of hospitalization were dyspnea, vomiting, and fever. Among basic parameters and comorbidities, age > 60 years, COPD, prior stroke, diabetes, kidney and cardiac diseases were also associated with increased risk of hospitalization. In conclusion, due to the delayed onset, ageusia and anosmia may be of limited use in differential diagnosis of SARS-CoV-2. However, differentiation between ageusia and anosmia may be useful for evaluating risk for hospitalization. [ABSTRACT FROM AUTHOR]

Objectives: During the corona pandemic, dental practices temporarily closed their doors to patients except for emergency treatments. Due to the daily occupational exposure, the risk of SARS-CoV-2 transmission among dentists and their team is presumed to be higher than that in the general population. This study examined this issue among dental teams across Germany. Materials and methods: In total, 2784 participants provided usable questionnaires and dry blood samples. Dry blood samples were used to detect IgG antibodies against SARS-CoV-2. The questionnaires were analyzed to investigate demographic data and working conditions during the pandemic. Multivariable logistic mixed-effects models were applied. Results: We observed 146 participants with positive SARS-CoV-2 IgG antibodies (5.2%) and 30 subjects with a borderline finding (1.1%). Seventy-four out of the 146 participants with SARS-CoV-2 IgG antibodies did not report a positive SARS-CoV-2 PCR test (50.7%), while 27 participants without SARS-CoV-2 IgG antibodies reported a positive SARS-CoV-2 PCR test (1.1%). Combining the laboratory and self-reported information, the number of participants with a SARS-CoV-2 infection was 179 (6.5%). Though after adjustment for region, mixed-effects models indicated associations of use of rubber dams (OR 1.65; 95% CI: 1.01–2.72) and the number of protective measures (OR 1.16; 95% CI: 1.01–1.34) with increased risk for positive SARS-CoV-2 status, none of those variables was significantly associated with a SARS-CoV-2 status in fully adjusted models. Conclusions: The risk of SARS-CoV-2 transmission was not higher among the dental team compared to the general population. Clinical relevance. Following hygienic regulations and infection control measures ensures the safety of the dental team and their patients. [ABSTRACT FROM AUTHOR]

Background: During COVID-19-related public health non-pharmaceutical prevention measures, such as social distancing, lockdown periods and use of face masks, a decrease in viral respiratory and gastroenterological infections was observed worldwide. Following discontinuation of preventative measures, a potential increase of respective infections outside of their usual seasons was a matter of concern. Method: We aimed to illustrate annual distribution of confirmed viral infections between 2017 and 2021 based on 32,506 clinical samples in a German pediatric tertiary care center and to explore the impact of the COVID-19 pandemic on the epidemiology of these infections in children. Results: While a decrease in overall viral infections was observed during the first and second lockdown period, an extraordinary increase in the number of viral respiratory infections, predominantly caused by human Rhino-/Enterovirus and respiratory syncytial virus (RSV), was observed after relaxation of preventive measures. Notably, Rhino-/Enterovirus infections increased 4-fold (2020 vs. 2019) and 16-fold (2021 vs. 2019). The occurrence of RSV was observed beginning from June to August 2021 and reached an all-time record with a 25- to 50-fold increase in numbers in September and October 2021 in relation to previous pre-pandemic years (2017–2019). In contrast, for non-respiratory viruses (i.e. Rota-/Norovirus), the effect on respective seasonal patterns was only minimal compared to previous years. Conclusion: The observed increase in respiratory infections in children is worrying and is already causing hospitals to become overburdened. Enhanced vigilance will be key to face clinical challenges due to these epidemiological changes in viral disease patterns in the months to come. [ABSTRACT FROM AUTHOR]

Purpose: Recommendations regarding the optimal number of blood cultures in children are not available. The aim of this article is to describe the correlation between blood culture (BC) rates and laboratory-confirmed bloodstream infection (LCBSI) rates, on different paediatric wards of a tertiary-care centre in Germany. Methods: We conducted a retrospective cohort study in a paediatric university hospital, from 1st January to 31st December 2018. All blood cultures collected from neonatal (NICU) and paediatric intensive-care units (PICU), haematology/oncology, and general paediatric wards were included. There were no exclusion criteria. BC taken/1000 patients-days (BC rates/BCR) and LCBSI/1000 patient-days at risk (LCBSI rates) were calculated for each unit. Results: A total of 6040 patients were admitted to the hospital with 3114 of them into wards studied. Of the 3072 BCs collected, 200 (6.5%) were positive. Collection of BCs was performed in 51/77 (66.2%) of admitted patients on NICU, in 151/399 (37.8%) of PICU patients, in 163/755 (21.6%) of haematology/oncology patients, and in 281/1883 (14.9%) of children on general paediatric wards. Gram-positive bacteria were the most commonly detected organisms in blood cultures from all wards with exception of NICU. The BCR in NICU, PICU, haematology/oncology wards, and general wards were 61.6, 196.2, 358.4, and 52.3, respectively. Excluding commensal pathogens and possible contaminations, the LCBSI rates in the same units were 2.4, 5.6, 4.4, and 1.0, respectively. Conclusion: We found different BCR values according the ward studied, being higher in patients with high risk of bloodstream infection such as haematology/oncology patients. [ABSTRACT FROM AUTHOR]

Background: In some areas of Germany, there is a shortage of specialist physicians for patients with inflammatory rheumatic diseases. Delegating certain medical care services to qualified, specialized rheumatological assistants (SRAs) might be an effective way to supplement the available capacity for specialized medical care. Methods: Patients under stable treatment for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were included in this trial, which was designed to demonstrate, in a first step, the non-inferiority of a form of care involving delegation of physicians' tasks to SRAs (team-based care), in comparison to standard care, with respect to changes in disease activity at one year. "Non-inferiority," in this context, means either superiority or else an irrelevant extent of inferiority. In a second step, in case non-inferiority could be shown, the superiority of team-based care with respect to changes in patients' health-related quality of life would be tested as well. Disease activity was measured with the Disease Activity Score 28, and health-related quality of life with the EQ-5D-5L. This was a randomized, multicenter, rater-blinded trial with two treatment arms (team-based care and standard care). The statistical analysis was performed with mixed linear models (DRKS00015526). Results: From September 2018 to June 2019, 601 patients from 14 rheumatological practices and 3 outpatient rheumatological clinics in the German states of North Rhine--Westphalia and Lower Saxony were randomized to either team-based or standard care. Team-based care was found to be non-inferior to standard care with respect to changes in disease activity (adjusted difference = -0.19; 95% confidence interval [-0.36; -0.02]; p <0.001 for non-inferiority). Superiority with respect to health-related quality of life was not demonstrated (adjusted difference = 0.02 [-0.02; 0.05], p = 0.285). Conclusion: Team-based care, with greater integration of SRAs, is just as good as standard care in important respects. Trained SRAs can effectively support rheumatologists in the care of stable patients with RA or PsA. [ABSTRACT FROM AUTHOR]

Educational reformers all around the globe are continuously searching for ways to make schools more effective and efficient. In Germany, this movement has led to reforms that reduced overall school time of high track secondary schools from 9 to 8 years, which was compensated for by increasing average instruction time per week in lower secondary school (Grades 5–10). Based on prior research, we assumed that this reform might increase gender disparities in STEM-related outcomes, stress, and health because it required students to learn similar content in less amount of time. Therefore, we investigated how the school time reform affected gender disparities at the end of upper secondary school between 2011 and 2013. Specifically, we considered representative data of the last two cohorts who completed lower secondary school before the reform (N = 2,405) and the first two cohorts after the reform (N = 2,413) from the National Educational Panel Study. Potential differences in gender disparities were investigated for upper secondary school outcomes of subject-specific standardized test performance, self-concept, and interest in mathematics, biology and physics, as well as outcomes of school-related stress and health. Overall, we found substantial disparities between girls and boys, which seemed to change little after the reform. Exceptions were the statistically significant gender × reform interactions for one stress dimension (Overload) and two health dimensions (Overburdening and Achievement-related fear) which increased for both boys and girls, but more strongly for girls. [ABSTRACT FROM AUTHOR]

Objective: Cancer patients often use complementary and alternative medicine (CAM). The aim of this study was to assess the expectations of cancer patients towards their general practitioner (GP) regarding information on and offers of CAM procedures. Methods: A standardised anonymous questionnaire was developed and handed out to cancer patients in GP practices and oncology clinics in Germany. Results: One hundred and eighty questionnaires were evaluable. For 88.1% of the patients, it was important that their GP regularly receives information on cancer therapy. Only a minority consulted with the GP regarding diagnosis and therapy of the cancer (32.4%) or approached him about side effects of the therapy (46.9%). About one fifth of the GPs offered CAM. Before the cancer diagnosis, only 7% of the patients received a CAM offer from the GP; after the diagnosis, it was 14%. A large majority wanted the GP to offer more complementary (70.9%) and alternative (54.3%) medicine. Conclusion: Our survey points to a clear mismatch of supply and demand regarding CAM for cancer patients in the primary care sector. Training for GPs on scientific evidence of as well as communication skills on CAM will be indispensable in the future to optimise the care of cancer patients by GPs. [ABSTRACT FROM AUTHOR]

The remediation of heavy-metal-contaminated sites represents a serious environmental problem worldwide. Currently, cost- and time-intensive chemical treatments are usually performed. Bioremediation by heavy-metal-tolerant microorganisms is considered a more eco-friendly and comparatively cheap alternative. The fungus Penicillium simplicissimum KS1, isolated from the flooding water of a former uranium (U) mine in Germany, shows promising U bioremediation potential mainly through biomineralization. The adaption of P. simplicissimum KS1 to heavy-metal-contaminated sites is indicated by an increased U removal capacity of up to 550 mg U per g dry biomass, compared to the non-heavy-metal-exposed P. simplicissimum reference strain DSM 62867 (200 mg U per g dry biomass). In addition, the effect of temperature and cell viability of P. simplicissimum KS1 on U biomineralization was investigated. While viable cells at 30°C removed U mainly extracellularly via metabolism-dependent biomineralization, a decrease in temperature to 4°C or use of dead-autoclaved cells at 30°C revealed increased occurrence of passive biosorption and bioaccumulation, as confirmed by scanning transmission electron microscopy. The precipitated U species were assigned to uranyl phosphates with a structure similar to that of autunite, via cryo-time-resolved laser fluorescence spectroscopy. The major involvement of phosphates in U precipitation by P. simplicissimum KS1 was additionally supported by the observation of increased phosphatase activity for viable cells at 30°C. Furthermore, viable cells actively secreted small molecules, most likely phosphorylated amino acids, which interacted with U in the supernatant and were not detected in experiments with dead-autoclaved cells. Our study provides new insights into the influence of temperature and cell viability on U phosphate biomineralization by fungi, and furthermore highlight the potential use of P. simplicissimum KS1 particularly for U bioremediation purposes. Graphical Abstract [ABSTRACT FROM AUTHOR]

With digitization and the spread of smartphones in many areas of life, mobile devices have also become increasingly relevant in education. While comprehensive research exists especially for smartphone use among teenagers and students, the findings for elementary school students are limited. Based on a survey, this case study provides exploratory insights into the smartphone usage behavior of elementary school students in a rural region in northern Germany. The responses of 33 students in grades 3 and 4 (ages 8 to 10) show that many students already own a smartphone at this age and use it daily, sometimes for several hours, especially for gaming and media consumption. The influence of owning an own smartphone on usage and leisure activities is reviewed. School use is of little relevance among the elementary school students surveyed. [ABSTRACT FROM AUTHOR]

Background: The results of recent surveys indicate that more than 50% of the German population has experience with complementary and alternative medicine (CAM) or uses CAM regularly. This study investigated the CAM usage and CAM-related needs of hospitalized patients at university medical centres in the state of Baden-Württemberg, Germany. Methods: A multi-centre, paper-based, pseudonymous survey was carried out by the members of the Academic Centre for Complementary and Integrative Medicine. Patients of all ages, regardless of sex, diagnosis and treatment, who were hospitalized in the Department of Cardiology, Gastroenterology, Oncology, Gynaecology or Surgery at the university medical centres in Freiburg, Heidelberg, Tübingen and Ulm were eligible for inclusion. Results: Of the 1275 eligible patients, 67% (n = 854) consented to participate in the survey. Forty-eight percent of the study participants stated that they were currently using CAM. The most frequently used therapies were exercise (63%), herbal medicine (54%) and dietary supplements (53%). Only 16% of the patients discussed CAM usage with their attending physician. Half of the patients (48%) were interested in CAM consultations. More than 80% of the patients desired reliable CAM information and stated that physicians should be better informed about CAM. Conclusions: The frequency of CAM usage and the need for CAM counselling among hospitalized patients at university medical centres in Baden-Württemberg are high. To better meet patients' needs, CAM research and physician education should be intensified. Trial registration: German Clinical Trial register (DRKS00015445). [ABSTRACT FROM AUTHOR]

Background: Non‐syndromic congenital ichthyosis describes a heterogeneous group of hereditary skin disorders associated with erythroderma and scaling at birth. Although both severe and mild courses are known, the prediction of the natural history in clinical practice may be challenging. Objectives: To determine clinical course and genotype‐phenotype correlations in children affected by non‐syndromic congenital ichthyosis in a case series from south‐western Germany. Methods: We performed a retrospective observational study of 32 children affected by non‐syndromic congenital ichthyoses seen in our genodermatosis clinic between 2011 and 2020. Follow‐ups included assessment of weight and severity of skin involvement utilizing a modified Ichthyosis Area Severity Index (mIASI). mIASI was calculated as a sum comprising the previously published IASI score and an additional novel score to evaluate palmoplantar involvement. Linear regression was assessed using Pearson correlation, and statistical analysis was performed using the Wilcoxon–Mann–Whitney test. Results: This study included 23 patients with autosomal recessive congenital ichthyosis, seven with keratinopathic ichthyosis and two with harlequin ichthyosis. Cutaneous manifestations improved in more than 70% of the children during the follow‐up. Especially in patients with mutations in ALOXE3 and ALOX12B, mIASI scores dropped significantly. The most common phenotype observed in this study was designated ′mild fine scaling ichthyosis′. Severe palmoplantar involvement occurred in patients with KRT1 and ABCA12 mutations; most patients demonstrated hyperlinearity as a sign of dryness and scaling. Weight was mainly in the normal range and negatively correlated with the severity of skin involvement. Conclusions: Congenital ichthyosis that self‐improves and evolves with mild fine scaling ichthyosis was the most common phenotype observed in our patients. This type might be underdiagnosed if the genetic diagnosis is not performed in the first year of life. mIASI is an easy and fast instrument for scoring disease severity and adding additional points for palmoplantar involvement might be valuable. [ABSTRACT FROM AUTHOR]

As a central goal of the energy transition in Germany, the share of renewable energies is to be increased to over 80% by 2050. Due to fluctuating wind conditions or the day-night cycle, storage systems must be integrated into the supply grid for a continuous regenerative power supply from wind and solar energy. In addition to pumped storage systems, batteries and Power2Gas approaches, compressed gases (optimally air) can also be used for this purpose. The aim of the research and development project presented is to develop such a storage unit with the best possible efficiency and long service life. To this end, basic calculations were first made on possible efficiencies depending on the assumed changes in the state of the working gas. Furthermore a piston compressor for compressed air generation was investigated experimentally with regard to its efficiency. In addition, the compressor was modelled and simulated in a corresponding software. Thus, on the one hand, the efficiency of the existing piston compressor could be determined experimentally and, on the other hand, the simulation model could be assessed with regard to its suitability for the purpose of simulation-based optimization. Measures to increase efficiency can be derived from the results. In addition, it becomes possible to forecast the achievable overall efficiency of such an energy storage system with compressed air. [ABSTRACT FROM AUTHOR]

Extensional tectonics in the Late Paleozoic Central Europe was accompanied by rift magmatism that triggered voluminous intracontinental caldera-forming eruptions. Among these, the Lower Permian Rochlitz Volcanic System (RVS) in the North Saxon Volcanic Complex (Eastern Germany, Saxony) represents a supereruption (VEI 8, estimated volume of 1056 km3) of monotonous rhyolites followed by monotonous intermediates. Mapping, petrography, whole-rock geochemistry along with mineral chemistry and oxygen isotopes in zircon display its complex eruption history and magma evolution. Crystal-rich (> 35 vol%), rhyolitic Rochlitz-α Ignimbrite with strong to moderate welding compaction erupted in the climactic stage after reheating of the magma by basaltic injections. Due to magma mixing, low-volume trachydacitic-to-rhyolitic Rochlitz-β Ignimbrite succeeded, characterized by high Ti and Zr-values and zircon with mantle δ18O. Randomly oriented, sub-horizontally bedded fiamme, and NW–SE striking subvolcanic bodies and faults suggest pyroclastic fountaining along NW–SE-oriented fissures as the dominant eruption style. Intrusion of the Leisnig and the Grimma Laccoliths caused resurgence of the Rochlitz caldera forming several peripheral subbasins. In the post-climactic stage, these were filled with lava complexes, ignimbrites and alluvial to lacustrine sediments. Significant Nb and Ta anomalies and high Nb/Ta ratios (11.8–17.9) display a high degree of crustal contamination for the melts of the RVS. Based on homogenous petrographic and geochemical composition along with a narrow range of δ18O in zircon Rochlitz-α Ignimbrite were classified as monotonous rhyolites. For the Rochlitz-β Ignimbrites, underplating and mixing with basic melts are indicated by Mg-rich annite–siderophyllite and δ18O < 6.0 in zircon. The wide spectrum of δ18O on zircon suggests an incomplete mixing process during the formation of monotonous intermediates in the RVS. [ABSTRACT FROM AUTHOR]

Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. Two intensive care units guided by anesthesiology at a German university hospital. Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. clinicaltrials.org TRN: NCT05071248 ; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred. [ABSTRACT FROM AUTHOR]

Scheduling of megaprojects is very challenging because of typical characteristics, such as expected long project durations, many activities with multiple modes, scarce resources, and investment decisions. Furthermore, each megaproject has additional specific characteristics to be considered. Since the number of nuclear dismantling projects is expected to increase considerably worldwide in the coming decades, we use this type of megaproject as an application case in this paper. Therefore, we consider the specific characteristics of constrained renewable and non-renewable resources, multiple modes, precedence relations with and without no-wait condition, and a cost minimisation objective. To reliably plan at minimum costs considering all relevant characteristics, scheduling methods can be applied. But the extensive literature review conducted did not reveal a scheduling method considering the special characteristics of nuclear dismantling projects. Consequently, we introduce a novel scheduling problem referred to as the nuclear dismantling project scheduling problem. Furthermore, we developed and implemented an effective metaheuristic to obtain feasible schedules for projects with about 300 activities. We tested our approach with real-life data of three different nuclear dismantling projects in Germany. On average, it took less than a second to find an initial feasible solution for our samples. This solution could be further improved using metaheuristic procedures and exact optimisation techniques such as mixed-integer programming and constraint programming. The computational study shows that utilising exact optimisation techniques is beneficial compared to standard metaheuristics. The main result is the development of an initial solution finding procedure and an adaptive large neighbourhood search with iterative destroy and recreate operations that is competitive with state-of-the-art methods of related problems. The described problem and findings can be transferred to other megaprojects. [ABSTRACT FROM AUTHOR]

Background: Autoimmune bullous diseases (AIBD) are rare disorders characterized by autoantibody formation against components of adhesion molecules; in pemphigoid diseases (PD), these are proteins of hemidesmosomes and basement membrane, important for cell‐matrix adhesion in skin and/or mucous membranes. Incidences of these diseases vary considerably between different populations. Objectives: To establish a registry prospectively recruiting all AIBD patients in a geographically well‐defined region in Northern Germany (Schleswig‐Holstein). Methods: Only patients with verified disease (by clinical presentation, histology, direct and/or indirect immunofluorescence and /or ELISA) living in Schleswig‐Holstein were included. Incidences of PD were estimated based on the total number of inhabitants in Schleswig‐Holstein, stratified by birth year and sex. Results: Of 67 patients with PD [35 male, 32 female, mean age 75 (standard deviation 14.3 years)], 83% were patients with bullous pemphigoid [n = 56, 28 male, 28 female, mean age 78 (SD 9.9)]. The resulting crude incidences were 23.4 patients/million/year for all pemphigoid patients, 19.6 patients/million/year for bullous pemphigoid (age‐standardized 16.9 patients/million/year) with a strong increase in bullous pemphigoid patients in the age group of 85–90 years with 262 patients/million/year. Incidences for bullous pemphigoid were higher in urban compared to rural areas. Other PD (mucous membrane pemphigoid, linear IgA disease, anti‐p200 pemphigoid) were less frequent with crude incidences of 2.1, 1.0 and 0.7 patients/million/year, respectively. Conclusions: This study prospectively analyses the incidence of PD in a carefully defined geographical area. The highest incidence among PD patients was found for bullous pemphigoid. The incidence of bullous pemphigoid is considerably increased compared to previous reports and reveals regional differences. Further studies are needed in order to clarify these findings. [ABSTRACT FROM AUTHOR]

Background: Particularly during the early and middle stages of the COVID-19 pandemic, a population's compliance with precautionary measures (e.g., hygiene rules, smart working, travel restrictions, and quarantine) is paramount in preventing the virus from spreading. Objective: The investigation and documentation of different socio-demographic and personality-specific factors in regards to preventative measures and consequent specific health behaviors during the COVID-19 pandemic, based on the Health Belief Model. Method: An online survey was conducted on N = 3,006 individuals living in Germany and Austria during the early stages of lockdown. The questionnaire consisted of a self-administered section, exploring the dimensions posited in the Health Belief Model: perceived severity, perceived susceptibility, perceived barriers, perceived benefits of health-promoting measures, and engagement in health-promoting behaviors. Additionally, the following standardized scales were used to record personality determinants: the Stress Coping Style Questionnaire SVF 78 to evaluate coping and processing strategies in stressful circumstances, the Positive and Negative Affect Schedule (PANAS) to assess the emotional state induced by the coronavirus crisis, the UI-18 scale to diagnose the intolerance of uncertainty, and the State-Trait Anxiety Inventory (STAI) to assess anxiety. Results: In line with the Health Belief model, four groups were created based on perceived susceptibility and engagement in health-promoting behaviors, and consequently studied in relation to personality determinants. Those four groups differed significantly in regards to almost all personality dimensions (p ≤ 0.005). Group 1 (n = 450) shows a reduced engagement with protective measures and displays underestimation of the COVID-19-pandemic. Group 2 (n = 984) displays many positive personality variables and high compliance with protective measures. Group 3 (n = 468) perceives the subjective risk of disease as high, but high emotional discomfort and stress caused by the protective measures leads to the activation of a complex fear defense. Group 4 (n = 1,004) is highly anxious and therefore compliant. Conclusion: This typification has implications for establishing the appropriate support systems. This is particularly important to encourage compliance with preventive regulations within the groups, which showed poor abidance for several reasons. For Group 1, further education on the realistic threat and efficient protective measures is as central as the fostering of empathy for others; with its resource-conscious exemplary behavior Group 2 could be used as a positive social role model. Group 3 would benefit from promoting self-care, while Group 4 requires information on psychosocial assistance availability in order to mitigate the high stress to which the group members are subjected. [ABSTRACT FROM AUTHOR]