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Increasing student numbers, heterogeneity and individual biographies lead to a growing need for personalized support. To meet these challenges, an Individual Digital Study Assistant (IDSA) provides features to help students improve their self-regulation and organizational skills to achieve individual study goals. Based on qualitative expert interviews, a quantitative student survey, and current literature we derived requirements for an IDSA. Based on them, we designed, developed, and implemented a first IDSA prototype for higher education institutions (HEI). We continuously evaluated the prototype within different workshops and analyzed the usage data to improve it further in three enhanced prototypes. Based on this iterative process, we derived guidelines for an IDSA design and development. Accordingly, the framework, project management, content, team selection, team development, team communication, marketing, and student habits are important to consider. The guidelines advance the knowledge base of IDSA in HEI and guide and support practitioners in the design, development, and implementation of IDSA in HEI.

During the COVID-19 pandemic, the availability of online higher education programs and tools has grown rapidly. One example is an individual digital study assistant (IDSA) for students, which provides functionalities to train self-regulation skills, to engage with own educational goals and to offer automated, first-level support to higher education institution (HEI) units and employees. An IDSA further can guide students through HEI and their administration. But, what are the critical success factors (CSF) and challenges for an IDSA? We deduce these using a mixed methods approach with one quantitative student survey, two rounds of interviews with various HEI experts, and a literature review. We classified our results according to the information system (IS) success model of DeLone & McLean (2016). Our results and findings show, e.g., that skilled and reliable HEI personnel, well-organized and useful content, cross-platform usability, ease of use, and students' social factors are essential. Attractive IDSA functionalities are a major challenge because students use many apps, daily. Based on our CSF and challenges, we deduce theoretical and practical recommendations and develop a further research agenda.

Background: Many newborn screening programs worldwide have introduced screening for diseases using DNA extracted from dried blood spots (DBS). In Germany, DNA-based assays are currently used to screen for severe combined immunodeficiency (SCID), spinal muscular atrophy (SMA), and sickle cell disease (SCD). Methods: This study analysed the impact of pre-analytic DNA carry-over in sample preparation on the outcome of DNA-based newborn screening for SCID and SMA and compared the efficacy of rapid extraction versus automated protocols. Additionally, the distribution of T cell receptor excision circles (TREC) on DBS cards, commonly used for routine newborn screening, was determined. Results: Contaminations from the punching procedure were detected in the SCID and SMA assays in all experimental setups tested. However, a careful evaluation of a cut-off allowed for a clear separation of true positive polymerase chain reaction (PCR) amplifications. Our rapid in-house extraction protocol produced similar amounts compared to automated commercial systems. Therefore, it can be used for reliable DNA-based screening. Additionally, the amount of extracted DNA significantly differs depending on the location of punching within a DBS. Conclusions: Newborn screening for SMA and SCID can be performed reliably. It is crucial to ensure that affected newborns are not overlooked. Therefore a carefully consideration of potential contaminating factors and the definition of appropriate cut-offs to minimise the risk of false results are of special concern. It is also important to note that the location of punching plays a pivotal role, and therefore an exact quantification of TREC numbers per μl may not be reliable and should therefore be avoided. [ABSTRACT FROM AUTHOR]

Today, access to real-time information from emergency scenes is still limited for emergency medical services, fire departments, and their professionals, also called first responders. Emergency Response Information Systems (ERISs) have recently been discussed in the literature as a potential solution to this problem. Using the Design Science Research (DSR) paradigm, we present a novel 5G-enabled ERIS (5G-ERIS) design that leverages 5G mobile network technologies to offer diverse real-time information. We provide a user-centered examination of design specifications for a 5G-ERIS based on a smart city digital twin. Based on literature and qualitative expert interviews with several first responders in Germany, we derive how emergency medical services and fire departments can improve their decision-making with this 5G-ERIS. Based on existing 5G application architectures, we structure our identified design specifications into four system layers. Our findings provide an essential knowledge base for the successful development, deployment, and long-term use of 5G-ERISs. We stimulate a broader discussion on the design objectives and specifications of 5G-ERISs in theory and practice. [ABSTRACT FROM AUTHOR]

In the present article we provide evidence for the occurrence of transfer of conceptualization patterns in narratives of two German-Turkish bilingual groups. All bilingual participants grew up in Germany, but only one group is still resident in Germany (n = 49). The other, the returnees, moved back to Turkey after having lived in Germany for thirteen years (n = 35). The study is based on the theoretical framework for conceptual transfer outlined in Jarvis and Pavlenko (2008) and on the typology of satellite-framed and verb-framed languages developed by Talmy (1985, 1991, 2000a, b) and Slobin (1987, 1996, 2003, 2004, 2005, 2006). In the present study we provide evidence for the hypothesis that language structure affects the organization of information structure at the level of the Conceptualizer, and show that bilingual speakers' conceptualization of motion events is influenced by the dominant linguistic environment in both languages (German for the group in Germany and Turkish for the returnees). The returnees follow the Turkish blueprints for the conceptualization of motion, in both Turkish and German event construals, whereas the German-resident bilinguals follow the German blueprints, when speaking German as well as Turkish. We argue that most of the patterns found are the result of transfer of conceptualization patterns from the dominant language of the environment.

Backgr ound: T-cell receptor excision circle (TREC)-based newborn screening (NBS) for severe combined immunodeficiencies (SCID) was introduced in Germany in August 2019. Methods: Children with abnormal TREC-NBS were referred to a newly established network of Combined Immunodeficiency (CID) Clinics and Centers. The Working Group for Pediatric Immunology (API) and German Society for Newborn Screening (DGNS) performed 6-monthly surveys to assess the TREC-NBS process after 2.5 years. Results: Among 1.9 million screened newborns, 88 patients with congenital T-cell lymphocytopenia were identified (25 SCID, 17 leaky SCID/Omenn syndrome (OS)/idiopathic T-cell lymphocytopenia, and 46 syndromic disorders). A genetic diagnosis was established in 88%. Twenty-six patients underwent hematopoietic stem cell transplantation (HSCT), 23/26 within 4 months of life. Of these, 25/26 (96%) were alive at last follow-up. Two patients presented with in utero onset OS and died after birth. Five patients with syndromic disorders underwent thymus transplantation. Eight syndromic patients deceased, all from non-immunological complications. TREC-NBS missed one patient, who later presented clinically, and one tracking failure occurred after an inconclusive screening result. Conclusion: The German TREC-NBS represents the largest European SCID screening at this point. The incidence of SCID/leaky SCID/OS in Germany is approximately 1:54,000, very similar to previous observations from North American and European regions and countries where TREC-NBS was implemented. The newly founded API-CID network facilitates tracking and treatment of identified patients. Short-term HSCT outcome was excellent, but NBS and transplant registries will remain essential to evaluate the long-term outcome and to compare results across the rising numbers of TREC-NBS programs across Europe. [ABSTRACT FROM AUTHOR]

Purpose: Infections with carbapenem-resistant gram-negative bacteria (in Germany classified as 4MRGN) are a growing threat in clinical care. This study was undertaken to understand the overall burden of 4MRGN infections in Germany in the context of a Health Technology Appraisal (HTA) for Ceftazidime/Avibactam (CAZ/AVI). Besides, the incidences mortality was an endpoint of interest. Methods: To assess infections with carbapenem-resistant gram-negative bacteria and related mortality, three different data sources have been used. From the German statistics office (DESTATIS) data have been retrieved to obtain the overall frequency these pathogens. Via two other databases, the German analysis database (DADB) and a Benchmarking of > 200 hospitals in a representative sample (BM-DB), the distribution of the infections and the mortality have been analyzed. Results: DESTATIS data showed a total of 11,863 carbapenem-resistant gram-negative bacteria codings, of which 10,348 represent infections and 1515 carriers. The most frequent infections were complicated urinary tract infections (cUTI) (n = 2,337), followed by pneumonia (n = 1006) and intra-abdominal infections (n = 730). A considerable amount of patients had multiple infections in one hospital episode (n = 1258). In-hospital mortality was 18.6% in DADB and 14.3% in the BM-DB population, respectively. In cases with additional bloodstream infections, DADB mortality was correspondingly higher at 33.0%. DADB data showed an incremental mortality increase of 5.7% after 30 days and 10.0% after 90 days resulting in a cumulative 90 day mortality of 34.3%. Conclusions: Infections with carbapenem-resistant gram-negative bacteria are still rare (6.8–12.4 per 100,000) but show a significant increase in mortality compared to infections with more sensitive pathogens. Using different data sources allowed obtaining a realistic picture. [ABSTRACT FROM AUTHOR]

Aim: According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. Materials and Methods: We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER‐MV; sub‐sample of the Federal State of Mecklenburg‐Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP‐TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. Results: For moderately to severely affected groups, YTL and incidence rates were higher in BARMER‐MV patients (0.35 and 0.18, respectively) than in untreated SHIP‐TREND controls (0.19 and 0.08, respectively). In line, treated SHIP‐TREND participants exhibited higher YTL rates than untreated SHIP‐TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. Conclusion: Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short‐ to mid‐term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long‐term tooth retainment. [ABSTRACT FROM AUTHOR]

Oral health surveys are considered the gold standard for assessing the caries experience of children. Analyses of routine data offer additional opportunities not yet fully explored. This study aimed at estimating the caries treatment experience by mining an insurance claims database. Comprehensive claims data sets were extracted from the data warehouse of a major health insurance company (BARMER, Germany). A surrogate variable for caries experience was formed that reflected the proportion of children without any former potentially caries-related treatment (filling, root canal treatment, and extraction) at ages from 1 to 14 years. The statistical calculations were based on Kaplan-Meier survival analyses. The evaluation for the permanent dentition comprised N = 593,330 children at 6 years and N = 114,568 at 12 years. At 12 years of age, 66.8% had not yet experienced potentially caries-related treatments. This value hints at a significantly higher caries experience at 12 years compared to available epidemiological data. For the deciduous dentition, the respective rates were 74.0% at 6 years and 45.8% at 10 years. Although various sources of bias have to be taken into account, the potential of routine data mining is evident. The approach is supplemental to oral health surveys. It can be useful in coming closer to reality when estimating the caries experience of children. From our results, we conclude that the oral health of up to 14-year-olds in Germany remains in urgent need of improvement. [ABSTRACT FROM AUTHOR]

Background: In 2020, around 1.4 million new prostate cancer (PCa) cases were recorded worldwide. Early detection of PCa by prostate-specific antigen (PSA) screening remains debated, leading to different specialist-specific recommendations in PCa guidelines. This study aimed to assess attitudes toward and use of PSA testing among urologists in Germany and general practitioners (GPs) in Lower Saxony (Germany). Methods: A nationwide questionnaire was sent to urologists via the mailing lists of the Professional Association of German Urologists and the German Urological Society. A version of the questionnaire for GPs was sent to email addresses via the Association of Statutory Health Insurance Physicians Lower Saxony. The online questionnaires covered use of PSA testing, information communication, handling of test results, and handling of/knowledge about national and international guidelines and recommendations on early detection of PCa. Statistical analysis was performed at a descriptive level. Results: In total, 432 of 6,568 urologists (6.6%) and 96 of 1,579 GPs (6.1%) participated in this survey. Urologists and GPs differed in their attitudes and approaches toward PSA testing. Most urologists (86.8%, n=375) judged the test as "very meaningful" or "meaningful", compared with 52.1% (n=50) of GPs. Almost two-thirds of the urologists (64.4%, n=278) viewed the PCa mortality reduction by PSA testing as proven, compared with one-fifth of GPs (20.8%, n=20). Almost 80% of male urologists (79.9%, n=291) indicated that they would undergo a PSA test in the future (again), compared with 55.1% of male GPs (n=38). In addition, 56.3% (n=243) of urologists stated that "considerably more than half" or "almost all" men aged 45 years or older received a PSA test, compared with 19.8% (n=19) of GPs. Conclusions: Urologists are more convinced about the PSA test than GPs. PSA testing is therefore used more often in urological settings, although the preselected patient population must be considered. In accordance with specialist-specific recommendations, GPs show a more reserved approach toward PSA testing. Instead of focusing on different attitudes and recommendations on PSA testing, the exchange between specialist groups should be improved to achieve a consistent approach to PSA testing. [ABSTRACT FROM AUTHOR]

Background: The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis. Methods: Anonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013. Results: Epistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups. Conclusion: The outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets. [ABSTRACT FROM AUTHOR]

Background: Provision of ambulatory care by medical specialists for nursing home residents (NHR) is discussed to be inadequate in Germany, however with only incomplete evidence on this topic. We wanted to know whether the transition to a nursing home is associated with a general decrease in medical specialist care and therefore compared contact rates before and after institutionalization.Methods: Claims data of 18,779 newly admitted NHR in 2013 were followed for the whole year prior to and up to two years after admission. The frequencies of contacts to specialists were assessed and stratified by sex, age, care level, dementia diagnosis and chronic conditions. Multivariate analyses were conducted to identify predictors for contacts to specialists.Results: One year after institutionalization the most pronounced decrease was found in contacts with ophthalmologists (38.4% vs. 30.6%) whereas with most other specialties only small changes were found. The only specialty with a large increase were neurologists and psychiatrists (27.2% vs. 43.0%). Differences depending on sex and age were rather small while NHR with dementia or a higher care level had lower contact rates after institutionalization. Before institutionalization most patients were referred to a specialist by a general practitioner (61.7-73.9%) while thereafter this proportion decreased substantially (27.8-58.6%). The strongest predictor for a specialist contact after admission to a nursing home was a contact to a specialist before (OR 8.8, CI 7.96-9.72 for contacts to neurologists or psychiatrists). A higher nursing care level and a higher age were also predictors for specialist contacts.Conclusions: Relevant decreases of ambulatory specialist care utilization after institutionalization are restricted to ophthalmologists. NHR of higher age and higher nursing care level had a lower chance for a specialist contact. The assessment of the adequacy of the provided care after institutionalization remains inconclusive due to little investigated but assumable changes in care needs of NHR. The decreased coordination of care by general practitioners after institutionalization conflicts with health policy goals. [ABSTRACT FROM AUTHOR]

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Background: Antibiotic resistance is a worldwide problem and inappropriate prescriptions are a cause. Especially among children, prescriptions tend to be high. It is unclear how they differ in bordering regions. This study therefore examined the antibiotic prescription prevalence among children in primary care between northern Netherlands and north-west of Germany. Methods: Two datasets were used: The Dutch (IADB) comprises representative data of pharmacists in North Netherland and the German (BARMER GEK) includes nationwide health insurance data. Both were filtered using postal codes to define two comparable bordering regions with patients under 18 years for 2010. Results: The proportion of primary care patients receiving at least one antibiotic was lower in northern Netherlands (29.8 %; 95 % confidence interval [95 % CI]: 29.3-30.3), compared to north-west Germany (38.9 %; 95 % CI: 38.2-39.6). Within the respective countries, there were variations ranging from 27.0 to 44.1 % between different areas. Most profound was the difference in second-generation cephalosporins: for German children 25 % of the total prescriptions, while for Dutch children it was less than 0.1 %. Conclusions: This study is the first to compare outpatient antibiotic prescriptions among children in primary care practices in bordering regions of two countries. Large differences were seen within and between the countries, with overall higher prescription prevalence in Germany. Considering increasing cross-border healthcare, these comparisons are highly valuable and help act upon antibiotic resistance in the first line of care in an international approach. [ABSTRACT FROM AUTHOR]

Objective Endothelial cell activation by tumor necrosis factor (TNF) and associated leukocyte infiltration are hallmarks of vasculitis. The aim of this study was to investigate the potential role of the cellular stress-associated endothelial X-box binding protein 1 (XBP-1) transcription factor in TNF-induced endothelial cell inflammation and vasculitis. Methods Mice with an endothelial cell-specific XBP-1 deficiency were used in a modified local Shwartzman reaction (LSR) model of TNF-induced small vessel vasculitis. To address the contribution of XBP-1 to the TNF-mediated inflammatory response in endothelial cells, we examined the activation of XBP-1 expression by TNF as well as the effect of XBP-1 knockdown in endothelial cells on TNF-induced signaling, proinflammatory gene expression, and leukocyte-endothelial cell adhesion. Results The active spliced form of XBP-1 in endothelial cells was triggered by TNF. In addition, endothelial XBP-1 contributed to the sustained TNF-triggered NF-κB−dependent transcriptional activation of proinflammatory molecules, which was associated with leukocyte-endothelial cell adhesion. In the LSR model, endothelial cell-specific XBP-1-deficient mice displayed significantly less vascular damage, accompanied by reduced perivascular neutrophil infiltration, as compared with wild-type mice. Conclusion Endothelial XBP-1 is activated by TNF and regulates leukocyte-endothelial cell adhesion in vitro as well as neutrophil infiltration and vascular damage in murine vasculitis. [ABSTRACT FROM AUTHOR]

Grapevine is a perennial crop, which is cultivated intensively over many decades. This provides optimal conditions for viroids, which need several months or years to be fully established in their host. After the viroids are initially introduced through infected planting material, they are easily transmitted through crop management practices. Since most viroids do not lead to strong regular symptoms in grapes, they are considered to be latent, thus unimportant for the grape producer. This might be the reason, why viroids can be found in most, if not all, grape production areas worldwide. Currently, there are six viroids reported to infect grapevines, of which the Australien grapevine viroid is thought to have evolved through recombination of different viroids present in a single host. Studies in the 1980s showed that the hop stunt viroid (HSVd) is present in Germany. However, other viroids are also present and known to induce yellow spots especially under warm weather conditions like the grapevine yellow speckle viroid 1 (GYSVd-1). Because grapevine is a reservoir for hoppathogenic viorids like the HSVd and also global warming is likely to increase symptom severity of GYSVd-1 in the future a preliminary survey and subsequent comparative sequence analysis was conducted to get an up-to-date overview of the infection status of German grapes. The analysis of leaf samples of commercial grape cultivars with reverse transcription and subsequent PCRs show that HSVd and GYSVd-1 are widely distributed in Germany. Furthermore, Sanger sequencing revealed that the dominat HSVd-variant (similar to X06873) is different from variants typically found in other grapes, citrus or hops. The effect of this HSVd-variant as pathogene for hop has not yet been studied. The effect of the "latent" infection of HSVd and GYSVd for grape yield and subsequent wine quality has not yet been determined. These topics need to be addressed in further studies. [ABSTRACT FROM AUTHOR]

The article discusses the armaments strategy of West Germany, or the Federal Republic of Germany (FRG), from 1955 through 1972. The ability of West Germany to project its power, including in regard to its relationship with the United States the North Atlantic Treaty Organization (NATO) and European countries, is discussed. An overview of West Germany's economic development is provided.

Background: Friedreich's Ataxia (FRDA) is a neurodegenerative disorder that causes progressive damage to the central and peripheral nervous systems having a significant impact upon quality of life. With little information in the literature, cross-sectional observational studies were conducted in the UK and Germany to collect data on resource use and the burden of the disease on individuals and their caregivers. Methods: Cross-sectional observational studies were conducted in the UK and Germany to estimate the burden of FRDA on individuals and on the respective healthcare systems. A total of 75 individuals in the UK and 28 in Germany were recruited to the study. Participants in both countries were asked to complete a Patient and Caregiver Information Form (PCIF), regarding access to, and use of, healthcare resources, and the impact FRDA has on their lifestyle. In Germany, doctors were asked to complete a Patient Record Form (PRF). Analyses of annual direct and indirect resource utilization were conducted for both countries while costs were calculated for the UK only. These figures were compared to the costs associated with Parkinson's disease; one of the most common neurodegenerative conditions and the one most similar in terms of disease progression. Results: The results showed that the annual burden of FRDA is significant and falls on the health and social care sectors, on society, on caregivers and on the individuals themselves. In the UK FRDA had a total annual cost per person of between £11,818 and £18,774 depending on whether the cost of long-term unemployment was included. Typically the largest component of direct costs is associated with professional care. Given the high proportion of children and young adults recruited and the long disease duration, (typically 40-50 years for FRDA, compared with 20 years for Parkinson's disease), these figures may underestimate the true burden of the disease. Conclusion: It is hoped that these estimates of resource utilization, can help in understanding the previously unquantified burden of FRDA. Given the long disease duration, management strategies should seek to minimise the impact of the condition on individuals and their caregivers, while maximising quality of life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Field studies guided by genetic monitoring of Vkorc1 need to be done to implicate mutations conclusively with rodent control problems due to the presence of animals resistant to anticoagulant rodenticides. Rodent control success in relation to Vkorc1 genotypes in house mice ( Mus musculus domesticus) was studied on two farms (I and II) in Germany. Tests were carried out to determine whether certain resistance profiles and Vkorc1 genotypes displayed dynamics over the course of sequential treatments with warfarin and difenacoum that were consistent with single nucleotide polymorphisms (SNPs) in Vkorc1 as indicators of resistance. RESULTS: On farms I and II, respectively, three (A to C) and two (A and B) types of control problem with anticoagulants (i.e. proxies for resistance) were encountered in spatially segregated subunits: A = none; B = control problems with warfarin but not with difenacoum; C = control problems with both anticoagulants. Unexpectedly, resistance was encountered in a population where only Vkorc1 wild-type mice were detected. In addition, the Arg58Gly Vkorc1 variant was found not to correlate with observed control failures. CONCLUSION: Control problems were encountered that cannot be explained by Vkorc1 coding or intronic SNPs, and therefore are likely due to non-coding Vkorc1 SNPs or due to other genetic or non-genetic factors. © 2012 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Introduction: To establish strategic priorities for the German national public health institute (RKI) and guide the institute's mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research. Methods: We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups. Results: 127 pathogens were scored. Eighty-six experts participated in the weighting; "Case fatality rate" was rated as the most important criterion. Twenty-six pathogens were ranked in the highest priority group; among those were pathogens with internationally recognised importance (e.g., Human Immunodeficiency Virus, Mycobacterium tuberculosis, Influenza virus, Hepatitis C virus, Neisseria meningitides), pathogens frequently causing large outbreaks (e.g., Campylobacter spp.), and nosocomial pathogens associated with antimicrobial resistance. Other pathogens in the highest priority group included Helicobacter pylori, Respiratory Syncytial Virus, Varicella zoster virus and Hantavirus. Discussion: While several pathogens from the highest priority group already have a high profile in national and international health policy documents, high scores for other pathogens (e.g., Helicobacter pylori, Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings. [ABSTRACT FROM AUTHOR]

Boron Neutron Capture Therapy for liver malignancies is being investigated at the University of Mainz. One important aim is the set-up of a reliable dosimetry system. Alanine dosimeters have previously been applied for dosimetry of mixed radiation fields in antiproton therapy, and may be suitable for measurements in mixed neutron and gamma fields. Material and methods. Two experiments have been carried out in the thermal column of the TRIGA Mark II reactor at the University of Mainz. Alanine dosimeters have been irradiated in a phantom and in liver tissue. Results. For the interpretation and prediction of the dose for each pellet, beside the results of the measurements, calculations with the Monte Carlo code FLUKA are presented here. For the phantom, as well as for the liver tissue, the measured and calculated dose and flux values are in good agreement. Discussion. Alanine dosimeters, in combination with flux measurements and Monte Carlo calculations with FLUKA, suggest that it is possible to establish a system for monitoring the dose in a mixed neutron and gamma field for BNCT and other applications in radiotherapy. [ABSTRACT FROM AUTHOR]

To establish Boron Neutron Capture Therapy (BNCT) for non-resectable liver metastases and for in vitro experiments at the TRIGA Mark II reactor at the University of Mainz, Germany, it is necessary to have a reliable dose monitoring system. The in vitro experiments are used to determine the relative biological effectiveness (RBE) of liver and cancer cells in our mixed neutron and gamma field. We work with alanine detectors in combination with Monte Carlo simulations, where we can measure and characterize the dose. To verify our calculations we perform neutron flux measurements using gold foil activation and pin-diodes. Material and methods. When L-α-alanine is irradiated with ionizing radiation, it forms a stable radical which can be detected by electron spin resonance (ESR) spectroscopy. The value of the ESR signal correlates to the amount of absorbed dose. The dose for each pellet is calculated using FLUKA, a multipurpose Monte Carlo transport code. The pin-diode is augmented by a lithium fluoride foil. This foil converts the neutrons into alpha and tritium particles which are products of the 7Li(n,α)3H-reaction. These particles are detected by the diode and their amount correlates to the neutron fluence directly. Results and discussion. Gold foil activation and the pin-diode are reliable fluence measurement systems for the TRIGA reactor, Mainz. Alanine dosimetry of the photon field and charged particle field from secondary reactions can in principle be carried out in combination with MC-calculations for mixed radiation fields and the Hansen & Olsen alanine detector response model. With the acquired data about the background dose and charged particle spectrum, and with the acquired information of the neutron flux, we are capable of calculating the dose to the tissue. Conclusion. Monte Carlo simulation of the mixed neutron and gamma field of the TRIGA Mainz is possible in order to characterize the neutron behavior in the thermal column. Currently we also speculate on sensitizing alanine to thermal neutrons by adding boron compounds. [ABSTRACT FROM AUTHOR]

International financial centres used to be stable economic clusters held together by the centripetal forces emanating from physical exchanges. However, given near complete 'virtualisation', these 'anchors' have gradually disappeared. As this article demonstrates, this has had telling consequences for second-tier financial centres like Amsterdam and Frankfurt. Empirically, the article adds cases of financial centre decline to the existing collection of case descriptions. Theoretically, the article assesses the explanatory capacity of the combination of two complementary theoretical perspectives, New Economic Geography and Comparative Political Economy, by determining to what extent they fit the two case studies. [ABSTRACT FROM AUTHOR]

The article discusses the developments which took place in international criminal law in the year 2008. It is reported that, in the year 2008 the Extraordinary Chambers in the Courts in Cambodia (ECCC) became the second international criminal tribunal to allow the victims to participate in sentencing proceedings. It is reported that, in the year 2008 the U.S. and Germany agreed to share fingerprint databases and information regarding known and suspected terrorists.

This article traces the location of foreign banks in Germany from 1949 to 2006. As suggested by New Economic Geography models, we find an inverted 'U'-shaped concentration of foreign banks in Germany. Only after a competition between several cities, Frankfurt has emerged as the pre-eminent financial centre, triggered by the 'historical event' of setting up the German central bank in Frankfurt. After a strong increase, Frankfurt's share in the location of foreign banks in Germany decreases slowly but significantly since the mid-1980s. We conclude that there will be a lesser role in Europe for second-tier financial centres in the future. [ABSTRACT FROM AUTHOR]

Background: Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI). To date, no prospective multicenter studies have been published on this topic. Methods: Prospective multicenter surveillance for HAI and nosocomial fever of unknown origin (nFUO) with specific case definitions and standardized surveillance methods. Results: 7 pediatric oncology centers (university facilities) participated from April 01, 2001 to August 31, 2005. During 54,824 days of inpatient surveillance, 727 HAIs and nFUOs were registered in 411 patients. Of these, 263 (36%) were HAIs in 181 patients, for an incidence density (ID) (number of events per 1,000 inpatient days) of 4.8 (95% CI 4.2 to 5.4; range 2.4 to 11.7; P < 0.001), and 464 (64%) were nFUO in 230 patients. Neutropenia at diagnosis correlated significantly with clinical severity of HAI. Of the 263 HAIs, 153 (58%) were bloodstream infections (BSI). Of the 138 laboratory-confirmed BSIs, 123 (89%) were associated with use of a long-term central venous catheter (CVAD), resulting in an overall ID of 2.8 per 1,000 utilization days (95% CI 2.3 to 3.3). The ID was significantly lower in Port-type than in Hickman-type CVADs. The death of 8 children was related to HAI, including six cases of aspergillosis. The attributable mortality was 3.0% without a significant association to neutropenia at time of NI diagnosis. Conclusion: Our study confirmed that pediatric cancer patients are at an increased risk for specific HAIs. The prospective surveillance of HAI and comparison with cumulative multicenter results are indispensable for targeted prevention of these adverse events of anticancer treatment. [ABSTRACT FROM AUTHOR]

In 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system (SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports in 2001-2005. The size of the outbreaks ranged from 2 to 527 cases. For outbreaks reported in 2002-2005, the median duration from notification of the first case to the local health department until receipt of the outbreak report at RKI was 7 days. Median outbreak duration ranged from 1 day (caused by Campylobacter) up to 73 days (caused by Mycobacterium tuberculosis). The most common settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were households (5,262; 53%), nursing homes (1,218; 12%), and hospitals (1,248; 12%). SurvNet may be a useful tool for other outbreak surveillance systems because it minimizes the workload of local health departments and captures outbreaks even when causative pathogens have not yet been identified. [ABSTRACT FROM AUTHOR]

The American Forces who occupied Germany in 1945–46 had hoped that popularising jazz music might assist in the redemocratisation of Germans under the age of thirty. The Amerika-Häuser established by the US State Department to build a cultural foundation for democracy amongst younger Germans, and American Forces Network radio each contributed to the gradual emergence of a West German jazz culture which was marked by a series of jazz festivals and the development of a viable recording industry. However most strata of German society neither understood nor cared about jazz. Jazz became confused with — and diluted by — rock ‘n’ roll. Both were rejected as unwanted “Americanization”. Fewer than ten percent of teenagers acquired any taste for jazz. Its appeal was confined to the more privileged and educated. Hence the jazz culture which did recruit itself from the surviving remnants of the Third Reich did not provide an impetus toward democracy. [ABSTRACT FROM AUTHOR]

Background: This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. Methods: We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). Results: From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3-26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2- 23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1-47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. Conclusions: Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks. [ABSTRACT FROM AUTHOR]

This paper uses a value chain approach to identify possible patterns of spatial (re)organisation resulting from the implementation of information and communication technologies (ICT) in wholesale financial services. Although ICT can be used to split up production processes and thus increase mobility, proximity – not only spatial but also cultural, organisational and professional – remains essential for the financial industry. Thus, while ICT may induce a ‘re–bundling’ of functions among financial centres, location continues to be a relevant factor. An analysis of the value chains of three financial products is presented with a focus on implications for the financial centre in Frankfurt. Frankfurt is a particularly interesting case study of this phenomenon as it is one of the centres for the development of ‘financial technology’, such as computer–based trading systems with remote access. [ABSTRACT FROM AUTHOR]

Focuses on the development of emission models to improve the quality and the spatial and temporal resolution of emission data in Germany. Determination of emissions and volatile organic compounds (VOC) split from lignite firings, gas stations and exhaust gases of passenger cars; Measurement of benzene emissions from gas stations; Calculation of emissions from combustion sources in the industrial sector.

Abstract Background: This analysis was based on an oral health survey with dental examination and interview by questionnaire. Method: The data set comprised a representative random sample of the over 14-year-old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.00≤1.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN). Results: The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01–0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01–0.08) for score 4. Further significant variables were: self-evaluation of tooth condition, gender, and the number of missing teeth. [ABSTRACT FROM AUTHOR]

Objective: To find out whether wide local resection is adequate treatment for patients with benign tumours of the papilla of Vater. Design: Retrospective study. Setting: University hospital, Germany. Subjects: 31 patients with benign tumours out of a total of 129 with lesions of the ampulla of Vater treated between May 1978 and February 1995. Interventions: Histological examination of specimens before, during, and after the operation. Main outcome measures: Sensitivity and positive predictive value of histologial examination, and outcome of treatment. Results: Histological examination before and during the operation had a sensitivity of 89% and 97%, respectively. 28 patients were treated by wide excision of the ampulla and 3 by pylorus-preserving partial pancreaticoduodenectomy. At a median follow up of 43 months (range 6–156) there was no evidence of recurrent disease. Conclusion: Wide excision of the ampulla with reconstruction and reimplantation of the duct is adequate treatment for benign lesions. If the histological picture is uncertain, partial pancreaticoduodenectomy is justified in patients at low risk. [ABSTRACT FROM AUTHOR]

Examines the role of jazz during the Third Reich from the vantage point of the history of the ordinary listening public in Germany. Factors defining the antagonism between National Socialism and jazz; Publicist polemics that supported the Nazi invective against jazz; Regional and local measures taken against jazz; Control of the live performances of jazz musicians.

In the realm of the sociology of medicine, for example, we still do not know enough about physician-patient relationships from, say, the founding of the Second Empire to the present. On the assumption, based on the meager evidence available, that this relationship had an authoritarian structure from the physician on downward, did it have anything to do with the shape of German medicine in the Weimar Republic and, later, the Third Reich? Another relative unknown is the role of Jews in the development of medicine as a profession in Germany. Surely volumes could be written on the significant influence Jews have exerted on medicine in its post-Wilhelmian stages, as well as the irreversible victim status Jewish doctors were forced to assume after Hitler's ascension to power. In this essay I shall attempt, first of all, to deal with the fate of Jewish physicians and, to a lesser extent, with that of their patients during the Third Reich. I shall then trace the historical antecedents of the anomalies of the medical profession during the period of the Third Reich; and finally, I will discuss the question of the consequences of these anomalies in post-Second World War Germany. [ABSTRACT FROM AUTHOR]

Profiles doctor Leonardo Conti in Germany. Effort to consolidate the individual jurisdiction of the health sector; Educational background; Factors to influence the failure of Conti in establishing a centralized medicine.

Presents the biographical literature of dictator Adolf Hitler in Germany. Position in the society; Views of Hitler on the Catholic Church being an institution; Uncertainty of Hitler on his own social station.

This article comments on the review of the book "Who Voted for Hitler?" The author says that the reviewer reports that the author had explored voting patterns in Germany's ten or so largest cities. This imprecision disappears in a subsequent paragraph when he declares the safest title for the author's book to be "Who Voted for Hitler in the Affluent Quarters of Ten Large Cities?" The author says that the reviewer announces several objections to the book's claims. The reviewer repeated assertion of the book's narrow and exclusive focus on the large city upper-class districts is belied at many points throughout the book, something indicated already in the previous paragraph. The problem, misrepresented contents, appears most glaringly in his complaint about the final chapter, for not actually saying whom it was that voted for Hitler. The author says that the reviewer reports that the author's review of provincial and rural territory during this period is only perfunctory, as no voting records were available to him. In reply to this comment the reviewer says that he conceded minor points of criticism, which the author objects to.

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Simple Summary: More than 80 million male piglets are castrated every year within the first week of life mostly without pain relief in the EU. Castration is performed to prevent boar taint, to minimize aggressive and sexual behavior associated with intact males and to gain a constant quality of meat. It is an important animal welfare issue to eliminate pain caused by castration. Local anesthesia, meaning the sole injection of a local anesthetic into the testicles and in the surrounding tissue of conscious piglets, prior to castration is a currently discussed method in Germany. Thus, it was the aim of the present study to investigate the effect of four local anesthetics (procaine, lidocaine, bupivacaine and mepivacaine) on pain relief during surgical castration in conscious piglets. To assess pain, defensive behavior of piglets undergoing injection and castration was evaluated. In addition, attention was paid to possible side effects. Considering healing, bleeding and weight gain no negative impacts were observed, but impairments of locomotor activity occurred. The results indicate that lidocaine and mepivacaine are able to achieve significant pain relief during the castration procedure, whereas procaine and bupivacaine only during the severing of the spermatic cord. The aim of the present study was to investigate the effect of four local anesthetics on pain relief during surgical castration under standardized conditions in conscious piglets. Therefore, 71 male piglets (three to seven days) were distributed into control groups (handling, castration without anesthesia or analgesia) and local anesthetic trial groups (procaine, lidocaine, bupivacaine, mepivacaine). Then, 20 min prior to castration, animals of the treatment groups, except piglets in the handling group, received an injection of a local anesthetic or sodium chloride of 0.5 mL intratesticularly and 0.5 mL subscrotally. During injection and castration, defensive behavior was evaluated. Locomotor activity, as well as postoperative bleeding, wound healing and average daily weight gain were assessed to detect side effects. The injection caused increased defensive movements, significantly in the bupivacaine group. Lidocaine and mepivacaine significantly reduced defensive movements during castration, and procaine and bupivacaine only during severing of the spermatic cord. Impairments of locomotor activity were found in piglets injected with lidocaine, bupivacaine or sodium chloride. Considering healing, bleeding and weight gain, no negative impacts were observed. In conclusion, lidocaine and mepivacaine were able to achieve significant pain relief during the castration procedure, whereas procaine and bupivacaine only during the severing of the spermatic cord. Moreover, the injection of bupivacaine seemed to be painful itself. [ABSTRACT FROM AUTHOR]

Objectives: While gout is a well-known entity, little research has been conducted on its pathophysiology. There is growing evidence that women with hyperuricemia are at higher cardiovascular risk than men with hyperuricemia. We aim to evaluate whether gender-specific cut-offs should be considered.Study Design: Cross-sectional study (the German Health Interview and Examination Survey for Adults; DEGS1).Main Outcome Measures: Self-reported gout or hyperuricemia and uric acid level.Results: Of 6,918 participants (mean age 47.2 years; 50.5% females), 9.7% had had a diagnosis of hyperuricemia or gout at least once in their lifetime. Men were nearly twice as often affected as women (12.9 vs. 6.5%). In women, the prevalence of cardiovascular and renal diseases increased with higher uric acid level to a much greater extent than in men. This association remained in multivariate analyses.Conclusions: No commonly accepted cut-off value for uric acid has been established. Overall, women were at lower risk of hyperuricemia. However, women were at higher risk of having cardiovascular and renal comorbidities, even at lower uric acid levels. Our results are in line with the accumulating evidence that we should consider gender in gout and hyperuricemia. [ABSTRACT FROM AUTHOR]

Background: Due to the increasing number of non-urgent visits to emergency departments, it is becoming increasingly important to also investigate emergency care in out-of-hours (OOH) primary care. The aim of this study was to provide an insight into the care structures of an OOH primary care centre, to evaluate the reasons for encounter (RFE) and to assess the urgency of the treatment from the physicians´ point of view. Methods: In the summer of 2017, we conducted a cross-sectional study over four weeks in the OOH primary care centre of Oldenburg, a city in Lower Saxony with about 160,000 inhabitants. We collected socio-demographic data, RFE and the duration of the complaints. The International Classification for Primary Care 2nd Edition (ICPC-2) was used to categorize symptoms. The attending physicians supplemented information on further treatment (including hospitalization) and the urgency of consultation in the OOH primary care centre. Results: A total of 892 of the 1098 OOH patients which were visiting the OOH primary care centre took part in the study (participation: 81.2%). More than half of the patients were between 18 and 39 years old. A quarter of all RFE named by study participants were in the ICPC-2 category "skin". More than 60% of patients had the symptoms for more than two days before visiting the OOH primary care centre. In 34.5% of all cases no medication was prescribed and one in six patients received further diagnostic tests such as urinalysis and blood tests (15.8%). From the physicians' point of view, 26.3% of all study participants could have been treated by the family doctor during the regular consultation hours. Conclusion: The study shows that in the OOH primary care centre about a quarter of all patients could have waited until regular consultation hours. Mostly young patients used the easily accessible and free care in the OOH primary care centre. Further studies are necessary to better understand the individual reasons of patients to use the OOH primary care centre. [ABSTRACT FROM AUTHOR]

Patent foramen ovale (pfo) has been associated with cryptogenic stroke in young individuals, but the association is less clear in older individuals where other causes of stroke predominate. Thus, this study from Germany is of interest. Out of 596 patients admitted to their stroke center, 503 were able to undergo transesophageal echocardiography (TEE), and thus formed the study population. They also had head CT, MRI, or both and carotid artery duplex sonography. Cerebral angiography by MRI or contrast, before transarterial thrombolysis, was done in 231 (46%). In addition, transthoracic echo and ECG were done, and those suspected of having atrial fibrillation had 24-hour Holter monitoring. Before TEE, the TOAST criteria were applied to classify the patients into one of the 4 known-causes of strokes or cryptogenic stroke. TEE was done a median of 2 days after the stroke with contrast and Valsalva. Results: Of the 503 patients, 26% were younger than 55 years of age. A cause of stroke could be identified before TEE in 55% of the patients. The rest were classified as cryptogenic (63% younger and 39% of the older patients). The prevalence of PFO was significantly greater in patients with cryptogenic stroke vs known cause stroke in the younger (44% vs 14%, OR 4.7, P < .001) and older patients (28% vs. 12%, OR 2.9, P < .001), as was the prevalence of PFO with atrial septal aneurysm (13 vs 2%, OR 7.4 younger and 15 vs 4% or 3.9 in the older). Multivariate analysis showed that PFO was independently associated with cryptogenic stroke in both groups (OR 3.7 young and 3.0 older). Handke and colleagues concluded that PFO with paradoxical embolism is a cause of cryptogenic stroke at all ages. [ABSTRACT FROM AUTHOR]

Walter MH, Schuette U, Raedel M, Koch R, Wolf B, Scheuch K, Kirch W. Oral health-related quality of life and oral status in a German working population. Eur J Oral Sci 2011; 119: 481-488. © 2011 Eur J Oral Sci The study aim was to identify predictors of impaired oral health-related quality of life (OHRQoL). Employees of five companies were offered a clinical full-mouth examination. Oral health-related quality of life was measured with the German version of the Oral Health Impact Profile (OHIP) and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Two logistic regression models were developed for the odds of increased scores of the target variables OHIP-ADD and OHIP-SC. The target variables were dichotomized, and for the OHIP-ADD, the cut-off point for having impaired OHRQoL was heuristically defined as OHIP-ADD > 34. For the OHIP-SC, the corresponding threshold was OHIP-SC > 0. In the model for the OHIP-ADD, female gender, impaired aesthetics, few posterior occluding pairs, and painful masticatory muscles proved to be significant independent variables. For the OHIP-SC, female gender, impaired aesthetics, painful masticatory muscles, joint sounds, missing mandibular teeth, and carious teeth were significant. This cross-sectional study showed that within the models for both OHIP-ADD and OHIP-SC the high-risk person for impaired OHRQoL is a woman with impaired aesthetics and painful masticatory muscles. [ABSTRACT FROM AUTHOR]

LITTLE IS KNOWN ABOUT THE LONG-TERM PROGNOSIS OF THE no-reflow phenomenon after percutaneous intervention (PCI) for acute ST elevation myocardial infarction (STEMI). Thus, these investigators from Munich, Germany, studied 1,406 patients with STEMI presenting within 24 hours of symptom onset and undergoing PCI by scintigraphic infarct size measurement 7-14 days after PCI. No-reflow was defined as TIMI flow grade ≤ 2 or a TIMI flow grade of 3 but a TIMI perfusion grade of ≤ 1 at 10 minutes after PCI. The primary endpoint was five years mortality. Results: No-reflow occurred in 410 of the 1,406 patients (29%). No-reflow patients were, in general, older, more often had prior bypass surgery, and had higher-peak troponin, CK-MB, and high-sensitivity CRP levels. Also, no-reflow patients had a longer time from symptom onset to hospital admission and were more likely to have multivessel disease. Scintigraphic MI size was larger in the no-reflow group (15% vs. 8%, p < 0.001). Mortality at five years was higher in the no-reflow group (18.2% vs. 9.5%, p < 0.001). MI size and the incidence of no-reflow were significantly associated. Multivariate predictors of five-year mortality included noreflow, age, diabetes, killip class, CRP, multivessel disease, and infarct size. After adjusting for these predictors, the hazard ratio for no-reflow confirmed that it is an independent predictor of five-year mortality (HR = 1.7, 95% CI 1.2-2.4, p = 0.004). The authors concluded that no-reflow is a strong predictor of five-year mortality in STEMI patients treated with PCI, and that no-reflow provides independent prognostic information beyond infarct size. [ABSTRACT FROM AUTHOR]

The article offers information on the postoperative care of patients having undergone pancreatic surgery. It discusses the diagnosis of pancreatic diseases and therapy of medium and long term consequences of pancreatic surgery. As stated, about 10,000 surgical pancreatic operations are performed annually in Germany. A table of post-operative complications in patients with chronic pancreatitis is also presented.