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Future transport systems will rely on new electrified drives utilizing batteries and hydrogen-powered fuel cells or combustion engines with sustainable fuels. These systems must complement each other and should not be viewed as competing. Properties such as efficiency, range, as well as transport and storage properties will determine their use cases. This article looks at the usability of liquid electro-fuels in freight transport and analyzes the production capacities that will be necessary through 2050 in Germany. Different scenarios with varying market shares of electro-fuels are considered. A scenario with a focus on fuel cells foresees a quantity of 220 PJ of electro-fuels, i.e., 5.1 million tons, which reduces 80% of carbon dioxide emissions in LDV and HDV transport. A further scenario achieves carbon-neutrality and leads to a demand for nearly 17 million tons of e-fuel, corresponding to 640 PJ. Considering a final production rate of 5.1 million tons of electro-fuels per year leads to maximum investment costs of around EUR 350 million/year in 2036 during the ramp-up phase. The total investment costs for synthesis plants amount to EUR 4.02 billion. A carbon-neutrality scenario requires more than a factor 3 for investment for the production facilities of electro-fuels alone. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups. Methods: Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions. Results: Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI:.117;.126) while engaging in more sedentary behavior (M = 0.24; 95% CI:.240;.247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines. Conclusions: Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks. [ABSTRACT FROM AUTHOR]

Reducing the heat demand of existing buildings is an essential prerequisite for achieving a greenhouse gas-neutral energy supply. Numerous studies and open-source tools deal with heat demand mapping. It is not uncommon that estimated heat demands deviate from real heat consumption, so existing approaches should be improved by including in-depth building information. Some tools have recognised this problem and offer built-in functions for factoring various parameters into their assessments. Nevertheless, the necessary information is usually missing and should be obtained first. In this paper, we analyse the impact of thermal refurbishment and climate on building heat demand; hence, generate public datasets with corresponding key figures for each building type in different efficiency states and years. Accounting for already performed refurbishments in methodologies for assessing the actual state heat demand for cities will result in a reduction of at least 8% up to more than 21%, depending on whether conventional or passive house components were installed. As a result of climatic differences within Germany, a building's heat demand can be up to 39% higher or up to 21% lower than the heat demand of an identical building in the reference climate of Germany. By further developing the approaches of the tools Hotmaps and Heat Cadastre Hamburg, we could improve the estimated heat demand of Hamburg to a value approximating the real consumption. [ABSTRACT FROM AUTHOR]

Global socio-environmental challenges and local impacts, global agendas, and local implementation: multi-level governance has never been more important – or more complex. To keep track of progress and the challenges in sustainable urban development, monitoring systems at all levels are at different stages of development and in need of harmonisation. In this context, national reporting can link the global level with the local one by identifying and reviewing framework conditions, and setting indicator and data standards for cities, counties, and municipalities. This raises questions about the awareness of different issues, resource imbalances and, not least, the effectiveness of standardised monitoring. This paper provides valuable insights into the lessons learned from the preparation of the first national progress report on the implementation of the New Urban Agenda. The reflections could support further governance and monitoring efforts not only at the national level but also across all levels. [ABSTRACT FROM AUTHOR]

Purpose: In Germany, colorectal robot-assisted surgery (RAS) has found its way and is currently used as primary technique in colorectal resections at our clinic. We investigated whether RAS can be extensively combined with enhanced recovery after surgery (ERAS®) in a large prospective patient group. Methods: Using the DaVinci Xi surgical robot, all colorectal RAS from 09/2020 to 01/2022 were incorporated into our ERAS® program. Perioperative data were prospectively recorded using a data documentation system. The extent of resection, duration of the operation, intraoperative blood loss, conversion rate, and postoperative short-term results were analyzed. We documented the postoperative duration of Intermediate Care Unit (IMC) stay and major and minor complications according to the Clavien–Dindo classification, anastomotic leak rate, reoperation rate, hospital-stay length, and ERAS® guideline adherence. Results: One hundred patients (65 colon and 35 rectal resections) were included (median age: 69 years). The median durations of surgery were 167 min (colon resection) and 246 min (rectal resection). Postoperatively, four patients were IMC-treated (median stay: 1 day). In 92.5% of the colon and 88.6% of the rectum resections, no or minor complications occurred postoperatively. The anastomotic leak rate was 3.1% in colon and 5.7% in rectal resection. The reoperation rate was 7.7% (colon resection) and 11.4% (rectal resection). The hospital stay length was 5 days (colon resection) and 6.5 days (rectal resection). The ERAS® guideline adherence rate was 88% (colon resection) and 82.6% (rectal resection). Conclusion: Patient perioperative therapy per the multimodal ERAS® concept is possible without any problems in colorectal RAS, leading to low morbidity and short hospital stays. [ABSTRACT FROM AUTHOR]

Objectives: Patients with peripheral arterial occlusive disease (PAOD) are at risk of worsening limb symptoms, major adverse cardiovascular events and exhibit an impaired life expectancy. There is a lack of evidence on the extent of pharmacological secondary prevention in PAOD patients. This study assesses treatment patterns of antithrombotic agents in symptomatic PAOD patients. Methods: This is a retrospective cohort study using data from the second largest insurance fund in Germany, BARMER. We included symptomatic PAOD patients undergoing in-hospital treatment with an index admission between 1 January 2010 and 31 December 2017. Outcomes were proportions of single antiplatelets (SAPT), dual antiplatelets (DAPT), vitamin-K antagonists (VKA), or direct oral anticoagulants (DOAC) in the 12 months prior and 6 months after the index hospitalization. Non-parametric cumulative incidence for competing risks was estimated to account for censoring and death after discharge from hospital stay. Patient flows were visualised by alluvial diagrams. All analyses were stratified by intermittent claudication (IC) and chronic limb-threatening ischaemia (CLTI). The protocol was registered to ClinicalTrials.gov (NCT03909022). Results: A total of 80,426 unique patient encounters were identified. Mean age was 72.7 (46.3% female). Amongst all patients, 25.6% were on SAPT, 4.1% on DAPT, 9.1% on VKA, 3.9% on DOAC, 3.9% on both antiplatelets and oral anticoagulation, and 53.3% without any antithrombotic therapy during the 12 months before index stay. The estimated cumulative incidence was 37.9% SAPT, 14.8% DAPT, 7.5% VKA, 4.3% DOAC, 7.4% both, and 28.1% without any antithrombotic therapy during the 6 months after index stay. The considerable increases in antiplatelet therapy were mainly driven by the group of patients without antithrombotics before index stay. As compared with IC, patients who suffered from CLTI received less often antiplatelets but more often anticoagulants both before and after index stay. Conclusions: Utilisation rates of antithrombotic therapy increased considerably after in-hospital treatment for PAOD. Yet, remarkably high rates of symptomatic patients without any blood-thinning therapy constitute a major concern with respect to adequate secondary prevention of PAOD patients. [ABSTRACT FROM AUTHOR]

As one of the founding states of the European Union (EU) and a long-standing member of the North Atlantic Treaty Organisation (NATO), Germany has made significant contributions to both organisations and to European security. Despite being frequently accused as a free rider, this article claims that Germany takes the position of balancer in the EU-NATO relationship whereby it facilitates cooperation through mediating between both organisations and their member states. This article analyses Germany's role and conceptualises it as balancer in interorganisational relations. As a member of both organisations, the debates concern how Germany can make effective use of its geographical, cultural and economic positions to contribute to European security. It takes a 'midstream' position in which it balances between the EU and NATO and among other member states. This article argues that due to its expansive network of bilateral and minilateral relations, Germany emphasises its role as balancer by using its diplomatic skills to broker among fellow member states. A well-working and amicable EU-NATO relationship is indispensable for its own interests. This paper therefore takes into account its particular position and capabilities as well as its multilateral linkages to examine how Germany positions itself as balancer in the EU-NATO relationship. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and related containment measures are affecting mental health, especially among patients with pre-existing mental disorders. The aim of this study was to investigate the effect of the first wave and its aftermath of the pandemic in Germany (March–July) on psychopathology of patients diagnosed with panic disorder, social anxiety disorder and specific phobia who were on the waiting list or in current treatment at a German university-based outpatient clinic. From 108 patients contacted, forty-nine patients (45.37%) completed a retrospective survey on COVID-19 related stressors, depression, and changes in anxiety symptoms. Patients in the final sample (n = 47) reported a mild depression and significant increase in unspecific anxiety (d =.41), panic symptoms (d =.85) and specific phobia (d =.38), while social anxiety remained unaltered. Pandemic related stressors like job insecurities, familial stress and working in the health sector were significantly associated with more severe depression and increases in anxiety symptoms. High pre-pandemic symptom severity (anxiety/depression) was a risk factor, whereas meaningful work and being divorced/separated were protective factors (explained variance: 46.5% of changes in anxiety and 75.8% in depressive symptoms). In line with diathesis-stress models, patients show a positive association between stressors and symptom load. Health care systems are requested to address the needs of this vulnerable risk group by implementing timely and low-threshold interventions to prevent patients from further deterioration. [ABSTRACT FROM AUTHOR]

Biodiversity loss, as often found in intensively managed agricultural landscapes, correlates with reduced ecosystem functioning, for example, pollination by insects, and with altered plant composition, diversity, and abundance. But how does this change in floral resource diversity and composition relate to occurrence and resource use patterns of trap‐nesting solitary bees? To better understand the impact of land‐use intensification on communities of trap‐nesting solitary bees in managed grasslands, we investigated their pollen foraging, reproductive fitness, and the nutritional quality of larval food along a land‐use intensity gradient in Germany. We found bee species diversity to decrease with increasing land‐use intensity irrespective of region‐specific community compositions and interaction networks. Land use also strongly affected the diversity and composition of pollen collected by bees. Lack of suitable pollen sources likely explains the absence of several bee species at sites of high land‐use intensity. The only species present throughout, Osmia bicornis (red mason bee), foraged on largely different pollen sources across sites. In doing so, it maintained a relatively stable, albeit variable nutritional quality of larval diets (i.e., protein to lipid (P:L) ratio). The observed changes in bee–plant pollen interaction patterns indicate that only the flexible generalists, such as O. bicornis, may be able to compensate the strong alterations in floral resource landscapes and to obtain food of sufficient quality through readily shifting to alternative plant sources. In contrast, other, less flexible, bee species disappear. [ABSTRACT FROM AUTHOR]

While the 2030 agenda addresses the United Nation member states primarily at their national levels, municipalities play a crucial role in implementing all of the 17 SDGs and many of the 169 targets. These processes must be monitored and evaluated. However, the UN indicators are not sufficiently applicable to the local context. Therefore, a multi-stakeholder working group was formed in Germany to develop a comprehensive set of Sustainable Development Goal (SDG) indicators for municipalities, together with additional instruments to support local SDG monitoring such as an SDG data portal. The first catalogue which included 47 core SDG indicators was published in 2018. According to consecutive evaluations and practical tests, the indicator set was substantially expanded and revised to a final number of 120 SDG indicators. About half of the 120 indicators are provided with local-level data and the other half must be assessed individually for comprehensive local SDG monitoring. Likewise, accompanying tools were relaunched with additional functionalities. Although this new and unique set of indicators now covers a majority of the municipally relevant targets, there are still some decisive monitoring gaps for various reasons. The strengths and weaknesses of our methodological approach, as well as implications for future research and practical developments, are discussed. [ABSTRACT FROM AUTHOR]

Background: Body mass index (BMI) at hospital admission in patients with anorexia nervosa (AN) represents a prognostic marker for mortality, chronicity and future body weight. The current study focused on the associations between BMI standard deviation score (BMI-SDS) at admission and reasons for seeking inpatient treatment. Further interest was given to the relationship between premorbid weight and weight at admission, as well as the effect of both weight at referral and reasons for admission on treatment outcome. Methods: Data ascertained in the German Register of Children and Adolescents with AN were analysed to assess the parental and patient overlap for 23 predefined reasons for admission, using factor analyses and regressions models. Results: Complete parent-patient data sets were available for 360 patients out of 769. The highest consensus rates between parents and patients were obtained for weight and eating behavior related reasons and hyperactivity. Based on factor analysis, four factors emerged. Premorbid BMI-SDS, age and 'low body weight' as stated by patients or parents explained almost 40% of the variance of the BMI-SDS at admission. Conclusions: Results underscore the relevance of age and premorbid BMI for BMI at admission. Only single reasons for admission explained further variance, with 'low body weight' having the largest effect. Approximately 40% of the variance of BMI-SDS was explained. For the first time, the effect of premorbid BMI for BMI at admission was robustly demonstrated in a multicenter study. Of the variance in BMI-SDS at discharge, our model could explain 37%, with reasons for admission having a small effect. Further investigation of the reasons for admission would be worthwhile to improve treatment and prognosis. [ABSTRACT FROM AUTHOR]

Background and purpose: Prevalence data are needed to reveal trends regarding the pediatric multiple sclerosis (MS) situation worldwide. The aim was to identify changes in MS diagnosis prevalence in pediatric patients over a 10‐year period in Germany. Methods: This analysis is based on nationwide outpatient claims data of children aged <18 years covered by the German statutory health insurance (n = 11,381,939 in 2018). People with MS (PwMS) had ≥1 documented MS diagnosis (International Classification of Diseases, 10th Revision, German modification code G35.x). The annual pediatric MS diagnosis prevalence was analyzed regarding age, sex, and place of residence during 2009–2018. Results: The prevalence of pediatric MS developed from 5.3 (2009) to 5.4 (2018)/100,000 insured population aged <18 years. The MS prevalence in patients aged 15–17 years showed a moderate increase over 10 years (19.6–22.7/100,000), whereas patients ≤14 years old showed a slight decrease (1.9–1.7/100,000). The sex ratio (female:male) in 2018 was relatively balanced in PwMS aged ≤14 years (1.32) but female‐dominated in those aged 15–17 years (2.47). The formerly different prevalence of pediatric MS between East and West Germany has converged since 2012. Conclusions: So far, this is the largest study of pediatric MS prevalence in terms of source population size (87% of German children <18 years of age, n = 11,381,939 in 2018) and study period (2009–2018) worldwide. The analyses revealed an increase in MS prevalence and a female‐dominated sex ratio in "older" adolescents compared to younger patients. [ABSTRACT FROM AUTHOR]

In most general education classrooms in Germany, students with and without special educational needs are taught together. To support teachers in adapting instruction to these heterogeneous classrooms, we have developed learning progress assessment (LPA) and reading instructional materials, the Reading Sportsman (RS), in line with the theoretical framework of data-based decision-making, which has led to beneficial effects in several studies. However, data from these studies have not been analyzed to examine effects for low-performing readers. Data within and across six quasi-experimental studies conducted by our team in Grades 2 to 4 were reanalyzed to examine the effects of LPA on students whose reading fluency scores were at or below the 25th percentile (n = 1,346 students from 264 classes). In each study, students had been assigned to a control group (with business-as-usual instruction), an LPA group only, or an LPA-RS group (i.e., with teachers provided with LPA and the RS). Separate multilevel regression results were integrated by means of meta-analytical methods to investigate the consistency of results. Overall, findings from the single studies indicated no positive effects of LPA with or without the RS compared with the control group. The integrated analyses showed small positive effect trends on reading fluency and intrinsic reading motivation. [ABSTRACT FROM AUTHOR]

Due to human‐induced climate and landscape changes, distribution and abundance of many ungulate species have increased worldwide. Especially in areas where natural predators are absent, hunting is the essential management tool for regulating ungulate populations. Therefore, understanding the factors associated with harvest rates is the first step toward an adaptive management approach. Weather influences hunter and ungulate behavior and thus presumably harvest, but how and which meteorological parameters are linked to harvest numbers have rarely been evaluated. We used nearly 65,000 "sit and wait" and driven hunt harvests of roe deer (Capreolus capreolus) in Bavaria, Germany, and weather data from 2008 to 2017 to test for factors affecting roe deer harvests (i.e., temperature, rain hours, wind speed, sunshine duration, snow depth, workdays vs. weekends, month) using zero‐inflated negative binomial mixed‐effect models. Our results reveal that, besides workdays, high temperatures and prolonged rain resulted in fewer harvested animals, whereas sunshine duration in summer and snow height in snow‐rich areas partially favored harvests during sitting hunts in summer and winter, respectively. The influence of wind speed varied over the course of the year. In summer and autumn, wind speed commonly had a negative effect, positively affecting harvests in winter in some regions. Daily harvest numbers decreased during the summer and autumn hunting periods (May till mid‐October), while they increased during the winter period (mid‐October till mid‐January). Interestingly, harvest success during driven hunts, which are planned well in advance and therefore take place largely independent of weather conditions, was similarly affected by the weather. This result suggests that the inferred weather influence is not only due to the hunters' decisions but also due to deer behavior. Since many ungulate populations may further benefit from climate change, building an understanding of the relationship between hunting success and weather will aid adaptive ungulate management. [ABSTRACT FROM AUTHOR]

Objectives: In Germany, the initial step of electronic waste (e-waste) recycling frequently takes place in sheltered workshops for physically and mentally handicapped workers (Werkstätten für behinderte Menschen (WfbM), in german language). E-waste recycling involves a potential risk of exposure to toxic metals. Therefore, we assessed the occupational exposure of recycling workers to toxic metals to identify potential health risks and insufficient protective measures. Methods: We used a combined air- and bio-monitoring approach to determine exposure of recycling workers to toxic metals. Air and urine samples were collected in five sheltered workshops in Germany and were analysed for their content of aluminium, antimony, arsenic, beryllium, cadmium, chromium, cobalt, mercury and nickel. Results were compared to German and international occupational limit values and to metal exposures of workers in conventional e-waste recycling firms. Results: Exposure of recycling workers in five German sheltered workshops to the studied metals and their compounds was below German and international occupational limit values across all facilities studied considering both air and urine samples. Workers in the present study were not exposed to higher amounts of toxic metals than workers in conventional e-waste recycling firms. Conclusion: This is the first study on toxic metal exposure of recycling workers in sheltered workshops. The results of this study revealed a low occupational exposure of e-waste recycling workers to toxic metals in this type of enterprises. Current work methods and safety measures provide the workers with adequate protection. [ABSTRACT FROM AUTHOR]

Background: Home postpartum care is a major part of midwifery care in Germany. The user perspective plays an increasingly important role in the evaluation of health services, but there is a lack of valid and theoretically based measuring instruments, especially in midwifery care. The aim of this study was to develop and validate an instrument for measuring quality of midwifery care in the postpartum period from the perspective of women.Methods: The following steps were taken to achieve this: (1) definition of the goals of midwifery work; (2) literature-based item development; (3) item selection based on a pre-test (n = 16); (4) item reduction and investigation of factor structure by means of explorative factor analysis (EFA; n = 133);(5) second EFA (n = 741) and confirmatory factor analysis (CFA; n = 744) based on a split representative sample survey; (6) hypothesis-based testing of correlations to sociodemographic characteristics of women and to characteristics of care.Results: Measurement of Midwifery quality postpartum (MMAYpostpartum) consists of three scales with a total of 17 items which were found to have acceptable internal consistency: Personal Control (Cronbach's alpha = .80), Trusting Relationship (Cronbach's alpha = .87) and Orientation and Security (Cronbach's alpha = .78). CFA verified and confirmed three factors: CFI = .928, TLI = .914, RMSEA = 0.073.Conclusion: MMAYpostpartum is a predominantly valid, reliable short tool for evaluating the quality of midwifery care postpartum. It can be used to evaluate midwifery care, to compare different care models and in intervention research. It thus supports the orientation of midwives' work towards the needs of women and their families. [ABSTRACT FROM AUTHOR]

Individual differences in dispositional coping might influence how ambiguous situations involving interactions of men and women are interpreted and remembered. Specifically, we hypothesized that women with a sensitive coping style actively maintain ambiguously threatening stimuli in their memory, showing so-called sensitive maintenance. As a prerequisite to investigate this hypothesis, two surveys (Studies 1 and 2; N = 151 and N = 252) were conducted to answer the questions whether fear of sexual assault is of relevance for young women in Germany and whether ambiguous (rather than only unambiguously threatening) situations are experienced to a significant extent. After confirming this for our target population, our main hypothesis was tested in Study 3 (N = 192) by combining tasks assessing the appraisal and the forgetting of nonthreatening, threatening, and ambiguous pictures showing interactions of men and women, and by varying the cognitive load during the retention interval. Whereas fear of rape predicted the appraisal of pictures, coping dispositions predicted forgetting of ambiguously and unambiguously threatening pictures in the hypothesized way. Results are discussed from the perspective of adaptivity and functionality of memory. [ABSTRACT FROM AUTHOR]

Aspects of open science and scholarly practices are often discussed with a focus on research and research dissemination processes. There is currently less discussion on open science and its influence on learning and teaching in higher education, and reversely. This paper discusses open science in relation to educational practices and resources and reports on a study to investigate current educational practices from the perspective of open science. We argue that offering students opportunities via open educational practices raises their awareness of future open science goals and teaches them the skills needed to reach those goals. We present online survey results from 210 participants with teaching responsibility at higher education institutions in Germany. While some of them try to establish more open learning and teaching settings, most respondents apply rather traditional ways of learning and teaching. 60% do not use open educational resources – many have not even heard of them – nor do they make their courses open for an online audience. Participants' priority lies in resource accuracy and quality and we still see a gap between the benefit of open practices and their practicability and applicability. The paper contributes to the general discussion of open practices in higher education by looking at open science practices and their adaptation to the learning and teaching environment. It formulates recommendations for improvements of open practice support and infrastructure. [ABSTRACT FROM AUTHOR]

Weighted voting institutionalises inequality in international organisations. How is it possible that states accept rules that formally privilege some over others even though this contradicts the sovereign equality of states and norms of democratic decision-making? This contribution to a special issue about global stratification shows that arguments about equality can actually serve to justify inequality in international institutions. This can be seen in moves by the German government to justify its proposals for a reform of voting in the Council of the European Union (1995–2008). Successive German governments focused on arguments about democracy based on the equality of states and of citizens to justify their push for a more privileged position for Germany in the Council. Efficiency also figured as a justification but was clearly less prominent. [ABSTRACT FROM AUTHOR]

The problem of declining membership in Germany's churches has been apparent for almost half a century. However, few scientific studies have investigated the respective influences of demographic and church-specific phenomena, as well as the potential impact if present trends continue. To answer these questions, we use a cohort component model and project the membership of each German Catholic diocese and Protestant regional church until 2060. Thus, for the first time we present a projection of church members for each of the 27 Catholic (arch-) dioceses and the 20 Protestant regional churches, as well as for the entire Evangelical Church and the Roman Catholic Church in Germany. We collected data from dioceses, Protestant regional churches and the Federal Statistical Office. Under the assumptions made, the results suggest a continued decline in membership and that by 2060 the number of church members would be half the number of 2017. Protestant Church membership would have shrunk slightly more than Catholic Church membership. We can conclude that church-specific factors (baptisms, leaving, and joining the church) would have a stronger influence on declining numbers than demographic factors. Moreover, demographic change would have a greater impact on registered church membership than on the total population. The proportion of Christians in the population would sharply decrease. Although in 2017 54.4 percent of the population belonged to one of the two major churches, according to the projection model, only 31.1 percent would be church members in 2060. As our results are not predictions but projections using trend analysis, we show how changed conditions would affect the projected development in five scenarios. [ABSTRACT FROM AUTHOR]

Saterland Frisian (Sfrs. Seeltersk) is the only living remnant of Old East Frisian. It is an endangered language, with an estimated number of 2250 speakers (Stellmacher 1998: 27) and is spoken in the municipality of the Saterland (Sfrs. Seelterlound), which is located in the federal state of Lower Saxony in northwestern Germany. [ABSTRACT FROM AUTHOR]

In this article, author talks about the social governance, education and socialist rule of law in China. Topics discussed include information on the adoption of aspects of liberal international law in China; discussions on the role of social institutions in a legal environment; discussions on the Republic of China adopted a Western-style legal code based on the German civil law tradition; and the information on the 18th Congress of Chinese Communist Party held in November 2012.

Background The study examined the association of social support with mental health, subjective work ability and psychological consultation. Methods The cohort study included 1886 German employees (40–54 years) with sickness absence exceeding six weeks in 2012. Postal surveys were carried out in 2013 and 2015. Results After adjustment for socio-demographic data, work-related characteristics and personality factors, persons with low social support compared to high social support had poorer mental health (b =−4.96; 95% CI: −7.11 to −2.81) and a lower work ability index (b =−1.10; 95% CI −2.00 to −0.21). Low social support was not associated with increased odds of consulting a psychologist (OR =1.30; 95% CI: 0.86–1.96). Conclusions Low social support is an independent predictor of poorer mental health and lower work ability. This study highlights the importance of identifying people who have limited access to social support. [ABSTRACT FROM AUTHOR]

Two years after the first European record in Italy, we report the first occurrence of the parasitoid wasp Leptopilina japonica Novković & Kimura, 2011 (Hymenoptera: Figitidae) in Germany. The species is a larval‐pupal parasitoid of Drosophila suzukii (Matsumura, 1931) (Diptera: Drosophilidae), which is a widespread invasive and economically important pest of soft‐skinned fruit. In total, we found 29 specimens of L. japonica in five different locations in southern and western Germany in the years 2021, 2022 and 2023. We examined the specimens morphologically and generated their DNA barcodes for identification. In three of the locations, L. japonica was sampled from raspberries. In two locations, L. japonica was caught in two and three consecutive years, respectively, which indicates adventive establishment. As D. suzukii and L. japonica originate from the same region in Asia, the possible establishment of L. japonica could be a case of unintentional biological control in Germany. In addition to this first record in Germany, we present a diagnosis of L. japonica to distinguish the species from the rest of the European Leptopilina fauna. [ABSTRACT FROM AUTHOR]

This study examines the use of natural environments for recreation among immigrants and factors that led to changes in their use of natural environments between home and host countries. The data were collected through individual interviews with 13 Latino and 13 Chinese immigrants in the U.S., 15 Ukrainian and 11 Vietnamese immigrants in Poland, 9 Moroccan immigrants in the Netherlands and 9 Turkish immigrants in Germany. The findings show that changes in the use of natural environments for recreation are related to different types of nature in home and host countries, access-related issues, quality of natural environments, work focus among immigrants, transportation problems, cultural differences, lack of knowledge of opportunities, life stage and ageing. Based on the findings, we develop a model that outlines different types of interaction with natural environments among immigrants following their settlement in the host countries. [ABSTRACT FROM PUBLISHER]

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion: The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available. [ABSTRACT FROM AUTHOR]

Introduction: A wide range of factors influence coordination and continuity of care. The aim of this study was to explore how management continuity of cardiovascularrelated ambulatory care is influenced by the following network characteristics: presence of a case coordinator, network reciprocity, network composition and team climate. Methods: This cross-sectional observational study included three written surveys. The primary outcome management continuity of cardiovascular care was measured with the team/cross-boundary scale in the Nijmegen Continuity Questionnaire. The final analysis comprised a multivariate linear multilevel model with the predictors: presence of a case coordinator, network reciprocity, network composition and team climate. Results: Eighteen general practices with 83 health workers and 340 patients participated. The linear multilevel regression analysis showed a positive influence of team climate on cross-boundary continuity of care (b-coefficient 0.44, 95% confidence interval 0.09-0.78, p = 0.02). No statistically significant influence was measured for the other predictors. Discussion: To improve integrated care, therefore, emphasis should also be placed on promoting the team climate within individual practices. Regarding network characteristics, further research is needed, especially in larger practices. Conclusion: This study showed that team climate had an independent, relevant and statistically significant association with cross-boundary continuity of cardiovascular ambulatory care. [ABSTRACT FROM AUTHOR]

A dual training system or programme tries to balance education (in a school) and training (in a company) in an equal manner to qualify, educate and socialise the next generation. Besides these effects (qualification, education and socialisation), it seems that this dual structure enables a country to achieve economic targets (e.g. economic growth) and social objectives (e.g. the integration of young people into the employment market), which is why attempts are being made in various countries to develop or to preserve dual training structures. This study focuses on emerging dual training programmes in the United States of America. Our questions are: How do German companies establish dual structures in the United States of America? How do they shape the cooperation between companies and schools? As the cooperation aspect will be the focus of the article, we will concentrate on the interface between the schools and the companies. Our theoretical reference is the concept of boundary objects; a concept within the tradition of cultural-historical activity theory. Using this concept, we show how and in which way dual training structures and an innovative workplace learning partnership have being established in a German transplant in the USA. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a standardized, patient-oriented, biopsychosocial back school after implementation in inpatient orthopedic rehabilitation.Methods: A multi-center, quasi-experimental controlled study of patients with low back pain (n=535) was conducted. Patients in the control group received the traditional back school before implementation of the new program (usual care); patients in the intervention group received the new standardized back school after implementation into routine care. Patients' illness knowledge and conduct of back exercises (primary outcomes) and secondary self-management outcomes and treatment satisfaction were obtained at admission, discharge, and 6 and 12 months after rehabilitation.Results: We found a significant small between-group intervention effect on patients' illness knowledge in medium- to long term (6 months: η2=0.015; 12 months: η2=0.013). There were trends for effects on conduct of back exercises among men (6 and 12 months: η2=0.008 both). Furthermore, significant small effects were observed for treatment satisfaction at discharge and physical activity after 6 months.Conclusions: The standardized back school seems to be more effective in certain outcomes than a usual care program despite heterogeneous program implementation.Practice Implications: Further dissemination within orthopedic rehabilitation may be encouraged to foster self-management outcomes. [ABSTRACT FROM AUTHOR]

What is known and objective Patients' drug administration errors are often promoted by poor drug knowledge resulting from inadequate oral or written information. It has previously been shown that a medication plan enhanced with graphical and textual information on drug handling (enhanced medication plan) proved to immediately increase patients' drug knowledge. This study aimed to evaluate the effect of the enhanced medication plan on drug knowledge in outpatients after 2 months (intervention group) compared to patients with a simple medication plan with standard information (control group). Methods We recruited patients using ≥5 drugs in four family practices in Germany. After inclusion, patients' knowledge on handling of their drugs was assessed using three questions from a standardized catalog. Thereafter, patients were randomized to the intervention or control group. After 2 months, drug knowledge was reassessed with three different questions from the same standardized catalog. Results and discussion Of 120 enrolled patients, 75% of participants in the control group (42/60 patients) and 78% of participants in the intervention group (46/60; P = 0·71) completed the study. Baseline drug knowledge was similar in both groups (43·7% vs. 40·6% correct answers). After 2 months, patients' drug knowledge showed an absolute increase of 23·2% in the intervention group ( P < 0·01) and was unchanged in the control group (46·0%; P = 0·70). What is new and conclusion The enhanced medication plan outperformed the effect of a simple medication plan and persistently increased the fraction of correct answers of polypharmacy patients. This demonstrates that the enhanced medication plan may be a useful tool in promoting drug knowledge. [ABSTRACT FROM AUTHOR]

Introduction: The increase of multidrug-resistant organisms in hospitals causes problems in nursing homes. Staff in geriatric nursing homes are at greater risk of MRSA colonisation. The aim of the study was to describe the occupational exposure to MRSA among health personnel in geriatric nursing. Methods: A point prevalence survey was conducted among health personnel and residents of geriatric nursing homes within the greater Hamburg district. Nasal swabs and, where relevant, wound swabs were collected for the screening survey. Risk factors for MRSA colonisation were identified by means of a questionnaire and using the files held on the residents. Where tests on nursing staff were positive, a control swab was taken; when the results were confirmed positive, decolonisation was performed. The responsible general practitioners were notified of positive MRSA findings among residents. A molecular biological examination of the MRSA samples was performed. Results: A total of 19 institutions participated in the study. Nasal swabs were taken from 759 nursing staff and 422 residents. Prevalence of MRSA was 1.6% among staff and 5.5% among residents. MRSA colonisation among health personnel indicated a correlation with male gender (OR 4.5, 95% CI 1.4–14.1). Among the residents, chronic skin diseases (OR 3.2, 95% CI 1.0–10.3) and indwelling devices (OR 3.2, 95% CI 1.2–8.1) were identified as risk factors. No link between MRSA in residents and in health personnel could be established. Conclusion: The number of MRSA colonisations among nursing staff and residents of geriatric nursing homes in Hamburg was rather low at 1.6% and 5.5% respectively and equates to the results of other surveys in non-outbreak scenarios. [ABSTRACT FROM AUTHOR]

A standardized curriculum back school (CBS) has been recommended for further dissemination in medical rehabilitation in Germany. However, implementation of self-management education programs into practice is challenging. In low back pain care, individual factors of professionals could be decisive regarding implementation fidelity. The study aim was to explore attitudes and experiences of professionals who conducted the back school. Qualitative interviews were led with 45 rehabilitation professionals. The data were examined using thematic analysis. Three central themes were identified: (a) “back school as a common thread,” (b) “theory versus practice,” and (c) “participation and patient-centeredness.” The CBS and its manual were frequently described positively because they provide structure. However, specified time was mentioned critically and there were heterogeneous perceptions regarding flexibility in conducting the CBS. Theory and practice in the CBS were discussed concerning amount, distribution, and conjunction. Participation and patient-centeredness were mainly mentioned in terms of amount and heterogeneity of participation as well as the demand for competences of professionals. Factors were detected that may either positively or negatively influence the implementation fidelity of self-management education programs. The results are explorative and provide potential explanatory mechanisms for behavior and acceptance of rehabilitation professionals regarding the implementation of biopsychosocial back schools. [ABSTRACT FROM AUTHOR]

The article presents the author's views on the relationship between National Socialism and the degenerate art concept in the 19th century, highlighting art after 1945. German artists Gerhard Richter and Sigmar Polke reportedly exaggerated problems related to degenerate art while Richter refused to paint concentration and extermination camps to return dignity to victims. Also discussed are the National Socialist's cultural barbarism and destruction of modernism in Germany, the book "Entartung" by Max Nordau, and Nazi's art policy.

Background: Structured exercise programs provide considerable health benefits for cancer patients. Therefore, various OnkoAktiv (OA) networks were established in Germany with the aim to connect cancer patients with certified exercise programs. However, knowledge about the integration of exercise networks into cancer care systems and conditions of interorganisational collaboration is lacking. The aim of this work was to analyse the OA networks to guide further network development and implementation work. Methods: We used methods of social network analysis within a cross-sectional study design. Network characteristics were analysed such as node and tie attributes, cohesion and centrality. We classified all networks into their level of organisational form in integrated care. Results: We analysed 11 OA networks with 26 actors and 216 ties on average. The smallest network counted 12 actors/56 ties, the largest 52/530. 76% of all actors operated within the medical/exercise sector, serving 19 different medical professions. In smaller "linkage" networks, several individual professionals were linked "from service to service", whereas the more integrated networks revealed a core-periphery-structure. Discussion: Collaborative networks enable the involvement of professional actors from different operational fields. This study provides an in-depth understanding of underlying organisational structures that provides information for further development of exercise oncology provision. Trial registration: Not applicable, as no health care intervention was performed. [ABSTRACT FROM AUTHOR]

Despite the increasing frequency of avian influenza (AI) cases in wild birds in Europe during the last decade, doves and pigeons were not recognized to be part of the AI epidemiology. Here we describe a natural, lethal HPAIV infection of subtype H5N1, clade 2.3.4.4b, in a wood pigeon (Columba palumbus) in Germany, 2022. The animal was housed in a bird sanctuary that suffered an HPAI-outbreak with multiple bird species affected. The pigeon's post mortem findings were dominated by an acute lymphohistiocytic meningoencephalitis as well as neuronal necrosis in the grey matter of the cerebral hemispheres and in the brain stem. Influenza A viral antigen was associated to these alterations with a striking ependymal and periventricular distribution most probably indicating intraventicular liquorogenic spread of the virus. In addition, typical severe multifocal to coalescing necrotizing pancreatitis was evident. Occasionally, vascular endothelial cells showed an intense viral antigen staining. Examination of oropharyngeal and cloacal swabs and of various tissues by real-time RT-PCR corroborated systemic infection with highly pathogenic (HP) AIV of subtype H5N1. Viral loads soared in brain and pancreas samples. Full genome sequencing directly from brain tissue confirmed the assignment of the virus to clade 2.3.4.4b of the goose/Guangdong lineage bearing a polybasic hemagglutinin cleavage site. Our results demonstrate the principal susceptibility of wood pigeons to HPAIV H5N1 resulting in a sporadic infection. Considering the wide distribution and roaming of wild, feral, and racing pigeons with often close contact to humans, thorough investigation of suspected cases including pathological manifestation is advisable. • Systemic infection by high pathogenicity avian influenza virus in a wood pigeon. • Neurogenic viral tropism showing intraventricular, liquorogenic virus spread. • Full genome sequence identifies virus as a rare genotype of H5N1, clade 2.3.4.4b. • Suspected HPAIV cases in pigeons require careful examination. [ABSTRACT FROM AUTHOR]

A reading experiment was designed to examine the effects of word boundaries and metrical structure on the temporal alignment of the accentual peak and the end of the fall in nuclear rising-falling accents. Participants were speakers of a number of closely related dialects and languages from the coastal area of the Netherlands and North-West Germany, covering Zeelandic Dutch, Hollandic Dutch, West Frisian, Dutch Low Saxon, German Low Saxon, and Northern High German. Our findings suggest that in no variety is the timing of the nuclear peak or the end of the fall systematically affected by the location of the final word boundary or that of the following stress. In most cases, the accentual peak was found to be stably aligned with the beginning of the nuclear accented syllable, while the end of the fall occurred at a fairly constant distance from the preceding F0 peak. These findings do not support a representation of the nuclear fall by a sequence of a high accentual tone and a 'phrase accent' that is secondarily associated to a postnuclear stress. In addition, we found substantial cross-linguistic variation in the overall timing of the beginning and end of the fall. One component in this variation is a geographically gradient shift in the alignment of the pitch gesture. [ABSTRACT FROM AUTHOR]

Increasing international labor migration has important effects on the workforce composition of firms in all migrant-receiving countries. The consequences of these changes for firm performance have attracted growing attention in recent years. In this paper, we focus explicitly on the impact of cultural diversity among migrant employees on the innovativeness of firms. We briefly synthesize empirical evidence from a range of contexts across Europe, North America, and New Zealand. We then utilize two unique and harmonized linked employer-employee datasets to provide comparative microeconometric evidence for Germany and the Netherlands. Our panel datasets contain detailed information on the generation of new products and services, determinants of innovation success, and the composition of employment in establishments of firms over the period 1999 to 2006. We find that innovation in both countries is predominantly determined by establishment size and industry. Moreover, obstacles encountered and organizational changes faced by firms drive innovation too. With respect to the composition of employment, the presence of high-skilled staff is most important. Cultural diversity of employees has a positive partial correlation with product innovation. The size and statistical significance of this effect depends on the econometric model specification and the country considered. We conclude from the literature synthesis and the new comparative evidence that cultural diversity of employees can make a positive, but modest and context dependent, contribution to innovation. [ABSTRACT FROM AUTHOR]

Background: The increase of multidrug-resistant organisms (MDROs) causes problems in geriatric nursing homes. Older people are at increased a growing risk of infection due to multimorbidity and frequent stays in hospital. A high proportion of the elderly require residential care in geriatric nursing facilities, where hygiene requirements in nursing homes are similar to those in hospitals. For this reason we examined how well nursing homes are prepared for MDROs and how effectively protect their infection control residents and staff. Methods: A cross-sectional study was performed on infection control in residential geriatric nursing facilities in Germany 2012. The questionnaire recorded important parameters of hygiene, resident and staff protection and actions in case of existing MDROs. Results: The response was 54% in Hamburg and 27% in the rest of Germany. Nursing homes were generally well equipped for dealing with infection control: There were standards for MDROs and regular hygiene training for staff. The facilities provided adequate protective clothing, affected residents are usually isolated and hygienic laundry processing conducted. There are deficits in the communication of information on infected residents with hospitals and general practitioners. 54% of nursing homes performed risk assessments for staff infection precaution. Conclusion: There is a growing interest in MDROs and infection control will be a challenge in for residential geriatric nursing facilities in the future. This issue has also drawn increasing attention. Improvements could be achieved by improving communication between different participants in the health service, together with specific measures for staff protection at work. [ABSTRACT FROM AUTHOR]

Objectives: Recently, a new interpretation problem of trends in period life expectancy has been discussed in the demographic literature. The so-called tempo effects arise if large numbers of deaths are suddenly postponed. In such conditions, the life table inflates longevity gains in the population because it weights avoided deaths with the full remaining life expectancy. This article explains how such effects occur and indicates their relevance using an illustrative example. Study Design and Setting: Data of East and West Germany from the Human Mortality Database for the years 1990e2009 were used. We simulated a scenario that contrasts the observed life expectancy in West and East Germany with an alternative one based on the assumption of short-term postponements of deaths. Results: Our example demonstrates that if tempo effects have distorted changes in life expectancy, the pace of improvement in underlying mortality conditions could be over- and underestimated. Conclusion: We recommend that the assumptions of the life table, in this case about the remaining life expectancy of avoided deaths, are carefully evaluated in all applications. Interdisciplinary efforts to develop models to detect and quantify tempo effects from life expectancy calculations should be put on the research agenda. [ABSTRACT FROM AUTHOR]

European ash ( Fraxinus excelsior) is threatened by Hymenoscyphus pseudoalbidus, the agent of ash dieback disease. Beside ordinary ash dieback symptoms, collar rots have been reported on declining ashes as an additional problem of increasing severity. Since 2009, ash dieback has been surveyed annually in a provenance trial on four different sites in southwest Germany (Metzler et al. in Ger J For Res 183:168–180, 2012 ). The trial was established in 2005. Data of tree growth, ash dieback symptoms and collar rot prevalence were collected by surveying the trial in summer 2012 and compared with previously published data of the trial. Evaluations revealed a continuous and considerable increase in dieback severity since 2009. The results suggest that the infection process has not come to a standstill yet. Up to 2012, 6 % of the trees remained symptomless, whereas mortality added up to 9 %. There were significant differences in ash dieback severity between the investigated provenances. Collar rot prevalence ranged from 19 to 59 % between study sites. Moreover, high spatial dependency of collar rot prevalence could be detected within sites. Collar rots were more abundant on trees of severe ash dieback intensity, but could also be detected on 15 % of otherwise healthy trees. Mycelium from collar rots could be identified by means of RFLP analyses and sequencing of the ITS region as most likely belonging to Armillaria gallica. The possible roles of Armillaria spp. and H. pseudoalbidus in collar rot formation are discussed. [ABSTRACT FROM AUTHOR]

To evaluate the outcomes of kidney transplantations (KTs) in the Eurotransplant Senior Program (ESP) with a focus on the very old, defined as recipients ≥75 years. This retrospective clinical study included 85 patients, who under the ESP protocol underwent deceased donor kidney transplantation from January 2010 to July 2018 at the Charité–Universitätsmedizin Berlin in Germany. Recipients were divided in three age groups, i.e., Group 65–69, Group 70–74, Group ≥75, and compared. Prognostic risk factors for short and long-term outcomes of kidney transplantations were investigated. Graft survival at 1 and 5 years were respectively 90.7% and 68.0% for group 65–69, 88.9% and 76.2% for Group 70–74, and 100% and 71.4% for Group ≥75. Patient survival at 1 and 5 years were respectively 92.9% and 68.0% for Group 65–69, 85.7% and 61.5% for Group 70–74 and 100% and 62.5% for Group ≥75. Serum creatinine did not significantly differ between the three groups, with the exception of serum creatinine at 1 year. Increased recipient age and prolonged time on dialysis correlated with increased occurrence of postoperative complication. An increase in BMI, pretransplant diabetes mellitus and prolonged time on dialysis correlated with the occurrence of delayed graft function (DGF). History of smoking was identified as an independent risk factor for events of rejection. Increased human leukocyte antigen mismatches (HLA-MM) and prolonged cold ischemia time (CIT) correlated with higher rates of intensive care unit (ICU) treatment. This study supports kidney transplantations for the very old. End-stage renal disease (ESRD) patients ≥75 years of age who underwent kidney transplantation experienced comparable results to their younger counterparts. A comprehensive evaluation of ESRD patients with consideration of prognostic risk factor is the most suitable mean of identifying adequate kidney transplant candidates. [ABSTRACT FROM AUTHOR]

Background: Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component. Aims: The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic HF. Methods: In a cross-sectional study of 318 patients with chronic systolic HF recruited in 48 German primary care practices, we evaluated the patient-reported European HF Self-care Behaviour scale (EHFScBs) assessments (range 12–60, where lower scores indicate better self-care). Potential determinants included socio-demographic (e.g. age, living status), clinical (e.g. NYHA class, LVEF, NT-proBNP levels, co-morbidities), behavioural (e.g. smoking and alcohol intake), psychosocial (SF-36 scales and KCCQ domains, e.g. quality of life and self-efficacy) and depression status (PHQ-D), plus previous health care utilisation. Mixed regression modelling was applied. Results: Patients had a mean (SD) age of 69.0 (10.4) years and were 71% male. They had a good overall EHFScBs score of 24.7 (7.8) (n=274). In the final regression model (n=271), six determinants were retained (β; descriptive p-value): self-efficacy (-0.24; <.001), age (-0.22; <.001), prosthetic heart valve (-0.14; .01), referrals to cardiologists (-0.14; .02), peripheral arterial disease (0.13; .03) and quality of life (0.16; .02). Conclusion: In this exploratory cross-sectional study, the potential non-modifiable and modifiable risk factors and resources involved in patients’ HF self-care were at the individual and organisational level. Self-efficacy and quality of life are potentially modifiable, so these could be targeted for improvement by enhancing patient motivation, HF education and further supporting a collaborative care approach. [ABSTRACT FROM AUTHOR]

Background: In Germany, a multidisciplinary rehabilitation named "behavioural medical rehabilitation" (BMR) is available for treatment of chronic low back pain (clbp). A central component of BMR is standard exercise therapy (SET), which is directed mainly to improve physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with clbp. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is unclear. Methods/design: To compare the effectiveness of two exercise programs with different approaches within BMR on the effects of BMR a prospective randomized controlled trial (RCT) in two rehabilitation centres will be performed. 214 patients aged 18-65 with clbp will be, based on an "urn randomisation"-algorithm, randomly assigned to a BMR with SET (function-oriented, n=107) and BMR with BET (behaviour-oriented, n=107). Both exercise programs have a mean duration of 26 hours in three weeks and are delivered by a limited number of not-blinded study therapists in closed groups with six to twelve patients who will be masked regarding study group. The main differences of BET lie in its detailed manualised program with a theory-based, goal-orientated combination of exercise, education and behavioural elements, active participation of patients and consideration of their individual preferences and previous experiences with exercise. The primary outcome is functional ability assessed with the Hannover Functional Ability Questionnaire directly before and after the rehabilitation program, as well as a six and twelve-month follow-up. Discussion: This RCT is designed to explore the effects of BET on the effectiveness of a BMR compared to a BMR with SET in the management of patients with clbp. Methodological challenges arise from conducting a RCT within routine health care as well as from ensuring high treatment integrity. Findings of this study might contribute to a better understanding of the mechanism of action of BMR and the special effects of BET and may be used to improve the quality of these interventions in routine care, therefore reducing the burden to patients with disabling clbp. [ABSTRACT FROM AUTHOR]

In the context of driving ability diagnostics in Germany, administrative cutoffs for various drugs and pharmaceuticals in urine have been established. Two liquid chromatography-tandem mass spectrometry methods for simultaneous detection and quantification of amphetamines, designer amphetamines, benzoylecgonine, benzodiazepines, opiates, and opioids in urine were developed and validated. A 500-μL aliquot of urine was diluted and fortified with an internal standard solution. After enzymatic cleavage, online extraction was performed by an ion-exchange/reversed-phase turbulent flow column. Separation was achieved by using a reversed-phase column and gradient elution. For detection, a Thermo Fisher TSQ Quantum Ultra Accurate Mass tandem mass spectrometer with positive electrospray ionization was used, and the analytes were measured in multiple-reaction monitoring mode detecting two transitions per precursor ion. The total run time for both methods was about 15 min. Validation was performed according to the guidelines of the Society of Toxicological and Forensic Chemistry. The results of matrix effect determination were between 78 % and 116 %. The limits of detection and quantification for all drugs, except zopiclone, were less than10 ng/mL and less than 25 ng/mL, respectively. Calibration curves ranged from 25 to 200 ng/mL for amphetamines, designer amphetamines, and benzoylecgonine, from 25 to 250 ng/mL for benzodiazepines, from 12.5 to 100 ng/mL for morphine, codeine, and dihydrocodeine, and from 5 to 50 ng/mL for buprenorphine and norbuprenorphine. Intraday and interday precision values were lower than 15 %, and bias values within ± 15 % were achieved. Turbulent flow chromatography needs no laborious sample preparation, so the workup is less time-consuming compared with gas chromatography-mass spectrometry methods. The methods are suitable for quantification of multiple analytes at the cutoff concentrations required for driving ability diagnostics in Germany. [ABSTRACT FROM AUTHOR]

Background: Several prior studies postulated an effect of hypertension on coagulation factors. However, population-based studies investigating the sex-specific associations between hypertension and hemostatic parameters are scarce. Therefore, we investigated the relationship between blood pressure and parameters of coagulation, namely activated partial thromboplastin time (aPTT), international normalized ratio (INR), fibrinogen, factor VIII, antithrombin III, protein C, protein S, and D-dimer in men and women from the general population. Methods: Based on 803 participants (376 men, 427 women) from the KORA-Fit Study the sex-specific relationship between systolic, diastolic, and pulse pressure and commonly measured coagulation factors were investigated using multivariable-adjusted linear regression models. Results: Hypertensive males had significantly higher median fibrinogen levels and factor VIII activity in comparison to normotensive males. There was a statistically significant difference between females with and without hypertension regarding the parameter fibrinogen, D-dimers, Protein S activity, and factor VIII activity. In multivariable linear regression analyses no significant association between systolic blood pressure, diastolic blood pressure, as well as pulse pressure and the investigated hemostatic parameters was found in men. In women, a significant positive association could be observed between systolic blood pressure and D-dimer level [β-estimate per mmHg increase 3.37 (95% CI 0.935–5.804; p = 0.007)] and between pulse pressure and D-dimer level [β-estimate per mmHg increase 5.351 (95% CI 1.772–8.930; p = 0.003)]. Conclusions: It appears that sex differences exist in the association between blood pressure parameters and commonly measured coagulation markers in the general population. Further studies are needed to identify the underlying causes. [ABSTRACT FROM AUTHOR]

Cryphonectria parasitica was discovered in the sweet chestnut forests of south-western Germany in 1992. Two main areas affected by chestnut blight were discerned, one to the east and one to the west of the Rhine valley. The occurrence of the fungal pathogen with respect to vegetative compatibility (vc) type and hypovirulence was analysed by sampling chestnut blight cankers between 1992 and 2010. Among 368 C. parasitica isolates sampled in south-western Germany, 9 different vc types were found. East of the Rhine valley, EU-2 is the most widespread vc type. In addition, two isolated forest areas infected with C. parasitica of the vc types EU-14 and EU-28 were detected. West of the Rhine valley, C. parasitica of the vc type EU-65 was repeatedly isolated from an infection focus, the spread of which was successfully suppressed for several years by sanitation measures. Since 2003, additional outbreaks of C. parasitica belonging to the vc types EU-2 and EU-5 were detected in the vicinity. Several other vc types (EU-1, EU-12, EU-33 and one vc type incompatible with any of the 74 European testers) were identified on isolated trees mainly in urban areas across the study area and were subsequently eradicated. The spatial and temporal distribution of the different vc types indicates at least nine different introductory events of C. parasitica into south-western Germany. Natural hypovirulence was only found in the infection area in Baden-Württemberg. A total of four hypovirulent isolates of the vc type EU-2 were obtained, one in 1992 and three in recent years. The four hypoviruses were genetically closely related and belonged to the Spanish/German subtype of Cryphonectria hypovirus 1. As the different vc types in south-western Germany occur mostly in spatially separated, single stands, the introduction of hypovirulence as biological control is expected to be effective. [ABSTRACT FROM AUTHOR]

The article addresses the exceptional textual and musical features of famous German composer Johann Sebastian Bach's "Meine Seele erhebt den Herren," within the context of the Magnificat's importance in Leipzig, Germany. It argues that the nature of the cantata "Meine Seele" helps understand it in a different way from other Bach's poetic and melodic cantatas. It proposes three factors that influenced Bach to choose "Meine Seele" as model for his chorale cantata for the Feast of Visitation.