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Cage-chiral tetra-tert-butyl-P5-deltacyclene 5 is accessible as a pair of highly enriched enantiomers 5′ and 5′′. The only secondary phosphorus atom P1 of the cage can be selectively oxidized by reaction with t-BuOOH. The P1-oxo species 9a′ and 9a′′, allow the direct determination of their ee values. Oxidation occurs with the complete retention of the optical activity of the compounds. The chiroptical properties of 9a′ and 9a′′ are strongly dominated by their cage chirality, the oxygen atom does not contribute significantly. Elemental sulfur and selenium oxidize P5 with high preference to yield P5-thio- and P5-seleno-P5-deltacyclenes 10 and 11 of the intact cages again. Longer reaction time and more than stoichiometric amounts of selenium, leads to tri-seleno-P5-tetracycloundecane 12, a partially opened oxidized rearrangement product. The ligand properties of racemic 9a were determined. Diphosphetane phosphorus atom P2 of 9a is the active donor center to bind a Cr(CO)5 fragment, but a tautomerization of 9a takes place if [(benzene)RuCl2]2 is added. A hydrogen atom migrates from P1 to the oxygen atom to form a phosphinous acid ligand. The lone pair of P1 is regenerated and acts as the active ligand function of the cage in this case. As for 5, the base n-BuLi induces an efficient cage rearrangement reaction of 9a, where P1 and the neighboring carbon atom C4 containing its t-Bu substituent change places. C4 moves to its new position without breaking the bond with P5, this way forming the novel P1-oxo-P5-norsnoutene cage in a highly diastereoselective process. [ABSTRACT FROM AUTHOR]

Background: In Germany, about a fifth of families with young children live under psychosocially stressful conditions that can threaten the healthy development of the child. In order to improve the referral of these families from pediatric practices to early childhood intervention services ("Frühe Hilfen"), the PATH intervention was developed and implemented in Baden-Württemberg. The first step in the referral process is to identify psychosocially stressed families. This study investigated whether the PATH intervention increases the proportion of identified families with psychosocial stress by pediatricians., Method: In a quasi-experimental study, a total of 293 psychosocially stressed families who were cared for by 29 pediatricians from established pediatric practices were examined. The intervention group (IG) consisted of families with pediatricians from Baden-Württemberg who took part in the PATH intervention. The control group (CG) consisted of families with pediatricians from Bavaria who did not take part in the PATH intervention. Additional qualitative telephone interviews were conducted with 10 pediatricians from the IG and 20 families from the IG with psychosocial stress., Results: A significantly higher proportion of psychosocially stressed families was identified in the IG than in the CG. The difference was about 20 percentage points and was similar regardless of the family's level of stress., Discussion: The results show that the PATH intervention improves the identification of psychosocially stressed families by pediatricians. This improved identification of psychosocially stressed families is an important prerequisite for referring families to tailored early childhood intervention services such as those provided by the "Frühe Hilfen"., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: C. Schlett, G. Metzner, C. Höhn, J.M. Giesler, M. Barth, K. Kaier, J. van Staa, S. Horstmann, S. Jünemann, I. Renner und M. Glattacker geben an, dass kein Interessenkonflikt besteht. M. Siebolds war an der Entwicklung der PATH-Intervention federführend beteiligt. Alle beschriebenen Befragungen wurden mit Zustimmung der Ethikkommissionen der Universität Freiburg (Nr. 20-1146), der Landesärztekammer Baden-Württemberg (Aktenzeichen: B‑F-2020-156) und der Landesärztekammer Bayern (Aktenzeichen: 2020-1270) im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Eltern und Praxispädiater*innen wurde vor Teilnahme an der Studie eine schriftliche Einwilligungserklärung eingeholt., (© 2024. The Author(s).)

Objective: This study investigated the predictive value of illness and treatment beliefs for patient satisfaction and health-related quality of life (HRQOL) in adolescents receiving inpatient rehabilitation treatment. In addition, we examined the relationship between fulfilled rehabilitation-related treatment expectations and patient satisfaction., Method: In this longitudinal study (recruitment between April 2019 and March 2020), 170 participants ( M = 14.3 years [ SD = 1.6]) answered self-report questionnaires before and at the end of rehabilitation (6 weeks later). We applied multiple hierarchical regression analyses, controlling for sociodemographic and diagnoses variables., Results: The results showed fulfilled expectations of treatment success and sustainability to be a significant predictor of patient satisfaction ( p < .01). The illness belief dimension of emotional representation predicted HRQOL ( p < .01). Rehabilitation-related treatment beliefs were not predictive of any outcome., Conclusion: This study provides a first insight into the relationships between these constructs in the context of inpatient pediatric rehabilitation. However, future research is needed to further examine illness and treatment beliefs in this specific treatment setting. Practical implications concern the incorporation of children's and adolescents' beliefs into treatment management to optimize rehabilitation outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Shift workers are at an increased risk of developing sleep disorders. The standard therapy recommended for sleep disorders is cognitive behavioural therapy for insomnia (CBT-I). Many of its interventions are based on a regular sleep and wake rhythm, which is difficult to apply for shift workers. We have therefore developed a new therapy manual specifically for shift workers (CBT-I-S), which should be more applicable to their needs. In particular, all interventions that require regularity have been removed, and instead, interventions that address factors that proved to be relevant to sleep in our preliminary study have been integrated. We now want to test this manual for its effectiveness., Methods: A randomised controlled trial with N = 142 will be conducted to compare two conditions: the newly developed therapy manual will be carried out in the experimental group, while cognitive behavioural therapy for insomnia will be employed in the standard group. Both treatments will be conducted online via MS Teams in a group setting with seven sessions each. Data will be collected at three measurement points (pre, post, 6-month follow-up) and analysed using linear mixed models. The study will investigate whether the two treatments have led to significant improvements in total sleep time, sleep onset latency, subjective sleep quality and daytime sleepiness in shift workers. It will also examine whether the new therapy manual is superior to standard therapy in shift workers and whether these effects are stable., Discussion: We assume that interventions designed to address depressive mood, anxiety, worry, rumination, dysfunctional thought patterns and attitudes towards sleep will also improve sleep. If this is indeed the case, these interventions could replace previous ones that require regularity. This could significantly improve the treatment of insomnia in shift workers., Trial Registration: German Clinical Trials Registry DRKS DRKS00032086 . Registered on August 16, 2023., (© 2024. The Author(s).)

Glycerol, a primary by-product of biodiesel production, can be oxidized into various value-added chemicals, significantly enhancing the techno-economic value of photoelectrochemical (PEC) cells. Several studies have explored various photoelectrode materials and co-catalysts, but the influence of electrolytes on PEC glycerol oxidation has remained relatively unexplored despite its significance. Here, we explore the impact of various acidic (pH = 2) electrolytes, namely NaNO 3 , NaClO 4 , Na 2 SO 4 , K 2 SO 4 , and KP i , on PEC glycerol oxidation using nanoporous thin film BiVO 4 as a model photoanode. Our experimental findings reveal that the choice of electrolyte anion and cation significantly affects the PEC performance ( i.e. , photocurrent, onset potential, stability, and selectivity towards value-added products) of BiVO 4 for glycerol oxidation. To explain this interesting phenomenon, we correlate the observed performance trend with the ion specificity in the Hofmeister series as well as the buffering capacity of the electrolytes. Notably, NaNO 3 is identified as the optimal electrolyte for PEC glycerol oxidation with BiVO 4 when considering various factors such as stability and production rates for glycerol oxidation reaction (GOR) products, surpassing the previously favored Na 2 SO 4 . Glycolaldehyde emerges as the most dominant product with ∼50% selectivity in NaNO 3 . The general applicability of our findings is confirmed by similar observation in electrochemical (EC) GOR with a polycrystalline platinum anode. Overall, these results emphasize the critical role of electrolyte selection in enhancing the efficiency of EC/PEC glycerol oxidation., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Exposure to short-wavelength light before bedtime is known to disrupt nocturnal melatonin secretion and can impair subsequent sleep. However, while it has been demonstrated that older adults are less affected by short-wavelength light, there is limited research exploring differences between adolescents and young adults. Furthermore, it remains unclear whether the effects of evening short-wavelength light on sleep architecture extend to sleep-related processes, such as declarative memory consolidation. Here, we recorded polysomnography from 33 male adolescents (15.42 ± 0.97 years) and 35 male young adults (21.51 ± 2.06 years) in a within-subject design during three different nights to investigate the impact of reading for 90 min either on a smartphone with or without a blue-light filter or from a printed book. We measured subjective sleepiness, melatonin secretion, sleep physiology and sleep-dependent memory consolidation. While subjective sleepiness remained unaffected, we observed a significant melatonin attenuation effect in both age groups immediately after reading on the smartphone without a blue-light filter. Interestingly, adolescents fully recovered from the melatonin attenuation in the following 50 min before bedtime, whereas adults still, at bedtime, exhibited significantly reduced melatonin levels. Sleep-dependent memory consolidation and the coupling between sleep spindles and slow oscillations were not affected by short-wavelength light in both age groups. Nevertheless, adults showed a reduction in N3 sleep during the first night quarter. In summary, avoiding smartphone use in the last hour before bedtime is advisable for adolescents and young adults to prevent sleep disturbances. Our research empirically supports general sleep hygiene advice and can inform future recommendations regarding the use of smartphones and other screen-based devices before bedtime., Competing Interests: The authors report no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: Patients with spinal cord injury (SCI) show abnormal cortical excitability that might be caused by deafferentation. We hypothesize a reduced short-interval intracortical inhibition preceding movement in patients with SCI compared with healthy participants. In addition, we expect that neuroplasticity induced by different types of sports can modulate intracortical inhibition during movement preparation in patients with SCI., Methods: We used a reaction test and paired-pulse transcranial magnetic stimulation to record cortical excitability, assessed by measuring amplitudes of motor-evoked potentials in preparation of movement. The participants were grouped as patients with SCI practicing wheelchair dancing ( n  = 7), other sports ( n  = 6), no sports ( n  = 9), and healthy controls ( n  = 24)., Results: There were neither significant differences between healthy participants and the patients nor between the different patient groups. A non-significant trend ( p  = .238), showed that patients engaged in sports have a stronger increase in cortical excitability compared with patients of the non-sportive group, while the patients in the other sports group expressed the highest increase in cortical excitability., Conclusion: The small sample sizes limit the statistical power of the study, but the trending effect warrants further investigation of different sports on the neuroplasticity in patients with SCI. It is not clear how neuroplastic changes impact the sensorimotor output of the affected extremities in a patient. This needs to be followed up in further studies with a greater sample size., Competing Interests: ET has received consultancy fees from Arvelle Therapeutics, Argenx, Clexio, Celegene, UCB Pharma, Eisai, Epilog, Bial, Medtronic, Everpharma, Biogen, Takeda, Liva-Nova, Newbridge, Sunovion, GW Pharmaceuticals, and Marinus; speaker fees from Arvelle Therapeutics, Bial, Biogen, Böhringer Ingelheim, Eisai, Everpharma, GSK, GW Pharmaceuticals, Hikma, Liva-Nova, Newbridge, Novartis, Sanofi, Sandoz and UCB Pharma; research funding (directly, or to his institution) from GSK, Biogen, Eisai, Novartis, Red Bull, Bayer, and UCB Pharma outside the submitted work. ET receives Grants from Austrian Science Fund (FWF), Österreichische Nationalbank, and the European Union. ET is the CEO of Neuroconsult Ges.m.b.H. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer-review process and the final decision., (© 2024 Frey, Langthaler, Renz, Zimmermann, Höhn, Schwenker, Thomschewski, Kunz, Höller, Nardone and Trinka.)

Renewable ("green") hydrogen production through direct photoelectrochemical (PEC) water splitting is a potential key contributor to the sustainable energy mix of the future. We investigate the potential of indium phosphide (InP) as a reference material among III-V semiconductors for PEC and photovoltaic (PV) applications. The p(2 × 2)/c(4 × 2)-reconstructed phosphorus-terminated p-doped InP(100) (P-rich p-InP) surface is the focus of our investigation. We employ time-resolved two-photon photoemission (tr-2PPE) spectroscopy to study electronic states near the band gap with an emphasis on normally unoccupied conduction band states that are inaccessible through conventional single-photon emission methods. The study shows the complexity of the p-InP electronic band structure and reveals the presence of at least nine distinct states between the valence band edge and vacuum energy, including a valence band state, a surface defect state pinning the Fermi level, six unoccupied surface resonances within the conduction band, as well as a cluster of states about 1.6 eV above the CBM, identified as a bulk-to-surface transition. Furthermore, we determined the decay constants of five of the conduction band states, enabling us to track electron relaxation through the bulk and surface conduction bands. This comprehensive understanding of the electron dynamics in p-InP(100) lays the foundation for further exploration and surface engineering to enhance the properties and applications of p-InP-based III-V-compounds for, e.g. , efficient and cost-effective PEC hydrogen production and highly efficient PV cells.

To examine the risk associated with bus riding and identify transmission chains, we investigated a COVID-19 outbreak in Germany in 2021 that involved index case-patients among bus-riding students. We used routine surveillance data, performed laboratory analyses, interviewed case-patients, and conducted a cohort study. We identified 191 case-patients, 65 (34%) of whom were elementary schoolchildren. A phylogenetically unique strain and epidemiologic analyses provided a link between air travelers and cases among bus company staff, schoolchildren, other bus passengers, and their respective household members. The attack rate among bus-riding children at 1 school was ≈4 times higher than among children not taking a bus to that school. The outbreak exemplifies how an airborne agent may be transmitted effectively through (multiple) short (<20 minutes) public transport journeys and may rapidly affect many persons.

Nonoscillatory measures of brain activity such as the spectral slope and Lempel-Ziv complexity are affected by many neurological disorders and modulated by sleep. A multitude of frequency ranges, particularly a broadband (encompassing the full spectrum) and a narrowband approach, have been used especially for estimating the spectral slope. However, the effects of choosing different frequency ranges have not yet been explored in detail. Here, we evaluated the impact of sleep stage and task engagement (resting, attention, and memory) on slope and complexity in a narrowband (30-45 Hz) and broadband (1-45 Hz) frequency range in 28 healthy male human subjects (21.54 ± 1.90 years) using a within-subject design over 2 weeks with three recording nights and days per subject. We strived to determine how different brain states and frequency ranges affect slope and complexity and how the two measures perform in comparison. In the broadband range, the slope steepened, and complexity decreased continuously from wakefulness to N3 sleep. REM sleep, however, was best discriminated by the narrowband slope. Importantly, slope and complexity also differed between tasks during wakefulness. While narrowband complexity decreased with task engagement, the slope flattened in both frequency ranges. Interestingly, only the narrowband slope was positively correlated with task performance. Our results show that slope and complexity are sensitive indices of brain state variations during wakefulness and sleep. However, the spectral slope yields more information and could be used for a greater variety of research questions than Lempel-Ziv complexity, especially when a narrowband frequency range is used., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 Höhn et al.)

Objective: Rehabilitation is an important component in the health care of children and adolescents with chronic diseases and aims at supporting patients' self-regulation for dealing with the disease. Patients' beliefs about illness and treatment are core elements in the self-regulation process. While questionnaires measuring illness beliefs for children and adolescents exist, questionnaires about their rehabilitation-related treatment beliefs are lacking. We therefore developed a questionnaire to assess the rehabilitation-related treatment beliefs of children and adolescents with chronic diseases (Rehabilitation Treatment Beliefs Questionnaire, RTBQ) and tested its psychometric properties., Methods: Ahead of their rehabilitation, children and adolescents, aged 12-17 years, answered 129 items, which were developed based on previous qualitative findings exploring children and adolescents' rehabilitation-related treatment beliefs. Psychometric testing included item analyses, exploratory factor analysis, internal consistency and bivariate correlations of the extracted scales, and the discriminatory power and difficulty of the final items., Results: The sample consisted of 170 participants with a mean age of 14.3 years (SD = 1.6); 53.5% were female. After item analyses, 47 items remained for the exploratory factor analysis which revealed 22 items allocated to 4 scales: "expectations of communication and interaction," "expectations of the treatment process," "expectations of treatment success and sustainability," and "expectations of one's own role in the rehabilitation process." The psychometric properties were acceptable to good., Conclusions: The RTBQ assesses various dimensions of rehabilitation-related treatment beliefs of children and adolescents with chronic diseases. While first psychometric results are promising, further psychometric testing is needed., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Medical rehabilitation plays an important role in the health care of chronically ill children and adolescents. During medical rehabilitation, supporting illness-related self-regulation is a central goal. Beliefs about illness and beliefs about treatment are core elements of patients' self-regulation, and there is evidence that these beliefs are relevant predictors of different health- and treatment-related outcomes such as adherence. However, little is known about adolescents' beliefs about rehabilitation. This study therefore explores adolescents' treatment beliefs in the context of inpatient medical rehabilitation., Methods: A qualitative study was conducted in a German rehabilitation clinic for children and adolescents. Using a purposive sampling method, 13 adolescents (12-16 years old) were recruited. Semi-structured, audiotaped interviews were conducted and analysed using content analysis., Results: Results demonstrate that adolescents have differentiated rehabilitation-related treatment beliefs. Twelve themes, with various subthemes, emerged, which include access to and knowledge about rehabilitation, the rehabilitation-related individual position and normative aspects, expectations of oneself, as well as in respect of the social context (fellow patients, contact with family and friends), expectations of the structure, process and outcome of rehabilitation, concerns and barriers and emotional aspects., Conclusions: Our explorative study revealed a broad range of rehabilitation-related treatment beliefs in adolescents, indicating parallels, but also differences, to research results with adults. Treatment beliefs are assumed to be an influencing factor for various health- and treatment-related outcomes. Thus, implications of our findings for clinical practice and further research are discussed., (© 2021 The Authors. Child: Care, Health and Development published by John Wiley & Sons Ltd.)

Previously, we presented our preliminary results (N = 14) investigating the effects of short-wavelength light from a smartphone during the evening on sleep and circadian rhythms (Höhn et al., 2021). Here, we now demonstrate our full sample (N = 33 men), where polysomnography and body temperature were recorded during three experimental nights and subjects read for 90 min on a smartphone with or without a filter or from a book. Cortisol, melatonin and affectivity were assessed before and after sleep. These results confirm our earlier findings, indicating reduced slow-wave-sleep and -activity in the first night quarter after reading on the smartphone without a filter. The same was true for the cortisol-awakening-response. Although subjective sleepiness was not affected, the evening melatonin increase was attenuated in both smartphone conditions. Accordingly, the distal-proximal skin temperature gradient increased less after short-wavelength light exposure than after reading a book. Interestingly, we could unravel within this full dataset that higher positive affectivity in the evening predicted better subjective but not objective sleep quality. Our results show disruptive consequences of short-wavelength light for sleep and circadian rhythmicity with a partially attenuating effect of blue-light filters. Furthermore, affective states influence subjective sleep quality and should be considered, whenever investigating sleep and circadian rhythms.

Montelukast is a well-established antiasthmatic drug with little side effects. It is a leukotriene receptor antagonist and recent research suggests cognitive benefits from its anti-inflammatory actions on the central nervous system. However, changes in brain activity were not directly shown so far in humans. This study aims to document changes in brain activity that are associated with cognitive improvement during treatment with Montelukast. We recorded EEG and conducted neuropsychological tests in 12 asthma-patients aged 38-73 years before and after 8 weeks of treatment with Montelukast. We found no significant changes on neuropsychological scales for memory, attention, and mood. In the EEG, we found decreased entropy at follow up during rest ( p < 0.005). During episodic memory acquisition we found decreased entropy ( p < 0.01) and acceleration of the background rhythm ( p < 0.05). During visual attention performance, we detected an increase in gamma power ( p < 0.005) and slowing of the background rhythm ( p < 0.05). The study is limited by its small sample size, young age and absence of baseline cognitive impairment of the participants. Unspecific changes in brain activity were not accompanied by cognitive improvement. Future studies should examine elderly patients with cognitive impairment in a double-blind study with longer-term treatment by Montelukast.

"Water-in-salt" (WIS) electrolytes have emerged as an excellent superconcentrated ionic medium for high-power energy storage systems such as supercapacitors due to their extended working potential compared to the conventional dilute aqueous electrolyte. In this work, we have investigated the performance of WIS supercapacitors using hollow carbon nanoplates as electrodes and compared it to that based on the conventional "salt-in-water" electrolytes. Moreover, the potentiostatic electrochemical impedance spectroscopy has been employed to provide an insightful look into the charge transport properties, which also, for the first time, reveals the formation of a solid-electrolyte interphase (SEI) and their temperature-dependent impedance for charge transfer and adsorption. Furthermore, the effect of temperature on the electrochemical performance of the WIS supercapacitors in the temperature range from 15 to 60 °C has been studied, which presents a gravimetric capacitance of 128 F g -1 and a volumetric capacitance of 197.12 F cm -3 at 55 °C compared to 87.5 F g -1 and 134.75 F cm -3 at 15 °C. The in-depth understanding about the formation of SEI layer and the electrochemical performance at different temperatures for WIS supercapacitors will assist the efforts toward designing better aqueous electrolytes for supercapacitors.

Smartphone usage strongly increased in the last decade, especially before bedtime. There is growing evidence that short-wavelength light affects hormonal secretion, thermoregulation, sleep and alertness. Whether blue light filters can attenuate these negative effects is still not clear. Therefore, here, we present preliminary data of 14 male participants (21.93 ± 2.17 years), who spent three nights in the sleep laboratory, reading 90 min either on a smartphone (1) with or (2) without a blue light filter, or (3) on printed material before bedtime. Subjective sleepiness was decreased during reading on a smartphone, but no effects were present on evening objective alertness in a GO/NOGO task. Cortisol was elevated in the morning after reading on the smartphone without a filter, which resulted in a reduced cortisol awakening response. Evening melatonin and nightly vasodilation (i.e., distal-proximal skin temperature gradient) were increased after reading on printed material. Early slow wave sleep/activity and objective alertness in the morning were only reduced after reading without a filter. These results indicate that short-wavelength light affects not only circadian rhythm and evening sleepiness but causes further effects on sleep physiology and alertness in the morning. Using a blue light filter in the evening partially reduces these negative effects.

There is an urgent need for cheap, stable, and abundant catalyst materials for photoelectrochemical water splitting. Manganese oxide is an interesting candidate as an oxygen evolution reaction (OER) catalyst, but the minimum thickness above which MnO x thin films become OER-active has not yet been established. In this work, ultrathin (<10 nm) manganese oxide films are grown on silicon by atomic layer deposition to study the origin of OER activity under alkaline conditions. We found that MnO x films thinner than 1.5 nm are not OER-active. X-ray photoelectron spectroscopy shows that this is due to electrostatic catalyst-support interactions that prevent the electrochemical oxidation of the manganese ions close to the interface with the support, while in thicker films, Mn III and Mn IV oxide layers appear as OER-active catalysts after oxidation and electrochemical treatment. From our investigations, it can be concluded that one Mn III,IV -O monolayer is sufficient to establish oxygen evolution under alkaline conditions. The results of this study provide important new design criteria for ultrathin manganese oxide oxygen evolution catalysts.

Background: In recent decades, the prevalence of chronic diseases in children and adolescents has increased significantly. Contextual factors play a central role in the self-regulation of chronic diseases. They influence illness and treatment representations, disease management, and health outcomes. While previous studies have investigated the influence of contextual factors on children's beliefs about their illness, little is known about subjective contextual factors of treatment representations of children and adolescents with chronic diseases, especially in the context of rehabilitation. Therefore, the aim of this qualitative analysis was to examine the contextual factors reported by chronically ill children and adolescents in relation to their treatment representations. Furthermore, we aimed to assign the identified themes to classifications of environmental and personal contextual factors in the context of the International Classification of Functioning, Disability and Health (ICF)., Methods: Between July and September 2018, semi-structured interviews were conducted with N = 13 children and adolescents in rehabilitation to explore their rehab-related treatment representations and associated contextual factors. The interviews started with an open narrative question about expectations and beliefs about rehabilitation, followed by further detailed questions. The interviews were recorded on audio tape, transcribed, and analysed using thematic content analysis., Results: Participants raised six themes associated with their rehab-related treatment representations that were interpreted as contextual factors: the living situation before rehabilitation, the idea of rehabilitation, previous solution attempts, rehab pre-experiences, information that the children and adolescents received from the clinic or sought themselves, and the assumed attitudes of their parents concerning rehabilitation. All the themes could be assigned to the classification of environmental and personal factors in the context of the ICF for children and youth., Conclusions: Although contextual factors have an important impact on self-regulation, little attention is paid to their investigation. Personal and environmental factors probably influence patients' treatment representations in terms of expectations and concerns as well as emotions regarding the treatment. Considering contextual factors could lead to the more appropriate allocation of medical care and the better customisation of treatment.

Introduction: Hip and knee arthroplasties are very frequently performed surgeries with high quality standards and continuous optimization potential. Intraoperative processes can be standardized and simplified by optimization of table setups in the operating room to improve the quality and to increase efficiency., Patients and Methods: The existing surgical setups for primary hip and knee arthroplasties in a university maximum care hospital with endoprosthesis center were simulated and analysed with a computer program and optimized setup suggestions were worked out, based on handover times, walking distance and ergonomic aspects determined in the program. In a prospective monocentric analysis, primary hip arthroplasties and knee arthroplasties were examined in currently used and in the new optimized setups (standard procedure according to in-house SOP, senior and main surgeons, no assistants). The surgeries were externally and independently supervised and analysed, whereby the time between incision and suture beginning, handovers per minute and handover times were documented, amongst other things. In addition, an evaluation sheet, which showed the satisfaction with the new setup, was filled by the surgical team., Results: In the period from April 2016 to December 2018, 19 hip arthroplasties in currently used and 15 in the new optimized setup as well as 9 knee arthroplasties in currently used and 13 in the new setup were performed. Attention was paid to constant conditions in the compared groups and disruptive factors (assisted surgeries, complex surgeries, different cementings, etc.) were excluded. In the group of hip arthroplasties, the handover times were significantly different (old 1.82 +/- 1.43 s.; new 1.08 +/- 0.78 s.; p <0.001), as well as the handovers per minute (old 1.62 +/- 0.45 handovers/min.; new 2.10 +/- 0.32 handovers/min.; p = 0,001). The time between incision and suture beginning indicated no significant difference (old 53.89 +/- 18.92 min.; new 49.73 +/- 12.18 min; p = 0.466): During the knee arthroplasties, handovers per minute were significantly different (old 1.83 +/- 0.38 handovers/min.; new 2.40 +/- 0.35 handovers/min.; p = 0.002). The time between incision and suture beginning (old 71.11 +/- 20.72 min.; new 70.69 +/- 17.12 min.; p = 0.959) and the handover times (old 1.06 +/- 0.64 s.; new 0.91 +/- 0.59 s.; p = 0.152) indicated no significant difference. The evaluation of the questionnaires showed a significant difference (p < 0.001) in the group of hip arthroplasties in the category "visibility". For the knee arthroplasties, all items except "visibility" (p = 0.261) differed significantly. Overall, a high level of staff satisfaction with the new setup was achieved., Conclusions: In both groups, more handovers per minute could be achieved in the optimized setup and in the group of the hip arthroplasties, the handover times were significantly faster. The evaluation sheet showed a high satisfaction of the surgical staff with the new setup. No reduction of the time between incision and suture beginning could be determined. This can be attributed to a certain training effect, the adjustment to the setup modification and the low number of cases. The new setup offers a practical alternative for hip arthroplasties as well as for knee arthroplasties as it optimizes the events in the operating room in many ways. For example, there were more handovers per minute possible and passing of the surgical instruments free from interferences. Moreover, it increases the efficiency and achieves a high satisfaction of the staff., (© 2020. The Author(s).)

Background: The design and internal layout of modern operating rooms (OR) are influencing the surgical team's collaboration and communication, ergonomics, as well as intraoperative hygiene substantially. Yet, there is no objective method for the assessment and design of operating room setups for different surgical disciplines and intervention types available. The aim of this work is to establish an improved OR setup for common procedures in arthroplasty., Methods: With the help of computer simulation, a method for the design and assessment of enhanced OR setups was developed. New OR setups were designed, analyzed in a computer simulation environment and evaluated in the actual intraoperative setting. Thereby, a 3D graphical simulation representation enabled the strong involvement of clinical stakeholders in all phases of the design and decision-making process of the new setup alternatives., Results: The implementation of improved OR setups reduces the instrument handover time between the surgeon and the scrub nurse, the travel paths of the OR team as well as shortens the procedure duration. Additionally, the ergonomics of the OR staff were improved., Conclusion: The developed simulation method was evaluated in the actual intraoperative setting and proved its benefit for the design and optimization of OR setups for different surgical intervention types. As a clinical result, enhanced setups for total knee arthroplasty and total hip arthroplasty surgeries were established in daily clinical routine and the OR efficiency was improved.

Antiepileptic drugs impair episodic memory in patients with epilepsy, but this effect has so far only been examined with tests that do not provide first-person experience-an aspect that is crucial for episodic memory. Virtual reality techniques facilitate the development of ecologically valid tests. In the present study, we measure the effect of antiepileptic drug changes in a within-subject design using a virtual reality test in order to provide direct evidence for effects of antiepileptic drugs on episodic memory. Among 106 recruited patients, 97 participated in a virtual reality test up to six times during a 4-day hospitalization, and 78 patients underwent changes in drug load during this period. There were six parallel versions of a virtual town test, with immediate recall and delayed recall after about 12 h. The test requires recall of elements, details, sequence of experience, and egocentric and allocentric spatial memory. We determined drug load by defined daily dose, and compared test performance at lowest antiepileptic drug load to highest antiepileptic drug load. Across the six towns, performance was lower in delayed compared to immediate recall. There was an overall effect of medication when comparing patients taking vs. not taking antiepileptic drugs and/or psychoactive drugs ( p = 0.005). Furthermore, there was a within-subject effect of antiepileptic drug load ( p = 0.01), indicating lower test performance at higher drug load. There was no effect of gender, daytime, circadian type, depression, seizures, lesions, and epilepsy. For patients with temporal lobe epilepsy, there was no effect of lateralization. The present study provides direct evidence for episodic memory impairment due to antiepileptic drugs, suggesting that a small change in drug load can matter. This study can serve as a proof of principle for the methodology, but a larger sample is needed to examine the differential effects of individual antiepileptic drugs., (Copyright © 2020 Höller, Höhn, Schwimmbeck, Plancher and Trinka.)