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This paper analyses the impact of fiscal spending shocks in a dynamic, multi-country model with international production networks. The response of real gross domestic product to a fiscal spending shock can be decomposed into a direct effect, income effect and price effect. The direct effect depends only on input-output linkages, while the price effect is zero in the aggregate. We apply this decomposition to the Eurozone, and find that fiscal spillovers from Germany and the core Eurozone countries can be large, and within the range of empirical estimates. Without international production networks, spillovers would be significantly smaller. In an empirical application, using the decomposition, we find results strongly consistent with the model. [ABSTRACT FROM AUTHOR]

This paper studies important determinants of adult self-control using population-representative data and exploiting Germany's division as quasi-experimental variation. We find that former East Germans have substantially more self-control than West Germans and provide evidence for government surveillance as a possible underlying mechanism. We thereby demonstrate that institutional factors can shape people's self-control. Moreover, we find that self-control increases linearly with age. In contrast to previous findings for children, there is no gender gap in adult self-control and family background does not predict self-control. [ABSTRACT FROM AUTHOR]

In the recent debate on megaprojects (MPs), greater attention is devoted to the functioning of the interorganizational and multiactor networks that are one of the most innovative features in recent years. The complexity of these structures brings out governability issues for an MP's management. Mutual recognition and consent become elements capable of inaugurating more collaborative processes and practices to reduce organizational and management criticalities in MPs. This paper focuses on a neglected relational dimension, namely legitimacy. We argue that legitimacy is instead the central dimension that attributes effectiveness and capacity for action to the organizations involved. Legitimacy regulates the relationship between various organizations--and especially--between organizations and the public sphere. Institutionalist theory assigns a central role to legitimacy in the construction of social processes, defining it as a generalized form of social acceptance toward an actor, an idea, or a project. In this paper, we hypothesize that the legitimacy attributed and "held" by the stakeholders is a crucial element in countering three critical aspects of MPs, namely the uncertainty, complexity, and conflict acting on the construction of public consensus and the quality of relationships between the participating stakeholders. We verify our hypothesis by analyzing a cross-border MP, the Fehmarnbelt Fixed Link between Germany and Denmark. The paper concentrates on the mechanisms with which stakeholders can acquire legitimacy using the Eriksen discursive legitimation scheme. These mechanisms are different (evidence-based, public participation, and legislators' command) and produce different outcomes in terms of increasing or containing these three criticalities. [ABSTRACT FROM AUTHOR]

Summary: In this study, we show results from ambient noise tomography around the KTB (Kontinentales Tiefbohrprogramm der Bundesrepublik Deutschland), a continental deep drilling site located at the western edge of the Bohemian Massif, within the Variscan belt of Europe. At the KTB site, crustal rocks have been drilled down to 9 km depth. Before the drilling activity started, several active seismic surveys had been performed to explore its surroundings during the 1980s and early 1990s, in the frame of an extensive exploration of the area aimed at unravelling the characteristics of the continental lower crust that is exposed at surface in this location. Despite the exploration campaigns held at and around the KTB drilling site, there are important targets that are worth further investigation; these are related in particular to the obduction of lower crustal units to the surface, and to the mechanism of orogenic processes in general. Here we present a new 3-D shear wave velocity model of the area from cross-correlations of ambient seismic noise. The model is obtained by a unique data set composed of 2 yr of continuous data recorded at nine 3-component temporary stations (installed from July 2012 to July 2014) located on top and around the drilling site, and together with the data from 19 permanent stations throughout the region. This paper is focusing on the upper crustal layers, and we show velocity variations at short scales that correlate well with known geological structures in the region of the KTB site, at the surface and at depth. These are used to discuss features that are less well-resolved at present. [ABSTRACT FROM AUTHOR]

Since the beginning of the 1990s, absolute gravity has been observed at several locations in Norway with FG5-type instruments to investigate the temporal gravity changes due to glacial isostatic adjustment (GIA). Previous work suggests that some of the estimated secular gravity trends may be affected by remaining unmodelled geophysical effects, such as the effect of local hydrology. In this work, we compute hydrological gravity effects from global hydrological models for the far zone and a combination of regional run-off models and modelling of residual hydrological effects for the near zone. The method developed in this paper is first tested at the geodetic observatory in Wettzell, Germany, where both high-resolution superconducting gravimeter data as well as a regional hydrological model are available. Next, the method is transferred to two Norwegian gravity sites (NMBU and TRYC), with long time-series of frequent absolute gravity observations using FG5-226. At these sites, we investigate the impact of the hydrological gravity correction on data variability as well as estimated secular gravity trends. We find that the data variability is reduced by up to 40 per cent when applying the modelled hydrological gravity effect at TRYC. The reduction is less at NMBU where the amplitude of the hydrological signal and in consequence also the signal-to-noise ratio are smaller. We also note that it is challenging to determine the near zone residual hydrological effects without carefully taking into account the hydrogeological setting of the area for modelling such effects. When utilizing the long corrected absolute gravity series to determine the gravity trends, we find that the estimated trends are not significantly different from the uncorrected observations. However, the uncertainty of the estimated trends is reduced significantly for a limited corrected gravity series. We further suggest repeatability analysis of the absolute gravimeter. From the long time-series at NMBU we find a significant step coinciding with hardware replacement. We find that the fit between observed and modelled secular trends improves when introducing the step. Further analysis of gravity rates at other stations is needed to verify the existence of a real instrumental offset. [ABSTRACT FROM AUTHOR]

In this paper we investigate how co-ethnic networks affect the economic success of immigrants. Using longitudinal data of immigrants in Germany and including a large set of fixed effects and pre-migration controls to address the possible endogeneity of initial location, we find that immigrants in districts with larger co-ethnic networks are more likely to be employed soon after arrival. This advantage fades after four years, as migrants located in places with smaller co-ethnic networks catch up due to greater human capital investments. These effects appear stronger for lower-skilled immigrants, as well as for refugees and ethnic Germans. [ABSTRACT FROM AUTHOR]

Background Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID - 19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE—especially with increased COVID-19 hygiene regimes. Aims This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. Methods In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. Results Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. Conclusions Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE. [ABSTRACT FROM AUTHOR]

The trend of rising income inequality in Germany since the mid-1990s is strongly amplified when considering income after housing expenditure. The income share of housing expenditure rose disproportionally for the bottom income quintile and fell for the top quintile. Factors contributing to these trends include declining relative costs of homeownership versus renting, changes in household structure, declining real incomes for low-income households and residential mobility towards larger cities. Younger cohorts spend more on housing and save less than older cohorts did at the same age, which will affect future wealth accumulation, particularly at the bottom of the income distribution. [ABSTRACT FROM AUTHOR]

How have differently institutionalized welfare regimes dealt with the Covid-19 crisis? In particular, how have they confronted the social and economic inequalities exposed by the virus? Taking three European countries--Germany, Sweden, and the UK, corresponding broadly to conservative-continental, social democratic, and liberal regime types--this paper tracks the virus response in the areas of income and employment protection and health and residential care. With attention paid to issues of "capacity" and the institutional arrangements in each case, we find that institutional histories in Germany and Sweden permitted a certain recidivistic reliance on established practices in the areas of employment and social protection. In sum, certain social and economic inequalities were mitigated as these countries set aside recent trends toward "liberalization" and mobilized longer-standing institutional capacities to protect some groups, although by no means all. Evidence of this trend is less clear in the health and residential care sectors, where Germany had existing capacity, allowing its older population to weather the crisis in better order than its counterparts in Sweden and the UK. In the UK, welfare liberalization has led to increased social and economic inequalities and funding reductions in health and residential care--all of which have reduced the country's ability to deal with severe crisis. The Covid response in this case was agile, but also chaotic, with little being done to ameliorate the positions of the most vulnerable groups. [ABSTRACT FROM AUTHOR]

The societal and policy transformations associated with the coronavirus disease pandemic are currently subject of intense academic debate. In this paper, we contribute to this debate by adopting a systemic perspective on policy change, shedding light on the hidden and indirect crisis effects. Based on a comprehensive analysis of policy agenda developments in Germany, we find that the pandemic led to profound shifts in political attention across policy areas. We demonstrate that these agenda gains and losses per policy area vary by the extent to which the respective areas can be presented as relevant in managing the coronavirus disease crisis and its repercussions. Moreover, relying on the analysis of past four economic crises, we also find that there is limited potential for catching up dynamics after the crisis is over. Policy areas that lost agenda share during crisis are unlikely to make up for these losses by strong attention gains once the crisis is over. Crises have hence substantial, long-term and so far, neglected effects on policymaking in modern democracies. [ABSTRACT FROM AUTHOR]

Background During the Coronavirus Disease 2019 (COVID-19) pandemic, immunization programmes struggled to reach all population groups equally. While migrant groups face multiple barriers to health systems, including vaccination, little is known about their vaccine uptake. Methods We conducted a cross-sectional telephone survey on adults with and without migration history in Germany to investigate barriers and drivers to COVID-19 vaccination (11 April 2021 to 18 December 2021). Interviews were conducted in six languages. We used logistic regression models and a mediation model to analyze the association between migration history and vaccine uptake. Furthermore, we determined the effect of psychological determinants (5C model) on vaccine uptake. Results The survey comprised 2039 individuals, including 1015 with migration history. Of these, 448 were interviews conducted in languages other than German. Individuals with migration history had a significantly lower vaccine uptake but, while still unvaccinated, had a higher intention to get vaccinated (P  = 0.015) compared with those without migration history. The association between migration history and vaccine uptake was no longer significant when other factors were included in the regression model (odds ratio = 0.9; 95% confidence interval: 0.57–1.47). Socio-economic index, language skills and discrimination experience fully mediated this association. Among the psychological determinants, 'higher confidence' and 'higher collective responsibility' increased the chance of individuals with migration history to be vaccinated. Conclusion Migration history alone cannot explain vaccine uptake; socio-economic index, language skills and discrimination experiences need to be considered. To achieve vaccine equity, future public health policy should aim to reduce relevant barriers through tailored interventions. [ABSTRACT FROM AUTHOR]

We investigate economic causes of the rising support of populist parties in industrialised countries. Looking at Germany, we find that exposure to imports from low-wage countries increases the support for nationalist parties between 1987–2009, while increasing exports have the opposite effect. The net effect translates into increasing support of the right-populist Alternative for Germany party after its emergence in 2013. Individual data from the German Socio-Economic Panel reveal that low-skilled manufacturing workers' political preferences are most responsive to trade exposure. Using a novel approach to causal mediation analysis, we identify trade-induced labour market adjustments as an economic mechanism causing the voting response to international trade. [ABSTRACT FROM AUTHOR]

Background Post-exposure prophylaxis (PEP) is an effective tool to prevent infection with HIV. Patients seeking PEP after potential HIV exposure usually present to the emergency department (ED). Our study sought to determine the concordance of ED physicians' decisions on HIV-PEP with national guidelines (primary objective) and to assess the clinical relevance of drug–drug interactions (DDIs) between the HIV-PEP regimen and patients' concomitant medication (secondary objective). Methods We conducted a retrospective cohort study at the ED of Hannover Medical School, Germany. Between 1 January 2018 and 31 December 2019, 113 of 11 246 screened patients presented to the ED after potential HIV exposure and were enrolled in the study. Results The median age of the patients (82.3% male) was 30 y (IQR 25–35.5), 85.8% of potential HIV exposures were characterised as sexual and 85.0% presented within 72 h. ED physicians' decisions on HIV-PEP were concordant with national guidelines in 93.8%. No clinically relevant DDIs were detected. Conclusions ED physicians' decisions on HIV-PEP were highly concordant with national guidelines. Approximately 1% of patient presentations to the ED were related to HIV exposure; therefore, training ED physicians on HIV transmission risk assessment and indications/contraindications for HIV-PEP is paramount. [ABSTRACT FROM AUTHOR]

The author examines whether Germany's new cannabis policy reform plans serve public health, as of October 2023. The goals of the new policy include the protection of cannabis consumers' health and safety, youth protection and the reduction of illicit cannabis markets as principal goals. Also cited is the two-step approach for cannabis policy reform in the revised proposal.

Background The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). Methods We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. Results Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. Conclusion Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries. [ABSTRACT FROM AUTHOR]

Background Little is known about delivery of neurosurgical care, complication rate and outcome of patients with high-grade glioma (HGG) during the coronavirus disease 2019 (Covid-19) pandemic. Methods This observational, retrospective cohort study analyzed routine administrative data of all patients admitted for neurosurgical treatment of an HGG within the Helios Hospital network in Germany. Data of the Covid-19 pandemic (March 1, 2020—May 31, 2022) were compared to the pre-pandemic period (January 1, 2016—February 29, 2020). Frequency of treatment and outcome (in-hospital mortality, length of hospital stay [LOHS], time in intensive care unit [TICU] and ventilation outside the operating room [OR]) were separately analyzed for patients with microsurgical resection (MR) or stereotactic biopsy (STBx). Results A total of 1763 patients underwent MR of an HGG (648 patients during the Covid-19 pandemic; 1115 patients in the pre-pandemic period). 513 patients underwent STBx (182 [pandemic]; 331 patients [pre-pandemic]). No significant differences were found for treatment frequency (MR: 2.95 patients/week [Covid-19 pandemic] vs. 3.04 patients/week [pre-pandemic], IRR 0.98, 95% CI: 0.89–1.07; STBx (1.82 [Covid-19 pandemic] vs. 1.86 [pre-pandemic], IRR 0.96, 95% CI: 0.80–1.16, P  > .05). Rates of in-hospital mortality, infection, postoperative hemorrhage, cerebral ischemia and ventilation outside the OR were similar in both periods. Overall LOHS was significantly shorter for patients with MR and STBx during the Covid-19 pandemic. Conclusions The Covid-19 pandemic did not affect the frequency of neurosurgical treatment of patients with an HGG based on data of a large nationwide hospital network in Germany. LOHS was significantly shorter but quality of neurosurgical care and outcome was not altered during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Rotational seismology opens a new avenue to study the deep interior of the Earth. Using data from the Wettzell Observatorium, Germany, where a ring laser gyroscope and a 3-component translational broadband seismometer are co-located, we report the presence of clear S, ScS and SdS signals on both rotational and translational seismograms. Using S wave arrivals, we propose a new methodology to extract information on velocity changes in the Earth mantle and we show that, by combining both translational and rotational data, we are able to solve the well known velocity-depth ambiguity inherent to classical inverse problems. The methodology is validated using ray theory and 2.5-D finite-difference synthetics. We provide a proof-of-concept showing that future studies of the Earth's deep interior can be improved by combining translational and rotational records. [ABSTRACT FROM AUTHOR]

The success of European efforts towards the recovery of the European eel (Anguilla anguilla) population will rely on accurate assessments of local stock status for the implementation of conservation measures. Yet, direct and continuous monitoring of the escapement of potential spawners ("silver eels") is unfeasible in most habitats. Therefore, population models are widely used to estimate local silver eel escapement, but require input information on recruitment, demographic characteristics, and mortalities that are often estimated with great uncertainties. We conducted a combined mark–recapture and acoustic telemetry study across two migration seasons to quantify the actual silver eel escapement in a sub-catchment of the German river Ems. Results were compared with predictions from the demographic model used to provide stock parameters in Germany according to the EU eel-regulation. Mark–recapture results suggested an annual female silver eel escapement of ∼15–17 tons, while the demographic model predicted 90–98 tons, indicating a considerable overestimation. Our results suggest that realistic prediction of silver eel escapement is hardly feasible without high-quality input information and highlight the need for site-specific model calibrations against monitoring data. Overestimations of local stock sizes are problematic if they obscure the necessity for adequate conservation measures, hindering their implementation. [ABSTRACT FROM AUTHOR]

With the increase in algorithms on social media, scholarship is increasingly focused on "algorithmic literacy," or users' understanding of algorithms. Algorithmic literacy is multi-faceted (knowledge, attitudes, and behavior), and researchers are still uncovering how these facets are connected. This article presents a preregistered survey of social media users from two western countries: the United States (n  =   990) and Germany (n  =   1117). Results show key predictors of algorithmic awareness—age, education, frequency of social media use—are the same in both countries. Nevertheless, U.S. social media users show higher algorithmic awareness and more positive attitudes toward algorithms than German social media users, likely due to their higher overall social media usage. Results also indicate that algorithmic awareness predicts attitudes about filtering algorithms depending on users' defense motivations or accuracy motivations and behaviors to counteract filtering. These patterns have implications for literacy interventions and for increasing algorithmic transparency. [ABSTRACT FROM AUTHOR]

Background: Health workforce shortage in German rheumatology and its negative impact in healthcare are increasingly recognised. Health policy has increased staffing targets, but effective intervention strategies are lacking. This paper aims to systematically map the rheumatology workforce and to explore opportunities for intervention, thus contributing to better health workforce management. Methods: The WHO National Health Workforce Accounts (NHWA) provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labour market flows, skill-mix and education/ training. Comparison of age-groups and time series was applied to explore trends. Public statistics and other secondary sources served the analysis, using descriptive methodology. Results: Rheumatologists nearly doubled in absolute numbers since 2000, but this trend shows a problematic demographic bias. Between 2000 and 2019 numbers increased markedly in the groups aged +50 years, but only about 9% in younger groups under 50 years. Most alarming, since 2010 the group 40 to 50 years showed a reverse trend and strong decreases. In 2019, absolute numbers of rheumatologists working in healthcare after retirement-age exceeded those aged 40 and under. Since 2015 an expanding workforce trend overall flattened, but strongest in the hospital sector; annual inflows do not show relevant growths. Conclusions: Health workforce assessment reveals negative demographic trends and decreasing appeal of the specialty especially to men, thus highlighting a need for more effective health workforce management. Intervention strategies should target innovation in resident training and task shifting and improve gender equality. Key messages: Health workforce trends indicate that new health policy planning targets cannot be met with an available stock of rheumatologist. The WHO NHWA provide a useful toolbox to map health workforce trends and identify weaknesses and gaps. [ABSTRACT FROM AUTHOR]

Background: The term Personlised Medicine (PM) was introduced to the public more than 20 years ago and was related to tailor-made medicines and a treatment considering the individual human genome. In the meantime, the term PM can be found with various definitions in several different contexts. Considering this, the aim of this research is to analyse the current status of PM in Germany, especially with regard to scientific articles and the pharmaceutical industry. Methods: First, a systematic literature review was conducted in PubMed and Web of Science. Each search strategy was adapted to the database conditions and consisted of the search terms personalised medicine or the MeSH term precision medicine, additionally pharmaceutical industry and Germany in topic, title or abstract (the Boolean operator AND was applied). Only results in German or English with an available abstract were considered. Second, the websites of all 47 members of the German association of research-based pharmaceutical companies (vfa) were systematically screened referring to their position and communication in terms of PM. Results: The literature research yielded a total of only 4 results. The scope of the papers is nanomedicine, an interview study and gene disorders. The second research part shows differences on the company websites: More than half of the companies have no relation to PM or an analysis was not possible (n=25). Some were categorized with indirect relation (n=3) and on 19 websites PM was communicated in different ways. Conclusions: The literature research clearly shows that although PM is not a new topic and furthermore, the research of pharmaceutical companies in this area is widely required, the number of scientific articles found is very low. The screening of company websites underlines this result as only 19 of 47 companies take a position to PM here and the scope varies greatly. Nevertheless, it is necessary to examine the reasons and how Germany compares to other countries. [ABSTRACT FROM AUTHOR]

Background: The WHO describes Health literacy (HL) as a critical determinant of health, and a number of studies among adults link low HL to adverse health outcomes. However, little research has been conducted on HL and health outcomes in younger populations. Thus, this study describes the relationship between HL, health behaviors, and health status among children in primary schools. Methods: A cross-sectional pen-and-paper survey was conducted in a convenience sample of 4th-graders in the federal state of North Rhine-Westphalia, Germany. Self-report measures were used for subjective HL, health behaviors (freq. of brushing teeth, eating fruit, exercising, screen time), and health status (subj. health, chronic condition, freq. of doctor visits, feeling ill). Correlations and binary logistic regression for the outcome "at least one adverse health behavior" (e.g. brushing teeth <2x a day; not eating fruit every day) are reported. Sex, age, family affluence, background of migration, numeracy, literacy, and health knowledge are included in the regression model. Results: In our sample of n = 899 children (mean age 9,56 years), HL is significantly correlated with subj. health (=.262) doctor visits (=.086), feeling ill (=-.078), brushing teeth (=.116), eating fruit (=.191) exercising (=.124) and screen time (=-.096). Logistic regression (X2 =29.237; p=.001, n = 648) shows that the relative risk for -1 adverse health behaviour is higher for boys (OR: 1.4; 95%-CI [1.016- 1.927]) and children with lowest family affluence (1.7 [1.097- 2.694]). Also, for one unit increase in HL (range 1-4), risk decreases by about 50% (0.472 [.298-.748]). Conclusions: Already at a young age (9-10 years), HL is linked to a number of health outcomes. Further, HL has been found to be a potential predictor of adverse health behaviors after controlling for confounders.Thus, the promotion of HL might play an important role in mitigating adverse health behaviors early in the life course. [ABSTRACT FROM AUTHOR]

Background There is limited knowledge of whether cognitive-behavioral therapy (CBT) or second-generation antipsychotics (SGAs) should be recommended as the first-line treatment in individuals at clinical high risk for psychosis (CHRp). Hypothesis To examine whether individual treatment arms are superior to placebo and whether CBT is non-inferior to SGAs in preventing psychosis over 12 months of treatment. Study Design PREVENT was a blinded, 3-armed, randomized controlled trial comparing CBT to clinical management plus aripiprazole (CM + ARI) or plus placebo (CM + PLC) at 11 CHRp services. The primary outcome was transition to psychosis at 12 months. Analyses were by intention-to-treat. Study Results Two hundred eighty CHRp individuals were randomized: 129 in CBT, 96 in CM + ARI, and 55 in CM + PLC. In week 52, 21 patients in CBT, 19 in CM + ARI, and 7 in CM + PLC had transitioned to psychosis, with no significant differences between treatment arms (P  = .342). Psychopathology and psychosocial functioning levels improved in all treatment arms, with no significant differences. Conclusions The analysis of the primary outcome transition to psychosis at 12 months and secondary outcomes symptoms and functioning did not demonstrate significant advantages of the active treatments over placebo. The conclusion is that within this trial, neither low-dose aripiprazole nor CBT offered additional benefits over clinical management and placebo. [ABSTRACT FROM AUTHOR]

Aims Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends. Methods Data came from nine waves (1995–2018; n total = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18–59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex. Results The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males. Conclusion Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern. [ABSTRACT FROM AUTHOR]

Many geophysical inverse problems are known to be ill-posed and, thus, requiring some kind of regularization in order to provide a unique and stable solution. A possible approach to overcome the inversion ill-posedness consists in constraining the position of the model interfaces. For a grid-based parameterization, such a structurally constrained inversion can be implemented by adopting the usual smooth regularization scheme in which the local weight of the regularization is reduced where an interface is expected. By doing so, sharp contrasts are promoted at interface locations while standard smoothness constraints keep affecting the other regions of the model. In this work, we present a structurally constrained approach and test it on the inversion of frequency-domain electromagnetic induction (FD-EMI) data using a regularization approach based on the Minimum Gradient Support stabilizer, which is capable to promote sharp transitions everywhere in the model, i.e., also in areas where no structural a priori information is available. Using 1D and 2D synthetic data examples, we compare the proposed approach to a structurally constrained smooth inversion as well as to more standard (i.e., not structurally constrained) smooth and sharp inversions. Our results demonstrate that the proposed approach helps in finding a better and more reliable reconstruction of the subsurface electrical conductivity distribution, including its structural characteristics. Furthermore, we demonstrate that it allows to promote sharp parameter variations in areas where no structural information are available. Lastly, we apply our structurally constrained scheme to FD-EMI field data collected at a field site in Eastern Germany to image the thickness of peat deposits along two selected profiles. In this field example, we use collocated constant offset ground-penetrating radar (GPR) data to derive structural a priori information to constrain the inversion of the FD-EMI data. The results of this case study demonstrate the effectiveness and flexibility of the proposed approach. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Studies of controlled hydraulic stimulation experiments with active and passive seismic monitoring conducted in Underground Research Laboratories (URLs) benefit from specific knowledge of hydraulic parameters, close by microseismic monitoring revealing structural details of the rock mass, and detailed evolution of seismicity in response to injection operations. Microseismic monitoring is commonly used to characterize a stimulated reservoir volume, for example, in terms of damage evolution of the rock mass. Since seismic attenuation is affected by damage of the rock volume, active seismic sources covering sizes from the centimetre to decimetre scale may help us to investigate space–time varying attenuation properties in a reservoir. This may allow us to monitor damage evolution of the stimulated rock volume in more detail, also since active seismic sources produce stronger signals leading to a broader frequency range that can be analysed compared to passive seismic signals. Within the STIMTEC project in the URL Reiche Zeche (URL-RZ) in Freiberg (Germany), more than 300 active Ultrasonic Transmission (UT) measurements were performed before and after hydraulic stimulations in two boreholes in the targeted rock volume, an anisotropic metamorphic gneiss. The signal-frequency content ranges between 1 and 60 kHz. Assuming scattering attenuation to dominate over intrinsic attenuation, we here apply the single isotropic scattering model. S -coda waves of 88 spatially representative UT measurements are used to estimate the coda quality factor (Q C). We obtain stable Q C estimates for centre frequencies of octave-width frequency bands between 3 and 21 kHz. We group neighbouring UT measurements to stabilize the observations and form eight UT groups in total, covering different depth intervals in three boreholes and four different time periods to investigate scattering attenuation changes in a spatiotemporal manner. Our final mean Q C (⁠|$\overline {{Q}_C} $|⁠) estimates show characteristic frequency-dependence as observed at the field scale in geological reservoirs. We find temporal variations of Q C are strongly connected to hydraulic stimulation, and these variations are more significant than those resolved from velocity changes. |$\overline {{Q}_C} $| estimates at frequencies above 15 kHz indicate healing of injection-induced small-scale fractures during a two-months post-stimulation phase. Larger fractures, mostly sampled by lower frequencies (<15 kHz), seem to be more persistent with time (over 15 months). We observe spatial differences of |$\overline {{Q}_C} $| values near the mine galleries (driftway and vein drift) and relate these observations to different extents and characteristics of the galleries' excavation damage zones. Our results further support previous assumptions based on borehole televiewer logs and mapped structures of an existing fault with larger damage zone that crosses the stimulated rock volume NW-SE between the galleries. We conclude that the coda analysis of active UT measurements complements established imaging methods used during experiments in URLs. In particular, coda analysis is a powerful tool for the detection of damage zones and for monitoring local fracture networks with immediate application for imaging georeservoirs considered for exploitation or underground storage of gases and liquids. [ABSTRACT FROM AUTHOR]

We estimate the push and pull factors involved in the outmigration of Jews facing persecution in Nazi Germany from 1933 to 1941. Our empirical investigation makes use of a unique individual-level data set that records the migration history of the Jewish community in Germany over the period. Our analysis highlights new channels, specific to violent contexts, through which social networks affect the decision to flee. We estimate a structural model of migration where individuals base their migration decision on the observation of persecution and migration among their peers. Identification rests on exogenous variations in local push and pull factors across peers who live in different cities of residence. Then we perform various experiments of counterfactual history to quantify how migration restrictions in destination countries affected the fate of Jews. For example, removing work restrictions for refugees in the recipient countries after the Nuremberg Laws (1935) would have led to an increase in Jewish migration out of Germany in the range of 12% to 20% and a reduction in mortality due to prevented deportations in the range of 6% to 10%. [ABSTRACT FROM AUTHOR]

Aims Studies assessing transfemoral transcatheter aortic valve implantation (TF-TAVI) showed lower rates of in-hospital mortality at high-volume hospitals and minimum caseloads were recommended to assure quality standards. Methods and results All patients in the German mandatory quality assurance registry with elective or urgent TF-TAVI procedures in 2018 and 2019 at 81 and 82 hospitals, respectively, were analysed. Observed in-hospital mortality was adjusted to expected mortality by the German AKL-KATH score (O/E) as well as by the EuroScore II (O/E2). Hospital volume and O/E were correlated by regression analyses and volume quartiles. 18 763 patients (age: 81.1 ± 1.0 years, mean EuroSCORE II: 6.9 ± 1.8%) and 22 137 patients (mean age: 80.7 ± 3.5 years, mean EuroSCORE II: 6.5 ± 1.6%) were analysed in 2018 and 2019, respectively. The average observed in-hospital mortality was 2.57 ± 1.83% and 2.36 ± 1.60%, respectively. Unadjusted in-hospital mortality was significantly inversely related to hospital volume by linear regression in both years. After risk adjustment, the association between hospital volume and O/E was statistically significant in 2019 (R 2 = 0.049; P = 0.046), but not in 2018 (R 2 = 0.027; P = 0.14). The variance of O/E explained by the number of cases in 2019 was low (4.9%). Differences in O/E outcome between the first and the fourth quartile were not statistically significant in both years (1.10 ± 1.02 vs. 0.82 ± 0.46; P = 0.26 in 2018; 1.16 0.97 vs. 0.74 ± 0.39; P = 0.084 in 2019). Any chosen volume cut-off could not precisely differentiate between hospitals with not acceptable quality (>95th percentile O/E of all hospitals) and those with acceptable (O/E ≤95th percentile) or above-average (O/E < 1) quality. For example, in 2019 a cut-off value of 150 would only exclude one of two hospitals with not acceptable quality, while 20 hospitals with acceptable or above-average quality (25% of all hospitals) would be excluded. Conclusion The association between hospital volume and in-hospital mortality in patients undergoing elective TF-TAVI in Germany in 2018 and 2019 was weak and not consistent throughout various analytical approaches, indicating no clinical relevance of hospital volume for the outcome. However, these data were derived from a healthcare system with restricted access to hospitals to perform TAVI and overall high TAVI volumes. Instead of the unprecise surrogate hospital volume, the quality of hospitals performing TF-TAVI should be directly assessed by real achieved risk-adjusted mortality. [ABSTRACT FROM AUTHOR]

Background Hyperkalemia (HK) is a frequent condition in patients with chronic kidney disease (CKD) that is associated with high morbidity and mortality. Patiromer has recently been introduced as a potassium binder. Data on patiromer use in patients with CKD in the real-world setting in Europe are lacking. We describe time to discontinuation and changes in serum potassium levels among German CKD stage 3–5 patients starting patiromer. Methods Duration of patiromer use was estimated by Kaplan–Meier curve, starting at patiromer initiation and censoring for death, dialysis, transplant or loss to follow-up. Serum potassium levels and renin–angiotensin–aldosterone system inhibitor (RAASi) use are described at baseline and during follow-up, restricted to patients remaining on patiromer. Results We identified 140 patiromer users within our analysis sample [81% CKD stage 4/5, 83% receiving RAASi, and median K+ 5.7 (5.4, 6.3) mmol/L]. Thirty percent of patiromer users had prior history of polystyrene sulfonate use. Overall, 95% of patiromer users stayed on treatment past 1 month, with 53% continuing for over a year. Mean serum potassium levels decreased after patiromer initiation and remained stable under treatment during follow-up (up to 180 days). Among these patients, 73%–82% used RAASis during the time periods before and after patiromer initiation, with no obvious trend indicating discontinuation. Conclusion Real-world evidence of patiromer use in Germany shows that, in line with what has been observed in clinical trials, patients on patiromer have a reduction in serum potassium when used long-term. Moreover, most patients on patiromer do not discontinue treatment prior to 1 year after initiation. [ABSTRACT FROM AUTHOR]

Background people aged 80 and over frequently have diverse and complex health trajectories, which has been well studied. But their oral health is seldom included in care models. To realise comprehensive healthcare, both general and oral ambulatory (i.e. outpatient) healthcare need to be explored and conceptualised equally. Objective to elicit what matters to very old people regarding ambulatory health and oral healthcare. Methods interviews were conducted with non-institutionalised people aged 80 and over living in the area of Cologne, Germany. They were interviewed regarding their experiences of and views on ambulatory healthcare and oral healthcare care, respectively. Thematic analysis was performed to understand their motives and elicit relevant characteristics of desirable health services. Results from the interviews with 22 participants, 16 characteristics of good healthcare were described. These were generally similar for both general and oral healthcare and had a particular focus on patient–provider interaction and the organisation of care. However, regarding oral healthcare, the participants focused more strongly on the technical–medical skills of professionals and the perceptible treatment results and were more concerned about costs. It was noticeable that older people had the urge to differentiate themselves from 'others unnecessarily using health services'. They were unaware of possible future oral health deterioration and the resulting future needs. Conclusions characteristics of good health and oral healthcare from the perspective of older people should be incorporated to ensure patient-centredness in care models. Older patients, as well as healthcare providers, need to be sensitised to their oral health needs to realise comprehensive healthcare. [ABSTRACT FROM AUTHOR]

The article highlights developments in public health in Europe as of October 2022. Topics mentioned include the acquisition of an operating grant by European Public Health Association from the European Commission, the lessons about health emergencies that can be learned from COVID-19 pandemic, and the advocacy of Association of Schools of Public Health in the European Region for public health.

Aims To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. Methods and results A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2–4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8–20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73–2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. Conclusion In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care. [ABSTRACT FROM AUTHOR]

Background Infectious complications are a major cause of morbidity and mortality after kidney transplantation. Methods In this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections. Results Of 804 renal transplant recipients (65.2% male, 51 ± 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first 3 months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9% [281/972]) and fungal (4.7% [46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was the most frequently isolated bacterium (20.9%), followed by E. coli (17.6%) and Klebsiella (12.5%). E. coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least 1 infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281 [49.8%]), and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was the most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis , were rare. Conclusions Renal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups, and resistant bacteria were identified in 10% of recipients. [ABSTRACT FROM AUTHOR]

Background Reactogenicity of coronavirus disease 2019 (COVID-19) vaccines can result in inability to work. The object of this study was to evaluate health care workers' sick leave after COVID-19 vaccination and to compare it with sick leave due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and quarantine leave. Methods A multicenter cross-sectional survey was conducted at Regensburg University Medical Center and 10 teaching hospitals in South-East Germany from July 28 to October 15, 2021. Results Of 2662 participants, 2309 (91.8%) were fully vaccinated without a history of SARS-CoV-2 infection. Sick leave after first/second vaccination occurred in 239 (10.4%) and 539 (23.3%) participants. In multivariable logistic regression, the adjusted odds ratio for sick leave after first/second vaccination compared with BNT162b2 was 2.26/3.72 for mRNA-1237 (95% CI, 1.28–4.01/1.99–6.96) and 27.82/0.48 for ChAdOx1-S (95% CI, 19.12–40.48/0.24–0.96). The actual median sick leave (interquartile range [IQR]) was 1 (0–2) day after any vaccination. Two hundred fifty-one participants (9.4%) reported a history of SARS-CoV-2 infection (median sick leave [IQR] 14 [10–21] days), 353 (13.3%) were quarantined at least once (median quarantine leave [IQR], 14 [10–14] days). Sick leave due to SARS-CoV-2 infection (4642 days) and quarantine leave (4710 days) accounted for 7.7 times more loss of workforce than actual sick leave after first and second vaccination (1216 days) in all fully vaccinated participants. Conclusions Sick leave after COVID-19 vaccination is frequent and is associated with the vaccine applied. COVID-19 vaccination should reduce the much higher proportion of loss of workforce due to SARS-CoV-2 infection and quarantine. [ABSTRACT FROM AUTHOR]

Objectives Differential diagnosis in children with prolonged fever is challenging. In particular, differentiating systemic-onset JIA (SJIA) from infectious diseases is difficult. Biomarkers are needed that support the diagnostic work-up. The aim of this study was to validate the usefulness of Myeloid-related protein 8/14 (MRP8/14) measurements in the diagnostic work-up of febrile children and to transfer it to clinical practice. Methods Data for 1110 paediatric patients were included and divided into two cohorts: (cohort A) for validation of MRP8/14 test performance with three different testing systems: the experimental ELISA, commercial ELISA and an innovative (point-of-care test) lateral flow immunoassay (LFIA); (cohort B) to validate the diagnostic accuracy with the two latter assays. Results In cohort A (n  = 940), MRP8/14 was elevated in SJIA (12 110 ± 2650 ng/ml mean ± 95% CI) compared with other diagnoses (including infections and autoinflammatory diseases; 2980 ± 510 ng/ml) irrespective of fever and anti-inflammatory treatment (P  < 0.001). In untreated patients with fever (n  = 195) MRP8/14 levels in SJIA (19 740 ± 5080 ng/ml) were even higher compared with other diagnoses (4590 ± 1160 ng/ml) (P  < 0.001, sensitivity 73%, specificity 90%). In group B1, the performance of the tests was confirmed in untreated patients with fever (n  = 170): commercial ELISA (sensitivity 79%, specificity 89%) and LFIA (sensitivity 84%, specificity 81%). Compared with ferritin, IL-18, ESR, soluble IL-2 receptor and procalcitonin, MRP8/14 showed the best accuracy. Conclusion MRP8/14 serum analyses have been validated as a helpful tool supporting the diagnosis of SJIA in febrile children. The results could be confirmed with commercial ELISA and LFIA enabling a rapid diagnostic point-of-care screening test. [ABSTRACT FROM AUTHOR]

Background and Aims Habitat degradation and landscape fragmentation dramatically lower population sizes of rare plant species. Decreasing population sizes may, in turn, negatively affect genetic diversity and reproductive fitness, which can ultimately lead to local extinction of populations. Although such extinction vortex dynamics have been postulated in theory and modelling for decades, empirical evidence from local extinctions of plant populations is scarce. In particular, comparisons between current vs. historical genetic diversity and differentiation are lacking despite their potential to guide conservation management. Methods We studied the population genetic signatures of the local extinction of Biscutella laevigata subsp. gracilis populations in Central Germany. We used microsatellites to genotype individuals from 15 current populations, one ex situ population, and 81 herbarium samples from five extant and 22 extinct populations. In the current populations, we recorded population size and fitness proxies, collected seeds for a germination trial and conducted a vegetation survey. The latter served as a surrogate for habitat conditions to study how habitat dissimilarity affects functional connectivity among the current populations. Key Results Bayesian clustering revealed similar gene pool distribution in current and historical samples but also indicated that a distinct genetic cluster was significantly associated with extinction probability. Gene flow was affected by both the spatial distance and floristic composition of population sites, highlighting the potential of floristic composition as a powerful predictor of functional connectivity which may promote decision-making for reintroduction measures. For an extinct population, we found a negative relationship between sampling year and heterozygosity. Inbreeding negatively affected germination. Conclusions Our study illustrates the usefulness of historical DNA to study extinction vortices in threatened species. Our novel combination of classical population genetics together with data from herbarium specimens, an ex situ population and a germination trial underlines the need for genetic rescue measures to prevent extinction of B. laevigata in Central Germany. [ABSTRACT FROM AUTHOR]

Objectives Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. Methods Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies. [ABSTRACT FROM AUTHOR]

Aims The prevalence of chronic limb-threatening ischaemia (CLTI) is increasing and available data often derive from cohorts with various selection criteria. In the present study, we included CLTI patients and studied sex-related differences in their risk profile, vascular procedures, and long-term outcome. Methods and results We analysed 199 953 unselected patients of the largest public health insurance in Germany (AOK: Local healthcare funds), hospitalized between 2010 and 2017 for a main diagnosis of CLTI. A baseline period of 2 years before index hospitalization to assess comorbidities and previous procedures, and a follow-up period until 2018 were included. Female CLTI patients were older (median 81.4 vs. 73.8 years in males; P  < 0.001) and more often diagnosed with hypertension, atrial fibrillation, chronic heart failure, and chronic kidney disease. Male patients suffered more frequently from diabetes mellitus, dyslipidaemia, smoking, cerebrovascular disease, and chronic coronary syndrome (all P  < 0.001). Within hospitalized CLTI patients, females represent the minority (43% vs. 57%; P  < 0.001) and during index hospitalization, women underwent less frequently diagnostic angiographies (67 vs. 70%) and revascularization procedures (61 vs. 65%; both P  < 0.001). Moreover, women received less frequently guideline-recommended drugs like statins (35 vs. 43%) and antithrombotic therapy (48 vs. 53%; both P  < 0.001) at baseline. Interestingly, after including age and comorbidities in a Cox regression analysis, female sex was associated with increased overall-survival (OS) [hazard ratio (HR) 0.95; 95% confidence interval (CI) 0.94–0.96] and amputation-free survival (AFS) (HR 0.84; 95% CI 0.83–0.85; both P  < 0.001). Conclusion Female patients with CLTI were older, underwent less often vascular procedures, and received less frequently guideline-recommended medication. Nevertheless, female sex was independently associated with better OS and AFS during follow-up. [ABSTRACT FROM AUTHOR]

In this work, we investigate methodological development and application of viscoelastic full waveform inversion to a multicomponent source and receiver data set at the near-surface scale. The target is located in Germany and lies in an ancient war trench from the War of the Spanish Succession that was buried at approximately 1 m depth. We present the pre-processing of the data, including a matching filter correction to compensate for different source and receiver coupling conditions during the acquisition, as well as a dedicated multistep workflow for the reconstruction of both P -wave and S -wave velocities. Our implementation is based on viscoelastic modelling using a spectral element discretization to accurately account for the wave propagation complexity in this shallow region. We illustrate the inversion stability by starting from different initial models, either based on dispersion curve analysis or homogeneous models consistent with first arrivals. We recover similar results in both cases. We also illustrate the importance of accounting for the attenuation by comparing elastic and viscoelastic results. The 3-D results make it possible to recover and locate the trench precisely in terms of interpretation. They also exhibit another trench structure, in a direction forming an angle at 45° with the direction of the targeted trench. This new structure had been previously interpreted as an artifact in former 2-D inversion results. The archaeological interpretation of this new structure is still a matter of discussion. [ABSTRACT FROM AUTHOR]

We show theoretically and empirically that the managerial organization of multiestablishment firms is interdependent across establishments. To derive our result, we study the effect of geographic frictions on firm organization. In our model, we assume that a CEO's time is a resource in limited supply, shared across headquarters and establishments. Geographic frictions increase the costs of accessing the CEO. Hiring middle managers at one establishment substitutes for CEO time, which is reallocated across all establishments. Consequently, geographic frictions between the headquarters and one establishment affect the organization of all establishments of a firm. Our model is consistent with novel facts about multiestablishment firm organization that we document using administrative data from Germany. We exploit the opening of high-speed railway routes to show that not only the establishments directly affected by faster travel times but also the other establishments of the firm adjust their organization. Our findings imply that local conditions propagate across space through firm organization. [ABSTRACT FROM AUTHOR]

The job-finding rate of unemployment insurance (UI) recipients declines in the initial months of unemployment and then exhibits a spike at the benefit exhaustion point. A range of theoretical explanations have been proposed, but those are hard to disentangle using data on job finding alone. To better understand the underlying mechanisms, we conducted a large text-message-based survey of unemployed workers in Germany. We surveyed 6,349 UI recipients twice a week for four months about their job search effort. The panel structure allows us to observe how search effort evolves in individuals over the unemployment spell. We provide three key facts: (i) search effort is flat early on in the UI spell, (ii) search effort exhibits an increase up to UI exhaustion and a decrease thereafter, (iii) UI recipients do not appear to time job start dates to coincide with the UI exhaustion point. A standard search model with unobserved heterogeneity struggles to explain the second fact, and a model of storable offers is not consistent with the third fact. The patterns are well captured by a model of reference-dependent job search or by a model with duration dependence in search cost. [ABSTRACT FROM AUTHOR]

In a recent article, Immel et al. (Immel A, Key FM, Szolek A, Barquera R, Robinson MK, Harrison GF, Palmer WH, Spyrou MA, Susat J, Krause-Kyora B, et al. 2021. Analysis of genomic DNA from medieval plague victims suggests long-term effect of Yersinia pestis on human immunity genes. Mol Biol Evol. 38:4059–4076) extracted DNA from 36 individuals dead from plague in Ellwangen, Southern Germany, during the 16th century. By comparing their human leukocyte antigen (HLA) genotypes with those of 50 present-day Ellwangen inhabitants, the authors reported a significant decrease of HLA-B*51:01 and HLA-C*06:02 and a significant increase of HLA-DRB1*13:01/13:02 frequencies from ancient to modern populations. After comparing these frequencies with a larger sample of 8,862 modern Germans and performing simulations of natural selection, they concluded that these changes had been driven by natural selection. In an attempt to provide more evidence on such stimulating results, we explored the HLA frequency patterns over all of Europe, we predicted binding affinities of HLA-B/C/DRB1 alleles to 106,515 Yersinia pestis -derived peptides, and we performed forward simulations of HLA genetic profiles under neutrality. Our analyses do not sustain the conclusions of HLA protection or susceptibility to plague based on ancient DNA. [ABSTRACT FROM AUTHOR]

Knowledge of the maximum forest stand density and the self-thinning process is important for understanding, modelling and scheduling thinnings in silviculture. The upper trajectories of stem number, N , vs mean diameter, dq or mean tree volume vs stem number are often used for quantifying maximum stand density. The long debate about how site conditions modify these relationships is presently revived due to global change. A crucial question is whether environmental conditions alter the trajectories themselves or just the velocity at which stands move along them. Our contribution is based on fully stocked plots from long-term Scots pine (Pinus sylvestris L.) fertilization experiments along an ecological gradient in South Germany. This allows us to compare the self-thinning trajectories of fertilized and unfertilized plots under different environmental conditions. We can show that repeated fertilization with nitrogen did not change the N ~ dq trajectories. Assuming that fertilization affects forests in a similar way as an ongoing atmospheric N -deposition, this means that presently growth, mortality, and volume accumulation in forest stands proceed faster in time but still follow the same N ~ dq allometric trajectories. Furthermore, we found that the level of the self-thinning line generally increases with the annual precipitation. The allometric self-thinning exponent, however, did not respond to environmental conditions. Finally, we quantitatively demonstrate and discuss the implications and consequences of the results regarding understanding and modelling forest stand dynamics, carbon sequestration and the development and adaptation of silvicultural guidelines in view of climate change. [ABSTRACT FROM AUTHOR]

Deviant interviewer behavior is a potential hazard of interviewer-administered surveys, with interviewers fabricating entire interviews as the most severe form. Various statistical methods (e.g. cluster analysis) have been proposed to detect falsifiers. These methods often rely on falsification indicators aiming to measure differences between real and falsified data. However, due to a lack of real-world data, empirical evaluations and comparisons of different statistical methods and falsification indicators are scarce. Using a large-scale nationally representative refugee survey in Germany with known fraudulent interviews, this study tests, evaluates, and compares statistical methods for identifying falsified data. We investigate the use of new and existing falsification indicators as well as multivariate detection methods for combining them. Additionally, we introduce a new and easy-to-use multivariate detection method that overcomes practical limitations of previous methods. We find that the vast majority of used falsification indicators successfully measure differences between falsifiers and nonfalsifiers, with the newly proposed falsification indicators outperforming some existing indicators. Furthermore, different multivariate detection methods perform similarly well in detecting the falsifiers. [ABSTRACT FROM AUTHOR]

We report the first outbreak of a new type of mass sociogenic illness that in contrast to all previously reported episodes is spread solely via social media. Accordingly, we suggest the more specific term 'mass social media-induced illness'. In Germany, the current outbreak of mass social media-induced illness is initiated by a 'virtual' index case, who is the second most successful YouTube creator in Germany and enjoys enormous popularity among young people. Affected teenagers present with similar or identical functional 'Tourette-like' behaviours, which can be clearly differentiated from tics in Tourette syndrome. Functional 'Tourette-like' symptoms can be regarded as the 'modern' form of the well-known motor variant of mass sociogenic illness. Moreover, they can be viewed as the 21st century expression of a culture-bound stress reaction of our post-modern society emphasizing the uniqueness of individuals and valuing their alleged exceptionality, thus promoting attention-seeking behaviours and aggravating the permanent identity crisis of modern man. We wish to raise awareness of the current global Tourette-like mass social media-induced illness outbreak. A large number of young people across different countries are affected, with considerable impact on health care systems and society as a whole, since spread via social media is no longer restricted to specific locations such as local communities or school environments spread via social media is no longer restricted to specific locations such as schools or towns. [ABSTRACT FROM AUTHOR]

Tilting of the ground due to loading by the variable atmosphere is known to corrupt very long period horizontal seismic records (below 10 mHz) even at the quietest stations. At BFO (Black Forest Observatory, SW-Germany), the opportunity arose to study these disturbances on a variety of simultaneously operated state-of-the-art broad-band sensors. A series of time windows with clear atmospherically caused effects was selected and attempts were made to model these 'signals' in a deterministic way. This was done by simultaneously least-squares fitting the locally recorded barometric pressure and its Hilbert transform to the ground accelerations in a bandpass between 100 and 3600 s periods. Variance reductions of up to 97 per cent were obtained. We show our results by combining the 'specific pressure induced accelerations' for the two horizontal components of the same sensor as vectors on a horizontal plane, one for direct pressure and one for its Hilbert transform. It turned out that at BFO the direct pressure effects are large, strongly position dependent and largely independent of atmospheric events for instruments installed on piers, while three post-hole sensors are only slightly affected. The infamous 'cavity effects' are invoked to be responsible for these large effects on the pier sensors. On the other hand, in the majority of cases all sensors showed very similar magnitudes and directions for the vectors obtained for the regression with the Hilbert transform, but highly variable from event to event especially in direction. Therefore, this direction most certainly has to do with the gradient of the pressure field moving over the station which causes a larger scale deformation of the crust. The observations are very consistent with these two fundamental mechanisms of how fluctuations of atmospheric surface pressure causes tilt noise. The results provide a sound basis for further improvements of the models for these mechanisms. The methods used here can already help to reduce atmospherically induced noise in long-period horizontal seismic records. [ABSTRACT FROM AUTHOR]

We investigate the wage, employment, and reallocation effects of the introduction of a nationwide minimum wage in Germany that affected 15% of all employees. Based on identification designs that exploit variation in exposure across individuals and local areas, we find that the minimum wage raised wages but did not lower employment. It also led to the reallocation of low-wage workers from smaller to larger, from lower- to higher-paying, and from less to more productive establishments. This worker upgrading accounts for up to 17% of the wage increase induced by the minimum wage. Moreover, at the regional level, average establishment quality increased in more affected areas in the years following the introduction of the minimum wage. [ABSTRACT FROM AUTHOR]

Background and hypothesis No objective tests are currently available to help diagnosis of major psychiatric disorders. This study evaluates the potential of eye movement behavior patterns to predict schizophrenia subjects compared to those with major affective disorders and control groups. Study design Eye movements were recorded from a training set of UK subjects with schizophrenia (SCZ; n  = 120), bipolar affective disorder (BPAD; n  = 141), major depressive disorder (MDD; n  = 136), and healthy controls (CON; n  = 142), and from a hold-out set of 133 individuals with proportional group sizes. A German cohort of SCZ (n  = 60) and a Scottish cohort of CON subjects (n  = 184) acted as a second semi-independent test set. All patients met DSMIV and ICD10 criteria for SCZ, BPAD, and MDD. Data from 98 eye movement features were extracted. We employed a gradient boosted (GB) decision tree multiclass classifier to develop a predictive model. We calculated the area under the curve (AUC) as the primary performance metric. Study results Estimates of AUC in one-versus-all comparisons were: SCZ (0.85), BPAD (0.78), MDD (0.76), and CON (0.85). Estimates on part-external validation were SCZ (0.89) and CON (0.65). In all cases, there was good specificity but only moderate sensitivity. The best individual discriminators included free viewing, fixation duration, and smooth pursuit tasks. The findings appear robust to potential confounders such as age, sex, medication, or mental state at the time of testing. Conclusions Eye movement patterns can discriminate schizophrenia from major mood disorders and control subjects with around 80% predictive accuracy. [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]