Search

This paper presents an innovative approach to decentralized data management in the German energy market, focusing on the use of decentralized data management with the help of Data Spaces to facilitate the automated change of energy suppliers within 24 h. The central focus of this research is the MakoMaker Space, a demonstrator project that employs the Connector from the Eclipse Data Space Components. The MakoMaker project demonstrates the successful automation of energy supplier changes, emphasizing the preservation of customer data sovereignty. It shows an alternative approach to the process, putting the customer into the center. Customers retain control of their data, which is accessible to providers as needed. While the paper discusses the potential for further enhancements, such as the integration of an identity provider and the development of a sustainable business model for service coordination, the primary focus is on the demonstrator's successful application in a pilot setting. [ABSTRACT FROM AUTHOR]

Electric vehicles (EVs) are expected to be vital in transitioning to a low-carbon energy system. However, integrating EVs into the power grid poses significant challenges for grid operators and energy suppliers, especially regarding the uncertainty and variability of EV charging demand. Accurate forecasting of EV charging demand is essential for optimal power system integration, yet previous studies have often only considered point predictions that are inadequate for risk assessment. Therefore, this paper compares different probabilistic forecasting models for the short-term prediction of EV charging demand at various aggregation levels, using a large and novel dataset of over 350,000 charging processes at more than 500 locations across Germany. The performance of both machine learning and deep learning methods is evaluated against a naïve benchmark model, and the impact of data availability on the forecasting models is investigated. Further, the paper examines the effects of forecast accuracy on energy procurement, which has so far received minor attention in the literature. The results show that machine learning methods such as Ada Boosting and Random Forest yield robust results with a normalized root mean square error of 0.42 and 0.41 and a mean absolute scaled error of 0.36 and 0.34 at the highest aggregation level. Furthermore, the results show the influence of different site compositions on the forecast quality and how many charging points are likely to yield a robust forecast. Energy and fleet managers can use the described method to reliably predict the required energy quantities for fleets of sufficient size and procure them at low risk. [ABSTRACT FROM AUTHOR]

Education is a key determinant of wage development. The relationship between education and wages is particularly strong in countries with vocationally oriented educational systems and a clear distinction between general and vocational education, such as Germany and Switzerland. However, whether general and vocational education offer the same returns to education is an ongoing debate. Previous findings from international research are still inconclusive. Against this background and based on theoretical arguments from human capital and signalling theory and the task-specific learning-by-doing approach, our paper examines the long-term wage development of Swiss university and professional education degree holders from the time they obtain their tertiary degree until their late career. It asks how differences between the two groups in wage development may be explained. Our results, produced with regression decomposition methods, show that within the first 20 years after graduation, university degree holders experience steeper wage growth. An important reason for this difference is that university graduates move more often than vocational tertiary degree holders into well-paid labour market positions endowed with formal authority, management responsibility, and a large proportion of cognitive nonroutine tasks. [ABSTRACT FROM AUTHOR]

Background: Renewable energies are key to reduce CO2 emissions and other environmental impacts of fossil-fueled electricity generation. However, renewable energy systems can also cause negative environmental effects. In this paper, we analyze the potential environmental trade-offs associated with different spatio-technical (de)centralization options for a renewable electricity system. For this purpose, we first review the potential environmental life cycle impacts of key technologies for renewable electricity systems. Subsequently, we develop a framework identifying which factors determine actual environmental effects of renewable electricity systems. We apply the framework to four basic spatio-technical (de)centralization options for the future Germany electricity system. Results: Our analysis shows that all (de)centralization options are associated with potential environmental trade-offs. We find that the (de)centralization of the system is a relevant factor determining these trade-offs. For instance, the two more centralized options considered have lower environmental impacts related to PV, whereas the two more decentralized options have lower environmental impacts related to grid infrastructure. However, we also find that the trade-offs depend on the specific way (de)centralization is pursued. For instance, only in one of the two considered more decentralized development options, there is a potential environmental trade-off between higher impacts related to battery storage and lower impacts related to offshore wind power. Conclusions: Our analysis reveals that the spatio-technical (de)centralization of a renewable electricity system plays a role for its environmental trade-offs while further factors like the institutional and stakeholder management in place also shape the environmental trade-offs. Policy makers should acknowledge the identified potential environmental trade-offs and their influencing factors when making policies favoring certain spatio-technical (de)centralization options. Highlights: Review of potential environmental impacts of key renewable technologies Framework on determinants of actual environmental effects of electricity systems Review of electricity system (de)centralization scenarios for Germany Application of framework to four spatio-technical (de)centralization options Environmental trade-off analysis for the four (de)centralization options [ABSTRACT FROM AUTHOR]

Quantum computing (QC) is a new and disruptive technology with large economic potential especially in application and downstream value creation stages. Hence, it is important for an economy to understand the current implementation state and to know the ecosystem to support the successful industrial application of this technology. Regularly identifying potential areas of improvement and then defining appropriate actions is necessary to ensure a leading position. Therefore, the Quantum Technology and Application Consortium (QUTAC) has developed a Key Performance Indicator (KPI) framework consisting of 24 KPIs that represent a country's performance in applying QC. Detailed measurement guidelines and clear data sources ensure transparency of measurement, reproducibility of KPI values and comparability over time. An aggregation method allows summarizing the results of all KPIs. Thus, it is possible to assess the performance of each stakeholder involved and to calculate a single composite indicator that represents the country's performance. The KPI framework can be adapted to any country and enables the comparison of the performance of different countries. It is a proposal for standardizing the evaluation of QC and its ecosystem on a national level. Thus, strengths and weaknesses can be identified and measurements for improvement derived. The paper highlights the development of the framework, its main features and the application of the framework to Germany. Based on the results, we will discuss the current state of QC application in Germany and make possible suggestions for improvement. [ABSTRACT FROM AUTHOR]

The promises and risks of Artificial Intelligence permeate current policy statements and have attracted much attention by AI governance research. However, most analyses focus exclusively on AI policy on the national and international level, overlooking existing federal governance structures. This is surprising because AI is connected to many policy areas, where the competences are already distributed between the national and subnational level, such as research or economic policy. Addressing this gap, this paper argues that more attention should be dedicated to subnational efforts to shape AI and asks which themes are discussed in subnational AI policy documents with a case study of Germany's 16 states. Our qualitative analysis of 34 AI policy documents issued on the subnational level demonstrates that subnational efforts focus on knowledge transfer between research and industry actors, the commercialization of AI, different economic identities of the German states, and the incorporation of ethical principles. Because federal states play an active role in AI policy, analysing AI as a policy issue on different levels of government is necessary and will contribute to a better understanding of the developments and implementations of AI strategies in different national contexts. [ABSTRACT FROM AUTHOR]

Background: Interleukin17 (IL17) is an important cytokine in host defense at mucosal surfaces and also mediates many autoimmune diseases, including rheumatoid arthritis (RA). In recent years, many types of research relevant to the structure and function of IL17 have been identified. However, there is no bibliometric analysis in this research field. This study aims to explore the history, research hotspots, and emerging trends of IL17 from the perspective of the structure and function dynamics. Methods: Articles relevant to IL17 in the last two decades were retrieved through the Web of Science Core Collection (WoSCC) database. The bibliometric analysis was performed by VOSview. Results: A total of 882 papers in this research were analyzed from 65 countries, and the rate of published articles has increased from 2008 annually, with the USA, China, and Germany leading the research effort. Frontiers in Immunology has significantly impacted research in this field and the University of Pittsburgh was the leading institution. Gaffen, Sarah L. from the University of Pittsburgh was the most productive researcher in this field and Papp Ka from the Probity Medical Research Incorporate of Canada is the most co-cited author. The analysis of keywords showed that inflammation, expression, Th17 cells, and cytokines were the main hotspots and frontier directions of IL17. The trend of clinical application in the future is the development of new therapy drugs based on the structure of IL17 or IL17 signaling pathway molecular. Conclusions: Our research summarized the developments and research trends of IL17 and would help researchers understand the research status of IL17 and provide a reference for future researchers as soon as possible. [ABSTRACT FROM AUTHOR]

Climate movements have gained momentum in recent years, aiming to create public awareness of the consequences of climate change through salient climate protests. This paper investigates whether concerns about climate change increase following demonstrative protests and confrontational acts of civil disobedience. Leveraging individual-level survey panel data from Germany, we exploit exogenous variations in the timing of climate protests relative to survey interview dates to compare climate change concerns in the days before and after a protest (N = 24,535). Following climate protests, we find increases in concerns about climate change by, on average, 1.2 percentage points. Further, we find no statistically significant evidence that concerns of any subpopulation decreased after climate protests. Lastly, the increase in concerns following protests is highest when concern levels before the protests are low. Climate movements aim to raise public awareness of climate change through protests, but their efficacy is debated. Here, the authors show that concerns about climate change increased in Germany after climate strikes and non-violent acts of civil disobedience. [ABSTRACT FROM AUTHOR]

Background: The accumulation of trace elements in mosses is used as an indirect measure of atmospheric deposition and an important complement to the techniques used to monitor the Geneva Air Pollution Convention. The aim of this paper is to quantify and map temporal and spatial trends of metal enrichment in mosses collected in Germany in 1990, 1995, 2000, 2005, 2015 and 2020. Collection and chemical analysis of the moss samples were carried out according to international guidelines. Results: The analysis shows that since 1990, the median concentrations of As, Cd, Cu, Ni, Pb and Sb in the mosses have been decreasing significantly, with the with the highest decline of Pb (− 86%). This trend reversed in 2000 and 2005 and between 2015 and 2020 by increases in the concentrations of some trace elements. In the 2000 Moss Survey, higher concentrations were measured for Cd, Cu, Ni and Sb than in 2015, ranging from + 26% (Cu) to + 165% (Ni). For As and Pb, no significant changes can be observed in 2020 compared to 2015. The increase in metal concentrations in the mosses over the last five years does not correspond to the corresponding trends in reported metal emissions in Germany (2015–2020). In contrast, the long-term trends of the As, Cd, Cu, Ni and Pb concentrations measured in the mosses showed good overall correspondence with the emission trends in Germany (1990–2020). The long-term trends of the moss data are mostly weaker than those of the emission data. The spatial patterns of the temporal trends were mapped and discussed for As, Cd, Cu, Ni, Pb and Sb. Conclusions: The study shows that for valid monitoring of atmospheric deposition, it is not enough to consider only emission data or the modelled deposition derived from these data. In this respect, the study provides one of many necessary contributions to the discussion on the extent to which analytes of current monitoring programmes are still relevant and up-to-date and whether there are new substances that are also relevant or even more relevant than existing analytes and to what extent this should be taken into account in designing future environmental monitoring. [ABSTRACT FROM AUTHOR]

This paper addresses the question whether and to what extent the experience of online hate speech affects victims' sense of security. Studies on hate crime in general show that such crimes are associated with a significantly higher feeling of insecurity, but there is little evidence concerning feeling of insecurity due to online hate speech. Based on a secondary data analysis of a representative population survey in Lower Saxony, Germany, on the topic of cybercrime in 2020 (N = 4,102), we tested three hypotheses regarding the effect of offline and online hate speech on feelings of insecurity. As a result, compared to non-victims, victims of online hate speech exhibit a more pronounced feeling of insecurity outside the Internet, while victims of other forms of cybercrime do not differ in this regard from non-victims. We found no effect for offline hate speech when relevant control variables were included in the statistical model. Possible reasons for this finding are assumed to lie in the characteristics of the phenomenon of online hate speech, for example, because the hateful content spreads uncontrollably on the Internet and reaches its victims even in protected private spheres. [ABSTRACT FROM AUTHOR]

Platinum group metals (PGM) and cerium as one of the rare-earth elements are considered as critical raw materials, thus their recycling and re-use is of utmost importance. Among the PGMs, platinum (Pt), palladium (Pd), and rhodium (Rh) are the basic and most valuable metals used in catalytic converters. Due to the high price of PGMs, there are already recycling routes in Europe and especially in Germany. For PGM and rare-earth elements, research is focusing on greener, plain recovery techniques, which utilize milder reagents, offer better energy efficiency, and replace the existing recycling routes. In this work, a hydrometallurgical process is proposed to add a hydrometallurgy method to the mostly pyrometallurgical industrial recycling routes, resulting in recovery rates for cerium and PGMs of 63.21% and only 1.03% with sulfuric acid, respectively. With hydrochloric acid, the leaching efficiency for cerium is even lower, and for PGM it is comparable. In the method proposed in the present paper, the main PGMs remain in monoliths and can be recycled in existing recycling routes like pyrometallurgical recycling. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

Introduction: In Germany, the estimation of the disease burden of respiratory syncytial virus (RSV) in older adults is limited. This makes it challenging for public health decision-makers to develop evidence-based recommendations for newly available vaccines against RSV for individuals aged 60 years and older (60+). This study investigates publicly available data sources in Germany to address the current gaps in evidence regarding the burden of RSV. Methods: Hospitalisation databases from the German Federal Statistical Office and national mortality statistic between 2000 and 2023, as well as regular surveillance reports from the national public health institute since 2014, were utilised to extract, combine and analyse data on RSV-related morbidity and mortality. These data were used to triangulate the age-specific burden of RSV. Results: The data indicate that the number of RSV-related outpatient consultations ranges between 1,313,100 and 3,911,800 cases per season from 2014/2015 to 2022/2023 for all age groups, with approximately 13.0% of outpatient consultations occurring in adults 60+. The significant increase in hospitalisations over time suggests that heightened testing due to the coronavirus disease 2019 (COVID-19) pandemic revealed the underdetection of inpatient RSV cases in pre-pandemic seasons. In the most recent season recorded, 2022/2023, the data show 12,800 RSV-related hospitalisations in adults 60+ (24% of all RSV-related hospitalisations) and 1340 in-hospital deaths in adults 60+ (93% of all RSV-related deaths). Conclusion: The comparison of pre- to post-pandemic seasons strongly suggest up to a sevenfold underdetection of RSV in individuals 60+, and the analysis of in-hospital mortality reveals higher mortality rates compared with the general German mortality statistics. These findings highlight the urgent need to improve surveillance and implement targeted prevention strategies to mitigate the impact of RSV in older adults. [ABSTRACT FROM AUTHOR]

This study examines whether premature termination of vocational education and training (VET) is more likely when trainees have to make compromises between their realistic occupational aspirations and the occupation for which they are trained in terms of the occupational dimensions of gender type, prestige, and occupational interests. Specifically, it examines the relative importance of the three compromise dimensions on premature VET termination. The study is based on a sample of 3,241 VET entrants from a cohort of ninth graders in 2010 in the German National Educational Panel Study (NEPS-SC4) in combination with aggregated data on occupational characteristics. Results from discrete hazard rate models indicate a higher risk of premature VET termination for trainees whose VET occupation differs from their realistic occupational aspiration from their school days. While compromises in prestige have no overall effect, both compromises in interests and gender type threaten the stability of VET. The results also indicate that compromises in interests have the strongest effect on the risk of premature VET termination and that the effects of compromises in gender type are partly mediated by the effects of compromises in interests. Furthermore, sensitivity analysis revealed that the main effects of compromises in gender type and prestige are gender specific. [ABSTRACT FROM AUTHOR]

Background: New regulations and market conditions in Germany affect the profitability of biomethane upgrading as a repowering option for existing biogas plants following on-site CHP utilization. These conditions present trade-off challenges between higher sustainability requirements, maintaining production capacity and new revenue opportunities. Optimization methods, such as linear programming (LP), are essential for determining the ideal substrate mixture and profitable solutions amidst multiple market conditions, plant-specific process constraints, and substrate properties. Methods: We updated a substrate mixture optimization model within an assessment framework for the repowering of existing biogas plants (BGPs), which focuses on the operator's perspective. By integrating multiple German biomethane markets for various BGPs, we assessed changes in the substrate mixture, GHG emissions, contribution margins, and constraint parameters to derive conclusions for operators and future framework design. Results: Integrating market revenues and constraints can increase contribution margins by 12–55%. Additional gains can be achieved by considering multiple markets simultaneously but limited to a few BGPs. The plant-specific LP solution space and used benchmark market are decisive. The former limits the potential of high substrate-specific contribution margins, which has a significantly higher impact than the relation between plant-specific characteristics and process constraints. The advanced fuel market is currently the lead market for biomethane, incentivizing GHG-emission extensive substrates, decreasing gas production and GHG emissions but increasing levelized cost of energy (LCOE) and partially CO2 abatement costs. Conclusions: The key to improve profitability and to supply an increasing biomethane demand while fulfilling new requirements is a large LP solution space. Increasing market options, substrate availability, and digestion system capacity achieve this on the operator's side. Policy makers could reduce normative requirements such as the maize cap or double counting of advanced fuels and favor high but uniform GHG requirements. Operators can prepare robustly for the future substrate mixture by adding digester volume and pre-treatment tech, ensuring long-term and diverse substrate availability, and contracts with flexible components. Although current market conditions can improve specific GHG emissions, they do not necessarily increase manure usage when other options, such as straw, are viable. Other regulatory support systems will be required to do so. [ABSTRACT FROM AUTHOR]

Marine fisheries are increasingly impacted by climate change, affecting species distribution and productivity, and necessitating urgent adaptation efforts. Climate vulnerability assessments (CVA), integrating expert knowledge, are vital for identifying species that could thrive or suffer under changing environmental conditions. This study presents a first CVA for the Western Baltic Sea's fish community, a crucial fishing area for Denmark and Germany. Characterized by a unique mix of marine, brackish, and freshwater species, this coastal ecosystem faces significant changes due to the combined effects of overfishing, eutrophication and climate change. Our CVA involved a qualitative expert scoring of 22 fish species, assessing their sensitivity and exposure to climate change. Our study revealed a dichotomy in climate change vulnerability within the fish community of the Western Baltic Sea because traditional fishing targets cod and herring as well as other species with complex life histories are considered to face increased risks, whereas invasive or better adaptable species might thrive under changing conditions. Our findings hence demonstrate the complex interplay between life-history traits and climate change vulnerability in marine fish communities. Eventually, our study provides critical knowledge for the urgent development of tailored adaptation efforts addressing existing but especially future effects of climate change on fish and fisheries in the Western Baltic Sea, to navigate this endangered fisheries systems into a sustainable future. [ABSTRACT FROM AUTHOR]

Background: The decarbonization of the mobility sector is one of the main challenges in the context of climate mitigation. In Germany, as in many other countries, policy measures aiming to make the mobility system greener frequently fail to produce substantial results, not least due to a lack of support by large sections of the general public. Policy measures directed at reducing car traffic in particular are often met with indifference and resistance. The question thus arises: what basis do citizens use to form their (often negative) opinions about sustainable mobility policies? As a conceptual starting point for our empirical analysis, we draw on the frame concept and focus on people's frames of the politics of mobility. With "politics of mobility" we refer to everything people could consider as political with regard to mobility. We understand frames as culturally mediated patterns of interpretation that ultimately motivate and guide actions. Results: Based on interviews and focus group data gathered in the region of the city of Stuttgart (Germany), we identify two dominant frames as well as combinations of these frames by which people make sense of the activities of political actors in the field of mobility. In one frame, which we labeled "politics-as-actor", mobility politics are interpreted with reference to politics as some kind of monolithic abstract actor. In the other, which we labeled as "politics-as-staged-process", mobility politics are portrayed as an interest-driven, opaque process that only purport to being democratic. Conclusions: In terms of policy recommendations, we use our findings to derive suggestions for how to increase support for green mobility policies: transparent implementation of policy measures, pragmatic policy styles and the involvement of intermediaries. [ABSTRACT FROM AUTHOR]

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45–49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65–69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches. [ABSTRACT FROM AUTHOR]

The i-DREAMS project focuses on establishing a framework known as the 'Safety Tolerance Zone (STZ)' to ensure drivers operate within safe boundaries. This study compares Long-Short-Term-Memory Networks and shallow Neural Networks to assess participants' safety levels during i-DREAMS on-road trials. Thirty German drivers' trips and Forty-Three Belgian drivers were analyzed using these methods, revealing factors contributing to risky behavior. Results indicate i-DREAMS interventions significantly enhance driving behavior, with Neural Networks displaying superior performance among the algorithms considered. [ABSTRACT FROM AUTHOR]

Autonomous on-demand services as part of public transport are discussed to improve public transport substantially. A household survey in Karlsruhe, Germany, was conducted among inhabitants of a residential area where a combined autonomous and on-demand minibus service with automation level 4 was offered. The study investigates the residents' appraisal of this service and reasons for using and not using it. Results indicate that people generally have a positive attitude towards it and are willing to use it in the future. Difficulties are found in travel speed, availability, and complexity of using such a new service. Favorable factors in the intention to use the service are having a mobility impairment, being open to other forms of new mobility, and not having a car in the household. In the future, to be successful, such services should improve travel times and reliability and address issues of their primary target group, such as the high complexity of accessing these services. [ABSTRACT FROM AUTHOR]

Background: The recurrent mental illness bipolar disorder is a major burden on the healthcare system, which underlines the importance of research into this disease. Germany is one of the most productive countries in this research activity. This bibliometric analysis aims to outline the social and conceptual structure of the German research landscape on bipolar disorder over the last decade. Furthermore, we provide a short overview over current public funding. Results: Concerning the social structure, most of the German publications were collaboration projects, both with a national but also international orientation, in the latter case predominantly with countries of the global North. Analysis of the conceptual structure of German research activity identified psychiatric genetics, early recognition of bipolar disorder, neuroimaging, and pharmacological interventions as important topics within the field. In the context of a survey, only few publicly funded research projects were reported, many of which did not exclusively investigate bipolar disorder but followed a transdiagnostic approach. Conclusions: Our bibliometric analysis revealed internationally well-networked German research activities on bipolar disorder. In stark contrast to its high prevalence and correspondingly high financial burden to the healthcare system, current grant support for research on this illness is strikingly low, particularly concerning the development of novel treatments. [ABSTRACT FROM AUTHOR]

In the social and behavioral sciences, surveys are frequently used to collect data. During the COVID-19 pandemic, surveys provided political actors and public health professionals with timely insights on the attitudes and behaviors of the general population. These insights were key in guiding actions to fight the pandemic. However, the data quality of these surveys remains unclear because systematic knowledge about how the survey data were collected during the COVID-19 pandemic is lacking. This is unfortunate, since decades of survey research have shown that survey design impacts data. Our Survey Data Collection and the COVID-19 Pandemic (SDCCP) project deals with this research gap. We collected rich metadata on survey design for 717 social and behavioral science surveys carried out in Germany during the first two years of the COVID-19 pandemic. In this data descriptor, we present a unique resource for a systematic assessment of the survey data collection practices and quality of surveys conducted in Germany during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The currently dominant types of land management are threatening the multifunctionality of ecosystems, which is vital for human well-being. Here, we present a novel ecological-economic assessment of how multifunctionality of agroecosystems in Central Germany depends on land-use type and climate. Our analysis includes 14 ecosystem variables in a large-scale field experiment with five different land-use types under two different climate scenarios (ambient and future climate). We consider ecological multifunctionality measures using averaging approaches with different weights, reflecting preferences of four relevant stakeholders based on adapted survey data. Additionally, we propose an economic multifunctionality measure based on the aggregate economic value of ecosystem services. Results show that intensive management and future climate decrease ecological multifunctionality for most scenarios in both grassland and cropland. Only under a weighting based on farmers' preferences, intensively-managed grassland shows higher multifunctionality than sustainably-managed grassland. The economic multifunctionality measure is about ~1.7 to 1.9 times higher for sustainable, compared to intensive, management for both grassland and cropland. Soil biodiversity correlates positively with ecological multifunctionality and is expected to be one of its drivers. As the currently prevailing land management provides high multifunctionality for farmers, but not for society at large, we suggest to promote and economically incentivise sustainable land management that enhances both ecological and economic multifunctionality, also under future climatic conditions. Land management impacts ecosystem functions. Here, the authors conduct field experiments in Germany assessing ecosystem variables in cropland and grasslands showing that sustainable agricultural practices enhance ecological and economic benefits. [ABSTRACT FROM AUTHOR]

Background: Policymakers are tasked with both driving the rapid expansion of renewable energy technologies and, additionally channelling the limited national potential of biomass into areas where it can provide the greatest benefit to the energy system. But do current policy instruments promote the use of biomass in these areas? As biomass is limited, its use must be sustainable without leading to further biodiversity loss or depleting forest or soil resources. In this study, short-term energy scenarios are generated using the BenOpt model, which take into account both current and alternative policy instruments under limited biomass utilisation. The results are compared with long-term, cost-optimal energy scenarios for the use of biomass. Results: The analysis reveals that the instrument of a GHG quota does not promote the use of biofuels in hard-to-electrify areas of the transport sector, where they should be cost-optimally allocated according to long-term energy scenarios. Biofuels are promoted for use in passenger road transport and not in the shipping or aviation sector. In contrast, alternative policy scenarios indicate that the sole instrument of a high CO2 price is more conducive to direct electrification and could displace more fossil fuels by 2030 than the GHG quota alone. This instrument also promotes the optimal use of biogas plants in the power sector in accordance with long-term cost-optimal developments. Conclusions: The instrument of a GHG quota might lead to counterproductive developments in passenger road transport, but it also helps to ramp up the biofuel capacities required in shipping and aviation in the long term. However, it does not provide the necessary incentives for the ramp-up of battery electric vehicles, which would be the cost optimal solution in passenger road transport according to the long-term scenarios. Even though alternative policy scenarios show that the sole instrument of a high CO2-price is more conducive to direct electrification, a high CO2 price alone is not enough (e.g. in the heat sector) to promote the efficient use of biomass instead of simply covering the base load demand. [ABSTRACT FROM AUTHOR]

Background: Monoclonal antibodies (mAbs) targeting the calcitonin gene-related peptide (CGRP) pathway have shown good efficacy in migraine prophylaxis. However, a subset of patients does not respond to the first mAb treatment and switches among the available mAbs. The goal of this study is to characterize the switching pattern of migraine patients treated with anti-CGRP(-receptor, -R) mAbs, and to describe the headache burden of those who did not switch, switched once, and switched twice. Methods: This study used real world data from the NeuroTransData Cohort, a registry of migraine patients treated at outpatient neurology clinics across Germany. Patients who had received at least one anti-CGRP(-R) mAb were included. Headache diaries were collected at baseline and during treatment, along with quality of life measures every three months. Results were summarized for the subgroups of patients who did not switch and those with one and two switches. Results: Of the 655 eligible patients, 479 did not switch, 135 switched once, 35 twice, and 6 three or more times. The ≥ 50% response rates for monthly migraine days were 64.7%, 50.7%, and 25.0% for the no switch, one switch, and two switches groups in their last treatment cycles, respectively. Quality of life measures improved for the no switch and one switch groups, but not for the two switches group. Conclusion: Patients who switched among anti-CGRP(-R) mAbs during the course of their treatment still benefited overall but to a lesser extent than those who did not switch. Treatment response in patients who switched twice was markedly lower compared to the no switch and one switch subgroup. [ABSTRACT FROM AUTHOR]

Gem sapphire is commonly retrieved from primary and secondary deposits associated with alkali basaltic fields, but its source rocks are rarely preserved. The Eifel (Rhenish Massif, western Germany), although not producing gem sapphire, shares many petrologic and geochemical similarities with such fields worldwide. Due to the young age of volcanic deposits and active quarrying, sapphire-bearing rocks are readily accessible, along with detrital sapphire from modern sediments. Here, oxygen isotope and trace element compositions are reported for 223 sapphire grains, and rutile and zircon inclusions in sapphire were dated indicating crystallization synchronous with Paleogene–Quaternary volcanism. Endmembers in δ18O range are sapphires from syenites representing mantle-derived differentiated melts with minor crustal contamination (~4–6‰) and contact metamorphic mica schists (>10‰) as purely crustal source rocks. Intermediate values between ~6 and 10‰ require variable degrees of mantle-crust hybridization. Lower crustal granulite sources are dismissed based on their oxygen isotopic compositions being lower than most sapphire crystals. Diffusion modelling of sharp oxygen isotopic zonation in compositionally zoned crystals precludes crystal residence at >900 °C over the lifetime of evolved magma reservoirs in the Eifel (c. 50 ka). This argues against direct mantle or lower crustal sapphire origins. Instead, low temperature residence is consistent with sharp δ18O gradients, coexisting andalusite, and fluid inclusion barometry. Hence, Eifel sapphire crystallization is attributed to contact metamorphic aureoles around upper crustal (5–7 km) magma bodies where phonolite, trachyte, and carbonatite melts differentiated from mafic parental magmas, and reacted with metasedimentary wall rocks. [ABSTRACT FROM AUTHOR]

Introduction: Evaluate the real-world efficacy of a single intra-articular injection of carboxymethyl-chitosan (CM-chitosan), a new product class for knee osteoarthritis (OA). Methods: This post-marketing study included adult patients with knee OA, who received a single injection of 60 mg CM-chitosan (currently marketed as KioMedinevsone) according to the instructions for use. Follow-up was performed at weeks 1, 12, 24, and 36. Efficacy was evaluated using a Visual Analog Scale (VAS) score for pain, the Knee injury and Osteoarthritis Outcome Score (KOOS), Patient's Global Assessment (PGA), and overall patient satisfaction. Results: Forty-nine patients were included in the study. VAS pain score significantly decreased from a median of 49.0 mm at baseline to 24.0 mm at week 1 and to 18 mm at week 36. Pain improvement was stable since at week 36; 91.8% of patients confirmed pain reduction. All KOOS subscales (symptoms, pain, activities of daily living, sports and recreational activities, quality of life) improved significantly compared to baseline at all time points. KOOS pain improved progressively from a median of 58.3% at baseline (mean 56.2 ± 18.8%) to 86.1% (mean 74.1 ± 24%) at week 36 compared to baseline. Overall, more than 70% of patients reported a condition gain (PGA), matching well with the more than 75% of patients being satisfied with the treatment. At 6 months, 72.7% of the patients could be classified as responder according to the OMERACT-OARSI proposed set of responder criteria. Conclusion: CM-chitosan showed a rapid onset of pain relief after 1 week and with a duration of 9 months. In a real-world setting, treatment with CM-chitosan would appear to be a potentially effective option to reduce pain and improve physical function and global condition in patients with knee OA, opening new perspectives in patients who are considered as refractory to current symptomatic therapies and where the unmet need is high. Trial Registration Number: NCT04757051 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

Prior research has shown that students from lower socio-economic backgrounds are less likely to graduate. We examine if this can be explained by background-specific pathways into higher education. Many students in Germany enter higher education with a vocational qualification and prior vocational qualifications occur more often among students from lower socio-economic backgrounds. We argue that vocational qualifications shift opportunity structures and opportunity costs of students who have to decide between continuing higher education and alternative options. We therefore examine if parental background and vocational qualifications are associated with the destinations after non-completion. We distinguish the destinations "re-entering higher education", "vocational training" and "skilled employment". Using the German Educational Panel Study (NEPS starting cohort 6), we apply competing risks models. Our results show that non-completers from higher socio-economic backgrounds are more likely to re-enter higher education than non-completers from lower socio-economic backgrounds. The higher rates of transfer to skilled employment among non-completers from lower backgrounds are mainly due to the fact that they more often hold a vocational qualification and have good chances to enter the skilled labour market without additional educational investments. Our results hence shed some new light on the question how vocational training "diverts" lower background students from higher education. [ABSTRACT FROM AUTHOR]

Background: The European flood that occurred between July 13th and 16th 2021, was a natural disaster that caused significant damage in Central European countries, including Germany, Netherlands, Belgium, and Luxembourg. This disaster resulted in the highest number of fatalities from a natural disaster in Germany during the twenty-first century, with over 180 people losing their lives and causing damages exceeding 30 bn€. The flood caused severe destruction in small mountainous river systems such as the Vicht and Inde rivers, particularly in the German state of North Rhine-Westphalia. In addition, the flood caused a significant release of pollutants, including old burdens from the former mining area of Stolberg. Results: To assess the extent of pollution caused by the flood in the affected floodplains and urban areas, this study was conducted to inventorize organic contaminants identified through a non-target screening in water and sediment samples taken immediately after the disastrous flood event. In total, 56 individual contaminants were identified from the water samples, including substances derived from urban effluents, such as personal care products, cosmetics, odors, technical additives, pharmaceuticals and surfactants. The analysis of sediment samples revealed different types of environmentally hazardous contaminants, such as petrogenics, urban effluent and wastewater indicators, chlorinated industrial compounds, and pesticides. This diverse range of pollutants and their broad dispersion across various environments in the catchment is attributed to the dynamic nature of the flood. Conclusion: The inventory of identified organic contaminants raises long-term environmental concerns and potential health implications for the flood-affected Vicht–Inde region. [ABSTRACT FROM AUTHOR]

High drop-out rates from Vocational Education and Training (VET) remain a severe problem in VET systems globally. Despite decades of drop-out research revealing numerous influencing factors, the role of trainees' vocational competence in their drop-out behavior has been neglected. This study aims to define the structure of vocational competence and analyze its effects on drop-out intention. Using longitudinal data from 458 commercial trainees in Germany, vocational competence is measured at three time points using a validated competence test, subdivided into domain-linked and domain-specific dimensions (Gelman and Greeno, 1989). Four different directions of drop-out intentions are considered, enabling a detailed effect inspection of the prevailing research gap. Additionally, factors identified in previous studies, such as educational level, age, language, and the degree of having chosen one's desired occupation, are controlled for. We conducted 12 rounds of ordinal logistic regression to test three lagged temporal combinations of the effect relationship between vocational competence and dropout intention over different time spans (T0- > T1, T1- > T2, T0- > T2). We find that lower domain-specific competence increases the intention to drop out from VET without qualification over different time spans. Initial lower domain-specific competence also affects trainees' intention to change their occupation in the final year of training. Furthermore, higher levels of domain-linked competence at the beginning increase the intention to leave VET to pursue higher qualifications in the midterm of training. [ABSTRACT FROM AUTHOR]

Background: The residential heating sector in many European countries requires a fundamental transformation if it is to become climate neutral. Besides the introduction of efficiency measures and updating heating systems, scholars and practitioners consider replacing fossil fuels in existing heating systems a viable approach. Drop-in renewable gases such as biomethane and synthetic natural gas (SNG) cause considerably fewer carbon dioxide (CO2) emissions than natural gas and can be used in natural gas boilers, the dominant heating system in many European countries. To move the ongoing debate around e-fuels forward, this study reports on a Discrete Choice Experiment with 512 respondents in Germany that analyzed consumer preferences and willingness to pay (WTP) for SNG. I build on these insights by comparing WTP to the production costs, making evidence-based decision-making possible. Results: The results show that consumers prefer renewable gases over natural gas. Comparing the two types of renewable gases, SNG and biomethane, reveals that consumers clearly favor the latter despite the criticism it has come under in the last 10–15 years. Consumers show a surprisingly high WTP for increasing shares of SNG, with premia of 40 to almost 70% over a natural gas-based tariff. Comparing production costs to the WTP reveals that only tariffs with small shares of SNG (5% and 10%) can be offered at cost-covering prices. Conclusions: Given the urgent need for a fundamental transition of the residential heating sector, marketers and policymakers should consider carefully whether it is worth channeling a rather unknown and expensive product like SNG into the voluntary market for heating gas, especially as biomethane is already established in the market and clearly a cheaper and more popular alternative. [ABSTRACT FROM AUTHOR]

Chat-based counseling hotlines emerged as a promising low-threshold intervention for youth mental health. However, despite the resulting availability of large text corpora, little work has investigated Natural Language Processing (NLP) applications within this setting. Therefore, this preregistered approach (OSF: XA4PN) utilizes a sample of approximately 19,000 children and young adults that received a chat consultation from a 24/7 crisis service in Germany. Around 800,000 messages were used to predict whether chatters would contact the service again, as this would allow the provision of or redirection to additional treatment. We trained an XGBoost Classifier on the words of the anonymized conversations, using repeated cross-validation and bayesian optimization for hyperparameter search. The best model was able to achieve an AUROC score of 0.68 (p < 0.01) on the previously unseen 3942 newest consultations. A shapely-based explainability approach revealed that words indicating younger age or female gender and terms related to self-harm and suicidal thoughts were associated with a higher chance of recontacting. We conclude that NLP-based predictions of recurrent contact are a promising path toward personalized care at chat hotlines. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to characterize the framework conditions in academic interventional radiology (IR) in Germany with focus on differences between genders. Materials and methods: After IRB approval, all members of The German Society for Interventional Radiology and Minimally Invasive Therapy (n = 1,632) were invited to an online survey on work and research. Statistical comparisons were undertaken with the Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test. Results: From 267 available questionnaires (general response rate 16.4%), 200 were fully completed. 40% of these (78/200) were involved in research (71% men vs. 29% women, p < 0.01) and eligible for further analysis. Of these, 6% worked part-time (2% vs. 17%, p < 0.05). 90% of the respondents spent less than 25% of their research during their paid working hours, and 41% performed more than 75% of their research during. leisure time. 28% received exemption for research. 88% were (rather) satisfied with their career. One in two participants successfully applied for funding, with higher success rates among male applicants (90% vs. 75%) and respondents with protected research time (93% vs. 80%). Compared to men, women rated their entrance in research as harder (p < 0.05), their research career as more important (p < 0.05), felt less noticed at congresses (93% vs. 53%, p < 0.01), less confident (98% vs. 71%, p < 0.01), and not well connected (77% vs. 36%, p < 0.01). Conclusion: Women and men did research under the same circumstances; however, women were underrepresented. Future programs should generally focus on protected research time and gather female mentors to advance academic IR in Germany. [ABSTRACT FROM AUTHOR]

Background: Our study aims to investigate inter- and intraindividual effects of trainee teachers' perceived opportunities of participation in vocational education and training teacher training on their emotional states. Additionally, it is examined whether the subjective reason for action as in intrinsic and extrinsic motivation affects the relationship between perceived participation and emotional states. In this respect, control-value theory constitutes the guiding conceptual framework in our study. Methods: On the basis of a longitudinal design with a total of 75 trainee teachers in Germany and a maximum of 58 survey time points during 18-months of teacher training (in total 1790 individual measurements), we traced the perception of participatory opportunities, intrinsic and extrinsic motivation as well as weekly emotional states. Multilevel modeling allowed us to examine both between- as well as within-person effects of perceived participation. Results: The results of our multilevel models indicate, among other findings, statistically significant within- and between-person effects of perceived participation opportunities on enjoyment, hope, pride, as well as anger, anxiety, shame, and hopelessness. Furthermore, the attributed subjective reason for action, i.e., the intrinsic or extrinsic motivation, moderates the relationship between perceived opportunities to participate and emotional states. Discussion: The findings, which are consistent across different emotions of the same valence and for the two different types of motivation, indicate that those trainee teachers who report low values for intrinsic motivation (or high values for extrinsic motivation) in a given week react more responsively to changes with regard to opportunities for participatory influence. [ABSTRACT FROM AUTHOR]

Background: The choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany. Methods: This is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding. Results: We included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02–1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41–1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide. Conclusion: In a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care. [ABSTRACT FROM AUTHOR]

Stratification is an important design feature of many studies using complex sampling designs and it is often used in large-scale assessment (LSA) studies, such as the Programme for International Student Assessment (PISA), for two main reasons. First, stratification variables that achieve a high between and low within strata variance can improve the efficiency of a survey design. Second, stratification allows one to, explicitly or implicitly, control for sample sizes across subpopulations. It ensures that some parts of a population are in the sample in predetermined proportions. In this study, we determine through simulation which stratification scheme is best for PISA in Germany. For this, we consider the constraints imposed by the international sampling design, the available information about schools, and specific national characteristics of the German educational system. We examine seven different stratification designs selected based on scenarios used in past LSAs in Germany and theoretical considerations for future implementations. The chosen scenarios were compared with two reference scenarios: (1) an unstratified design and (2) a synthetic optimal stratification design. The simulation study reveals that the stratification design currently applied in PISA produces satisfactory results regarding sampling precision. The present stratification design is based on Germany's federal states and school types. However, this approach leads to small strata, which has been problematic for estimating sampling variance in previous cycles. Therefore, alternative stratification scenarios were considered and, in addition to overcoming the small-strata problem, also led to smaller standard errors for estimates of student mean performance in mathematics, science, and reading. As a result of this study, we recommend considering three different stratification designs for Germany in future cycles of PISA. These recommendations aim to: (1) improve the sampling efficiency while keeping the sample size constant, (2) follow a sound methodological approach, and (3) make conservative and cautious changes while maintaining a reflection of the structure of the German federal school system with different school types. These suggestions include a reinvented stratification of grouped German federal states and designs with school types as explicit stratifiers and federal states as implicit stratifiers. [ABSTRACT FROM AUTHOR]

Background: A recently published article, by Reiber et al., on the representativity of macroinvertebrate communities in outdoor micro- or mesocosm studies, used as a higher tier tool in the environmental risk assessment of plant protection products (PPPs) in the EU, concluded that 'micro-/mesocosm studies do not represent natural macroinvertebrate communities'. Fundamentally, the article based its conclusion on the analysis of data from 26 streams used in a monitoring project in Germany (2018–2019), in comparison to taxa found in seven lentic micro- and mesocosm studies, conducted at four test sites (2013 – 2018), and submitted to the UBA, Germany. Results: There are multiple reasons why this conclusion is incorrect, e.g. the number of taxa, for which the Minimum Detectable Differences (MDDs) were low enough to allow a detection of direct effects in the seven lentic mesocosm studies, cannot be compared to the number of taxa just present in at least five of 26 streams. We have further investigated the data from five of the seven studies which were analysed in detail by Reiber et al. and determined that the MDDs of 12 to 18 invertebrate taxa per study fulfilled the current recommendation to allow a detection of medium effects (MDD up to 70%). However, which taxa can be considered potentially sensitive depends on the specific test item. While lentic test systems may not be suitable to test effects on typical stream taxa, taxa occurring in lentic systems such as ponds and ditches are not by definition less sensitive, or vulnerable, to pesticides than taxa living in streams, and their relative sensitivity can be checked in laboratory tests, or artificial streams, if needed. Conclusions: In our view, well conducted micro- and mesocosm studies do provide reliable and useful data for the environmental risk assessment of plant protection products covering long-term, as well as indirect, effects under semi-natural conditions. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes. Methods: The pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device. Results: Statistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039). Conclusions: A relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI. Trial registration: ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. Methods: We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. Results: We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. Conclusions: High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments. Key Points: Several high-quality economic evaluations of physiotherapeutic treatments for the back and knee exist Economic evaluations of other joints are rare Physiotherapeutic interventions are often cost-effective over treatments provided by other health professionals The description of provided interventions in cost-effectiveness analyses needs improvement, to allow fair treatment comparisons [ABSTRACT FROM AUTHOR]

Background: Based on the legal framework laid down in section 130b (9) of Book V of the German Social Code, various criteria are relevant for the negotiated price for new patented drugs in Germany. European reference prices (ERPs) are one criterion. The ERP is based on the ex-factory prices (EFPs) of the countries included in the European country basket. However, in some of these countries, the EFP is not published due to confidential wholesale margins. Wholesale margins must therefore be estimated and deducted from purchase prices. In this context literature-based estimates to date do not assume regressive margins with higher pharmaceutical prices. This assumption is questionable and can lead to systematically underestimated country prices, especially for high-priced drugs. Percentage wholesale margins in the majority of European countries develop to a comparable extent regressively with increasing prices. It should therefore be examined (1) whether statistical models can predict the margins of individual countries, in principle and especially for countries where margins are unknown and regressive trends are likely, and (2) to what extent the estimation of margins improves when regressive statistical models are used to estimate margins instead of cross-price averages published in the literature. Methods: Qualitative preliminary research explores the basic wholesale pricing mechanisms in countries with confidential wholesale margins. Wholesale margins for reimbursable drugs were then modeled for regulated European countries. Estimation quality and impact of the model was compared to estimations based on average margins. Results: In both regulated countries and in countries with confidential wholesale margins, percentage margins of wholesalers develop regressively as drug prices rise. Regressive courses of margins can be resiliently modeled for the regulated countries using a power distribution with significantly lower mean squared errors in a linear mixed model in comparison to literature-based estimations with country-specific cross-price averages. Conclusion: If there is reason to believe that margins are regressive, confidential wholesale margins are expected to be better estimated by the power function based on margins of regulated countries than by the published country-specific average margins, reducing significantly inaccurate effects on margin estimations of high-price drugs. [ABSTRACT FROM AUTHOR]

Introduction: Invasive meningococcal disease (IMD) causes significant mortality and long-term sequelae. This study assesses the potential public health impact of adolescent vaccination strategies employing MenACWY and MenC vaccines in Germany, where the existing meningococcal immunisation programme predominantly involves MenC administration in toddlers. Methods: A dynamic transmission model was developed to simulate the carriage of five meningococcal serogroup compartments (AY/B/C/W/Other) from 2019 until 2060 within 1-year age groups from 0 to 99 years of age. IMD cases were estimated based on case-carrier ratios. The model considered vaccine effectiveness against carriage acquisition and IMD. Results: The model predicts that introducing MenACWY adolescent vaccination could lead to a considerable reduction in IMD incidence, with the potential to prevent up to 65 cases per year and a cumulative total of 1467 cases by 2060. This decrease, mainly driven by herd effects, would result in a reduction of IMD incidence across all age groups, regardless of vaccination age. Furthermore, implementing MenACWY vaccination in adolescents is projected to decrease annual MenACWY-related IMD mortality by up to 64%, equating to an overall prevention of 156 IMD deaths by 2060. These protective outcomes are expected to culminate in approximately 2250 life years gained (LYG) throughout the model's projected time horizon. In contrast, the adoption of MenC vaccination in adolescents is predicted to have minimal influence on both IMD incidence and mortality, as well as on LYG. Conclusion: The results of this study demonstrate that implementing MenACWY vaccination for adolescents in Germany is likely to notably reduce IMD incidence and mortality across age groups. However, the introduction of MenC adolescent vaccination shows only limited impact. Considering the extensive healthcare resources typically required for IMD management, these findings suggest the potential for economic benefits associated with the adoption of MenACWY adolescent vaccination, warranting further cost-effectiveness analysis. [ABSTRACT FROM AUTHOR]

Remote monitoring of cognition holds the promise to facilitate case-finding in clinical care and the individual detection of cognitive impairment in clinical and research settings. In the context of Alzheimer's disease, this is particularly relevant for patients who seek medical advice due to memory problems. Here, we develop a remote digital memory composite (RDMC) score from an unsupervised remote cognitive assessment battery focused on episodic memory and long-term recall and assess its construct validity, retest reliability, and diagnostic accuracy when predicting MCI-grade impairment in a memory clinic sample and healthy controls. A total of 199 participants were recruited from three cohorts and included as healthy controls (n = 97), individuals with subjective cognitive decline (n = 59), or patients with mild cognitive impairment (n = 43). Participants performed cognitive assessments in a fully remote and unsupervised setting via a smartphone app. The derived RDMC score is significantly correlated with the PACC5 score across participants and demonstrates good retest reliability. Diagnostic accuracy for discriminating memory impairment from no impairment is high (cross-validated AUC = 0.83, 95% CI [0.66, 0.99]) with a sensitivity of 0.82 and a specificity of 0.72. Thus, unsupervised remote cognitive assessments implemented in the neotiv digital platform show good discrimination between cognitively impaired and unimpaired individuals, further demonstrating that it is feasible to complement the neuropsychological assessment of episodic memory with unsupervised and remote assessments on mobile devices. This contributes to recent efforts to implement remote assessment of episodic memory for case-finding and monitoring in large research studies and clinical care. [ABSTRACT FROM AUTHOR]

Cardiac Troponin I (cTnI) could be used to identify individuals at elevated risk of cardiac death in lung cancer (LC) screening settings. In a population-based, randomized LC screening trial in Germany ("LUSI" study) serum cTnI was measured by high-sensitivity assay in blood samples collected at baseline, and categorized into unquantifiable/low (< 6 ng/L), intermediate (≥ 6–15 ng/L), and elevated (≥ 16 ng/L). Cox proportional-hazard models were used to estimate risk of all-cause and cardiac mortality with cTnI levels. After exclusion criteria, 3653 participants were included for our analyses, of which 82.4% had low, 12.8% intermediate and 4.8% elevated cTnI, respectively. Over a median follow up of 11.87 years a total of 439 deaths occurred, including 67 caused by cardiac events. Within the first 5 years after cTnI measurement, intermediate or elevated cTnI levels showed approximately 1.7 (HR = 1.69 [95% CI 0.57–5.02) and 4.7-fold (HR = 4.66 [1.73–12.50]) increases in risk of cardiac death relative to individuals with unquantifiable/low cTnI, independently of age, sex, smoking and other risk factors. Within this time interval, a risk model based on age, sex, BMI, smoking history and cTnI showed a combined area under the ROC curve (AUC) of 73.6 (58.1–87.3), as compared to 70.4 (53.3–83.5) for a model without cTnI. Over the time interval of > 5–10 years after blood donation, the relative risk associations with cTnI and were weaker. cTnI showed no association with mortality from any other (non-cardiac) cause. Our findings show that cTnI may be of use for identifying individuals at elevated risk specifically of short-term cardiac mortality in the context of LC screening. [ABSTRACT FROM AUTHOR]

Continuous monitoring of volcanic gas emissions is crucial for understanding volcanic activity and potential eruptions. However, emissions of volcanic gases underwater are infrequently studied or quantified. This study explores the potential of Distributed Acoustic Sensing (DAS) technology to monitor underwater volcanic degassing. DAS converts fiber-optic cables into high-resolution vibration recording arrays, providing measurements at unprecedented spatio-temporal resolution. We conducted an experiment at Laacher See volcano in Germany, immersing a fiber-optic cable in the lake and interrogating it with a DAS system. We detected and analyzed numerous acoustic signals that we associated with bubble emissions in different lake areas. Three types of text-book bubbles exhibiting characteristic waveforms are all found from our detections, indicating different nucleation processes and bubble sizes. Using clustering algorithms, we classified bubble events into four distinct clusters based on their temporal and spectral characteristics. The temporal distribution of the events provided insights into the evolution of gas seepage patterns. This technology has the potential to revolutionize underwater degassing monitoring and provide valuable information for studying volcanic processes and estimating gas emissions. Furthermore, DAS can be applied to other applications, such as monitoring underwater carbon capture and storage operations or methane leaks associated with climate change. [ABSTRACT FROM AUTHOR]

When analyzing health data in relation to environmental stressors, it is crucial to identify which variables to include in the statistical model to exclude dependencies among the variables. Four meteorological parameters: temperature, ultraviolet radiation, precipitation, and vapor pressure and four outdoor air pollution parameters: ozone ( O 3 ), nitrogen dioxide ( NO 2 ), particulate matter ( P M 2.5 , P M 10 ) were studied on a daily basis for Baden-Württemberg (Germany). This federal state covers urban and rural compartments including mountainous and river areas. A temporal and spatial analysis of the internal relationships was performed among the variables using (a) cross-correlations, both on the grand ensemble of data as well as within subsets, and (b) the Local Indications of Spatial Association (LISA) method. Meteorological and air pollution variables were strongly correlated within and among themselves in time and space. We found a strong interaction between nitrogen dioxide and ozone, with correlation coefficients varying over time. The coefficients ranged from negative correlations in January (−0.84), April (−0.47), and October (−0.54) to a positive correlation in July (0.45). The cross-correlation plot showed a noticeable change in the correlation direction for O 3 and NO 2 . Spatially, NO 2 , P M 2.5 , and P M 10 concentrations were significantly higher in urban than rural regions. For O 3 , this effect was reversed. A LISA analysis confirmed distinct hot and cold spots of environmental stressors. This work examined and quantified the spatio-temporal relationship between air pollution and meteorological conditions and recommended which variables to prioritize for future health impact analyses. The results found are in line with the underlying physico-chemical atmospheric processes. It also identified postal code areas with dominant environmental stressors for further studies. [ABSTRACT FROM AUTHOR]

Background: This study explores morphologic changes in the Ahr River, Germany, caused by the high-energy flood in mid-July 2021. This study aims to assess the flood's significance as a morphological driver using the Lateral Mobility Index (LMI), as well as the impact of infrastructure on morphodynamics in terms of the formation of mud deposits and stagnant water pools, considering three focus areas of about 1 to 5 km river length. The three focus areas cover differences in the valley morphology as well as near natural and anthropogenically affected sections. Results: The LMI is derived from orthophotos from 1998 to 2022, and based on the surface area of the old and the new channel. It describes the sum of new and abandoned channel area in relation to the previous channel area. For the 2021 high-energy event, an increased LMI suggests an increasing change in river course and morphology. Post-flood, the LMI in focus areas 1 (furthest upstream, LMI of 1.5) and 3 (at the Rhine confluence, LMI of 3.2) surpasses the historic LMI by a factor of about 3. Focus area 3 exhibits the highest activity, while focus area 2 (LMI between 0.25 and 0.70) the lowest. The area of mud deposits and stagnant water pools increased immediately after the flood, especially in focus area 3. Over the following months, initial post-flood mud deposits not only washed away but also rebuilt to some degree later on. Conclusions: The LMI enabled to quantitatively identify a rare and significant morphological disruption in the Ahr River's lateral development in three focus areas, and thus, serves as additional proof that the flood of mid-July 2021 was a high-energy event impacting the local river geomorphology. Infrastructure impacted the formation of mud deposits and stagnant water zones during and after the flood, with additional influence from factors such as driftwood and valley width. The data suggested a phase of resuspension of sediments after the flood, likely due to cleanup and ad hoc river management, highlighting the need for continued river monitoring. [ABSTRACT FROM AUTHOR]

In times of economic crisis, many employers in liberal labor markets reduce their employees' working hours, which leads to an increase in the incidence of involuntary part-time work. We analyze the effectiveness of working time regulation in preventing such an increase during downswings. For this we look at the case of Germany, where hours adjustments are highly restricted by law. Using a state-level panel regression approach, we find that the incidence of involuntary part-time work is positively associated with the unemployment rate but that the association is much weaker than in the US and in the UK. Transition probabilities between employment states over the cycle suggest two particular underlying mechanisms: First, already employed workers are more likely to want a full-time position in economic downturns ("added hours effect"). Second, job seekers make concessions with regards to their desired hours when labor market conditions are bad ("reservation hours effect"). We are the first to document these margins of cyclical hours adjustments which are fundamentally different from those in less regulated labor markets, where the cyclicality of involuntary part-time work is predominantly driven by hours changes at the same employer. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children's daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children's socioeconomic background (SEB). Methods: Data from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017–March2020, n = 26,314), or following the first (postLDI: Aug2020–Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021–Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS). Results: Significant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = − 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children's BMI increased in response to lockdowns, especially in postLDII (b = − 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns. Conclusions: These findings highlight the dependency of children's BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers. Key Points: Children's weight status and health could be affected in the short and long term as a consequence of increased BMI in primary school cohorts following COVID-19 pandemic-related lockdowns. Children from lower socioeconomic backgrounds are at particularly high risk of poor weight status and have higher BMIs. This socioeconomic gradient increased in post-lockdown cohorts, which is why the health of socioeconomically disadvantaged children may have been disproportionally affected by the pandemic. Authorities and policymakers are called upon to take countermeasures to minimize the impact of the COVID-19 pandemic on children's weight status and to counteract risks of increasing childhood obesity rates, especially in socioeconomically poorer regions. [ABSTRACT FROM AUTHOR]

With the beginning of the Early Bronze Age in Central Europe ~ 2200 BC, a regional and supra-regional hierarchical social organization emerged with few individuals in positions of power (chiefs), set apart by rich graves with extensive burial constructions. However, the social organization and stratification within the majority of people, who represent the non-elite, remain unclear. Here, we present genome-wide data of 46 individuals from the Early Bronze Age burial ground of Leubingen in today's Germany, integrating archaeological, genetic and strontium isotope data to gain new insights into Early Bronze Age societies. We were able to reconstruct five pedigrees which constitute the members of close biological kinship groups (parents and their offspring), and also identify individuals who are not related to individuals buried at the site. Based on combined lines of evidence, we observe that the kinship structure of the burial community was predominantly patrilineal/virilocal involving female exogamy. Further, we detect a difference in the amount of grave goods among the individuals buried at Leubingen based on genetic sex, age at death and locality but see no difference in the types of grave goods. [ABSTRACT FROM AUTHOR]

Somatic symptoms are common in a wide range of medical conditions. In severe cases, they are associated with high individual and economic burden. To explore social inequalities in somatic symptom severity (SSS) and to identify social groups with highest SSS, we applied an intersectional research approach. Analyses are based on cross-sectional data of the adult population living in Germany (N = 2413). SSS was assessed with the Somatic Symptom Scale-8. A multiple linear regression model with three-way interaction of gender, income and history of migration and post-hoc pairwise comparison of estimated marginal means was conducted. Analyses revealed intersectional inequalities in SSS along the axis of gender, income, and history of migration. Highest SSS was found in males with low income whose parent(s) immigrated, females with low income who immigrated themselves, and females with low income and no history of migration. Intersectional approaches contribute to a more comprehensive understanding of health disparities. To reduce disparities in SSS, proportionate universal interventions combining universal screening and targeted treatment seem promising. [ABSTRACT FROM AUTHOR]