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With the world population growth, energy consumption and the rapid development of industrial economy, a large amount of carbon emissions has brought destruction and threats to the earth's environment on which human beings depend. The development of low-carbon economy has become the consensus of governments all over the world and has been vigorously advocated & promoted. This paper focuses on the top five global GDP nations in 2022: The United States, China, Japan, Germany, and Britain. A comprehensive evaluation index system of urban low-carbon economic development level is constructed from four dimensions: economic development level, environmental quality, energy consumption emission intensity and social development speed by using literature review and field interview. The evaluation measures are determined using the TOPSIS evaluation method with entropy weight and the grey relational model, providing a comprehensive assessment of the low-carbon economy's development level in these five countries." Judging from the comprehensive evaluation score, the overall development of low-carbon economy in American cities is in good condition and has reached the development standard of low-carbon economy; Germany and Japan rank second and third, and they are low-carbon economies. Britain ranks fourth in comprehensive evaluation, although it belongs to a low-carbon economy country, but there is still a certain gap with Germany and Japan; There is still a big gap between China and the other four countries. Based on the measurement and evaluation outcomes, it presents recommendations and strategies to foster the growth of low-carbon economies, offering valuable insights for the advancement of such economies across different nations. The research results guide countries all over the world to reduce carbon emissions in the process of economic development, protect the earth environment on which human beings depend, and make a better tomorrow for sustainable development. [ABSTRACT FROM AUTHOR]

Status or relative concerns (as in the idiom 'keeping up with the Joneses') can lead to negative feelings such as stress and anxiety. One key question is whether these concerns relate to daily smoking behaviour. The conjecture is that status concerns and the accompanying stress and anxiety might be associated with a higher likelihood of smoking and a higher number of cigarettes smoked, generating a higher instant physical reward and reducing the stress and anxiety. The literature aiming to identify this relationship focuses mostly on a single cross section of individuals, ignoring potential differences in unobserved characteristics of smokers and non-smokers (e.g., genetic factors, personality differences, parental smoking during childhood). This paper investigates the role of unobserved individual characteristics on this relationship, which has not been done in previous studies. Using a long panel data of smoking information in Germany and a variety of panel data model specifications, we show that there is no statistically significant association between relative income concerns and the likelihood of smoking or the number of cigarettes smoked among the overall population. We find a positive and significant relationship only among people who smoked at least one cigarette in the past. A 10% appreciation in the income of comparable other individuals relates to about 3.5 more cigarettes per month among these people. Importantly, failing to allow for the unobserved influences of smoking leads to three times larger estimates than when using models with unobserved factors correlating to the income and smoking behaviour. The results are robust with respect to alternative assumptions and specifications where we use different functional forms of unobserved heterogeneity, definitions of relative concerns, incomes, and reference groups. [ABSTRACT FROM AUTHOR]

Background: Currently, more than 30,200,000 COVID-19 cases have been diagnosed in Germany alone. However, data regarding prevalence of COVID-19 in children, both in Germany and internationally, are sparse. We sought to evaluate the number of infected children by measuring IgG antibodies. Methods: Oropharyngeal swabs were collected between December 2020 and August 2021 to measure SARS-CoV-2, and capillary blood for the detection of SARS-CoV-2 antibodies (by rapid test NADAL® and filter paper test Euroimmun® ELISA); venous blood was taken for validation (Roche® ECLIA and recomLine Blot) in 365 German children aged 3–16 years from 30 schools and preschools. We used multiple serological tests because the filter paper test Euroimmun® ELISA performs better in terms of sensitivity and specificity than the rapid test NADAL®. The Roche® ECLIA test is used to detect SARS-CoV-2 spike protein, and the recomLine Blot test is used to rule out the possibility of infection by seasonal SARS-viruses and to test for specific SARS-CoV-2 proteins (NP, RBD and S1). In addition, one parent each (n = 336), and 4–5 teachers/caregivers (n = 90) per institution were tested for IgG antibodies from capillary blood samples. The total study duration was 4 months per child, including the first follow-up after 2 months and the second after 4 months. Results: Of 364 children tested at baseline, 3.6% (n = 13) were positive for SARS-CoV-2 IgG antibodies using Euroimmun® ELISA. Seven children reported previously testing positive for SARS-CoV-2; each of these was confirmed by the Roche® Anti-SARS-CoV-2-ECLIA (antibody to spike protein 1) test. SARS-CoV-2 IgG antibodies persisted over a 4-month period, but levels decreased significantly (p = 0.004) within this timeframe. The median IgG values were 192.0 BAU/ml [127.2; 288.2], 123.6 BAU/ml [76.6; 187.7] and 89.9 BAU/ml [57.4; 144.2] at baseline, 2 months and 4 months after baseline, respectively. During the study period, no child tested positive for SARS-CoV-2 by oropharyngeal swab. A total of 4.3% of all parents and 3.7% of teachers/caregivers tested positive for IgG antibodies by Euroimmun® ELISA at baseline. Conclusion: We noted a rather low seroprevalence in children despite an under-reporting of SARS-CoV-2 infections. Measurement of IgG antibodies derived from capillary blood appears to be a valid tool to detect asymptomatic infections in children. However, no asymptomatic active infection was detected during the study period of 4 months in the whole cohort. Further data on SARS-CoV-2 infections in children are needed, especially in the group of <5-year-olds, as there is currently no licensed vaccine for this age group in Germany. The Robert Koch Institute's Standing Commission on Vaccination (STIKO) recommended COVID-19 vaccination for 12–17 and 5–11 year olds in August 2021 and May 2022 respectively. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic revealed a need for better collaboration among research, care, and management in Germany as well as globally. Initially, there was a high demand for broad data collection across Germany, but as the pandemic evolved, localized data became increasingly necessary. Customized dashboards and tools were rapidly developed to provide timely and accurate information. In Saxony, the DISPENSE project was created to predict short-term hospital bed capacity demands, and while it was successful, continuous adjustments and the initial monolithic system architecture of the application made it difficult to customize and scale. Methods: To analyze the current state of the DISPENSE tool, we conducted an in-depth analysis of the data processing steps and identified data flows underlying users' metrics and dashboards. We also conducted a workshop to understand the different views and constraints of specific user groups, and brought together and clustered the information according to content-related service areas to determine functionality-related service groups. Based on this analysis, we developed a concept for the system architecture, modularized the main services by assigning specialized applications and integrated them into the existing system, allowing for self-service reporting and evaluation of the expert groups' needs. Results: We analyzed the applications' dataflow and identified specific user groups. The functionalities of the monolithic application were divided into specific service groups for data processing, data storage, predictions, content visualization, and user management. After composition and implementation, we evaluated the new system architecture against the initial requirements by enabling self-service reporting to the users. Discussion: By modularizing the monolithic application and creating a more flexible system, the challenges of rapidly changing requirements, growing need for information, and high administrative efforts were addressed. Conclusion: We demonstrated an improved adaptation towards the needs of various user groups, increased efficiency, and reduced burden on administrators, while also enabling self-service functionalities and specialization of single applications on individual service groups. [ABSTRACT FROM AUTHOR]

In this paper we check whether social capital changes the association of subjective well-being with own income and social comparisons. We use panel data from Germany and publicly available data from three international surveys, for a total of nearly 500,000 respondents from industrial countries. Results show that the association of own income and social comparisons to subjective well-being weakens for individuals with high social capital. This finding holds in a variety of settings, and is robust to various measures of subjective well-being, of social capital, and of social comparisons. We also find evidence indicating that the role of social capital is, at least in part, causal. Finally, our findings support the macro-level implication that income differences are less related to subjective well-being differences in countries with high social capital. [ABSTRACT FROM AUTHOR]

Background: Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. Methods: Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80–20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. Results: For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. Conclusion: The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients. [ABSTRACT FROM AUTHOR]

There are warnings that human actions will lead to irreversible environmental damage if they continue at their current pace and scale. With regard to individual aspects, a pro-environmental attitude and positive affective-motivational beliefs towards sustainability represent fundamentals for a more sustainable future. However, there is little data regarding these constructs and relevant explanatory factors, especially with regard to young people. We examined environmental attitude (two-dimensional: utilization and preservation) and affective-motivational beliefs towards sustainability with regard to gender, age, socio-economic status, school type and time spent in nature in 484 adolescents (11–14 years) living in German cities by means of univariate and multiple regression analyses. Mean values were high in preservation and affective-motivational beliefs towards sustainability, and relatively low in utilization. Female adolescents had higher values compared to male students in affective-motivational beliefs towards sustainability. Age did not play a substantial role. Although being strongly correlated with each other, school type and socio-economic status each exhibited positive associations to environmental attitude and affective-motivational beliefs towards sustainability. Furthermore, multiple regression analyses identified time spent in nature as a significant predictor of incremental value, suggesting a tentative recommendation to spend at least half an hour per week in nature in order to promote positive attitudes towards the environment and sustainability. In sum, special needs for topic-related education seem to exist for male students, students with lower formal level of education, students with a lower socio-economic status and students who spend little time in nature. [ABSTRACT FROM AUTHOR]

Background: Retrospective hospital quality indicators can only be useful if they are trustworthy signals of current or future quality. Despite extensive longitudinal quality indicator data and many hospital quality public reporting initiatives, research on quality indicator stability over time is scarce and skepticism about their usefulness widespread. Objective: Based on aggregated, widely available hospital-level quality indicators, this paper sought to determine whether quality indicators are stable over time. Implications for health policy were drawn and the limited methodological foundation for stability assessments of hospital-level quality indicators enhanced. Methods: Two longitudinal datasets (self-reported and routine data), including all hospitals in Germany and covering the period from 2004 to 2017, were analysed. A logistic regression using Generalized Estimating Equations, a time-dependent, graphic quintile representation of risk-adjusted rates and Spearman's rank correlation coefficient were used. Results: For a total of eight German quality indicators significant stability over time was demonstrated. The probability of remaining in the best quality cluster in the future across all hospitals reached from 46.9% (CI: 42.4–51.6%) for hip replacement reoperations to 80.4% (CI: 76.4–83.8%) for decubitus. Furthermore, graphical descriptive analysis showed that the difference in adverse event rates for the 20% top performing compared to the 20% worst performing hospitals in the two following years is on average between 30% for stroke and AMI and 79% for decubitus. Stability over time has been shown to vary strongly between indicators and treatment areas. Conclusion: Quality indicators were found to have sufficient stability over time for public reporting. Potentially, increasing case volumes per hospital, centralisation of medical services and minimum-quantity regulations may lead to more stable and reliable quality of care indicators. Finally, more robust policy interventions such as outcome-based payment, should only be applied to outcome indicators with a higher level of stability over time. This should be subject to future research. [ABSTRACT FROM AUTHOR]

Over the year of 2015, about 800.000 refugees arrived in Germany, a number which equals around one percent of the total population. This migration process was labelled the refugee crisis and was accompanied by a contested debate. On the one hand, there was a widespread willingness to voluntarily help arriving refugees, on the other hand, the number of xenophobic attacks against refugees drastically increased. Our paper will focus on a specific form of xenophobic violence with a strong symbolic meaning: We analyze how arson attacks against collective accommodation facilities spread. Using a comprehensive web chronicle, we collected temporal and spatial data about arson attacks perpetrated on accommodations or facilities for refugees in Germany between 2015 and 2017. We counted 251 attacks, assigned each incident location to its county, merged county characteristics such as population size, proportion of foreigners, right-wing party support, and—going beyond previous research—added geographically coded media data from two digital archives. Besides newspaper contents of a popular nation-wide tabloid, we use a data base that covers local fake news on refugees. Based on these data, we constructed a balanced panel data set with the counties as geographical units and periods of 14 days as the time dimension. Results indicate that social contagion drives the diffusion process of arson attacks. Spatial proximity of previous attacks increased the propensity of attacks in the neighboring counties. Attacks were more likely to occur in counties with larger populations and fewer foreigners. While local newspaper coverage did not impact the diffusion of xenophobic attacks, fake news were relevant–but only in East Germany. We also considered two particularly salient threatening events that received nation-wide media attention, namely Merkel's "border opening" on the 5th of September 2015 and the sexual assaults occurring during New Year's 2015/16 in Cologne. Both were followed by temporary increases in violence. [ABSTRACT FROM AUTHOR]

The German Socio-Economic Panel (SOEP) serves a global research community by providing representative annual longitudinal data of respondents living in private households in Germany. The dataset offers a valuable life course panorama, encompassing living conditions, socioeconomic status, familial connections, personality traits, values, preferences, health, and well-being. To amplify research opportunities further, we have extended the SOEP Innovation Sample (SOEP-IS) by collecting genetic data from 2,598 participants, yielding the first genotyped dataset for Germany based on a representative population sample (SOEP-G). The sample includes 107 full-sibling pairs, 501 parent-offspring pairs, and 152 triads, which overlap with the parent-offspring pairs. Leveraging the results from well-powered genome-wide association studies, we created a repository comprising 66 polygenic indices (PGIs) in the SOEP-G sample. We show that the PGIs for height, BMI, and educational attainment capture 22∼24%, 12∼13%, and 9% of the variance in the respective phenotypes. Using the PGIs for height and BMI, we demonstrate that the considerable increase in average height and the decrease in average BMI in more recent birth cohorts cannot be attributed to genetic shifts within the German population or to age effects alone. These findings suggest an important role of improved environmental conditions in driving these changes. Furthermore, we show that higher values in the PGIs for educational attainment and the highest math class are associated with better self-rated health, illustrating complex relationships between genetics, cognition, behavior, socio-economic status, and health. In summary, the SOEP-G data and the PGI repository we created provide a valuable resource for studying individual differences, inequalities, life-course development, health, and interactions between genetic predispositions and the environment. [ABSTRACT FROM AUTHOR]

The need to better understand economic change and the social uses of long-ago established pottery types to prepare and consume food has led to the study of 124 distinct ceramic vessels from 17 settlement and funerary sites in Central Germany (present day Saxony-Anhalt). These, dated from the Early Neolithic (from 5450 cal. BCE onwards) to the Late Bronze Age (1300–750 cal. BCE; youngest sample ca. 1000 BCE), include vessels from the Linear Pottery (LBK), Schiepzig/Schöningen groups (SCHIP), Baalberge (BAC), Corded Ware (CWC), Bell Beaker (BBC), and Únětice (UC) archaeological cultures. Organic residue analyses performed on this assemblage determined the presence of vessel contents surviving as lipid residues in 109 cases. These were studied in relation to the changing use of settlement and funerary pottery types and, in the case of burials, to the funerary contexts in which the vessels had been placed. The obtained results confirmed a marked increase in the consumption of dairy products linked to innovations in pottery types (e.g., small cups) during the Funnel Beaker related Baalberge Culture of the 4th millennium BCE. Although the intensive use of dairy products may have continued into the 3rd millennium BCE, especially amongst Bell Beaker populations, Corded Ware vessels found in funerary contexts suggest an increase in the importance of non-ruminant products, which may be linked to the production of specific vessel shapes and decoration. In the Early Bronze Age circum-Harz Únětice group (ca. 2200–1550 BCE), which saw the emergence of a highly hierarchical society, a greater variety of animal and plant derived products was detected in a much more standardised but, surprisingly, more multifunctional pottery assemblage. This long-term study of lipid residues from a concise region in Central Europe thus reveals the complex relationships that prehistoric populations established between food resources and the main means to prepare, store, and consume them. [ABSTRACT FROM AUTHOR]

Background: In cardiology, cardiac output (CO) is an important parameter for assessing cardiac function. While invasive thermodilution procedures are the gold standard for CO assessment, transthoracic Doppler echocardiography (TTE) has become the established method for routine CO assessment in daily clinical practice. However, a demand persists for non-invasive approaches, including oscillometric pulse wave analysis (PWA), to enhance the accuracy of CO estimation, reduce complications associated with invasive procedures, and facilitate its application in non-intensive care settings. Here, we aimed to compare the TTE and oscillometric PWA algorithm Antares for a non-invasive estimation of CO. Methods: Non-invasive CO data obtained by two-dimensional TTE were compared with those from an oscillometric blood pressure device (custo med GmbH, Ottobrunn, Germany) using the integrated algorithm Antares (Redwave Medical GmbH, Jena, Germany). In total, 59 patients undergoing elective cardiac catheterization for clinical reasons (71±10 years old, 76% males) were included. Agreement between both CO measures were assessed by Bland-Altman analysis, Student's t-test, and Pearson correlations. Results: The mean difference in CO was 0.04 ± 1.03 l/min (95% confidence interval for the mean difference: -0.23 to 0.30 l/min) for the overall group, with lower and upper limits of agreement at -1.98 and 2.05 l/min, respectively. There was no statistically significant difference in means between both CO measures (P = 0.785). Statistically significant correlations between TTE and Antares CO were observed in the entire cohort (r = 0.705, P<0.001) as well as in female (r = 0.802, P<0.001) and male patients (r = 0.669, P<0.001). Conclusions: The oscillometric PWA algorithm Antares and established TTE for a non-invasive estimation of CO are highly correlated in male and female patients, with no statistically significant difference between both approaches. Future validation studies of the Antares CO are necessary before a clinical application can be considered. [ABSTRACT FROM AUTHOR]

Although research has confirmed that the first COVID-19-related lockdown has increased stress and mental health problems in children, less is known about the longer-term effects of the pandemic on children's COVID-related future anxiety (CRFA). Because of CRFA's potentially debilitating effects, risk and resilience factors against this anxiety were investigated. To this end, n = 140 children (49% female) in 3rd and 4th grade classrooms in Germany were asked to perform a working memory task and to self-report about their CRFA and emotion regulation in December 2020 and in May 2021. More maladaptive emotion regulation in December 2020 contributed to the explanation of a high CRFA score in May 2021, whereas a better performance on working memory updating contributed a lower CRFA score later when controls were in place. These results were confirmed when children's CRFA in December 2020 was included in the prediction of their later CRFA. They suggest that maladaptive strategies of emotion regulation, such as rumination, may explain higher or increasing levels of CRFA, whereas efficient working memory updating may be an indicator of processing information in a way which shields children from CRFA-related thoughts. The concepts underlying these variables should be included in prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Various studies point to the lack of evidence of distributive opinion polarization in Europe. As most studies analyse the same item batteries from international social surveys, this lack of polarization might be due to an item's issue (e.g., the nature or substance of an item) or item formulation characteristics used to measure polarization. Based on a unique sample of 817 political attitudinal items asked in 2022 by respondents of a non-random online panel in Germany, we empirically assess the item characteristics most likely to lead to distributive opinion polarization–measured with the Van der Eijk agreement index. Our results show that only 20% of the items in our sample have some–at most moderate–level of opinion polarization. Moreover, an item's salience in the news media before the survey data collection, whether an item measures attitudes toward individual financial and non-financial costs, and the implicit level of knowledge required to answer an item (level of technicality) are significantly associated with higher opinion polarization. By contrast, items measuring a cultural issue (such as issues on gender, LGTBQI+, and ethnic minorities) and items with a high level of abstraction are significantly associated with a lower level of polarization. Our study highlights the importance of reflecting on the potential influence of an item's issue and item formulation characteristics on the empirical assessment of distributive opinion polarization. [ABSTRACT FROM AUTHOR]

Changes in human behaviors, such as reductions of physical contacts and the adoption of preventive measures, impact the transmission of infectious diseases considerably. Behavioral adaptations may be the result of individuals aiming to protect themselves or mere responses to public containment measures, or a combination of both. What drives autonomous and policy-induced adaptation, how they are related and change over time is insufficiently understood. Here, we develop a framework for more precise analysis of behavioral adaptation, focusing on confluence, interactions and time variance of autonomous and policy-induced adaptation. We carry out an empirical analysis of Germany during the fall of 2020 and beyond. Subsequently, we discuss how behavioral adaptation processes can be better represented in behavioral-epidemiological models. We find that our framework is useful to understand the interplay of autonomous and policy-induced adaptation as a "moving target". Our empirical analysis suggests that mobility patterns in Germany changed significantly due to both autonomous and policy-induced adaption, with potentially weaker effects over time due to decreasing risk signals, diminishing risk perceptions and an erosion of trust in the government. We find that while a number of simulation and prediction models have made great efforts to represent behavioral adaptation, the interplay of autonomous and policy-induced adaption needs to be better understood to construct convincing counterfactual scenarios for policy analysis. The insights presented here are of interest to modelers and policy makers aiming to understand and account for behaviors during a pandemic response more accurately. [ABSTRACT FROM AUTHOR]

Background: Limited evidence on utilisation of health care by recently arrived asylum seekers and refugees in high-income countries is available. This study aims to describe the implementation of an integrated care facility (ICF) in an initial reception centre and measure the utilisation of care and the influence of operational parameters. Methods: In a retrospective cohort study design, using medical records, we followed inhabitants of a reception centre in Germany between 11.10.2015 and 30.05.2018. We assessed frequency of visits and revisits to a newly established integrated care facility (ICF), and the effects of the ICF on visits to the local emergency department (LED) in the regional tertiary hospital using survival analysis and time series regression. We also explore the influence of operational parameters on the different implementation phases; phase 1: provisional clinic with 1–2 hours of physician presence daily, phase 2: implementation of ICF with 2–4 hours of care by a team of doctors and nurses daily, phase 3: routine running of ICF with daily operational hours of 10am–2pm with care provided by an interdisciplinary team of doctors and nurses. Results: 14,419 total medical visits were recorded from 1,883 persons seeking health care in the ICF. The absolute number of visits per day remained similar over the study period (19·9/day), yet the relative number of visits changed from 2·2 to 15 per 100 inhabitants from phase 2 to 3, respectively. Most visits were due to respiratory infections (612/3080, 20%), and trauma and musculoskeletal conditions (441/3080, 14%). The rate of revisits to ICF was 2·9 per person per month (95%CI 2·9–3), more for those older, female, from North Africa and those with a translator present. The ratio of visits to the LED changed from 0·3/100 inhabitants per day to 0·14/100 inhabitants after implementation of the ICF and back to 0·3/100 inhabitants during the routine running. Conclusions: Though seasonal variation and referral practices must be considered, a high rate of revisits to the ICF were recorded. While visits to the LED decreased after the implementation of the ICF, visits returned to the pre-ICF levels during the routine running of the ICF. The results show that AS&R require reliable access to health care, yet the needs of specific groups of migrants may be different, especially those with language barriers, minority groups or those from certain regions. As such, care should be migrant sensitive and adapt to the changing needs of the population. Though more research is required to better understand the differing needs of migrants, this study may help to inform guidelines surrounding migrant sensitive standards of care in Germany. [ABSTRACT FROM AUTHOR]

Vaccination willingness against COVID-19 is generally perceived as low. Moreover, there is large heterogeneity across and within countries. As a whole, Germany has average vaccination rates compared to other industrialized countries. However, vaccination rates in the 16 different German federal states differ by more than 20 percentage points. We describe variation in vaccination rates on the level of the 400 German counties using data on all vaccinations carried out until December 2022. Around 52-72% of that variation can be explained by regional differences in demographic characteristics, housing, education and political party preferences. We find indications that the remaining part may be due to differences in soft factors such as risk aversion, trust in the German government, trust in science, and beliefs in conspiracy theories regarding the origins of the Corona virus. We conclude that improving the trust in science and the fight against conspiracy theories may possibly be effective tools to improve vaccination rates and effectively fight pandemics. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has highlighted the importance of local evidence ecosystems in which academia and practice in the Public Health Service (PHS) are interconnected. However, appropriate organizational structures and well-trained staff are lacking and evidence use in local public health decision-making has to be integrated into training programs in Germany. To address this issue, we developed a framework incorporating a toolbox to conceptualize training programs designed to qualify public health professionals for working at the interface between academia and practice. We conducted a scoping review of training programs, key-informant interviews with public health experts, and a multi-professional stakeholder workshop and triangulated their output. The resulting toolbox consists of four core elements, encompassing 15 parameters: (1) content-related aspects, (2) context-related aspects, (3) aspects relevant for determining the training format, and (4) aspects relevant for consolidation and further development. Guiding questions with examples supports the application of the toolbox. Additionally, we introduced a how-to-use guidance to streamline the creation of new training programs, fostering knowledge transfer at the academia-practice interface, equipping public health researchers and practitioners with relevant skills for needs-based PHS research. By promoting collaborative training development across institutions, our approach encourages cross-institutional cooperation, enhances evidence utilization, and enables efficient resource allocation. This collaborative effort in developing training programs within local evidence ecosystems not only strengthens the scientific and practical impact but also lays a foundation for implementing complex public health measures effectively at the local level. [ABSTRACT FROM AUTHOR]

Maladaptive personality, the motivational systems, and intolerance of uncertainty play important roles in the statistical explanation of depression and anxiety. Here, we notably examined for the first time whether symptoms of depression, anxiety, health anxiety, and fear of COVID-19 share similar associations (e.g., variance explained) with these important dispositional dimensions. For this cross-sectional study, data from 1001 participants recruited in Germany (50% women; mean age = 47.26) were collected. In separate models, we examined the cross-sectional associations of the symptoms of depression, anxiety, health anxiety, and fear of COVID-19 with the Personality Inventory for DSM Short Form Plus scales, the Behavioral Inhibition System / Flight–Fight–Freeze System / Behavioral Activation System scales, and Intolerance of Uncertainty scales. Relative weight analyses were used to determine the within-model importance of the different scales in the prediction of the symptoms. All in all, our study showed that maladaptive personality and intolerance of uncertainty dimensions are more important sets of predictors of the studied outcomes (with which depressive and anxious symptomatology feature very similar associations) than are the motivational system dimensions. Within predictor sets, the scales with the most important predictors were: Negative Affectivity, the Behavioral Inhibition System, and Burden due to Intolerance of Uncertainty. Our findings highlight the relevance of focusing behavioral targets of psychotherapy on these within-set traits and identify potential research priorities (maladaptive personality and intolerance of uncertainty) in relation to the symptoms of interest. [ABSTRACT FROM AUTHOR]

Objective: We sought to examine the relationship of unfavorable psychosocial working conditions with slips and lapses and poor patient interaction as well as potential intermediate factors among medical assistants (MAs) in Germany based on prospective data. Methods: We used data from 408 MAs from a 4-year cohort study (follow-up: 2021). At baseline, psychosocial working conditions were assessed by the established effort-reward-imbalance questionnaire and a MA-specific questionnaire with 7 subscales. Frequency of slips and lapses (e.g., pertaining to measurements and documentation) and the quality of patient interactions (e.g., unfriendliness or impatience) due to work stress were assessed at follow-up with three items each (potential score ranges = 3–15). Potential intermediate factors at baseline included work engagement (i.e., vitality and dedication (UWES)), work satisfaction (COPSOQ), anxiety (GAD-2), depressiveness (PHQ-2), and self-reported health. We ran multivariable linear regression using z-standardized exposures to estimate unstandardized coefficients (B) and 95% confidence intervals (CI). Potential intermediate factors were added separately to the regression models. Attenuation of the association between exposure and outcome toward the null value (B = 0) was interpreted as mediation. Results: High reward and lack of resources were weakly associated with the frequency of slips and lapses (the Bs were -0.18 and 0.23, respectively; p<0.05), with little evidence of mediation. With the exception of low recognition, all unfavorable psychosocial working conditions predicted a higher frequency of poor interactions with patients (p-values<0.01). These associations were attenuated by work engagement, work satisfaction, and health outcomes. Conclusion: We found mostly non-significant associations between adverse psychosocial working conditions and the frequency of slips and lapses. However, unfavorable psychosocial working conditions among MAs predicted a higher frequency of poor interaction with patients due to stress. [ABSTRACT FROM AUTHOR]

Impressions of vertebrate bodies or their parts, such as trace fossils and natural molds of bones, are a valuable source of information about ancient faunas which may supplement the standard fossil record based on skeletal elements. Whereas trace fossils of animal activity are relatively common and actively studied within the field of ichnology, and natural impressions of internal or external surfaces are a frequent preservation mode in fossil invertebrates, natural molds of bones are comparatively rare and less extensively documented and discussed. Among them, internal molds (steinkerns) of turtle shells are a relatively well-known form of preservation, but the mechanisms and taphonomic prerequisites leading to their formation are poorly studied. External shell molds are even less represented in the literature. Herein, we describe a historic specimen of a natural external turtle plastron mold from the Triassic (Norian) Löwenstein Formation of Germany–a formation which also yielded a number of turtle steinkerns. The specimen is significant not only because it represents an unusual form of preservation, but also due to its remarkably large size and the presence of a potential shell pathology. Although it was initially interpreted as Proterochersis sp., the recent progress in the knowledge of proterochersid turtles leading to an increase in the number of known taxa within that group allows us to verify that assessment. We confirm that the specimen is morphologically consistent with the genus and tentatively identify it as Proterochersis robusta, the only representative of that genus from the Löwenstein Formation. We note, however, that its size exceeds the size observed thus far in Proterochersis robusta and fits within the range of Proterochersis porebensis from the Grabowa Formation of Poland. The marks interpreted as shell pathology are morphologically consistent with Karethraichnus lakkos–an ichnotaxon interpreted as a trace of ectoparasites, such as leeches. This may support the previously proposed interpretation of Proterochersis spp. as a semiaquatic turtle. Moreover, if the identification is correct, the specimen may represent a very rare case of a negative preservation of a named ichnotaxon. Finally, we discuss the taphonomy of the Löwenstein Formation turtles in comparison with other Triassic turtle-yielding formations which show no potential for the preservation of internal or external shell molds and propose a taphonomic model for the formation of such fossils. [ABSTRACT FROM AUTHOR]

Freshwater salinization poses global challenges for aquatic organisms inhabiting urban streams, impacting their physiology and ecology. However, current salinization research predominantly focuses on mortality endpoints in limited model species, overlooking the sublethal effects on a broader spectrum of organisms and the exploration of adaptive mechanisms and pathways under natural field conditions. To address these gaps, we conducted high-throughput sequencing transcriptomic analysis on the gill tissue of the euryhaline fish Gasterosteus aculeatus, investigating its molecular response to salinity stress in the highly urbanized river Boye, Germany. We found that in stream sections with sublethal concentrations of chloride costly osmoregulatory systems were activated, evidenced by the differential expression of genes related to osmoregulation. Our enrichment analysis revealed differentially expressed genes (DEGs) related to transmembrane transport and regulation of transport and other osmoregulation pathways, which aligns with the crucial role of these pathways in maintaining biological homeostasis. Notably, we identified candidate genes involved in increased osmoregulatory activity under salinity stress, including those responsible for moving ions across membranes: ion channels, ion pumps, and ion transporters. Particularly, genes from the solute carrier family SLC, aquaporin AQP1, chloride channel CLC7, ATP-binding cassette transporter ABCE1, and ATPases member ATAD2 exhibited prominent differential expression. These findings provide insights into the potential molecular mechanisms underlying the adaptive response of euryhaline fish to salinity stress and have implications for their conservation and management in the face of freshwater salinization. [ABSTRACT FROM AUTHOR]

Point Pattern Analysis (PPA) has gained momentum in archaeological research, particularly in site distribution pattern recognition compared to supra-regional environmental variables. While PPA is now a statistically well-established method, most of the data necessary for the analyses are not freely accessible, complicating reproducibility and transparency. In this article, we present a fully reproducible methodical framework to PPA using an open access database of archaeological sites located in south-west Germany and open source explanatory covariates to understand site location processes and patterning. The workflow and research question are tailored to a regional case study, but the code underlying the analysis is provided as an R Markdown file and can be adjusted and manipulated to fit any archaeological database across the globe. The Early Iron Age north of the Alps and particularly in south-west Germany is marked by numerous social and cultural changes that reflect the use and inhabitation of the landscape. In this work we show that the use of quantitative methods in the study of site distribution processes is essential for a more complete understanding of archaeological and environmental dynamics. Furthermore, the use of a completely transparent and easily adaptable approach can fuel the understanding of large-scale site location preferences and catchment compositions in archaeological, geographical and ecological research. [ABSTRACT FROM AUTHOR]

Objective: Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree. Methods: Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success. Results: A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success. Conclusion: The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results. [ABSTRACT FROM AUTHOR]

The allocation of renewable energy plants, especially wind turbines, is stagnating in Germany. Although the citizens approve of the energy transition, they resist concrete local projects. In recent years, research has shown that interactive map applications support participatory planning through motivation, social interaction, and knowledge transfer. We aim to reduce biases against renewable energy (RE) and support informed decision making while accepting local responsibility. We hypothesized that finding a new gamified participation format, based on behavioral mechanisms, would strengthen the empowerment of people. To this end, we designed a dialogue tool and participation format, 'Vision:En 2040', which combines: (i) a precise target electricity yield, (ii) an interactive map showing results of people's actions, information about environmental impacts, and (iii) game rules which foster cooperation. In facilitated workshops, participants simulate the allocation of wind and photovoltaic power plants in their municipality to achieve a target electricity yield. The developed tool is based on methods of environmental planning and geoinformatics. 'Vision:En 2040' was systematically tested with a technical test and a pre-test. In addition, its impact on participants was assessed through surveys and qualitative content analysis. The evaluation results show that the tool can influence the acceptance of the energy transition in terms of attitude. Through 'Vision:En 2040', participants became aware of the community's responsibility in the energy transition and expanded their knowledge. In addition, decision makers used the workshop results to plan RE sites. Our results indicate that 'Vision:En 2040' is helpful for informal citizen participation in accelerating the energy transition. [ABSTRACT FROM AUTHOR]

Background: The international collaboration study PRICOV-19 –Primary Health Care in times of COVID-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on the subjective perceptions of general practitioners on primary health care and the impact of political measures during the second wave of the COVID-19 pandemic. Within this survey, the "open text field" of the questionnaire was utilised remarkably frequently and extensively by the respondents. It became clear that the content that was named needed to be analysed in an exploratory manner. Accordingly, this paper addresses the following question: What preoccupies general practitioners in Germany during COVID-19 that we have not yet asked them enough? Methods: The data collection took place throughout Germany from 01.02.2021 to 28.02.2021with a quantitative online questionnaire consisting of 53 items arranged across six topics as well as an "open text field" for further comments. The questionnaire's open text field was analysed following the premises of the qualitative content analysis. Results: The topics discussed by the respondents were: insufficient support from health policies, not being prioritised and involved in the vaccination strategy, feeling insufficient prepared, that infrastructural changes and financial concerns threatened the practice, and perceiving the own role as important, as well as that health policies affected the wellbeing of the respondents. One of the main points was the way general practitioners were not sufficiently acknowledged for their contribution to ensuring high-quality care during the pandemic. Discussion: German general practitioners perceived their work and role as highly relevant during the COVID-19 pandemic. In controversy with their perception, they described political conditions in which they were the ones who contributed significantly to the fight against the pandemic but were not given enough recognition. [ABSTRACT FROM AUTHOR]

With the onset of the COVID-19 pandemic, parents had to reorganize their family routines under many external stressors (e.g., limited external childcare), which could have negatively affected their relationship satisfaction. This study aimed to examine the changes in relationship satisfaction of young parents from pre-pandemic times up to the second wave of the COVID-19 pandemic in Germany in December 2020 and whether these changes were different for mothers and fathers. Additionally, the role of perceived pandemic-related stress and changes in family routines was investigated. Data from 564 participants from DREAMCORONA, a sub-study of the prospective longitudinal cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM), were analyzed. Relationship satisfaction was assessed at three measurement points (T0: pre-pandemic, i.e., August 2018–March 2020; T1: May–June 2020; T2: October–December 2020). To estimate changes in relationship satisfaction over time, Latent Growth Curve Models were calculated. Changes in family routines (i.e., changes in the division of housework and childcare from T0 to T1 as well as the availability of external childcare facilities at T1) and perceived pandemic-related stress at T1 were used as predictors. The models were adjusted for education and number of children per household. There was no significant change in relationship satisfaction over time, with no differences between mothers and fathers. The multi-group model revealed that changes in the division of housework and childcare predicted changes in relationship satisfaction in mothers, but not in fathers. For mothers, doing more housework than before the pandemic was negatively associated with changes in their relationship satisfaction over time. Additionally, reporting that their partner did more childcare than before the pandemic was positively associated with the relationship satisfaction of mothers. Our results indicate no general negative prospective association between the COVID-19 pandemic and parental relationship satisfaction over time. Nevertheless, our findings highlight the importance of the division of housework and childcare for mothers' relationship satisfaction and how pandemic-related changes in family routines alter this association. [ABSTRACT FROM AUTHOR]

Both the basic human values approach and the economic preference approach have been developed and applied to represent fundamental drivers of human behavior in various domains by measuring people's underlying preferences and motivations. Both of them have been used, however, in isolation from each other, the former primarily in social psychology studies and the latter mainly in economic studies. But how similar are they? Finding that they differ may suggest that combining them to explain human behavior might be beneficial. To the best of our knowledge, only a few studies have attempted to explore and empirically examine the theoretical and empirical link between variables in both approaches. The current study tries to fill this gap by examining relations between basic human values and major economic preferences. We examine the associations between the values of self-transcendence, self-enhancement, openness to change and conservation, and the economic preferences of risk aversion (or seeking), altruism, trust, and positive and negative reciprocity. We propose mechanisms as to how they may be associated with one another. For example, we expect an association between conservation and risk aversion as both are motivated by attributing importance to stability and the status quo, or between self-transcendence and altruism, as both are motivated by concern for others. For the empirical analysis we employed convenience samples collected in Poland and Germany. Results in both samples support our expectations: several values and economic preferences are linked in theoretically predictable ways, but only to a weak or moderate extent. We conclude that they are not mutually exclusive but may rather be complementary, and therefore likely both relevant for investigations into explaining behavior. [ABSTRACT FROM AUTHOR]

Acute type A aortic dissection (ATAAD) is a dramatic emergency exhibiting a mortality of 50% within the first 48 hours if not operated. This study found an absolute value of cosine-like seasonal variation pattern for Germany with significantly fewer ATAAD events (Wilcoxon test) for the warm months of June, July, and August from 2005 to 2015. Many studies suspect a connection between ATAAD events and weather conditions. Using ERA5 reanalysis data and an objective weather type classification in a contingency table approach showed that for Germany, significantly more ATAAD events occurred during lower temperatures (by about 4.8 K), lower water vapor pressure (by about 2.6 hPa), and prevailing wind patterns from the northeast. In addition, we used data from a classification scheme for human-biometeorological weather conditions which was not used before in ATAAD studies. For the German region of Berlin and Brandenburg, for 2006 to 2019, the proportion of days with ATAAD events during weather conditions favoring hypertension (cold air advection, in the center of a cyclone, conditions with cold stress or thermal comfort) was significantly increased by 13% (Chi-squared test for difference of proportions). In contrast, the proportion was decreased by 19% for conditions associated with a higher risk for patients with hypotension and therefore a lower risk for patients with hypertension (warm air advection ahead of warm fronts, conditions with no thermal stress or heat stress, in the center of a cyclone with thermal stress). As many studies have shown that hypertension is a risk factor for ATAAD, our findings support the hypothesized relation between ATAAD and hypertension-favoring weather conditions. [ABSTRACT FROM AUTHOR]

In March 2020, the WHO declared the coronavirus a pandemic. Since then, the German government has tried to control the spread of the virus with various restrictions. These restrictions had a direct impact on the life of German students. In this study, we investigate to what extent the restrictions led to a change of value priorities of German students. From January 2019 to January 2022, we conducted a cross-sectional study with four measurement points and, in total, 1,328 participants. Two measurement points were before the first outbreak of COVID-19 in Germany, one in the second lockdown phase and the third after two years in the pandemic. In this study, the students were asked to indicate their value priorities while solving a real-world decision problem important to them. Results suggest increased value priorities of the values Intellectual Fulfillment and Environment and Nature and a decrease of Family and Partner value priority as a direct effect of the second lockdown phase. We also found small differences regarding value priorities between the male and female subjects. The data show bounce-back effects as the pandemic became more normal to the students. In the long run, value priorities seem to be stable, with the exception of a longer-lasting increase in Freedom and Independence. [ABSTRACT FROM AUTHOR]

An integrated botanical and chemical approach is used to study surface residues on Funnel Beaker ceramics from the site of Oldenburg LA 77, in northern Germany. Organic residues were discovered adhering to fragments of thick-walled, undecorated ceramic vessels (n = 19) and ceramic discs (n = 2). The surface residues were studied using scanning electron microscopy (SEM), to examine remains of cereals and other plant tissues that survived food preparation and cooking, and using attenuated total reflectance Fourier transform infrared spectroscopy (ATR–FTIR) and direct time-resolved mass spectrometry (DTMS), to chemically identify specific food components. The SEM results show a reoccurring presence of cereal grain (emmer and barley) and one case of co-occurrence of emmer and fat-hen seeds. The SEM evidence for the use of sprouted emmer grain and milk-ripe barley from the Oldenburg residues greatly enhances our understanding of Neolithic foodways in northwestern Europe. The ATR-FTIR results showed that roughly a third of the surface residues contain traces of the original foods prepared or processed and DTMS results confirm that most of the residues primarily contain polysaccharides and a minimal amount of plant protein and that they lack lipids. Only one residue presents minor indications for a (partly) animal origin. The ceramic vessels were thus used almost exclusively for the processing or cooking of cereal grains. This study offers an intimate view of the cuisine and cooking practices (and in some cases their seasonal timing) in an early agricultural village located in a marginal farming region on the south coast of the Baltic Sea. [ABSTRACT FROM AUTHOR]

Financing entrepreneurship spurs innovation and economic growth. Digital financial platforms that crowdfund equity for entrepreneurs have emerged globally, yet they remain poorly understood. We model equity crowdfunding in terms of the relationship between the number of investors and the amount of money raised per pitch. We examine heterogeneity in the average amount raised per pitch that is associated with differences across three countries and seven platforms. Using a novel dataset of successful fundraising on the most prominent platforms in the UK, Germany, and the USA, we find the underlying relationship between the number of investors and the amount of money raised for entrepreneurs is loglinear, with a coefficient less than one and concave to the origin. We identify significant variation in the average amount invested in each pitch across countries and platforms. Our findings have implications for market actors as well as regulators who set competitive frameworks. [ABSTRACT FROM AUTHOR]

Fasciola hepatica is an internal parasite of both human and veterinary relevance. In order to control fasciolosis, a multitude of attempts to predict the risk of infection such as risk maps or forecasting models have been developed. These attempts mainly focused on the influence of geo-climatic and meteorological features. Predicting bovine fasciolosis on farm level taking into account farm-specific settings yet remains challenging. In the present study, a new methodology for this purpose, a data-driven machine learning approach using a random forest classification algorithm was applied to a cross-sectional data set of farm characteristics, management regimes, and farmer aspects within two structurally different dairying regions in Germany in order to identify factors relevant for the occurrence of F. hepatica that could predict farm-level bulk tank milk positivity. The resulting models identified farm-specific key aspects in regard to the presence of F. hepatica. In study region North, farm-level production parameters (farm-level milk yield, farm-level milk fat, farm-level milk protein), leg hygiene, body condition (prevalence of overconditioned and underconditioned cows, respectively) and pasture access were identified as features relevant in regard to farm-level F. hepatica positivity. In study region South, pasture access together with farm-level lameness prevalence, farm-level prevalence of hock lesions, herd size, parity, and farm-level milk fat appeared to be important covariates. The stratification of the analysis by study region allows for the extrapolation of the results to similar settings of dairy husbandry. The local, region-specific modelling of F. hepatica presence in this work contributes to the understanding of on-farm aspects of F. hepatica appearance. The applied technique represents a novel approach in this context to model epidemiological data on fasciolosis which allows for the identification of farms at risk and together with additional findings in regard to the epidemiology of fasciolosis, can facilitate risk assessment and deepen our understanding of on-farm drivers of the occurrence of F. hepatica. [ABSTRACT FROM AUTHOR]

The present study is a follow-up of a prior study examining a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using cross-cultural data from the Bochum Optimism and Mental Health (BOOM) study. The present study sought to expand prior findings on positive mental health predictors to a longer longitudinal timeframe. The analysis, specifically, tests our prior model using a third time point, The following positive constructs were examined in relation to later positive mental health: resilience, social support, social rhythm, family affluence, physical health and expectations for fertility. Negative predictors depression, anxiety, and stress were also examined in relation to time 3 positive mental health. Participants included university student samples from Germany (N = 591) and China (N = 8,831). Structural equation modeling was used to examine the effects of predictors on mental health. In China, three of the six salutogenic predictors (social rhythm regularity, positive mental health, resilience) at baseline were predictive of positive mental health at both follow-ups with generally small, but significant effects. Social support at baseline predicted more, and stress and anxiety predicted less positive mental health at follow-up 1, with generally small effects. Depression at baseline predicted less positive mental health at follow-up 2. In Germany, two of the six salutogenic predictors (positive mental health, social support) at baseline were predictive of positive mental health at both follow-ups, with generally small effects. Pathogenic predictors were not predictive of positive mental health at either follow-up. According to multi group analysis, the paths from positive mental health baseline to positive mental health follow-up 1 (FU1) as well as the path positive mental health FU1 to positive mental health follow-up 2 (FU2) were found to differ between Germany and China. All other paths could be seen as equivalent in Germany and China. Results indicate prediction of positive mental health over an extended period of time, and in particular by salutogenic predictors. Pathogenic predictors were also (negatively) predictive of PMH, but with more mixed results, underscoring the differential prediction of PMH from salutogenic and pathogenic factors. [ABSTRACT FROM AUTHOR]

Introduction: Artificial intelligence (AI) has the potential to transform clinical decision-making as we know it. Powered by sophisticated machine learning algorithms, clinical decision support systems (CDSS) can generate unprecedented amounts of predictive information about individuals' health. Yet, despite the potential of these systems to promote proactive decision-making and improve health outcomes, their utility and impact remain poorly understood due to their still rare application in clinical practice. Taking the example of AI-powered CDSS in stroke medicine as a case in point, this paper provides a nuanced account of stroke survivors', family members', and healthcare professionals' expectations and attitudes towards medical AI. Methods: We followed a qualitative research design informed by the sociology of expectations, which recognizes the generative role of individuals' expectations in shaping scientific and technological change. Semi-structured interviews were conducted with stroke survivors, family members, and healthcare professionals specialized in stroke based in Germany and Switzerland. Data was analyzed using a combination of inductive and deductive thematic analysis. Results: Based on the participants' deliberations, we identified four presumed roles that medical AI could play in stroke medicine, including an administrative, assistive, advisory, and autonomous role AI. While most participants held positive attitudes towards medical AI and its potential to increase accuracy, speed, and efficiency in medical decision making, they also cautioned that it is not a stand-alone solution and may even lead to new problems. Participants particularly emphasized the importance of relational aspects and raised questions regarding the impact of AI on roles and responsibilities and patients' rights to information and decision-making. These findings shed light on the potential impact of medical AI on professional identities, role perceptions, and the doctor-patient relationship. Conclusion: Our findings highlight the need for a more differentiated approach to identifying and tackling pertinent ethical and legal issues in the context of medical AI. We advocate for stakeholder and public involvement in the development of AI and AI governance to ensure that medical AI offers solutions to the most pressing challenges patients and clinicians face in clinical care. [ABSTRACT FROM AUTHOR]

In order to shed light on unmeasurable real-world phenomena, we investigate exemplarily the actual number of COVID-19 infections in Germany based on big data. The true occurrence of infections is not visible, since not every infected person is tested. This paper demonstrates that coronavirus-related search queries issued on Google can depict true infection levels appropriately. We find significant correlation between search volume and national as well as federal COVID-19 cases as reported by RKI. Additionally, we discover indications that the queries are indeed causal for infection levels. Finally, this approach can replicate varying dark figures throughout different periods of the pandemic and enables early insights into the true spread of future virus outbreaks. This is of high relevance for society in order to assess and understand the current situation during virus outbreaks and for decision-makers to take adequate and justifiable health measures. [ABSTRACT FROM AUTHOR]

Measuring subjective well-being in a multidimensional, valid, reliable, and parsimonious way is important for both social science research and social policy. Here, we present an efficient measure of distinct domains of subjective well-being and overall flourishing. The Flourishing Index (FI) consists of five sub-domains: 1. happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, and 5. close social relationships. The Secure Flourishing Index (SFI) adds the sub-domain financial and material stability, which is thought to be necessary to sustain the other domains over time. We developed a German version of these measures in a multi-stage translation and scale testing process. The results of an exploratory factor analysis in Study 1 (N = 192) suggest a unidimensional structure of the FI and a two-dimensional structure of the SFI. Moreover, both indices (and most sub-domains) revealed acceptable to good reliability. The factor structures were confirmed in Study 2 (N = 13,268). We provide indications for measurement invariance of both indices with regard to gender and age. We furthermore examined inter-correlations with related constructs such as importance of health, self-efficacy, and social support. Study 3 (N = 317) finds evidence for high convergent validity of both the FI and the SFI with overall well-being as well as sub-scores of the PERMA-Profiler. These results suggest that the FI and the SFI are efficient measures of distinct domains of subjective well-being and overall flourishing. Our translation of the FI and SFI, along with the empirical relationships that we found among the measures that we reviewed, will help scholars in Germany (and beyond) explore an expanded range of domains of well-being, including the comparatively neglected domains of character and virtue, physical health, and financial and material stability. [ABSTRACT FROM AUTHOR]

Fasciola hepatica is one of the economically most important endoparasites in cattle production. The aim of the present work was to evaluate the relevance of production level on the associations of on-farm presence of F. hepatica with farm-level milk yield, milk fat, and milk protein in Holstein cows, a specialised dairy breed, and in Simmental cows, a dual purpose breed. Furthermore, we investigated whether differential associations were present depending on breed. Data from 560 dairy farms across Germany housing 93,672 cows were analysed. The presence of F. hepatica antibodies was determined via ELISA on bulk tank milk samples. Quantile regression was applied to model the median difference in milk yield, milk fat, and milk protein depending on the interaction of breed and fluke occurrence. Whereas a reduction in milk yield (-1,206 kg, p < 0.001), milk fat (-22.9 kg, p = 0.001), and milk protein (-41.6 kg, p <0.001) was evident on F. hepatica positive German Holstein farms, only milk fat (-33.8 kg, p = 0.01) and milk protein (-22.6 kg, p = 0.03) were affected on F. hepatica positive German Simmental farms. Subsequently, production traits were modelled within each of the two breeds for low, medium, and high producing farms in the presence of F. hepatica antibodies and of confounders. On Holstein farms, the presence of F. hepatica seropositivity was associated with lower production, while on German Simmental farms such an association was less evident. This work demonstrates that production level is relevant when assessing the associations between the exposure to F. hepatica with production characteristics. Moreover, both models indicate a breed dependence. This could point towards a differential F. hepatica resilience of specialised dairy breeds in comparison with dual purpose breeds. [ABSTRACT FROM AUTHOR]

Background: Congenital cytomegalovirus (cCMV) infection can have a broad range of manifestations. This study aimed to assess cCMV-associated sequelae and healthcare resource utilization (HCRU) in infants during the first year of life in Germany. Methods: A retrospective, controlled cohort study using German claims data from the Institute for Applied Health Research Berlin (InGef) database was conducted. cCMV-associated sequelae and HCRU during the first year of life were assessed by matching (1:60) infants with at least one inpatient/outpatient cCMV diagnosis (ICD-10-GM: P35.1) ≤90 days after birth (cCMV90 cohort) and infants with at least one inpatient cCMV diagnosis plus specific sequelae ≤21 days after birth (cCMV21-S) to infants without cCMV or CMV (ICD-10-GM: B25) diagnosis (control group), respectively. Outcomes were analyzed during the first 365 days of life. Results: Between 2014–2018, we identified 54 newborns for cCMV90 and 24 newborns for cCMV21-S cohort. Compared to the 3,240 and 1,440 controls, respectively, more cCMV90 infants (83.3% vs. 41.9%, p<0.01) presented with at least one sequela during the first year of life, including intrauterine growth retardation (42.6% vs. 5.3%, p<0.01), sensorineural hearing loss (SNHL) to deafness (38.9% vs. 2.2%, p<0.01), and motor development disorders (33.3% vs. 10.9%, p<0.01). Further, 13.0% of cCMV90 infants (vs. 2.3%, p<0.01) suffered from visual impairment. In cCMV21-S cohort, intrauterine growth retardation (79.2% vs. 6.0%, p<0.01), prematurity (54.2% vs. 7.3%, p<0.01), and motor development disorders (50.0% vs. 11.0%, p<0.01) were the most frequent sequelae. Infants in the cCMV90 and cCMV21-S cohort had, on average, 7.3 times and 9.5 times more hospitalizations and 2.0 times and 2.1 times more outpatient physician visits than their respective controls (p<0.01). Hospitalized infants with cCMV stayed, on average, significantly longer in hospital compared to their controls (cCMV90 cohort: 30.3 days vs. 9.0 days, p<0.01; cCMV21-S cohort: 46.5 days vs. 9.3 days, p<0.01). Conclusions: cCMV-infection shows a considerable disease and healthcare burden during the first year of life. More than 80% of the identified newborns with cCMV suffered from at least one associated sequela during the first year of life, including long-term sequelae such as SNHL (40%) and visual impairment (13%). Additional steps for prevention of cCMV infection and associated sequelae as well as a comprehensive monitoring of disease burden are needed. [ABSTRACT FROM AUTHOR]

Introduction: Root canal sealing materials play a crucial role in an endodontic procedure by forming a bond between the dentinal walls and the gutta-percha. The current study aims to analyse the dentinal tubule penetration and adhesive pattern, including the push-out bond strength of six commercially available root canal sealers. Methodology: Eighty-four mandibular first premolars were split into seven groups (and n = 12), Group 1: Dia-Root, Group 2: One-Fil, Group 3: BioRoot RCS, Group 4: AH Plus, Group 5: CeraSeal, Group 6: iRoot SP, Group 7: GP without sealer (control). Two groups were made, one for dentinal tubule penetration and the other for push-out bond strength; the total sample size was one hundred sixty-eight. Root canal treatment was performed using a method called the crown down technique, and for obturation, the single cone technique was used. A confocal laser scanning microscope (Leica, Microsystem Heidel GmbH, Version 2.00 build 0585, Germany) was used to evaluate dentinal tubule penetration, and Universal Testing Machine was utilised to measure the push-out bond strength (Shimadzu, Japan) using a plunger size of 0.4 mm and speed of 1mm/min. Finally, the adhesive pattern of the sealers was analysed by HIROX digital microscope (KH-7700). Statistical analysis was carried out by a one-way Anova test, Dunnet's T3 test, and Chi-square test. Results: Highest dentinal tubule penetration was noticed with One-Fil (p<0.05), followed by iRoot SP, CeraSeal, AH Plus, Dia-Root also, the most negligible value was recorded for BioRoot RCS. Meanwhile, BioRoot RCS (p<0.05) demonstrated the greater value of mean push-out bond strength, followed by One-fil, iRoot SP, CeraSeal, AH Plus and Dia-Root. Regarding adhesive pattern, most of the samples were classified as type 3 and type 4 which implies greater sealing ability and better adherence to the dentinal wall. However, BioRoot RCS revealed the most type 4 (p<0.05), followed by AH Plus, One-Fil, CeraSeal and Dia-Root. Conclusion: The highest dentinal tubule penetration was shown by One-Fil compared to other groups. Meanwhile, BioRoot RCS had greater push-out bond strength and more adhesive pattern than other tested materials. [ABSTRACT FROM AUTHOR]

The construct of justice sensitivity has four perspectives that capture individual differences in the strength of reactions to injustice when becoming a victim of injustice (victim sensitivity), when witnessing injustice as an outsider (observer sensitivity), when passively benefitting from an injustice done to others (beneficiary sensitivity), or when committing an injustice (perpetrator sensitivity). Individual differences in these four justice sensitivity perspectives are highly relevant in moral research. With just eight items in total, the Justice Sensitivity Short Scales–8 (JSS-8) are a very efficient way to measure the four perspectives. JSS-8 was initially constructed in German (Ungerechtigkeitssensibilität-Skalen–8, USS-8) and later translated into English. In the present study, we empirically validated this English-language adaptation in a heterogeneous quota sample from the UK. The results show that the psychometric properties (i.e., reliability, validity, standardization) of JSS-8 are good, and that they are comparable with those of the German-language source version. Because of the invariance of loadings, intercepts, and residual variances, researchers can compare manifest scale statistics (i.e., means, variances) of JSS-8 across the UK and Germany. JSS-8 is thus particularly suitable for measuring justice sensitivity in various research areas with constraints on assessment time and questionnaire space. [ABSTRACT FROM AUTHOR]

Background: Quarantine is one of the most effective interventions to contain an infectious disease outbreak, yet it is one of the most disruptive. We investigated the quarantine of an entire village to better understand risk communication requirements for groups. Methods: We conducted a cross-sectional, mixed-methods survey study on a single cohort of adult residents in Neustadt am Rennsteig, Germany, six weeks after the removal of a 14-day mandatory community quarantine. The survey response rate was 33% (289/883 residents). Findings: Survey participants reported a lack of information on the quarantine implementation process. What authorities communicated was not necessarily what residents desired to know. While inhabitants used social media and telephones to communicate with each other, the official information sources were regional radio, television, newspapers and official websites. Public health authorities did not employ social media communication to engage with their communities. Despite a lack of information, the majority of respondents stated that they had complied with the quarantine and they expressed little sympathy for those who violated the quarantine. After lifting the quarantine, many respondents continued to avoid places where they suspected a significant risk of infection, such as family and friends' homes, doctor's offices and grocery stores. Interpretation: The survey participants utilised existing social networks to disseminate vital information and stabilise its group identity and behaviour (quarantine compliance). The authorities communicated sparsely in a unidirectional, top-down manner, without engaging the community. Despite the lack of official information, the social coherency of the group contributed to considerate and compliant conduct, but participants expressed dissatisfaction with official leadership and asked for more attention. Conclusion: Public health risk communication must engage with communities more effectively. This necessitates a deeper comprehension of groups, their modes of communication and their social needs. [ABSTRACT FROM AUTHOR]

Background: Ageing societies and urbanization are global phenomena that pose new challenges for care delivery. It is important to create a scientific evidence base to prepare for these changes. Hence, the aim of our study was to assess which research agenda older adults living in an urban environment in Germany suggest. Methods: A total of 1000 participants aged 65 years or older from five different neighborhoods of Berlin were randomly chosen and were sent a single item questionnaire allowing them to freely propose research topics regarding ageing well in the city. Codes were developed inductively and clustered into categories. In a second stage, these results were discussed with the participants and local stakeholders in a workshop and video calls. Results: 102 persons suggested 18 research topics in 6 categories: health, living environment, social issues, mobility, and accessibility to information and communication. Proposed research topics ranged from accessibility of health care, green spaces and recreational means to social involvement and loneliness. Conclusion: There is a substantial interest of older adults for research regarding their living situation. Research projects and local urban planning committees are encouraged to invite older adults to participate and integrate their perspectives suggested by older adults. [ABSTRACT FROM AUTHOR]

The closure of all sports facilities during the two lockdowns in Germany favoured a reduction of leisure time physical activity during the COVID-19 pandemic. The aim of this study was to compare leisure time physical activity during the 1st and 2nd lockdown and to examine exercise performance before and after resumption of exercise. Leisure time physical activity was measured by the Longitudinal Urban Cohort Ageing Study (LUCAS) functional ability index and energy expenditure in the Minnesota Leisure Time Physical Activity Questionnaire. Participants' exercise performance was extracted from a chip-controlled fitness circuit. Differences were tested for statistical significance using Friedman tests. 35 participants above 60 years were included from the Oldenburg area (20 women, 15 men, mean age and standard deviation 71±6 years). The decline in energy expenditure was higher during the 2nd lockdown (1st lockdown: Median -55.7 kcal.day-1, Q0.25−121.3 kcal.day-1, Q0.75 132.9 kcal.day-1; 2nd lockdown: Median -119.7 kcal.day-1, Q0.25−255.6 kcal.day-1, Q0.75−65.1 kcal.day-1; Friedman test: p<0.001, n = 35, W = 0.262). The time spent in the fitness circuit decreased from lockdown to lockdown as well as the number of participants exercising there. Intense activities were performed during the two lockdowns by only 7 and 3 participants, respectively, and were not resumed by two-thirds of the participants after the 2nd lockdown. During the 1st lockdown, exercise performance on resistance exercise devices increased in most of them, while it decreased by 1 to 7% during the 2nd lockdown. The lockdowns limited leisure time physical activity in older adults. This was more pronounced during the lockdown in winter 2020/2021, when participants engaged less in outdoor activities. Therefore, measures should be taken to maintain physical activity and muscle strength, especially during winter months, with a home-based training, if visiting gyms is not possible. [ABSTRACT FROM AUTHOR]

In the present research we tested the differential effects of anger versus shame as emotional predictors of ingroup disidentification in one rather collectivistic (Japan) and two rather individualistic societies (Germany, Canada). We tested the idea that individuals cope with socially undesired emotions by disidentifying from their group. Specifically, we predicted that after a group conflict, anger, an undesired emotion in Japan, would elicit disidentification in Japan, whereas shame, an undesired emotion in Canada and Germany, would elicit disidentification in Germany and Canada. Study 1 (N = 378) found that anger, but not shame, was related to disidentification in Japan, whereas shame, but not anger, was related to disidentification in Canada and Germany. Study 2 (N = 171) shows that, after group conflict, Japanese disidentified more when imagining to feel angry, whereas Germans disidentified more when imagining to feel ashamed. Implications for these findings are discussed. [ABSTRACT FROM AUTHOR]

The paper investigates potentials and challenges during the interpretation of prehistoric settlement dynamics based on large archaeological datasets. Exemplarily, this is carried out using a database of 1365 Neolithic sites in the Weiße Elster river catchment in Central Germany located between the southernmost part of the Northern German Plain and the Central Uplands. The recorded sites are systematically pre-processed with regard to their chronology, functional interpretation and spatial delineation. The quality of the dataset is reviewed by analyzing site distributions with respect to field surveys and modern land use. The Random Forests machine learning algorithm is used to examine the impact of terrain covariates on the depth of sites and pottery preservation. Neolithic settlement dynamics are studied using Site Exploitation Territories, and site frequencies per century are used to compare the intensity of land use with adjacent landscapes. The results show that the main trends of the Neolithic settlement dynamics can be derived from the dataset. However, Random Forests analyses indicate poor pottery preservation in the Central Uplands and a superimposition of Neolithic sites in the southernmost part of the Northern German Plain. Throughout the Neolithic the margins between soils on loess and the Weiße Elster floodplain were continuously settled, whereas only Early and Late Neolithic land use also extended into the Central Uplands. These settlement patterns are reflected in the results of the Site Exploitation Territories analyses and explained with environmental economic factors. Similar with adjacent landscapes the Middle Neolithic site frequency is lower compared to earlier and later periods. [ABSTRACT FROM AUTHOR]

Public perceptions of COVID-19 vaccines are critical in reaching protective levels of herd immunity. Vaccine skepticism has always been relatively high in Germany, and surveys suggest that over the course of the pandemic, enthusiasm for the COVID-19 vaccine has dropped. Looking at the period just prior to the approval of the Pfizer/BioNTech and Moderna vaccines in Germany in the latter half of 2020, this paper aims to assess the reasons for and against COVID-19 vaccine uptake among residents of Germany, and to provide in-depth qualitative data to better understand and address concerns surrounding the safety and efficacy of a COVID-19 vaccine. Our findings indicate that there is widespread trust in German institutions and health experts to provide a safe vaccine for those who need it most. However, interviewees also point to the need for more information and the centrality of support from trusted medical authorities in making individual vaccination decisions. We also present the complexity of individual positions on vaccination, and suggest that vaccine hesitancy in relation to COVID-19 needs to be understood as a nuanced, and socially malleable, territory. This indicates that the goal of a vaccination campaign is not only achieving 'herd immunity,' but also a social endorsement of the collaborative effort that is required for a vaccine to be successful. [ABSTRACT FROM AUTHOR]

European countries more than ever face shifts towards aging societies with accompanying challenges for health and aged care services. Economic evaluation has mainly relied on health measures such as EQ-5D across populations and conditions. We want to know how well the EQ-5D performs in the target population to avoid bias to the disadvantage of older adults and care-dependents. Therefore, we aim to explore differences and similarities of EQ-5D-3L and EQ-5D-5L in comparison to the old-age specific WHOQOL-OLD instrument in a sample of older adults receiving aged care services. We collected data from n = 329 older adults (≥65 years) receiving aged care services in Germany; the majority was at least 80 years and had varying care needs. We assessed instruments' feasibility, test-retest reliability, instruments' association and sensitivity to known-group differences. In terms of feasibility and test-retest reliability both EQ-5D versions performed better than the WHOQOL-OLD. All measures differentiated well between groups based on aspects of general health and care levels. The analysis of relationship between measures indicated that EQ-5D and WHOQOL-OLD assess partially overlapping, but distinct constructs. We found no clear evidence of superiority of either EQ-5D version over the other. The EQ-5D-5L performed better in terms of test-retest reliability and stronger correlations with WHOQOL-OLD facets. We conclude that using the WHOQOL-OLD alongside EQ-5D in this sample added further information on different aspects of quality of life. [ABSTRACT FROM AUTHOR]

Monkeypox is a double-stranded DNA virus with an envelope and is a member of the Poxviridae family's Orthopoxvirus genus. This virus can transmit from human to human through direct contact with respiratory secretions, infected animals and humans, or contaminated objects and causing mutations in the human body. In May 2022, several monkeypox affected cases were found in many countries. Because of its transmitting characteristics, on July 23, 2022, a nationwide public health emergency was proclaimed by WHO due to the monkeypox virus. This study analyzed the gene mutation rate that is collected from the most recent NCBI monkeypox dataset. The collected data is prepared to independently identify the nucleotide and codon mutation. Additionally, depending on the size and availability of the gene dataset, the computed mutation rate is split into three categories: Canada, Germany, and the rest of the world. In this study, the genome mutation rate of the monkeypox virus is predicted using a deep learning-based Long Short-Term Memory (LSTM) model and compared with Gated Recurrent Unit (GRU) model. The LSTM model shows "Root Mean Square Error" (RMSE) values of 0.09 and 0.08 for testing and training, respectively. Using this time series analysis method, the prospective mutation rate of the 50th patient has been predicted. Note that this is a new report on the monkeypox gene mutation. It is found that the nucleotide mutation rates are decreasing, and the balance between bi-directional rates are maintained. [ABSTRACT FROM AUTHOR]

Background: Despite physical activity (PA) health benefits, people with dementia (PwD) continue to report low levels of PA engagement compared with healthy older adults. Evidencing that PA initiatives still not reflect effective practice and outcomes. Previous studies have shown that several factors can mediate PA initiatives implementation in this population. However, most prior research have not use implementation science frameworks to outline in-depth barriers and facilitators that enables improved PA strategies in PwD. Therefore, a more holistic understanding of mediating factors is still needed. Objective: To identify multilevel barriers and facilitator factors, applying the Consolidated Framework for Implementation Research (CFIR) to orient a systematic evaluation of one PA project in PwD and provide evidence-based evaluation results to enhance PA implementation efforts for PwD. Method: A qualitative study implemented in 4 German sports associations that applied a PA project for PwD. A total of 13 semi-structured interviews were conducted with 21 participants, project leaders (PLs) and sports trainers (STs). The Consolidated Framework for Implementation Research (CFIR) was used as an evaluation framework to orient both the data collection and analysis. Results: A total of 13 interviews were conducted with 21 participants. The CFIR guided the identification of barriers and facilitating factors that need to be targeted at different levels for successful implementation. Barriers were identified, especially in the external level, as more solid networks and funding for sustainable proposals are still needed. Other barriers were low participation rates, stigma around the disease and the COVID 19 pandemic. On an individual and structural level facilitators were found like motivated appointed leaders, established planning process, and external organizations supporting sports associations in the implementation. Conclusion: Sports projects for PwD can benefit from structuring their interventions based on the CFIR framework as it helps identify multilevel factors that may influence their success and promote PA among PwD. Future efforts should continue working on implementing frameworks that facilitate and reduce the complexity of implementing sustainable PA projects for PwD. [ABSTRACT FROM AUTHOR]