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Reconstruimos la teoría central de las redes bayesianas n-dimensionales de forma clara y completa en el marco estructuralista. Nuestra formulación también incluye los n espacios de probabilidad unidimensionales y un espacio de probabilidad n-dimensional. Explicamos los sistemas previstos y la afirmación empírica de la teoría de las redes bayesianas n-dimensionales. En nuestra formulación, se destaca el concepto de dimensión, y discutimos si los eventos o las oraciones (enunciados, proposiciones) podrían usarse como bloques de construcción básicos.

Implicit solvent models that reduce solvent degrees of freedom into effective interaction potentials are widely used in the study of soft materials and biophysical systems. For electrolyte and polyelectrolyte solutions, coarse-graining the solvent degrees of freedom into an effective dielectric constant embeds entropic contributions into the temperature dependence of the dielectric constant. Properly accounting for this electrostatic entropy is essential to discern whether a free energy change is enthalpically or entropically driven. We address the entropic origin of electrostatic interactions in a dipolar solvent and provide a clarified physical picture of the solvent dielectric response. We calculate the potential of mean force (PMF) between two oppositely charged ions in a dipolar solvent using molecular dynamics and dipolar self-consistent field theory. We find with both techniques that the PMF is dominated by the entropy gain from the dipole release, owing to the diminished orientational polarization of the solvent. We also find that the relative contribution of the entropy to the free energy change is nonmonotonic with temperature. We expect that our conclusions are applicable to a broad range of problems involving ionic interactions in polar solvents.

Um kleine Losgrößen robotergestützt wirtschaftlich zu fertigen, müssen die entsprechenden Steuerungsprogramme aufwandsarm anpassbar sein. Eine besondere Herausforderung ist dabei die Umstellung optischer Sensoren zur autonomen Erkennung und Lagebestimmung von Werkstücken, weil die eingesetzten Algorithmen meist auf bestimmte Objekt- und Umwelteigenschaften zugeschnitten sind. Ein Lösungsansatz besteht in der Kombination von Digitalen Zwillingen mit Methoden der Künstlichen Intelligenz in einem cyber-physischen System, um neue Produkte automatisch zu identifizieren, ihre Lage zu bestimmen und die Roboterprogramme anzupassen.

Anoxic microniches in sinking particles in lakes have been identified as important water phase production zones of monomethylmercury (MeHg). However, the production and decay of MeHg during organic matter (OM) decomposition in the water column and its relation to the total Hg concentration in seston are poorly understood. We investigated total Hg and MeHg in relation to chemical changes in sinking seston and hydrochemical settings in a small and shallow (12 m deep) eutrophic lake during phytoplankton blooms from April to November 2019. The results show that MeHg proportions reach up to 22 % in seston in oxygen super saturation at the water surface and highest values (up to 26 %) at the oxic–suboxic redox boundary. MeHg concentrations were highest in May and November when algal biomass production was low and seston were dominated by zooplankton. Biodilution of MeHg concentrations could not be observed in the months of the highest algal biomass production; instead, MeHg and THg concentrations in seston were comparatively high. During suboxic OM decomposition and with decreasing redox potential (Mn and nitrate reduction), the concentration and proportion of MeHg in seston strongly decreased (

Abstract: Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.

Youth living with HIV in sub-Saharan Africa have poor HIV care outcomes. We determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15-24 years living with HIV in rural Kenya and Uganda. This was a cross-sectional analysis of 995 youth enrolled in the SEARCH Youth study. At baseline, providers assessed recent (within 6 months) life-events, defined as changes in schooling/employment, residence, partnerships, sickness, incarceration status, family strife or death, and birth/pregnancy, self-reported alcohol use, being a parent, and HIV-status disclosure. We examined the frequencies of events and their association with ART status and HIV viral suppression (400 copies/ul). Recent significant life-events were prevalent (57.7%). Having

OBJECTIVE A reluctance to monitor extraocular cranial nerve (EOCN) function has restricted skull base surgery worldwide. Spontaneous and triggered electromyography (EMG) monitoring can be recorded intraoperatively to identify and assess potential cranial nerve injury. Determining the conductive function of EOCNs requires the collection of clear, reliable, and repeatable compound muscle action potentials (CMAPs) secondary to stimulation. EOCN EMG needle electrodes can, although infrequently, cause ocular morbidity including hematoma, edema, and scleral laceration. The aim of this study was to ascertain if minimally invasive 7-mm superficial needle electrodes would record CMAPs as well as standard 13-mm intraorbital electrodes. METHODS Conventionally, the authors have monitored EOCN function with intraorbital placement of paired 13-mm needle electrodes into three extraocular muscles: medial rectus, superior oblique, and lateral rectus. A prospective case-control study was performed using shorter (7-mm) needle electrodes. A single minimally invasive electrode was placed superficially near each extraocular muscle and coupled with a common reference. CMAPs were recorded from the minimally invasive electrodes and compared with CMAPs recorded from the paired intraorbital electrodes. The presence or absence of CMAPs was analyzed and compared among EMG recording techniques. RESULTS A total of 429 CMAPs were analyzed from 71 EOCNs in 25 patients. The experimental setup yielded 167 true-positive (39%), 106 false-positive (25%), 17 false-negative (4%), and 139 true-negative (32%) responses. These values were used to calculate the sensitivity (91%), specificity (57%), positive predictive value (61%), and negative predictive value (89%). EOCN electrodes were placed in 82 total eyes in 58 patients (CMAPs were obtained in 25 patients). Twenty-six eyes showed some degree of edema, bruising, or bleeding, which was transient and self-resolving. Three eyes in different patients had complications from needle placement or extraction including conjunctival hemorrhage, periorbital ecchymosis, and corneal abrasion, ptosis, and upper eyelid edema. CONCLUSIONS Because of artifact contamination, 106 false-positive responses (25%), and 17 false-negative responses (4%), the minimally invasive EMG technique cannot reliably record CMAP responses intraoperatively as well as the intraorbital technique. Less-invasive techniques can lead to an inaccurate EOCN assessment and potential postoperative morbidity. EOCN palsies can be debilitating and lifelong; therefore, the benefits of preserving EOCN function outweigh the potential risks of morbidity from electrode placement. EMG monitoring with intraorbital electrodes remains the most reliable method of intraoperative EOCN assessment.

To evaluate the associations between preconception sleep characteristics and shift work with fecundability and live birth.Secondary analysis of the Effects of Aspirin in Gestation and Reproduction study, a preconception cohort.Four US academic medical centers.Women aged 18-40 with a history of 1-2 pregnancy losses who were attempting to conceive again.Not applicable.We evaluated baseline, self-reported sleep duration, sleep midpoint, social jetlag, and shift work among 1,228 women who were observed for ≤6 cycles of pregnancy attempts to ascertain fecundability. We ascertained live birth at the end of follow up via chart abstraction. We estimated fecundability odds ratios (FORs) using discrete, Cox proportional hazards models and risk ratios (RRs) for live birth using log-Poisson models.Sleep duration ≥9 vs. 7 to8 hours (FOR: 0.81, 95% confidence interval [CI], 0.61; 1.08), later sleep midpoints (3rd tertile vs. 2nd tertile: FOR: 0.85; 95% CI, 0.69, 1.04) and social jetlag (continuous per hour; FOR: 0.93, 95% CI: 0.86, 1.00) were not associated with reduced fecundability. In sensitivity analyses, excluding shift workers, sleep duration ≥9 vs. 7 to8 hours (FOR: 0.62; 95% CI, 0.42; 0.93) was associated with low fecundability. Night shift work was not associated with fecundability (vs. non-night shift work FOR: 1.17, 95% CI, 0.96; 1.42). Preconception sleep was not associated with live birth.Overall, there does not appear to be a strong association between sleep characteristics, fecundability, and live birth. Although these findings may suggest weak and imprecise associations with some sleep characteristics, our findings should be evaluated in larger cohorts of women with extremes of sleep characteristics.Clinicaltrials.gov NCT00467363.

Abstract. Background: Several reviews are available on the effects of specific nursing tasks in oncology care. However, a synthesis across cancer entities and stages is lacking. Aim: To synthesise the results of reviews assessing the scope and effectiveness of tasks of nurses specifically qualified in cancer care. Methods: We conducted an Umbrella Review based on systematic searches in six databases and a search for grey literature following a priori-defined inclusion criteria. Further steps: standardised data extraction and quality assessment, determination of the degree of overlap, and structured narrative summary on outcome measures of health-related quality of life, symptom burden, utilisation of care services/resources, and patient satisfaction. All reviews were categorised according to the EONS Cancer Nursing Education Framework and the Omaha System Intervention Scheme. Results: After screening 2,657 references, 11 reviews (10 high quality) for a total of 148 studies were included. Specially qualified nurses and advanced practice nurses take on a variety of tasks in the disease process, especially related to education, counselling, and case management. Effects on outcome measures are mixed, with increased indications of reduced symptom burden. Conclusion: Specially qualified nurses with expanded roles have the potential to contribute to improved oncology care. This emphasises the importance of appropriate task profiles and qualification programs. More well-reported studies based on theoretical framework models are needed.

Composite hemangioendothelioma (CHE) is a very rare low-grade malignant vascular neoplasm. Here, we present the first case of it occurring on a penis with two local recurrences over a 9 year span and its progression to a high-grade morphology.

Mixed evidence exists of associations between mobility data and coronavirus disease 2019 (COVID-19) case rates. We aimed to evaluate the county-level impact of reducing mobility on new COVID-19 cases in summer/fall of 2020 in the United States and to demonstrate modified treatment policies to define causal effects with continuous exposures. Specifically, we investigated the impact of shifting the distribution of 10 mobility indexes on the number of newly reported cases per 100,000 residents 2 weeks ahead. Primary analyses used targeted minimum loss-based estimation with Super Learner to avoid parametric modeling assumptions during statistical estimation and flexibly adjust for a wide range of confounders, including recent case rates. We also implemented unadjusted analyses. For most weeks, unadjusted analyses suggested strong associations between mobility indexes and subsequent new case rates. However, after confounder adjustment, none of the indexes showed consistent associations under mobility reduction. Our analysis demonstrates the utility of this novel distribution-shift approach to defining and estimating causal effects with continuous exposures in epidemiology and public health.

This review provides a multidisciplinary overview of the challenges and opportunities for dynamic covalent chemistry-based macromolecules towards the design of new, sustainable, and recyclable materials for a circular economy.

Environmental neutrons are a source of background for rare event searches (e.g., dark matter direct detection and neutrinoless double beta decay experiments) taking place in deep underground laboratories. The overwhelming majority of these neutrons are produced in the cavern walls by means of intrinsic radioactivity of the rock and concrete. Their flux and spectrum depend on time and location. Precise knowledge of this background is necessary to devise sufficient shielding and veto mechanisms, improving the sensitivity of the neutron-susceptible underground experiments. In this report, we present the design and the expected performance of a mobile neutron detector for the LNGS underground laboratory. The detector is based on capture-gated spectroscopy technique and comprises essentially a stack of plastic scintillator bars wrapped by gadolinium foils. The extensive simulation studies demonstrate that the detector will be capable of measuring ambient neutrons at low flux levels ($\sim$$10^{-6}\,\mathrm{n/cm^2/s}$) at LNGS, where the ambient gamma flux is by about 5 orders of magnitude larger.

The detection of right temporal lobe dysfunction with nonverbal memory tests has remained difficult in the past. Reasons for this might be the potential influence of other biasing cognitive functions such as executive functions or the verbalisability of nonverbal material. The aim of this study was to investigate three classic nonverbal memory tests by identifying their neuroanatomical correlates with lesion-symptom mapping (LSM) and by probing their independence from verbal encoding abilities and executive functions. In a cohort of 119 patients with first-time cerebrovascular accident, memory performance was assessed in the Nonverbal Learning and Memory Test for Routes (NLMTR), the Rey Complex Figure Test (RCFT), and the Visual Design Learning Test (VDLT). Calculating multivariate LSM, we identified crucial brain structures for these three nonverbal memory tests. Behavioural analyses were performed to assess the impact of executive functions and verbal encoding abilities with regression analyses and likelihood-ratio tests. LSM revealed for the RCFT mainly right-hemispheric frontal, insular, subcortical, and white matter structures and for the NLMTR right-hemispheric temporal (hippocampus), insular, subcortical, and white matter structures. The VDLT did not reach significance in LSM analyses. Behavioural results showed that amongst the three nonverbal memory tests the impact of executive functions was most pronounced for RCFT, and the impact of verbal encoding abilities was most important in VDLT. Likelihood-ratio tests confirmed that only for NLMTR did the goodness of fit not significantly improve by adding executive functions or verbal encoding abilities. These results suggest that amongst the three nonverbal memory tests the NLMTR, as a spatial navigation test, could serve as the most suitable marker of right-hemispheric temporal lobe functioning, with the right hippocampus being involved only in this test. In addition, the behavioural results propose that only NLMTR seems mostly unaffected by executive functions and verbal encoding abilities.

Das Forschungsprojekt „PendlerRatD“ verfolgt das Ziel, motorisierte Berufspendler*innen zum Umstieg auf das Fahrrad zu bewegen. Der Bewusstseinswandel steht dabei im Vordergrund. Unterstützt wird dieser Wandel durch eine native App mit einem Bonus- und Challengesystem. Damit können Arbeitgeber gezielt Anreize zum täglichen Pendeln mit dem Fahrrad setzen. Dieser Artikel stellt das Vorgehen im Projekt sowie ausgewählte Studienergebnisse dar.

Background There is substantial heterogeneity between trial outcomes in pressure ulcer prevention research. The development of core outcome sets is one strategy to improve comparability between trial results and thus increase the quality of evidence. Objectives To identify core outcomes for pressure ulcer prevention trials. Methods A workshop was held with service users to discuss their views and understanding of the outcomes identified by a scoping review and to identify any missing outcomes. In a next step, a Delphi survey comprising three rounds was conducted to evaluate a compiled list of outcomes by their importance. Afterwards the preselection from the Delphi survey was discussed in a virtual consensus meeting with the aim of agreeing on a final set of core outcomes. Individuals who had completed all three rounds of the Delphi survey were eligible to participate in this meeting. Participants included practitioners, service users, researchers and industry representatives. The OUTPUTs project is registered in the COMET database and is part of the Cochrane Skin Core Outcome Set Initiative. Results The workshop did not reveal any missing outcomes, but highlighted the need for further efforts to make lay people understand what an outcome is in a study setting. The Delphi survey took place between December 2020 and June 2021. After the three rounds, 18 out of 37 presented outcomes were rated to be critically important. In the following consensus meeting, six outcomes were prioritized to be included in the core outcome set for pressure ulcer prevention trials: (i) pressure ulcer occurrence; (ii) pressure ulcer precursor signs and symptoms; (iii) mobility; (iv) acceptability and comfort of intervention; (v) adherence/compliance; and (vi) adverse events/safety. Conclusions Based on a comprehensive list of outcomes in pressure ulcer prevention research, there was clear agreement on the six identified core outcomes in three international Delphi rounds and in the consensus meeting. Although outcome measurement instruments need to be identified next, the six identified core outcomes should already be considered in future trials, as service users, practitioners, researchers and industry representatives have agreed that they are critically important. What is already known about this topic? There are numerous trials on pressure ulcer prevention, but evidence on the effectiveness of preventive measures is limited due to heterogeneity between trial outcomes.The development of a core outcome set is one strategy to improve comparability between trial results. What does this study add? A service user workshop, a three-round Delphi survey and an online consensus meeting with practitioners, service users, researchers and industry representatives were conducted to identify core outcomes for pressure ulcer prevention trials.Six core outcomes were defined: (i) pressure ulcer occurrence, (ii) pressure ulcer precursor signs and symptoms, (iii) mobility, (iv) acceptability and comfort of intervention, (v) adherence/compliance and (vi) adverse events/safety. What are the clinical implications of this work? Better evidence of interventions for pressure ulcer prevention will help health professionals and service users to decide which interventions are most appropriate and effective.Better evidence may contribute to better pressure ulcer prevention.

Indacenodithiophene (IDT) copolymers are a class of conjugated polymers that have limited long-range order and high hole mobilities, which makes them promising candidates for use in deformable electronic devices. Key to their high hole mobilities is the coplanar monomer repeat units within the backbone. Poly(indacenodithiophene-benzothiadiazole) (PIDTC16-BT) and poly(indacenodithiophene-thiapyrollodione) (PIDTC16-TPDC1) are two IDT copolymers with planar backbones, but they are brittle at low molecular weight and have unsuitably high elastic moduli. Substitution of the hexadecane (C16) side chains of the IDT monomer with isocane (C20) side chains was performed to generate a new BT-containing IDT copolymer: PIDTC20-BT. Substitution of the methyl (C1) side chain on the TPD monomer for an octyl (C8) and 6-ethylundecane (C13B) afford two new TPD-containing IDT copolymers named PIDTC16-TPDC8 and PIDTC16-TPDC13B, respectively. Both PIDTC16-TPDC8 and PIDTC16-TPDC13B are relatively well deformable, have a low yield strain, and display significantly reduced elastic moduli. These mechanical properties manifest themselves because the lengthened side chains extending from the TPD-monomer inhibit precise intermolecular ordering. In PIDTC16-BT, PIDTC20-BT and PIDTC16-TPDC1 side chain ordering can occur because the side chains are only present on the IDT subunit, but this results in brittle thin films. In contrast, PIDTC16-TPDC8 and PIDTC16-TPDC13B have disordered side chains, which seems to lead to low hole mobilities. These results suggest that disrupting the interdigitation in IDT copolymers through comonomer side chain extension leads to more ductile thin films with lower elastic moduli, but decreased hole mobility because of altered local order in the respective thin films. Our work, thus, highlights the trade-off between molecular packing structure for deformable electronic materials and provides guidance for designing new conjugated polymers for stretchable electronics.

BackgroundDespite longstanding guidelines endorsing isoniazid preventive therapy (IPT) for people with HIV, uptake is low across sub-Saharan Africa. Mid-level health managers oversee IPT programmes nationally; interventions aimed at this group have not been tested. We aimed to establish whether providing structured leadership and management training and facilitating subregional collaboration and routine data feedback to mid-level managers could increase IPT initiation among people with HIV compared with standard practice.MethodsWe conducted a cluster randomised trial in Uganda among district-level health managers. We randomly assigned clusters of between four and seven managers in a 1:1 ratio to intervention or control groups. Our intervention convened managers into mini-collaboratives facilitated by Ugandan experts in tuberculosis and HIV, and provided business leadership and management training, SMS platform access, and data feedback. The control was standard practice. Participants were not masked to trial group, but study statisticians were masked until trial completion. The primary outcome was IPT initiation rates among adults with HIV in facilities overseen by participants over a period of 2 years (2019-21). We conducted prespecified analyses that excluded the third quarter of 2019 (Q3-2019) to understand intervention effects independent of a national 100-day IPT push tied to a financial contingency during Q3-2019. This trial is registered with ClinicalTrials.gov (NCT03315962), and is ongoing.FindingsBetween Nov 15, 2017, and March 14, 2018, managers from 82 of 82 eligible districts (61% of Uganda's 135 districts) were enrolled and randomised: 43 districts to intervention, 39 to control. Intervention delivery took place between Dec 6, 2017, and Feb 2, 2022. Over 2 years, IPT initiation rates were 0·74 versus 0·65 starts per person-year in intervention versus control groups (incidence rate ratio [IRR] 1·14, 95% CI 0·88-1·46; p=0·16). Excluding Q3-2019, IPT initiation was higher in the intervention group versus the control group: 0·32 versus 0·25 starts per person-year (IRR 1·27, 95% CI 1·00-1·61; p=0·026).InterpretationFollowing an intervention targeting managers in more than 60% of Uganda's districts, IPT initiation rates were not significantly higher in intervention than control groups. After accounting for large increases in IPT from a 100-day push in both groups, the intervention led to significantly increased IPT rates, sustained after the push and during the COVID-19 pandemic. Our findings suggest that interventions centred on mid-level health managers can improve IPT implementation on a large, subnational scale, and merit further exploration to address key public health challenges for which strong evidence exists but implementation remains suboptimal.FundingNational Institute of Allergy and Infectious Diseases.

Background Social network analysis can elucidate tuberculosis transmission dynamics outside the home and may inform novel network-based case-finding strategies. Methods We assessed the association between social network characteristics and prevalent tuberculosis infection among residents (aged ≥15 years) of 9 rural communities in Eastern Uganda. Social contacts named during a census were used to create community-specific nonhousehold social networks. We evaluated whether social network structure and characteristics of first-degree contacts (sex, human immunodeficiency virus [HIV] status, tuberculosis infection) were associated with revalent tuberculosis infection (positive tuberculin skin test [TST] result) after adjusting for individual-level risk factors (age, sex, HIV status, tuberculosis contact, wealth, occupation, and Bacillus Calmette–Guérin [BCG] vaccination) with targeted maximum likelihood estimation. Results Among 3 335 residents sampled for TST, 32% had a positive TST results and 4% reported a tuberculosis contact. The social network contained 15 328 first-degree contacts. Persons with the most network centrality (top 10%) (adjusted risk ratio, 1.3 [95% confidence interval, 1.1–1.1]) and the most (top 10%) male contacts (1.5 [1.3–1.9]) had a higher risk of prevalent tuberculosis, than those in the remaining 90%. People with ≥1 contact with HIV (adjusted risk ratio, 1.3 [95% confidence interval, 1.1–1.6]) and ≥2 contacts with tuberculosis infection were more likely to have tuberculosis themselves (2.6 [ 95% confidence interval: 2.2–2.9]). Conclusions Social networks with higher centrality, more men, contacts with HIV, and tuberculosis infection were positively associated with tuberculosis infection. Tuberculosis transmission within measurable social networks may explain prevalent tuberculosis not associated with a household contact. Further study on network-informed tuberculosis case finding interventions is warranted.

Large cardamom is one of the most important spices that can significantly contribute to the economical farming in the country of Nepal. It is grown in Nepal and north-eastern states of India which provide suitable agroclimatic growing conditions of high humidity, ambient temperature and high rainfall. Meeting the demand for high quality plants and yield of cardamom is challenging with traditional methods of propagation. The present study has used the plant tissue culture technique to produce high quality plants. In this regard, MS media with three different hormonal combinations were used for the development protocol for 8 weeks. Shoot length, root length, shoot number and root number were assessed at intervals. The best protocol for growth was MS media with 1 mg/L BAP + 0.5 mg/L IBA for the Ramsey variety, with no significant difference for Golsai, Dambarsai, or Sikkimae varieties. Similarly, the acclimatization and field transfer study was done. The use of any substrate composition in ratio of coco peat: soil 1:2; moss: coco peat 1:2 and sawdust: coco peat 1:2 enables transfer of healthy plants to the field. The results indicate that the varieties respond differently to the micropropagation process and to hormone concentrations indicated by differing root and shoot production. The protocol of 1mg/L BAP and 0.5mg/L IBA could be used for the Ramsai while optimal shoot production for Golsai and Sikkimae should be at 0.5mg/L and 5mg/L for shoot production. All varieties showed optimal root production at 0mg/L BAP and 0.5mg/L IBA. This study sheds light on the different responsiveness of varieties to tissue culture and hormone concentrations for both root and shoot development in micropropagation.

General practitioners (GPs) played a vital role during the COVID-19 pandemic. Little is known about GPs’ view of their role, leadership, participation in regional services and preferences for future pandemic preparedness. This representative study of German GPs comprised a web-based survey and computer-assisted telephone interviewing (CATI). It addressed GPs’ satisfaction with their role, self-perceived leadership (validated C-LEAD scale), participation in newly established health services, and preferences for future pandemic preparedness (net promotor score; NPS; range −100 to +100%). Statistical analyses were conducted using Spearman’s correlation and Kruskal–Wallis tests. In total, 630 GPs completed the questionnaire and 102 GPs the CATI. In addition to their practice duties, most GPs (72.5%) participated in at least one regional health service, mainly vaccination centres/teams (52.7%). Self-perceived leadership was high with a C-LEAD score of 47.4 (max. 63; SD ± 8.5). Overall, 58.8% were not satisfied with their role which correlated with the feeling of being left alone (r = −0.349, p < 0.001). 77.5 % of respondents believed that political leaders underestimated GPs’ potential contribution to pandemic control. Regarding regional pandemic services, GPs preferred COVID-19 focus practices (NPS +43.7) over diagnostic centres (NPS −31). Many GPs, though highly engaged regionally, were dissatisfied with their role but had clear preferences for future regional services. Future pandemic planning should integrate GPs’ perspectives.

Background 177Lu-radiopharmaceuticals are routinely used for the treatment of various tumor entities. The productions of radiopharmaceuticals follow strict good-manufacturing practice guidelines and synthesis optimizations thereof have a strong impact on e.g. the quality of the product, radiation safety and costs. The purpose of this study is to optimize the precursor load of three radiopharmaceuticals. For that, different precursor loads were evaluated and compared to previously reported findings. Results All three radiopharmaceuticals were successfully synthesized in high radiochemical purities and yields on the ML Eazy. The precursor load was optimized for [177Lu]Lu-FAPI-46 from 27.0 to 9.7 µg/GBq, for [177Lu]Lu-DOTATOC from 11 to 10 µg/GBq and for [177Lu]Lu-PSMA-I&T from 16.3 to 11.6 µg/GBq. Conclusions We successfully reduced the precursor load for all three radiopharmaceuticals while maintaining their quality.

BACKGROUND The question of the utility of face masks in preventing acute respiratory infections has received renewed attention in the context of the COVID-19 pandemic. However, given the inconclusive evidence of existing RCT, evidence based on real-world data with high external validity is missing. OBJECTIVE This study evaluated whether face mask mandates in 53 countries increased public face mask use and reduced weekly Sars-CoV-2 reproduction numbers and growth rates of COVID-19 cases and deaths. METHODS An event-study approach was applied to real-world data pooled from three different sources: country-level information on mask use was obtained from the COVID-19 Trends and Impact Survey. Data from the Oxford COVID-19 Government Response Tracker and the COVID-19 Our World in Data dataset provided information on face mask mandates and COVID-19 reproduction numbers and growth rates. RESULTS Mandates lead to an average increase in mask use by 8.54 percent points (95%-CI 2.65 to 14.44) and Sars-CoV-2 reproduction numbers declined on average by -0.35 units (95%-CI -0.56 to -0.14). While an effect of mask mandates was observed for weekly growth rates of COVID-19 cases (-6.40 percent points, 95%-CI -14.58 to 1.78), no changes in growth rates of COVID-19-related deaths (-0.22 percent points, 95% -6.84 to -6.39) were found. Our results are robust to alternate model specifications that control for additional containment policies, as well as counterfactual linear trends. Further, recommendations for voluntary mask use had no effect on mask use, reproduction numbers and growth rates. Conclusion: Mask mandates can be used as an effective measure to curb the spread of Sars-CoV-2. Our study adds external validity to existing RCTs on the effectiveness of face masks to reduce the spread of Sars-CoV-2. CONCLUSIONS Mask mandates can be used as an effective measure to curb the spread of Sars-CoV-2. Our study adds external validity to existing RCTs on the effectiveness of face masks to reduce the spread of Sars-CoV-2.

The effect of an externally applied directional force on molecular friction is so far poorly understood. Here, we study the force-driven dissociation of the ligand-protein complex biotin-streptavidin and identify anisotropic friction as a not yet described type of molecular friction. Using AFM-based stereographic single molecule force spectroscopy and targeted molecular dynamics simulations, we find that the rupture force and friction for biotin-streptavidin vary with the pulling angle. This observation holds true for friction extracted from Kramers’ rate expression and by dissipation-corrected targeted molecular dynamics simulations based on Jarzynski’s identity. We rule out ligand solvation and protein-internal friction as sources of the angle-dependent friction. Instead, we observe a heterogeneity in free energy barriers along an experimentally uncontrolled orientation parameter, which increases the rupture force variance and therefore the overall friction. We anticipate that anisotropic friction needs to be accounted for in a complete understanding of friction in biomolecular dynamics and anisotropic mechanical environments.

BACKGROUND Critical care information systems (CCIS) can have positive, neutral or negative effects on clinical care in intensive care units (ICUs) and the job satisfaction of ICU staff. Central mediating factors here are a high usability of the IT system and sufficient training, but also possible occuring resistance generated by increased control via the system and lack of participation. The usability of CCIS and co-determination factors in connection with CCIS use are not sufficiently examined. OBJECTIVE The aim of the study was to investigate the usage barriers of CCIS to derive recommendations for action for manufacturing companies and hospitals. The aim was to directly address previously researched potentially relevant factors and at the same time to leave room for free comments. METHODS Ten semi-structured qualitative interviews of 1 hour were conducted with ICU staff of 3 ICUs of a German university hospital (4 nurses, 6 doctors) where the CCIS was also reviewed together. The 10 interviews were recorded, transcribed, coded with MAXQDA and analyzed in terms of content structure (deductive and inductive). RESULTS : A total of 86 different usability problems was found, which were divided into 7 main categories and 22 subcategories. Particularly relevant were the unclear presentation of information (especially in medication documentation and order), too small or lengthy interaction steps in documentation (especially in nursing documentation), missing information or information distributed on different pages (especially also missing reminders of new entries), necessary duplicate entries of data and too low a speed of the system. Independently of this, other problems mentioned in connection with the use of the system were categorized as training, co-determination, feeling of being hazed, standard operating procedures and process changes. Satisfaction with the system was described as directly related to job satisfaction. CONCLUSIONS The usability of the CCIS is a central factor for the satisfaction with the IT system and can explain why CCIS use can have such opposing outcomes. Improving the usability of a complex system like an CCIS is a promising but challenging task and should involve iterative user testing. As co-determination is a relevant factor for use satisfaction, a comprehensive, transparent communication and opportunities for employee participation should be established. Sufficient training opportunities and SOPs for the system should also be a focus. System implementation requires sufficient monetary and time resources to create effective organizational structures and roles that can enable an effective feedback structure and system development.

Floods are amongst the most frequent and widespread disaster worldwide, posing enormous development challenges. Also in West Africa, flood risk still needs proper addressing. Ecosystem-based disaster risk reduction (Eco-DRR) approaches are increasingly recognised as cost-effective part of the solution, providing ecosystem services that reduce all three components of risk, namely hazard, exposure and vulnerability. Indeed, Eco-DRR, such as floodplain restoration or agroforestry, can affect hydrological processes, altering the flood hazard and exposure, and provide ecosystem services that reduce people’s vulnerability to floods and/or enhance their adaptive capacities. To fully understand the impact of Eco-DRR on the three components of risk, it is thus important to take an interdisciplinary approach to the assessment of Eco-DRR. Yet, there remains a substantial gap in the comprehensive evaluation of Eco-DRR effects, including guidance on how to depict the flow of ecosystem services and their benefits to people, which undermines the effective use of Eco-DRR measures in flood-prone environments.Using the case study of flood risk in the Ouémé River Basin, this contribution will share advances in the comprehensive evaluation of Eco-DRR measures. After defining locally-relevant Eco-DRR measures based on administrative plans, the scientific literature, and expert surveys, a systematic literature review has been conducted to understand the impact of selected Eco-DRR measures on both hydrological processes and ecosystem services provisioning, so as to evaluate the Eco-DRR measure against its effects on all risk dimensions. For the hazard, the hydrological model SWAT is used, comparing the flood hazard under different land use and land cover change scenarios. Preliminary results, with a focus on the Eco-DRR measure of agroforestry, and lessons learnt will be presented in the session.

DAI e-Jahresberichte, e-Jahresbericht 2022 des Deutschen Archäologischen Instituts