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Structured doctoral education is increasingly preferred compared to the individual model. Several science policy organisations give recommendations on how to structure doctoral education. However, there is little research on to what extent these recommendations find their way into practice. In our study, we first compared European and German recommendations on doctoral education with, second, the institutional regulations of structured doctoral programmes (N = 98) in the life sciences at twelve different German universities. Additionally, we third asked doctoral graduates (N = 1796) of these structured doctoral programmes and graduates of individual doctoral studies about their experience in doctoral education. Fourth, we contrasted the regulations of structured doctoral programmes with the reported experiences of their graduates. We found significant deviations of the reported practices of graduates from the regulations of their organisations, regarding the student admission, supervision and curricular activities of doctoral candidates. The efficacy of structured versus traditional doctoral education should be examined based on reported practice rather than on the respective written regulations. [ABSTRACT FROM AUTHOR]

Individual differences in dispositional coping might influence how ambiguous situations involving interactions of men and women are interpreted and remembered. Specifically, we hypothesized that women with a sensitive coping style actively maintain ambiguously threatening stimuli in their memory, showing so-called sensitive maintenance. As a prerequisite to investigate this hypothesis, two surveys (Studies 1 and 2; N = 151 and N = 252) were conducted to answer the questions whether fear of sexual assault is of relevance for young women in Germany and whether ambiguous (rather than only unambiguously threatening) situations are experienced to a significant extent. After confirming this for our target population, our main hypothesis was tested in Study 3 (N = 192) by combining tasks assessing the appraisal and the forgetting of nonthreatening, threatening, and ambiguous pictures showing interactions of men and women, and by varying the cognitive load during the retention interval. Whereas fear of rape predicted the appraisal of pictures, coping dispositions predicted forgetting of ambiguously and unambiguously threatening pictures in the hypothesized way. Results are discussed from the perspective of adaptivity and functionality of memory. [ABSTRACT FROM AUTHOR]

Background and aims: Data on rates of prescription opioid use disorder (pOUD) in European countries is limited. The aim of this investigation was to analyze a representative population sample regarding the 1-year prevalence of opioid use disorder in patients who received prescription opioid pain therapy and to identify related risk factors. Design: Cross-sectional secondary data analysis Setting: Secondary data analysis based on data from the 2015 Epidemiological Survey of Substance Abuse (ESA 2015) in Germany Participants: German-speaking individuals living in private households aged 18 to 64 years were investigated. A total of 9204 individuals participated in the survey, resulting in a response rate of 52.2%. Primary and secondary outcome measures: Primary outcome measure was the weighted prevalence of pOUD in the subgroup of study participants who had received prescription opioids. Secondary outcome measure was an analysis of risk factors connected with pOUD in the same subgroup. Findings: A total of n = 9204 participants were included in the study of which n = 275 had received an opioid prescription in the last 12 months of which n = 54 were diagnosed with pOUD. The weighted 1-year prevalence of pOUD was 21.2% (mild: 14.7% | moderate: 3.5% | severe: 2.9%). Participants who had received opioid pain therapy had significantly higher odds of pOUD if they reported signs of depression (OR: 2.69; CI 95%: 1.13–6.38), inexplicable physical complaints (OR: 2.68; CI 95%: 1.14–6.31) or a psychiatric diagnosis (OR: 4.12; CI 95%: 1.36–12.43), and significantly lower odds of pOUD if they reported the use of non-opioid painkillers (OR: 0.27; CI 95%: 0.09–0.81). Conclusions: pOUD is a common phenomenon in working-age patients who receive prescription opioid pain therapy in Germany and may be related to the co-existence of psychosomatic and psychiatric disorders such as depression. [ABSTRACT FROM AUTHOR]

Aims: The European Senior Program (ESP) aims to avoid waiting list competition between younger and elderly patients applying for renal transplantation. By listing patients ≥65 years on a separate waiting list and locally allocating of grafts ≥65 years exclusively to this cohort, waiting and cold ischemia times are predicted to be shortened, potentially resulting in improved kidney transplantation outcomes. This study compared a historic cohort of renal transplant recipients being simultaneously listed on the general and the ESP waiting lists with a collective exclusively listed on the ESP list in terms of surrogates of the transplantation outcome. Methods: Total 151 eligible patients ≥ 65 years from Münster transplant Center, Germany, between 1999 and 2014 were included. Graft function, graft and patient survival were compared using surrogate markers of short- and long-term graft function. Patients were grouped according to their time of transplantation. Results: Recipients and donors in the newESP (nESP) cohort were significantly older (69.6 ± 3.5 years vs 67.1 ± 2 years, p<0.05; 72.0 ± 5.0 years vs 70.3 ± 5.0 years, p = 0.039), had significantly shorter dialysis vintage (19.6 ± 21.7 months vs 60.2 ± 28.1 months, p<0.001) and suffered from significantly more comorbidities (2.2 ± 0.9 vs 1.8 ± 0.8, p = 0.009) than the historic cohort (HC). Five-year death-censored graft survival was better than in the HC, but 5-year graft and patient survival were better in the ESP cohort. After 2005, cold ischemia time between groups was comparable. nESP grafts showed more primary function and significantly better long-term graft function 18 months after transplantation and onwards. Conclusion: nESP recipients received significantly older grafts, but experienced significantly shorter time on dialysis. Cold ischemia times were comparable, but graft function in the nESP cohort was significantly better in the long term. [ABSTRACT FROM AUTHOR]

Non-invasive neuromodulatory techniques, including transcranial direct current stimulation (tDCS), have been shown to modulate neuronal function and are used both in cognitive neuroscience and to treat neuropsychiatric conditions. In this context, animal models provide a powerful tool to identify the neurobiological mechanisms of action of tDCS. However, finding a current generator that is easily usable and which allows a wide range of stimulation parameters can be difficult and/or expensive. Here, we introduce the Open-tES device, a project under a Creative Commons License (CC BY, SA 4.0) shared on the collaborative platform Git-Hub. This current generator allows tDCS (and other kinds of stimulations) to be realized, is suitable for rodents, is easy to use, and is low-cost. Characterization has been performed to measure the precision and accuracy of the current delivered. We also aimed to compare its effects with a commercial stimulator used in clinical trials (DC-Stimulator Plus, NeuroConn, Germany). To achieve this, a behavioral study was conducted to evaluate its efficacy for decreasing depression related-behavior in mice. The stimulator precision and accuracy were better than 250 nA and 25 nA, respectively. The behavioral evaluation performed in mice in the present study did not reveal any significant differences between the commercial stimulator used in clinical trials and the Open-tES device. Accuracy and precision of the stimulator ensure high repeatability of the stimulations. This current generator constitutes a reliable and inexpensive tool that is useful for preclinical studies in the field of non-invasive electrical brain stimulation. [ABSTRACT FROM AUTHOR]

Unemployment is an important predictor of one's future employment success. Yet, much about the endurance of unemployment effects on workers' careers remains poorly understood. Our study complements this knowledge gap by examining the rate of recovery in the quality of careers following an unemployment spell among a representative sample of previously unemployed workers with different socio-demographic characteristics in Germany. We apply a new dynamic measure that quantifies the quality of binary sequences, distinguishing between "good" (i.e., employment) from "bad" labor force status activities (i.e., unemployment and inactivity). We use longitudinal data from the German Socio-Economic Panel (GSOEP) before the Great Financial Recession over the period 1984–2005 and deploy a series of hybrid models that control for unobserved heterogeneity. We find a non-linear recovery process after unemployment across gender and age groups. That is, after a period of recovery, career quality worsens. Least impacted are men experiencing unemployment when aged between 25–34 years, while men 55–66 have rather stable, though stronger, penalties. Furthermore, we find that recovery processes are contingent upon when respondents experience unemployment. [ABSTRACT FROM AUTHOR]

The present study examines a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using data from the BOOM study. Participants were drawn from university student samples in Germany (1,608), Russia (677) and China (12,057). A structural equation model was conducted with four groups of predictors and PMH/NMH as criteria (outcomes). Five of the six salutogenic predictors were predictive of both positive mental health (positively) and negative mental health, as measured by depression (negatively). Pathogenic predictors anxiety and depression were related to future depression, but not to positive mental health. Stress at baseline was related to both future positive mental health (negatively) and future depression (positively). Being male in this study was associated with increased future depression. Results hold across Germany, Russia, and China. Results support the conceptualization of positive and negative mental health as related, but independent dimensions across three cultures. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under "lockdown" conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions. Methods: This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16th to April 16th, 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies. Results: A total of 243 in-patients were treated between March 16th and April 16th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Göttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%. Conclusion: Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in morbidity and mortality are still unpredictable, efforts should be made to accommodate all patients in need of hospital access going forward. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has already changed our globalised world and its long-term impact is not yet known. It is apparent that businesses and institutions are increasingly affected. COVID-19 discussions often focus on intensive care units in hospitals. However, COVID-19 also effects life-saving and -prolonging radiotherapy for patients suffering from cancer. Method: We have conducted a structured online survey among medical physicists in Germany, Austria and Switzerland from March 23rd to 26th 2020. In total 154 responses (82 completed, 72 partially completed) were analysed in the context of the COVID-19 dissemination. Results: 72.4% of the respondent's state that their processes are affected due to COVID-19, while the top three answers are longer processing times (54.2%), patient no-shows (42.5%) and staff reduction (36.7%). 75.8% expect further unavailability of their personnel in the upcoming weeks. All participants have already taken several measures, especially providing information for patients at the entrance (89.6%) or over the phone (73.6%), restricting access for accompanying persons (77.4%) and providing disinfectant at the entrance (72.6%). Discussion: The results presented in this article aim to support business continuity and risk management for radiotherapy centres to prepare for future challenges. The results show that most radiotherapy centres has implemented initial contingency measures, applying them pragmatically. The main problem however remains, that is the high risk of infection both for patients and medical personnel along with the associated risk of temporarily loss of personnel and ordered closure of business. [ABSTRACT FROM AUTHOR]

As part of a Germany-wide project that evaluates strategies for the reduction of multi-resistant bacteria along the poultry production chain, the impact of different hatching egg disinfectants on hatchability and health of the broiler chicks was evaluated. Animal trials were conducted with extended-spectrum beta-lactamase- (ESBL) producing Escherichia (E.) coli contaminated hatching eggs and six disinfection protocols that used formaldehyde, hydrogen peroxide, low-energy electron irradiation, peracetic acid and an essential oil preparation. Each protocol was tested on a group of 50 chicks. Equally sized positive and negative control groups were carried along for each trial. Hatchability, mortality and body weight were recorded as performance parameters. During necropsy of half of the animals in each group on day 7 and 14 respectively, macroscopic abnormalities, body weight, weights of liver and gut convolute were recorded and a range of tissue samples for histological examination were collected as part of the health assessment. A decrease in hatchability was recorded for spray application of essential oils. Body weight development was overall comparable, in several groups even superior, to the Ross308 performance objectives, but a reduced performance was seen in the hydrogen peroxide group. Histologically, lymphoid follicles were regularly seen in all sampled organs and no consistent differences were observed between contaminated and non-contaminated groups. Significances were infrequently and inconsistently seen. In conclusion, remarkable findings were a decrease in hatchability caused by the essential oils spray application and a reduced body weight development in the hydrogen peroxide group. Therefore, the essential oils preparation as spray application was deemed inappropriate in practice, while the application of hydrogen peroxide was considered in need of further research. The other trial results indicate that the tested hatching egg disinfectants present a possible alternative to formaldehyde. [ABSTRACT FROM AUTHOR]

Background: Universities undertake the majority of publicly funded research in Germany and hence bear a responsibility to contribute to global health efforts. So far, involvement and impact of German medical faculties in global health are unknown. Our aim was to systematically asses and evaluate German medical faculties' contribution to global health related research and education, as well as their policies and practices concerning open access publishing and equitable licensing. Methods: We assessed the involvement in global health of all 36 publicly funded medical faculties in Germany during 2010–2014 in three areas: innovation, access and education, using the following indicators: research funding and publications focused on global health or poverty-related and neglected diseases; open access publishing and policies promoting access to medical innovations worldwide; provision of global health education. Data were gathered from public databases, university websites and questionnaires sent to individual universities for validation and triangulation. Results: There was a high level of variability between institutions and indicators. The proportion of research funding for poverty-related and neglected diseases research ranged between 0.0–1.1%. The top five institutions received nearly 85% of the total poverty-related and neglected diseases research funding. 20 of 36 universities had an institutional open access publishing policy, 19 had an open access publishing fund, 16 had neither. Only one university reported having used an equitable licensing policy. 22 of 36 faculties provided some global health education, but only one of them included global health in their core undergraduate medical curriculum as a compulsory course with more than just single lectures. Conclusion: Obtained data indicate that global health and poverty-related and neglected diseases research at German medical faculties is highly concentrated in a few institutions, open-access publishing and equitable licensing policies are mostly absent, and only little global health education exists. Universities and government should address global health strategically in both research and education at medical faculties to reflect the country's economic and political weight and human resource potential. [ABSTRACT FROM AUTHOR]

Background: Germany is considered to be a low prevalence country for viral Hepatitis B, C and D (HBV, HCV, HDV). However, the burden of disease can be high among subpopulations. To meet the world Health Organization (WHO) viral hepatitis (VH) elimination goals, a national strategy was developed by the German government in 2016. We performed a scoping review to understand the baseline epidemiological situation in Germany regarding burden of disease, sequelae and care of HBV, HCV and HDV as a reference to monitor the progress of the national VH elimination and to identify further knowledge gaps and research needs. Methods: The protocol of the systematic review was prepared following the PRISMA statement guidelines for scoping reviews. Relevant search terms were used to identify eligible studies according to the research questions. We searched six online databases for original work published between January 2005 and March 2017. Based on the identified references, a matrix was developed presenting the eligible literature by targeted population group and outcome category. Results: 104 publications were eligible for extraction covering 299 outcome results. The population groups targeted in the identified studies included the general population and proxy populations, a range of clinical populations, people who inject drugs, men who have sex with men, healthcare workers, people in prisons and different migrant/mobile populations. Other vulnerable populations (e.g. sex workers) were not targeted. Overall, good evidence was found for HBV and HCV prevalence and HBV vaccination coverage in the GP and proxy populations. Evidence for these outcomes was weaker in populations at risk for VH. For HBV and HCV incidence and mortality, we identified large evidence gaps in all population groups. Outcomes on VH sequelae and care were mainly covered by studies in clinical populations of people living with viral hepatitis. For HDV the overall evidence available was scarce. Conclusions: We created a comprehensive evidence-based overview on the current epidemiological situation of viral hepatitis in Germany. We identified knowledge gaps for further research and established a baseline for future monitoring of viral hepatitis elimination goals in Germany. [ABSTRACT FROM AUTHOR]

Objective: To analyze the pattern and appropriateness of pain medications in older adults receiving home care. Methods: We performed a prospective cross-sectional study in patients ≥65 years old having chronic pain and receiving home care in Berlin, Germany. Data on prescribed pain medications were collected using self-reported information, nursing documents, and medication plans during interviews at home. Pain intensity was determined with the numeric rating scale (NRS) and the Pain Assessment In Advanced dementia (PAINAD) scale. The Pain Medication Appropriateness Scale score (SPMAS) was applied to evaluate inappropriateness (i.e. a score ≤67) of pain medication. Results: Overall 322 patients with a mean age of 82.1 ± 7.4 years (71.4% females) were evaluated. The average pain intensity scores during the last 24 hours were 5.3 ± 2.1 and 2.3 ± 2.3 on NRS and PAINAD scale (range 0–10, respectively). Sixty (18.6%) patients did not receive any pain medication. Among the treated patients, dipyrone was the most frequently prescribed analgesic (71.4%), while 50.8% and 19.1% received systemic treatment with opioids and non-steroidal anti-inflammatory drugs, respectively. The observed median SPMAS was 47.6 (range 0–100) with 58 (18.0%) of patients achieving appropriate values. Half of the patients were treated with scheduled, while 29.9% were only treated with on-demand medications. Cognitive status had no effect on appropriateness of pain treatment. Conclusions: We observed substantial deficits in dosing patterns and appropriateness of pain medication in older adults with pain receiving home care. This applied to both patients with and without severe cognitive impairment. [ABSTRACT FROM AUTHOR]

There are growing demands to ensure animal health and, from a broader perspective, animal welfare, especially for farmed animals. In addition to the newly developed welfare assessment protocols, which provide a harmonised method to measure animal health during farm visits, the question has been raised whether data from existing data collections can be used for an assessment without a prior farm visit. Here, we explore the possibilities of developing animal health scores for fattening pig herds using a) official meat inspection results, b) data on antibiotic usage and c) data from the QS (QS Qualität und Sicherheit GmbH) Salmonella monitoring programme in Germany. The objective is to aggregate and combine these register-like data into animal health scores that allow the comparison and benchmark of participating pig farms according to their health status. As the data combined in the scores have different units of measure and are collected in different abattoirs with possibly varying recording practices, we chose a relative scoring approach using z-transformations of different entrance variables. The final results are aggregated scores in which indicators are combined and weighted based on expert opinion according to their biological significance for animal health. Six scores have been developed to describe different focus areas, such as "Respiratory Health", "External Injuries/ Alterations", "Animal Management", "Antibiotic Usage", "Salmonella Status" and "Mortality". These "focus" area scores are finally combined into an "Overall Score". To test the scoring method, existing routine data from 1,747 pig farm units in Germany are used; these farm units are members of the QS Qualität und Sicherheit GmbH (QS) quality system. In addition, the scores are directly validated for 38 farm units. For these farm units, the farmers and their veterinarians provided their perceptions concerning the actual health status and existing health problems. This process allowed a comparison of the scoring results with actual health information using kappa coefficients as a measure of similarity. The score testing of the focus area scores using real information resulted in normalised data. The results of the validation showed satisfactory agreement between the calculated scores for the project farm units and the actual health information provided by the related farmers and veterinarians. In conclusion, the developed scoring method could become a viable benchmark and risk assessment instrument for animal health on a larger scale under the conditions of the German system. [ABSTRACT FROM AUTHOR]

Background: A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research. Methods: Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future. Results: We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting. Discussion: Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use. [ABSTRACT FROM AUTHOR]

Objectives: It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample. Materials and methods: Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex. Results: Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028–1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913–0.996 and RR: 0.943; 95% confidence interval 0.894–0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed. Conclusion: Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance. [ABSTRACT FROM AUTHOR]

Purpose: Schools and organized sports both offer great chances to promote physical activity among children. Full-day schools particularly allow for extensive participation in extra-curricular physical activities. However, due to time reasons, full-day schools may also prevent children from engagement in organized sports outside school. There is only little national and international research addressing the possible competition of full-day schools and providers of organized sports outside school and the potential effects on children's physical activity behavior. In Germany's educational system, a transformation towards more full-day schools is currently taking place. The existence of both, half-day and full-day schools, gave occasion to the following research question: Do students attending half-day and full-day school differ with respect to a) sports club membership rate and b) weekly amount of sports club training? Methods: Data were collected in eleven German primary schools. Selected schools offered both half-day and full-day (minimum three days/week with at least seven hours) care. 372 students' data (grades 1–4; N = 153 half-day, N = 219 full-day; 47.4% male, 8.8±1.2y) were eligible for analyses. We assessed sports club membership and weekly training duration via questionnaire. Statistical analyses included Chi-square and Mann-Whitney-U-Tests. Results: 83% of half-day school students and 67% of full-day school students were sports club members (χ2(1) = 12.31, p<.001). Weekly duration of training in sports clubs among sports club members (N = 266) also differed between the groups (mdn = 150 min in half-day, mdn = 120 min in full-day school students; z = -2.37, p =.018). Additional analyses stratified for age and gender showed similar results. Conclusion: Primary school students attending full-day schools engage less in organized sports outside school than half-day school students, regardless of age and gender. Future studies should examine if the detected lower engagement in sports club physical activity is compensated by physical activities in other settings such as school or non-organized leisure time. [ABSTRACT FROM AUTHOR]

High quality diagnostic services are crucial for tuberculosis (TB) diagnosis, treatment and control. A strong laboratory quality management system (QMS) is critical to ensuring the quality of testing and results. Recent initiatives to improve TB laboratory quality have focused on low and middle-income countries, but similar issues also apply to high-income countries. Using a multipronged approach reviews of facilities, equipment, processes (purchasing, pre-analytic, analytic and post-analytic), staff, health and safety, documentation, information management and organization based on the ISO 15189 and the twelve quality system essentials were conducted between October 2015 and January 2016 at the National TB Reference Laboratory in Germany. Outcome assessment included proportion of smear positive slides, proportion of contaminated liquid cultures and DNA contamination rates before and after implementation of QMS. The odds ratio for these outcomes was calculated using a before/after comparison. Reviews highlighted deficiencies across all twelve quality system essentials and were addressed in order of priority and urgency. Actions aimed at improving analytical quality, health and safety and information management were prioritised for initial implementation in parallel with each other. The odds ratio for a sample to be tested as microscopically positive increased by 2.08 (95%CI 1.41–3.06) comparing the time before with the time after implementation of quality managed fluorescence microscopy. Liquid culture contamination rates decreased from 23.6- 7.6% in April-July 2016 to <10% in November 2017-March 2018. The proportion of negative controls showing evidence of DNA contamination decreased from 38.2% in 2013 to 8.1% in 2017, the corresponding odds ratio was 0.14 (95%CI 0.07–0.29). This study showed marked improvement on quality indicators after implementation of a QMS in a National TB Reference Laboratory. The challenges and lessons learned in this study are valuable not just for high-income settings, but are equally generalizable to other laboratories. [ABSTRACT FROM AUTHOR]

Germany is ethnically diverse and the social climate is more or less welcoming for different immigrant groups. The social climate can be described by stereotypes of members of the receiving society about immigrant groups, which in turn shape receiving-society members’ behavioral tendencies of support or discrimination. We investigated warmth and competence stereotypes about 17 immigrant groups in Germany. Results showed four clusters of immigrant groups in the two-dimensional space of warmth and competence. Groups who immigrated comparatively recently and from regions of conflict (e.g., the Balkans, Northern Africa) were stereotyped most negatively (moderate warmth, low competence). Across groups, path analysis investigated the socio-structural relations proposed by the stereotype content model and the BIAS map for immigrant groups in the German context. In a pre-registered model all hypothesized paths were significant but model fit was not good. Therefore, an exploratory model included additional paths as well as intercorrelations between exogenous variables and error terms. The modified model showed good fit and partly replicated the relations proposed by the BIAS map. Threat predicted warmth, whereas status predicted competence. Warmth predicted active behavioral tendencies and competence predicted passive behavioral tendencies. Additional paths from status to warmth, threat to competence, as well as from warmth to passive behavioral tendencies and competence to active behavioral tendencies were also significant. Thus, findings support receiving-society members’ active role in the process of integrating immigrant groups into German society. Based on the results, social-psychological approaches to foster immigrant integration are discussed. [ABSTRACT FROM AUTHOR]

Background: The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs. Objectives: We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time. Data and methods: We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997–2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan’s method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE. Results: There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level. Conclusions: Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: The German Committee on Vaccination recommends pneumococcal vaccination for infants, seniors 60+ years and patients at risk with defined underlying diseases. Aim of this study was to assess the pneumococcal vaccination rate (pnc-VR) in patients with certain incident inherited or acquired immunodeficiency or immunosuppression and to understand who vaccinates these patients who are particularly at high risk to develop a pneumococcal infection. Methods: We conducted a cohort study in patients aged 2 years or older, with a first episode of a “high-risk” condition between January 2013 and December 2014 based on a representative sample of German claims data. Pnc-VR was calculated as the proportion of patients receiving any pneumococcal vaccine within two years after first episode of “high-risk” condition. Further analyses cover pnc-VR stratified by high risk conditions and region, time to vaccination, and physician specialty administering the pneumococcal vaccination. Results: The study population comprised 204,088 incident “high-risk” patients (56% female). The overall pnc-VR within two years was 4.4% (95%-confidence interval: 4.3%-4.5%). Within specific high-risk conditions, we found the highest vaccination rate of 11.5% (10.1%-13.0%) among patients starting immunosuppressants with underlying rheumatoid arthritis followed by 9.9% (7.8%-12.4%) in HIV patients. Stratification by region revealed a slightly higher vaccination rate in Eastern (6.5%: 6.0%-6.9%) compared to Western Germany (4.2%: 4.1–4.3%). Median time to vaccination within the first two years in vaccinated patients was 332.5 days (Q1 142 days, Q3 528 days). The majority of patients (92.6%) got vaccinated by a general practitioner. Conclusion: Although these vulnerable patients need protection most, our study suggests that the overall pnc-VR after a first episode of a high-risk condition for pneumococcal disease is very low and vaccination is far too late. To prevent pneumococcal disease in patients at high risk, further efforts are needed to increase awareness and improve the timeliness of pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

Background: A general recommendation for adult pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) for adults 60 and older has been in place in Germany since 1998, but uptake has been low. Just over a decade after the implementation of an infant pneumococcal conjugate vaccine recommendation, we examined indirect protection effects on adult invasive pneumococcal disease (IPD) in Germany. Methods and findings: Reported IPD cases decreased in children under two years of age from 11.09 per 100,000 in 2003–2006 to 5.94 per 100,000 in 2017/18, while in adult age groups, reported IPD cases rose across the board, most dramatically in adults 60 years of age and over, from 1.64 to 10.08 cases per 100,000. PCV13-type IPD represents 31% of all cases in this age group, the lion’s share of which is due to the rapid increase of serotype 3 IPD, which, by itself, has reached 2.11 reported cases per 100,000 and makes up 21% of all IPD cases in this age group. The two vaccine formulations currently in development (PCV15 and PCV20) would increase current (PCV13) coverage by 8.5% points and 28.0% points in children, while in adults coverage would increase by 10.4% points and 21.9% points, respectively. Conclusions: While original models predicted that indirect effects of childhood vaccination would suffice for adults, it seems that the herd protection effect has reached its limit, with vaccine serotypes 4, 19F, and 19A IPD persisting in adults after initial reductions, and serotype 3 IPD not showing any herd protection effect at all. [ABSTRACT FROM AUTHOR]

Clear-cuts of forests severely affect soil structure and thus soil organic matter (SOM) and nutrient cycling dynamics therein, though with yet unknown consequences for SOM composition as well as phosphorus (P) and sulfur (S) chemical form within the soil microaggregate size fraction. To determine the effects of conventional clear-cutting on soil chemistry in a Cambisol of the Wüstebach Forest (northwestern Germany), we sampled the mineral A- and B-horizons prior to clear-cut as well as 10 and 24 month thereafter. We measured the SOM composition of soil microaggregates using pyrolysis field ionization mass spectrometry (Py-FIMS), as well as P and S chemical form and speciation using wet-chemical extractions and X-ray absorption near edge structure (XANES) spectroscopy. We found that clear-cut led to an increase of the microaggregate size fraction up to 6% due to break-down of macroaggregates and initially significantly increased total elemental concentrations (C, N, P, S) due to the introduction of slash-residues. The SOM of slash-residues consisted to a substantial amount of sterols and was generally found to be of low thermal stability and probably did not contribute to aggregate stability. Deterioration of the aggregate structure probably led to an exposure of originally inaccessible sites within aggregates to the attack by soil microorganisms and thus to an increased P and S turnover as reflected in a significantly reduction of available P proportions (4 to 7%) and a reduction of the most reduced S forms (5%). A probable increased microbial activity and contribution to SOM after clear-cut is also reflected in the significantly increasing hexose:pentose ratio by 0.25 between 10 and 24 month after clear-cut, significantly increasing the general thermal stability of SOM in the microaggregate size fraction and believed to contribute to aggregate stability. This indicated that a first deterioration of the aggregate structure after clear-cut might in the long-term be remediated with time. [ABSTRACT FROM AUTHOR]

Recent years have seen tremendous advances in the scientific study of networks, as more and larger data sets of relationships among nodes have become available in many different fields. This has led to pathbreaking discoveries of near-universal network behavior over time, including the principle of preferential attachment and the emergence of scaling in complex networks. Missing from the set of network analysis methods to date is a measure that describes for each node how its relationship (or links) with other nodes changes from one period to the next. Conventional measures of network change for the most part show how the degrees of a node change; these are scalar comparisons. Our contribution is to use, for the first time, the cosine similarity to capture not just the change in degrees of a node but its relationship to other nodes. These are vector (or matrix)-based comparisons, rather than scalar, and we refer to them as “rewiring” coefficients. We apply this measure to three different networks over time to show the differences in the two types of measures. In general, bigger increases in our rewiring measure are associated with larger increases in network density, but this is not always the case. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016. Methods: The population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0–14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression. Results: The rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years. Conclusion: Due to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes. [ABSTRACT FROM AUTHOR]

The rich Mediterranean imports found in Early Celtic princely sites (7th-5th cent. BC) in Southwestern Germany, Switzerland and Eastern France have long been the focus of archaeological and public interest. Consumption practices, particularly in the context of feasting, played a major role in Early Celtic life and imported ceramic vessels have consequently been interpreted as an attempt by the elite to imitate Mediterranean wine feasting. Here we present the first scientific study carried out to elucidate the use of Mediterranean imports in Early Celtic Central Europe and their local ceramic counterparts through organic residue analyses of 99 vessels from Vix-Mont Lassois, a key Early Celtic site. In the Mediterranean imports we identified imported plant oils and grape wine, and evidence points towards appropriation of these foreign vessels. Both Greek and local wares served for drinking grape wine and other plant-based fermented beverage(s). A wide variety of animal and plant by-products (e.g. fats, oils, waxes, resin) were also identified. Using an integrative approach, we show the importance of beehive products, millet and bacteriohopanoid beverage(s) in Early Celtic drinking practices. We highlight activities related to biomaterial transformation and show intra-site and status-related differences in consumption practices and/or beverage processing. [ABSTRACT FROM AUTHOR]

Objective: To examine the test performance of careHPV, Hybrid Capture2 (HC2) and visual inspection with acetic acid (VIA) for detection of cytologically diagnosed high-grade cervical lesions or cancer (HSIL+). Design: Cross-sectional study. Setting: Ocean Road Cancer Institute (ORCI) and Kilimanjaro Christian Medical Center (KCMC), Tanzania. Population: Women attending routine cervical cancer screening. Method: We enrolled 4080 women (25–60 years) in the study. The women were interviewed on lifestyle habits, and tested for HIV. A cervical specimen for careHPV testing (performed at ORCI and KCMC), and a liquid-based cytology sample for HPV DNA detection using HC2 (performed at Tuebingen University Hospital, Germany) and for cytology assessment (performed at Vejle Hospital, Denmark) were obtained at a gynecological examination. Subsequently, VIA was performed. With cytology as gold standard, the sensitivity and specificity of careHPV, HC2, and VIA for detection of HSIL+ were calculated. Results: Altogether, 23.6% had a positive careHPV test, 19.1% had positive HC2 test, and 6.3% had a positive VIA test. The sensitivity/specificity was 88.9%/78.9% for careHPV and 91.1%/83.7%, for HC2. VIA showed a low sensitivity of 31.1% but a high specificity (94.6%) for detection of HSIL+. The sensitivity of careHPV, HC2 and VIA was higher among younger women, and among HIV positive women. VIA triage of careHPV positive women improved specificity, but sensitivity dropped to 27%. Conclusion: Our results confirm the low sensitivity of VIA for detection of HSIL+ and further document that careHPV test is promising as a primary screening method for cervical-cancer prevention in low-resource regions. A suitable triage test has to be identified. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the effectiveness of a care management intervention in improving self-management behavior in multimorbid patients with type 2 diabetes; care was delivered by medical assistants in the context of a primary care network (PCN) in Germany. Methods: This study is an 18-month, multi-center, two-armed, open-label, patient-randomized parallel-group superiority trial (ISRCTN 83908315). The intervention group received the care management intervention in addition to the usual care. The control group received usual care only. The primary outcome was the change in self-care behavior at month 9 compared to baseline. The self-care behavior was measured with the German version of the Summary of Diabetes Self-Care Activities Measure (SDSCA-G). A multilevel regression analysis was applied. Results: We assigned 495 patients to intervention (n = 252) and control (n = 243). At baseline, the mean age was 68 ±11 years, 47.8% of the patients were female and the mean HbA1c was 7.1±1.2%. The primary analysis showed no statistically significant effect, but a positive trend was observed (p = 0.206; 95%-CI = -0.084; 0.384). The descriptive analysis revealed a significantly increased sum score of the SDSCA-G in the intervention group over time (P = 0.012) but not in the control group (p = 0.1973). Conclusion: The sum score for self-care behavior markedly improved in the intervention group over time. However, the results of our primary analysis showed no statistically significant effect. Possible reasons are the high baseline performance in our sample and the low intervention fidelity. The implementation of this care management intervention in PCNs has the potential to improve self-care behavior of multimorbid patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Caring for patients with advanced lung cancer is of high relevance in different clinical settings. Lung cancer is among the most common causes of death from malignant neoplasms worldwide; with increasing prevalence and mortality. Aim: To get a better understanding of individual patients’ needs, exploring the experiences and meaning of living with advanced lung cancer at the end of life, and to develop strategies for improving patient-centred care in Germany. Design: Qualitative explorative interview study with patients, using grounded theory. Setting/Participants: A sample of 17 adults living with advanced lung cancer in Lower Saxony/Germany was recruited in two university hospitals. Patients were asked to tell of their experiences of living with advanced lung cancer. The emphasis of this study was the period of palliative tumour therapy. Results: The main phenomenon of living with advanced lung cancer is the feeling of having to redefine one’s own existence, such as social roles within and outside the family. The diagnosis trigger powerlessness, which can lead to information passivity, followed by acceptance of aggressive tumour treatment. Patients perceive a high degree of psychological and social stress, without being able to express this. There is a lack of regular appropriate psychosocial care accompanying chemotherapy. Patients ascribe their physical suffering to the side effects of tumour treatment, which may trigger a desire to die. Finally, patients tend to hide their individual needs, even when asked. Conclusions: Regarding the patients’ needs, greater emphasis must be placed on psychosocial care as part of the biopsychosocial model to adequately consider the patients’ concerns. Assessments can be helpful to enhance communication at an early stage across all professions into the multi-professional therapy. [ABSTRACT FROM AUTHOR]

The loss of Neanderthal groups across Western and Central Europe during Oxygen Isotope Stage (OIS) 3 has held the attention of archaeologists for decades. The role that climatic change, genetic interbreeding, and interspecies competition played in the extinction of Neanderthal groups is still debated. Hohle Fels is one of several important Middle and Upper Paleolithic sites from the Ach Valley in southwestern Germany which documents the presence of Neanderthals and modern humans in the region. Chronological and stratigraphic records indicate that these two groups occupied the site with little to no overlap or interaction. This provides the opportunity to examine the behavioural variability of Swabian Neanderthal populations without the complication of cross-cultural influence. In this study we contribute a terrestrial paleoenvironmental record derived from the small mammal material from Hohle Fels Cave to the ever-growing archaeological record of this period. By reconstructing the climate and landscape of the Ach Valley during this time we can identify the effect that the OIS 3 environment had on the presence of Neanderthals in the region. Based on indicator taxa and the habitat weighing method, the small mammal record, which includes rodents, insectivores, and bats, from Hohle Fels shows that the earliest Neanderthal occupation took place on a landscape characterized by substantial woodland and forest, rivers and ponds, as well as moist meadows and grasslands. A gradual increase in cold tundra and arctic environments is clear towards the end of the Middle Paleolithic, extending to the end of the early Aurignacian which may correlate with the onset of the Heinrich 4 event (~42,000 kya). Our taphonomic analysis indicates the material was accumulated primarily by opportunistic predators such as the great grey owl, snowy owl, and European eagle owl, and therefore reflects the diversity of landscapes present around the site in the past. Importantly, at the time Neanderthals abandoned the Ach Valley we find no indication for dramatic climatic deterioration. Rather, we find evidence of a gradual cooling of the Swabian landscape which may have pushed Neanderthal groups out of the Ach Valley prior to the arrival of modern human Aurignacian groups. [ABSTRACT FROM AUTHOR]

After years of hypothetical surveys and simulator studies, automated vehicles (AVs) are now being tested in realistic traffic environments adding validity to knowledge about their acceptance. We present data from a pilot test with participants (n = 125) after experiencing a ride in an electric AV on a large clinic area in Berlin, Germany. As a first contribution, we bridge the gap between missing definitions of key constructs, confusion about their operationalisations, and a rigorous test of their statistical properties and data structure by examining scales on acceptance, trust, perceived safety, intention to use, and—for the first time applied to AVs—the emotions amusement, fear, surprise, and boredom. Tests of reliability and normality were satisfying for almost all constructs (Cronbach’s alphas ≥ .69; six of eight scales normally distributed). The vehicles were accepted (M = 1.22; SD = 0.70; range -2 to 2), trusted (M = 3.29; SD = 0.81; range 1 to 5), and perceived as safe (M = 3.29; SD = 1.03; range 1 to 5). However, factor analyses did not reflect the hypothesised data structure, and validity concerns question the suitability of some constructs for attitude assessment of electric AVs. Our open item for comments added valuable insights in qualitative aspects of user attitudes towards electric AVs regarding driving style, technical features, and (unsettling) audio-visual feedback. We thus argue for broader conceptualisations of key constructs based on interdisciplinary exchange and multi-methodical study designs. [ABSTRACT FROM AUTHOR]

Can participation in job-related training contribute to the formation and maintenance of adults’ literacy skills? Although evidence suggests that participation in training is related to higher literacy skills, it remains unclear whether this association reflects a causal effect of training participation on literacy (training effects), results from the self-selection of more high-skilled individuals into training (selection effects), or is due to other sources of endogeneity (e.g., omitted variable bias). To unravel these possibilities, we used data from the Programme for the International Assessment of Adult Competencies (PIAAC) and its German follow-up, PIAAC-Longitudinal (PIAAC-L). As these unique data offer repeated measures of literacy skills, spaced three years apart, in a large and representative sample, they allowed us to disentangle training effects from selection effects and to account for potential endogeneity. Analyses revealed that, even after taking account of formal education and a host of job characteristics, individuals with higher literacy skills were more likely to participate in training. By contrast, no evidence for effects of training on literacy skills emerged in any of our models, which comprised lagged-dependent, fixed effects, and instrumental-variable models. These findings suggest that, rather than job-related training contributing to literacy development, individuals with higher literacy skills are more likely to participate in training. [ABSTRACT FROM AUTHOR]

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood worldwide, and causes significant impairments in overall functioning. In order to develop effective prevention and intervention programs, knowledge of the determinants that have an impact on the onset and development of ADHD symptoms is essential. So far, little is known about factors affecting ADHD symptoms in children and adolescents over time. Therefore, this study investigates potential psychosocial risk and protective factors for ADHD symptoms based on cross-sectional and longitudinal data of a German population-based study. Methods: Data on children and adolescents (n = 1,384 aged 11 to 17 years) were collected at three measurement points (baseline, 1-year and 2-year follow-ups) covering a period of two years. We used latent growth modelling to investigate effects of parental mental health problems (risk factor) and self-efficacy, family climate and social support (protective factors) on symptoms of ADHD based on cross-sectional as well as longitudinal data. Sociodemographic factors, pre- and postnatal factors, and comorbid symptoms of internalizing and externalizing mental health problems were considered as covariates. Results: At baseline, male gender, younger age, stronger aggressive behavior, and stronger parental mental health problems were related to more ADHD symptoms. Longitudinal analyses showed that female gender, migration status, increasing symptoms of generalized anxiety, increasing aggressive behavior and increasing parental mental health problems were associated with stronger increase of ADHD symptoms over time. However, improving family climate was related to decreasing ADHD symptoms over time. We further found moderator effects for social support. Conclusion: The findings of the study provide important information concerning risk and protective factors in the context of ADHD. Hence, the results may be integrated into the planning and implementation of future prevention and early intervention strategies that target affected children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Large proportions of the populations in many European countries, including Germany, are migrants. Migrant children and adolescents tend to be less physically active than their non-migrant peers. However, current research is limited as it does not sufficiently consider different domains of physical activity. Using a representative dataset, the present study examines the patterns of sports participation and other domains of physical activity among migrant and non-migrant children and adolescents residing in Germany. Methods: Nationwide data from the Motorik-Modul (MoMo) Study is used. Five different domains of physical activity participation (sports clubs, outside of sports clubs, extra-curricular physical activity, physical activity, outdoor play and active commuting to school) were compared between children and adolescents with no, one-sided and two-sided migration background using logistic regression adjusted for demographic factors. Interaction terms were included in order to examine whether difference between the three groups differ by age and gender. Results: Information on n = 3,323 children and adolescents was available. As compared to non-migrants, children and adolescents with a two-sided migration background had a 40% (adjusted odds ratio [aOR] = 0.60, 95%-CI: 0.44–0.81), those with a one-sided migration background a 26% (aOR = 0.74, 95%-CI: 0.55-<1.00) lower chance of participating in sport club activities. In contrast, children and adolescents with a two-sided migration background were at 65% higher chance of participating in extra-curricular physical activity than non-migrants (OR = 1.65, 95%-CI: 1.15–2.36). Conclusion: The study shows that differences in levels of physical activity between migrant and non-migrant children and adolescents are less pronounced than previous research has suggested. In particular, it reveals that migrants are only disadvantaged regarding participation in sports clubs whereas they fare better with respect to extra-curricular physical activity. Interventions should therefore address barriers migrant children and adolescents encounter in the access to sport clubs while maintaining their high level of extra-curricular physical activity. [ABSTRACT FROM AUTHOR]

In research into higher education, the evaluation of completion and dropout rates has generated a steady stream of interest for decades. While most studies only calculate quotes using student and graduate numbers for both phenomena, we propose to additionally consider the budget available to universities. We transfer the idea of the excellence shift indicator [] from the research to the teaching area, in particular to the completion rate of educational entities. The graduation shift shows the institutions’ ability to produce graduates as measured against their basic academic teaching efficiency. It is an important advantage of the graduation shift that it avoids the well-known heterogeneity problem in efficiency measurements. Our study is based on German universities of applied science. Given their politically determined focus on education, this dataset is well-suited for introducing and evaluating the graduation shift. Using a comprehensive dataset covering the years 2008 to 2013, we show that the graduation shift produces results, which correlate closely with the results of the well-known graduation rate and standard Data Envelopment Analysis (DEA). Compared to the graduation rate, the graduation shift is preferable because it allows to take the budget of institutions into account. Compared to the DEA, the computation of the graduation shift is easy, the results are robust, and non-economists can understand them results. Thus, we recommend the graduation shift as an alternative method of efficiency measurement in the teaching area. [ABSTRACT FROM AUTHOR]

Overview: The protective effect of infant pneumococcal conjugate vaccine (PCV) recommendation can be seen in Germany as a whole and in smaller regional groups. Comparisons between population-normalized geographic regions of Germany show different serotype distributions after program implementation, particularly in non-vaccine serotypes. The prior distinct differences in serotype distribution in children between the former East and former West German federal states have vanished. Children under six remain a vulnerable group, but the occurrence of vaccine-type (VT) invasive pneumococcal disease (IPD) in children correctly vaccinated (using a three-dose primary series plus one booster dose) with PCV13 was low (9 out of 374 cases, 2.4%). However, only 18.4% of children in Germany with IPD were correctly vaccinated with PCV13 according to the recommended schedule. Continued surveillance and better schedule adherence are essential to definitively establish the most effective PCV administration schedule. Vaccination effects: For all PCV products used in Germany (PCV7, PCV10, and PCV13), vaccination status was the most common statistically significant predictor of infection with a particular serotype: Unvaccinated children old enough to have received at least one dose of vaccine in the PCV7 group had significantly higher odds (OR: 6.84, 95%CI: 2.66–22.06, adjusted for per capita income and residence in the northeastern federal states) of contracting VT IPD. In the PCV10 group, VT IPD had an OR of 4.52 (95% CI: 1.60–15.62, adjusted for year of infection, median household size, and residence in the southern federal states) in unvaccinated children, and in the PCV13 group, unvaccinated children continued to have higher odds (OR: 6.21, 95%CI: 3.45–11.36, adjusted for year of infection, age of child, per capita income, residence in the southern federal states, and percentage of children using public daycare) of getting vaccine-type IPD. Being unvaccinated was the most frequent significant indicator for infection with vaccine-type serotypes for each analysis group, while geographic groupings showed more limited potential to predict serotype of infection in early childhood IPD in Germany. [ABSTRACT FROM AUTHOR]

Background: Pregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women’s experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors. Methods: In this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material. Results: 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child’s father. Social support and personal coping styles provided relief for some participants. Conclusions: This study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women’s health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process. [ABSTRACT FROM AUTHOR]

Though many European Upper Palaeolithic sites document early examples of symbolic material expressions (e.g., cave art, personal ornaments, figurines), there exist few reports on the use of earth pigments outside of cave art–and occasionally Neanderthal–contexts. Here, we present the first in-depth study of the diachronic changes in ochre use throughout an entire Upper Palaeolithic sequence at Hohle Fels cave, Germany, spanning from ca. 44,000–14,500 cal. yr. BP. A reassessment of the assemblage has yielded 869 individual ochre artefacts, of which 27 show traces of anthropogenic modification. The ochre artefacts are from all Upper Palaeolithic layers, stemming from the earliest Aurignacian horizons to the Holocene. This wide temporal spread demonstrates the long-term presence and continuity of ochre use in a part of Europe where it has not been systematically reported before. The anthropogenic modifications present on the ochre artefacts from the Gravettian and Magdalenian are consistent with pigment powder production, whereas the only modified piece from the Aurignacian displays a possible engraved motif. The non-modified artefacts show that more hematite-rich specular ochres as well as fine-grained deep red iron oxide clays were preferred during the Gravettian and Magdalenian, while the Aurignacian layers contain a broader array of colours and textures. Furthermore, numerous other artefacts such as faunal elements, personal ornaments, shells, and an ochre grindstone further strengthen the conclusion that ochre behaviours were well established during the onset of the Aurignacian and subsequently flourished throughout the Upper Palaeolithic at Hohle Fels cave. [ABSTRACT FROM AUTHOR]

Background: Monitoring the reasons why a considerable number of people do not receive recommended vaccinations allows identification of important trends over time, and designing and evaluating strategies to address vaccine hesitancy and increase vaccine uptake. Existing validated measures assessing vaccine hesitancy focus primarily on confidence in vaccines and the system that delivers them. However, empirical and theoretical work has stated that complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and aspects pertaining to collective responsibility (willingness to protect others) also play a role in explaining vaccination behavior. The objective was therefore to develop a validated measure of these 5C psychological antecedents of vaccination. Methods and findings: Three cross-sectional studies were conducted. Study 1 uses factor analysis to develop an initial scale and assesses the sub-scales’ convergent, discriminant, and concurrent validity (N = 1,445, two German convenience-samples). In Study 2, a sample representative regarding age and gender for the German population (N = 1,003) completed the measure for vaccination in general and for specific vaccinations to assess the potential need for a vaccine-specific wording of items. Study 3 compared the novel scale’s performance with six existing measures of vaccine hesitancy (N = 350, US convenience-sample). As an outcome, a long (15-item) and short (5-item) 5C scale were developed as reliable and valid indicators of confidence, complacency, constraints, calculation, and collective responsibility. The 5C sub-scales correlated with relevant psychological concepts, such as attitude (confidence), perceived personal health status and invulnerability (complacency), self-control (constraints), preference for deliberation (calculation), and communal orientation (collective responsibility), among others. The new scale provided similar results when formulated in a general vs. vaccine-specific way (). In a comparison of seven measures the 5C scale was constantly among the scales that explained the highest amounts of variance in analyses predicting single vaccinations (between 20% and 40%; ). The present studies are limited to the concurrent validity of the scales. Conclusions: The 5C scale provides a novel tool to monitor psychological antecedents of vaccination and facilitates diagnosis, intervention design and evaluation. Its short version is suitable for field settings and regular global monitoring of relevant antecedents of vaccination. [ABSTRACT FROM AUTHOR]

Background: The city of Wrocław in Poland represents one of Central Europeans oldest capitals of science with numerous Nobel laureates. Due to a long history of political suppressions with Nazi Germany and Communism from 1933 until 1989, its scientific community was suppressed for more than half a century. Methods: The present study assessed scientific activities in the field of social and neighbouring sciences using density equalizing mapping. On the basis of the NewQIS (New Quality and Quantity Indices in Science) platform and the Social Sciences Citation Index (SSCI) of the Web of Science database, a total of 1787 articles originating from Wrocław were identified between 1966 and 2017. Results: In total, 549 research collaborations of Wrocław with 96 different countries were present (30.7%). Among the 107 research areas the highest activity was found for the field of Business and Economics with n = 272 articles (average citation rate (AVR) of 12.54), followed by Psychology (n = 252 articles, AVR = 9.06), Psychiatry (n = 205 articles, AVR = 4.74) and Public, Environmental and Occupational Health (n = 145 articles, AVR = 7.96). The highest AVR was found for Operations Research (25.36 with n = 87 articles). Density equalizing mapping procedures revealed a global pattern of social sciences research collaborations with scientists from Germany, the UK and the US as the primary cooperating partner of Wrocław. The different countries had major differences in the area of research collaborations. Conclusions: This is the first study that depicts the global network of Wrocław scientific activities in the field of social sciences. The exorbitant increase in research activity from 2006 onwards can lead to the assumption that Wrocław social sciences encounter a fruitful future. [ABSTRACT FROM AUTHOR]

Background: According to James Fries morbidity compression is present if morbidity rates are decreasing to a larger extent than mortality rates. Compression also occurs if age at onset is increasing at a faster pace than age at death. These two variants of the compression hypothesis were formulated as a population concept. Compression has seldom been studied with a specific disease as application. Methods: Morbidity compression was examined in terms of myocardial infarction (MI) by using German claims data covering the years 2006 to 2015. The findings are based on an annual case number of about 2 m women and men aged 18 years and older. Analyses were performed by means of proportional hazards regression and by using linear regression. Results: Decreases of morbidity rates were more pronounced than those of mortality. For men, the hazard ratio for contracting MI in 2015 as compared to 2006 was hr = 0.66 and hr = 0.71 for the female population. The respective results for mortality were hr = 0.75 in men and hr = 1.0 in women. They can be interpreted in favor of morbidity compression. For the subgroup of women and men with MI, changes of onset age revealed marked gender differences. For 2015 as compared with 2006, age at MI-occurrence in men increased by 10.5 months as compared to an increase of 10.4 months for age at death. In women changes were smaller and statistically not significant. The findings referring to women have to be interpreted against the backdrop of higher onset age and higher age at death than in men. Conclusions: Taken together, morbidity compression has occurred in terms of decreasing MI-rates as well as in terms of increased onset age in men. It can be concluded that both processes have led to an improvement of healthy lifetime. Decreasing morbidity rates in women are also pointing towards morbidity compression, a finding that is not complemented by changes of onset age. Our data are demonstrating that morbidity rates and age at onset may vary independently. From this perspective morbidity compression is a multi-faceted phenomenon. [ABSTRACT FROM AUTHOR]

The concepts of 340 university freshmen concerning urban water cycles include various misconceptions (or intuitive conceptions) which severely contrast with correct scientific ones. Almost no student knew the correct urban water cycle in total, including cycle steps in the appropriate sequence: consumer (given), sewage-plant, nature and waterworks. Concepts mainly omit nature and waterworks, only the sewage plant is included in almost all concepts. This reflects an exaggeration of the importance of the cycle-step sewage plant relative to the other steps, when the topic is taught in school. Students acquired knowledge from two main sources: School and media. Most students are aware of the origin of drinking water, although several concepts reflect a pipe-to-pipe system, where wastewater is cleared in sewage plants and brought back to consumers, skipping the roles of nature and waterworks. Everyday matters with an important impact on our life-standards, like the urban water cycle, need specific attention during school time. Currently, only primary school syllabi include the issue of urban water cycles in Germany. More effort is needed to explain wastewater and drinking water issues in order to correct misconceptions. [ABSTRACT FROM AUTHOR]

Several scholars have concluded that ethnic diversity has negative consequences for social trust. However, recent research has called into question whether ethnic diversity per se has detrimental effects, or whether lower levels of trust in diverse communities simply reflect a higher concentration of less trusting groups, such as poor people, minorities, or immigrants. Drawing upon a nationally representative sample of the German population (GSOEP), we make two contributions to this debate. First, we examine how ethnic diversity at the neighborhood level–specifically the proportion of immigrants in the neighborhood–is linked to social trust focusing on the compositional effect of poverty. Second, in contrast to the majority of current research on ethnic diversity, we use a behavioral measure of trust in combination with fine-grained (zip-code level) contextual measures of ethnic composition and poverty. Furthermore, we are also able to compare the behavioral measure to a standard attitudinal trust question. We find that household poverty partially accounts for lower levels of trust, and that after controlling for income, German and non-German respondents are equally trusting. However, being surrounded by neighbors with immigrant background is also associated with lower levels of social trust. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. Methods: The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. Results: Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach’s α, .83–.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. Limitation: Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. Conclusions: The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures. [ABSTRACT FROM AUTHOR]

Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration. [ABSTRACT FROM AUTHOR]

Avoiding dangerous climate change necessitates the decarbonization of electricity systems within the next few decades. In Germany, this decarbonization is based on an increased exploitation of variable renewable electricity sources such as wind and solar power. While system security has remained constantly high, the integration of renewables causes additional costs. In 2015, the costs of grid management saw an all time high of about € 1 billion. Despite the addition of renewable capacity, these costs dropped substantially in 2016. We thus investigate the effect of natural climate variability on grid management costs in this study. We show that the decline is triggered by natural wind variability focusing on redispatch as a main cost driver. In particular, we find that 2016 was a weak year in terms of wind generation averages and the occurrence of westerly circulation weather types. Moreover, we show that a simple model based on the wind generation time series is skillful in detecting redispatch events on timescales of weeks and beyond. As a consequence, alterations in annual redispatch costs in the order of hundreds of millions of euros need to be understood and communicated as a normal feature of the current system due to natural wind variability. [ABSTRACT FROM AUTHOR]

Objective: Adverse drug events (ADEs) during hospital stays are a significant problem of healthcare systems. Established monitoring systems lack completeness or are cost intensive. Routinely assigned International Statistical Classification of Diseases and Related Health Problems (ICD) codes could complement existing systems for ADE identification. To analyze the potential of using routine data for ADE detection, the validity of a set of ICD codes was determined focusing on hospital-acquired events. Material and methods: The study utilized routine data from four German hospitals covering the years 2014 and 2015. A set of ICD, 10th Revision, German Modification (ICD-10-GM) diagnoses coded most frequently in the routine data and identified as codes indicating ADEs was analyzed. Data from psychiatric and psychotherapeutic departments were excluded. Retrospective chart review was performed to calculate positive predictive values (PPV) and sensitivity. Results: Of 807 reviewed ADE codes, 91.2% (95%-confidence interval: 89.0, 93.1) were identified as disease in the medical records and 65.1% (61.7, 68.3) were confirmed as ADE. For code groups being predominantly hospital-acquired, 78.5% (73.7, 82.9) were confirmed as ADE, ranging from 68.5% to 94.4% dependent on the ICD code. However, sensitivity of inpatient ADEs was relatively low. 49.7% (45.2, 54.2) of 495 identified hospital-acquired ADEs were coded as disease in the routine data, from which a subgroup of 12.1% (9.4, 15.3) was coded as drug-associated disease. Conclusions: ICD codes from routine data can provide an important contribution to the development and improvement of ADE monitoring systems. Documentation quality is crucial to further increase the PPV, and actions against under-reporting of ADEs in routine data need to be taken. [ABSTRACT FROM AUTHOR]

Background: Unintentional weight loss (UWL) is common in older age and associated with adverse outcomes including mortality. The aim of the present study was to determine psychosocial correlates of UWL. Methods: Data were derived from a large, nationally representative study of community-dwelling individuals in the second half of life (40 years and over) in Germany in 2014 (n = 7,933). Data on UWL were assessed in face-to-face interviews as unintentional loss of more than 5kg (11 pounds) in weight in the past 12 months, and data on psychosocial factors were recorded in self-administered questionnaires. Results: Multiple logistic regressions revealed that UWL was positively associated with depressive symptoms and positive affect, whereas it was negatively associated with self-esteem. Individuals with UWL were more likely to feel lonely and perceive themselves as socially excluded. Conclusion: The findings of important psychosocial correlates of UWL may help to identify individuals at risk for UWL in older age. This is in particular important since interventions to treat this phenomenon in older age are available that reduce adverse consequences resulting from UWL. [ABSTRACT FROM AUTHOR]

A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 719) were obtained between 2009 and 2014. Most isolates were obtained from blood (92.1%). The proportions of isolates from cerebrospinal fluid, pleural fluid, synovial fluid and peritoneal fluid were 3.9%, 1.8%, 1.7% and 0.6%, respectively. The most common emm types were emm 1 (31.8%), emm 28 (15.4%) and emm 89 (14.5%). The most common superantigen genes (speA, speC, speG, speH, speI, speJ, speK, speL, speM, ssa) identified from S. pyogenes were speG (92.1%), speJ (50.9%), and speC (42.0%). Significant associations of superantigen genes with underlying conditions or risks were observed in speG, speH, speJ, and speK. Significant associations between emm types or superantigen genes with clinical complications were observed in emm type 3 and in superantigen gene speA 1–3. Most frequent clinical manifestations included sepsis 59.4%, STSS 6.3%, meningitis 5.4%, and necrotizing fasciitis 5.0% (significantly associated with emm1). [ABSTRACT FROM AUTHOR]

Trackways and tracemakers preserved together in the fossil record are rare. However, the co-occurrence of a drag mark, together with the dead animal that produced it, is exceptional. Here, we describe an 8.5 m long ammonite drag mark complete with the preserved ammonite shell (Subplanites rueppellianus) at its end. Previously recorded examples preserve ammonites with drag marks of < 1 m. The specimen was recovered from a quarry near Solnhofen, southern Germany. The drag mark consists of continuous parallel ridges and furrows produced by the ribs of the ammonite shell as it drifted just above the sediment surface, and does not reflect behaviour of the living animal. [ABSTRACT FROM AUTHOR]