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Background: Though evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners' (GP) care during the pandemic in nursing homes is still scarce. Methods: A retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses. Results: The majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1–50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51–100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents. Conclusion: We found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes. [ABSTRACT FROM AUTHOR]

Background: Overall, 55% of the German population suffers from primary episodic headaches according to recent studies. Inadequate management of headache disorders is a significant medical problem. The prevalence of medication overuse headache (MOH) is about 1% with an estimated number of 800,000 people in Germany. Medication overuse (MO) and MOH are usually managed through a complex process of medication withdrawal and initiating of prophylaxis. However, patients who were successfully treated for MO or MOH have a high relapse rate in the following 2 years. Previously, continued monitoring of self-reported medication intake demonstrated lower relapse rates. The prevalence and burden of MO and MOH are high, and effective strategies to prevent the development of a relapse into MOH or de novo MOH are still missing. Therefore, the MOH trial was designed to assess the effects of combining self-reported medication intake with daily monitoring of the entered data and a personalized patient-specific medication intake feedback system in an easy-accessible app-based platform in order to prevent the development and relapse of MO(H).Methods: The MOH trial is a randomized, controlled, parallel, multicenter, prospective trial. A total of 624 migraine patients with frequent migraine attacks and 336 patients who underwent treatment for MO(H) will be randomly allocated to use either a customized app with or without individual feedback regarding their self-reported medication intake for 12 months. The primary outcome will be the proportion of patients developing MO or MOH for at least 3 consecutive months between baseline and end of study visits.Discussion: This trial will assess the effects of providing patients with feedback regarding their self-reported use of migraine medications and migraine days using a mobile software on the development or prevention of MO(H). We hypothesize that the development of MO(H) in patients with frequent episodic migraine (EM) or chronic migraine (CM) and relapse after treatment of MO(H) can be reduced by a feedback system. If this trial proves that using an app with specific and unspecific messaging to the patient is successful, this method, which is now investigated mainly in specialized headache centers, could later be extended to primary care, thus providing benefits for a broader patient group.Trial Registration: German Clinical Trials Register DRKS00025961 . Registered on 04 August 2021. [ABSTRACT FROM AUTHOR]

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

The steadily increasing demand on the natural stone market is accompanied by a predominantly poor economic balance in the extraction of the raw material "ornamental stone". Thus, the net production of raw blocks is far too low in relation to the resulting overburden, which is often the result of insufficient geoscientific input and evaluation of the deposit itself and the deposit-controlling factors. Under these conditions, the investigation pursued the goal of capturing an essential part of the geological conditions with the analytical observation of the fractures systems, in order to contribute to an optimized stone extraction. Only by critically derived constraints on the quarrying process based on the geological situation can the economic viability of natural stone deposits be maintained or increased in the long term, and this from an environmentally friendly point of view. Profitable dimensional stone production mainly depends on the number of extracted blocks. Compared to statistical approaches, the application of the 3D-BlockExpert computer code is based on modelling the block sizes on the discontinuity system such as fracture spacing and fracture orientation. The assessment of all joint and fracture systems provides a forward-looking approach for sustainable quarry management. It is essential to make the best possible use of high-quality material and to minimize the impact quarrying activities has on the natural landscape. Investigations were carried out in quarry areas with different lithologies in Germany and Spain, like sandstones, limestones, slate and granites. The block sizes, the irregularity of acute-angled blocks and the waste to block ratio controls the economic success by avoiding time- and cost-consuming procedures based on geoscientific considerations. [ABSTRACT FROM AUTHOR]

Three small stalagmites from Zoolithencave (southern Germany) show visible laminae, which consist of a clear and a brownish, pigmented layer pair. This potentially provides the opportunity to construct precise chronologies by counting annual laminae. The growth period of the three stalagmites was constrained by the 14C bomb peak in the youngest part of all three stalagmites and 14C-dating of a piece of charcoal in the consolidated base part of stalagmite Zoo-rez-2. These data suggest an age of AD 1970 for the top laminae and a lower age limit of AD 1973–1682 or AD 1735–1778. Laminae were counted and their thickness determined on scanned thin sections of all stalagmites. On stalagmites Zoo-rez-1 and -2, three tracks were measured near the growth axes, each separated into three sections at prominent anchor laminae (I, II, III). Each section was replicated three times (a, b, c). For Zoo-rez-3, only one track was measured. The total number of laminae counted for Zoo-rez-1 ranges from 138 to 177, for Zoo-rez-2 from 119 to 145, and for Zoo-rez-3 from 159 to 166. The numbers agree well with the range constrained by the bomb peak and the age of the charcoal, which supports the annual origin of the laminae. The replicated measurements of the different tracks as well as the three different tracks on the stalagmites Zoo-rez-1 and -2 were cross-dated using the TSAP-Win® tree-ring software. This software is very useful for cross-dating because it enables to insert or delete missing or false laminae as well as identifying common pattern by shifting the series back and forth in time. However, visual inspection of the thin sections was necessary to confirm detection of missing or false laminae by TSAP-Win®. For all three Zoo-rez speleothems, cross-dating of the mean lamina thickness series was not possible due to a missing common pattern. The cross-dating procedure results in three refined chronologies for the three Zoo-rez stalagmites of ranging from AD 1821–1970 (Zoo-rez-1), AD 1835–1970 (Zoo-rez-2), and AD 1808–1970 (Zoo-rez-3). • Testing cross-dating of stalagmites by replicated lamina thickness tracks. • Application of tree-ring software to annually laminated speleothems. • Modern age anchor points by 14C bomb peak detection in three stalagmites. [ABSTRACT FROM AUTHOR]

The new HLRS flagship system Hazel Hen (a Cray XC40) is Europe's fastest system in the High Performance Conjugate Gradients (HPCG) benchmarking list. Designed to provide maximum sustainable performance to the users of HLRS - ignoring both peak and Linpack performance numbers - it has even climbed to number 8 in the TOP500 list and is one of the fastest systems in the world used both by research and industry. This paper will present insight into the strategy that was at the heart of the HLRS decision. It will further show how Hazel Hen can and has already impacted research and industry by providing high sustained performance for real world applications. In this paper we will show two applications and discuss the industrial uptake of the system. [ABSTRACT FROM AUTHOR]

Background: In out-of-hours urgent care practices in Germany, physicians of different specialties care for a large number of patients, most of all unknown to them, resulting in a high workload and challenging diagnostic decision-making. As there is no common patient file, physicians have no information about patients' previous conditions or received treatments. In this setting, a digital tool for medical history taking could improve the quality of medical care. This study aims to implement and evaluate a software application (app) that takes a structured symptom-oriented medical history from patients in urgent care settings., Methods: We conduct a time-cluster-randomized trial in two out-of-hours urgent care practices in Germany for 12 consecutive months. Each week during the study defines a cluster. We will compare participants with (intervention group) and without app use (control group) prior to consultation and provision of the self-reported information for the physician. We expect the app to improve diagnostic accuracy (primary outcome), reduce physicians' perceived diagnostic uncertainty, and increase patients' satisfaction and the satisfaction with communication of both physician and patient (secondary outcomes)., Discussion: While similar tools have only been subject to small-scale pilot studies surveying feasibility and usability, the present study uses a rigorous study design to measure outcomes that are directly associated with the quality of delivered care., Trial Registration: The study was registered at the German Clinical Trials Register (No. DRKS00026659 registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659., (© 2023. The Author(s).)

Background: Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. Methods/Design: This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods - with varying deprivations levels and trajectories of change - in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. Discussion: This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups. [ABSTRACT FROM AUTHOR]

In recent years, two approaches to automatic content analysis have been introduced in the social sciences: semantic network analysis and supervised text classification. We argue that, although less linguistically sophisticated than semantic parsing techniques, statistical machine learning offers many advantages for applied communication research. By using manually coded material for training, supervised classification seamlessly bridges the gap between traditional and automatic content analysis. In this paper, we briefly introduce the conceptual foundations of machine learning approaches to text classification and discuss their application in social science research. We then evaluate their potential in an experimental study in which German online news was coded with established thematic categories. Moreover, we investigate whether and how linguistic preprocessing can improve classification quality. Results indicate that supervised text classification is generally robust and reliable for some categories, but may even be useful when it fails. [ABSTRACT FROM AUTHOR]

While not specifically designed for cartographic purposes, Excel and other spreadsheet programs have been used in various ways to create maps, and offer the advantages of ubiquity and simplicity over specialized software. This article demonstrates the capability of Excel's scatter-plot graphing function to create maps by mapping a complicated section of the Germano-Belgian boundary using survey data taken from a boundary treaty atlas. [ABSTRACT FROM AUTHOR]

Features an evaluation software for the technical and economic profitability of rainwater on an industrial site in Berlin, Germany. Importance of storm water reuse in a sustainable development context; Presentation of the decision-making tool; Discussion of different results and the application of the tool.

The article focuses on the Dalim workflow management system for printers and publishers in the Germany. Dalim was founded in 1987 that developed a successful collection for graphics presentation. The success of the magazine contributed the popularity to Dalim system that lead to larger deals with Axel Spring Verlag and Heinrich Bauer Verlag. The software already had a licensed to run on 2,000 machines worldwide that is used start of printing process and packaging applications in publishing. Dalim Mistral is the top-of-the-line product in which developed from the page-assembly and retouching software.