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Purpose: To give an overview of the multicenter Prostate Cancer Outcomes (PCO) study, involving paper-based and web-based collection of patient-reported outcome measures (PROM) in patients undergoing local treatment for prostate cancer in certified centers in Germany. The PCO study is part of the larger Movember-funded TrueNTH Global Registry. The article reports on the study's design and provides a brief progress report after the first 2 years of data collection. Methods: Prostate cancer centers (PCCs) certified according to German Cancer Society requirements were invited to participate in collecting patient-reported information on symptoms and function before and at least once (at 12 months) after treatment. The data were matched with disease and treatment information. This report describes progress in patient inclusion, response rate, and variations between centers relative to online/paper use, and also data quality, including recruitment variations relative to treatment in the first participating PCCs. Results: PCC participation increased over time; 44 centers had transferred data for 3094 patients at the time of this report. Patient recruitment varied widely across centers. Recruitment was highest among patients undergoing radical prostatectomy. The completeness of the data was good, except for comorbidity information. Conclusions: The PCO study benefits from a quality improvement system first established over 10 years ago, requiring collection and harmonization of a predefined clinical dataset across centers. Nevertheless, establishing a PROM routine requires substantial effort on the part of providers and constant monitoring in order to achieve high-quality data. The findings reported here may be useful for guiding implementation in similar initiatives. [ABSTRACT FROM AUTHOR]

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Background: Schizophrenia is a complex neuropsychiatric disorder of unclear etiology. The strongest known genetic risk factor is the 22q11.2 microdeletion. Research has yet to confirm which genes within the deletion region are implicated in schizophrenia. The minimal 1.5 megabase deletion contains MIR185, which encodes microRNA 185. Methods: We determined miR-185 expression in embryonic and adult mouse brains. Common and rare variants at this locus were then investigated using a human genetics approach. First, we performed gene-based analyses for MIR185 common variants and target genes using Psychiatric Genomics Consortium genome-wide association data. Second, MIR185 was resequenced in German patients (n = 1000) and controls (n = 500). We followed up promising variants by genotyping an additional European sample (patients, n = 3598; controls, n = 4082). Results: In situ hybridization in mice revealed miR-185 expression in brain regions implicated in schizophrenia. Gene-based tests revealed association between common variants in 3 MIR185 target genes (ATAT1, SH3PXD2A, NTRK3) and schizophrenia. Further analyses in mice revealed overlapping expression patterns for these target genes and miR185. Resequencing identified 2 rare patient-specific novel variants flanking MIR185. However, follow-up genotyping provided no further evidence of their involvement in schizophrenia. Limitations: Power to detect rare variant associations was limited. Conclusion: Human genetic analyses generated no evidence of the involvement of MIR185 in schizophrenia. However, the expression patterns of miR-185 and its target genes in mice, and the genetic association results for the 3 target genes, suggest that further research into the involvement of miR-185 and its downstream pathways in schizophrenia is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To extend knowledge about measurement equivalence of depression measures assessed by tablet and paper-pencil administration, the present study evaluated the effect of mode of administration (MoA) on scale and item level for the Patient Health Questionnaire (PHQ-9) and the Aachen Depression Item Bank (ADIB) in elderly patients.Methods: Primary care patients (N = 193, ≥60 years) were assessed following a crossover design in Leipzig, Germany. All participants filled out the PHQ-9 and the ADIB in both MoAs under study. Effects of MoA were analyzed by intra-class correlation, mixed-effects regression, and differential item functioning (DIF). Additionally, detection rates between both MoAs were compared using receiver operating characteristics analysis compared to a diagnostic interview (SCID-I, N = 163).Results: No effect of MoA was found in the PHQ-9 on scale score or item level. Two ADIB items showed DIF according to MoA. In terms of discriminatory power, MoA did not influence detection rates of both instruments.Conclusions: In summary, our findings suggest that no severe effect of mode of administration on self-report assessments of depression should be expected. It can be concluded that tablets provide a valid way to electronically assess depressive symptoms in elderly patients. Yet changes in item presentation can influence the psychometric properties and require equivalence testing using sophisticated analyses on item level such as DIF. [ABSTRACT FROM AUTHOR]

Background: Learning arrangements in health care profession education are increasingly taking place in digital environments. Virtual reality (VR) in nursing education, as a digital element, is the subject of controversial debate. On one hand, it supports the authenticity of case studies by adding realistic perspectives and information. On the other hand, the costs of developing and maintaining software and hardware hinder its long-term implementation. Based in the German context, our aim is to promote the adoption of innovative digital methods in nursing education and to offer invaluable experiences from the field. Methods: In this paper, we describe our findings and insights from two different research projects focused on the incorporation of digital tools, particularly VR, into nursing education. Results: Starting with a brief recapitulation of the projects, we elucidate pedagogical strategies for embedding VR-driven scenarios in nursing education. Based on our experiences during the projects, we identify various positive aspects, such as changing perspective and simulating acute situations. Key findings: Although potential drawbacks remain, we advocate the long-term implementation and specific use of VR at the interface between theory and practice. Nevertheless, it is crucial to establish regular evaluation, observing the value of digitalisation, especially VR, for nursing education. [ABSTRACT FROM AUTHOR]

A growing interdisciplinary literature examines the role of hair textures and styles in Black and mixed‐race women's identity performances. Through an analysis of travel narratives, this paper extends and complements research on the context‐dependency of racialized identity performances. This paper presents an analysis of 24 qualitative interviews with Black and mixed‐race women in England and Germany. The question it seeks to answer is: 'How do changes in context alter Black and mixed‐race women's hairstyling practices as a performance of identity?' Navigating a novel context could lead the women to (1) conform to local standards of beauty and femininity, (2) resist external expectations, (3) try out novel performances and (4) negotiate the complex performance of belonging. All in all, this paper shows that Black and mixed‐race women dialogically re/negotiated and performatively re/created how they identify and how they are identified by others as they moved from one context to another. [ABSTRACT FROM AUTHOR]

Purpose: Refugees' access to psychotherapeutic care is insufficient in Germany. One factor particularly contributing to hindering their access to adequate therapeutic care is a lack of provision of language mediation. This paper aims to explore the institutional system in which the financing of language mediation in the context of the medical treatment of asylum seekers in Germany is located. It examines why the language barrier problem resulting from a lack of financing is not being solved, even though it has been well known for years as a structural problem of day-patient health care to refugees and migrants in Germany. Design/methodology/approach: The financing of language mediation is analysed against the background of theories of the so-called "shunting yard", in which public responsibilities for the assumption of costs are shifted from one level and actor to the other, thus preventing sustainable solutions being achieved. A mix of qualitative methods including the evaluation of official documents, reports and secondary literature, and of 23 expert interviews was used. Findings: The financing of language mediation is a perfect example of the "shunting yard" phenomenon, with responsibilities being shifted between federal government, health insurance bodies and the municipalities in Germany. This paper argues that the specific financing structure in the German federal system can be viewed as a reason for the non-solution of the language barrier that hinders refugees' access to health care. Originality/value: The problem of the financing of language mediation in the context of health care has been rarely treated from a social sciences perspective. This paper contributes to addressing this gap. [ABSTRACT FROM AUTHOR]

Background: To assess quality of life and unmet needs after stroke, patient-reported outcome measures (PROMs) have gained increasing attention. However, patients' perspectives on assessing PROMs remain unclear, potentially hindering implementation into clinical practice. Therefore, this study explored patients' preferences on assessing PROMs after ischemic stroke. Methods: A paper-based questionnaire was sent to stroke survivors treated at the Department of Neurology, University of Leipzig, Germany. Health-related quality of life (HRQoL, EQ-5D-5L) and preferences regarding different aspects of data collection to assess PROMs were investigated and linked to socio-demographic and medical characteristics. Results: 158 persons were contacted and 80 replies were subsequently analyzed. Mean age was 70.16 years and mean HRQoL was 68.79 (visual analogue scale with a theoretical maximum of 100). Participants showed positive attitudes towards PROMs as they saw potential to improve care of other patients (n = 66/79; 83.54%) or to improve their own situation (n = 53/74; 71.62%). Participants preferred an annual interview after stroke (n = 39/80; 48.75%) and would preferably spend 15–30 min (n = 41/79; 51.90%) to answer a written survey (n = 69/80; 86.25%). The initially treating clinic was preferred as initiator of such surveys (n = 43/79; 54.43%). Stratification revealed that participants with more than 1 h of daily digital media usage preferred email as way of communication. Conclusions: For the first time, this study showed individual preferences on assessing PROMs after ischemic stroke, focusing on the way, time interval, duration, and initiation site of surveys. These insights might help to successfully implement PROMs after stroke and subsequently detect unmet needs and deficits in stroke care. [ABSTRACT FROM AUTHOR]

Introduction: Various developments result in increasing workloads in general practices. New models of care and a restructuring of the division of tasks could provide relief. One approach is to extend the delegation of medical tasks from general practitioners (GPs) to medical practice assistants (MPAs). So far, there has been a lack of information about specific situations in which patients are willing to be treated exclusively by MPAs. Methods: In three German federal states, patients who visited a general practice were surveyed exploratively and cross-sectionally with a self-designed, paper-based questionnaire. The data were analysed descriptively and multivariate. A mixed binary logistic regression model was calculated to account for cluster effects at practice level (random intercept model). The dependent variable was patients' acceptance of task delegation. Results: A total of 1861 questionnaires from 61 general practices were included in the analysis. Regarding the current problem/request, a total of 30% of respondents could imagine being treated only by MPAs. Regarding theoretical reasons for consultation, more than half of the patients agreed to be treated by MPAs. According to the regression model, MPAs were preferred when patients were younger (10-year OR = 0.84, 95%-CI [0.75, 0.93]) or had a less complicated issue (OR = 0.44, 95%-CI [0.26, 0.8]). For four current problems/requests ("acute complaints" OR = 0.27, 95%-CI [0.17, 0.45], "routine health check" OR = 0.48, 95%-CI [0.3, 0.79], "new problem" OR = 0.13, 95%-CI [0.06, 0.28], "known problem" OR = 0.16, 95%-CI [0.1, 0.27]) patients prefer to be treated by GPs instead of MPAs. Discussion: For the first time, statements could be made on patients' acceptance of task delegation in relation to current and theoretical reasons for treatment in general practices in Germany. The discrepancy in response behaviour on a theoretical and individual level could be explained by different contexts of questions and differences at practice level. Overall, patients seem to be open to increased delegation of medical tasks, depending on the reason for treatment. Selection and response biases should be considered in the interpretation. Conclusion: The results are not completely opposed to an extension of task delegation. Further interventional studies could provide information on the possible effects of expansion of delegable tasks. [ABSTRACT FROM AUTHOR]

Little is known about the current state of research on the involvement of young people in hate speech. Thus, this systematic review presents findings on a) the prevalence of hate speech among children and adolescents and on hate speech definitions that guide prevalence assessments for this population; and b) the theoretical and empirical overlap of hate speech with related concepts. This review was guided by the Cochrane approach. To be included, publications were required to deal with real-life experiences of hate speech, to provide empirical data on prevalence for samples aged 5 to 21 years and they had to be published in academic formats. Included publications were full-text coded using two raters (κ =.80) and their quality was assessed. The string-guided electronic search (ERIC, SocInfo, Psycinfo, Psyndex) yielded 1,850 publications. Eighteen publications based on 10 studies met the inclusion criteria and their findings were systematized. Twelve publications were of medium quality due to minor deficiencies in their theoretical or methodological foundations. All studies used samples of adolescents and none of younger children. Nine out of 10 studies applied quantitative methodologies. Eighteen publications based on 10 studies were included. Results showed that frequencies for hate speech exposure were higher than those related to victimization and perpetration. Definitions of hate speech and assessment instruments were heterogeneous. Empirical evidence for an often theorized overlap between hate speech and bullying was found. The paper concludes by presenting a definition of hate speech, including implications for practice, policy, and research. [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal‐setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person‐centred tool to find out the individual perception of reading functions, reading‐related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. Aims: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. Methods & Procedures: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self‐reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German‐speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. Outcomes & Results: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy‐induced change. We found moderate correlations between outcomes of the questionnaire and text‐level reading speed. Conclusions & Implications: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal‐setting with German‐speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self‐reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject: Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal‐setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person‐centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge: In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German‐speaking PWA. We demonstrated that the German version is accessible for German‐speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self‐reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work?: The German version of the questionnaire could be a valuable self‐reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) continues to be a global problem. The increasing international research, focussing on children who witness IPV between their parents, indicates that these circumstances might influence children in different ways. Despite these efforts, little evidence stems from Germany. Using data from a German school student survey from 2017 and 2019 (N = 21,382), this paper aims to examine the consequences of witnessing IPV. The present paper takes a closer look at children's violent behaviour, attitudes and quality of life while controlling for other potential influences (e.g. physical and psychological child abuse). Results indicate that IPV has a significant negative effect on children's quality of life, in particular on children's sense of security at home and children's life satisfaction. No other effects were significant. In discussing these complex dynamics, the results of the present study highlight the importance of considering children who witness IPV as direct victims. A home with personal threats cannot provide emotional and physical security. Coping with this absence of a secure base at home may lead to the neglect of important developmental tasks during that time, which can have possible far-reaching implications on different areas of children's lives (e.g. social competence). Further research examining the severity and duration of witnessing IPV within the context of a longitudinal design is recommended. [ABSTRACT FROM AUTHOR]

This paper explores the knowledge transfer of internationally mobile scientists. It builds upon previous work on the development of methods for detecting the knowledge transfer of German scientists. Using abstract terms of publications covered in Scopus, this paper proposes a lexical‐based approach to identify knowledge transmitters. These scientists are characterized by acquiring knowledge from their co‐workers during their international stay and transferring it upon return to German co‐workers. Knowledge is operationalized as the co‐occurrence of rarely used abstract terms. Knowledge transfer is expressed as the diffusion of these term combinations in co‐authorship networks. The method developed was validated by contacting the bibliometrically identified knowledge transmitters and asking them what they believe they learned during their stay abroad. A control group of internationally mobile scientists without traceable knowledge transfer was similarly asked to report on their knowledge acquisition. The findings suggest that bibliometric data are capable of detecting knowledge transmitters among German scientists who were internationally mobile. The juxtaposition of the responses on their perceived knowledge acquisition and the bibliometrically identified lexical terms shows that the method proposed is well suited to studying the knowledge transfer of internationally mobile scientists. The strength of the method is its simplicity and high precision. [ABSTRACT FROM AUTHOR]

The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing. [ABSTRACT FROM AUTHOR]

Background: Students often show unfavourable attribution: they attribute poor school performance to stable factors such as lack of ability and good school performance to variable factors such as effort. However, attribution can be influenced by individualized digital re‐attributional feedback leading to positive motivational effects and higher learning outcomes. This is very promising, but it still is unclear, whether this digital re‐attributional feedback can also be successfully integrated in everyday classroom activities. Objectives: The present field experiment investigated how integrating digital re‐attributional feedback into classroom instruction affects student attribution, motivation and learning outcomes. Methods: In the experiment, 8th–10th grade high school students (N = 322) worked with a digital mathematics learning program which was integrated in a three‐week teaching unit. Half the students in each classroom received only standard feedback after each practice task (SF group); the other half received additionally an individual re‐attributional feedback (RF group) after every third task. Attribution, mathematics self‐concept, and self‐efficacy were measured by an online questionnaire twice a week; learning outcomes in mathematics were measured weekly. Results and Conclusion: Hierarchical analyses showed that re‐attributional feedback led to a more favourable attribution in case of success on stable factors. Especially low‐performing students benefited from this feedback. No effects on attribution in case of failure, self‐efficacy or learning outcomes could be found. Further research could investigate if certain adaptations to the digital re‐attributional feedback is more effective in a real classroom setting and has a broader impact on different students. Lay Description: What is already known about this topic: Working with computers in the classroom and at home is becoming more common.Re‐attributional feedback can increase student's motivation when given directly after solving a task and at a high density.Digital re‐attributive feedback can be given in a high density.Re‐attributional training sessions have been shown to be effective in individual training sessions or outside the students' classroom. What this paper adds: The study took place within a real teaching environment during mathematics class for 4 weeks.Digital re‐attributional feedback sessions were directly integrated into the students' online learning which was part of the teaching plan. The implications of study findings for practitioners: Computer‐based re‐attributional training show some limited effects in regular classroom instruction and could be well integrated in student online learning—when adapted accordingly.Low‐performing students show less favourable attribution than better‐performing students in case of success and benefit the most from re‐attributional training. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

Background: Medical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students. Methods: Fifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between May 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC. Results: Demands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003). Conclusion: The results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions. [ABSTRACT FROM AUTHOR]

Backgound: Headache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers. Methods: Data stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6). Results: Higher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p =.014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of "SES*obesity". Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups. Conclusions: SES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES. [ABSTRACT FROM AUTHOR]

Handwriting is a complex task that includes planning the content and the execution of handwriting movements on paper or on a tool (e.g., a tablet). This execution depends on the involvement of specific muscles in the hand (distal) and arm (proximal). The present study combines the parallel recording of the writing process on tablets and the related muscle activity with electromyography to investigate the differences in handwriting movements in two groups. A total of 37 intermediate writers (third and fourth graders, mean age 9.6 years, SD 0.5) and 18 skilled adults (mean age 28.6 years, SD 5.5) participated in three handwriting tasks. The tablet data results replicate previous findings in handwriting research for the writing process. The muscle activity data reflected a differential relationship between distinct muscle activity and handwriting performance depending on the handwriting skill (intermediate or advanced writers). Furthermore, the combination of both methods revealed that skilled writers tend to involve rather distal muscles to control the pressure of the writing pen on the surface, whereas developing writers mainly use their proximal muscles to control the velocity of their handwriting movements. This research contributes to a deeper understanding of the underlying processes of handwriting and the development of efficient handwriting execution. [ABSTRACT FROM AUTHOR]

Background: The communication processes between different stakeholders in outpatient palliative care face challenges when multiprofessional teams want to keep each other updated on patient information. Meanwhile, the software market offers different tools to connect these teams in real-time to improve communication. In the research project ADAPTIVE (Impact of Digital Technologies in Palliative Care), we investigated how information and communication technology affects collaboration and work in multiprofessional teams and what advantages and disadvantages the use of said software might entail. Methods: We conducted 26 semi-structured interviews between August and November 2020 with general practitioners (n = 8), palliative care nurses (n = 17), and a pharmacist (n = 1). They were conducted in a hybrid format, meaning that both face-to-face interviews and telephone interviews were carried out. Subsequently, we analyzed the interviews following the qualitative content analysis according to Kuckartz. Results: Information and communication software has the potential to enable faster communication and delegation of tasks and to simplify communication and task management between providers. Furthermore, it creates the opportunity to decrease unnecessary supervision of duties and responsibilities for physicians in multiprofessional teams. Therefore, it allows facilitating the collaboration between multiprofessional teams that work independently of each other but care for the same patients. All providers have the same knowledge about their patients without time-consuming coordination such as phone calls or search processes in paper documentation. On the other hand, mishandling, poor Internet connection, and unfamiliarity with various features can diminish these benefits. Conclusion: Even though the use of such software offers many advantages, these advantages only reveal themselves if the software is used as it was intended by the developers. Misuse and unawareness of the individual functions can lead to the full potential not being realized. The software developers frequently offer specialized training, and the multiprofessional teams should utilize that to improve team communication, facilitate tasks, and allow physicians to delegate tasks. Trial registration: The study is registered in the German Clinical Trials Register (DRKS): https://www.drks.de/drks%5fweb/navigate.do?navigationId=trial.HTML&TRIAL%5fID=DRKS00021603 (Registration number: DRKS00021603; date of first registration: 02/07/2020). [ABSTRACT FROM AUTHOR]

Purpose: Teachers are exposed to many stressors. Compared to other occupational groups, they are more frequently affected by psychosomatic complaints. In recent decades, numerous prevention and intervention measures for promoting health have been developed and implemented for this target group. However, it remains unclear how the uptake of health-promotion measures (HPMs) by teachers can be increased in order to prevent stress-related disorders. This paper examines two facets of health literacy—health awareness and health value—in terms of their importance in both the take-up and intended take-up of HPMs. Design/methodology/approach: In the 2017/2018 school year, data were collected by paper and pencil from a representative sample of 830 teachers across all school types in the German State of Brandenburg. Findings: Teachers who place great value on their own health show significantly higher levels of take-up and intended take-up of HPMs. The findings regarding health awareness are more heterogeneous. Further associations were found with age and psychosocial stress. Originality/value: While there has been growing academic interest in developing HPMs for teachers, there has been relatively little focus on the factors that may influence the implementation and uptake of these measures. The paper contributes to addressing this gap by shedding light on the relevance of two facets of health literacy. Strengthening the perceived importance of health could be a starting point for increasing the use of HPMs by teachers and thus improving their health. [ABSTRACT FROM AUTHOR]

The paper reports the results of an exploratory online survey among German, Austrian, and Swiss hospital chaplains (n = 158, response rate 17%) to identify the ethical conflicts they encounter in their work. Respondents indicated that questions surrounding end-of-life care are predominant among the conflicts faced. Chaplains get involved with these conflicts most often through the patients themselves or through nursing staff. Most encounters occur during pastoral care visits rather than in structured forms of ethics consultation such as clinical ethics committees. The results add to the ongoing discussion of chaplains as agents in ethics consultation within healthcare systems as well as their specific role and contribution. [ABSTRACT FROM AUTHOR]

Background: Research has shown that routinely assessed, patient-reported outcome measures (PROMs) have positive effects in patients with advanced oncologic diseases. However, the transferability of these results to specialist palliative care is uncertain because patients are more impaired and staff doubt the feasibility and benefits. The aim of this study is to evaluate the feasibility of patient self-assessment of PROMs, their use by staff and the benefits in palliative care wards. Method: A multicentre observational study was conducted in the context of the implementation of the Integrated Patient Outcome Scale (IPOS) in three specialist palliative care wards at university hospitals in Germany. All admitted patients who screened positive regarding their ability to complete questionnaires were asked to participate and complete the IPOS on paper weekly, with assistance if necessary. Feasibility of questionnaire completion (e.g. proportion of patients able to complete them), use (e.g. involvement of different professional groups) and benefit (e.g. unexpected information in IPOS as rated by treating physicians) were assessed. Staff members' opinion was obtained in a written, anonymous evaluation survey, patients' opinion in a short written evaluation. Results: A total of 557 patients were screened for eligibility, 235 were assessed as able to complete the IPOS (42.2%) and 137 participated in the study (24.6%). A majority needed support in completing the IPOS; 40 staff members and 73 patients completed the evaluation. Unexpected information was marked by physicians in 95 of the 137 patient questionnaires (69.3%). The staff differed in their opinions on the question of whether this also improved treatment. A majority of 32 staff members (80.0%) were in favour of continuing the use of IPOS (4 against continuation, 4 no answer); 43 (58.9%) patients rated their overall experience of IPOS use as 'positive', 29 (39.7%) as 'neutral' and 1 (1.4%) as 'negative'. Conclusions: While most staff wished to continue using IPOS, it was a challenge to integrate the effort to support the completion of IPOS into daily practice. Digital implementation was not successful, despite various attempts. To explore the effects on care and patient outcomes, multicentre cluster-randomised trials could be employed. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00016681 (24/04/2019). [ABSTRACT FROM AUTHOR]

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. [ABSTRACT FROM AUTHOR]

Assessing the impact of dysarthria on a patient's ability to communicate should be an integral part of patient management. However, due to the high demands on reliable quantification of communication limitations, hardly any formal clinical tests with approved psychometric properties have been developed so far. This study investigates a web-based assessment of communication impairment in dysarthria, named KommPaS. The test comprises measures of intelligibility, naturalness, perceived listener effort and communication efficiency, as well as a total score that integrates these parameters. The approach is characterized by a quasi-random access to a large inventory of test materials and to a large group of naïve listeners, recruited via crowdsourcing. As part of a larger research program to establish the clinical applicability of this new approach, the present paper focuses on two psychometric issues, namely specificity and sensitivity (study 1) and retest-reliability (study 2). Study 1: KommPaS was administered to 54 healthy adults and 100 adult persons with dysarthria (PWD). Non-parametric criterion-based norms (specificity: 0.95) were used to derive a standard metric for each of the four component variables, and corresponding sensitivity values for the presence of dysarthria were identified. Overall classification accuracy of the total score was determined using a ROC analysis. The resulting cutscores showed a high accuracy in the separation of PWD from healthy speakers for the naturalness and the total score. Study 2: A sub-group of 20 PWD enrolled in study 1 were administered a second KommPaS examination. ICC analyses revealed good to excellent retest reliabilities for all parameters. [ABSTRACT FROM AUTHOR]

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The German version of the Parenting stress Index from Abidin, the Eltern-Belastungs-Inventar (EBI) merely provides reference samples of 538 mothers of children in toddlers and preschool age. Although meant to measure parenting stress, there are no father specific reference samples provided. The aim was to investigate differences in parenting stress between fathers and the provided reference samples of German mothers. Furthermore, the aim was to examine potential differences in the perceived stress between fathers who did and those who did not take parental leave. A total of 497 fathers living in Germany, of which more than half took parental leave, filled out the questionnaire via an online survey or the paper-pencil-version. All fathers completed the EBI and provided socio-economic data. The collected data were analyzed in terms of test quality, such as mean and standard deviation, corrected item–total correlation and reliability. Moreover, differences between the provided norm data and our sample were calculated. Analyses showed that fathers reported significantly higher levels of parenting stress than mothers. Furthermore, fathers taking parental leave did not differ significantly from those who did not, regarding their level of education or their perceived parenting stress. In conclusion, as it stands right now, the EBI does not adequately measure parenting stress in fathers, and father specific norms are needed to properly assess their levels of parenting stress. The results concerning parenting stress and parental leave were thus inconclusive. Furthermore, since reducing parenting stress in fathers is beneficial for the child's development and the welfare of the parents, further studies focusing on fathers' parenting stress are needed. [ABSTRACT FROM AUTHOR]

Means-tested transfer schemes in Europe and elsewhere tend to include not only income tests but also asset tests of various sorts. The role of asset tests in minimum income protection provisions has been extensively researched in the Anglo-Saxon context. Far fewer authors have assessed the role of asset tests on social policy in a continental European context. Although asset tests may be useful in singling out the more deserving of the poor, we know relatively little of their actual impact on eligibility and social outcomes in European welfare states. This paper looks at the prevalence and design of asset tests in European minimum income protection schemes. We distinguish between two main types of asset tests: outright disqualification when assets reach a certain value, versus a more gradual tapering at a fictional rate of return. We then analyse in greater detail how asset tests in Belgium and Germany, as representatives of these two types, affect minimum income protection eligibility and poverty outcomes. We use the EUROMOD microsimulation model on the Household Finance and Consumption Survey data in order to assess the effects of asset tests. This survey was explicitly designed to more realistically reflect assets and capital incomes. [ABSTRACT FROM AUTHOR]

Forecasts predict a growing shortage of skilled nursing staff in countries worldwide. Nurse migration is already a common strategy used to address nursing workforce needs. Germany, the UK, and Australia are reviewed here as examples of destination countries for nurse migrants. Agreements exist between countries to facilitate nurse migration; however, it is not evident how nurse migrants have contributed to data on which these arrangements are based. We examined existing primary research on nurse migration, including educational needs and initiatives to support policymakers', stakeholders', and health professions educators' decisions on measures for ethical and sustainable nurse migration. We conducted a rapid evidence assessment to review available empirical research data which involved, was developed with, or considered migrant nurses to address the research question: what are the findings of research that directly involves migrant nurses in producing primary research data? A total of 56 papers were included. Four main themes were identified in this research data: Research does not clearly define what is meant by the term migrant nurses; discrimination is often reported by migrant nurses; language and communication competencies are important; and structured integration programs are highly valued by migrant nurses and destination healthcare employers. Migrant nurses continue to experience discrimination and reduced career opportunities and therefore should be included in research about them to better inform policy. Structured integration programs can improve the experience of migrant nurses by providing language support (if necessary), a country-specific bridging program and help with organisational hurdles. Not only researching migrant nurses but making them active partners in research is of great importance for successful, ethical, and sustainable migration policies. A broader evidence base, especially with regard to the views and experiences of migrant nurses and their educational support needs, should be promoted to make future immigration policy more needs-based, sustainable and ethically acceptable. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown that teachers hold misconceptions about multimedia learning (e.g., multimedia instruction needs to be adapted to students' learning styles), which may be at odds with evidence‐based teaching. Objectives: Refutation texts are a classical method to reduce misconceptions and thus to stimulate conceptual change. We wanted to know whether making use of a computer algorithm to personalize refutation texts would best initiate teachers' conceptual change. Methods: We designed an online experiment, in which N = 129 in‐service teachers read either (1) expository texts (without direct refutation), (2) common refutation texts, or (3) personalized refutation texts. The teachers filled in a misconception questionnaire pre and post to assess their conceptual change. Results and Conclusions: Statistical analyses revealed that personalized refutation texts initiated the strongest conceptual change, which was driven by increased feelings of guilt and shame. Common refutation texts did not foster teachers' conceptual change as compared to expository texts. These findings indicate that refutation texts should be personalized for experienced practitioners such as teachers. Takeaways: Personalized refutation seems to be promising in the context of online teacher training programs. Further research should test to which extent the present findings also apply to other groups of experienced learners or practitioners. Lay Description: What is already known about this topic?: Teachers hold misconceptions about multimedia learning (e.g., learning materials should be adapted to students' individual learning styles, such as visualizers or verbalizers).Refutation texts, naming a commonly held misconception, disproving it and introducing a scientific explanation, are a common means to reduce misconceptions.Personalization fosters learning by drawing the learner's attention toward the discrepancy between their own beliefs and the learning material, further creating an impasse experience.Said impasse experience may trigger teachers' conceptual change, as, for teachers' conceptual change, a certain degree of discomfort is required. Yet, anger, caused by lessoning teachers on their topic may cause repulse and hamper learning. What this paper adds?: With a computer algorithm, we can efficiently personalize refutation texts by automatically matching them to teachers' answers in a pre‐test. Such a personalized refutation instruction may especially foster conceptual change.Within a randomized experiment, the personalized refutation instruction worked best compared to common refutation texts and expository texts.Feelings of guilt and shame moderated the effect of a personalized refutation, as teachers felt more addressed in their misconceptions and thus experienced the required impasse experience.Feelings of anger did not play an important role within our experiment. The implications of study findings for practitioners: Computer algorithms enable efficient personalization of instruction to better deal with heterogeneous groups of learners (e.g., with big differences in prior knowledge or experience, such as in the case of in‐service teachers).Refutation texts work better for teachers when they are personalized. Common refutation texts do not work better than expository texts.An advantage of digital instruction is the use of algorithms to efficiently personalize instructions even for larger groups. [ABSTRACT FROM AUTHOR]

Background: Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. Objective: To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. Design: Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). Data Sources: PubMed. Connected Papers. The search was performed in February 2021. Eligibility Criteria: English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. Results: Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. Conclusion: This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted. [ABSTRACT FROM AUTHOR]

Background: Person-centred care (PCC) has been suggested as the preferred model of dementia care in all settings. The EPCentCare study showed that an adapted PCC approach was difficult to implement and had no effect on prescription of antipsychotics in nursing home residents in Germany. This paper reports the qualitative process evaluation to identify facilitators and barriers of the implementation of PCC in German nursing homes from the perspective of participating practice development champions. Methods: Five individual and 14 group interviews were conducted with 66 participants (staff and managers) from 18 nursing homes. The analysis was based on inductive coding to identify factors influencing the PCC implementation process. Identified factors were systematised and structured by mapping them to the four constructs (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalization Process Theory (NPT) as a framework that explains implementation processes. Results: Facilitating implementation factors included among others broadening of the care perspective (coherence), tolerance development within the care team regarding challenging behaviour (cognitive participation), testing new approaches to solutions as a multi-professional team (collective action), and perception of effects of PCC measures (reflexive monitoring). Among the facilitating factors reported in all the NPT constructs, thus affecting the entire implementation process, were the involvement of relatives, multi-professional teamwork and effective collaboration with physicians. Barriers implied uncertainties about the implementation and expectation of a higher workload (coherence), concerns about the feasibility of PCC implementation in terms of human resources (cognitive participation), lack of a person-centred attitude by colleagues or the institution (collective action), and doubts about the effects of PCC (reflexive monitoring). Barriers influencing the entire implementation process comprised insufficient time resources, lack of support, lack of involvement of the multi-professional team, and difficulties regarding communication with the attending physicians. Conclusions: The findings provide a comprehensive and detailed overview of facilitators and barriers structured along the implementation process. Thus, our findings may assist both researchers and clinicians to develop and reflect more efficiently on PCC implementation processes in nursing homes. Trial registration: ClinicalTrials.gov identifier: NCT02295462; November 20, 2014. [ABSTRACT FROM AUTHOR]

Aim: With the COVID-19 pandemic, we witnessed an increase in purchases of certain products, such as toilet paper, disinfectants, or groceries. In the present study, we examined the individual and socio-psychological determinants of stockpiling behavior. For this purpose, we defined an explanatory model based on the Health Belief Model (HBM), which includes threat perceptions, barriers and benefits, and self-efficacy beliefs as main predictors of health-related behaviors, and extended the model to include social norms. Subject and methods: Participants were recruited via social media platforms and data collection was conducted via an online survey. The final sample included 861 German respondents (male = 199, female = 642, mean age = 36.76, SD = 12.38). Results: Perceived barriers of stockpiling, such as financial constraints or regulations in supermarkets, turned out to be the strongest predictors of stockpiling. Regarding the role of threat perception, the perceived severity of the disease in particular was positively related to stockpiling behavior. Finally, our results suggest a significant impact of social cues, showing that descriptive normative beliefs are associated with stockpiling behavior. Conclusion: Based on these findings, we propose targeted interventions to a) reduce perceived benefits of stockpiling and severity beliefs related to COVID-19, b) emphasize disadvantages of stockpiling, and c) reduce media exposure of stockpiling behavior to prevent panic buying. [ABSTRACT FROM AUTHOR]

Reflective smartphone disengagement (i.e., deliberate actions to self-regulate when and how one should use one's smartphone) has become a necessary skill in our ever-connected lives, contributing to a healthy balance of related benefits and harms. However, disengaging from one's smartphone might compete with impulsive psychosocial motivators such as fear of missing out (FoMO) on others' rewarding experiences or feelings of loneliness. To shed light into these competitive processes, the present paper disentangles the reciprocal, over-time relationships between reflective smartphone disengagement, FoMO, and loneliness using data from a two-wave panel study among emerging adults (16–21 years of age). Measurement-invariant structural equation modeling suggests that FoMO and reflective smartphone disengagement negatively predict each other over time, indicating a possible spiraling process. In addition, reflective smartphone disengagement was also negatively related to feelings of loneliness. Together, these findings underline (a) how young people's impulsive and reflective system compete with each other over control of their smartphone usage, where (b) psychosocial benefits of reflective smartphone disengagement were validated among emerging adults, potentially helping them to strengthen the benefits and limit the harms of permanent interactions with and through technology. [ABSTRACT FROM AUTHOR]

Background: Formative assessments are needed to enable monitoring how student knowledge develops throughout a unit. Constructed response items which require learners to formulate their own free‐text responses are well suited for testing their active knowledge. However, assessing such constructed responses in an automated fashion is a complex task and requires the application of natural language processing methodology. In this article, we implement and evaluate multiple machine learning models for coding energy knowledge in free‐text responses of German K‐12 students to items in formative science assessments which were conducted during synchronous online learning sessions. Dataset: The dataset we collected for this purpose consists of German constructed responses from 38 different items dealing with aspects of energy such as manifestation and transformation. The units and items were implemented with the help of project‐based pedagogy and evidence‐centered design, and the responses were coded for seven core ideas concerning the manifestation and transformation of energy. The data was collected from students in seventh, eighth and ninth grade. Methodology: We train various transformer‐ and feature‐based models and compare their ability to recognize the respective ideas in students' writing. Moreover, as domain knowledge and its development can be formally modeled through knowledge networks, we evaluate how well the detection of the ideas within responses translated into accurate co‐occurrence‐based knowledge networks. Finally, in terms of the descriptive accuracy of our models, we inspect what features played a role for which prediction outcome and if the models pick up on undesired shortcuts. In addition to this, we analyze how much the models match human coders in what evidence within responses they consider important for their coding decisions. Results: A model based on a modified GBERT‐large can achieve the overall most promising results, although descriptive accuracy varies much more than predictive accuracy for the different ideas assessed. For reasons of comparability, we also evaluate the same machine learning architecture using the SciEntsBank 3‐Way benchmark with an English RoBERTa‐large model, where it achieves state‐of‐the‐art results in two out of three evaluation categories. Lay Description: What is already known about this topic?: Formative assessments are needed to test and monitor the development of learners' knowledge throughout a unit to provide them with appropriate automated feedback.Constructed response items which require learners to formulate their own free‐text responses are well suited for testing their active knowledge.Assessing constructed responses in an automated fashion is a widely researched topic, but the problem is far from solved and most of the work focuses on predicting holistic scores or grades.To allow for a more fine‐grained and analytic assessment of learners' knowledge, systems which go beyond predicting simple grades are required.To guarantee that models are stable and make their predictions for the correct reasons, methods for explaining the models are required. What this papers adds?: A core topic in physics education is the concept of energy.We implement and evaluate multiple systems based on natural language processing technology for assessing learners' conceptual knowledge about energy physics using transformer language models as well as feature‐based approaches.The systems assess students' knowledge about various forms of energy, indicators for the same and the transformation of energy from form into another.As our systems are based on machine learning methodology, we introduce a novel German short answer dataset for training them to detect the respective knowledge elements within students' free‐text responses.We evaluate the performance of these systems using this dataset as well as the well‐established SciEntsBand‐3‐Way dataset and manage to achieve, to our best knowledge, new state‐of‐the‐art results for the latter.Moreover, we apply methodology for explaining model predictions to assess whether predictions are carried out for the correct reasons. Implications for practice and/or policy: It is indeed possible to assess constructed responses for the demonstrated knowledge about energy physics in an analytic fashion using natural language processing.Transformer language models can outperform more specialized feature‐based approaches for this task in terms of predictive and descriptive accuracy.Co‐occurrences of different concepts within the same responses can lead models to learn undesired shortcuts which make them unstable. [ABSTRACT FROM AUTHOR]

Grammatical knowledge has often been investigated in wug tests, in which participants inflect pseudo-words. It was argued that in inflecting these pseudo-words, speakers apply their knowledge of word formation. However, it remains unclear what exactly this knowledge is and how it is learned. According to one theory, the knowledge is best characterised as abstractions that specify how units are combined. Another theory maintains that it is best characterised by memory-based analogy. In both cases the knowledge is learned by association based on positive evidence alone. In this paper, we model the classification of pseudo-words to Maltese plurals using a shallow neural network trained with an error-driven learning algorithm. We demonstrate that the classifications mirror those of Maltese speakers in a wug test. Our results indicate that speakers rely on gradient knowledge of a relation between the phonetics of whole words and plural classes, which is learned in an error-driven way. [ABSTRACT FROM AUTHOR]

Background: Past research has shown that seductive details (i.e., interesting, but irrelevant adjuncts in learning materials) hamper learning in short, instructor‐paced learning sessions through impaired cognitive processing. Objectives: We integrate theory and research on multimedia learning and self‐control to test whether detrimental effects of seductive details also apply to longer and strenuous learning sessions (e.g., online lectures), in which there is greater need for self‐control. Methods: A total of N = 194 students studied five chapters in a digital learning unit about chemistry either (1) without seductive details, or (2) with seductive details but without being informed about their irrelevance for the learning goal, or (3) with seductive details while being informed about their irrelevance. To assess learning outcomes, all students completed the same posttests for recall and transfer of knowledge. Results and conclusions: For students who were uninformed about the details' irrelevance, the seductive details impeded learning outcomes not just overall, but also in the final phase of prolonged studying (i.e., when the willingness to self‐control is reduced). The latter effect was mediated through a reduced positive affect. Implications: The seductive details effect seems to generalize to prolonged learning sessions, where students may start to dislike the seductive details. Lay Description: What is already known about this topic?: Seductive details (i.e., interesting, but irrelevant adjuncts) hamper learning in short instructor‐paced learning sessions through impaired cognitive processing.However, they also have beneficial effects on affective factors.These benefits did not translate to better learning outcomes in past research.It is unknown whether the affective benefits could translate to better learning outcomes in longer, more self‐paced learning sessions (e.g., digital learning sessions), with higher self‐control demands. What this paper adds?: The harmful effect of seductive details on learning also appears in extended and self‐paced digital learning sessions.However, seductive details hampered learning only when students perceived them as relevant. The implications of study findings for practitioners: Seductive details should be used very cautiously or even be excluded from instructional material.If it is impossible to dismiss the seductive details in actual learning materials, students should be informed about the details' irrelevance for learning to avoid their potential negative effects. [ABSTRACT FROM AUTHOR]

Aims To report a systematic review of the psychometric properties of self-report instruments to identify the symptoms of anxiety in pregnancy to help clinicians and researchers select the most suitable instrument. Background Excessive anxiety in pregnancy is associated with adverse birth outcomes, developmental and behavioural problems in infants and postnatal depression. Despite recommendations for routine psychological assessment in pregnancy, the optimal methods to identify anxiety in pregnancy have not been confirmed. Design Psychometric systematic review. Data sources A systematic literature search of the multiple databases (1990-September 2014). Review methods Identification of self-report instruments to measure anxiety in pregnancy using COSMIN guidelines to assess studies reporting a psychometric evaluation of validity and reliability. Results Thirty-two studies were included. Studies took place in the UK, Australia, Belgium, Canada, Germany, Italy, Scandinavia, Spain and the Netherlands. Seventeen different instruments were identified. Measures of validity were reported in 19 papers and reliability in 16. The overall quality of the papers was rated as fair to excellent using the COSMIN checklist. Only one paper scored excellent in more than one category. Conclusion Many instruments have been adapted for use in different populations to those for which they were designed. The State Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale have been tested more frequently than other instruments, yet require further assessment to confirm their value for use in pregnancy. [ABSTRACT FROM AUTHOR]

In this paper, we report on the development and refinement of a progressive physical exercise training and home modification intervention for older people with a risk of falling located in Germany by using the United Kingdom's Medical Research Council framework. The process was iterative and six phases of development emerged: (1) establishing an intervention development group, (2) identifying the evidence on interventions, (3) identifying a theory to underpin the intervention, (4) designing the intervention components, (5) drafting the intervention manual and training course, and (6) piloting and refining of intervention components. The result was an evidence-based, theory-informed, and user-endorsed intervention: FIT-at-Home. This intervention comprised nine individual sessions over 12 weeks and two follow-up booster sessions delivered by trained occupational therapists. A feasibility study demonstrated the acceptance and feasibility of intervention delivery. Users responses were generally favorable and included recommendations about the intervention manual, mode of delivery of the home hazard assessment, and producing a manual for older people. We developed a feasible home-based lifestyle-integrated physical exercise training and home modification intervention for older people with a risk of falling by using a systematic approach. Implications include how this intervention could enrich occupational therapy fall prevention strategy in older people living at home. Falls in older people represent a major public health concern and occupational therapists in rehabilitation practice are encouraged to apply evidence-based interventions that reduce the risk of falls in older people living in a community. Many physical and environmental fall risks are modifiable by lifestyle changes such as physical exercise training, home safety assessment, and home modification. We developed a home-based balance and strength exercise training and home modification intervention that aims to improve strength, balance, and home safety. This study indicates that older people, at risk of falling, with functional limitations, and limited mobility, who participated in the FIT-at-Home intervention, felt that exercising at home suited them best. [ABSTRACT FROM AUTHOR]

Background: The so-called sports consumption models are looking for the factors that influence the sports spending of households. This paper aims to examine the Hungarian, Polish and German households' sports expenditures which can be an important indicator of physical activity and sporty lifestyle.Methods: Surveying of households in three countries (Hungary, Poland and Germany) has been conducted with a self-designed questionnaire. We have used descriptive and bivariate non-parametric and parametric statistical methods: (1) χ2 test, Mann-Whitney test and Kruskal-Wallis test for checking the relationship between sociodemographic and physical activity variables and (2) independent sample t-test and ANOVA for checking the differences in sports expenditures.Results: Our research concluded that men, especially previous athletes, exercise more than women and those who have no history as registered athletes. The choice of sports venues is obviously different between the countries in the sample. Members of the study population spend the most on sports services while they spend the least on sports equipment. German households have the highest spending rates compared to the other two countries.Conclusions: Results are in line with our previous research findings and with other literatures. The difference in preferences of sports venues could have the reason of different supply of sports clubs or the different living standards too. It needs further researches to clear it. Material wealth, income level and sport socialisation can be a determining factor regarding the level of sports spending. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort.The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions.Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression.Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. What the paper adds to existing knowledge?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil."Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists.Emotions play an important role in decision‐making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups.Staff members consider reflective interventions, such as team supervisions or post‐seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely.Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. What are the implications for practice?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions.Structured post‐seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. Introduction: Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim: The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method: Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results: Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post‐seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion: The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications: The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores practical and ethical dilemmas for professionals when securing the protection of children in the complex non‐clinical setting of individual families. It is based on a cross‐country study on cultural encounters in interventions against child physical abuse and neglect in four countries (England/Wales, Germany, Portugal, and Slovenia). Drawing on national reports of legal‐organizational frameworks and socio‐cultural backgrounds of European child protection systems, it also presents the results of a series of focus groups with professionals. Data were analysed to identify implicit and explicit discursive constructions as well as normative representations and from this deriving the key ethical issues and dilemmas. Despite a shared normative framework across Europe, intervention cultures vary across the four countries and between the different stakeholder groups. Although each child protection system faced widespread mistrust, policy approaches differ, some relying on strong and detailed guidance whereas others stress professional skill and judgement. We conclude that despite a shared commitment to the protection of children, deliberations and perceived ethical dilemmas suggest interdependency between differences in system cultures and policy approaches that inform the character of professional interventions in the four countries. [ABSTRACT FROM AUTHOR]

This paper primarily examines the perspectives of dying persons in Germany, in terms of if and when the dying feels lonely during their final weeks. The author contrasts emic perceptions with public discourses in regards to the non-dying ones possibly neglecting or tabooing the terminally ill. Secondly, the paper explores how and where the dying persons included in the study want to pass away. The dying individuals involved did not feel tabooed or ignored by non-dying persons. Dying at home did not necessarily remain the preferred option compared to dying at institutions. The author collected data between 2013 and 2015 in Western Germany, using long-term participant observation and interviews with individuals diagnosed as terminally ill. [ABSTRACT FROM AUTHOR]

This paper examines the discretionary reasoning of the judiciary in three jurisdictions, England, Germany and Norway, in cases deciding whether a newborn child is safe with her parents or intervention is necessary. Our analysis focuses on one specific dimension of decision makers' exercise of discretion, namely, if and how the strengths and weaknesses of the mother are considered. The data material consists of all decisions concerning care orders of newborns from one large city in Germany from 2015 to 2017 (n = 27) and 2016 in Norway (n = 76) and all publicly available newborn removal decisions in England for 2015–2017 (n = 14). The findings reveal a high number of risk factors in the cases and less focus on risk‐reducing factors. The situation of the newborn is considered to be harmful, as most cases result in a care order. Judicial discretion differs by how much information, and what types of factors, are included in the justification for the decision. A learning point for decision makers and policymakers would be to actively undertake a balancing act between risk‐increasing and risk‐reducing factors. [ABSTRACT FROM AUTHOR]

This paper explores trade union strategies to protect wages in the face of EU migration after the enlargement of the European Union. We argue that unions have three instruments at their disposal to deal with the risks linked to downward wage pressure: closure through immigration control, equalisation through collective bargaining and minimum wages, and the organisation of migrant workers. Using comparative case studies of Sweden, Germany and the UK, we show how different types of power resources shape union strategies: unions with substantial organisational resources (in Sweden) relied on a large membership to pursue an equalisation strategy and expected to be able to 'afford' openness. German unions with low membership but access to the political system pushed for a mix of closure and equality drawing on political intervention (e.g. minimum wages). British unions, unable to pursue either, focused their efforts on organisation. [ABSTRACT FROM AUTHOR]

Background: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China.Methods: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist.Results: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited.Conclusion: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China. [ABSTRACT FROM AUTHOR]

Background Germany has been identified as one of a few high-income countries that opposed a strong Framework Convention on Tobacco Control (FCTC), the WHO's first global public health treaty. This paper examines whether the tobacco industry had influenced the German position on the FCTC. Methods Analysis of previously confidential tobacco industry documents. Results The tobacco industry has identified Germany as a key target within its global strategy against the FCTC. Building on an already supportive base, the industry appears to have successfully lobbied the German government, influencing Germany's position and argumentation on key aspects of the FCTC. It then used Germany in its efforts to weaken the FCTC. The evidence suggests that the industry enjoyed success in undermining the Federal Health Ministry's position and using Germany to limit the European Union negotiating mandate. The tactics used by the tobacco industry included the creation of controversy between the financial, trade and other ministries on one side and the health ministry on the other side, the use of business associations and other front groups to lobby on the industry's behalf and securing industry access to the FCTC negotiations via the International Standardization Organization. Conclusion The evidence suggests that Germany played a major role in the tobacco industry's efforts to undermine the FCTC. Germany's position consistently served to protect industry interests and was used to influence and constrain other countries. Germany thus contributed significantly to attempts to weaken an international treaty and, in doing so, failed in its responsibility to advance global health. [ABSTRACT FROM AUTHOR]

In many developed countries lone parent families face high rates of child poverty. Among those lone parents who do get child maintenance there is a hidden problem. States may retain all, or a proportion, of the maintenance that is paid in order to offset other fiscal costs. Thus, the potential of child maintenance to alleviate poverty among lone parent families may not be fully realized, especially if the families are also in receipt of social assistance benefits. This paper provides an original comparative analysis exploring the effectiveness of child maintenance to reduce child poverty among lone parent families in receipt of social assistance. It addresses the question of whether effectiveness is compromised once interaction effects (such as the operation of a child maintenance disregard) are taken into account in four countries Australia, Finland, Germany and the UK using the LIS dataset (2013). It raises important policy considerations and provides evidence to show that if policy makers are serious about reducing child poverty, they must understand how hidden mechanisms within interactions between child maintenance and social security systems can work as effective cost recovery tools for the state, but have no poverty reduction impact. [ABSTRACT FROM AUTHOR]

Aims: The European Society of Cardiology (ESC) guidelines state that heart failure nurse specialists (heart-failure nurses) with specific competences are essential for a successful heart-failure-management programme. Thus, the Heart Failure Association (HFA) of the ESC developed the heart failure nurse curriculum (HFA curriculum). Several ESC member states developed cardiovascular education programmes to enable nurses to deliver high specialist care, but little is known of whether these curricula are in line with the HFA curriculum. Therefore, this paper describes the extent to which cardiovascular education programmes in Belgium, The Netherlands and Germany correspond to the HFA curriculum. Methods and results: A case study approach was adopted to obtain an in-depth understanding of the programme contents in relation to the HFA curriculum. For this purpose, representatives of the educational programmes and/or delegates of the national cardiovascular nursing organization shared their educational curricula. All of the studied cardiovascular education programmes aim to provide heart failure and/or cardiovascular nurses with essential competences for implementation of evidence based and guideline derived care. However, every cardiovascular education programme has a different focus/area of attention. Cardiovascular education in Belgium discusses aspects of all core-learning objectives of the HFA curriculum and emphasizes mostly knowledge aspects of these. Learning objectives in cardiovascular education in The Netherlands focus on chronic diseases in general and on learning objectives concerning patient education, support in self-care and management of device and pharmacological therapy. Cardiovascular education in Germany discusses most learning objectives; however, not all learning objectives receive equal attention. Conclusions: Although local cardiovascular education programmes adopt certain aspects of the HF curriculum, the curriculum as a whole is not adopted. [ABSTRACT FROM AUTHOR]