Search

The implementation of educating "Basic Life Support (BLS) competences" in German schools is particularly affected by the often reported "implementational gap" --limited transfer of empirical findings into practice. This Design-Based Research (DBR) study evaluates two different methodologies for BLS teaching, generating implications for transfer. Students (N = 136) of a secondary school (11-13 years) were assigned to different methodological approaches. A test group (TG) received intervention implemented into regular biology lessons (10 units; n = 48); the control group (CG) participated in a basic instruction (2 units; n = 68). Both large-scale methods -- subject-matter teaching (TG) and project activity (CG) -- were compared regarding current motivation, self-efficacy, constructivist instruction, cognitive load, and practical skills. Data from n = 125 students (TG=48; TG=68) could be included into analysis (Mage=11,16; SD=.45; 55.2% female). Probability of success and interest increased, anxiety perception decreased (no group-interaction effect), whereas challenge perception remained constantly. Self-efficacy overall improved from before to after intervention, with TG reporting higher social self-efficacy and less negative outcome expectancies. No differences were found for practical BLS performance. MANOVA (after intervention) showed higher values for anxiety in TG, and for self-efficacy, CG has higher values for negative outcome expectancies (post hoc analysis). For cognitive load and constructivist instruction, no differences between groups were found. In conclusion, both methodological approaches seem to have their own pedagogical justification. Schools' implementation processes may benefit from combining (subject-matter) curriculum content with BLS information or content to facilitate time and resource-saving realization.

The ubiquity of formal education in modern nations is often accompanied by an assumption that students' motivation for learning is innate and self-sustaining. The latter is true for most children in domains (e.g., language) that are universal and have a deep evolutionary history, but this does not extend to learning in evolutionarily novel domains (e.g., mathematics). Learning in evolutionarily novel domains requires more cognitive effort and thus is less motivating. The current study tested the associated hypothesis that learning will feel easier and more motivating for evolutionarily relevant (e.g., "mother," "food") than evolutionarily novel (e.g., "computer," "gravity") word pairs and that a growth mindset emphasizing the importance of effort in learning might moderate this effect. Specifically, 144 adults were presented with 32 word pairs (half evolutionarily relevant and half evolutionarily novel) and were randomly assigned to a growth mindset or a control condition. Evolutionarily relevant words were better remembered than evolutionarily novel words (d = 0.65), and the learning was reported as more enjoyable (d = 0.49), more interesting (d = 0.38), as well as less difficult (d = - 0.96) and effortful (d = - 0.78). Although the growth mindset intervention fostered a mindset belief, compared to the control condition, it did not lead to improved recall performance or changes in motivational beliefs. These results are consistent with the prediction of higher motivation and better learning of evolutionarily relevant words and concepts than for evolutionarily novel words and concepts. Implications for future research and educational practice are discussed.

Abstract Background As an indigestible component of human breast milk, Human Milk Oligosaccharides (HMOs) play an important role as a substrate for the establishing microbiome of the newborn. They have further been shown to have beneficial effects on the immune system, lung and brain development. For preterm infants HMO composition of human breast milk may be of particular relevance since the establishment of a healthy microbiome is challenged by multiple disruptive factors associated with preterm birth, such as cesarean section, hospital environment and perinatal antibiotic exposure. In a previous study it has been proposed that maternal probiotic supplementation during late stages of pregnancy may change the HMO composition in human milk. However, there is currently no study on pregnancies which are threatened to preterm birth. Furthermore, HMO composition has not been investigated in association with clinically relevant outcomes of vulnerable infants including inflammation-mediated diseases such as sepsis, necrotizing enterocolitis (NEC) or chronic lung disease. Main body A randomized controlled intervention study (PROMO = probiotics for human milk oligosaccharides) has been designed to analyze changes in HMO composition of human breast milk after supplementation of probiotics (Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis) in pregnancies at risk for preterm birth. The primary endpoint is HMO composition of 3-fucosyllactose and 3’-sialyllactose in expressed breast milk. We estimate that probiotic intervention will increase these two HMO levels by 50% according to the standardized mean difference between treatment and control groups. As secondary outcomes we will measure preterm infants’ clinical outcomes (preterm birth, sepsis, weight gain growth, gastrointestinal complications) and effects on microbiome composition in the rectovaginal tract of mothers at delivery and in the gut of term and preterm infants by sequencing at high genomic resolution. Therefore, we will longitudinally collect bio samples in the first 4 weeks after birth as well as in follow-up investigations at 3 months, one year, and five years of age. Conclusions We estimate that probiotic intervention will increase these two HMO levels by 50% according to the standardized mean difference between treatment and control groups. The PROMO study will gain insight into the microbiome-HMO interaction at the fetomaternal interface and its consequences for duration of pregnancy and outcome of infants.

This article develops an index to measure the level of susceptibility of courses to cheating using ChatGPT (Chat Generative Pre-trained Transformer), an advanced text-based artificial intelligence (AI) language model. It demonstrates the application of the index to a sample of business courses in a mid-sized university. The study finds that the vulnerability index varies across disciplines and teaching modalities. As advanced language models become more common in academic settings and create new educational challenges, the study provides an intuitive and practical mechanism for instructors and academic units to measure and assess the vulnerability of their courses to various language-based predictive models.

Student counselors and tutors guide students' choices of study profiles (subjects) within Dutch secondary education. This study addressed three research questions: (1) According to counselors and tutors, what factors should inform students' study profile choices? (2) Into what types can the views of counselors and tutors be classified? (3) According to counselors and tutors, which factors should secondary school students consider when choosing their study profiles in a forced-choice situation? Interviews held with 70 tutors and counselors identified students' interests, abilities, and future-oriented considerations as most important (RQ1). Six types of views were identified in which one, two, or all of the above-mentioned factors were regarded the most important by the participants (RQ2). Responses to the forced-choice situations largely confirmed different perspectives on the factors: the majority of participants perceived students' interests very important (RQ3).

This study investigates the use of overt and null subjects in Bulgarian in child heritage speakers with L2 German. The alternation of overt and null pronominal subjects in null-subject languages like Bulgarian depends on grammatical and discourse conditions and contrasts with German. Oral narratives were elicited in Bulgarian, comparing the performance of the heritage children to that of monolingual children and adults. Overall 68 Bulgarian narratives of 39 speakers were analysed as to the use of overt and null pronominal subjects in topic-continuity and topic-shift contexts. The results reveal similar subject realisation for all speakers, supporting early acquisition of null-subject grammars. Analyses of topic-continuity and -shift contexts showed similar overall patterns in children's and adults' subject use, with children producing somewhat more overt subjects in topic-continuity and ambiguous overt pronouns in topic-shift contexts than adults. However, the bilinguals used significantly more ambiguous null subjects than monolinguals. These results suggest that fine-grained discourse constraints of null-subject grammars are more difficult for bilinguals to acquire and maintain. The near adult-like performance of the bilinguals in some contexts can be attributed to the fact that most of them were Bulgarian-dominant and received non-attrited parental input. Differences are also attributable to cross-linguistic influence.

Abstract The continued evolution of SARS-CoV-2 underscores the need to understand qualitative aspects of the humoral immune response elicited by spike immunization. Here, we combine monoclonal antibody (mAb) isolation with deep B cell receptor (BCR) repertoire sequencing of rhesus macaques immunized with prefusion-stabilized spike glycoprotein. Longitudinal tracing of spike-sorted B cell lineages in multiple immune compartments demonstrates increasing somatic hypermutation and broad dissemination of vaccine-elicited B cells in draining and non-draining lymphoid compartments, including the bone marrow, spleen and, most notably, periaortic lymph nodes. Phylogenetic analysis of spike-specific monoclonal antibody lineages identified through deep repertoire sequencing delineates extensive intra-clonal diversification that shaped neutralizing activity. Structural analysis of the spike in complex with a broadly neutralizing mAb provides a molecular basis for the observed differences in neutralization breadth between clonally related antibodies. Our findings highlight that immunization leads to extensive intra-clonal B cell evolution where members of the same lineage can both retain the original epitope specificity and evolve to recognize additional spike variants not previously encountered.

Abstract Introduction Emergency care of critically ill patients in the trauma room is an integral part of interdisciplinary work in hospitals. Live threatening injuries require swift diagnosis, prioritization, and treatment; thus, different medical specialties need to work together closely for optimal patient care. Training is essential to facilitate smooth performance. This study presents a training tool for familiarization with trauma room algorithms in immersive virtual reality (VR), and a first qualitative assessment. Materials and methods An interdisciplinary team conceptualized two scenarios and filmed these in the trauma room of the University Medical Center Mainz, Germany in 3D-360°. This video content was used to create an immersive VR experience. Participants of the Department of Anesthesiology were included in the study, questionnaires were obtained and eye movement was recorded. Results 31 volunteers participated in the study, of which 10 (32,2%) had completed specialist training in anesthesiology. Participants reported a high rate of immersion (immersion(mean) = 6 out of 7) and low Visually Induced Motion Sickness (VIMS(mean) = 1,74 out of 20). Participants agreed that VR is a useful tool for medical education (mean = 1,26; 1 very useful, 7 not useful at all). Residents felt significantly more secure in the matter after training (p

This article aims to present the overview of the situation during the coronavirus disease 2019 (COVID-19) pandemic about issues concerning the prevalence of mental disorders such as depression, anxiety, rate of suicide attempts, and long COVID (LC) infections in the general population during COVID-19 pandemic. Analysis of the literature (in English, Polish and Spanish language) on topics related to COVID-19, mental disorders (suicide attempts, depression, anxiety) and LC infection published during the 4 years (2020–2023) was done using Pubmed and PubMed Central search engine. Keywords such as “COVID-19,” “mental disorders,” “long COVID infection,” “depression,” “anxiety,” “suicide attempts” were used during the search. The conduct of this review/comment followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol, which corresponds to a checklist of 27 items designed to facilitate the development and reporting of a robust protocol for systematic reviews or meta-analyses. Overall 35 studies were selected and analyzed in the review on topics: including among others LC (14 studies), suicide attempts (7 studies), mental disorders (depression, anxiety) (14 studies). The main issues raised in the articles were: higher risk of LC symptoms in women, fatigue and brain fog listed as frequently encountered patient’s complaints together with anxiety, depression, loneliness, especially in younger age groups and in women. Issues regarding LC, mental disorders and suicide attempts requires further research as the results vary in different countries. Int J Occup Med Environ Health. 2024;37(3):360–80

Abstract The development of reliable computational methods for novel battery materials has become essential due to the recently intensified research efforts on more sustainable energy storage materials. Here, we use a recently developed framework allowing to consistently incorporate quantum-mechanical activation barriers to classical molecular dynamics simulations to study the reductive solvent decomposition and formation of the solid electrolyte interphase for a graphite/carbonate electrolyte interface. We focus on deriving condensed-phase effective rates based on the elementary gas-phase reduction and decomposition energy barriers. After a short initial transient limited by the elementary barriers, we observe that the effective rate shows a transition to a kinetically slow regime influenced by the changing coordination environment and the ionic fluxes between the bulk electrolyte and the interface. We also discuss the impact of the decomposition on the ionic mobility. Thus, our work shows how elementary first-principles properties can be mechanistically leveraged to provide fundamental insights into electrochemical stability of battery electrolytes.

Background: The COVID-19 lockdown forced students and teachers to adjust to remote lecturers and digital learning material and design criteria for online classes became the centre of discussion. Objectives: The purpose of this empirical study was to investigate the relationship between design principles of educational online practices in higher education and students' active engagement in the online learning process. Methods: A total of 127 students participated in the study after their first semester of fully online classes resulting from the COVID-19 lockdown. The online classes enabled real-time communication and allowed for the creation of professional learning communities or the collaborative creation of content, for example. To evaluate the classes and to indicate perceived student learning, the study applied scales for measuring academic student engagement, as well as the four distinct factors for assessing online teaching effectiveness. Results and Conclusions: Bivariate correlational analysis suggested that the two design elements Time on Task (TT) and Active Learning (AL) are related to emotional engagement at a meaningful level thus influencing student commitment and class activities. The results further indicated that TT and AL are significant design elements in relation to perceived usefulness and students' perceived learning. Implications: The results may identify effective means to support and enhance student engagement in online settings, thus improving the quality of online teaching and learning.

The stability of catalyst layers and membranes in proton exchange membrane water electrolysis (PEMWE) cells represents an ongoing challenge, compounded by the dissolution of components and migration of elements within the catalyst‐coated membrane (CCM). Conventional microscopy methods often struggle to efficiently evaluate large cross‐sections of PEMWE membranes, which is essential for representative analysis of technical scale CCMs. Herein, synchrotron radiation‐based X‐Ray fluorescence microscopy is exploited to analyze the stability of CCMs with around 1 μm resolution and a field of view of ≈200 × 75 μm2. Three application scenarios are investigated: 1) migration of catalyst elements, 2) dissolution of components, and 3) contaminated water supply containing Fe2+ ions. XRF is performed at three different X‐Ray energies (11.7, 11.4, and 11.0 keV), revealing the local elemental composition, including Pt, Ir, Ti, and Fe, under different stressing conditions. Notable observations include the distribution of Ir across the membrane and in the cathode catalyst layer, localization of Pt within the membrane, accumulation of Ti in the cathode catalyst layer, and minimal presence of Fe. XRF has been demonstrated to be a powerful analytical tool for accurate and high throughput imaging of catalyst degradation in PEMWE scenarios, particularly of technical scale devices.

Background With a growing population of older people in all Western countries, interprofessional education (IPE) can help to prepare students for the complex care for these patients. Which aspects of this complex care could benefit from IPE? In this study we evaluated the differences in content of health care plans made by students who participated in IPE. Methods Undergraduate nursing and medical students were included and attended four sessions in which they wrote a health care plan for a paper-based geriatric patient case. Approximately half of the students were included in the IPE-group. To evaluate the content of interprofessional collaboration between the students, the other half of the students were included in a ‘uniprofessional education’ (UPE) group. UPE-students made the health care plan alone. In the IPE-group a medical and a nursing students compiled the health care plan together. All health care plans were assessed by comparing them with a validated health care plan. We zoomed into the differences in the content of the health care plans, and calculated a score ratio, proportion of correct items. Results The health care plans made by IPE-students had an average score ratio of 0.31. The health care plans made by UPE-students had an average score ratio of 0.22. Most differences were found in the subcategories medication, nursing actions and aftercare. Specific items within these categories were more frequently thought of in the IPE-group than in the UPE-group, for example delirium interventions and consultation with a transfer nurse. Conclusion This study gives insights into which health care actions are more often considered by interprofessional couples in IPE than by students in UPE. Awareness of these items in clinical practice could make a difference in the care for older patients.

Linear programs are frequently employed to optimize national energy system models, which are used to find a minimum-cost energy system. For the operation, they assume perfect forecasting of the weather and demands over the whole optimization horizon and can therefore perfectly fit the energy systems’ design and operation. Therefore, they will yield lower costs than any real energy system that only has partial forecasting available. We compare linear programming with a priority list, a heuristic operation strategy which uses no forecasting at all, in a model of a climate-neutral German energy system. We find a 28% more expensive energy system under the priority list. Optimizing the same energy system model with both strategies envelopes the cost and design of any energy system that has partial forecasting. We demonstrate this by incorporating some rudimentary forecasting into a modified priority list, which actually reduces the gap to 22%. This is thus an approach to find an upper bound for how much a linear program possibly underestimates the costs of a real energy system in Germany in regard to imperfect forecasting. We also find that the two approaches differ mainly in the dimensioning and operation of energy storage. The priority list yields 63% less batteries, 73% less thermal storage and 54% more hydrogen storage. The use of renewables and other components in the system is very similar.

Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized.

In densely populated countries, land competition is a key challenge in light of a growing population and the land-intensive decarbonization of energy supply. We apply an energy system model using linear optimization to Germany as an example for a densely populated and industrialized nation with a high energy demand to show how land competition affects the economics of land-intensive renewable energies. Bioenergy crops are currently cultivated on 6.5% of Germany’s land area. We find that allocating only 6% of the total land to the future energy system, which is even less than the current allocation to bioenergy crops, allows for a system that is close to the cost-minimum that we calculate when not restricting the land area. This 6% of the land area is divided into 4% for photovoltaics (PV), 2% for onshore wind and 0% for bioenergy crops. This would save 15billion€/a (15.1%) relative to the system that matches current political targets for utility-scale PV. For areas exceeding this 6%, we find that the most cost-efficient utilization comes from bioenergy crops, but they only add value to the energy system if there is plenty of land available. The value of land to the energy system is at least twice as high for 0% remaining emissions when compared to the case of 10% remaining green house gas emissions, although both scenarios are separated by less than five years according to current German law. Both our findings underline that considering the value of land as early as possible is necessary when developing state policies that shall lead to cost-efficient renewable energy systems.

Physiologically based pharmacokinetic (PBPK) modelling is an important tool to predict drug disposition in the body. Rabbits play a pivotal role as a highly valued small animal model, particularly in the field of ocular therapeutics, where they serve as a crucial link between preclinical research and clinical applications. In this context, we have developed PBPK models designed specifically for rabbits, with a focus on accurately predicting the pharmacokinetic profiles of protein therapeutics following intravenous administration. Our goal was to comprehend the influence of key physiological factors on systemic disposition of antibodies and their functional derivatives. For the development of the systemic PBPK models, rabbit physiological factors such as gene expression, body weight, neonatal fragment crystallizable receptor (FcRn) binding, target binding, target concentrations, and target turnover rate were meticulously considered. Additionally, key protein parameters, encompassing hydrodynamic radius, binding kinetic constants (KD, koff), internal degradation of the protein-target complex, and renal clearance, were represented in the models. Our final rabbit models demonstrated a robust correlation between predicted and observed serum concentration-time profiles after single intravenous administration in rabbits, covering IgG, Fab, F(ab)2, Fc, and Fc fusion proteins from various publications. These pharmacokinetic simulations offer a promising platform for translating preclinical findings to clinical settings. The presented rabbit intravenous PBPK models lay an important foundation for more specific applications of protein therapeutics in ocular drug development.

Abstract Recombinant native-like HIV-1 envelope glycoprotein (Env) trimers are used in candidate vaccines aimed at inducing broadly neutralizing antibodies. While state-of-the-art SOSIP or single-chain Env designs can be expressed as native-like trimers, undesired monomers, dimers and malformed trimers that elicit non-neutralizing antibodies are also formed, implying that these designs could benefit from further modifications for gene-based vaccination approaches. Here, we describe the triple tandem trimer (TTT) design, in which three Env protomers are genetically linked in a single open reading frame and express as native-like trimers. Viral vectored Env TTT induced similar neutralization titers but with a higher proportion of trimer-specific responses. The TTT design was also applied to generate influenza hemagglutinin (HA) trimers without the need for trimerization domains. Additionally, we used TTT to generate well-folded chimeric Env and HA trimers that harbor protomers from three different strains. In summary, the TTT design is a useful platform for the design of HIV-1 Env and influenza HA immunogens for a multitude of vaccination strategies.

Supramolecular peptide nanofiber hydrogels are emerging biomaterials for tissue engineering, but it is difficult to fabricate multi-functional systems by simply mixing several short-motif-modified supramolecular peptides because relatively abundant motifs generally hinder nanofiber cross-linking or the formation of long nanofiber. Coupling bioactive factors to the assembling backbone is an ideal strategy to design multi-functional supramolecular peptides in spite of challenging synthesis and purification. Herein, a multi-functional supramolecular peptide, P1R16, is developed by coupling a bioactive factor, parathyroid hormone related peptide 1 (PTHrP-1), to the basic supramolecular peptide RADA16-Ⅰ via solid-phase synthesis. It is found that P1R16 self-assembles into long nanofibers and co-assembles with RADA16-Ⅰ to form nanofiber hydrogels, thus coupling PTHrP-1 to hydrogel matrix. P1R16 nanofiber retains osteoinductive activity in a dose-dependent manner, and P1R16/RADA16-Ⅰ nanofiber hydrogels promote osteogenesis, angiogenesis and osteoclastogenesis in vitro and induce multi-functionalized osteoregeneration by intramembranous ossification and bone remodeling in vivo when loaded to collagen (Col) scaffolds. Abundant red blood marrow formation, ideal osteointegration and adapted degradation are observed in the 50% P1R16/Col scaffold group. Therefore, this study provides a promising strategy to develop multi-functional supramolecular peptides and a new method to topically administrate parathyroid hormone or parathyroid hormone related peptides for non-healing bone defects.

The advent of X-ray free-electron lasers (XFELs) has revolutionized fundamental science, from atomic to condensed matter physics, from chemistry to biology, giving researchers access to X-rays with unprecedented brightness, coherence and pulse duration. All XFEL facilities built until recently provided X-ray pulses at a relatively low repetition rate, with limited data statistics. Here, results from the first megahertz-repetition-rate X-ray scattering experiments at the Spectroscopy and Coherent Scattering (SCS) instrument of the European XFEL are presented. The experimental capabilities that the SCS instrument offers, resulting from the operation at megahertz repetition rates and the availability of the novel DSSC 2D imaging detector, are illustrated. Time-resolved magnetic X-ray scattering and holographic imaging experiments in solid state samples were chosen as representative, providing an ideal test-bed for operation at megahertz rates. Our results are relevant and applicable to any other non-destructive XFEL experiments in the soft X-ray range.

Der Beitrag stellt die im Rahmen des Projekts InDigO (Inklusion und Digitalisierung im OER-Format lernen, weiterentwickeln und verbreiten) entstandene Kooperation der Hochschulstandorte Bielefeld und Köln dar. Anhand einer gemeinsam entwickelten Seminarkonzeption zur inklusionsorientierten Gestaltung von Übergängen in Schule wird die kollaborative Nutzung und Weiterentwicklung von OER in der Hochschullehre und die Förderung inklusions- und digitalisierungsbezogener Kompetenzen in der universitären Lehrer:innenbildung beschrieben. Die Reflexionsergebnisse von Lehrenden und Studierenden, die im Anschluss an das Seminar erhoben wurden, zeigen vielfältige Chancen, aber auch komplexe Herausforderungen beim Einsatz von OER in der Hochschullehre.

BackgroundObesity and caries have become increasingly prevalent. As of yet, research results on the relationship between obesity and caries in children and adolescents have been inconclusive. This study aimed to evaluate the association between caries and obesity in adolescents.MethodsThis was a cross-sectional study of a convenience sample of 187 Puerto Rican adolescents aged 13–19 years, attending, among them, five high schools. Each participant received dental exams for caries using the criteria of the International Caries Detection and Assessment System (ICDAS), had his or her body mass index (BMI) determined, and took a 19-item risk factor questionnaire. The Significant Caries (SiC) index (for DMFT) was calculated to compare obese and healthy adolescents. Statistical analysis was performed using descriptive and inferential statistics.ResultsNearly 60% of the sample population was female, with a mean age of 15.7 (±1.25). The mean BMI percentile was 72.24 (±28.78); 48.66% of the participants had a healthy weight, 19.79% were overweight, and 30.48% were obese. Dental caries was observed in 68% of the participants; the mean caries index D3-6MFS was 5.17(±5.92) and the mean D3-6MFT was 3.59 (±3.97). No significant differences were found between caries indexes and obesity status (P > 0.05). The median (p25, p75) SiC index among overweight/obese adolescents was 9.5 (7, 12), whereas for healthy weight/underweight participants was 7 (5, 8) (p

Especially in the energy supply of multi-family houses, a wide variety of stakeholders are involved, from owners, to users, to energy service providers and society. They usually have different requirements and understandings of optimality, but ultimately have to make joint decisions and thus sensible compromises. In Germany in particular, there are a large number of multi-family houses and, at the same time, many government restrictions and subsidies in terms of energy supply. This makes it difficult to make clear recommendations for the choice of an energy supply concept that takes all stakeholder interests into account. We first identify the relevant stakeholders and define their objectives. In order to relate these with one another, we present a methodology based on energy system simulation and TOPSIS to make energy concepts objectively evaluable. A generic multi-family house with 40 residential units is examined, combining different energy technologies and insulation standards. There is no energy concept that satisfies all stakeholders equally and it is difficult to build coalitions between them. The best results are achieved by air-source heat pumps in combination with photovoltaic.

Abstract Background This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care. Methods Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre‐ and post‐LPS launch were compared. Results Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%–8.4%, p = 0.001), with outpatient procedures increasing over 5‐fold (3.3% pre‐LPS to 18.7% post‐LPS, p