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Pesticides from agricultural practices are among the most pressing reasons why groundwater sources do not reach the good chemical status standards as required by the European Water Framework directive. Complementary to previous federal pesticide reports, we analysed groundwater-monitoring data from 13 German Länder assembled in a database consisting of 26.192 groundwater measuring sites sampled between 1973 and 2021 of in total 521 parent compounds and metabolites. This study focuses on agricultural plant protection products. The monitored substance spectrum and site density developed over time and differs between Länder. More than 95 % of all samples lie below the respective (multiple) limits of quantification (LOQ). We thus report the frequency of exceedance above concentration thresholds, which allows to compare measurements temporally and spatially. Pesticide detections were found in all aquifer types, land uses and well screen depths. Most detections of higher concentrations were found in agricultural areas, at shallow screen depth in porous aquifers. Karst aquifers showed also a higher percentage of samples in higher concentration classes. Metabolites with high mobility and persistence were found in higher concentration ranges. Herbicides and metabolites thereof dominate the top 20 of pesticides that most frequently exceed 0.1 μg L -1 . The ranking for 2010-2019 includes both authorised and banned compounds and their occurrence is discussed in the context of their mobility, persistence and underlying monitoring density. Yearly exceedance frequencies above 0.05, 0.1 μg L -1 and higher thresholds of metazachlor and its esa-metabolite, and national sales data of the parent compound did not show a temporal correlation in subsequent years. This study stresses the need for the harmonisation of heterogeneous pesticide data. Further, a characterisation of the groundwater data used to analyse pesticide occurrence in selected concentration ranges for relevant site factors and compound properties and provides a pesticide ranking based on exceedance frequencies is provided., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Effective handoffs in the intensive care unit (ICU) are key to patient safety., Purpose: This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement., Materials and Methods: Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived., Results: The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety., Conclusion: Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The rise in intensive care treatment procedures is accompanied by an increase in the complexity of decisions regarding the selection, administration and duration of treatment measures. Whether a treatment goal is desirable in an individual case and the treatment plan required to achieve it is acceptable for the patient depends on the patient's preferences, values and life plans. There is often uncertainty as to whether a patient-centered treatment goal can be achieved. The use of a time-limited treatment trial (TLT) as a binding agreement between the intensive care unit (ICU) team and the patient or their legal representative on a treatment concept over a defined period of time in the ICU can be helpful to reduce uncertainties and to ensure the continuation of intensive care measures in the patients' best interest., (© 2024. The Author(s).)

Background: The tenosynovial giant cell tumor (pigmented villonodular synovitis) is a proliferative, mainly benign soft tissue tumor of the tendon sheaths, bursae and joints arising from the synovia. It can be divided into circumscribed localized and destructive diffuse types. Approximately 1% of all joint diseases are due to this entity. The tumor is considered as a rarity. Mostly case studies exist. For this study the focus was set on the localized type (L-TSRZT), which accounts for 90% of the diagnoses of this tumor. Given its rarity, data are limited. Therefore, the research aim was to provide data on prevalence, primary location and sensitivity of clinical versus histopathological diagnosis in a German sample., Methods: Based on the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology, the data of the L‑TSRZT were retrospectively analyzed (time frame 1 January 2018-28 December 2020)., Results: This database contained N = 7595 cases of arthropathy. A total of n = 45 patients with the diagnosis L‑TSRZT were identified. The prevalence of the tumor was 0.6%, 95% CI [0.4%, 0.8%], or 5.9 cases per 1000. The primary location involved the finger (48.9%). In 14 of 45 cases the diagnosis was correctly determined from the clinical side, corresponding to a sensitivity of 31.1%, 95% CI [18.2%, 46.7%]., Conclusion: For the first time, this paper was able to provide data on a large sample for Germany. Notably, the low sensitivity of the clinical diagnosis confirms the importance of histopathology for diagnosing L‑TSRZT., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

In this initial study of a research project, this paper seeks to understand the thermal conditions in the cities of Lisbon and Munich, specifically focusing on Urban Heat Island intensity and on thermal comfort using the Universal Thermal Climate Index modeling data at the Local Climate Zone scale. Based on these datasets, Munich has exhibited more unfavourable thermal conditions than Lisbon. In terms of UHII, both cities have shown that low, medium, and high rise compact urban areas and bare rock or paved areas have the highest values, while sparsely built areas have the lowest. These results differ from the UTCI, which indicates that in Lisbon and Munich, these sparsely built areas as well as areas with low plants and vegetation are the most uncomfortable. In Munich, the population was exposed to very strong heat stress, while Lisbon experienced strong heat stress conditions. Conversely, low, medium, and high rise compact urban areas and densely wooded areas in Munich, and scattered trees areas and large low-rise urban areas in Lisbon, have demonstrated the lowest monthly mean and average maximum values. These results will be further explored in future studies in the city of Lisbon and cross-checked with data obtained from roving missions. This will enable a more detailed temporal and local analysis., (© 2024. The Author(s).)

Purpose: The Comprehensive assessment of Acceptance and Commitment Therapy (CompACT) is a 23-item questionnaire measuring psychological flexibility, a quality of life protective factor. An 18-item version was recently produced. We assessed validity and reliability of CompACT, and equivalence of paper and electronic (eCompACT) versions in people with multiple sclerosis (PwMS) in Italy, Germany and Spain., Methods: We used confirmatory factor analysis and assessed CompACT-23 and CompACT-18 measurement invariance between the three language versions. We assessed construct validity (Spearman's correlations) and internal consistency (Cronbach's alpha). Test-retest reliability (intraclass correlation coefficient, ICC) and equivalence of paper and eCompACT (ICC and linear regression model for repeated measures) were assessed in subsamples of PwMS., Results: A total of 725 PwMS completed the study. The three-factor structure of the CompACT-23 showed poor fit (RMSEA 0.07; CFI 0.82; SRMR 0.08), while the fit of the CompACT-18 was good (RMSEA 0.05; CFI 0.93; SRMR 0.05). Configural and partial metric invariance were confirmed, as well as partial scalar invariance (reached when five items were allowed to vary freely). The CompACT-18 showed good internal consistency (all alpha ≥ 0.78); and test-retest reliability (all ICCs ≥ 0.86). Equivalence between paper and eCompACT was excellent (all ICCs ≥ 0.86), with no mode, order, or interaction effects., Conclusion: Results support using the refined CompACT-18 as a three-factor measure of psychological flexibility in PwMS. Paper and eCompACT-18 versions are equivalent. CompACT-18 can be used cross-culturally, but sub-optimal scalar invariance suggests that direct comparison between the three language versions should be interpreted with caution., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Although the use, structural variety, and prevalence of synthetic cannabinoids (SCs) have steadily increased on the drug market, they are rarely analyzed in abstinence control programs for driver's license regranting. The aim of this study was to determine the SC prevalence in these programs by analyzing hair samples collected between March 2020 and March 2021 from various regions in Germany, mainly Bavaria (40%). Specimens were analyzed quantitatively for drugs of abuse and qualitatively for 107 SCs. Hair samples were screened by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and to search for unknown SC analogs, positive samples were additionally screened by liquid chromatography-high resolution time of flight mass spectrometry (LC-qTOF/MS). The analysis of 5097 hair samples resulted in 181 SC detections (3.6%), showing a wide range of 44 SCs, with up to 13 different compounds found in a single sample. The most prevalent compounds were 5F-MDMB-PICA and MDMB-4en-PINACA; furthermore, 10 new substances not initially covered by LC-MS/MS analysis were detected by LC-qTOF/MS. The SC positivity rate was comparable to cocaine (5.4%) and amphetamine (2.6%). Only in 35 cases (0.7%), SC analysis was requested by the clients, highlighting the insufficient coverage of SC consumption in the studied collective. In summary, hair sample analysis proved to be a valuable tool to monitor the use of SCs. In order to keep pace with newly emerging SC analogs, an up-to-date analytical method is essential. Prospectively, SCs should be more routinely screened in hair analysis for abstinence control to avoid cannabis substitution by SCs., (© 2023 The Authors. Drug Testing and Analysis published by John Wiley & Sons Ltd.)

Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Although the incidence of LB in Germany has been assessed in several studies, those studies either used data from statutory surveillance, which frequently underreport cases, or data from health claims databases, which may overestimate cases due to non-specific LB case definitions. Here, using a more specific case definition, we describe the incidence of medically-attended LB by disease manifestation, age group, and federal state for the period 2015-2019. Both inpatient and outpatient cases were analyzed from a claims database. To be eligible for inclusion, patients were required to have an LB specific ICD-10 GM diagnosis code plus an antibiotic prescription, and for disseminated manifestations, a laboratory test order additionally. LB cases were classified as erythema migrans (EM), or disseminated disease including Lyme arthritis (LA), Lyme neuroborreliosis (LNB), and all other disease manifestations (OTH). Between 2015 and 2019, the incidence of medically-attended LB cases ranged from 195.7/100,000 population per year (95% confidence interval [CI], 191.0 - 200.5) to 254.5/100,000 population per year (95% CI, 249.0 - 260.0) per year. The majority of cases (92.2%) were EM, while 2.8% presented as LA, 3.8% as LNB, and 1.2% as OTH. For both EM and disseminated disease, the incidence peaked in children aged 5-9 years and in older adults. By federal state, the incidence of medically-attended EM ranged from 74.4/100,000 population per year (95% CI, 71.9 - 77.0) per year in Hamburg, to 394.1/100,000 population per year (95% CI, 370.7 - 417.6) per year in Saxony, whereas for medically-attended disseminated disease, the highest incidence was in Thuringia, Saxony, and Bavaria (range: 22.0 [95% CI, 19.9 - 24.0] to 35.7 [95% CI, 34.7 - 36.7] per 100,000 population per year). This study comprehensively estimated the incidence of all manifestations of medically-attended LB and showed a high incidence of LB throughout Germany. Results from the study support performing epidemiological studies in all federal states to measure the burden of LB and to invest in public health interventions for prevention., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gordon Brestrich reports financial support and writing assistance were provided by Pfizer Pharma GmbH, Berlin, Germany. Gordon Brestrich reports a relationship with Pfizer Pharma GmbH, Berlin, Germany that includes: employment. This study was supported and jointly funded by Valneva and Pfizer as part of their co–development of a Lyme disease vaccine. All authors had complete autonomy for the process of designing the study, carrying out the analysis, interpreting the results and writing the manuscript. GB, AP, JHS, FJA, and HY are employees of Pfizer in Germany, Austria and the US. CH is a former employee of Pfizer in Germany and was involved in the design of this study, developing the study protocol, and in analyzing the data. JD and NK are employees of WIG2 GmbH, which is an independent insti-tute and paid consultant to Pfizer Pharma GmbH for designing the study, carrying out the analysis, interpreting the results and writing the manuscript. JS received an honorarium from Pfizer Pharma GmbH in connection with designing the study and interpreting the results. JS received not further funding from another company or other partners. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

This paper explores the origins of German banks' risk‐taking in the years preceding the 1931 crisis. The 1920s were marked by a large and prolonged increase in capital flows into Germany, chiefly from the United States and the United Kingdom. This coincided, at the individual bank level, with a rise in leverage and a fall in liquidity. We examine possible connections between the two phenomena. Our analysis is based on a combination of historiographical work and statistical modelling based on a newly hand‐collected bimonthly dataset on German reporting banks from 1925 to 1935. Bank by bank we examine the effects of foreign inflows on decisions related to leverage, lending, and liquidity. The Dawes Plan of 1924 and the relative absence of a too‐big‐to‐fail (TBTF) environment allow us to mitigate endogeneity concerns. We suggest that while capital inflows did not seem to impact banks' liquidity decisions, their impact on leverage was non‐negligeable. [ABSTRACT FROM AUTHOR]

This paper studies important determinants of adult self-control using population-representative data and exploiting Germany's division as quasi-experimental variation. We find that former East Germans have substantially more self-control than West Germans and provide evidence for government surveillance as a possible underlying mechanism. We thereby demonstrate that institutional factors can shape people's self-control. Moreover, we find that self-control increases linearly with age. In contrast to previous findings for children, there is no gender gap in adult self-control and family background does not predict self-control. [ABSTRACT FROM AUTHOR]

• The highlights of this work can be seen in several focal points. First, the parameters slip amplitude, contact pressure and fatigue loading were investigated independently of each other, for the material groups of cast iron and aluminum on a special test bench. It was thus possible to experimentally determine three-dimensional fretting maps (fretting fatigue strength versus slip amplitude and contact pressure). In this way, a worst-case parameter combination of slip amplitude and contact pressure could be determined, which served as the basis for the development of a calculation concept. • The second highlight is the developed calculation rule itself. This is based on the FKM guideline from Germany and extends it to include the aspect of fretting fatigue. The FKM guideline is a robust guideline for engineers and designers. With the extended method, they now have the possibility to calculate fretting fatigue components in a practical way, which was not possible before. • The third highlight is the validation of the developed method on realistic connecting rod components. With the new calculation method, it was possible to achieve a significant increase in calculation accuracy (in contrast to the classic FKM guideline). The original error of up to 90% in the determination of the degree of utilization was reduced to a maximum error of 18.7%. Many components made of cast iron (e.g., in combustion engines) and aluminium (e.g., in aircraft construction) are subject to fretting fatigue. This results in a need for a method for assessing the strengths of the aforementioned materials that takes into account the reduction in fatigue strength due to fretting as well as the accompanying reduction in service life. In a first paper, the authors already presented a calculation method for the fail-safe design of steel–steel contacts subject to fretting fatigue. This enables the engineer or designer to perform a strength assessment for any component connection made of steel. The calculation method is based on a tribological worst-case assumption and can be integrated into the analytical strength assessment of the internationally known FKM Guideline. The strength reduction is taken into account by use of empirically determined fretting factors. The frequent failures of component connections made of cast iron and aluminium in the field made an extension of the calculation method became necessary. This work therefore includes experimental investigations into the materials EN-GJS-700, EN-GJS-400 and EN-GJL-300 (cast iron), as well as EN AW-7075 T651, EN AW-6082 T651 and EN AW-5083 (aluminium). Since the main parameters determining fretting fatigue strength are slip amplitude and contact pressure, the worst-case combinations of these parameters (resulting in the lowest friction fatigue strength) were first determined for each of the two material groups using a laboratory test setup. These parameters could be found at s a = 10 μ m ; p = 40 M P a for cast iron and s a = 5 μ m ; p = 10 M P a for aluminium. Based on these worst-cases, the fretting fatigue limits of the aforementioned materials were determined, as well as the effect of mean stress. The fretting factors of the materials were derived from the experimental results. Additional experimental investigations using a connecting-rod-like geometry served to validate an application typical of the industry. Using the calculation method, the degree of utilisation of the connecting rods could be determined with good accuracy (maximum error: 18.7 %). [ABSTRACT FROM AUTHOR]

Objective: Endometriosis affects approximately 10% of women of reproductive age and leads to significant morbidity and financial burden. Consequently, countries such as France and Germany are formulating strategies to combat endometriosis. In this study, we propose the implementation of our three‐dimensional model (3D‐E) to raise awareness about endometriosis and enhance timely diagnosis, treatment, and long‐term care for affected patients. Methods: Based on the adapted Six Sigma Principle and the modified recommendation of Sales et al. for implementing evidence‐based findings into a clinical routine, we first conducted a comprehensive investigation to identify risk factors leading to diagnostic delay of endometriosis. After identifying improvable factors, the applicable options were selected due to defined criteria such as integrability in the clinical routine, cost‐effectiveness, and evidence‐based‐principle. Finally, solutions feasible for health care providers were integrated and the 3D‐E model was established. Results: Some of the main risk factors contributing to diagnostic delays are symptoms acceptance and misinterpreted symptoms, especially if presenting to nongynecologists in cases of extragenital endometriosis with atypical presentation. Therefore, we tried to sensitize colleagues (first dimension) with a review paper in Germany's largest medical journal and started an elective for medical students (second dimension) at our university. In order to involve additional health care professionals in endometriosis care (third dimension), we are preparing the concept of the EndoNurse. Conclusion: The 3D‐E model is a relatively low‐cost, comprehensive, and worldwide adaptable approach for facilitating knowledge transfer, sensitizing health care providers, and improving endometriosis diagnostics and therapy for patients with endometriosis who are in the center of the model. Synopsis: The 3D‐E model could have the potential to be a first step to improve endometriosis awareness and care. [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of the paper is to offer a personal view on the development of documentation/information and documentation (IuD) in Germany, while pointing out the need to further investigate the specific features of its development paths. The methodology is based on critical review of the available literature sources in the German language. Design/methodology/approach: The paper uses the method of critical review of published documents in journals (especially in Nachrichten für Dokumentation), books and reports of state and provincial administrations that are directly related to monitoring and/or encouraging the development of the young field of documentation. Findings: The paper offers a review and interpretation of the most significant development phases, the contributions of individuals and the influence of the official state and information policy based on the consulted sources. Research limitations/implications: This research is limited to the literature written in German language. Practical implications: The paper could be of interest to researchers and professionals who are interested in the development of documentation. Social implications: The paper covers the period after the World War II until the end of 1980s that is especially interesting from the social point of view in divided Germany. Originality/value: To the author's knowledge, there is no comprehensive history of documentation in German-speaking countries written in English. This paper is the result of a research project started three years ago with colleagues from Germany, Austria and Switzerland, that aims to cover all phases of the appearance and development of information science in German-speaking countries and could be understood as a kind of introduction to papers planned to follow. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to explore and understand, how strong financial literacy influences the cognitive biases of students in Germany while investing. Second, it also evaluates the most influential cognitive biases that students encounter when undertaking their investment decisions within this environment. Design/methodology/approach: A quantitative approach is used to assess the relationship between financial literacy and students' investment-related cognitive biases by using the frameworks proposed by Clercq (2019) and Pompian (2012). Findings: The results advocate that the students' financial literacy positively impacts their cognitive biases within the investment process. It additionally revealed the most significant biases regarding students' investment decision-making and proposed the possible reasons behind their behavioral distortions. Research limitations/implications: The study provides a detailed review of the behavioral tendencies of the younger generation while investing and creates recommendations for prospective researchers. Originality/value: This research lies at the junction of the behavioral finance field, suggesting that it assists in developing a theoretical framework of cognitive biases within students' financial decisions. Furthermore, it serves as an addition to the financial management subject course that would provide valuable insights about, first and foremost, financial literacy and subsequently, the theory behind the investment process. [ABSTRACT FROM AUTHOR]

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Religiosity influences economic behavior in various domains, but what determines religiosity? Using data from the representative Socio‐Economic Panel Study for Germany (SOEP), this paper shows that religious activity increases after a family member's death. The life event's effect is larger after a partner's death when compared to a parent's death. Our results indicate that the influence of a family member's death on religious activity is temporary and are consistent with the religious coping hypothesis. [ABSTRACT FROM AUTHOR]

How do far-right actors and issues structure public debates and become mainstream over time? Previous research has shown that far-right actors are central actors in political conflicts in Western Europe, partly due to their dominance in struggles on cultural issues. The entrenchment of the far right substantially depends on their networks and public visibility. However, we still lack a long-term understanding of public debates about far-right actors and their discursive interconnections across issues. In this paper, we deliver the first longitudinal analysis of the evolution and structure of far-right discourse networks and the diffusion of far-right ideas in public debates since the 1990s. Methodologically, this paper innovates by combining discourse network analysis with automated text analysis to investigate how the relations between far-right actors and issues are represented in mass media. We analyze more than 500,000 newspaper articles in six different mass media outlets in Germany. The results show that far-right actors have gained more public visibility since the 1990s. The study demonstrates that the mass media debates have introduced and amplified cultural issues "owned" by the far right. Far-right discourse networks in mass media have grown, discursive interactions have intensified and discourse networks have become more centralized. Our results indicate that the discursive mainstreaming of the far right evolved in the context of the "refugee crisis" in 2015, and was linked to the AfD's institutional access. Overall, the study aids in developing a better understanding of the success of the far right and the crucial role of public debates. [ABSTRACT FROM AUTHOR]

This study analyses the role of generalized trust and control in households' employment of domestic help. Applying a basic trust game with uncertainty, we argue that households differ in their estimate of the proportion of opportunistic domestic workers, variation which we ascribe to generalized trust. Households with low trust should estimate a lower proportion of non-opportunistic individuals, making them less willing to accept a domestic worker. Control, through direct supervision of the domestic worker, is assumed to serve as a substitute for trust and is expected to increase acceptance. We also consider the role of income, which we expect to alter the relation between the potential losses and gains associated with outsourcing. To test our hypotheses, we use a factorial survey conducted in 2020 in Germany and the UK (N = 1877) which enables us to explore the robustness of the effects across countries. Experimental results show that individuals are more accepting of domestic outsourcing if they have higher trust, higher income, and if control of the worker is easily possible. Interaction effects reveal that the positive effect of higher trust and higher income is only relevant in low control situations. This suggest that households with higher trust and income have an advantage when it comes to fully utilizing the benefits of domestic help since costly control is not required. Consequently, the results substantially contribute to existing literature on explaining causes of social inequality in service use beyond financial restrictions and shed light on the complex interplay of trust and control. [ABSTRACT FROM AUTHOR]

Wood has always been an indispensable material in human society throughout history. Its efficient utilization is even more crucial today in achieving the Sustainable Development Goals (SDGs). However, its production, trade, use, and recycling are seldom systematically assessed, with Germany being an exception due to the extensive work conducted by the University of Hamburg and the Thünen Institute over the years. To provide a more precise account of wood use, this study employs oven-dry metric tonne as the reference unit to construct a static wood flow based on the material flow analysis and wood resource balance in Germany in 2020. The Sankey diagrams comprehensively visualize the flow and stock of wood in various sectors, including forests, sawmills, pulp mills, buildings, energy, and waste. Results showed that forest felling volume exceeded growth due to significant wood demand and export, while forest carbon sinks increased because more hardwood was retained in German forests. The building and construction sector was the largest consumer of primary wood products, accounting for 52.1 % of the total, followed by furniture (29.5 %) and packaging (14.0 %). All waste paper was used to produce recycled fiber pulp, whereas only 14 % of waste wood was employed in particle board production. The woody biomass energy, amounting to 142.4 TWh, provided approximately 4.4 % of Germany's primary energy consumption, with around half of it used in private households. In addition to apparent data, this study also uses resource allocation, carbon storage, and cascade potential as examples to demonstrate that wood flow is applicable for further in-depth analysis, supporting wood efficient utilization. It can even be applied to any country and period with sufficient data and conversion factors, but here, they also prevented this study from comprehensively describing past and future wood flows. [Display omitted] [ABSTRACT FROM AUTHOR]

On the one hand, unemployment is known to have detrimental effects on individuals' mental health. On the other hand, poor mental health reduces re‐employment chances quite drastically, creating a vicious cycle. Active labour market policies (ALMPs) such as training programs or wage subsidies have been shown to ameliorate negative effects on mental health and improve labour market integration on average for the general unemployed population. In the context of individuals with severe mental health issues, however, it is unclear whether these interventions can be expected to deliver similar positive effects. In fact, one may argue that they have the potential to worsen employment prospects of individuals by adding additional stress to their pre‐existing mental health problems. Hence, this paper estimates the long‐term causal effects of ALMPs on the labour market integration of individuals with self‐reported severe mental health issues and compares estimates to individuals without such issues using unique combined survey and administrative data. Effects are estimated using the innovative double machine learning method and show that ALMPs do not only improve labour market integration of unemployed individuals with severe mental health issues, but they do so more effectively than for other unemployed individuals. [ABSTRACT FROM AUTHOR]

Transdisciplinary processes deal with transdisciplinary problems that are (i) complex, (ii) societally relevant, (iii) ill-defined, and (iv) real-world problems which often show a high degree of ambiguity resulting in contested perceptions and evaluations among and between scientists and practitioners. Therefore, they are susceptible to multiple trade-offs. Transdisciplinary processes construct socially robust orientations (SoROs) particularly for sustainable transitioning. The integration of science and practice knowledge on equal footing (1) is considered the core of transdisciplinary processes. Yet other forms of knowledge integration contribute essentially to construct SoROs. Individuals may (2) use different modes of thought; (3) refer to various cultures with diverse value and belief systems; and (4) problems are perceived and prioritized based on roles and interests. Coping with transdisciplinary problems, (5) purposeful differentiation and integration and (6) an integration of evolutionary evolving codes of representing knowledge are necessary. Finally, (7) what systems to integrate requires consensus-building among participating scientists and practitioners. This paper is Part I of a two-part publication. It provides a conceptualization of the different types of knowledge integration. Part II analyzes tasks, challenges, and barriers related to different types of knowledge integration in five transdisciplinary processes which developed SoROs for sensitive subsystems of Germany affected by the irresponsible use of digital data. • Systemic, epistemic, and normative feature characterize transdisciplinary problems. • Science and practice use different drivers, rationales, and reward systems. • Seven types of knowledge integration build the core of transdisciplinary processes. • Understanding knowledge integration requires history and theory of science analyses. • The types of knowledge integration improve the practice of transdisciplinarity. [ABSTRACT FROM AUTHOR]

Background: In 2019, the Digital Healthcare Act created the legal basis for prescribable mobile health applications, referred to as DiGA (in German: Digitale Gesundheitsanwendungen), as a novel healthcare delivery option in Germany [1, 2]., Objectives: The aim of this study is to analyze the use of DiGA in primary care, focusing on the influence of socio-demographic characteristics of family doctors (FDs) and patient-related factors., Methods: Pen-and-paper survey among 97 FDs in the district of Giessen, Hesse, Germany., Results: 59.4% of surveyed FDs have already prescribed DiGA. The age and digital affinity of FDs as well as the location of their practice are significantly correlated with the level of information and willingness to use DiGA. Male und younger FDs rate their digital affinity higher. When deciding whether to prescribe DiGA, 72.9% of surveyed physicians take patient-related factors such as digital affinity, motivation, age and health literacy into consideration., Conclusion: Socio-demographic characteristics of FDs and patient-related factors have an influence on the use of DiGA.

Background: In patients requiring general anesthesia, lung-protective ventilation can prevent postoperative pulmonary complications, which are associated with higher morbidity, mortality, and prolonged hospital stay. Application of positive end-expiratory pressure (PEEP) is one component of lung-protective ventilation. The correct strategy for setting adequate PEEP, however, remains controversial. PEEP settings that lead to a lower pressure difference between end-inspiratory plateau pressure and end-expiratory pressure ("driving pressure," ΔP) may reduce the risk of postoperative pulmonary complications. Preliminary data suggests that the PEEP required to prevent both end-inspiratory overdistension and end-expiratory alveolar collapse, thereby reducing ΔP, correlates positively with the body mass index (BMI) of patients, with PEEP values corresponding to approximately 1/3 of patient's respective BMI. Thus, we hypothesize that adjusting PEEP according to patient BMI reduces ΔP and may result in less postoperative pulmonary complications. Methods: Patients undergoing general anesthesia and endotracheal intubation with volume-controlled ventilation with a tidal volume of 7 ml per kg predicted body weight will be randomized and assigned to either an intervention group with PEEP adjusted according to BMI or a control group with a standardized PEEP of 5 mbar. Pre- and postoperatively, lung ultrasound will be performed to determine the lung aeration score, and hemodynamic and respiratory vital signs will be recorded for subsequent evaluation. The primary outcome is the difference in ΔP as a surrogate parameter for lung-protective ventilation. Secondary outcomes include change in lung aeration score, intraoperative occurrence of hemodynamic and respiratory events, oxygen requirements and postoperative pulmonary complications. Discussion: The study results will show whether an intraoperative ventilation strategy with PEEP adjustment based on BMI has the potential of reducing the risk for postoperative pulmonary complications as an easy-to-implement intervention that does not require lengthy ventilator maneuvers nor additional equipment. Trial registration: German Clinical Trials Register (DRKS), DRKS00031336. Registered 21st February 2023. Trial status: The study protocol was approved by the ethics committee of the Christian-Albrechts-Universität Kiel, Germany, on 1st February 2023. Recruitment began in March 2023 and is expected to end in September 2023. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that Omicron breakthrough infections can occur at higher SARS-CoV-2 antibody levels compared to previous variants. Estimating the magnitude of immunological protection induced from COVID-19 vaccination and previous infection remains important due to varying local pandemic dynamics and types of vaccination programmes, particularly among at-risk populations such as health care workers (HCWs). We analysed a follow-up SARS-CoV-2 serological survey of HCWs at a tertiary COVID-19 referral hospital in Germany following the onset of the Omicron variant. Methods: The serological survey was conducted in January 2022, one year after previous surveys in 2020 and the availability of COVID-19 boosters including BNT162b2, ChAdOx1-S, and mRNA-1273. HCWs voluntarily provided blood for serology and completed a comprehensive questionnaire. SARS-CoV-2 serological analyses were performed using an Immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Antibody levels were reported according to HCW demographic and occupational characteristics, COVID-19 vaccination and SARS-CoV-2 infection history, and multivariate linear regression was used to evaluate these associations. Results: In January 2022 (following the fourth COVID-19 wave in Germany including the onset of the Omicron variant), 1482/1517 (97.7%) HCWs tested SARS-CoV-2 seropositive, compared to 4.6% in December 2020 (second COVID-19 wave). Approximately 80% had received three COVID-19 vaccine doses and 15% reported a previous laboratory-confirmed SARS-CoV-2 infection. SARS-CoV-2 IgG geometric mean titres ranged from 335 (95% Confidence Intervals [CI]: 258–434) among those vaccinated twice and without previous infection to 2204 (95% CI: 1919–2531) among those vaccinated three times and with previous infection. Heterologous COVID-19 vaccination combinations including a mRNA-1273 booster were significantly associated with the highest IgG antibody levels compared to other schemes. There was an 8-to 10-fold increase in IgG antibody levels among 31 HCWs who reported a SARS-CoV-2 infection in May 2020 to January 2022 after COVID-19 booster vaccination. Conclusions: Our findings demonstrate the importance of ongoing COVID-19 booster vaccination strategies in the context of variants such as Omicron and despite hybrid immunity from previous SARS-CoV-2 infections, particularly for at-risk populations such as HCWs. Where feasible, effective types of booster vaccination, such as mRNA vaccines, and the appropriate timing of administration should be carefully considered. [ABSTRACT FROM AUTHOR]

Background: Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences. Methods: In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité—Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators. Results: The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment. Conclusions: Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace. [ABSTRACT FROM AUTHOR]

In the past three decades, there has been a rise in young academy movements in the Global North and South. Such movements, in at least Germany and the Netherlands, have been shown to be quite effective in connecting scientific work with society. Likewise, these movements share a common goal of developing interdisciplinary collaboration among young scientists, which contributes to the growth of a nation's-but also global-scientific endeavors. This paper focuses on the young academy movement in the fourth-largest country hosting the biggest Muslim population in the world, which is also the third-most populous democracy: Indonesia. We observe that there has been rising awareness among the young generation of scientists in Indonesia of the need to advocate for the use of sciences in responding to upcoming and current multidimensional crises. Science advocacy can be seen in their peer-based identification of Indonesia's future challenges, encompassing the fundamental areas for scientific inquiry, discovery, and intervention. We focus on the Indonesian Young Academy of Sciences (ALMI) and its network of young scientists. We describe ALMI's science communication practice, specifically SAINS45 and Science for Indonesia's Biodiversity, and how they have been useful for policymakers, media, and school engagements. The article closes with a reflection on future directions for the young academy movement in Indonesia and beyond., Competing Interests: Competing interests statement:The authors declare no competing interest.

Background: Self-initiated and proactive changes in working conditions through crafting are essential for shaping work and improving work-related well-being. Recently, the research stream of job crafting has been extended to other life domains. The present paper aims to study a novel crafting concept-work-nonwork balance crafting-investigating the role of its antecedents and identifying relevant outcomes. Work-nonwork balance crafting is defined as individuals' unofficial techniques and activities to shape their work-nonwork balance, here considering their life domain boundary preferences., Methods: In the study, 1,060 employees in three European countries (Austria, Germany and Switzerland) were surveyed in a longitudinal three-wave study with three-month intervals. We explored the influences of job/home demands and resources as antecedents of work-nonwork balance crafting. Important constructs for employee health and well-being (i.e., work engagement, work-related burnout, mental well-being and detachment from work) were investigated as outcomes., Results: The findings suggest that resources and demands in the context of work or home are key antecedents of work-nonwork balance crafting. Work-nonwork balance crafting was also predictive for important employee health and well-being outcomes over three months, mainly in a positive and health-promoting way., Conclusion: This study provides insights into the antecedents of proactive efforts to balance the complex interplay of life domains. By studying work-nonwork balance crafting, we provide a new perspective on crafting beyond job crafting, which may help maintain or improve employees' mental health and well-being., (© 2024. The Author(s).)

Agricultural pesticides, nutrients, and habitat degradation are major causes of insect declines in lowland streams. To effectively conserve and restore stream habitats, standardized stream monitoring data and societal support for freshwater protection are needed. Here, we sampled 137 small stream monitoring sites across Germany, 83 % of which were located in agricultural catchments, with >900 citizen scientists in 96 monitoring groups. Sampling was carried out according to Water Framework Directive standards as part of the citizen science freshwater monitoring program FLOW in spring and summer 2021, 2022 and 2023. The biological indicator SPEAR pesticides was used to assess pesticide exposure and effects based on macroinvertebrate community composition. Overall, 58 % of the agricultural monitoring sites failed to achieve a good ecological status in terms of macroinvertebrate community composition and indicated high pesticide exposure (SPEAR pesticides status class: 29 % "moderate", 19 % "poor", 11 % "bad"). The indicated pesticide pressure in streams was related to the proportion of arable land in the catchment areas (R 2  = 0.23, p < 0.001). Also with regards to hydromorphology, monitoring results revealed that 65 % of the agricultural monitoring sites failed to reach a good status. The database produced by citizen science groups was characterized by a high degree of accuracy, as results obtained by citizen scientists and professionals were highly correlated for SPEAR pesticides index (R 2  = 0.79, p < 0.001) and hydromorphology index values (R 2  = 0.72, p < 0.001). Such citizen-driven monitoring of the status of watercourses could play a crucial role in monitoring and implementing the objectives of the European Water Framework Directive, thus contributing to restoring and protecting freshwater ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The Hospice and Palliative Care Act of 2015 aimed at developing and regulating the provision of palliative care (PC) services in Germany. As a result of the legal changes, people with incurable diseases should be enabled to experience their final stage of life including death according to their own wishes. However, it remains unknown whether the act has impacted end-of-life care (EoLC) in Germany. Objective: The present study examined trends in EoLC indicators for patients who died between 2016 and 2020, in the context of Lower Saxony, Germany. Methods: Repeated cross-sectional analysis was conducted on data from the statutory health insurance fund AOK Lower Saxony (AOK-LS), referring to the years 2016–2020. EoLC indicators were: (1) the number of patients receiving any form of outpatient PC, (2) the number of patients receiving generalist outpatient PC and (3) specialist outpatient PC in the last year of life, (4) the onset of generalist outpatient PC and (5) the onset of specialist outpatient PC before death, (6) the number of hospitalisations in the 6 months prior to death and (7) the number of days spent in hospital in the 6 months prior to death. Data for each year were analysed descriptively and a comparison between 2016 and 2020 was carried out using t-tests and chi-square tests. Results: Data from 160,927 deceased AOK-LS members were analysed. The number of patients receiving outpatient PC remained almost consistent over time (2016 vs. 2020 p =.077). The number of patients receiving generalist outpatient PC decreased from 28.4% (2016) to 24.5% (2020; p <.001), whereas the number of patients receiving specialist outpatient PC increased from 8.5% (2016) to 11.2% (2020; p <.001). The onset of generalist outpatient PC moved from 106 (2016) to 93 days (2020; p <.001) before death, on average. The onset of specialist outpatient PC showed the reverse pattern (2016: 55 days before death; 2020: 59 days before death; p =.041). Conclusion: Despite growing needs for PC at the end of life, the number of patients receiving outpatient PC did not increase between 2016 and 2020. Furthermore, specialist outpatient PC is being increasingly prescribed over generalist outpatient PC. Although the early initiation of outpatient PC has been proven valuable for the majority of people at the end of life, generalist outpatient PC was not initiated earlier in the disease trajectory over the study period, as was found to be true for specialist outpatient PC. Future studies should seek to determine how existing PC needs can be optimally met within the outpatient sector and identify factors that can support the earlier initiation of especially generalist outpatient PC. Trial registration: The study "Optimal Care at the End of Life" was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019). [ABSTRACT FROM AUTHOR]

Background: Diabetic kidney disease (DKD) is a primary microvascular complication of diabetes with limited therapeutic effects. Delving into the pathogenic mechanisms of DKD and identifying new therapeutic targets is crucial. Emerging studies reveal the implication of ferroptosis and immune dysregulation in the pathogenesis of DKD, however, the precise relationship between them remains not fully elucidated. Investigating their interplay is pivotal to unraveling the pathogenesis of diabetic kidney disease, offering insights crucial for targeted interventions and improved patient outcomes. Methods: Integrated analysis, Consensus clustering, Machine learning including Generalized Linear Models (GLM), RandomForest (RF), Support Vector Machine (SVM) and Extreme Gradient Boosting (xGB), Artificial neural network (ANN) methods of DKD glomerular mRNA sequencing were performed to screen DKD-related ferroptosis genes.CIBERSORT, ESTIMATE and ssGSEA algorithm were used to assess the infiltration of immune cells between DKD and control groups and in two distinct ferroptosis phenotypes. The ferroptosis hub genes were verified in patients with DKD and in the db/db spontaneous type 2 diabetes mouse model via immunohistochemical and Western blotting analyses in mouse podocyte MPC5 and mesangial SV40-MES-13 cells under high-glucose (HG) conditions. Results: We obtained 16 differentially expressed ferroptosis related genes and patients with DKD were clustered into two subgroups by consensus clustering. Five ferroptosis genes (DUSP1,ZFP36,PDK4,CD44 and RGS4) were identified to construct a diagnostic model with a good diagnosis performance in external validation. Analysis of immune infiltration revealed immune heterogeneity between DKD patients and controls.Moreover, a notable differentiation in immune landscape, comprised of Immune cells, ESTIMATE Score, Immune Score and Stromal Score was observed between two FRG clusters. GSVA analysis indicated that autophagy, apoptosis and complement activation can participate in the regulation of ferroptosis phenotypes. Experiment results showed that ZFP36 was significantly overexpressed in both tissue and cells while CD44 was on the contrary.Meanwhile,spearman analysis showed both ZFP36 and CD44 has a strong correlation with different immune cells,especially macrophage. Conclusion: The regulation of the immune landscape in DKD is significantly influenced by the focal point on ferroptosis. Newly identified ferroptosis markers, CD44 and ZFP36, are poised to play essential roles through their interactions with macrophages, adding substantial value to this regulatory landscape. [ABSTRACT FROM AUTHOR]

Introduction: Entrepreneurs play a central role in economic and social stability, yet the start-up rate in Germany has declined in recent years, possibly due to the stress associated with entrepreneurial endeavors. Stressors such as financial uncertainty and time pressure are prevalent among entrepreneurs and negatively affect their psychological well-being. However, research on stress management strategies among self-employed individuals remains limited. Methods: This pilot study conducted a quantitative analysis with 117 selfemployed participants in Germany. The study focused on typical entrepreneurial work demands and selected stress coping mechanisms. Results: The analysis revealed a significant correlation between quantitative demands and mental exhaustion. Furthermore, a high positive correlation between presenteeism and workload suggests that presenteeism may partially explain the variance in workload. These findings underscore how high job demands can lead to self-endangering behaviors that are detrimental to mental health. Discussion: Although no significant moderating effect of proactive coping on the relationship between job demands and mental exhaustion was observed, significant negative correlations between proactive coping and both job demands and mental exhaustion suggest a potential protective role of proactive coping against workrelated stress. This study highlights the importance of understanding stress coping strategies among self-employed individuals and their impact on entrepreneurial success and mental well-being. Further research in this area is warranted to develop effective interventions to support the well-being and productivity of self-employed individuals in Germany. [ABSTRACT FROM AUTHOR]

With its ability to store and transport energy without releasing greenhouse gases, hydrogen is considered an important driver for the decarbonisation of energy systems. As future hydrogen import prices from global markets are subject to large uncertainties, it is unclear what impact different hydrogen and derivative import prices will have on the future German energy system. To answer that research question, this paper explores the impact of three different import price scenarios for hydrogen and its derivatives on the German energy system in a climate-neutral setting for Europe in 2045 using three different energy system models. The analysis shows that the quantities of electricity generated as well as the installed capacities for electricity generation and electrolysis increase as the hydrogen import price rises. However, the resulting differences between the import price scenarios vary across the models. The results further indicate that domestic German (and European) hydrogen production is often cost-efficient. • Comparison of the energy system models REMod, SCOPE SD and Enertile. • Detailed derivation of three import price scenarios for hydrogen and its derivatives. • Transformation pathways in Germany towards a climate-neutral energy system in 2045. • Increasing capacities for electricity generation and electrolysis in all models as the hydrogen import price rises. • Comparison of effects on storage technologies and electricity imports as well as on the industry and transport sectors. [ABSTRACT FROM AUTHOR]

Background: Establishing successful lactation in mothers of very low birth weight (VLBW, <1500g) infants requires structured lactation support. Little is known about mothers' perspectives on lactation support in German neonatal intensive care units (NICUs). Methods: This paper features a convergent mixed-method approach that includes a retrospective, cross-sectional questionnaire and interview data to showcase mothers' perceptions of lactation support in NICUs. Content analysis of the interviews (n = 12) and a descriptive analysis of quantitative data (n = 533) were performed to illustrate the current status and need for lactation support in German NICUs. Results: The results show that lactation support in German NICUs is often inadequate and does not comply with recommendations based on the existing literature to encourage pumping and breastfeeding in mothers. The data imply that even if lactation is successfully initiated in most cases, it is often not maintained over time, which may be due to a lack of personal support and consistent information. Conclusion: The overall structures and institutional guidelines for lactation support should be encouraged to promote nutrition with mother´s own milk in German NICUs. [ABSTRACT FROM AUTHOR]

Despite international efforts to foster the circular economy, plastic waste remains a major environmental problem. In the circular economy, the success of a waste management system depends, inter alia, on consumers properly sorting their plastic waste. Yet mis-sorting of plastic food packaging waste happens routinely. We sought to find out why and to outline the ways consumers prefer to receive information about waste sorting procedures. Tailoring information to consumer preferences can improve the effectiveness of waste management policy. Using the Motivation Opportunity Ability (MOA) framework to explain consumer behaviour, we conducted focus group discussions in two German cities. Our findings suggest that more accurate information and financial incentives best motivate consumers to sort waste correctly. Uncertainty and confusion over the packaging material are the most severe hindrances to correct sorting behaviour. The Internet and social media are preferred most for acquiring information on how to sort plastic food packaging correctly. Policymakers can use our results to adjust packaging and waste management regulations to help eliminate confusion among consumers and to facilitate their recycling intentions. Food industry practitioners and company decision makers can use our results to adjust their plastic packaging features to better match consumer preferences for easily recyclable waste., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

• The net ecosystem carbon balance was extended for harvest residues (HR). • The balance term related to HR can be in the range of other cumulative carbon terms. • Therefore, it is imperative to consider HR in the carbon balance of croplands. • Soil carbon loss/gain are mostly controlled by the fast-decomposing carbon pools. Over the past two decades, major efforts have been made to quantify the extent to which and under what conditions croplands are sources or sinks for carbon. For this purpose, the net carbon stock change of the study site is typically quantified based on net CO 2 fluxes monitored with an eddy covariance or chamber system, on measured C import by organic fertilizer and C export by harvest. While in cropland studies this balance is usually referred to as net biome productivity (NBP), we prefer to use the term net ecosystem carbon balance (NECB) here. NECB is basically the sum of the stock change of plant carbon (ΔPC) and soil organic carbon (ΔSOC). In the standard approach, the assumption is that at an annual cropland site the bulk of plant biomass is typically removed at harvest, and that ΔPC can therefore be neglected. In this case, ΔSOC equals NECB. In this paper we show that this assumption is problematic, particularly if in crop rotation systems the budget is determined over a single cropping period. The present contribution extends the concept of NECB to include harvest residues (HR) and applies it to a case study over a maize - winter wheat - winter wheat rotation at a cropland site in southwest Germany. In all three cropping periods, the sign of NECB was opposite that of ΔSOC. Accordingly, neglecting HR led to an incorrect result concerning the question whether the site is a sink or a source for soil carbon. Our findings demonstrate that for croplands HR must be included to obtain an accurate and meaningful carbon balance. [ABSTRACT FROM AUTHOR]

Simple Summary: We studied the feasibility and safety of using bronchoscopically implanted electromagnetic transponders to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT) of primary lung cancers or lung metastases. Three transponders were implanted near the tumor, followed by CT simulation. The initial gating window was ±5 mm; in a second cohort, the window was incrementally reduced to determine the smallest feasible gating window: this was identified to be ±3 mm. Among the 48 patients enrolled, transponder-guided DIBH was feasible in all but two patients (96% feasible), where it failed because the distance between the transponders and the antenna was >19 cm. Toxicities at least possibly related to transponders or the implantation procedure were grade 2 in six patients, grade 3 in three patients, and grade 4 in one patient. Toxicities at least possibly related to RT were grade 2 in 18 patients and grade 3 in four patients. Transponder-guided DIBH is a feasible and safe approach for delivering thoracic RT. Background: Electromagnetic transponders bronchoscopically implanted near the tumor can be used to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT). The feasibility and safety of this approach require further study. Methods: We enrolled patients with primary lung cancer or lung metastases. Three transponders were implanted near the tumor, followed by simulation with DIBH, free breathing, and 4D-CT as backup. The initial gating window for treatment was ±5 mm; in a second cohort, the window was incrementally reduced to determine the smallest feasible gating window. The primary endpoint was feasibility, defined as completion of RT using transponder-guided DIBH. Patients were followed for assessment of transponder- and RT-related toxicity. Results: We enrolled 48 patients (35 with primary lung cancer and 13 with lung metastases). The median distance of transponders to tumor was 1.6 cm (IQR 0.6–2.8 cm). RT delivery ranged from 3 to 35 fractions. Transponder-guided DIBH was feasible in all but two patients (96% feasible), where it failed because the distance between the transponders and the antenna was >19 cm. Among the remaining 46 patients, 6 were treated prone to keep the transponders within 19 cm of the antenna, and 40 were treated supine. The smallest feasible gating window was identified as ±3 mm. Thirty-nine (85%) patients completed one year of follow-up. Toxicities at least possibly related to transponders or the implantation procedure were grade 2 in six patients (six incidences, cough and hemoptysis), grade 3 in three patients (five incidences, cough, dyspnea, pneumonia, and supraventricular tachycardia), and grade 4 pneumonia in one patient (occurring a few days after implantation but recovered fully and completed RT). Toxicities at least possibly related to RT were grade 2 in 18 patients (41 incidences, most commonly cough, fatigue, and pneumonitis) and grade 3 in four patients (seven incidences, most commonly pneumonia), and no patients had grade 4 or higher toxicity. Conclusions: Bronchoscopically implanted electromagnetic transponder–guided DIBH lung RT is feasible and safe, allowing for precise tumor targeting and reduced normal tissue exposure. Transponder–antenna distance was the most common challenge due to a limited antenna range, which could sometimes be circumvented by prone positioning. [ABSTRACT FROM AUTHOR]

Background: Subarachnoid hemorrhage (SAH) patients with cerebral autoregulation (CA) impairment at an early post-SAH period are at high risk of unfavorable outcomes due to delayed cerebral ischemia (DCI) or other complications. Limited evidence exists for an association between early-stage CA impairments and SAH patient outcomes. The objective of this prospective study was to explore associations between CA impairments detected in early post-SAH snapshot examinations and patient outcomes. Methods: The pilot observational study included 29 SAH patients whose CA status was estimated 2–3 days after spontaneous aneurysm rupture and a control group of 15 healthy volunteers for comparison. Inflatable leg recovery boots (reboots.com, Germany) were used for the safe controlled generation of arterial blood pressure (ABP) changes necessary for reliable CA examination. At least 5 inflation‒deflation cycles of leg recovery boots with a 2–3 min period were used during examinations. CA status was assessed according to the delay time (∆TCBFV) measured between ABP(t) and cerebral blood flow velocity (CBFV(t)) signals during artificially induced ABP changes at boot deflation cycle. CBFV was measured in middle cerebral artery by using transcranial Doppler device. Results: Statistically significant differences in ∆TCBFV were found between SAH patients with unfavorable outcomes (∆TCBFV = 1.37 ± 1.23 s) and those with favorable outcomes (∆TCBFV = 2.86 ± 0.99 s) (p < 0.001). Early assessment of baroreflex sensitivity (BRS) during the deflation cycle showed statistically significant differences between the DCI and non-DCI patient groups (p = 0.039). Conclusions: A relatively small delay of ∆TCBFV <1.6 s between CBFV(t) and ABP(t) waves could be an early warning sign associated with unfavorable outcomes in SAH patients. The BRS during boot deflation can be used as a biomarker for the prediction of DCI. Trial registration: ClinicalTrials.gov Identifier: NCT06028906. Registered 31 August 2023 - Retrospectively registered, https://www.clinicaltrials.gov/study/NCT06028906. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists. Methods: We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist. Results: We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons. Conclusions: High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments. Key Points: Several high-quality economic evaluations of physiotherapeutic treatments for the back and knee exist Economic evaluations of other joints are rare Physiotherapeutic interventions are often cost-effective over treatments provided by other health professionals The description of provided interventions in cost-effectiveness analyses needs improvement, to allow fair treatment comparisons [ABSTRACT FROM AUTHOR]

During the past ten years, lots of new data-driven products and services for tools, machinery and equipment have been developed. While several new players from other industries gained a certain market share, plant and machinery producers also started to enhance their portfolio to take on new data-driven products and services because of the technological changes in Industry 4.0. As a first part of the research, an extensive market study was carried out to analyze how many German companies already offer data-based products and services in addition to their core machines and understand what kind of offerings they make. To classify these offerings, a scheme based on established Industry 4.0 maturity models was developed. In brief, the market for data-driven products and services is still developing, with few technology leaders and fast movers taking the largest share. While the market study gave an overview of what was on offer, the second part of this contribution analyzes how the fast movers with a high level of Industry 4.0 maturity conducted their data-driven services and products. Thus, these few companies were analyzed in more detail, based on public material as well as subsequent expert interviews. Most fast movers in this study relied on the same patterns and approaches, especially when looking at organizational issues such as customer-driven innovation, agile organization of operations, mixed teams, partnering and portfolio enhancement. [ABSTRACT FROM AUTHOR]

This paper examines the emergence of 1,072 solar initiatives (268 associations and 804 cooperatives operating photovoltaic systems) from 2006 to 2018 in Germany. The study draws on organizational ecology theory to identify factors that influence the likelihood of establishing a solar initiative by investigating the impacts of two opposing effects: legitimation effects and competition effects. We show that the density of medium-scale photovoltaic installations in a district negatively affects the likelihood of establishing a solar initiative, suggesting that competitive dynamics prevail between different market entrants, dampening the emergence of solar initiatives. By contrast, we find that the founding of a solar initiative in a district has a positive effect on the probability of founding other solar initiatives in the same district, confirming legitimacy effects. Further, we show that solar initiatives are more likely to be founded in rural areas, especially in densifying rural areas. • Citizens collectively install PV systems where there are fewer similar systems present. • Initiatives are more likely to emerge in districts with existing initiatives. • Initiatives emerge primarily in densified rural areas. • Enhancing organizational rather than technological knowledge is important. [ABSTRACT FROM AUTHOR]

Background: Brain-derived neurotrophic factor (BDNF) is essential for antidepressant treatment of major depressive disorder (MDD). Our repeated studies suggest that DNA methylation of a specific CpG site in the promoter region of exon IV of the BDNF gene (CpG -87) might be predictive of the efficacy of monoaminergic antidepressants such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and others. This trial aims to evaluate whether knowing the biomarker is non-inferior to treatment-as-usual (TAU) regarding remission rates while exhibiting significantly fewer adverse events (AE). Methods: The BDNF trial is a prospective, randomized, rater-blinded diagnostic study conducted at five university hospitals in Germany. The study's main hypothesis is that {1} knowing the methylation status of CpG -87 is non-inferior to not knowing it with respect to the remission rate while it significantly reduces the AE rate in patients experiencing at least one AE. The baseline assessment will occur upon hospitalization and a follow-up assessment on day 49 (± 3). A telephone follow-up will be conducted on day 70 (± 3). A total of 256 patients will be recruited, and methylation will be evaluated in all participants. They will be randomly assigned to either the marker or the TAU group. In the marker group, the methylation results will be shared with both the patient and their treating physician. In the TAU group, neither the patients nor their treating physicians will receive the marker status. The primary endpoints include the rate of patients achieving remission on day 49 (± 3), defined as a score of ≤ 10 on the Hamilton Depression Rating Scale (HDRS-24), and the occurrence of AE. Ethics and dissemination: The trial protocol has received approval from the Institutional Review Boards at the five participating universities. This trial holds significance in generating valuable data on a predictive biomarker for antidepressant treatment in patients with MDD. The findings will be shared with study participants, disseminated through professional society meetings, and published in peer-reviewed journals. Trial registration: German Clinical Trial Register DRKS00032503. Registered on 17 August 2023. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of reminders in recruiting and maintaining participation in an online panel. Methods: 50,045 individuals from five German federal states were invited by regular mail to participate in the online study "Health-Related Beliefs and Healthcare Experiences in Germany." Those who did not respond to the first attempt received a postal reminder. Comparisons of sociodemographic characteristics and responses were made between first-attempt respondents and those who enrolled after the second letter. Results: After the initial letter, 2,216 (4.4%, 95%CI: 4.3%-4.6%) registered for the study; after a reminder 1,130 (2.5%, 2.3%-2.6% of those reminded) enrolled. Minor sociodemographic differences were observed between the groups and the content of the responses did not differ. Second-attempt respondents were less likely to participate in subsequent questionnaires: 67.3% of first-attempt vs. 43.3% of second-attempt respondents participated in their fourth survey. Recruitment costs were 79% higher for second-attempt respondents. Conclusion: While reminders increased the number of participants, lower costeffectiveness and higher attrition of second-attempt respondents support the use of single invitation only for studies with a similar design to ours when the overall participation is low. [ABSTRACT FROM AUTHOR]

Background: The phyllosphere microbiome is crucial for plant health and ecosystem functioning. While host species play a determining role in shaping the phyllosphere microbiome, host trees of the same species that are subjected to different environmental conditions can still exhibit large degrees of variation in their microbiome diversity and composition. Whether these intra-specific variations in phyllosphere microbiome diversity and composition can be observed over the broader expanse of forest landscapes remains unclear. In this study, we aim to assess the variation in the top canopy phyllosphere bacterial communities between and within host tree species in the temperate European forests, focusing on Fagus sylvatica (European beech) and Picea abies (Norway spruce). Results: We profiled the bacterial diversity, composition, driving factors, and discriminant taxa in the top canopy phyllosphere of 211 trees in two temperate forests, Veluwe National Parks, the Netherlands and Bavarian Forest National Park, Germany. We found the bacterial communities were primarily shaped by host species, and large variation existed within beech and spruce. While we showed that there was a core microbiome in all tree species examined, community composition varied with elevation, tree diameter at breast height, and leaf-specific traits (e.g., chlorophyll and P content). These driving factors of bacterial community composition also correlated with the relative abundance of specific bacterial families. Conclusions: While our results underscored the importance of host species, we demonstrated a substantial range of variation in phyllosphere bacterial diversity and composition within a host species. Drivers of these variations have implications at both the individual host tree level, where the bacterial communities differed based on tree traits, and at the broader forest landscape level, where drivers like certain highly plastic leaf traits can potentially link forest canopy bacterial community variations to forest ecosystem processes. We eventually showed close associations between forest canopy phyllosphere bacterial communities and host trees exist, and the consistent patterns emerging from these associations are critical for host plant functioning. [ABSTRACT FROM AUTHOR]

Climate movements have gained momentum in recent years, aiming to create public awareness of the consequences of climate change through salient climate protests. This paper investigates whether concerns about climate change increase following demonstrative protests and confrontational acts of civil disobedience. Leveraging individual-level survey panel data from Germany, we exploit exogenous variations in the timing of climate protests relative to survey interview dates to compare climate change concerns in the days before and after a protest (N = 24,535). Following climate protests, we find increases in concerns about climate change by, on average, 1.2 percentage points. Further, we find no statistically significant evidence that concerns of any subpopulation decreased after climate protests. Lastly, the increase in concerns following protests is highest when concern levels before the protests are low. Climate movements aim to raise public awareness of climate change through protests, but their efficacy is debated. Here, the authors show that concerns about climate change increased in Germany after climate strikes and non-violent acts of civil disobedience. [ABSTRACT FROM AUTHOR]

Introduction: The negative consequences of climate change are widespread and have a global impact. An industrialized region of Germany must adapt to the effects of climate change and comply with political regulations. Previous studies indicate that economic actors who are not directly affected by climate change approach climate change mitigation and adaptation primarily based on legal requirements and often feel discouraged by the absence of data-based reports. Addressing this challenge, game-based learning emerges as a promising pathway. Methods: To examine game-based learning's applicability and potential for climate adaptation, we developed a business simulation game, simultaneously identifying didactically effective elements for managers who would participate in it. Using expert interviews and focus groups, we conducted a qualitative study with three HR developers from larger companies and nine managers and founders of startups to develop a business simulation game on climate adaptation. Based on the Grounded Theory methodology, theoretical coding was used to analyze the qualitative data. Results: The derived core categories indicate that personnel development in companies is evolving in response to economic changes. Individual resources such as motivation (especially for managers), personnel and time play a crucial role in establishing a business game as an educational offering. The identified game elements can also be used theoretically and practically in the development of other educational games. Discussion: We discussed common human resource development measures in companies and compared them with more innovative approaches such as a simulation game. The study underscores the importance of innovative approaches, such as game-based learning, in fostering climate adaptation efforts among economic actors. By integrating theoretical insights with practical applications, our findings provide valuable guidance for the development of educational games aimed at addressing complex challenges like climate change. Further research and implementation of such approaches are essential for promoting proactive climate adaptation strategies within industrialized regions and beyond. [ABSTRACT FROM AUTHOR]

Introduction: As sexuality in physical education (PE) is often treated as a taboo subject, social media platforms, online chats, and internet forums are emerging as spaces where it is negotiated more openly and broadly by current and former actors of the field. This paper contributes to a better understanding of the discursive construction of sexuality in PE in such online communication. Methods: In line with The Sociology of Knowledge Approach to Discourse (SKAD) we investigate basic schemes of interpretation of sexuality with a heterogeneous sample of threads (17 threads from seven different online forums) on different PE situations in Germany. The threads are analyzed using grounded theory coding procedures. Results: Our discourse analysis reveals that the multifaceted and often controversial online discussions are structured by two dominant schemes of interpreting students' sexuality in PE, both of which are differentiated in complex ways: The online communication draws on - and by that reproduces - a nature and a culture perspective on constellations of body, sex, gender, and sexuality. We detail how from each perspective, different knowledge about these constellations, different everyday phenomena and problems in PE, and different norms for dealing with these phenomena and problems become important. Discussion: Discussing these results in the context of previous literature, we argue that it is important to address sexuality in a subject-specific approach and take the discursive knowledge and fundamental schemes of interpretation into account that shape the (im-)possibilities of addressing sexuality in PE. [ABSTRACT FROM AUTHOR]