Search

In Nazi Germany (1933–45), reclaiming waste became an intrinsic component of the regime's economy as well as its ideological, racial, and expansionist ambitions. National Socialist interventions into waste streams began in 1934 with salvage campaigns. The state then brought urban waste policies and municipal waste services under its control, restructuring and 'Aryanising' the waste salvage trade. Moreover, both consumers and producers were prompted to collect and reprocess waste. Over time, the gradual expansion of the Nazi waste recovery policies and campaigns – here referred to as the 'Nazi waste exploitation regime' – brought forth a determined vision of a circular economy in which no waste whatsoever should escape its reclamation for the national community or Volksgemeinschaft. This article sketches the actors, structures, and objectives of this waste exploitation regime for the case of rags and paper and uncovers its entanglement with Nazi racist and genocidal ideology and expansionism. [ABSTRACT FROM AUTHOR]

Several studies have investigated the relationship between the energy performance of buildings and housing prices. First, this paper identifies a price premium for energy efficiency within the German rental market. Then, the indexed price differences and associated marginal benefits are compared with the marginal costs of energy retrofits. An extensive database of Germany's largest online platform for housing over a time span from 2016 to 2020 is used in a hedonic regression approach. In addition, to extract the marginal costs of energy consumption abatement, a dataset of 1048 rental units regarding green-retrofit measures is utilized. Although a significant green premium is identified in the rental market, the findings suggest that it is not high enough to compensate landlords for the money they have to spend to retrofit. The marginal costs exceed the marginal benefits by far. Furthermore, it is found that the German government's recent plans to split the carbon tax between landlords and tenants do not change this because the price per metric ton of carbon is insufficiently high. Limitations with respect to the data basis and consequently to the interpretation of the results exist. Nevertheless, the findings can help both tenants and landlords in their decision-making, as well as policy makers in the implementation of decarbonization efforts. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run. A structured, multimodal form of care reduces costs in the treatment of Hidradenitis suppurativa compared to standard care. [ABSTRACT FROM AUTHOR]

Smaller towns in rural regions are important anchors for regional development, but they are not usually considered particularly innovative and open to new ideas. This paper asks how the network of small and medium-sized towns, Cittaslow, could establish slowing down as something new in local development. Against the theoretical background of sociological innovation research, an analytical framework of social innovation is elaborated to analyse Cittaslow using four case studies: two German and two Italian towns. Based on fieldwork in the four towns, this paper shows that discourse and communication on slowing down, local projects labelled as slow and new cooperation structures go hand in hand. This leads to the conclusion that new ways of local development need a communicative umbrella under which projects and stakeholders come together. The paper furthermore demonstrates that the analytical framework, with its triad of semantics, pragmatics and grammar, is extremely helpful for analysing spatial development and has the potential to be adapted as a tool for policy strategies. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected how people go about their daily lives, often in various and substantial ways. This study aims to prospectively evaluate the changes in social participation during the COVID-19 pandemic in persons with a high risk for a severe COVID-19 course in Germany. A paper-pencil-based survey was conducted starting at March 2021. Participants filled out questionnaires at four time points based on their COVID-19 vaccination status: before COVID-19 vaccination, one month, six months and twelve months after COVID-19 vaccination. Social participation measures included the Pandemic Social Participation Questionnaire (PSP-Q) and the Index for measuring participation restrictions (IMET). Repeated measures ANOVA and paired t-test were used to test for changes between time-points. Repeated measures correlation was used to assess the relationship between social participation and local COVID-19 incidences. Data from 245 participants was analyzed before and one month after COVID-19 vaccination. In addition, data from 156 participants was analyzed at time points one, six and twelve months after COVID-19. PSP-Q and IMET scores changed significantly after participants received a COVID-19 vaccination. Between one month and twelve months after vaccination, social participation improved significantly measured by PSP-Q. Social participation was negatively correlated with regional COVID-19 incidences before and after COVID-19 vaccination. Social participation was positively correlated with COVID-19 incidences between one month and twelve months after COVID-19 vaccination. Social participation improved in persons with a high risk for a severe COVID-19 course during the pandemic. The local COVID-19 incidence showed a negative association with social participation only until the fall of 2021 when it was used as the sole metric to regulate COVID-19 protective measures. Although our data describes the trends in social participation, further studies are needed to identify the influencing factors for the observed increase in social participation. [ABSTRACT FROM AUTHOR]

This paper aims to discuss the influence of migration policy risk on market segmentation of housing and rental markets in the Euro Area. Policy risk is represented by the Migration Policy Uncertainty Index (MPUI) and Migration Fear Index (MFI) of Germany and the United Kingdom; in this study, whether these indexes influence the interaction between the housing and rental markets of the two countries and euro-area countries was examined. The empirical results showed that the influence of the United Kingdom's migration policy risk on the euro-area countries is higher than that of Germany. The United Kingdom's MPUI and MFI significantly contribute to the influence of the United Kingdom's housing market on other markets except for Belgium and Spain. Compared with housing market connectedness, the rental market connectedness is less influenced by migration policy risk and migration fear. This may be because variables related to short-term residence policies influence the rental market. The high policy risk is more likely to influence decisions related to long-term house purchase, but not those related to short-term residence. Finally, this study found that the higher the uncertainty of the migration policies of the United Kingdom and Germany is, the higher the house market segmentation is. [ABSTRACT FROM AUTHOR]

Background: Since its academic inception in the 1960s, Germany's general practice has seen numerous dissertations, many of which are housed in the 'Archive of German language General Practice' (ADAM). Aim: This study aims to provide the first comprehensive overview of dissertation topics from the discipline of general- and family medicine in Germany, establishing a foundation for advancing research. Method: We employed a systematic review approach, examining 801 dissertations from both ADAM and online sources. Each topic was identified, categorized, and finalized through consensus by two independent reviewers. Results: Our analysis encompassed 486 dissertations from ADAM, 176 from the German national library, and 139 from university libraries. A total of 167 unique research topics were identified. The predominant themes included medical education (n = 49), medication orders (n = 39), frequent consultation issues (n = 33), complementary medicine (n = 32), and screening measures (n = 29). The use of qualitative methods was constantly rising, from no qualitative methods used from 1965–1974, up to 22% of dissertations in recent years. Conclusion: The diversity of 167 research topics underscores the vastness and complexity of general practice in Germany. This structured overview is pivotal for facilitating focused and interconnected research endeavors in the field. [ABSTRACT FROM AUTHOR]

Classroom management is an emotionally demanding task for mathematics teachers, especially if students exhibit frequent discipline problems. Intense classroom conflicts can result in persistent latent emotional dispositions, such as fear or anger, that teachers are not directly aware of but that have a strong influence on their classroom management. However, little is known about the relationship between mathematics teachers' latent emotions and their classroom management strategies. This paper reports on findings from an exploratory, video-based single case study in an urban secondary school in Germany. One mathematics double lesson (95 minutes in total) was videotaped to conduct a depth-hermeneutical analysis of identified classroom management strategies and the corresponding latent teacher emotions. The results suggest that mathematics teachers use classroom management strategies not only to establish orderly lessons but also to regulate intense latent emotions that arise during classroom teaching. [ABSTRACT FROM AUTHOR]

This paper studies the conditions under which quality conventions in coffee can be revised. It shows how value is captured by a collective composed by Colombian producers overseeing coffee quality attributes, engaging in relational approaches and building knowledge with international buyers. Interviews were conducted with selected organic producers in Santa Marta, Colombia and buyers (e.g. in Germany, the Netherlands). Due to the sound relations between the staff of the producer organization and a German buyer, the manager of the collective proposed to also export roasted coffee in addition to green coffee. Although roasting at origin is not common in coffee exports, in the case analyzed existing hesitations were abandoned. Eye-level relationships, trust based on a relational approach and knowledge were key to achieving a collective quality construction and subsequent value capture by producers. Over time, these producers have improved their material quality techniques and become more familiar with the places where their coffee circulates and is valued, allowing them to influence the commercial spheres of the coffee business. The discussion is not about changing quality conventions, but on how quality conventions are institutionalized and the narratives behind them. [ABSTRACT FROM AUTHOR]

The disruptions associated with health and energy crisis have emphasized the need for hyperlocal cities. However, in Europe, a tool to measure the efficiency of land use and accessibility planning for localizing urban mobility is missing. In this paper, we construct a comparable 15-Minute-Walking City (15-MWC) index that assesses the walking performance of 121 European metropolitan areas and seven amenity types. The data are combined equally following the PROMETHEE II multicriteria approach to assign a final score and to present a ranking of 15-Minutes cities. The main visualization demonstrates European-level disparities and indicates that most of leading cities are in Germany, while most of the worst performers are in the UK. We also reveal a statistically significant difference in 15-MWC performance due to their GDP per capita disparities. The empirical results may serve as a referencing tool for cross-city comparisons and may support policymakers when designing transport and city-planning strategies. [ABSTRACT FROM AUTHOR]

Multi-locality - a lifestyle involving living in several places - is very diverse. Involving temporary presences and absences, it can impact local communities and the environment. This paper looks at the effects of multi-local lifestyles in three rural districts in Lower Saxony, Germany, evaluating quantitative surveys and qualitative interviews with multi-local residents, company representatives and officials. The methods are supplemented by visualizations and reflexive photography. Multi-locals can be seen as both an opportunity and a risk for civic involvement: multi-locality makes it possible to avoid relocation, but the limited periods of presence make it unlikely for multi-locals to become involved locally. Likewise, multi-locality impacts the environment, leading to an increasing volume of traffic and higher land consumption, even if it less significant than the impact of daily commuting. [ABSTRACT FROM AUTHOR]

Companies across the globe have intensified the digital interconnectedness of their manufacturing processes. Much attention was devoted to how industrial employment will be affected in this new production paradigm. In this paper, we use survey data collected from German industrial workers in 2014 and 2020 to contribute to the literature on digitalisation and industrial employment. This is the first scientific study on Industry 4.0 that empirically deals with the development of key parameters of industrial employment over time. Our findings support the argument that whilst increased digital interconnectedness creates more opportunities for highly skilled workers, the extent to which manual workers will be substituted is often overestimated. Second, our data suggests that the operations of larger companies tend to be more highly digitally interconnected than those of smaller firms. We also provide evidence that German industrial workers are less likely to expect substantial job losses through digitalisation than in 2014. [ABSTRACT FROM AUTHOR]

In striving to achieve the Paris Agreement and the 2030 Agenda, governments have the opportunity to implement their climate and sustainability goals more coherently. Such coherence requires the coordination of interdependent policies across different policy fields, sectors and actors. This paper explores how governments design and implement synergic solutions to concomitantly achieve both international agendas. With the empirical cases of Germany and South Africa, we investigate two independent approaches to the synergic solution of a just energy transition, whereby countries aim to phase out coal as a means to tackle climate change while also ensuring that the achievement of other Sustainable Development Goals (SDGs) is not hindered. Methodologically, we apply a deductive qualitative approach consisting of literature review, semi-structured interviews, and content analysis. To that end, we examine relevant policies and institutional arrangements by applying a combined conceptual framework of energy justice and just transition in both countries. We find major challenges in overcoming environmental, economic and social burdens of the coal phase-out, especially related to jobs and inequality (SDGs 8, 10) and the Water-Energy-Food-Land nexus (SDGs 2, 6, 7, 15). Through the selection of Germany and South Africa, we illustrate how countries with different political, social and economic backgrounds strive to manage such a transition. Our developed framework and case-studies' findings point towards important considerations when designing just energy transition pathways, such as ensuring inclusiveness in decision-making, thoroughly assessing social, economic and environmental impacts, and adequately coordinating across different actors and the local, provincial and national levels. [ABSTRACT FROM AUTHOR]

This paper investigates the acceptance of Autonomous Vehicles (AVs) in Japan, the UK and Germany and speculates on the implications for policy and practice. Three on-line surveys of 3,000 members of the public in total, which were conducted in January 2017 (Japan), March 2018 (UK) and November/December 2018 (Germany) were analysed using Principal Component Analysis and then with an Ordered Logit Model. It finds that acceptance of AVs was higher amongst people with higher expectations of the benefits of AVs, those with less knowledge of AVs, and those with lower perceptions of risk. It also finds frequent drivers and car passengers to be more accepting, but that socio-economic factors were mostly insignificant. Finally, there were significant cultural differences between the levels of acceptance between Japan (broadly positive), the UK (broadly neutral) and Germany (broadly negative). These findings suggest that AV promoters should raise (or at least maintain) expectations of AVs among the public; engage with the public to reverse the negative perception of AVs; address AV-generated fears; not bother targeting people by socio-economic group; target frequent car drivers and passengers with information about what AVs could do for them; and target countries where AVs already enjoy a positive image. [ABSTRACT FROM AUTHOR]

The paper deals with the application of stochastic optimization principles for investment decision making. The authors present the investment management system based on an adequate portfolio model. For optimal portfolio construction and stock selection, the method of stochastically informative expertise and ranging is used. Investment portfolios in equity and currency markets are formed considering investor risk tolerance and risk preference level, as well as an individual utility function. Investment portfolios are constructed according to three criteria: return, risk, and reliability. The markets of Germany, the USA, and China, as well as foreign exchange markets, are analysed. The results reveal the efficient investment possibilities in the mentioned markets, allowing to reach investment return substantially exceeding market index return. Along with that, an innovative stochastic clustering methodology for investment assets is proposed. The obtained results are of great value for individual as well as institutional investors and are a suitable means to form efficient investment strategies in financial markets. [ABSTRACT FROM AUTHOR]

The increasing inequality of private income and wealth requires the redistribution of financial resources. Thus, several financial support schemes allocate budget across countries or regions. This work shows how to estimate private wealth at low regional levels by means of a modified Fay–Herriot approach that deals with (a) unit and item non-response, especially with used multiple imputation, (b) the skewness of the wealth distribution, and (c) inconsistencies of the regional estimates with the national direct estimate. One compelling example for financial redistribution is the promoted catching-up process of East Germany after the German reunification. This work shows that 25 years after the reunification differences are more diverse than just between the East and the West by estimating private wealth at two regional levels in Germany. The analysis is based on the Household Finance and Consumption Survey (HFCS) that the European Central Bank launched for all euro area countries in 2010. Although the application in this paper focuses particularly on Germany, the approach proposed is applicable to the other countries participating in the HFCS as well as to other surveys that make use of multiple imputation. [ABSTRACT FROM AUTHOR]

This study targets hitherto largely understudied empirical processes and activities through which certain ideas and imaginaries are being commercialised and used by corporate actors in the global Early Childhood Education and Care (ECEC) industry. The aim is to analyse and critically discuss representations of the Scandinavian ECEC regime in the context of ECEC export. This is achieved empirically through a case study of a Swedish education company and its expansion in Germany, as well as by devoting analytical attention to the social, political and fantasmatic logics in the processes that constitute and characterise the "Scandinavian ECEC offer" as it is being exported. The analysis draws on corporate documents, websites and interviews with top-level company representatives. The analysis highlights how the Scandinavian ECEC regime is made up of four interlinked elements; equality, the autonomous child, integration of care and learning and outdoor pedagogy, aligned and sustained by "gripping" and "sticking" forces in fantasmatic logics that hide contingencies. In summary, the powerful imaginary of the Scandinavian ECEC regime, bringing accessibility, social justice, gender equality, nature, democracy, children's rights and autonomy, serves to conceal the political and ideological dimension of the economic logic of capitalism. [ABSTRACT FROM AUTHOR]

This article analyzes the power relations in the field of German economics. By incorporating the capital and field theory of Pierre Bourdieu, the study investigates the distribution of economic, social, and symbolic capital on economists in Germany. In a first step, the three forms of capital have been defined and operationalized on publicly available information. This leads to eight main samples of economists. In a second step, information on these economists have been collected to derive indicators regarding their paradigmatic stance and institutional background. The findings indicate a monopolization of mainstream economics and concentration of resources on the large economic departments. Furthermore, these characteristics relate to an increased importance of Colander's Edge, an almost complete marginalization of heterodox economics and a significant center-periphery disparity. Thus, in the field of economics in Germany, a social structural verticalization and elitism of universities as well as a paradigm monism can be observed. [ABSTRACT FROM AUTHOR]

Plant-based diets reduce the risk of cardiovascular disease but also increase the risk of certain micronutrient deficiencies, particularly, of vitamin B12 (B12). The extent to which the unsupervised use of oral nutrient supplements is sufficient to prevent these deficiencies is not well established. We analyzed nutrient intake, laboratory biomarkers, supplementation behavior, and B12 status adequacy amongst young, healthy, physically active omnivores, lacto-ovo-vegetarians and vegans from Germany. We recruited 115 participants (n = 40 omnivores; n = 37 lacto-ovo-vegetarians, and n = 38 vegans) with comparable age, sex, marital status, physical activity and educational levels through online advertisements and local newspapers in Freiburg, Germany. Energy intake and macronutrient distribution were comparable across diets. Major differences included intake of fiber, cholesterol, and several vitamins. Vegans had the lowest intake of B12 from foods (0.43 (0.58) µg/d), compared to omnivores (2.14 (2.29) µg/d) and lacto-ovo-vegetarians (0.98 (1.34) µg/day). Multivariate analysis of 36 blood biomarkers revealed that three major classes of biomarkers contributed the most to the clustering of individuals by dietary group, namely, biomarkers of B12 status (B12, holoTC, Hcy), iron (iron, ferritin, transferrin) and lipid metabolism (vitamin A, HDL, LDL, total cholesterol, TAG). This suggests that nutrients that modify the metabolic pathways represented by these biomarkers have the most penetrating effect on health status across diets. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Fewer lacto-ovo-vegetarians used B12 supplements compared to vegans (51% versus 90%). Even amongst homogeneously healthy Germans, each diet manifested with measurable differences in dietary intakes and biomarkers of health. Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Supplementation of healthy vegans with B12 (median 250 µg B12/day, over 1 year) secured an adequate B12 status that was comparable to that of healthy omnivores. Clinical Trial Registry: German Clinical Trial register number: DRKS00027425 Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Supplementation with B12 (median 250 µg B12/day, over 1 year) in healthy physically-active vegans secured an adequate B12 status that was comparable to that of healthy omnivores. [ABSTRACT FROM AUTHOR]

Background: Potential risk contacts for HIV transmission may lead to presentations to the emergency department (ED) for counseling and initiation of post-exposure prophylaxis (PEP). Objective: To examine the impact of German health insurance covering pre-exposure prophylaxis (PrEP) following Sept 1st 2019 for certain risk groups on the frequency and reasons for PEP counseling in a university-based ED in Germany. Methods: In a before-after study design, all persons aged ≥18 years who presented for PEP counseling were analyzed retrospectively. We compared characteristics of presentations in the 18 months prior to PrEP coverage on Sept 1st, 2019, with those in the following 18 months. Results: 154 ED presentations occurred in the first study period, and 155 ED presentations in the second period. Regarding the reasons for ED visits, no statistically significant difference was found [occupational risk contact (18.2 vs. 26.5%, p = 0.081), sexual risk contact (74.7 vs. 69.0%, p = 0.266), other non-occupational risk contact (7.1 vs. 4.5%, p = 0.329)]. For men who have sex with men (MSM), no statistically significant differences were found [38.9 (n = 60) vs. 35.5% (n = 55), p = 0.537]. All persons presenting to the HIV outpatient clinic after ED PEP initiation (n = 60 vs. n = 52) tested negative for HIV 3 months later. Conclusion: In this study, reasons to present for PEP counseling to a university ED showed no change following the implementation of PrEP coverage by health insurances. Therefore, PEP remains an important prevention for HIV transmission and presentations to the ED for PEP counseling may provide an opportunity to educate persons at risk of HIV infection about PrEP, thereby helping to prevent new HIV infections. [ABSTRACT FROM AUTHOR]

Balancing the demand for ecosystem services (ES) with available supply is one key challenge for decision making in sustainable landscape management. ES demand is context-specific. Therefore, the assessment of perceptions articulated by multiple societal actors in different regions can help to identify differences and commonalities in predominant preferences for landscapes and their ES. The goal of this study was to investigate four societal actor groups (citizens, farmers, foresters, nature managers) in 12 study regions across Bavaria, Germany, with respect to their valuation of landscapes and ES provided by certain landscape elements. The 2,438 participants mapped specific locations and selected landscape elements that they perceived as valuable, and further elaborated on this value in open statements. We applied qualitative content analysis, word frequency analysis, spatial location-density analysis, and statistical testing. The perceived value of landscape elements for ES differed across actor groups and regions. Preference for landscape elements was driven by topography and land use and was significantly associated with actor groups. The most apparent differences occurred between farmers and nature managers. Generally, participants preferred forests, water bodies, natural landscapes, and distinct geographical structures. The landscape was mostly valued for its habitat, diverse wildlife, recreational purposes, climate-regulating functions, and provisioning of water and food. We conclude that, although differences exist among societal actors, the study respondents highly valued the importance of functioning and diverse ecosystems. The high perceived value for many ecosystem services and species protection suggests that ambitious policy measures are supported by different societal actors. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic many employees perform under increasingly digital conditions. Enabling home office environments became mandatory for companies wherever possible in consideration of the ongoing pandemic. Simultaneously, studies reported on digital stress. The current literature lacks rigorous research into digital stress on psychosomatic outcomes, emotions, and disease. Therefore, we endeavor to understand how digital stress developed over the course of the pandemic and if it predicts differences in negative emotions and physical complaints in the home office setting. To answer the research question, we conducted an online survey among 441 employees in 2020 and 398 employees in 2022 from three municipal administrations in Germany, who were working from home at least occasionally. We used a cluster analysis to detect digitally stressed employees. Regression analyses were performed on digital stress, negative emotions, and physical complaints. The analysis revealed an increase from 9 to 20% in digital stress, while negative emotions and physical complaints did not show evident differences. In the multivariate model, we observe a change in the proportion of digitally stressed employees between 4 and 17%, while the control variables explain around 9%. Digital stress did not significantly affect either negative emotions or physical complaints. However, digital stress appeared to exert a more substantial predictive influence on negative emotions. The study emphasizes rising digital stress, which contradicts a positive adaption to the digital working conditions within the observed period. The psychosomatic relations are low or lagged. Further research investigating digital stress and countermeasures, especially to understand how to prevent harmful long-term effects such as distress resulting from working from home conditions, is needed. [ABSTRACT FROM AUTHOR]

Discrepancies exist between guideline recommendations and real-world practice of blood pressure (BP) measurements. The aim of this study was to assess, with a nationwide, questionnaire-based survey, the current practice of BP measurement and associated BP values in German medical practices. A nationwide survey in German medical practices was performed in the period from 10 May 2021 to 15 August 2021. The questionnaire was divided into five sections. The current office BP (OBP) values as well as the current drug therapy were recorded. In addition, the implementation of office BP (OBP) and home BP monitoring (HBPM) was queried. For analysis, questionnaires were scanned and automatically digitised. A total of 7049 questionnaires were analysed, the majority of which came from general practitioners (66%) and internal medicine practices (34%). The average OBP (SD) was 140.0 (18)/82.7 (11) mmHg. 40.8% of treated patients had OBP in the controlled range, with monotherapy (34.7%) or dual combination therapy (38.2%) prescribed in most cases. OBP was taken from a single measurement in 66.3% of cases, and in 21.8% from 23 measurements. OBP was mostly measured after a rest period (87.1%) and in a separate room (80.4%). HBPM was performed in 62.3% of patients; however, in 24.9% of the participants HBP measurements were recorded once a week or less. In this nationwide survey in German medical practices, BP control remains at below 50%, while monotherapy is prescribed in around one third of patients. Moreover, office measurements and HBPM are often not performed according to current guideline recommendations. What is the context? Elevated blood pressure (hypertension) is an important risk factor for diseases such as stroke or heart attack. However, sufficient drug therapy can significantly reduce the risk of complications such as a stroke. An adequate blood pressure measurement is the basis for diagnostics and successful therapy. In order to measure blood pressure as accurately as possible, recommendations for performing blood pressure measurements (at home as well as in the office) have been published by medical societies. Research suggests that blood pressure is not always measured according to these recommendations. However, there are no current studies for Germany. What is new? In this study, we analysed the results of a survey in which medical practices and pharmacies throughout Germany were asked about blood pressure measurement and blood pressure therapy. The key results of our study suggest that: • The blood pressure of many participants with known hypertension is not within the desired target range. • Office blood pressure measurements are often not performed as suggested by guidelines. This mainly affects time-consuming work steps such as repeating the measurement several times. • Home blood pressure is not recorded in a structured form, as suggested, but rather according to a random pattern by the patient. What is important? This study suggests that blood pressure control is not sufficient in the study participants. Furthermore, blood pressure measurement as an important tool for hypertension management is frequently not performed as proposed by guidelines. [ABSTRACT FROM AUTHOR]

Trend significance of time series that are serially correlated is once more addressed. Most conventional techniques to "pre-whiten" the series prior to calculating trends rely on the assumption of autoregressive residual noise, AR(1). Monthly recordings of 40 water level stations in Germany are investigated, revealing strong memory up to lag 2. A new scheme (PW(p)) is introduced that extends pre-whitening to AR(p) with p > 1. It performs well on surrogate series with prescribed trend and memory. For seven series the estimated trends are unrealistically off, raising doubts about the validity of the basic assumptions of short-memory noise. The series are characterized by a hockey stick pattern from which any pre-whitening produces trends that are all but plausible. The pattern also reveals that pre-whitening is not invariant under time reversal. Regardless of the validity of the noise model, these special cases serve as a warning for using pre-whitening in general. [ABSTRACT FROM AUTHOR]

The flood history of the transboundary Moselle River has so far not been analysed at the watershed scale. This study is based on a large collection of historical archives in hydrology dating to the beginning of the instrumental period. Many valuable archives are made available by the authors but data are discontinuous and heterogeneous. We describe homogenization and reconstruction methods leading to an original flood dataset covering the entire Moselle basin over the last two centuries. The flood series show that the basin is predominantly affected by oceanic floods that mostly occur in winter and that severe flooding generally affects the entire basin. A flood frequency analysis shows that the series are stationary and that flood quantiles obtained with short measured record series and reconstructed series are quite similar. However, although long historical series give robustness to the frequency analyses they also highlight bias and uncertainties related to sampling. [ABSTRACT FROM AUTHOR]

For gay and bisexual men who are confronted with minority stress, online dating sites may provide opportunities for coping. Extant research has largely neglected this, and those pieces that did address it did not sufficiently account for different motivations of use. Two survey studies served to explore links between minority stress, online dating use, and well-being (Study 1: N = 97, Study 2: N = 25,884). The present work finds evidence that the use of online dating sites may have limited buffering effects on associations between minority stress and well-being. The findings contribute to existing work on online dating and the mental health of gay and bisexual men. [ABSTRACT FROM AUTHOR]

Histomonosis has become an important disease of turkeys since the ban of effective feed additives and therapeutics. Some critical risk factors for pathogen introduction into a farm have already been identified but open questions remain. Therefore, a retrospective case–control-study was used to identify the most significant risk factors for Histomonas (H.) meleagridis-introduction into a turkey farm. A total of 113 questionnaires were collected from 73 control-farms and 40 Histomonas-positive case-farms in Germany between 20 April 2021 and 31 January 2022. The data were analysed for possible risk factors by descriptive and univariate, single- and multi-factorial analysis. The presence of earthworms, snails and beetles, as vectors of H. meleagridis, as well as the proximity to other poultry-keeping farms in addition to a frequent observation of wild birds nearby the turkey farm, showed the highest risk potential for histomonosis outbreaks. Furthermore, poor biosecurity measures seem to have increased the probability for an outbreak. Insufficient climate management, straw as litter material and an inadequate litter refill frequency might have promoted a favourable humidity for vector- or pathogen survival providing important areas for improved disease control measures in the future. A retrospective case–control-study was conducted to identify impactful risk factors for a H. meleagridis introduction. The probability of a histomonosis outbreak was increased by the presence of vectors and reservoirs nearby a farm. Impactful risk factors concerning biosecurity measures, climate and litter management were identified. [ABSTRACT FROM AUTHOR]

This article examines the long-term development of two strategic alliances between major Spanish (RUI and Iberostar) and German (TUI and Neckermann) tourist firms. Our research builds on the literature on foreign direct investment and institutionalism applied to cross-border cooperation, yet using business history research methods. The study aims to understand how the local Spanish context shaped the interaction between foreign and domestic firms and how this interaction influenced the development of the Spanish companies. Our cases suggest that the Spanish institutional framework affected the nature and strength of alliances. Foreign partners were crucial in providing financial and commercial support, brand consolidation, market knowledge and reputation. However, local actors also played an important role as proactive partners eager to develop their domestic business and upgrade their existing capabilities. Ultimately this strategy would contribute to the internationalisation of Spanish firms after 1990. [ABSTRACT FROM AUTHOR]

Background: In Germany, oral emergency contraception (EC) with the active ingredients levonorgestrel (LNG) and ulipristal acetate (UPA) is available as over-the-counter (OTC) medicine only from community pharmacies (CPs). Because of the window of effect, which is limited to only a few days, CPs have a great responsibility to provide rapid and unimpeded access, while also ensuring "adequate" counseling. The aim was—for the first time in Europe and thus also in Germany for the methodology used in this study—to investigate immediate availability, pricing, and aspects of counseling. Methods: Covert mystery calls were conducted in a random sample of CPs stratified by districts in the German capital Berlin. Each of the 263 CPs included was called once at random by one of two trained female student mystery callers. They simulated a product-based scenario for the UPA original ellaOne®, citing a contraceptive failure one day ago as the reason. Results: Of 257 successfully called CPs, UPA preparations were immediately available in 98.4% (253/257) and LNG preparations in 86.8% (184/212) of CPs. Prices for UPA preparations varied from €15.95 to €42.95 (∆ 169%; median €35.00 [interquartile range (IQR) €5.91]) and for LNG preparations from €10.60 to €32.49 (Δ 207%; median €22.00 [IQR €5.76]). Information about the correct different window of effect of UPA and LNG preparations was provided in 69.8% (127/182) of CPs. UPA preparations were recommended in 63.1% (111/176) and LNG preparations in 17.2% (30/174) of CPs. Information was provided on how to take them as soon as possible in 30.8% (44/143) of CPs and on how to use them after vomiting in 46.0% (64/139). Conclusions: Berlin CPs support access through high immediate availability, especially to UPA preparations. However, access is hampered by high absolute price ranges of both UPA and LNG preparations, which could ideally be minimized by a comparison app. It is positive that CPs promote the benefits of UPA preparations by recommending them noticeably more often than LNG preparations. However, there are deficiencies in giving advice, so there is a need to raise awareness among pharmacy staff to ensure "adequate" counseling in advance over the phone. [ABSTRACT FROM AUTHOR]

We explored patient satisfaction with baricitinib, an oral Janus kinase inhibitor, in patients with atopic dermatitis (AD) treated in routine clinical practice. Adults with moderate-to-severe AD treated with baricitinib in clinical practice for ≥4 weeks in France, Germany, and the UK completed a one-time online survey under market research methodologies. Treatment satisfaction was assessed using a Likert scale and abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9). Patients reported demographic, disease, and treatment information. Data were analyzed descriptively. The survey was completed by 170 patients with a mean age of 39.3 years (SD = 13.5), 59% (n = 101) were female. At baricitinib initiation, 79% rated their AD as "Severe", yet 28% reported body surface area (BSA) involvement ≥10%. Most were "Satisfied" or "Very satisfied" (76%/18%) with baricitinib, with high rates reported for controlling itch (36%/56%). Itch improvements were noted by 97% of patients. Some tapered/stopped (50%/32%) topical corticosteroid use, aligned with reported improvements on the patient global assessment and BSA. Mean TSQM-9 convenience score was 78.0 (SD = 14.0). Satisfaction with itch control was particularly high, reflected in rates of improvement in itch since starting baricitinib. On the TSQM-9, the convenience score was the highest. Many patients tapered/stopped concomitant topicals, indicating baricitinib's effect in controlling AD symptoms. [ABSTRACT FROM AUTHOR]

Despite national recommendations for use of pneumococcal vaccines, rates of community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) remain high in Germany. New pneumococcal conjugate vaccines (PCVs) with expanded coverage have the potential to reduce the pneumococcal disease burden among adults. Using a Markov model, we evaluated the lifetime outcomes/costs comparing 20-valent PCV (PCV20) with standard of care (SC) vaccinations for prevention of CAP and IPD among adults aged ≥60 years and at-risk adults aged 18–59 years in Germany. PCV20 also was compared with sequential vaccination with 15-valent PCV (PCV15) followed by PPSV23 in a scenario analysis. Over the course of a lifetime (82 years), use of PCV20vs. SC would prevent 54,333 hospitalizations, 26368 outpatient CAP cases, 10946 disease-related deaths yield 74,694 additional life-years (LYs), while lowering total medical costs by 363.2 M €. PCV20 remained cost saving (i.e. dominant) versus SC even in numerous sensitivity analyses, including a sensitivity analysis assuming moderate effectiveness of the SC pneumococcal polysaccharide vaccine against noninvasive pneumococcal CAP. In several scenario analyses and a probabilistic sensitivity analysis, PCV20 was also cost-saving compared toPCV15 PPSV23 vaccination. One dose of PCV20 among adults aged ≥60 years and adults aged 18–59 years with moderate- and high-risk conditions wouldsubstantially reduce pneumococcal disease, save lives, and be cost saving compared with SC. [ABSTRACT FROM AUTHOR]

Background: Pharmacist-led medication reviews are considered a valuable measure to address risks of polypharmacy. The software Medinspector® is used in community pharmacies to assist the performance of this complex service by structuring the medication review process and supporting pharmacists in their decision-making with targeted clinical knowledge. Key feature is a computerized risk assessment of both the initial and adjusted medication regimen of a patient in multiple domains, thus aiming to support the identification and solving of drug-related problems. This study will examine the effects of medication reviews performed with the clinical decision support system in daily routine practice on medication-related and patient-reported outcomes in elderly patients with polypharmacy. Methods: A prospective, before–after observational study is conducted in German community pharmacies aiming to include 148 patients aged 65 or older, who chronically use five or more active pharmaceutical substances with systemic effects and utilize the software-supported medication review service. The study is based on routine documentation within the software over the course of the medication review, including a patient's baseline medication, the medication proposed by pharmacists, and the final medication regimen. A software-implemented questionnaire comprising self-developed and literature-derived instruments is used to collect patient-reported outcome data at baseline and follow-up. Primary outcome is the appropriateness of medication measured with an adapted version of the Medication Appropriateness Index (MAI). Secondary medication-related outcomes are medication underuse, exposition towards anticholinergic/sedative drugs, number of drugs in long-term use and the implementation of pharmacist-proposed medication adjustments by the physicians. Secondary patient-reported outcomes are symptom burden, medication-related quality of life, adherence, fulfillment of medication review-related goals, and perception of the service. Discussion: With the recently introduced remuneration of community pharmacist-led MR in Germany, the demand for digital tools supporting the MR process is assumed to rise. The OPtiMed-study is expected to create evidence on the effects of a novel tool on patient care in a vulnerable patient population. Trial registration German Clinical Trials Register, DRKS00027410. Registered 22 December 2021, https://www.drks.de/drks%5fweb/navigate.do?navigationId=trial.HTML&TRIAL%5fID=DRKS00027410. Also available on the WHO meta-registry: https://trialsearch.who.int/?TrialID=DRKS00027410 [ABSTRACT FROM AUTHOR]

Unconditional intergovernmental grants are popular with economists but increasingly rarely observed in practice. Conversely, earmarking grants became a common form of the centres' support to states in federalist countries, though they are seriously flawed by welfare loss induced by the intended reallocation of states' provision of goods and services. Conditional grants bring states' governments a dilemma: intergovernmental grants increase states' revenues and enhance welfare, but the revenue gain is paid with amendments on the expenditure side, which harms welfare. We introduce the notion of price-shifting fungibility. It describes the effect of grant-receiving states minimizing the distortionary impact of conditional grants by lowering the prices or quality of the targeted good. By reducing the expenditure for the subsidized good, states create financial leeway to promote goods and services other than the targeted interest. By doing so, they can compensate for the welfare loss caused by conditional grants. We provide a simple theoretical model and some empirical evidence. [ABSTRACT FROM AUTHOR]

To examine stroke inpatients' real-life wayfinding behaviour and how the built environment of rehabilitation clinics might influence their behaviour and experiences. Stroke inpatients in seven rehabilitation clinics were observed (n = 70), each over the course of 12 consecutive hours. Their paths through the clinic and the locations of encountered wayfinding-related events were mapped on the floor plans and described in the written notes. The observations were supplemented by a survey asking patients about their wayfinding experiences. For a third of observed patients, at least one wayfinding-related event was observed on the observation day, and 50% of patients reported getting lost in their clinic at least once. Most wayfinding-related events occurred between patient rooms and therapy rooms, and patients frequently relied on backtracking or the help of the staff to find their way. Clinics' layout organization was found to play a role in the wayfinding behaviour of patients. Wayfinding is a common challenge that stroke inpatients encounter in rehabilitation clinics. Avoiding multiple decision nodes on the paths between patient rooms and therapy rooms and creating distinct identities for corridor segments in the decision nodes and the areas in front of elevators would likely improve wayfinding performance. [ABSTRACT FROM AUTHOR]

Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance. [ABSTRACT FROM AUTHOR]

Studies on cultural ecosystem services (CES) in urban forests using Public Participation GIS mapping are a well-established field of research. However, far fewer studies do exist that also illuminate perceived disservices, thus omitting an important part of human-forest relationships. Advancing knowledge on unpleasant places can promote outdoor recreation and help forest managers focus on disservices that matter. This study aims at spatially identifying people's perceptions in urban forests with focus on unpleasant experiences. We elicited perceived disservices and CES spatially by collecting Public Participation GIS data (PPGIS) from city dwellers in three urban forests in Germany's Southwest (755 respondents mapped 1552 places of disservices). We investigated relationships between sociodemographic characteristics and the number of mapped places using Spearman's rank. We also explored the spatial concurrence between disservices and CES using Spearman's rank. We identified a hierarchy of importance of forest visitors' perceived dislikes. We revealed that negative perceptions of urban forest visitors originated broadly from people and their traces and rarely from the ecosystem according to existing ecosystem disservices typologies (EDS). We found a significant relationship between age and the number of mapped services. We found clusters of disliked places and correlations between disservices and CES, indicating that hotspots of CES in turn are also hotspots of disservices. We conclude that city foresters may best address disservices by advancing guidance-concepts for spatial movements of urban forest visitors within the forest to avoid conflicting clusters of various stakeholders. Our results may help city foresters to better manage both the forest and visitors' various interests. [ABSTRACT FROM AUTHOR]

Copyright of Tapuya: Latin American Science, Technology & Society is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study focuses on the efforts of Sir Charles Addis to defend the pre-1914 system of cosmopolitan capitalism. Our central research question is to understand why this merchant banker fought in preserve cosmopolitan capitalism when so many of his peers acquiesced in and even championed its demise. Addis's moral ideal was an international economic order in which the nationality of firms was irrelevant to the strategies of managers. The First World War dramatically increased the salience of firm nationality in international business. Addis, who was a committed classical liberal, fought against this trend to a degree that is hard to explain with reference to economic self-interest alone. The article, which is based on a range of sources including Addis's diary, explores Addis's connections to, and views of, 'German' bankers, his relations with the British government, and the political economy of the reparations imposed on Germany by the Versailles Peace settlement. [ABSTRACT FROM AUTHOR]

Background: Pharmaceutical spending has been increasing rapidly for years and is higher than ever before. To control the rising costs, countries are implementing regulatory frameworks such as (internal) reference pricing, price cuts or generics substitution. Internal reference pricing establishes a reference price within a country which serves as the maximum level of reimbursement for a group of pharmaceuticals. Price setting in the German market is especially relevant for many European countries, which use Germany as a reference country for their own price setting. Methods: We evaluate pharmaceutical price dynamics for not reference priced pharmaceuticals (NRPs) as well as for reference priced pharmaceuticals (RPs) in Germany—referring to the internal reference price system. 64,862 medication packs have been extracted from the German pharmaceutical pricing register Lauer-Taxe. For each pack, we extracted detailed data on the company, manufacturer rebates, pharmacy retail prices, reference prices, co-payments, import quotas, and discount agreements. We then investigated price setting and dynamics of NRPs vs. RPs for all 14 indication areas by ATC code level 1. Results: The average manufacturer price per pack was 604.84€ for NRPs and 112.11€ for RPs. Similar differences were found for the wholesale price and the pharmacy retail price. The reference price was—as expected—0.00€ for NRPs, and 154.40€ for RPs. NRP packs were imported in 42.38%, while RP packs were imported only in 24.62%. Highest average pharmacy retail prices could be found in the therapeutic areas 'antineoplastic and immunomodulating agents' (1711.47€), 'systemic hormonal preparations' (1331.95€), and 'blood and blood forming organs' (1260.58€). We detected high fluctuations in pharmacy retail prices per indication, as well as for reference prices per indication. The indications with the highest number of reference price regulated medical packs are 'cardiovascular system', 'musculo-skeletal system', and 'nervous system'. Highest co-payments were found in the indications 'antineoplastic and immunomodulating agents', 'blood and blood forming organs', and 'antiinfectives for systemic use'. Conclusion: Price setting and price dynamics vary substantially between NRP and RP medication packs. Further, we saw major differences across all indication areas as well as when comparing medication packs launched by top 20 pharma companies vs. the rest. [ABSTRACT FROM AUTHOR]

Ferrous scrap is a vital ingredient in the manufacture of steel, and it constitutes a strategic material of the greatest significance in modern warfare. During the late 1930s, Britain exported considerable quantities of scrap metal to Nazi Germany, a trade which subsequently proved embarrassing and which officialdom sought to obscure. Following the Second World War, Britain obtained large amounts of iron and steel from Western Germany, much of which it took—often surreptitiously—as war booty. Historians have paid relatively scant attention to this flow of scrap, yet it had important economic, strategic, and diplomatic consequences. Two reasons for this lack of attention are the overwhelming influence that the US and the USSR played in shaping the fate of postwar Germany, and a tendency of British policymakers and historians to support an overly simplified narrative that contrasted Western beneficence toward their former enemy with Soviet rapaciousness. [ABSTRACT FROM AUTHOR]

Since the fall of Communism in 1989, the Czechs have received considerable foreign direct investment from Germany. But the historical relationship between the Czechs and Germans has long been a difficult one. The legacy of the past still overshadows the relationship between the Czech Republic and Germany even after the accession of the Czech Republic to the European Union. The article examines how Czech managers in a joint venture with a German organization drew upon narratives and metaphors of the history of their relationship and historical stereotypes of German behaviour rather than economic explanations to understand and explain their experience of a failed joint venture. [ABSTRACT FROM AUTHOR]

To investigate general practitioners' (GPs') willingness to participate in long-term medical research and in research networks (RNs). Cross-sectional survey among German GPs around Halle-Wittenberg and Leipzig in 2020. Random sample of 905 GPs. Response rate 37%, 69% female. Overall, 57% were interested in participating in medical research, 34% in an active role in a RN. Interest in RN participation was positively associated with male sex, younger age, previous experiences in medical research, being involved in teaching undergraduates, and having qualification in a further specialty. Main motivators were improving patient care, giving a more realistic picture of GP care, and carrying out research on topics within their own interest areas and a reliable contact person at the leading institution. Most GPs were not afraid of reduced earnings; however, time investment was the main barrier for participation. GPs were willing to dedicate twice as much time to research when remuneration was offered. High rated topics were polypharmacy, chronic diseases, drug safety and adverse drug reactions. GPs are interested to participate in practice-based research. The study results providing useful and generalizable insights in barriers and motivators should be considered when building and running GP-RNs. There is a difference between general practitioners' (GPs') overall interest in clinical research and their job and socio-demographic related readiness to participate in research networks (RNs). GPs are interested in RNs when it is a resource of and leading to enhanced patient-oriented care. GPs are willing to dedicate twice as much time to research when remunerated. GPs need a reliable counterpart within the leading institution. [ABSTRACT FROM AUTHOR]

This article explains how the firms involved in tobacco trade between the largest producer and consumer of Oriental-type tobacco (Greece and Germany) adapted their strategies in response to the economic environment of the interwar period, which was characterised by increased economic étatism, high barriers to trade, and generalised economic depression. The leading firm of Germany's cigarette industry Reemtsma adopted innovative strategies for sourcing its raw material, while Greek leaf merchants turned to collective action and political advocacy in response to international competition and labour activism. The history of these strategies exemplify the interplay between politics and business decisions. It also provides a concrete example of how German economic power over southeastern Europe in the interwar period manifested itself in a specific industry. [ABSTRACT FROM AUTHOR]

The monumental Late Bonze Age royal tomb of Seddin is located in the old morainic landscape of the Prignitz region, northeastern Germany. Together with other richly equipped burials and a row of stone pits in its direct vicinity, it provides evidence for the presence of an elite from the nineth to sixth centuries BCE in this region. Our map emphasizes the well-chosen location of the royal tomb in relation to the spatial arrangement of other archaeological monuments that together form an ensemble of a ritual landscape. We trace legacies of land use from the Bronze Age to the present against the backdrop of Late Quaternary landscape evolution. These include the Bronze Age landscape (re-)organization for ritual and economic purposes, its medieval use for arable farming, its economic use and settlement history in historic times, and modern times melioration of agricultural areas that together form the palimpsest of the present-day landscape. [ABSTRACT FROM AUTHOR]

The Nazi Party launched a series of ambitious building programs soon after seizing power intended to achieve a comprehensive spatial reorganization of Germany. As part of these expansive building programs, the regime invested considerable time, effort, and resources in creating an archipelago of places of memory substantiating Nazi ideology and power. This commemorative topography stitched together a profusion of places and spaces into a totalitarian liturgy that glorified notions of struggle and sacrifice on behalf of Hitler and his movement. This article investigates how this topography of Nazi memory worked to translate intangible ideologies into tangible places and experiences, and in doing so, highlights the mutable and multifaceted relationships between places of memory, historic preservation, and place attachment. [ABSTRACT FROM AUTHOR]

Germany has an ambitious global health strategy, yet its universities provide few opportunities for global child health researchers. Improved understanding of the reasons and the academic role of global child health is needed. The objective of this study is to offer insights into Germany's academic global child health landscape by describing the actors and their priorities in research and education and by analysing perceived barriers and opportunities. We used a sequential exploratory mixed-method design. Participants were selected purposively to represent German global child health academics. Information was gathered first from a 33-item online survey and from interviews conducted four to six months post-survey. Surveys were analysed descriptively. A joint thematic approach using content analysis was used to analyse interview transcripts. Four categories emerged: training and professional orientation; professional realities; representation and advocacy, and barriers. Of the 20 survey participants (median [IQR] age 55 years [17], five female), seven agreed to be interviewed. Research experiences abroad shaped individuals' career choices in global child health. They engaged in global child health education, primary health care and access to health services, frequently in clinical and humanitarian settings, but spent little time on global child health-related activities. Participants were active and valued in international networks and keen to extend their activities. Yet they felt under-represented academically and reported multiple structural and individual barriers in Germany. They perceived a lack of leadership positions, career paths, funding opportunities, and institutional and project support which limits academic advancement. Germany's global child health experts are motivated to engage with global child health-related topics but face difficulties in advancing academically. Academic actors may need to intensify research and training efforts in order to expand global child health's scientific base in Germany. [ABSTRACT FROM AUTHOR]

With rising numbers of students, shorter hospital stays and increasing workload of academic teachers, teaching time have become a scarce resource. Thus, optimal preparation by teachers is key for good clinical teaching. Though a lot of teaching duties are performed by residents in Germany, they are not likely to have been educated in didactic techniques. We developed and evaluated a mobile teaching application using the "Learning Toolbox (LTB)" platform (Raycom BV, Utrecht, Netherlands) that was offered to academic teachers for preparation and support during curricular courses at our medical school. Courses were part of the curricula in Anaesthesiology, Emergency Medicine, and Orthopaedic and Trauma Surgery, and course length could vary up to 40 h per week. Information provided by the novel platform included logistic information, learning objectives, and curricula for the individual courses. A basic tutorial on didactic techniques, suggestions for providing feedback and for enhancing students' participation was also part of the platform. After one semester, interviews with teachers indicated an increase in overall satisfaction. Residents appreciated didactic aids and content provided for preparation, leading to higher motivation and self-confidence. The more experienced teachers were particularly satisfied with easy access to scheduling, teaching assignments and daily planning. The app increased teachers' satisfaction with their performance and enabled better integration of teaching in the daily schedule. [ABSTRACT FROM AUTHOR]

Purpose: Prior research provides limited information on the roles that leisure can play among Western international students studying in Eastern countries. Exploring this directional difference can provide its implications for Western international student support. Therefore, the purpose of this study is to explore leisure behaviours and leisure benefits associated with acculturation among Western international students residing in South Korea.Method: Using a purposeful criterion sampling strategy, a total of 18 participants (7 males and 11 females) were recruited. This study employed semi-structured in-depth interviews and a content mapping and content mining question strategy was incorporated.Results: The following core themes were associated with the health benefits of leisure activities experienced by international students living in South Korea: (a) promoting mental health, (b) experiencing dynamics of inter-and intra-group friendships, and (c) facilitating acculturation.Conclusions: The findings showed that participants developed friendships with the host individuals and other international students, became well acculturated into a new culture and experienced benefits to their mental health, indicating that leisure participation can be instrumental in improving social and psychological wellbeing. [ABSTRACT FROM AUTHOR]

In Germany, two-week clinical clerkships in university-associated general practices have existed since 2002. Approximately 10,000 medical students participate in these decentral clerkships each year. Empirical information on quality management strategies in decentral learning environments is sparse. This nationwide study aims to describe the current quality management efforts of German family medicine departments in response to negative events. A nationwide three-part mixed methods study on the quality management of family medicine clerkships was conducted. First, individuals from n = 37 family medicine departments involved in the organization of family medicine clerkships were interviewed. Interview transcripts were analyzed with qualitative content analysis. Second, a questionnaire on quality management of decentralized learning environments based on the categories of the analysis was developed and sent to the departments. Three negative event cases in family medicine clerkships were included in the questionnaire. Third, interview and survey data were integrated based on respondents' process descriptions of how each department handled the cases. Of the 37 contacted departments, n = 12 (32%) performed an interview. Major categories of negative events included problems in the student-teacher interaction, didactical challenges, and problematic student behavior. Twenty departments answered at least one questionnaire (54%). Most respondents indicated that their department conducts quality management in decentralized teaching. Negative events in decentral family medicine clerkships occurred at a rate of 66.4 to 179.5 events per 10,000 Students per semester. The mixed-method analysis showed that departments are conscious about quality management issues in decentral learning environments but adhere to heterogeneous local standards. Negative events occur regularly in decentral learning environments. Local quality management processes exist but lack national harmonization. Further outcome-based research is needed to explore the effectiveness and feasibility of quality management strategies. This will become increasingly relevant with an expected upscaled family medicine content. [ABSTRACT FROM AUTHOR]

Climate change (CC) is adversely affecting human health and will become far more dangerous in the future, if no substantial measures are taken. Young people in particular are taking an energetic stand for CC awareness. Some CC experts argue that medical doctors are especially well positioned to inform about the impact of CC on public health, as it is well established that they are among the most trusted members of society. However, medical doctors seem to be unsure of their role in addressing CC. This study aimed to investigate future doctors´, i.e., final year medical students´ (FYMS), attitudes towards CC and their personal role in CC education and health care. A questionnaire was developed to examine (1) the expected consequences of CC for FYMS, (2) their perceived individual responsibility, and their attitudes towards an additional (3) professional responsibility. To examine the climate-questionnaire's component correlations, we ran a factor analysis using oblique (promax) rotation and conducted a one-way ANOVA with repeated measures to compare the mean scores of the factors. Data are presented as mean ± SD or percentage, as appropriate. n = 65 FYMS (response rate: 87%) were participating and all of them completed the questionnaire. Items of the factor professional responsibility showed the lowest level of agreement (47.2 ± 21.2), while the 2 other factors showed higher levels of agreement (expected consequences (75.6 ± 18.4), individual responsibility (75.1 ± 20.6). Future doctors at Heidelberg University Hospital are well-informed about the expected health consequences of CC. They recognize human contributions to CC and make personal decisions to mitigate the impact. However, the opinion that they have a professional responsibility as physicians to patients or society in regard to CC is weaker. Specific teaching could help to change the way future doctors see their role and responsibility in tackling CC. [ABSTRACT FROM AUTHOR]