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Soil and soil biodiversity are often a neglected component in assessments of ecosystems and their services. One of the reasons is the increasing complexity of scientific investigation of biotic and abiotic interactions and mechanisms from soil biodiversity and soil components via ecosystem structures, processes, and functions that finally provide specific ecosystem services for human well-being. In particular, soil-related cultural ecosystem services are missing in the publications on interactions. We tested this hypothesis by using a systematic literature analysis and taking Germany as a case study. The findings revealed a huge research gap. Among 2104 peer-reviewed scientific papers, covering all types of soil-related ecosystem services, only 28 publications were related to soil-related cultural ecosystem services in Germany. Furthermore, the terminological awareness of "ecosystem services" is still limited. The following five main categories for cultural soil-related ecosystem services were identified: (1) place of sense, (2) spiritual value, (3) recreation, (4) forecasts and measures, and (5) soil as an archive. Soil as an archive was further divided into storage, archaeological site, and reconstruction of the past. By highlighting the importance of cultural soil-related ecosystem services and their interactions with soil biodiversity, this study underlines the urgent need to better consider soil biodiversity and soil processes in ecosystem service assessments. This systemic and interdisciplinary approach increases also the societal and political relevance of soil. [ABSTRACT FROM AUTHOR]

The 11th Revision of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD-11) will replace its predecessor as international standard for cause-of death-statistics. The digitization of healthcare is a main motivation for its introduction. In parallel, the replacement of the paper-based death certificate with an electronic format is under evaluation. At the moment, the death certificate is used in paper-based format with ICD-10 for coding in Germany. To be prepared for the switch to ICD-11, the compatibility between ICD-11 and the electronic certificate should be assured. Objectives were to check the appropriateness of diagnosis-related information found on death certificates for an ICD-11 coding and to describe enhancements to the certificate's structure needed to fully utilize the strengths of ICD-11. As part of an exploratory test of a respective application, information from 453 electronic death certificates were provided by one local health authority. From a sample of 200 certificates, 433 diagnosis texts were coded into the German version of ICD-11. The appropriateness of the results as well as the further requirements of ICD-11, particularly with regard to post-coordination, were checked. For 430 diagnosis texts, 649 ICD-11 codes were used. Three hundred and sixty two diagnosis texts were rated as appropriately represented through the coding result. Almost all certificates contained diagnosis texts that lacked details required by ICD-11 for a precise coding. The distribution of diseases was very similar between ICD-10 and ICD-11 coding. A few gaps in ICD-11 were identified. Information requested by ICD-11 for a mandatory post-coordination were almost entirely absent from the death certificates. The structure and content of the death certificate are currently not well prepared for an ICD-11 coding. Necessary information was frequently missing. The line-oriented structure of death certificates has to be supplemented with a more flexible approach. Then, the semantic knowledge base of ICD-11 should better guide the content related input fields of a future electronic death certificate. [ABSTRACT FROM AUTHOR]

This paper asks the question, 'What does Islamic education mean for the 21st century university?' To begin with, the paper addresses the modern university as an institution facing numerous challenges, which can be conceived of by understanding the nature of the 'academic imagination'. In so doing, this argument draws on the fundamental elements of thought itself by foregrounding imagination as a primary route by which knowledge is conceived, created and disseminated. At root, it is an argument that suggests that to understand the university is to apprehend its imaginative functions. 'Problems of the imagination' are thereafter defined as 'depth perception', 'vertigo' and 'paralysis', respectively. In light of these challenges, the rise of Centers of Islamic Theology in Germany, and Islamic education as a discipline in particular, are considered as uncharted paths towards a discussion of the dilemmas of contemporary academia. Methodologically, the paper is a philosophical reflection on the role of the future of the university and the place of Islamic Theology and Islamic education therein. As such, use of the contemporary literature on higher education, as well as classical works on Islamic education, shall be employed for the purposes of the argument. In so doing, this paper turns the normative discussion of contemporary Islamic education on its head: from how we may make room for such education in the modern university, to consider how its presence may help the institution and its imaginative conundrums. [ABSTRACT FROM AUTHOR]

Acceptability analyses of place–based innovations provide crucial in-depth knowledge (e.g., perceptions and values on landscapes) for the social–ecological transformation of landscapes. However, previous acceptability analyses often neglected complex and ongoing processes. We argue that, for the design of a sustainability-oriented transformation and to address spatial and temporal dynamics in landscapes, an operational heuristic is needed; one that integrates acceptability analyses into an adaptive landscape co-design and management approach. Therefore, this conceptual–empirical paper introduces the concept of the 'acceptability and landscape design cycle' (ALDC), which is based on findings from various transdisciplinary innovation processes in the Spreewald region (Germany). It is composed of four iterative phases: (1) defining the preconditions for acceptability analysis, (2) conducting the acceptability analysis, (3) integrating the results into the landscape development strategy, and (4) re-designing and refining it. We illustrate the application of these phases using a case study of the cultural landscape in Spreewald. The paper provides practical implementation guidelines of the ALDC and contributes to a better understanding of the dynamics of acceptability decisions regarding the transformation processes of landscapes. Furthermore, it can advance the understanding of how co-evolution of socio-ecological systems occurs. [ABSTRACT FROM AUTHOR]

Purpose: Psychosocial care is an integral component of caring for individuals living with cancer. The identification of psychosocial distress has been acknowledged as a hallmark of quality cancer care, and screening for distress standards has been established in several countries. The purpose of this brief review is to highlight recent developments in screening for distress in oncology populations; to provide insight into significant trends in research and implementation; and to explore implications for oncology nursing practice. Methods: This paper reports a brief review of the literature from March 2021 to July 2024 on the topic of screening for distress in oncology. The literature was accessed through PubMed and reviewed by two authors. Trends in the topics presented were identified independently and then discussed to achieve consensus. Results: The search within the designated period produced 47 publications by authors in North America, Australasia, and Europe. Topic trends included the design and adaptation of tools for special populations, the use of technology, descriptions of programs, identification of benefits, challenges, and overcoming barriers to screening for distress. Conclusions: Screening for distress is endorsed as part of the provision of quality oncology care. Nurses have an important role in screening individuals at risk for developing psychosocial problems and acting to reduce the associated morbidity. By continuing to be informed and educated about the emerging developments in screening for distress, nurses can understand and overcome barriers to implementation. [ABSTRACT FROM AUTHOR]

The emerging energy transition is particularly described as a move towards a cleaner, lower-carbon system. In the context of the global shift towards sustainable energy sources, this paper reviews the potential and roadmap for hydrogen energy as a crucial component of the clean energy landscape. The primary objective is to present a comprehensive literature overview, illuminating key themes, trends, and research gaps in the scientific discourse concerning hydrogen production and energy policy. This review focuses particularly on specified geographic contexts, with an emphasis on understanding the unique energy policies related to renewable energy in Brazil, Austria, and Germany. Given their distinct social systems and developmental stages, this paper aims to delineate the nuanced approaches these countries adopt in their pursuit of renewable energy and the integration of hydrogen within their energy frameworks. Brazil exhibits vast renewable energy potential, particularly in wind and solar energy sectors, positioning itself for substantial growth in the coming years. Germany showcases a regulatory framework that promotes innovation and technological expansion, reflecting its highly developed social system and commitment to transitioning away from fossil fuels. Austria demonstrates dedication to decarbonization, particularly through the exploration of biomethane for residential heating and cooling. [ABSTRACT FROM AUTHOR]

In areas affected by mining, which are undergoing reclamation, their geotechnical characteristics need to be monitored and the level of landslide risk should be assessed. This risk should preferably be reduced by nature-based solutions. This paper presents a KurZeS slope stability assessment technique based on areal data. This method is suitable for large areas. In addition, a procedure is presented for how to incorporate a prediction of the impact of nature-based solutions into this method, using the example of vegetation root reinforcement. The paper verifies the KurZeS method by comparing its results with the results of stability calculations by GEO5 software (version 5.2023.52.0) and validates the method by comparing its results with a map of closed areas in the area of the former open-cast mine Lohsa II in Lusatia, Germany. The original feature of the KurZeS method is the use of a pre-computed database. It allows the use of an original geometrical and geotechnical concept, where slope stability at each Test Point is evaluated not just along the fall line but also along different directions. This concept takes into account more slopes and assigns the Test Point the lowest safety factor in its vicinity. This could be important, especially in soil dumps with rugged terrain. [ABSTRACT FROM AUTHOR]

The number of obstetric departments in German hospitals has declined in the last decades. In particular, rural hospitals are challenged to sustain their delivery services. In this paper, we analyse the role of variation and overheads of obstetric departments from the perspective of current and future German hospital financing. For this purpose, we develop a Monte Carlo simulation model that analyses the workload of the labour room and the obstetric ward. The results show that a hospital with less than 640 deliveries per year cannot break even. In order to offer services 24 h per day, 365 days per year, five nurses, five midwives, and five gynaecologists are needed. This results in high fixed costs. At the same time, the variation coefficient of the labour room and the obstetric ward declines with an increasing number of deliveries. Consequently, small hospitals have a higher risk of over- and under-utilization in the course of the year. This paper acknowledges that economics is not the only decision dimension. The quality of the institution and the transport to the hospital have to be considered, as well as the population's wish for nearby services. However, the simulations clearly demonstrate that unless the hospital financing system is changed fundamentally, the decline in the number of hospitals offering delivery services will continue. [ABSTRACT FROM AUTHOR]

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. [ABSTRACT FROM AUTHOR]

Rarely has a chemical elicited as much controversy as dichloroacetate (DCA). DCA was initially considered a dangerous toxic industrial waste product, then a potential treatment for lactic acidosis. However, the main controversies started in 2008 when DCA was found to have anti-cancer effects on experimental animals. These publications showed contradictory results in vivo and in vitro such that a thorough consideration of this compound's in cancer is merited. Despite 50 years of experimentation, DCA's future in therapeutics is uncertain. Without adequate clinical trials and health authorities' approval, DCA has been introduced in off-label cancer treatments in alternative medicine clinics in Canada, Germany, and other European countries. The lack of well-planned clinical trials and its use by people without medical training has discouraged consideration by the scientific community. There are few thorough clinical studies of DCA, and many publications are individual case reports. Case reports of DCA's benefits against cancer have been increasing recently. Furthermore, it has been shown that DCA synergizes with conventional treatments and other repurposable drugs. Beyond the classic DCA target, pyruvate dehydrogenase kinase, new target molecules have also been recently discovered. These findings have renewed interest in DCA. This paper explores whether existing evidence justifies further research on DCA for cancer treatment and it explores the role DCA may play in it. [ABSTRACT FROM AUTHOR]

In Germany, there are over 32,000 schools, representing great potential for climate protection. On the one hand, this applies to educational work, as understanding the effects of climate change and measures to reduce GHG emissions is an important step to empower students with knowledge and skills. On the other hand, school buildings are often in bad condition, energy is wasted, and the possibilities for using renewable energies are hardly used. In our "Schools4Future" project, we enabled students and teachers to draw up their own CO2 balances, identify weaknesses in the building, detect wasted electricity, and determine the potential for using renewable energies. Emissions from the school cafeteria, school trips, and paper consumption could also be identified. The fact that the data can be collected by the students themselves provides increased awareness of the contribution made to the climate balance by the various school areas. The most climate-friendly school emits 297 kg whilst the school with the highest emissions emits over one ton CO2 per student and year. Our approach is suitable to qualify students in the sense of citizen science, carry out a scientific investigation, experience self-efficacy through one's own actions, and engage politically regarding their concerns. [ABSTRACT FROM AUTHOR]

In contemporary times, the utilization of liquid organic hydrogen carriers (LOHCs) has gained prominence due to their high volumetric storage density and material properties closely resembling conventional fuels. Numerous countries are incorporating LOHCs in hydrogen demonstration initiatives, encompassing applications such as hydrogen refueling stations, hydrogen-powered ships, and trains. This paper conducts a comprehensive review of seventeen LOHC projects, spanning Germany, Europe, and other nations, presenting detailed project specifications. This review includes information on project consortiums, funding sources, covered supply chains, transport modalities, and employed technologies. Through a global evaluation of LOHC projects, this review underscores the promising and competitive nature of LOHCs as a viable option for the large-scale and long-distance storage and transportation of hydrogen. The future development of this field is discussed at in the last section. [ABSTRACT FROM AUTHOR]

The paper departs from the observation that the role of migrant organisations (MOs) in Germany has changed significantly since the strong influx of refugees in 2015/16. As a result of this specific historical situation, it seems that MOs were able to strengthen their position as important civil society and integration policy actors and reduce reservations about them. While there has been growing attention on MOs' civic and social contributions, both in public and academic debates, this article also highlights the risks of failure and inflated expectations and the often rather fragile structures of MOs. Thus, the article aims to broaden the view on MOs by focusing on aspects which have been neglected in the course of recent public and academic interest and rather optimistic perceptions. The methodological approach is one of "embedded research": the author has been a senior executive of one of the largest German MOs for six years and, at the same time, a migration researcher for many years. From this special inside/outside view, an ambivalent picture emerges: despite a significantly greater appreciation of the achievements of MOs and much verbal recognition, there is a clear lack of the necessary material/structural support, jeopardising the sustainability and viability of many MOs. [ABSTRACT FROM AUTHOR]

Several northern European countries have announced ambitious plans to become carbon neutral already before the year 2050. Recent research has, however, highlighted how potential bottlenecks in raw material and resource availability could significantly delay or hinder wind and solar photovoltaic (PV) expansion and continued biomass usage in parts of Europe. To address this issue, this paper assesses how exposed the national energy and climate plans (NECPs) of Finland, Estonia, Germany, Sweden, and Denmark are to resource limitations and techno-economic risks by reviewing and analysing 2030 NECP targets compared to statistical energy use data in these countries. The results indicate that the NECPs of Denmark and Germany are particularly exposed to risks related to global raw material availability, as Denmark plans to rapidly grow the share of wind and solar PV in electricity generation to 81% and 13% by 2030, respectively, followed by Germany, which outlines a 39% and 16% share of wind and solar PV in its national climate strategy. The NECPs of Finland and Germany are also shown to be vulnerable to limitations in biomass availability, as there is a significant disparity between the projected biomass usage and legally binding European Union (EU) targets for land use, land use change, and forestry (LULUCF) sector emissions in 2030 in these countries. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [ABSTRACT FROM AUTHOR]

In this paper, an experimental and numerical investigation of the effect of leading-edge erosion in transonic blades was performed. The measurements were carried out on a linear blade cascade in the Transonic Cascade Wind Tunnel of DLR in Cologne at two operating points with an inflow Mach number of 1.05 and 1.12. The numerical simulations were performed by ANSYS Germany. The type and specifications of the erosion for the study were derived from real engine blades and applied to the leading edges of the experimental cascade blades using a waterjet process, as well as modeled in detail and meshed within the numerical setup. Numerical simulations and extensive wake measurements were carried out on the cascades to evaluate the aerodynamic performance. The increase in losses was quantified to be 4 percent, and a reduction in deflection and a rise in pressure were detected at both operating points. [ABSTRACT FROM AUTHOR]

This paper introduces a novel nothing-on-road (NOR) bridge weigh-in-motion (BWIM) approach with deep learning (DL) and non-invasive ground-based radar (GBR) time-series data. BWIMs allow site-specific structural health monitoring (SHM) but are usually difficult to attach and maintain. GBR measures the bridge deflection contactless. In this study, GBR and an unmanned aerial vehicle (UAV) monitor a two-span bridge in Germany to gather ground-truth data. Based on the UAV data, we determine vehicle type, lane, locus, speed, axle count, and axle spacing for single-presence vehicle crossings. Since displacement is a global response, using peak detection like conventional strain-based BWIMs is challenging. Therefore, we investigate data-driven machine learning approaches to extract the vehicle configurations directly from the displacement data. Despite a small and imbalanced real-world dataset, the proposed approaches classify, e.g., the axle count for trucks with a balanced accuracy of 76.7% satisfyingly. Additionally, we demonstrate that, for the selected bridge, high-frequency vibrations can coincide with axles crossing the junction between the street and the bridge. We evaluate whether filtering approaches via bandpass filtering or wavelet transform can be exploited for axle count and axle spacing identification. Overall, we can show that GBR is a serious contender for BWIM systems. [ABSTRACT FROM AUTHOR]

In recent years, research on carbon dioxide removal (CDR) has significantly increased. Numerous studies have analyzed demonstration projects, outlined scenarios, modeled pathways, or focused on CDR's national or international governance. However, regional case studies investigating the dynamics that may facilitate or impede the broader adoption of CDR methods in spatially explicit settings are critically absent. Understanding implementation contexts on the ground is vital, and comparing them across different removal methods is essential for effectively scaling up CDR. This paper aims to address this research gap by comparatively examining the development of biomass-based CDR in three regions of Germany. Taking an exploratory approach, we conducted surveys in these regions to gain insight into stakeholder perceptions of the following six CDR methods: forest management, agriculture and soil carbon, long-lasting building materials, rewetting of peatlands and paludiculture, biochar, and bioenergy with carbon capture and storage. In this article, we present the results of the stakeholder survey, which offers multiple perspectives that can shape future studies of regional implementation and yield policy-relevant guidance. Although our research primarily focuses on the regional level in Germany, it sheds light on various conflicts, uncertainties, and potentials that are likely to be relevant for the rollout of CDR in other countries. By examining these aspects, we contribute to the broader discourse on CDR and its potential implementation. [ABSTRACT FROM AUTHOR]

This paper presents the preliminary results of an investigation on the unexplored topic of polychromy on provincial stone sculptures from the Roman provinces in Germania through the innovative application of heritage materials science techniques. A group of three life-sized statues dating to the 1st Century CE recovered from Ingelheim, near Mainz, retains remarkably well-preserved traces of pigments. These are ripe for emerging non-invasive technologies supplemented by micro-sampling to validate results and provide information relating to mixing and layering not available to the naked eye. The most strikingly visible areas of extant polychromy were retained on the sculpture of a young woman, reported on here as the first phase of this programme of research. The results suggest that the statue was originally covered in a gypsum layer before the application of complex and diverse recipes of pigment applied as mixtures and in layers to create required hues and shadowing on sculpted features. The palette includes ochres and green earth mixed with small amounts of minium (red lead), realgar and lapis lazuli (ultramarine blue) added to create skin tones, and a vibrant blue-green tunic created from Egyptian blue, bone black, ochres, cinnabar and green earth; the palla and peplos contained ochres, bone black, and orpiment, and mixes of these created the detail of coloured jewellery. Of great interest was the detection of bone black on many features, particularly as a shading agent to enhance sculpted features, such as folds in cloth, providing a more realistic and flowing articulation. This is a revolutionary observation that provides previously unexplored insights into artistic polychromic practice in Antiquity. [ABSTRACT FROM AUTHOR]

Women are underrepresented in many areas of journalistic newsrooms. In this paper, we examine if this established effect persists in the new forms of journalistic communication, namely social media networks. We use mentions, retweets, and hashtags as measures of journalistic amplification and legitimation. Furthermore, we compare two groups of journalists in different stages of development: political and data journalists in Germany in 2021. Our results show that journalists identified as women tend to favor other women journalists in mentions and retweets on Twitter (now called X), compared to men. While both professions are dominated by men, with a high share of tweets authored by men, women mention and retweet other women more than their male colleagues. Female data journalists also leverage different sources than men. In addition, we found data journalists to be more inclusive of non-member sources in their networks compared to political journalists. [ABSTRACT FROM AUTHOR]

The energy sector faces a pressing need for significant transformation to curb CO2 emissions. For instance, Czechia and Germany have taken steps to phase out fossil thermal power plants by 2038, opting instead for a greater reliance on variable renewable energy sources like wind and solar power. Nonetheless, thermal power plants will still have roles, too. While the conventional multistage axial turbine design has been predominant in large-scale power plants for the past century, it is unsuitable for small-scale decentralized projects due to complexity and cost. To address this, the study investigates less common turbine types, which were discarded as they demonstrated lower efficiency. One design is the Elektra turbine, characterized by its velocity compounded radial re-entry configuration. The Elektra turbine combines the advantages of volumetric expanders (the low rotational speed requirement) with the advantages of a turbine (no rubbing seals, no lubrication in the working fluid, wear is almost completely avoided). Thus, the research goal of the authors is the implementation of a 10 kW-class ORC turbine driving a cost-effective off-the-shelf 3000 rpm generator. The paper introduces the concept of the Elektra turbine in comparison to other turbines and proposes this approach for an ORC working fluid. In the second part, the 1D design and 3D–CFD optimization of the 7 kW Elektra turbine working with Hexamethyldisiloxane (MM) is performed. Finally, CFD efficiency characteristics of various versions of the Elektra are presented and critically discussed regarding the originally defined design approach. The unsteady CFD calculation of the final Elektra version showed 46% total-to-static isentropic efficiency. [ABSTRACT FROM AUTHOR]

This paper examines the current and prospective greenhouse gas (GHG) emissions of e-fuels produced via electrolysis and Fischer–Tropsch synthesis (FTS) for the years 2021, 2030, and 2050 for use in Germany. The GHG emissions are determined by a scenario approach as a combination of a literature-based top-down and bottom-up approach. Considered process steps are the provision of feedstocks, electrolysis (via solid oxide co-electrolysis; SOEC), synthesis (via Fischer–Tropsch synthesis; FTS), e-crude refining, eventual transport to, and use in Germany. The results indicate that the current GHG emissions for e-fuel production in the exemplary export countries Saudi Arabia and Chile are above those of conventional fuels. Scenarios for the production in Germany lead to current GHG emissions of 2.78–3.47 kgCO2-eq/L e-fuel in 2021 as the reference year and 0.064–0.082 kgCO2-eq/L e-fuel in 2050. With a share of 58–96%, according to the respective scenario, the electrolysis is the main determinant of the GHG emissions in the production process. The use of additional renewable energy during the production process in combination with direct air capture (DAC) are the main leverages to reduce GHG emissions. [ABSTRACT FROM AUTHOR]

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

The summer of 2022 was one of the hottest and driest summers that Germany experienced in the 21st century. Water levels in rivers sank dramatically with many dams and reservoirs running dry; as a result, fields could not be irrigated sufficiently, and even power generation and supply were affected. The impact of abnormally high temperatures for extended periods (heatwaves) is not restricted to nature and the economy but is also a considerable public health burden. Experts worldwide agree that these extreme weather events are being driven by climate change and will increase in intensity and frequency in the future. The adverse impact of these extreme weather events multiplies among dense urban environments, e.g., through heat islands. This calls for cities to take action to heat-proof and water-secure their urban developments. Water-Sensitive Urban Design (WSUD) is one such approach to mitigate the aforementioned challenges by leveraging the urban water ecosystem with special attention to the subject of water reclamation, retention, treatment and distribution. This paper introduces and builds upon a prototype of WSUD that centers around an artificial lake as an integrated water resource management system (IWRMS) fed by treated grey water and storm water obtained from two housing blocks flanking the water reservoir. Based on the specifications of this prototype, indicators of site suitability are derived and applied to identify potential locations for replicable projects in the city of Darmstadt. The results confirm the impact WSUD can have: a total of 22 sites with 2527 apartments are found suitable for prototype implementation in Darmstadt. Savings in town water consumption from these 22 sites would add up to 147 million liters. Further benefits include the provision of 24 million liters of irrigation water, storm water retention, adiabatic cooling during heatwave, increased biodiversity and the improvement in livability of the sites and the city. [ABSTRACT FROM AUTHOR]

Reducing the heat demand of existing buildings is an essential prerequisite for achieving a greenhouse gas-neutral energy supply. Numerous studies and open-source tools deal with heat demand mapping. It is not uncommon that estimated heat demands deviate from real heat consumption, so existing approaches should be improved by including in-depth building information. Some tools have recognised this problem and offer built-in functions for factoring various parameters into their assessments. Nevertheless, the necessary information is usually missing and should be obtained first. In this paper, we analyse the impact of thermal refurbishment and climate on building heat demand; hence, generate public datasets with corresponding key figures for each building type in different efficiency states and years. Accounting for already performed refurbishments in methodologies for assessing the actual state heat demand for cities will result in a reduction of at least 8% up to more than 21%, depending on whether conventional or passive house components were installed. As a result of climatic differences within Germany, a building's heat demand can be up to 39% higher or up to 21% lower than the heat demand of an identical building in the reference climate of Germany. By further developing the approaches of the tools Hotmaps and Heat Cadastre Hamburg, we could improve the estimated heat demand of Hamburg to a value approximating the real consumption. [ABSTRACT FROM AUTHOR]

In this paper, we present a comprehensive assessment of the effects of residential loads, electric vehicles (EVs), and electric heat pumps (HPs) on low-voltage (LV) grids in urban, suburban, and rural areas of Germany. Firstly, real data are used to determine the typical structures for each LV grid region. Secondly, nine scenarios are defined with different levels of EV and HP penetration. Thirdly, the Low Voltage Load Flow Calculation in the DIgSILENT PowerFactory is performed for all scenarios while taking the simultaneity factor (SF) for each load type into consideration to calculate the minimum voltage and maximum loadings of transformer and lines in each grid; this allows for the grid's potential bottlenecks to be identified. The network simulations are carried out with the consideration of charging powers of 11 kW and 22 kW in order to evaluate how an increasing EV load in the future may affect the grid's parameters. To the best of our knowledge, no study in the literature has simultaneously addressed all of the aforementioned topics. The results of this study provide a useful framework that distribution system operators (DSOs) may apply to anticipate the forthcoming challenges and figure out when grid reinforcement will be required. [ABSTRACT FROM AUTHOR]

Wastewater from plastic manufacturing or processing industries is often highly polluted with microplastics (MPs) and high levels of oxidizable organic matter, which results in a high chemical oxygen demand (COD). When industrial wastewater enters wastewater streams, the high microplastic load is a high burden for municipal wastewater treatment plants (WWTPs), as they are not sufficiently removed. To prevent MP from entering the WWTPs, an upstream prevention method is essential. This paper presents a pilot-scale plant study for the removal of MP and COD from industrial wastewater that was tested on-site at a plastic manufacturer in Germany. Eight test phases were performed over 3 months, with each test phase processing 1 m3 wastewater and four treatments. Per test phase, 12 samples were analyzed for 5 parameters: COD, total suspended solids (TSSs), particle count, pH, and turbidity. The results showed an average decrease in MP by 98.26 ± 2.15% measured by TSSs and 97.92 ± 2.31% measured by particle count. This prevents the emission of 1.1 kg MP/m3 water and an estimated 2.7 t MP/year. The COD was reduced efficiently by 94.3 ± 8.9%. Besides MP and COD, this treatment allows reuse of water and agglomerates, resulting in a reduction in the CO2 footprint. [ABSTRACT FROM AUTHOR]

Wastewater treatment companies are particularly confronted by the energy and supply crisis resulting from the war in the Ukraine. More specifically, production and supply problems with precipitant production have shown that today's wastewater treatment technology in Germany is not crisis-proofed and must become more resilient. The aim of this paper was to determine a required precipitant quantity for Germany with regard to chemical phosphorus elimination, as well as the expected shortfalls due to the shortage situation. Furthermore, possible solutions were identified for how the precipitant can be saved or substituted. Study surveys were conducted to gather data for a meaningful response regarding the operators (wastewater treatment plants, industry, and water suppliers), manufacturers, and the German federal states. A recommendation is given on what a path to more resilient wastewater management with a focus on phosphorus elimination could look like. Based on the data obtained, the report focused on wastewater engineering issues for wastewater treatment plants and industry. The results of the study are relevant for decision-makers, researchers, and operators in the wastewater sector in order to intervene in the market themselves if necessary, e.g., money for production or conversion to biological phosphorus elimination. [ABSTRACT FROM AUTHOR]

The successful introduction of battery electric trucks heavily depends on public charging infrastructure. But even as the first trucks capable of long-haul transportation are being built, no coherent fast-charging networks are yet available. This paper presents a methodology for assessing fast charging networks for electric trucks in Germany from the literature. It aims to establish a quantitative understanding of the networks' performance and robustness to deviations from idealized system parameters and identify crucial charging sites from a transportation planning perspective. Additionally, the study explores the quantification of adaptation effects displayed by agents in response to charging site outages. To achieve these objectives, a comprehensive methodology incorporating infrastructure, vehicle and operational strategy modeling, simulation, and subsequent evaluation is presented. Factors such as charging station locations, C-rates, mandatory rest periods, and vehicle parameters are taken into account, along with the distribution of traffic according to publicly available data. The study aims to offer a comprehensive understanding of charging networks' performance and resilience. This will be applied in a case study on two proposed networks and newly created derivatives. The proposed network offers over 99% coverage for long-haul transport but leads to a time loss of approximately 7% under reference conditions. This study advances the understanding of the performance and resilience of proposed charging networks, providing a solid foundation for the design and implementation of robust and efficient charging infrastructure for electric trucks. [ABSTRACT FROM AUTHOR]

Conducting quantitative research involving adolescents demands a thoughtful approach to the question of supervision, given that each option comes with its distinct set of implications. This study reviews these implications and empirically tests whether differences in data quality can be found among three modes of standardized survey research with medium-sized groups of adolescents (12–17 years). The data basis is a quasi-experimental survey study testing different forms of digital, hybrid, or in-person supervision that took place in 2021 in secondary schools in Germany (N = 923). The aim of this study is to test how aspects of data quality—item nonresponse, interview duration, drop-out rate, and response patterns—differ between these forms of supervision. Results could help researchers surveying young people to decide (1) whether they allow confidants or other adults to be present during interviews, (2) if they can rely on teachers alone when surveying classrooms, and (3) if it is cost-efficient to send out external supervisors for classroom sessions. While drop-out rates do not differ, item non-response, interview duration, and response patterns differ significantly; students supervised at home by external interviewers answered more questions, took more time to answer, and were less likely to give potentially meaningless answers in grid questions. The implications drawn from the findings question the common approach of solely relying on teachers for survey administration without the support of external supervisors or adequate training. Recruiting respondents via schools and surveying them online in their homes during school hours has been shown to be a robust method with regard to the analyzed indicators. [ABSTRACT FROM AUTHOR]

With the rapid development of novel energy vehicles, power generation, photovoltaics, and other industries, power electronic devices have gained considerable attention. Insulated-gate bipolar transistors (IGBTs) have been widely used in those fields. With the emergence of intelligent manufacturing concepts such as Germany's "Industry 4.0" and China's "Made in China 2025", conventional manufacturing which needs to be upgraded with higher efficiency and yield is rapidly pivoting toward digitalization and intelligence. The digital twin methodology has been extensively used in various industries for constructing virtual models of physical entities, facilitating real-time data interconnection to reduce costs and improve efficiency. This study proposes a modular intelligent IGBT production line based on the digital twin. Real-time data are transmitted from a physical line to a digital line for storage and analysis. The digital line is visualized, and an intelligent management platform containing multiple functions is developed. Additionally, a process simulation database is established to obtain the optimal process parameters. Numerous quality issues that can arise during each process of IGBT packaging are addressed using a problem-solving approach based on the digital twin methodology. Consequently, this digital-twin-based IGBT intelligent production line effectively enhances yield rates and efficiency. IGBT modules with various packaging forms such as ACF, ACE, and ACD are manufactured. [ABSTRACT FROM AUTHOR]

Background: The healthcare sector is currently undergoing a significant transformation, driven by an increased utilization of data. In this evolving landscape, surveys are of pivotal importance to the comprehension of patient needs and preferences. Moreover, the digital affinity of patients and physicians within the healthcare system is reforming the manner in which healthcare services are accessed and delivered. The utilization and donation of data are influencing the future of medical research and treatment, while artificial intelligence (AI) is empowering patients and physicians with knowledge and improving healthcare delivery. Methods: In order to evaluate the opinions of patients and physicians regarding the management of personal health data and the functionality of upcoming data management devices in the context of healthcare digitization, we conducted an exploratory study and designed a survey. The survey focused on a number of key areas, including demographics, experience with digitization, data handling, the identification of needs for upcoming digitization, and AI in healthcare. Results: A total of 40 patients and 15 physicians participated in the survey. The results indicate that data security, timesaving/administrative support, and digital communication are aspects that patients associate with patient-friendly digitization. Based on the responses provided by physicians, it might be concluded that future digital platforms should prioritize usability, time efficacy, data security, and interoperability. Conclusions: In terms of expectations for future digital platforms, there is a notable overlap between the needs expressed by patients and those identified by physicians, particularly in relation to usability, time management, data security, and digital communication. This suggests that the requirements of different stakeholders can be combined in a future system, although individual issues may still require attention. [ABSTRACT FROM AUTHOR]

Background/Objectives: The main outcomes of the COVID-19 pandemic can be used to assess the capability and sustainability of public healthcare and Long-Term Care (LTC) systems. This study aims to identify the population's demographic and socio-economic characteristics, as well as other national resources associated with the incidence and mortality of COVID-19, by comparing three European countries during the first pandemic period (Italy, Spain, and Germany). The results will identify possible strengths and weaknesses that could be considered as hints of the need for health and social intervention. Methods: Variables describing the countries' core demographics, socio-economic characteristics, and national resources were collected from 2001–2021 from well-established international databases. COVID-19 incidence and death figures from 1 March 2020 to 31 March 2021 were extracted from national health databases. Analysis focused on bivariate and weighted multivariable linear regressions between incidence, mortality, and socio-economic covariates. Results: Findings show that both care models and socio-demographic characteristics influenced the capability of the first year's response to the COVID-19 emergency. Formal public care appears to represent the most effective strategy against incidence and mortality regarding COVID-19, especially for older people, because it mitigates the adverse effects of socio-economic characteristics. Conclusions: Current strategies oriented towards privatizing care should, therefore, be considered critically, since they may result in weaker protection of vulnerable groups, such as frail older people, due to the unequal position of individuals with different socio-economic conditions in purchasing services from the care market. [ABSTRACT FROM AUTHOR]

Background/Objectives: The previous literature has identified increased work-related stress among healthcare workers (HCWs) during the COVID-19 pandemic. This study analyzes work-related perceived stress experienced by therapists during the COVID-19 pandemic in Germany to identify potential for supporting this crucial group of HCWs in future health crises. Methods: Survey data on stress, measured through the Perceived Stress Scale 4, among HCWs (therapists n = 612, nurses n = 501, and doctors n = 461) were analyzed using descriptive statistics, and data from four semi-structured interviews and seven focus group discussions with therapists were analyzed using thematic content analysis. Data were collected from March to September 2022. Results: Therapists reported similar stress levels to other HCWs, with the reporting of perceived stress differing between work contexts. Eight stressors were identified through the thematic analysis: (1) concerns about maintaining the quality of care, (2) uncertainty about the future, (3) workload, (4) interactions with colleagues and patients, (5) PPE, (6) the risk of infection, (7) insufficient information flow, and (8) the lack of public and political recognition. Conclusions: This study emphasizes the distinct challenges that therapists experienced during the COVID-19 pandemic. By identifying the factors that contributed to the stress experienced, the study can inform targeted support strategies which can enhance therapists' work, ultimately contributing to sustaining essential healthcare services during public health crises. [ABSTRACT FROM AUTHOR]

Floods in Germany have become increasingly frequent and severe over recent decades, with notable events in 2002, 2013, and 2021. This study examines the trends and drivers of flood occurrences in Germany from 1990 to 2024, focusing on the influence of climate-change-related variables, such as temperature, precipitation, and river discharge. Using a comprehensive time series analysis, including Auto-Regressive Integrated Moving Average (ARIMA) and Artificial Neural Network (ANN) models and correlation and regression analyses, we identify significant correlations between these climatic variables and flood events. Our findings indicate that rising temperatures (with a mean of 8.46 °C and a maximum of 9 °C) and increased precipitation (averaging 862.26 mm annually)are strongly associated with higher river discharge (mean 214.6 m3/s) and more frequent floods (mean 197.94 events per year). The ANN model outperformed the ARIMA model in flood forecasting, showing lower error metrics (e.g., RMSE of 10.86 vs. 18.83). The analysis underscores the critical impact of climate change on flood risks, highlighting the necessity of adaptive flood-management strategies that incorporate the latest climatic and socio-economic data. This research contributes to the understanding of flood dynamics in Germany and provides valuable insights into future flood risks. Combining flood management with groundwater recharge could effectively lower flood risks and enhance water resources' mitigation and management. [ABSTRACT FROM AUTHOR]

Simple Summary: When we consider nutrition in patients with head and neck cancer (HNC), we mostly focus on the type of nutrition; studies on the type of nutrition at different time points are sparse. This retrospective study analyzed patients with HNC according to their nutritional status and association with percutaneous endoscopic gastrostomy (PEG) from admission to six months after treatment at a tertiary hospital in Germany from 2017 to 2019. Results showed that 14.9% required PEG before starting therapy. The need for PEG increased to 22.7% at six weeks after therapy and remained stable at 23% six months later. PEG placement was more frequently required for alcohol or nicotine use, oropharyngeal and hypopharyngeal carcinoma, squamous cell carcinoma, cancer stage III/IV, chemotherapy and impaired feeding. There has been an increase in the percentage of PEG over the observation period. This retrospective monocentric cohort study analyzed patients with head and neck cancer according their nutritional status and association of percutaneous endoscopic gastrostomy (PEG) from admission to six months after treatment at a tertiary hospital in Germany from 2017 to 2019. A total of 289 patients (76.5% men; median age 62 years; 63.3% stage IV) were included. Univariate analyses and ANOVAs with repeated measures were performed to analyze differences over time. The percentage of patients requiring PEG was 14.9% (43 of 289 patients) before start of treatment (Z0), 14% (40 of 286 patients alive) after one week (Z1), 22.7% (58 of 255 patients) after six weeks (Z2) and 23% (53 of 230 patients) after six months (Z3) from the end of treatment. PEG placement was associated with alcohol or nicotine consumption, in oropharyngeal and hypopharyngeal carcinoma, squamous cell carcinoma, cancer stage III/IV, chemotherapy and impairment of food intake (all p < 0.05). Weight loss between Z1 and Z3 with PEG did not differ from patients without PEG at Z0 (p = 0.074), although patients with PEG at Z0 had a lower mean weight at the beginning. PEG was important for a quarter of the patients alive at Z3 and helped to prevent weight loss. [ABSTRACT FROM AUTHOR]

Fully autonomous vehicles, once legally and technically feasible and widely available, have numerous advantages compared to human-driven vehicles, from greater availability and shorter travel times to lower negative environmental emissions and fewer accidents. This, combined with a usage-based form of payment, can massively increase the usage rate of vehicles without the need for high initial investments. This study explores the determinants affecting the willingness to adopt Autonomous Mobility as a Service (AMaaS) in Germany. Utilizing a mobile cross-sectional survey via Pollfish, 400 complete responses of German speakers aged 18 years or older in Germany were collected to assess influential factors. The survey data were analyzed using binary logistic regression analysis. Age, possession of a driving license, and the quality of public transport were identified as significant predictors. Younger people and driving license holders showed a higher willingness to use AMaaS, while low-quality public transport reduced their willingness to use it. This study concludes that targeted strategies for AMaaS implementation should consider these key demographic and infrastructural factors to maximize market penetration and acceptance in Germany. [ABSTRACT FROM AUTHOR]

Introduction. Pediatric traumatology is a complex field that requires a comprehensive understanding of physeal development, remodeling potential, and the ossification process in order to ensure appropriate patient treatment. The objective of this study was to assess the willingness of practicing physicians to participate in a telemedicine collaboration aimed at enhancing the exchange between the outpatient and inpatient sectors and promoting the digitalization of the pediatric sector. This is in response to the growing significance of digitalization in the medical field. Methods. A survey consisting of 15 items was sent to 800 practicing trauma surgeons, pediatric surgeons, and pediatricians within a 100 km radius of Hamburg, Germany. The survey included questions about the respondents' professional experience and telemedicine experience, as well as inquiries about possible telemedicine collaborations. Results. The response rate was 19.3%. Less than half of the participants already used telemedicine in daily practice. In general, 75% of respondents expressed an interest in collaborating with the inpatient sector. The most common reasons for hospital referral were the need for surgery, inadequate treatment of children in practice and co-assessment. The majority were in favor of flexible communication, either via video telephony, imaging applications like or messaging applications. Conclusions. The study revealed a high level of interest in telemedicine collaboration. Information exchange should be tailored to individual needs, with practitioners requiring a versatile and personalized approach that includes imaging. Strict enforcement of data protection regulations is essential. Further research is needed to evaluate the effectiveness of telemedicine collaboration in the treatment of pediatric trauma in both hospital and outpatient settings. [ABSTRACT FROM AUTHOR]

Background/Objectives: In recent years, changing paradigms, both culturally and scientifically, have fundamentally altered the approach to the treatment of children with Disorders of Sexual Development (DSD) prior to reaching the age of legal consent. In Germany, the situation changed with the introduction of legislation that includes a partial ban on DSD surgery in children in 2021. This study aims to analyze the impact of this legislation on clinical practice. Methods: From 2014 to 2024, all patients with DSD in our institution were included. The study group comprised all patients operated on after the legislation. All patients operated on before the legislation served as the control group. Karyotype, phenotype, resulting type of DSD, age at presentation and age at operation were recorded. Results: A total of 35 patients were included in this study, with 15 in the study group and 20 in the control group. The operation was authorized by the family court for all patients in the study group. A total of 46,XY patients with severe hypospadias and clinical aspect of intersexual outer genitalia were the largest proportion (25 patients, 71.4%). Nine patients (25.7%) were 46,XX girls with classical congenital adrenal hyperplasia (CAH) type. One patient (2.9%) showed a mixed gonadal dysgenesis. The mean age of the patients at first presentation in our institution was 10.7 months in the control group and 11.0 months in the study group. The mean age at operation was significantly higher in the study group (20.1 months) compared to the control group (15.1 months; p = 0.032, unpaired t-test). Conclusions: The introduction of the legislation with a partial ban of genital surgery in DSD children in Germany has led to a significant delay in surgery. Since the majority of the patients comprise severe hypospadias and 46,XX CAH patients, further amendments of the law are proposed to minimize potential harm. [ABSTRACT FROM AUTHOR]

Simple Summary: Although Anaplasma (A.) phagocytophilum infection in cats is considered to be less frequent compared with dogs, there is evidence indicating that the risk of the infection in cats might be underestimated. The study aimed to find out if infections in cats are underestimated and to discover which factors increase the risk of infection. Blood samples of 1015 cats across Europe were tested for A. phagocytophilum DNA from 2017 to 2022. The number of samples sent for testing increased over the 6 years. Anaplasma phagocytophilum DNA was found in 76 out of 1015 cats (7.5%). Infections were more common in Northern Europe than in Central or Southern Europe. During summer, the number of positive samples was significantly higher compared with winter (p = 0.047). The risk for A. phagocytophilum infection in cats should not be underestimated, especially in Northern Europe. Preventing tick bites is essential for cats' health all over Europe, not just in the Mediterranean regions. Infections with Anaplasma (A.) phagocytophilum in cats seem to be rare. The study aimed to determine whether infections in cats are underestimated and to identify the risk factors for infection. Blood samples of 1015 cats across Europe (2017–2022), sent to IDEXX Laboratories, Germany, were tested for A. phagocytophilum DNA. The influence of the cats' origin on A. phagocytophilum infection was assessed by univariable analysis, while multivariable logistic regression evaluated associations with the cats' sex and age, and the years, and seasonality of the samples' submission. Furthermore, univariable linear regression was used to determine patterns in PCR orders. The number of submitted samples increased significantly during the 6 years (p = 0.042). Anaplasma phagocytophilum DNA was detected in 76/1015 of cats (7.5%, 95% CI 6.0–9.3%). Infections were significantly more common in Northern compared to Central (p < 0.001, OR: 8.70) and Southern Europe (p < 0.001, OR: 39.94). A significantly higher likelihood for infections during the summer compared with winter (p = 0.047, OR: 3.13) was found. Bacteremia with A. phagocytophilum in European cats is not uncommon. Anaplasma phagocytophilum infection should be considered an important risk, particularly in Northern Europe. Effective tick prevention is crucial for managing feline health across Europe, not just in the Mediterranean region. [ABSTRACT FROM AUTHOR]

This article presents the results of the research "post-pandemic education: understanding of analogic education and digital education from the perspective of educational institutions and teachers in Brazil and Germany", whose main objective is to analyze how teachers and educational institutions mobilize and position themselves for the expansion of digital education practices. The following methods were used: documentary research with the German state secretariats of education, as well as documentary analysis of educational policies aimed at the implementation of digital information and communication technologies in compulsory education in Germany. We then proceeded to construct a large-scale survey to be answered by teachers of distinct levels of education. We contacted around 9400 compulsory education institutions in the three largest German states in terms of population. As a result, in general, teachers understand the importance of digital technologies in student education and demonstrate knowledge of the policies established by public agencies of the state. The mobilizations around digital pedagogical practices reveal the importance of considering teachers' and students' knowledge about technologies inside and outside the school context. The results allow us to understand the place that digital technologies occupy in the daily teaching routine. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early childhood can be a stressful period for families with a significant impact on parents' mental health, the child's healthy development, and the development of a secure mother–child attachment. The goal of the cross-sectional study part of SKKIPPI was to assess the occurrence of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions. Methods: Based on random samples from three residents' registration offices, parents with infants aged up to 12 months were invited to participate. An online screening questionnaire was developed in four languages to assess common psychosocial stressors and mental health problems of parents with small children. Results: The study enrolled 4984 mothers and 962 fathers. The most common potential psychosocial stressors were professional problems (mothers 22%, fathers 33%), lack of social support (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obsessive–compulsive thoughts (21%, 16%) and depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory problems of the child were reported by between 1.5% and 5.1% of parents. Conclusions: The study showed that a substantial proportion of parents are burdened by psychosocial problems and suffer from mental health problems in the first years after the birth of their children. Early preventive and low-threshold support measures should be available in the health and social care system. Low-threshold questionnaires, which cover a wide range of possible stress factors, should be further developed for the practical healthcare of this group of people. [ABSTRACT FROM AUTHOR]

Simple Summary: This study analyzes 61 rare tumors and lesions mimicking peripheral nerve tumors using data from the German Peripheral Nerve Tumor Registry. These cases exhibit significant heterogeneity with various morphological features and biological potentials, including malignant peripheral nerve tumors, perineuriomas, and hybrid nerve sheath tumors. This study underscores the challenges in preoperatively differentiating these rare entities from benign tumors using clinical and radiological methods alone. It highlights the importance of a multidisciplinary approach involving radiologists, neurologists, neuropathologists, and neurosurgeons for accurate diagnosis and effective treatment. The supplementary material offers valuable insights to help clinicians recognize these rare tumors early, improving patient outcomes. The most common peripheral nerve tumors are of a benign nature and include schwannoma or neurofibroma. In rare cases, other tumors or non-tumorous lesions can mimic peripheral nerve tumors clinically or radiologically. Based on data from the multicentric German Peripheral Nerve Tumor Registry (PNTR), which encompasses current information on 315 surgically treated patients from three high-volume centers, we present 61 cases of rare tumors and lesions that mimic tumors associated with peripheral nerves. This cohort displays considerable heterogeneity, featuring a broad spectrum of morphological features and biological potentials. Histopathological diagnoses include various intrinsic peripheral nerve tumors such as malignant peripheral nerve tumors (MPNSTs) (n = 13), perineurioma (n = 17), and hybrid nerve sheath tumors (HPNSTs, comprising schwannoma/perineurioma and schwannoma/neurofibroma) (n = 14), as well as atypical neurofibromatous neoplasm with unknown biological potential (ANNUBP) (n = 1). Additionally, the cohort encompasses extrinsic tumorous lesions like lymphoma (n = 3), lymphangioma (n = 2), hemangioma (n = 2), solitary fibrous tumor (n = 2), metastatic disease (n = 1), and single cases of other rare tumor entities (n = 6). An overview of the underlying pathology, imaging features, and clinical presentation is provided, with a brief description of each entity. A definitive preoperative differentiation between benign peripheral nerve tumors and rare intrinsic and extrinsic tumors is often not possible. Clinical examination and subtle imaging clues can at least indicate the possibility of a rare entity. The basic requirement is close cooperation between radiologists, neurologists, neuropathologists, and neurosurgeons at a specialized center to develop a multidisciplinary concept and offer the patient the best therapeutic approaches. [ABSTRACT FROM AUTHOR]

Simple Summary: Taste and smell alterations (TSAs) are a distressing yet underdiagnosed side effect in cancer patients undergoing chemotherapy. However, long-term investigations using both questionnaires and chemosensory tests are scarce. We examined the prevalence of quantitative and qualitative TSAs, as well as their connection with clinical characteristics such as age, sex, anorexia, and neuropathy. We also compared patients receiving perpetual or temporary chemotherapy. All patients were examined up to five times within 12 to 24 months, commencing before the beginning of chemotherapy. We found TSAs in approximately 4 out of 5 patients during chemotherapy. The highest prevalence was documented among patients above 60 years of age as well as among those reporting anorexia or presenting signs of neuropathy. Post-therapy, taste and smell function recovered; however, scores did not reach baseline levels within 6 to 12 months. Future investigations will assess potential interventions to prevent or reduce TSAs. Previous data regarding chemotherapy-induced olfactory and gustatory dysfunction (CIOGD) are heterogeneous due to inconsistent study designs and small numbers of patients. To provide consistent, reliable data, we conducted a cohort study using standardized testing. Patients diagnosed with lymphoma, leukemia, or gastrointestinal malignancies were examined up to five times (T1 to T5), beginning prior to chemotherapy. We examined patients receiving temporary treatment up to 12 months post-therapy. Clinical assessment included extensive questionnaires, psychophysical tests of olfactory and gustatory function, and measurement of peripheral neuropathy. Statistical analysis included non-parametric tests to evaluate the longitudinal development of CIOGD. Our data (n = 108) showed a significant decline in olfactory and gustatory testing during chemotherapy (p-values < 0.001). CIOGD appeared stronger among patients above 60 years, while sex did not matter significantly. However, we identified distinct associations between CIOGD and reported anorexia as well as with higher neuropathy scores. Self-assessment appeared less sensitive to chemosensory dysfunction than psychophysical testing. Post-therapy, olfactory and gustatory function regenerated, though baseline levels were not attained within 6 to 12 months. In conclusion, our data highlight the wide prevalence and slow recovery of CIOGD. Understanding CIOGD as a potential neurotoxic effect may disclose new therapeutic prospects. [ABSTRACT FROM AUTHOR]

For the first time, the AGRUM model consortium—consisting of the agro-economic model RAUMIS, the water balance model mGROWA, the hydrological nutrient transport models DENUZ, WeKu and MEPhos, and the urban emission model MONERIS—was jointly set up throughout Germany (357,000 km2). This provided a nationwide consistent nutrient model to capture the current status of N and P inputs to surface waters from diffuse sources and urban areas. Diffuse nutrient emissions were quantified in high spatial resolution for the input pathways' groundwater, drainage runoff, and natural interflow (100 m × 100 m), as well as for water erosion and wash-off (25 m × 25 m). The sum of diffuse nutrient inputs to surface waters is about 385,000 metric tons N/yr and ca. 11,530 metric tons P/yr. Urban emissions were quantified either as point source inputs (wastewater treatment plants, industrial direct dischargers) or at municipality scale for different collection and treatment systems, e.g., rainwater sewers or decentralized treatment plants, and sum up to ca. 95,000 t N/yr and 7500 t P/yr. As modelled, total N and P inputs into surface waters correspond well with observed N and P loads in rivers. The model results represent valuable information for water managers, being responsible for the preparation of management plans for the third management cycle of the EC Water Framework Directive spanning from 2021 to 2027. [ABSTRACT FROM AUTHOR]

This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Methods: Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Results: Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. Conclusion: The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises. [ABSTRACT FROM AUTHOR]

As leptospirosis is re-emerging, a seroprevalence study was conducted, assessing the prevalence of anti-Leptospira IgG antibodies and infection-associated risk factors among forestry workers (FWs) in Lower Saxony, Germany, to develop targeted public health measures. Sera of 877 FWs, sampled in 2016, were tested for anti-Leptospira seropositivity by commercial IgG-ELISA. Data on demographics and Leptospira-specific exposures, knowledge, sources of information, and preventive measures were collected by standardized, self-administered questionnaire. A subset of 244 sera was retested via in-house IgG-ELISA. Risk factors were assessed from the subset using multivariable logistic regression analysis. The commercial IgG-ELISA revealed a seroprevalence of 4.8% (95% confidence interval CI95 = 3.5–6.4). Of the 601 FWs who completed the questionnaire, 67.9% had been informed about leptospirosis and Leptospira spp., mainly by employers (55.2%) and peers (38.9%). Positive associations with seropositivity were observed for canoeing (adjusted odds ratio (aOR) = 2.35, p = 0.044), touching rodents (aOR = 2.4, p = 0.021), and living close to beech trees (aOR = 2.18, p = 0.075). Frequently cleaning animal stables was negatively associated (aOR = 0.20, p = 0.002). The unexpected positive association with wearing gloves when handling plants and soil (aOR = 2.16, p = 0.011) needs further discussion. Overall, seroprevalence was in the range of other studies in Germany. The identified factors will be used to develop targeted information reaching out to at-risk groups tapping various communication channels. [ABSTRACT FROM AUTHOR]

Simple Summary: Sacrectomy represents a radical indication for bone sarcomas (e.g., osteosarcoma or chondrosarcoma) and chordomas, as well as selected carcinomas with invasion of the sacrum. Extralesional en bloc excision is surgically demanding and associated with resection-induced neurologic deficits and risks. Due to the low incidence of bone sarcomas, the rare localization in the sacrum and the complexity of the surgical procedure, studies reporting on the oncological outcome and corresponding complications in larger patient numbers are rare. The aim was to describe the oncosurgical management and the complication profile and to analyze our own treatment results after partial/total sacrectomy, with attention paid to a possible benefit by using intraoperative 3D navigation. There was a significant difference in progression-free and metastasis-free survival between sarcoma, chordoma and carcinoma patients. Complications were common, but no independently influencing causative factors could be identified. Although there was a subjective impression of improved intraoperative 3D orientation and easier identification of resection planes, the use of navigation did not significantly influence resection status or oncological patient outcome. Introduction: Bone sarcoma or direct pelvic carcinoma invasion of the sacrum represent indications for partial or total sacrectomy. The aim was to describe the oncosurgical management and complication profile and to analyze our own outcome results following sacrectomy. Methods: In a retrospective analysis, 27 patients (n = 8/10/9 sarcoma/chordoma/locally recurrent rectal cancer (LRRC)) were included. There was total sacrectomy in 9 (incl. combined L5 en bloc spondylectomy in 2), partial in 10 and hemisacrectomy in 8 patients. In 12 patients, resection was navigation-assisted. For reconstruction, an omentoplasty, VRAM-flap or spinopelvic fixation was performed in 20, 10 and 13 patients, respectively. Results: With a median follow-up (FU) of 15 months, the FU rate was 93%. R0-resection was seen in 81.5% (no significant difference using navigation), and 81.5% of patients suffered from one or more minor-to-moderate complications (especially wound-healing disorders/infection). The median overall survival was 70 months. Local recurrence occurred in 20%, while 44% developed metastases and five patients died of disease. Conclusions: Resection of sacral tumors is challenging and associated with a high complication profile. Interdisciplinary cooperation with visceral/vascular and plastic surgery is essential. In chordoma patients, systemic tumor control is favorable compared to LRRC and sarcomas. Navigation offers gain in intraoperative orientation, even if there currently seems to be no oncological benefit. Complete surgical resection offers long-term survival to patients undergoing sacrectomy for a variety of complex diseases. [ABSTRACT FROM AUTHOR]

Background and Objectives: Anastomotic insufficiencies (AI) and perforations of the upper gastrointestinal tract (uGIT) result in high morbidity and mortality. Endoscopic stent placement and endoluminal vacuum therapy (EVT) have been established as surgical revision treatment options. The Eso-Sponge® is the only licensed EVT system with limitations in treating small defects (<10 mm). Therefore, a fistula sponge (FS) was developed for the treatment of such defects as a new therapeutic approach. The aim of this study was to evaluate both EVT options' indications, success rates, and complications in a retrospective, comparative approach. Materials and Methods: Between 01/2018 and 01/2021, the clinical data of patients undergoing FS-EVT or conventional EVT (cEVT; Eso-Sponge®, Braun Melsungen, Melsungen, Germany) due to AI/perforation of the uGIT were recorded. Indication, diameter of leakage, therapeutic success, and complications during the procedure were assessed. FSs were prepared using a nasogastric tube and a porous drainage film (Suprasorb® CNP, Lohmann & Rauscher, Rengsdorf, Germany) sutured to the distal tip. Results: A total of 72 patients were included (20 FS-EVT; 52 cEVT). FS-EVT was performed in 60% suffering from AI (cEVT = 68%) and 40% from perforation (cEVT = 32%; p > 0.05). FS-EVT's duration was significantly shorter than cEVT (7.6 ± 12.0 d vs. 15.1 ± 14.3 d; p = 0.014). The mean diameter of the defect was 9 mm in the FS-EVT group compared to 24 mm in cEVT (p < 0.001). Therapeutic success was achieved in 90% (FS-EVT) and 91% (cEVT; p > 0.05). Conclusions: EVT comprises an efficient treatment option for transmural defects of the uGIT. In daily clinical practice, fistulas < 10 mm with large abscess formations poses a special challenge since intraluminal cEVT usually is ineffective. In these cases, the concept of extraluminal FS placement is safe and effective. [ABSTRACT FROM AUTHOR]