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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]

Background: In Germany, more than 40% of infants are born to immigrant parents. Increased survival rates of very preterm (below 32 weeks gestation at birth; VP) infants have not resulted in equally improved life chances and quality of life. More information on perinatal variations in outcomes according to social inequalities, migration background, and language barriers is needed. We tested whether mothers' immigrant status and language barriers are associated with perinatal health and short-term neonatal outcomes. Methods: The data are from the national multi-centre German Neonatal Network (GNN) cohort, including VP births from 2009 onwards. In total, 3606 (n = 1738 female) children were assessed, and 919 (n = 449 female) of these children had immigrant backgrounds. Immigrant status was operationalised as a binary variable based on the children's mothers' countries of birth (born in Germany vs. foreign-born). Self-reported home language (L1) was used to calculate the average linguistic distance to German as one continuous variable. Results: Mixed-effects models showed that two out of fourteen effects of interest survived the adjustment for known confounders and accounting for the nestedness of data within birth hospitals. Linguistic distance from mothers' L1s to German was independently associated with diagnoses of preeclampsia (OR = 1.01, 95% CI = [1.00, 1.01]). Infants of foreign-born mothers had higher odds for amniotic infection syndrome (AIS; OR = 1.45 [1.13, 1.86]) than infants of German mothers. Conclusions: Our findings from this large multi-centre longitudinal cohort of VP-born children indicate that maternal immigrant status and language barriers have limited impact on perinatal health and severe neonatal outcomes. This suggests that, regardless of background or language skills, there may be few inequalities in the perinatal health of pregnant women and their newborn preterm infants. [ABSTRACT FROM AUTHOR]

In the context of the German Energiewende, the current government intends to install six million heat pumps by 2030. Replacing gas heating by power has significant implications on the infrastructure. One of the biggest advantages of using gas is the existing storage portfolio. It has not been clarified yet how power demand should be structured on an annual level—especially since power storage is already a problem and solar power is widely promoted to fuel heat pumps, despite having an inverse profile. In this article, three different solutions, namely, hydrogen, batteries, and carbon capture and storage, are discussed with respect to resources, energy, and financial demand. It shows that relying solely on batteries or hydrogen is not solving the structuring problem. A combination of all existing technologies (including fossil fuels) is required to structure the newly generated electricity demand. [ABSTRACT FROM AUTHOR]

Meeting Germany's climate targets urgently demands substantial investment in renewable energies such as hydrogen, as well as tackling industrial CO2 emissions with a strong CO2 transport infrastructure. This is particularly crucial for CO2-heavy industries such as steel, cement, lime production, power plants, and chemical plants, given Germany's ban on onshore storage. The CO2 transport network is essential for maintaining a circular economy by capturing, transporting, and either storing or utilizing CO2. This study fills gaps in CO2 pipeline transport research, examining pipeline diameters, costs, and pressure drop, and providing sensitivity analysis. Key findings show that the levelized cost of CO2 transport (LCO2T) ranges from 0.25 €/t to 55.82 €/t based on varying transport masses (1000 t/day to 25,000 t/day) and distances (25 km to 500 km), with compression costs pushing LCO2T to 33.21 €/t to 92.82 €/t. Analyzing eight pipeline diameters (150 mm to 500 mm) and the impact of CO2 flow temperature on pressure loss highlights the importance of selecting optimal pipeline sizes. Precise booster station placement is also crucial, as it significantly affects the total LCO2T. Exploring these areas can offer a more thorough understanding of the best strategies for developing cost-effective, efficient, and sustainable transport infrastructure. [ABSTRACT FROM AUTHOR]

Germany is undergoing an energy transition. By 2045, fossil fuels will be gradually replaced by clean energy. An alternative option is to use geothermal, solar and wind energy to generate heat or electricity. Currently, an economic model that considers these three energy sources and incorporates the design and installation of the energy system as well as operational costing focusing on the local market is lacking. In this study, we present a concept for a hybrid energy system combining solar, wind and geothermal energy for small, detached houses. We also develop a simplified economic model for the German market and local energy subsidy policies. The model was applied to two different cities in northern Germany, calculating the installation and long-term operating costs of different energy systems and combinations over a period of 100 years, including the consideration of the lifespan of variable equipment. The calculations show that for this small hybrid energy system the initial installation costs can vary from EUR 20,344 to EUR 70,186 depending on different portfolios. Long-term operating costs come mainly from electricity purchased from the grid to compensate for periods of low solar or wind production. In addition, the study included a calculation of the payback period for retrofitting a natural gas heating system. Results show that combining a photovoltaic system with a ground source heat pump, especially in the form of a near-surface heat exchanger, yields a shorter payback period (5 to 10 years). However, the incorporation of on-roof wind turbines into the hybrid energy system may significantly prolong the payback period and is therefore not recommended for use in low wind speed areas. [ABSTRACT FROM AUTHOR]

Simple Summary: In the present study, the intraoperative fluorescence of brain metastases after the administration of 5-aminolevulinic acid (5-ALA) is investigated in 80 cases. Brain metastases fluoresced in 57.5% of cases, with no significant correlation between fluorescence and primary tumor or histological subtype. Complete resection of brain metastases was detected in 82.5%, of which 56.1% were fluorescence positive, compared to 43.9% which were non-fluorescent. Thus, prior administration of 5-ALA tended to improve the resectability rate by 12.1%. Fluorescence-positive and -negative metastases showed significantly different overall survival in this study. Therefore, administration of 5-ALA as a surgical adjuvant may be beneficial in resecting brain metastases and may potentially optimize the surgical procedure. (1) Background: In this study, the intraoperative fluorescence behavior of brain metastases after the administration of 5-aminolevulinic acid (5-ALA) was analyzed. The aim was to investigate whether the resection of brain metastases using 5-ALA fluorescence also leads to a more complete resections and thus to a prolongation of survival; (2) Methods: The following variables have been considered: age, sex, number of metastases, localization, involvement of eloquent area, correlation between fluorescence and primary tumor/subtype, resection, and survival time. The influence on the degree of resection was determined with a control MRI within the first three postoperative days; (3) Results: Brain metastases fluoresced in 57.5% of cases. The highest fluorescence rates of 73.3% were found in breast carcinoma metastases and the histologic subtype adenocarcinoma (68.1%). No correlation between fluorescence behavior and localization, primary tumor, or histological subtype was found. Complete resection was detected in 82.5%, of which 56.1% were fluorescence positive. There was a trend towards improved resectability (increase of 12.1%) and a significantly longer survival time (p = 0.009) in the fluorescence-positive group; (4) Conclusions: 5-ALA-assisted extirpation leads to a more complete resection and longer survival and can therefore represent a low-risk addition to modern surgery for brain metastases. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explored advanced diagnostic methods that are used for identifying skin cancer in high-risk melanoma patients. A total of 410 patients were examined using a combination of three advanced imaging techniques: 3D total body photography, digital dermoscopy, and reflectance confocal microscopy. These methods were used in addition to regular skin exams. Results showed that the specialized imaging detected 16 melanomas in 39 removed pigmented lesions, while regular exams detected only 7 melanomas in 163 removed lesions. This indicates that specialized imaging was much more efficient. Each imaging method found melanomas that the others did not. The study concludes that combining these three imaging techniques improves melanoma detection and reduces unnecessary skin removals in high-risk patients. Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients. [ABSTRACT FROM AUTHOR]

Background: Endovascular treatment of lower-extremity peripheral disease (PAD) is associated with higher complication rates and suboptimal outcomes in women. Atherectomy has shown favourable outcomes in calcified lesions, minimising the incidence of stent placement caused by recoil or flow-limiting dissection. To date, there are no published mid-term outcomes evaluating the performance of atherectomy differentiated by sex. This study aims to evaluate sex-specific outcomes and prognostic factors affecting the results of atherectomy-assisted endovascular treatment in severe PAD. Methods: A retrospective analysis was conducted at a single centre in Germany, initiated by physicians and not sponsored by industry, on patients presenting with Rutherford categories ranging from III to V and featuring de novo occlusive or stenotic lesions of the superficial femoral (SFA) and/or popliteal arteries. The intervention involved rotational atherectomy-assisted angioplasty utilising the Jetstream (Boston, US®) device. The point of interest of this study was postinterventional clinical improvement as well as mid-term outcomes, including primary patency, over a targeted 2-year follow-up period. Statistical analysis utilised Cox regression (survival analysis) to calculate hazard ratios according to sex category. Comparative survival analysis was performed using the log-rank test and visually represented through Kaplan–Meier curves. Risk factors associated with absence of clinical improvement were examined across both sex groups utilising the chi-square or Fisher exact test, as appropriate. Results: A total of 98 patients (103 limbs) were initially included, with >75% having moderate-to-severe lesion calcification (>50%). A total of 84 patients (97 limbs, 62 male and 35 female) proceeded to a 2-year follow-up (mean 16.4 months for males and 16.1 for females) after a successful index procedure. Age distribution, Rutherford class, diabetes, chronic kidney disease (CKD), target vessel, lesion type, and length were balanced among both groups. Similar primary patency rates, of 89% among female and 91% among male limbs, were observed (p = 0.471). Female patients exhibited a lower rate of clinical improvement based on the Rutherford scale in comparison to males (80.6% vs. 94.5%, p = 0.048). CDK was the only significant prognostic factor across pooled data (odds ratio for CKD: 15.15, p < 0.001). Conclusions: Rotational atherectomy showed comparably high rates of mid-term primary patency, with low rates of bailout stent placement. These findings highlight the beneficial use of atherectomy in female patients who are per se at risk for higher rates of complications during and after endovascular interventions. [ABSTRACT FROM AUTHOR]

Developmental changes in functional neural networks are sensitive to environmental influences. This EEG study investigated how infant brain responses relate to the social context that their families live in. Event-related potentials of 255 healthy, awake infants between six and fourteen months were measured during a passive auditory oddball paradigm. Infants were presented with 200 standard tones and 48 randomly distributed deviants. All infants are part of a longitudinal study focusing on families with socioeconomic and/or cultural challenges (Bremen Initiative to Foster Early Childhood Development; BRISE; Germany). As part of their familial socioeconomic status (SES), parental level of education and infant's migration background were assessed with questionnaires. For 30.6% of the infants both parents had a low level of education (≤10 years of schooling) and for 43.1% of the infants at least one parent was born abroad. The N2–P3a complex is associated with unintentional directing of attention to deviant stimuli and was analysed in frontocentral brain regions. Age was utilised as a control variable. Our results show that tone deviations in infants trigger an immature N2–P3a complex. Contrary to studies with older children or adults, the N2 amplitude was more positive for deviants than for standards. This may be related to an immature superposition of the N2 with the P3a. For infants whose parents had no high-school degree and were born abroad, this tendency was increased, indicating that facing multiple challenges as a young family impacts on the infant's early neural development. As such, attending to unexpected stimulus changes may be important for early learning processes. Variations of the infant N2–P3a complex may, thus, relate to early changes in attentional capacity and learning experiences due to familial challenges. This points towards the importance of early prevention programs. [ABSTRACT FROM AUTHOR]

Climate change is increasing air temperatures and altering the precipitation and hydrological regime on a global scale. Challenges arise when assessing the impacts of climate change on the local scale for water resource management purposes, especially for low-mountain headwater catchments that not only serve as important water towers for local communities but also have distinct hydrological characteristics. Until now, no low-flow or hydrological drought studies had been carried out on the Lauter River. This study is unique in that it compares the Lauter River, a transboundary Rhine tributary, with a nearby station on the Rhine River just below its confluence at the French–German border. The Lauter catchment is a mostly natural, forested catchment; however, its water course has been influenced by past and present cultural activities. Climate change disturbances cascade through the hydrologic regime down to the local scale. As we are expecting more low-flow events, the decrease in water availability could cause conflicts between different water user groups in the Lauter catchment. However, the choice among different methods for identifying low-flow periods may cause confusion for local water resource managers. Using flow-rate time series of the Lauter River between 1956 and 2022, we compare for the first time three low-flow identification methods: the variable-threshold method (VT), the fixed-threshold method (FT), and the Standardized Streamflow Index (SSI). Similar analyses are applied and compared to the adjacent Maxau station on the Rhine River for the same time period. This study aims at (1) interpreting the differences amongst the various low-flow identification methods and (2) revealing the differences in low-flow characteristics of the Lauter catchment compared to that of the Rhine River. It appears that FT reacts faster to direct climate or anthropogenic impacts, whereas VT is more sensitive to indirect factors such as decreasing subsurface flow, which is typical for small headwater catchments such as the Lauter where flow dynamics react faster to flow disturbances. Abnormally low flow during the early spring in tributaries such as the Lauter can help predict low-flow conditions in the Rhine River during the following half-year and especially the summer. The results could facilitate early warning of hydrological droughts and drought management for water users in the Lauter catchment and further downstream along some of the Rhine. [ABSTRACT FROM AUTHOR]

Universities are commonly imagined as "enlightened institutions" that leave no room for discrimination. While studies from other countries and some studies from German universities cast doubt on this notion, the extent and characteristics of university students' experiences of discrimination in Germany are not yet sufficiently researched. Therefore, the aim of this study was to assess university students' experiences of discrimination in a cross-sectional online survey. A total of 890 students completed the questionnaire. Of these, 45% reported that they had witnessed discrimination in the university, while 28% reported first-hand experiences. For those who had experienced discrimination themselves, it occurred repeatedly (68%) or regularly (15.5%). The most common grounds for discrimination were sex or gender (33% of all reported grounds for discrimination), non-German origin (12.5%) and having a chronic illness (7%). University lecturers were mentioned most often (by 80% of those who reported discrimination) as the perpetrators of discrimination. Taking these findings into consideration, universities should revisit their policies and structures that protect students against discrimination and support them in the case of harassment. This could entail obligatory training for university employees but should also consider that the university's hierarchical structure facilitates abuses of power and can therefore be considered a variable in its own right. [ABSTRACT FROM AUTHOR]

Students experience both positive and negative emotions during lessons. However, little research has been conducted into students' perspectives on how they deal with these emotions. For this reason, the current study aimed to investigate how students perceive, deal with, and interact in emotional classroom situations, using a mixed-methods approach. In Study 1, 28 primary school children in the fourth grade drew pictures of achievement-emotion situations and were subsequently interviewed. In a three-step analysis process, students' drawings and interviews were analysed using open coding and content analysis. In Study 2, 635 students from 38 primary and secondary schools in northern Germany reported (via the DECCS questionnaire) their appraisals, achievement emotions, emotion regulation behaviour, and desired teacher support regarding two case vignettes: one involving a learning situation and the other a performance situation. The results of Study 1 reveal that peers play a crucial role in how students deal with positive emotions in class. The structural equation model of Study 2 shows that almost all pathways between emotion regulation behaviour (maladaptive as well as adaptive) and students' desired teacher behaviour in the form of praise and support are significant. The results of both studies indicate that social support (i.e., peer interactions and teacher support) is crucial in how students deal with both positive and negative achievement emotions in class. [ABSTRACT FROM AUTHOR]

This work shows the original projection of a 1:57,600 scale map of southern Germany at the end of the 18th century, produced under the direction of Karl-Heinrich von Schmitt (1743–1805). The sections of the map were scanned and georeferenced as part of the MAPIRE project, and the results are publicly available. In the present work, we use contemporary documents, in particular the books of César-Francois Cassini de Thury and manuscript sketches of the map found in the Military Archive of Vienna, to show that the overall projection of the map is identical to that used in Cassini's survey of France (first half of the 18th century). In the archive, we managed to find the overview sheet on which—in addition to the Paris Cassini coordinate system—the section grid of the Schmitt map was also constructed. This sketch served as the basis for the compilation and copying work, wherein the existing map works and survey sketches were inserted into 197 sections of the Schmitt map. Thus, the map coordinate system can be modeled in GIS systems using the Cassini (or Cassini-Soldner) projection, with the Paris Observatory as the projection origin. The georeferencing accuracy of using the pure Cassini projection is around 1–1.3 km (at the extremes, around 5 km), which is much more inaccurate than the one used in later topographic surveys. It is considered a combined result of the compilation of the different maps, presumably surveyed by graphic triangulation with measuring tables. [ABSTRACT FROM AUTHOR]

School-related stress and burnout can have serious consequences for students' well-being and academic outcomes. However, there are few studies that assess the prevalence of school burnout, especially in Germany. The present study aims to determine the percentage of N = 1117 high school students who are likely to suffer from school burnout—also with regard to differences in gender and grade level. For this purpose, two different cut-off criteria are compared. Prior to this, the psychometric quality of the MBI-SuS adapted to the school context is examined. The validity and reliability of the three-factor MBI-SuS could be confirmed. Scalar measurement invariance was found for grade level but only partially for gender. The overall prevalence of school burnout of 20.9% found with the common cut-off criterion fits international prevalences, whereas the prevalence of 4.6% (determined with our recommended content-related cut-off criterion) is in line with observations from clinical practice. Depending on the cut-off value, girls suffer slightly more from school burnout, but no differences were found with respect to grade level. Results indicate that a substantial proportion of students are at risk for school burnout, highlighting the importance of prevention and intervention. Criteria for cut-off values should be applied with caution. [ABSTRACT FROM AUTHOR]

Background: Suboptimal influenza and pneumococcal vaccination rates have been reported before the COVID-19 pandemics in certain populations at risk for severe infection. The aim of this longitudinal cohort study was to investigate changes in influenza and pneumococcal vaccination rates and patient perceptions in patients with psoriasis (PsO) before and during the pandemic. Methods: Data on vaccination, patient and disease characteristics, comorbidity, and patient perceptions were collected with questionnaires before and during the pandemic approximately one year later. Results: Over the whole cohort who participated in the follow-up visit (n = 287; 59.2% male; mean age: 56.3 years), both influenza and pneumococcal lifetime vaccination prevalences increased significantly from 50.5% to 66.2% and from 16.0% to 41.5%, respectively. A total of 88.5% of PsO patients were interested in a COVID-19 vaccination or had already received it. The reasons for and against vaccinations changed significantly before and during the pandemic. Conclusions: Despite a promising increase in the vaccination prevalence in our PsO cohort, it remains important that awareness for vaccinations is encouraged and closely monitored in future research, particularly in populations at risk. [ABSTRACT FROM AUTHOR]

Demographic changes have led to an increase in older people in prisons. Whereas the rehabilitative process of younger offenders is geared towards their reintegration into the labour market, successful ageing should be a policy aim for older prisoners. This study explores how older incarcerated persons view their ageing. A qualitative study using a written survey with only the single question What does ageing in prison mean to you? was conducted in Bavaria, Germany. A total of 64 prisoners (61 male, 3 female) supplied answers varying in length from a few words to several pages. The thematic analysis revealed that together with health concerns, social relations and everyday activities, the uncertainty of the future was a central focus point for the older adults in prison. The authors propose that a positive vision of the future needs to be included in any model of successful ageing. If successful ageing is used as an aim for older prisoners, more attention needs to be paid to support interventions during and after the release process. [ABSTRACT FROM AUTHOR]

Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data. [ABSTRACT FROM AUTHOR]

Long-duration energy storage is the key challenge facing renewable energy transition in the future of well over 50% and up to 75% of primary energy supply with intermittent solar and wind electricity, while up to 25% would come from biomass, which requires traditional type storage. To this end, chemical energy storage at grid scale in the form of fuel appears to be the ideal option for wind and solar power. Renewable hydrogen is a much-considered fuel along with ammonia. However, these fuels are not only difficult to transport over long distances, but they would also require totally new and prohibitively expensive infrastructure. On the other hand, the existing natural gas pipeline infrastructure in developed economies can not only transmit a mixture of methane with up to 20% hydrogen without modification, but it also has more than adequate long-duration storage capacity. This is confirmed by analyzing the energy economies of the USA and Germany, both possessing well-developed natural gas transmission and storage systems. It is envisioned that renewable methane will be produced via well-established biological and/or chemical processes reacting green hydrogen with carbon dioxide, the latter to be separated ideally from biogas generated via the biological conversion of biomass to biomethane. At the point of utilization of the methane to generate power and a variety of chemicals, the released carbon dioxide would be also sequestered. An essentially net zero carbon energy system would be then become operational. The current conversion efficiency of power to hydrogen/methane to power on the order of 40% would limit the penetration of wind and solar power. Conversion efficiencies of over 75% can be attained with the on-going commercialization of solid oxide electrolysis and fuel cells for up to 75% penetration of intermittent renewable power. The proposed hydrogen/methane system would then be widely adopted because it is practical, affordable, and sustainable. [ABSTRACT FROM AUTHOR]

Simple Summary: Due to the rarity of Merkel cell carcinoma (MCC), only a few studies on both incidence and survival have been conducted. We provide up-to-date population-based incidence and relative survival estimates of MCC. We analyzed data from the cancer registry of North Rhine-Westphalia, Germany, for the years of 2008–2021, covering a population of 18 million individuals. We included all newly diagnosed MCC cases and calculated incidence rates and relative survival (observed divided by expected survival). Our analysis included 2164 MCC patients. The incidence of MCC was 5.2 and 3.8 per million for men and women, respectively. The 5-year relative survival was 59% in men and 71% in women. Survival was lower among men than women in all age–sex groups and was the highest for MCC of the upper extremity in both men and women. In terms of survival, the first two years are particularly critical. Background: To date, only a few population-representative studies have been carried out on the rare Merkel cell carcinoma (MCC). We provide incidence and survival estimates of MCC, including the conditional relative survival. Methods: We analyzed data from the cancer registry of North Rhine-Westphalia, Germany, 2008–2021, covering a population of 18 million. We included all newly diagnosed MCCs and calculated age-standardized (old European Standard population) incidence rates and unconditional and conditional relative survival. Results: Our analysis included 2164 MCC patients. The age-standardized incidence of MCC was 5.2 (men) and 3.8 (women) per million person-years. The 5-year relative survival was 58.8% (men) and 70.7% (women). Survival was lower among men than women in all age–sex groups and was highest for MCC of the upper extremity in both men (68.2%) and women (79.3%). The sex difference in survival is particularly due to the better survival of women with MCC of the head and neck. In terms of survival, the first two years are particularly critical. Conclusions: Our data validate the worse survival among men and highlights a more favorable prognosis for MCCs located on the limbs. The first two years after diagnosis of MCC are the years with the highest excess mortality. [ABSTRACT FROM AUTHOR]

Simple Summary: Most cancer patients are older and have concomitant diseases because the incidence of most cancer types increases with age. This leads to patients taking a variety of medications that can cause drug-related problems (DRPs). DRPs can cause harm, including increased illness, avoidable hospital stays, and even death. Common DRPs are drug–drug interactions, not taking medication as prescribed, and adverse drug reactions. In our study, we aimed to assess these medication risks in hospitalized cancer patients and to identify factors that influence their health-related quality of life (HRQOL) as a patient-relevant outcome. The results of the pharmacist-led medication reviews show that DRPs are common in hospitalized cancer patients. Therefore, patient questionnaires about therapy-related symptoms could improve the detection of DRPs. While drug-related factors had no effect on HRQOL during the hospital stay, our analysis revealed other influencing factors, such as relapse status of the cancer disease and length of hospital stay. Background: We aimed to assess medication risks and determine factors influencing the health-related quality of life (HRQOL) in cancer inpatients. Methods: A retrospective analysis was conducted to identify drug-related problems (DRPs) based on medication reviews, including patient-reported outcomes (PROs). Multiple linear regression analyses were performed to identify sociodemographic, disease-related, and drug therapy-related factors influencing changes from hospital admission to discharge in the scales of the EORTC QLQ-C30 questionnaire. Results: A total of 162 inpatients with various hematological and solid cancer diseases was analyzed. Patients received a mean of 11.6 drugs and 92.6% of patients exhibited polymedication resulting in a mean of 4.0 DRPs per patient. Based on PRO data, 21.5% of DRPs were identified. Multiple linear regression models described the variance of the changes in global HRQOL and physical function in a weak-to-moderate way. While drug therapy-related factors had no influence, relapse status and duration of hospital stay were identified as significant covariates for global HRQOL and physical function, respectively. Conclusion: This analysis describes underlying DRPs in a German cancer inpatient population. PROs provided valuable information for performing medication reviews. The multiple linear regression models for global HRQOL and physical function provided explanations for changes during hospital stay. [ABSTRACT FROM AUTHOR]

Simple Summary: This multicenter study (n = 1133, inclusion criteria: 3.5 cm maximum tumor size and preoperative indication for a boost) provides detailed data on acute and long-term toxicities in breast cancer patients undergoing breast-conserving surgery combined with an anticipated intraoperative boost with low-energy X-rays followed by whole breast irradiation. Toxicity assessments, based on LENT SOMA criteria, were performed annually up to 10 years of follow-up. IORT boost was completed in 90% and EBRT in 97% of cases. No grade 3 or 4 acute toxicities were observed, with mild acute side effects reported in a small proportion of patients. Chronic toxicities were seen in 16.2% of patients with teleangiectasia, 14.3% with grade ≥ 2 fibrosis, 3.4% with grade ≥ 2 pain, and 1.1% with hyperpigmentation. The results show that the therapy is safe and feasible in terms of toxicity and confirms intraoperative boost as a standard method of boost application in a large prospective cohort. In the context of breast cancer treatment optimization, this study prospectively examines the feasibility and outcomes of utilizing intraoperative radiotherapy (IORT) as a boost in combination with standard external beam radiotherapy (EBRT) for high-risk patients. Different guidelines recommend such a tumor bed boost in addition to whole breast irradiation with EBRT for patients with risk factors for local breast cancer recurrence. The TARGIT BQR (NCT01440010) is a prospective, multicenter registry study aimed at ensuring the quality of clinical outcomes. It provides, for the first time, data from a large cohort with a detailed assessment of acute and long-term toxicity following an IORT boost using low-energy X-rays. Inclusion criteria encompassed tumors up to 3.5 cm in size and preoperative indications for a boost. The IORT boost, administered immediately after tumor resection, delivered a single dose of 20 Gy. EBRT and systemic therapy adhered to local tumor board recommendations. Follow-up for toxicity assessment (LENT SOMA criteria: fibrosis, teleangiectasia, retraction, pain, breast edema, lymphedema, hyperpigmentation, ulceration) took place before surgery, 6 weeks to 90 days after EBRT, 6 months after IORT, and then annually using standardized case report forms (CRFs). Between 2011 and 2020, 1133 patients from 10 centers were preoperatively enrolled. The planned IORT boost was conducted in 90%, and EBRT in 97% of cases. Median follow-up was 32 months (range 1–120, 20.4% dropped out), with a median age of 61 years (range 30–90). No acute grade 3 or 4 toxicities were observed. Acute side effects included erythema grade 1 or 2 in 4.4%, palpable seroma in 9.1%, punctured seroma in 0.3%, and wound healing disorders in 2.1%. Overall, chronic teleangiectasia of any grade occurred in 16.2%, fibrosis grade ≥ 2 in 14.3%, pain grade ≥ 2 in 3.4%, and hyperpigmentation in 1.1%. In conclusion, a tumor bed boost through IORT using low-energy X-rays is a swift and feasible method that demonstrates low rates in terms of acute or long-term toxicity profiles in combination with whole breast irradiation. [ABSTRACT FROM AUTHOR]

Simple Summary: To obtain new insights in prostate cancer care, multiple clinics and research institutions must jointly analyse their data (by some, referred to as "big data analysis"). For this purpose, a common "data language" should be used. The OMOP CDM (common data model) is such a data language that can be used by different data holders. The aim of this article is to describe how a large dataset from a prostate cancer study with almost 50,000 prostate cancer cases was successfully transferred to the OMOP CDM standard. Challenges and their solutions during this process are discussed, and the importance of using data standards within prostate cancer research are reported from a scientific data holder's perspective. To enhance international and joint research collaborations in prostate cancer research, data from different sources should use a common data model (CDM) that enables researchers to share their analysis scripts and merge results. The OMOP CDM maintained by OHDSI is such a data model developed for a federated data analysis with partners from different institutions that want to jointly investigate research questions using clinical care data. The German Cancer Society as the scientific lead of the Prostate Cancer Outcomes (PCO) study gathers data from prostate cancer care including routine oncological care data and survey data (incl. patient-reported outcomes) and uses a common data specification (called OncoBox Research Prostate) for this purpose. To further enhance research collaborations outside the PCO study, the purpose of this article is to describe the process of transferring the PCO study data to the internationally well-established OMOP CDM. This process was carried out together with an IT company that specialised in supporting research institutions to transfer their data to OMOP CDM. Of n = 49,692 prostate cancer cases with 318 data fields each, n = 392 had to be excluded during the OMOPing process, and n = 247 of the data fields could be mapped to OMOP CDM. The resulting PostgreSQL database with OMOPed PCO study data is now ready to use within larger research collaborations such as the EU-funded EHDEN and OPTIMA consortium. [ABSTRACT FROM AUTHOR]

Simple Summary: Functional MRI has become established in the surgery of brain metastases (BM) as a preoperative diagnostic tool to identify intact eloquent cortex areas. Evidence shows that by allowing surgeons to spare these intraoperatively, patients' postoperative outcome is improved in terms of significantly reduced mortality and morbidity. The influence specifically of BM on the fMRI signal and brain networks has scarcely been investigated, as most studies to date refer only to primary brain tumors or include various tumor entities. Our work examined how BM affect cortical activation and brain networks using task-based fMRI. We found a qualitative attenuation of patients' fMRI signal in the metastasis-affected hemisphere compared to the contralateral hemisphere and alterations in all examined brain networks of the patients compared to healthy controls, and also in the contralateral hemisphere. Thus, our results provide insights into the behavior of BM during fMRI examination and their impact on the integrity of the brain. To date, there are almost no investigations addressing functional connectivity (FC) in patients with brain metastases (BM). In this retrospective study, we investigate the influence of BM on hemodynamic brain signals derived from functional magnetic resonance imaging (fMRI) and FC. Motor-fMRI data of 29 patients with BM and 29 matched healthy controls were analyzed to assess percent signal changes (PSC) in the ROIs motor cortex, premotor cortex, and supplementary motor cortex and FC in the sensorimotor, default mode, and salience networks using Statistical Parametric Mapping (SPM12) and marsbar and CONN toolboxes. In the PSC analysis, an attenuation of the BOLD signal in the metastases-affected hemisphere compared to the contralateral hemisphere was significant only in the supplementary motor cortex during hand movement. In the FC analysis, we found alterations in patients' FC compared to controls in all examined networks, also in the hemisphere contralateral to the metastasis. This indicates a qualitative attenuation of the BOLD signal in the affected hemisphere and also that FC is altered by the presence of BM, similarly to what is known for primary brain tumors. This transformation is not only visible in the infiltrated hemisphere, but also in the contralateral one, suggesting an influence of BM beyond local damage. [ABSTRACT FROM AUTHOR]

Simple Summary: Folate receptors can serve to increase folate uptake in cancer cells through significant overexpression, which is ultimately critical for cell proliferation and tumor growth. Therefore, the characterization of folate receptor expression in cancer presents exciting opportunities in multiple dimensions. On the one hand, the folate receptor can be used as a target for selective transfer of therapeutic agents. On the other hand, it can be used for risk stratification. We found that in prostate cancer (PCa), activation and membrane integration by GPI–transamidase exhibit significant changes. By image analysis, we could demonstrate these differences to healthy control cells and tissues, and we expect high potential in this approach to identify biological subtypes and allow risk stratification based on these alterations in PCa. Due to the proliferation-induced high demand of cancer cells for folic acid (FA), significant overexpression of folate receptors 1 (FR1) is detected in most cancers. To our knowledge, a detailed characterization of FR1 expression and regulation regarding therapeutic and diagnostic feasibilities in prostate cancer (PCa) has not been described. In the present study, cell cultures, as well as tissue sections, were analyzed using Western blot, qRT-PCR and immunofluorescence. In addition, we utilized FA-functionalized lipoplexes to characterize the potential of FR1-targeted delivery into PCa cells. Interestingly, we detected a high level of FR1-mRNA in healthy prostate epithelial cells and healthy prostate tissue. However, we were able to show that PCa cells in vitro and PCa tissue showed a massively enhanced FR1 membrane localization where the receptor can finally gain its function. We were able to link these changes to the overexpression of GPI–transamidase (GPI-T) by image analysis. PCa cells in vitro and PCa tissue show the strongest overexpression of GPI-T and thereby induce FR1 membrane localization. Finally, we utilized FA-functionalized lipoplexes to selectively transfer pDNA into PCa cells and demonstrate the therapeutic potential of FR1. Thus, FR1 represents a very promising candidate for targeted therapeutic transfer pathways in PCa and in combination with GPI-T, may provide predictive imaging in addition to established diagnostics. [ABSTRACT FROM AUTHOR]

Background: To clinically evaluate how dry eye symptoms in preoperatively diagnosed dry eye patients change with the use of sodium hyaluronate- and dexpanthenol-containing eye drops (HYLO CARE (HC), URSAPHARM Arzneimittel GmbH, Saarbruecken, Germany) after cataract surgery. The aim of the study was not to compare different eye drops but to implement standard treatment in patients with dry eye undergoing cataract surgery. The impact of treatment was evaluated using Symptom Assessment Tools for Dry Eye. Methods: In this prospective, single-center, open-label clinical trial, 49 patients undergoing cataract surgery were included who showed signs and symptoms of dry eye disease assessed by the Symptom Assessment in Dry Eye (Visual Analogue Scale (VAS)) questionnaire, Ocular Surface Disease Index (OSDI), and fluorescein tear break-up Time (TBUT). Patients were instructed to apply HC three to four times a day for 5 weeks in the operated eye in addition to the standard postoperative topical anti-inflammatory regimen. The primary endpoint was the change in TBUT. Secondary endpoints were the assessment of the subjective symptoms (VAS), corrected distance visual acuity (CDVA), and slit-lamp examination including the corneal staining score, Schirmer test, and intraocular pressure. Results: At 5 weeks after operation, the mean TBUT increased from 6.42 ± 1.57 s (s) to 7.81 ± 1.83 s in the per-protocol (PP) population (p > 0.001) and from 6.33 ± 1.64 s to 7.71 ± 2.05 s in the intention-to-treat (ITT) population (p < 0.001). There was a statistically significant decrease in all scores (p < 0.05) from the VAS questionnaire except for the tearing score (p = 0.062) at 5 weeks after operation. The mean total corneal staining score also decreased statistically significantly from 8.85 ± 2.49 before operation to 5.61 ± 3.37 at 5 weeks after operation on a 15-point scale. Conclusions: Controlled standardized dry eye treatment (with HC) improved tear film stability, ocular surface defects, and subjective symptoms of dry eye disease in patients 5 weeks after undergoing cataract surgery. Both the patient and physician assessments indicated high efficacy, tolerability, and a reliable safety profile, as indicated by the low number of at least possibly related adverse events (AE), suggesting its beneficial role in the postoperative management of the ocular surface (OS) in patients with dry eye symptoms prior to and after cataract surgery. [ABSTRACT FROM AUTHOR]

As one of the automated guided vehicle (AGV) positioning methods, the LiDAR positioning method, based on artificial landmarks, has been widely used in warehousing logistics industries in recent years. However, the traditional LiDAR positioning method based on artificial landmarks mainly depends on the three-point positioning method, the performance of which is limited due to landmarks' layout and detection requirements. This paper proposes a LiDAR positioning algorithm based on iterative closest point (ICP) and artificial landmarks assistance. It provides improvements based on the traditional ICP algorithm. The result of positioning provided by the landmarks is used as the initial iteration ICP value. The combination of the ICP algorithm and landmarks enables the positioning algorithm to maintain a certain positioning precision when landmark detection is disturbed. By comparing the proposed algorithm with the positioning scheme developed by SICK in Germany, we prove that the combination of the ICP algorithm and landmarks can effectively improve the robustness under the premise of ensuring precision. [ABSTRACT FROM AUTHOR]

The last ten years have witnessed an increase in publications focusing on bioeconomy as a proposal to confront the global challenges of climate change, depletion of non-renewable resources and ecosystem degradation. This paper investigates the scientific literature on issues related agricultural bioeconomy by applying a bibliometric network analysis. Bibliometric analysis is applied to the publications of the Scopus database during the period 2010–2020 in order to provide an overview of the main aspects that characterize agricultural bioeconomy. The results showed that out of a total of 1100 scientific papers, only 2.45% were published in 2010, while the corresponding share in 2020 was 20.81%. In the five years of 2016–2020, cumulatively, 70.63% of the publications were made, showing the dynamic evolution of bioeconomy. In addition, out of 85 countries in total, Germany and Italy are the two countries with most publications, while the fragmentation of research is evident with the creation of two main nodes, the European and the American. Moreover, keyword analysis showed that biomass and sustainability are two main recurring concepts, confirming that, currently, bioeconomy operates at three different levels: energy demand, land demand, and governance. It is apparent that to boost the development of agricultural bioeconomy, the following aspects should be assessed: the effective use of resources, an understanding of the key drivers of agricultural bioeconomy, and a clear perception of their associations. There is still no consensus as to which are the key factors that will accelerate its sustainable development. Our pursuit is to use the tools of bibliometric analysis to reach more critical conclusions regarding the agricultural bioeconomy, rather than approach it in a static way. [ABSTRACT FROM AUTHOR]

With the increasing use of sensitive loads in frequency converters and in relays in distribution networks, voltage sag has become a major power quality issue that urgently needs to be solved. For the purpose of improving the understanding of voltage sag severity in distribution networks, a comprehensive weight-based severity evaluation method of voltage sag is presented in this paper. First, a multi-side index system that takes into account the combined influence of the source, network, and the load is established. A comprehensive weight method, which combines the improved analytic hierarchy process (IAHP) and the entropy method, is then adopted to determine the index weight. The weight of each index and the degree of superiority are linearly weighted to obtain the severity of voltage sag at different observation points. Finally, the effectiveness of the proposed method is verified using a distribution network model established in DIgSILENT PowerFactory (15.1.7, Gomaringen, Germany). [ABSTRACT FROM AUTHOR]

The campus of the Karlsruhe Institute of Technology (KIT) contains several waste heat streams. In an effort to reduce greenhouse gas emissions by optimizing thermal power consumption on the campus, researchers at the KIT are proposing a 'DeepStor' project, which will sequester waste heat from these streams in an underground reservoir during the summer months, when the heat is not required. The stored heat will then be reproduced in the winter, when the campus's thermal power demand is much higher. This paper contains a preliminary geochemical risk assessment for the operation of this subsurface, seasonal geothermal energy storage system. We used equilibrium thermodynamics to determine the potential phases and extent of mineral scale formation in the plant's surface infrastructure, and to identify possible precipitation, dissolution, and ion exchange reactions that may lead to formation damage in the reservoir. The reservoir in question is the Meletta Beds of the Upper Rhein Graben's Froidefontaine Formation. We modeled scale- and formation damage-causing reactions during six months of injecting 140 °C fluid into the reservoir during the summer thermal storage season and six months of injecting 80 °C fluid during the winter thermal consumption season. Overall, we ran the models for 5 years. Anhydrite and calcite are expected mineral scales during the thermal storage season (summer). Quartz is the predicted scale-forming mineral during the thermal consumption period (winter). Within ~20 m of the wellbores, magnesium and iron are leached from biotite; calcium and magnesium are leached from dolomite; and sodium, aluminum, and silica are leached from albite. These reactions lead to a net increase in both porosity and permeability in the wellbore adjacent region. At a distance of ~20–75 m from the wellbores, the leached ions recombine with the reservoir rocks to form a variety of clays, i.e., saponite, minnesotaite, and daphnite. These alteration products lead to a net loss in porosity and permeability in this zone. After each thermal storage and production cycle, the reservoir shows a net retention of heat, suggesting that the operation of the proposed DeepStor project could successfully store heat, if the geochemical risks described in this paper can managed. [ABSTRACT FROM AUTHOR]

The intensive electrification of the automotive sector means that the energy system must be able to adapt to the current market situation. The increase in energy demand is a major factor associated with electric vehicles. The study analyzed the operation of a grid-connected facility operating a vehicle fleet providing transport services in the region Halle/Saale, Germany. Measurement data were used in the analysis, including global positioning system data of the vehicles and technical data, including average fuel consumption on a given route section, daily load demand of the industrial facility, and energy generation from photovoltaics. This paper shows the impact of using a battery electric vehicles (BEVs) fleet in the load distribution for the industrial facility considered. The NEDC energy consumption profile for the Nissan e-NV200 were used in this study. Furthermore, the paper presented simulation results allowing one to determine the usage potential, energy demand, and consumption of EVs using real data, reliably representing the processes related to EV daily use. The measurement data were captured using available specialized equipment: Dako-Key (GPS data), PV power generation (Siemens 7KM PAC4200), and load (Janitza UMG 604-Pro) in September, 2018. On this basis, it is possible to identify the effects and variations in load on the power grid during the replacement of combustion vehicle fleets used currently by EVs for the provision of transport services. Three models were presented, making it possible to calculate changes in energy demand for each scenario. In the first model, EVs were charged exclusively from the distribution network. In the second, the energy generation from a renewable source was considered and the possibility of compensating the energy demand of the vehicles from this source was demonstrated. In the third model, the daily load profile and the period of maximum load in the electricity grid were considered. The results are presented in graphical and tabular form. Finally, the potential of using an EV fleet to increase the functionality of a modern industry object was determined and discussed. Based on data for the adopted scenarios, electrification of transport can increase demand for energy by 40.9% for individual enterprises. The electrification of the automotive sector will increase the instantaneous energy demand of businesses, forcing the integration of renewable energy sources during designing new invests. [ABSTRACT FROM AUTHOR]

Using deep boreholes for the final disposal of high-level radioactive waste (HLRW) can take advantage of multiple geologic barriers as safety features and aims for the safe containment of radionuclides by containment-providing rock zones (CPRZ). The great depth efficiently prolongs or hinders radionuclide transport and also impedes proliferation. Finally, there may be a time benefit with regard to technical implementation and costs. Due to the phase-out from nuclear energy in Germany the number of boreholes could be less than 100. A simplified, generic safety concept, and the requirements for the diameter of boreholes and containers are derived in this paper. Furthermore, the operational safety of emplacement, the retrieval of waste and sealing of the boreholes is discussed. It is outlined that boreholes can be sealed quickly and over long distances with proven technologies, for example, using the creep properties of salt rock formations. This concept is assessed for its compliance with the safety requirements of the German Federal Ministry for the Environment, Nature Conservation, Building and Nuclear Safety (BMUB), and the requirements and criteria for site selection defined by the German commission on "Storage of high-level radioactive waste". The retrievability of HLRWis assessed to be technically feasible based on today's knowledge, but recoverability after closure cannot be guaranteed for long time spans. Further developments in details of the concept of deep borehole disposal (DBD), a demonstration of its technical feasibility and an assessment of operational and long-term safety are still necessary to make DBD an approved option. [ABSTRACT FROM AUTHOR]

Currently only 8.2% of German surface water bodies have reached the goal of the European Water Framework Directive to bring all water into a "good status". For all water bodies that presumably will not achieve the objective by 2027, the member states have to justify an exemption by 2021, for example, by arguing that the costs of achieving "good status" would be "disproportionately high". In this paper, two approaches for assessing cost-disproportionality of surface water bodies are empirically tested and compared on a set of real-world data from a German federal state. In the first approach, called average cost approach, costs are considered as being disproportionately high if they are significantly higher than what would be a "relatively normal effort". The core idea of the second, the benchmark approach, is to take the past public expenditures on water management as a basis for comparison. Both approaches include generated utility for determination of a water-body-specific disproportionality threshold. While the benchmarking approach needs less data, the empirical tests indicate that both approaches yield comparable results and are suitable to support authorities in the decision as to which water bodies are to be considered disproportionately expensive such that exemptions are justified. [ABSTRACT FROM AUTHOR]

The Industry 4.0 (I4.0) concept is concerned with the fourth industrial revolution in manufacturing, in which technological trends such as digitalization, automation and artificial intelligence are transforming production processes. Since the concept's introduction at the Hannover Fair in Germany in 2011, I4.0 has enjoyed a meteoric rise in popularity and is currently high on the agenda of governments, politicians and business elites. In light of these observations, some commentators have asked the question of whether I4.0 is a concept that is hyped up and possibly just the latest in a long line of fashionable management concepts introduced over the course of the last few decades. Therefore, the aim of this paper is to provide a critical outside-in look at the emergence and rise of I4.0. Theoretically, these processes are viewed through the lens of management fashion, a theoretical perspective well suited to examinations of evolutionary trajectories of management concepts and ideas. The findings indicate that the I4.0 concept has quickly become highly popular and is dominating much of the popular management discourse. The concept has migrated out of the specialized manufacturing discourse to become a more general concept with mainstream appeal and applicability, evidenced by a multitude of neologisms such as Work 4.0 and Innovation 4.0. The numbers 4.0 have spread in a meme-like fashion, evidenced by the fact that the combination of a noun and the numbers 4.0 are used to signal and usher in discussions about the future of business and society. While there is much evidence that clearly shows that the concept has had a wide-ranging impact at the discursive level, the currently available research is less clear about what impact the concept has had so far on industries and organizations worldwide. [ABSTRACT FROM AUTHOR]

Renewable energy (RE) is one of the most popular public policy orientations worldwide. Compared to some other countries and continents, Europe has gained an early awareness of energy and environmental problems in general. At the theoretical level, free-market environmentalism indicates that based on the principle of private property rights, with fewer state interventionist and regulation policies, entrepreneurs, as the driving force of the market economy, can provide better services to meet the necessity of offering RE to protect the environment more effectively. Previous studies have revealed that Germany, Denmark, and the United Kingdom have made some progress in using the market to develop RE. However, this research did not analyze the three countries' RE conditions from the perspective of free-market environmentalism. Based on our review of the principles of free-market environmentalism, this paper originally provides an empirical study of how Germany, Denmark, and the United Kingdom have partly conducted free-market-oriented policies to successfully achieve their policy goal of RE since the 1990s on a practical level. In particular, compared with Germany and Denmark, the UK has maintained a relatively low energy tax rate and opted for more pro-market measures since the Hayekian-Thatcherism free-market reform of 1979. The paper also discovers that Fredrich A. Hayek's theories have strongly impacted its energy liberalization reform agenda since then. Low taxes on the energy industry and electricity have alleviated the burden on the electricity enterprises and consumers in the UK. Moreover, the empirical results above show that the energy enterprises play essential roles in providing better and more affordable RE for household and industrial users in the three sampled countries. Based on the above results, the paper also warns that state intervention policies such as taxation, state subsidies, and industrial access restrictions can impede these three countries' RE targets. Additionally, our research provides reform agendas and policy suggestions to policymakers on the importance of implementing free-market environmentalism to provide more efficient RE in the post-COVID-19 era. [ABSTRACT FROM AUTHOR]

Long-term transition pathways to a low-carbon energy system are analysed by applying the energy system model REMod. All in all, the paper contributes to the current research through an innovative scenario approach, using assumptions for societal trends and quantitative results for scenarios, analysing the paths towards climate neutrality and defossilization in 2050. In the case study of Germany, these trends and drivers influence the results and the technology composition in each consumption sector (buildings, transport, and industry). Across all scenarios, it can be observed that the electrification of all sectors is important for the defossilization of the energy system, as the direct use of electricity from renewable energy is more efficient than the consumption of carbon-neutral synthetic energy carriers. However, different consumer behavior (e.g., non-acceptance or resistance against specific technologies) influences not only the efficient use of (green) electricity, it also changes the optimal pathways of the transition to paths with greater efforts. One potential societal trend—sufficiency—could be an important cornerstone for reaching the targets, as the required expansion and exchange of technologies are lower and thus facilitate the transition. [ABSTRACT FROM AUTHOR]

Simple Summary: Mineral deficiencies are very widespread among small ruminant herds throughout the world and play a big role in small ruminant herd health management. This paper describes the occurrence of a primary molybdenosis causing secondary copper deficiency, combined with ovine white liver disease (cobalt deficiency) and white muscle disease (selenium deficiency) in a group of pastured ram lambs in Northern Germany. To the authors' knowledge, this is the first proven report of multiple trace element deficiencies in sheep in Germany for decades. To the author's knowledge this paper describes the first proven report of a combined primary molybdenosis, secondary copper (Cu) deficiency, Ovine White Liver Disease—Cobalt (Co) deficiency, and selenium (Se) deficiency in a small pedigree herd of White Horned Heath sheep in Germany (8 ewes, 2 rams, 3 yearling ewes, 17 lambs) for decades. Clinical signs associated with these mineral deficiencies in a group of pastured ram lambs included emaciation, conjunctivitis, anaemia, growth retardation, discolouration of the wool and photodermatitis. Morbidities and mortalities arose in 4–6-month-old lambs despite intensive veterinary treatment in the summer of 2014 and 2015 (n = 13, 23% died). Se (3/5), Cu (4/7), and Co (3/3) deficiencies in combination with elevated values for Molybdenum (Mo, 2/2) were found. Hamburg is a large industrial city and an input of heavy metals from surrounding industries and coal-fired power stations in combination with a sandy, non-fertilised soil and monoculture grass species might offer a potential explanation for the severity of mineral deficiencies observed in this herd. [ABSTRACT FROM AUTHOR]

The reduction in PV prices and interest in energy independence accelerate the adoption of residential battery storage. This storage can support various functions of an energy system undergoing decarbonization. In this work, operative benefits of storage from the system perspective, namely, generation cost reduction and congestion mitigation, are investigated. Germany is chosen as a case study due to its strong reliance on variable renewable energy. For the analysis, an economic dispatch model with a high spatial resolution is coupled with a pan-European transmission grid model. It is shown that the system's generation costs are highest when the assets are used only to maximize PV self-consumption, and the costs are lowest when the storage also reacts to the market dynamics. This amounts to a 6% cost reduction. Both operation strategies result in an equal level of grid congestion and infrastructure loading. This is improved with a strategy that accounts for regional peak reduction as a secondary objective. The high congestion level emphasizes that grid expansion needs to keep pace with the generation and electrification expansion necessary to decarbonize other sectors. Lastly, policymakers should enable multipurpose utilization, e.g., via the introduction of market-oriented retail electricity prices with intervention options for grid operators. [ABSTRACT FROM AUTHOR]

Background: In hemodynamically unstable patients, the passive leg raise (PLR) test is recommended for use as a self-fluid challenge for predicting preload responsiveness. However, to interpret the hemodynamic effects and reliability of the PLR, the method of performing it is of the utmost importance. Our aim was to determine the current practice of the correct application and interpretation of the PLR in intensive care patients. Methods: After ethical approval, we designed a cross-sectional online survey with a short user-friendly online questionnaire. Using a random sample of 1903 hospitals in Germany, 182 hospitals with different levels of care were invited via an email containing a link to the questionnaire. The online survey was conducted between December 2021 and January 2022. All critical care physicians from different medical disciplines were surveyed. We evaluated the correct points of concern for the PLR, including indication, contraindication, choice of initial position, how to interpret and apply the changes in cardiac output, and the limitations of the PLR. Results: A total of 292 respondents participated in the online survey, and 283/292 (97%) of the respondents completed the full survey. In addition, 132/283 (47%) were consultants and 119/283 (42%) worked at a university medical center. The question about the performance of the PLR was answered correctly by 72/283 (25%) of the participants. The limitations of the PLR, such as intra-abdominal hypertension, were correctly selected by 150/283 (53%) of the participants. The correct effect size (increase in stroke volume ≥ 10%) was correctly identified by 217/283 (77%) of the participants. Conclusions: Our results suggest a considerable disparity between the contemporary practice of the correct application and interpretation of the PLR and the practice recommendations from recently published data at German ICUs. [ABSTRACT FROM AUTHOR]

In densely built-up urban areas, green spaces such as gardens, parks, forests and water bodies can greatly enhance the quality of life for local residents and promote human health. These areas mitigate heat stress and the urban heat island effect to create a balanced local climate. To quantify the ecosystem service of "urban climate regulation" provided by urban green infrastructure, we developed a national indicator for specific measurement and monitoring. This indicator captures both the supply of climate-regulating services by urban green spaces and the demand for this service from the residential population. Using nationwide geodata, a cooling capacity value can be calculated that reflects the tree canopy, soil cover, sizes of green area and site characteristics. This cooling capacity value is then related to the affected residential population in the neighbourhood. Our analysis indicates that 76% of the population in the 165 case cities in Germany enjoy high or very high cooling capacities in their immediate living environment. In 37 cities, over 85% of the population benefits from good or very good cooling capacity provided by green space. The proposed indicator enables a comparison of the cooling service of urban green infrastructure and offers a sound basis for spatial planning and decision-making in urban areas. [ABSTRACT FROM AUTHOR]

This study aimed to compare different pancreatic enzyme preparations (PEPs) available in Germany regarding particle geometry and size, and to evaluate enzyme activity under physiologically relevant conditions in vitro. Pancreatic endocrine insufficiency is characterized by deficiency of pancreatic enzymes resulting in maldigestion. It is orally treated by pancreatic enzyme replacement therapy. The formulations differ in their physical properties and enzyme release behavior, potentially resulting in inconsistent dosages and poor interchangeability of products. A total of 25 products were analyzed for particle size and number of particles per capsule. Enzyme activities of lipase, amylase, and protease were measured by digestion of olive oil emulsion, starch, and casein, respectively. To analyze enzyme release, gastric environments were simulated by incubating PEPs at pH 1, 4, or 5. Duodenal conditions were simulated by subsequent incubation at pH 6. Regarding physical properties and enzyme release kinetics, considerable differences between different PEPs were found. Furthermore, compared to the label claim, excess lipase activity was observed for most products, reaching up to 148%. These in vitro results suggest poor interchangeability of PEPs, potentially explained by physical and release characteristics. Physicians and patients should be aware of the potential gap between label claims and the real-life performance of different PEPs. [ABSTRACT FROM AUTHOR]

This study investigates the production of clausal embeddings by 195 Russian speakers (67 monolingually raised speakers, 68 heritage speakers in the US, and 60 heritage speakers in Germany) in different communicative situations varying by formality (formal vs. informal) and mode (spoken vs. written). Semi-spontaneous data were manually annotated for clause type and analyzed using a binomial generalized mixed-effects model. Our results show that heritage speakers of both groups and monolingually raised speakers behave alike regarding their use of embedded clauses. Specifically, all speaker groups produce embedded clauses more frequently in formal situations compared to informal situations. Mode was not found to influence the production of embedded clauses. This behavior suggests an underlying register awareness in heritage speakers of Russian. Such register awareness might be a result of the high involvement of heritage speakers with Russian. This study contributes to our understanding of linguistic outcomes of heritage speakers and highlights the influence of communicative situations on language production. [ABSTRACT FROM AUTHOR]

As an outgrowth of globalization, religious globalization has significantly transformed the religious landscape worldwide. Contemporary societies exhibit religious pluralism, posing challenges for services such as spiritual or pastoral care. This study aimed to investigate how pastoral/spiritual caregivers of divergent cultural and religious backgrounds navigate religious diversity and how their religious location influences their inter-religious relations. Data were gathered through a standardized open-ended interview protocol. The study sample consisted of German Christian pastoral caregivers and Turkish Muslim spiritual caregivers from Germany and Turkey, respectively (N = 67). Overall, the entire sample expressed a generally positive attitude towards providing spiritual/pastoral care (S/PC) to individuals of other religious affiliations. German participants emphasized a human-centered approach towards individuals from diverse religious and cultural backgrounds, whereas Turkish participants placed greater emphasis on the qualifications of the caregiver. Turkish participants exhibited less exposure to other cultures/religions compared to their German counterparts, yet both subsamples responded positively to requests for care from individuals of different faiths. Both subsamples adhered to standard procedures during S/PC visits. German participants were more inclined to incorporate elements from other religions/cultures into their S/PC work compared to Turkish participants. The majority of participants regarded their respective institutions (Church/Diyanet) as responsible for addressing the spiritual needs of others. However, the German subsample displayed greater reluctance towards the employment of pastoral caregivers from different religious backgrounds by their institution, as opposed to the Turkish subsample. [ABSTRACT FROM AUTHOR]

Deriving from the growing cultural and religious diversity in Germany and the need for educational professionals to be able to deal with heterogeneous groups and communicate to children about how to coexist peacefully with others, this essay focuses on the relationship between common sense and tolerance, particularly in places of inescapable dense coexistence characterised by religious and cultural diversity. Using institutions of preschool and primary education as an example, the extent to which peaceful coexistence and conflict resolution is borne by common sense and supported by practices of tolerance is discussed. Subsequently, the significance of a common-sense approach to practices of tolerance for conceptualising ethical judgement in intercultural and inter-religious education is explored. The article closes with thoughts on the contribution of religious ethics to questions of human coexistence in highly dense and conflict-ridden contexts and briefly addresses aspects of Protestant social ethics. [ABSTRACT FROM AUTHOR]

South Korea is an aging society with a rapidly increasing number of people with dementia. In that context, this study aimed to compare dementia nursing home building standards in South Korea and Germany, based on the minimum physical and architectural requirements specified by both countries' relevant laws, to gain insights into improving South Korean building standards. I examined South Korea's Welfare of Senior Citizens Act and its Enforcement Regulations, and Germany's Federal Nursing Home Act (HeimG), Regulation on Minimum Standards for Nursing Homes (HeimMindBauV), and the corresponding state regulations. The analysis revealed differences regarding the basic requirements, facility sizes, composition of necessary rooms, and detailed regulations pertaining to these rooms. South Korea emphasized autonomy, including barrier-free and compensatory environments, as well as safety and security. Meanwhile, Germany enhanced similar aspects of autonomy to those in South Korea, including the barrier-free standard DIN 18040-2. Additionally, Germany incorporated features such as familiarity, sensory stimulation, legibility, and social interaction, reflecting aspects that offer orientational cues for autonomy. Improving South Korean building standards requires stronger regulations on the autonomy of individuals with dementia. Further, additional regulations on familiarity, sensory stimulation, legibility, and social interactions should be considered. The results provide foundational data for cross-national comparisons to establish building standards for dementia-friendly built spaces in dementia nursing homes in South Korea. Further surveys on spatial utilization, discussions, and the application of proposed improvements in Korea would contribute to enhancing the dementia-friendly nursing home design in the country. [ABSTRACT FROM AUTHOR]

Efficiency in stock markets is essential for economic stability and growth. This study investigates the efficiency and herding behavior of the stock markets from the top economies of the world (known as G20 countries). We classify stock market indices using MSCI classification for the developed and emerging markets to provide a comparative examination using the latest data and by employing the robust multifractal detrended fluctuation (MFDFA) method. In addition to the full sample, the analysis uses sub-sample periods to reveal the hidden features and efficiencies of the G20 markets during the Russia–Ukraine War and COVID-19 for the first time. The findings show the availability of varied multifractality among all G20 stock markets during the overall and crisis periods, exhibit long-range correlations, and may support the fractal market hypothesis. In addition, Italy remains the least efficient, while Germany remains the most efficient stock market. The sub-sample results further reveal unevenness in the local fluctuations and resultant higher inefficiency considering the sheer magnitude and impact of crises on the G20 stock markets. However, the efficiency of developed stock markets performed better as compared to emerging markets. The study of G20 stock markets is useful and provides several implications for a wider audience. [ABSTRACT FROM AUTHOR]

Simple Summary: The "PraeRi" study, conducted by three German veterinary universities from 2016 to 2020, was aimed at enhancing dairy health and welfare. With 765 visited dairy farms and 101,307 animals examined, the designed study provided an opportunity for improving animal well-being. Researchers applied good epidemiologic practice and concepts proven in large-scale studies, in a study comprising three different regions in Germany with varying farm characteristics. A sample size of 250 farms per region, determined through stratified sampling based on farm size, ensured representative estimates. According to the information provided by the farmers, mastitis was the most frequently occurring disease in their herds (14.2% to 16.3% of the herd—depending on the region). For most disorders, prevalence data were lowest for the region South compared with the two remaining regions. Statistical analyses identified risk factors, with results communicated through individual reports and benchmarking flyers to participating farmers. Challenges arose from managing practical procedures and communication due to the project's vast scale. Harmonizing data management and hypothesis testing across involved parties added complexity. Despite challenges, the PraeRi study considerably contributed to advancing dairy health and welfare practices. From 2016 to 2020, the "PraeRi" study, conducted by three German veterinary universities, was aimed at enhancing animal health and welfare in dairy farms. With 765 dairy farms visited and 101,307 animals examined, this study provided a basis for improving animal health and welfare. The study population comprised three different regions representing a broad variety of characteristics. To ensure representative estimates, a sample size of 250 farms was determined for each region, employing a stratified sampling plan based on farm size. According to the information provided by the farmers, the most commonly occurring disease in their herds was mastitis without general disorder (14.2% to 16.3% of the herd—depending on the region). For most disorders, prevalence data were lowest for the region South compared with the two remaining regions. Multivariable regression analyses were performed to identify risk factors for various target variables, and the results were communicated through individual reports and benchmarking flyers to participating farmers. The authors encountered challenges in management and communication due to the project's size in terms of personnel, data, and farms examined. Harmonizing data management and hypothesis testing across all involved parties added complexity. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer is one of the most commonly diagnosed cancers worldwide with a high probability of developing metastasis over the course of the disease. Only certain patients with colorectal liver metastases can be treated by surgical resection. Different interventional treatments such as laser-induced thermotherapy, microwave ablation, as well as transarterial chemoembolization can be applied for treating colorectal liver metastases. These therapies have been discussed in various studies. However, the current medical literature is still lacking research from large long-term studies. This retrospective monocentric study includes 2140 patients with colorectal liver metastases treated by different locoregional treatments. It is based upon data collected over a period of more than 26 years at the University Hospital Frankfurt of Goethe University. The aim of this study was to analyze the long-term results of different locoregional treatments for colorectal cancer liver metastases (CRLM), including transarterial chemoembolization (TACE), laser-induced thermotherapy (LITT) and microwave ablation (MWA). A total of 2140 patients with CRLM treated at our department between 1993 and 2020 were included in this retrospective study. The patients were divided into the following groups: LITT (573 patients; median age: 62 years), TACE + LITT (346 patients; median age: 62 years), MWA (67 patients; median age: 59 years), TACE + MWA (152 patients; median age: 65 years), and TACE (1002 patients; median age: 62 years). Median survival was 1.9 years in the LITT group and 1.7 years in the TACE + LITT group. The median survival times in the MWA group and TACE + MWA group were 3.1 years and 2.1 years, respectively. The median survival in the TACE group was 0.8 years. The 1-, 3-, and 5-year survival rates were 77%, 27%, and 9% in the LITT group and 74%, 18%, and 5% in the TACE + LITT group, respectively. The corresponding survival rates were 80%, 55%, and 33% in the MWA group, 74%, 36%, and 20% in the TACE + MWA group and 37%, 3%, and 0% in the TACE group, respectively. The long-term results of this study demonstrate the efficacy of locoregional treatments in treating patients with CRLM. The longest survival was found in the MWA group, followed by the combination therapy of TACE and MWA. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain. [ABSTRACT FROM AUTHOR]