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Simple Summary: Non-small cell lung cancer (NSCLC) is the most common form of lung cancer. Treatments and outcomes for NSCLC are evolving as a result of multiple approvals for immunotherapies and targeted therapies but may also be affected by limitations in clinical care access. In the PRATER study, we described the profile and treatments of patients diagnosed with Stage I–III NSCLC in Austria prior to the introduction of new therapies in the pre-/post-operative setting. We found that therapeutic strategies were aligned with guidelines at that time. Clinical care was timely delivered in most but not all early-stage NSCLC patients. As an additional exploratory objective, we showed that lung cancer care was not significantly affected by COVID-19 restrictions in Austria. Real-world evidence generated here will support future cancer care policies and evaluations of healthcare system efficiency in clinical adoption of new therapies. This was a retrospective study of the profile and initial treatments of adults diagnosed with early-stage (ES) non-small cell lung cancer (NSCLC) during January 2018–December 2021 at 16 leading hospital institutions in Austria, excluding patients enrolled in clinical trials. In total, 319 patients were enrolled at a planned ~1:1:1 ratio across StI:II:III. Most tested biomarkers were programmed death ligand 1 (PD-L1; 58% expressing), Kirsten rat sarcoma virus (KRAS; 22% positive), and epidermal growth factor receptor (EGFR; 18% positive). Of 115/98/106 StI/II/III patients, 82%/85%/36% underwent surgery, followed by systemic therapy in 9%/45%/47% of those [mostly chemotherapy (ChT)]. Unresected treated StIII patients received ChT + radiotherapy [43%; followed by immune checkpoint inhibitors (ICIs) in 39% of those], ICI ± ChT (35%), and ChT-alone/radiotherapy-alone (22%). Treatment was initiated a median (interquartile range) of 24 (7–39) days after histological confirmation, and 55 (38–81) days after first medical visit. Based on exploratory analyses of all patients newly diagnosed with any stage NSCLC during 2018–2021 at 14 of the sites (N = 7846), 22%/10%/25%/43% had StI/II/III/IV. The total number was not significantly different between pre-COVID-19 (2018–2019) and study-specific COVID-19 (2020–2021) periods, while StI proportion increased (21% vs. 23%; p = 0.012). Small differences were noted in treatments. In conclusion, treatments were aligned with guideline recommendations at a time which preceded the era of ICIs and targeted therapies in the (neo)adjuvant setting. [ABSTRACT FROM AUTHOR]

This study uses boundary crossing in activity theory as one normative framework for opening a deliberative inquiry in new discursive spaces to elicit "gender awareness" in teachers' practices. We illustrate this framework by drawing from data in one European teacher education project. Seven case studies were conducted and data were analysed from a convenience sample of teacher educators who alongside the authors acted as national coordinators for the project. Data sources included questionnaires of initial ratings, case study reports, transcripts of team meetings and interviews. A cluster analysis of ratings was guided in a step-wise manner and yielded two distinct cluster groups where one group of case studies had high ratings of gender-specific settings. This finding was then used in a qualitative interpretation of data sources for deeper contextual understandings of teacher educators' perspectives. Gender-specific settings had a reported context of aspects in an activity system which three case studies grasped as school-based planning, pedagogical innovation and mentoring supports. The framework for analysis of higher order gender aspects showed success in distinguishing case studies with isolated views of gender. Findings also showed limitations in the partially restricted framing of gender as an activity system at the outset of the project and indicated in some instances, reluctant teacher educators. The study underscores the explanatory power of the framework adopted and opens up hypotheses for further research and consideration.

This study delves into the analysis of a vineyard in Carinthia, Austria, focusing on the automated derivation of ecosystem structures of individual vine parameters, including vine heights, leaf area index (LAI), leaf surface area (LSA), and the geographic positioning of single plants. For the derivation of these parameters, intricate segmentation processes and nuanced UAS-based data acquisition techniques are necessary. The detection of single vines was based on 3D point cloud data, generated at a phenological stage in which the plants were in the absence of foliage. The mean distance from derived vine locations to reference measurements taken with a GNSS device was 10.7 cm, with a root mean square error (RMSE) of 1.07. Vine height derivation from a normalized digital surface model (nDSM) using photogrammetric data showcased a strong correlation (R2 = 0.83) with real-world measurements. Vines underwent automated classification through an object-based image analysis (OBIA) framework. This process enabled the computation of ecosystem structures at the individual plant level post-segmentation. Consequently, it delivered comprehensive canopy characteristics rapidly, surpassing the speed of manual measurements. With the use of uncrewed aerial systems (UAS) equipped with optical sensors, dense 3D point clouds were computed for the derivation of canopy-related ecosystem structures of vines. While LAI and LSA computations await validation, they underscore the technical feasibility of obtaining precise geometric and morphological datasets from UAS-collected data paired with 3D point cloud analysis and object-based image analysis. [ABSTRACT FROM AUTHOR]

Real estate valuation is typically based on hedonic regression models where the expected price of a property is explained in dependence of its attributes. However, investors in the housing market are equally interested in the distribution of real estate market values (including price variation), that is, determining the impact of attributes of a property on the entire conditional distribution. We therefore consider Bayesian structured additive distributional and quantile regression models for real estate valuation. In the first approach, each parameter of a potentially complex parametric response distribution is related to a structured additive predictor. In contrast, the second approach proceeds differently and models arbitrary quantiles of the response distribution directly and nonparametrically. Both models presented are based on a multilevel version of structured additive regression thereby utilizing the typical hierarchical structure of real estate data. We demonstrate the proposed methodology within a detailed case study based on more than 3 000 owner-occupied single family homes in Austria, discuss interpretation of the resulting effect estimates, and compare models based on their predictive ability. [ABSTRACT FROM AUTHOR]

Background: Due to the COVID-19 pandemic, workplaces in the medical field experienced changes. Non-frontline workers in the health sector (WHS) were in many cases allowed to work from home (WFH). Changes in work locations have affected the perception of productivity during the COVID-19 pandemic compared to the pre-pandemic perception. Studies regarding this research field are rare for WHS. The aim of the present study was to investigate the perception of productivity and its impact on symptoms of depression during the COVID-19 pandemic. The second objective was to assess the implications for post-pandemic work settings such as WFH or work scenarios in hospitals during pandemics. Methods: At three points in time during the COVID-19 pandemic (t1; n = 161: April 2020, t2; n = 1598 winter 2020/2021, t3; n = 1879 winter 2021/2022), an online survey of WHS (e.g., medical doctors, nurses, scientific staff) in Austria concerning their productivity in their current workplace (pre- and post-pandemic) was conducted. The online survey included questions about the perceptions of productivity changes (i.e., perceptions of lower, equal, and higher productivity, before and during the COVID-19 pandemic) in different work settings (e.g., working in a hospital or working from home), as well as standardized questionnaires like the Patient Health Questionnaire (PHQ-9), assessing symptoms of depression in WHS. Results: χ2 tests showed that WHS working in hospitals experienced significantly fewer fluctuations in their perceptions of productivity than WHS working from home. An analysis of variance (ANOVA) indicated that WHS with a lower perception of productivity tended to have higher self-assessed depressive symptoms. Conclusion: The possibility of remaining working in the hospital in stressful scenarios like the COVID-19 pandemic might stabilize the feeling of productivity. Moreover, productivity is associated with self-assessed depressive symptoms. Hence, looking into the reasons behind this discrepancy between WHS in hospitals and those working from home might help to improve the home office modality and to create better structures, which are related to symptoms of depression. [ABSTRACT FROM AUTHOR]

Clinical cases of 'staggering disease', a nonsuppurative encephalomyelitis associated with gait abnormalities in cats, have been documented for decades in Sweden. In Austria, an increased incidence was observed in the 1990s. Only recently, rustrela virus (RusV) was identified as the causative agent of this clinicopathologic disease entity. In this retrospective study, we analyzed a total of 23 brain and spinal cord samples from Austrian cats with the pathohistological diagnosis of nonsuppurative encephalomyelitis and clinical signs consistent with staggering disease from 1994 to 2016 using reverse transcription real-time polymerase chain reaction (RT-qPCR) and in situ hybridization. We were able to detect RusV nucleic acids in seven of the examined samples. Borna disease virus 1 (BoDV-1) could be excluded in all cases via immunohistochemistry and RT-qPCR. This study confirms that RusV has been a relevant etiological agent of nonsuppurative encephalomyelitis of cats in a geographically and temporally limited disease cluster in Austria, mainly in the 1990s. The geographic distribution of the positive samples in this study is consistent with earlier reports on 'staggering disease' in Austria. Further studies are necessary to confirm the reservoir host of 'staggering disease' in Austria, as well as investigations on the disappearance of this disease and its possible zoonotic potential. [ABSTRACT FROM AUTHOR]

This study aimed at evaluating the extent of benzodiazepine (BZD) consumption among nursing home residents and examining additional mental health problems. Urine samples were collected in nursing homes in a border region between Austria and Germany and analyzed for BZD using a liquid chromatographic-tandem mass spectrometric method (LC–MS/MS). In addition, a questionnaire was applied to the residents including the ICD-10 symptom rating scale; nursing staff filled out a further questionnaire on residents' consumption of addictive drugs. Of 301 urine samples collected in 33 nursing homes, 103 (34.2%) were BZD positive. BZD users showed significantly higher values for depression and anxiety. Nursing staff reported consumption of addictive drugs in 29 (37.2% of BZD positives) with almost entirely BZD use. In nearly 4% of BZD users, nursing staff indicated drug abuse/dependence. BZD use appears to be rather common in nursing homes and nurses apparently do not recognize the addictive potential of BZD sufficiently. Interventions should aim at a reduction of BZD prescriptions by sensitizing primary care physicians and nursing staff. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate whether time of birth, unit volume, and staff seniority impact the incidence of maternal complications in deliveries ≥34 + 0 gestational weeks. Methods: We conducted a population‐based cross‐sectional study of 87 065 deliveries occurring between 2004 and 2015 in ten public hospitals in Styria, Austria. A composite adverse maternal outcome measure of uterine atony, postpartum hysterectomy, postpartum bleeding, impaired wound healing, postpartum infections requiring antibiotic treatment, sepsis, or maternal death was used to compare outcomes by time of birth, unit volume, and staff seniority. Based on delivery data, generalized estimating equations (GEEs) were used to calculate the risk of maternal adverse outcomes. Results: Maternal adverse events occurred in 1.33% of deliveries. Incidence of maternal adverse events was highest for units with >1000 deliveries (adjusted OR 1.40; CI 95%: 1.16–1.69) and higher for perinatal centers (adjusted OR 1.35; CI 95%: 1.15–1.57) compared with reference units (500–1000 deliveries/year). Delivery during the daytime compared with the afternoon and nighttime did not affect the incidence of maternal complications (P = 0.765 and P = 0.136, respectively). Compared with resident‐guided deliveries, the odds ratio for an adverse event was the same when a consultant attended the delivery (adjusted OR 1.13; CI 95%: 0.98–1.30) but lower in deliveries managed by midwives only (adjusted OR 0.21; CI 95%: 0.07–0.64). Conclusion: Procedures performed during the night shift were not associated with increased complication rates. Delivery volume and high‐volume centers were associated with the highest risk of maternal complications, and units with 500–1000 deliveries per year were the lowest. With increasing odds of pregnancy risks, these results change, and delivering in a high‐volume center becomes at least as safe as delivering in a smaller unit. [ABSTRACT FROM AUTHOR]

'Staggering disease' is a neurological disease entity considered a threat to European domestic cats (Felis catus) for almost five decades. However, its aetiology has remained obscure. Rustrela virus (RusV), a relative of rubella virus, has recently been shown to be associated with encephalitis in a broad range of mammalian hosts. Here, we report the detection of RusV RNA and antigen by metagenomic sequencing, RT-qPCR, in-situ hybridization and immunohistochemistry in brain tissues of 27 out of 29 cats with non-suppurative meningoencephalomyelitis and clinical signs compatible with'staggering disease' from Sweden, Austria, and Germany, but not in non-affected control cats. Screening of possible reservoir hosts in Sweden revealed RusV infection in wood mice (Apodemus sylvaticus). Our work indicates that RusV is the long-sought cause of feline 'staggering disease'. Given its reported broad host spectrum and considerable geographic range, RusV may be the aetiological agent of neuropathologies in further mammals, possibly even including humans. Rustrela virus (RusV) was detected in the brains of 27 out of 29 domestic cats with 'staggering disease', but not of 29 control cats. This suggests RusV as the long-sought causative agent of 'staggering disease', which had been obscure for 50 years. [ABSTRACT FROM AUTHOR]

Background: During the peak of the COVID-19 pandemic, healthcare workers worked under stressful conditions, challenging their individual resilience. Therefore, we explored the bidirectional influence of resilience and the factors of COVID-19 work-related fears and anhedonia in Austrian healthcare workers. Methods: Healthcare workers in Austria completed an online survey at two points in time. The first measurement started in winter 2020/2021 (t1), and a second measurement began approximately 1.5 years later (t2). One hundred and eight six individuals completed both surveys and were investigated in a longitudinal design. We applied the Resilience Scale, the Snaith-Hamilton Pleasure Scale, and a self-created questionnaire assessing COVID-19 work-related fears. We used a repeated measures analysis of variance and applied Pearson-Correlations as well as univariate and multivariate analyses of covariance. Results: Resilience was significantly correlated with COVID-19 work-related fears and anhedonia at both points in time in all participants. We found no significant differences for frontline vs. non-frontline workers at t1 and t2. Resilience decreased significantly over time. Limitations: Most subjects were examined cross-sectionally. Frontline workers were underrepresented in our sample. Conclusion: Our findings highlight the importance of resilience in healthcare providers. Steps must be taken to maintain and promote resilience in healthcare workers. We suggest that the improvement of resilience, dealing with fears and uncertainty, and the ability to experience joy might have a beneficial influence on the respective other categories as well. [ABSTRACT FROM AUTHOR]

Aims The presence of pulmonary hypertension (PH) severely aggravates the clinical course of heart failure with preserved ejection fraction (HFpEF). To date, neither established heart failure therapies nor pulmonary vasodilators proved beneficial. This study investigated the efficacy of chronic treatment with the oral soluble guanylate cyclase stimulator riociguat in patients with PH-HFpEF. Methods and Results The phase IIb, randomized, double-blind, placebo-controlled, parallel-group, multicentre DYNAMIC trial assessed riociguat in PH-HFpEF. Patients were recruited at five hospitals across Austria and Germany. Key eligibility criteria were mean pulmonary artery pressure ≥25 mmHg, pulmonary arterial wedge pressure >15 mmHg, and left ventricular ejection fraction ≥50%. Patients were randomized to oral treatment with riociguat or placebo (1:1). Patients started at 0.5 mg three times daily (TID) and were up-titrated to 1.5 mg TID. The primary efficacy endpoint was change from baseline to week 26 in cardiac output (CO) at rest, measured by right heart catheterization. Primary efficacy analyses were performed on the full analysis set. Fifty-eight patients received riociguat and 56 patients placebo. After 26 weeks, CO increased by 0.37 ± 1.263 L/min in the riociguat group and decreased by −0.11 ± 0.921 L/min in the placebo group (least-squares mean difference: 0.54 L/min, 95% confidence interval 0.112, 0.971; P  = 0.0142). Five patients dropped out due to riociguat-related adverse events but no riociguat-related serious adverse event or death occurred. Conclusion The vasodilator riociguat improved haemodynamics in PH-HFpEF. Riociguat was safe in most patients but led to more dropouts as compared to placebo and did not change clinical symptoms within the study period. [ABSTRACT FROM AUTHOR]

Aims: To find out which variables may be associated with comfort of patients in an epilepsy monitoring unit. Design: Exploratory, quantitative study design. Methods: Data were collected from October 2018 to November 2019 in Austria and Southern Germany. A total of 267 patients of 10 epilepsy centres completed the Epilepsy Monitoring Unit Comfort Questionnaire which is based on Kolcaba's General Comfort Questionnaire. Secondary data analysis were conducted by using descriptive statistics and an exploratory model building approach, including different linear regression models and several sensitivity analyses. Results: Total comfort scores ranged from 83 to 235 points. Gender, occupation and centre turned out to be possible influential variables. On average, women had a total comfort score 4.69 points higher than men, and retired persons 28.2 points higher than high school students ≥18 years. Comfort scores of younger patients were lower than those of older patients. However, age did not show a statistically significant effect. The same could be observed in marital status and educational levels. Conclusion: When implementing comfort measures, nurses must be aware of variables which could influence the intervention negatively. Especially, high school students ≥18 years should be supported by epilepsy specialist nurses, in order to reduce uncertainty, anxiety and discomfort. But, since the identified variables account only for a small proportion of the inter‐individual variability in comfort scores, further studies are needed to find out additional relevant aspects and to examine centre‐specific effects more closely. Impact: Nurses ensure patient comfort during a hospital stay. However, there are variables that may impair the effectiveness of the nursing measures. Our study showed that the experience of comfort was highly individual and could be explained by sociodemographic variables only to a limited extent. Nurses must be aware that additional factors, such as the situation in the individual setting, may be relevant. [ABSTRACT FROM AUTHOR]

Simple Summary: There are many causes of mortality in free-living songbirds, and, usually, the general public is not particularly interested in these issues. Only when large numbers of dead birds are observed within small geographic areas and within a short period of time is some public attention focused on these phenomena. In this study, we investigated episodes of mass mortality of songbirds, especially in greenfinches all over Austria, which occurred between 2012 and 2020. We noticed that all of these losses were caused by a particular protozoal parasite (Trichomonas (T.) gallinae) which induced severe inflammation of the upper digestive tract and subsequently death due to starvation. We were able to establish clear links with almost identical disease outbreaks in other countries and thus trace the path of the pathogen through Europe. It could be shown that T. gallinae has spread over the whole of Austria in recent years and occurred in many different songbird species, with a preference for greenfinches, leading to a significant decline in the population of this bird species. Since most birds are presumably infected at feeding sites, hygiene conditions and the correct selection of feeders play an important role in the prevention of disease. In the early summer of 2012, sudden mass mortality among songbirds, particularly in greenfinches (Chloris chloris, syn: Carduelis chloris) was observed in Austria, which was caused by the protozoan parasite Trichomonas gallinae. This pathogen induced fibrinonecrotic ingluvitis and/or esophagitis, leading to impairment of food intake and ultimately death due to starvation. The pathogen was successfully detected within the lesions by polymerase chain reaction (PCR) and chromogenic in situ hybridization. The epizootic resulted in a significant decline in the Austrian greenfinch population. Continuing passive surveillance in the subsequent years (2013–2020) revealed that the condition occurred each year and was present in the entire country. Genetic characterization of the pathogen showed the presence of an identical strain irrespective of geographical location, bird species, and year. [ABSTRACT FROM AUTHOR]

State budgets reflect political priorities, providing a measure of issue relevance over time and comparatively across states. This article offers the first analysis of Länder budgets for women's policy agencies (WPA) in Germany and Austria between 1991 and 2018. Comparing Länder WPA budgets provides insights into material allocations to, and the conditionality of, gender politics in Germany's strongly federalized state and Austria's weak federation. We find that German Länder budgeted for independent WPA earlier than Austrian Länder. However, with the advent of the 1999 Austrian coalition of Christian Democrats and the right-wing Freedom Party, which aimed to dismantle national-level gender policies, Austrian Länder investment in WPA grew to compensate for diminishing federal funds. The party constellation in power mattered more in Austria, but in both countries the parties in power were more important for WPA financing than the descriptive representation of women in Länder parliaments. [ABSTRACT FROM AUTHOR]

During the last glacial maximum (LGM), large parts of the European Alps were occupied by an extensive interconnected system of valley glaciers. At lower elevations on the eastern fringe of the Alps, only a patchy pattern of isolated glaciers developed. Erosion by many of these smaller glaciers was however sufficient to excavate subglacial basins ('overdeepening') large enough to act as sedimentary archives of deglaciation processes. To constrain the deglaciation history and the post-LGM evolution of an isolated glacial system, we analyzed the geomorphology and the sedimentary record of a local overdeepening at the northern fringe of the Northern Calcareous Alps. We focus on the heavily silted lake system Taferlklaussee (TKS) (Höllengebirge massif, Austria) confined by a succession of terminal moraines and a steep headwall. Field techniques (mapping, Direct Current Resistivity, and core drilling), lab techniques (lithostratigraphic analyses and radiocarbon dating) and Geographic Information System (GIS) analyses are employed to document dynamics of erosion and sedimentation after deglaciation. We discuss drivers and controls of paraglacial landscape evolution. The almost complete postglacial (lake) record indicates abundant sediment input during the lateglacial and early Holocene, but strongly reduced dynamics since the Mid-Holocene. Sediment storage volumes range between 3.83 Mm³ and 5.75 Mm³ and lithology-specific mechanical denudation rates range between 0.8 mm/a and 1.7 mm/a depending on the scenario used. The study provides a well-constrained reference for the depositional dynamics of isolated LGM glacier systems of the Eastern Alps. It highlights the potential of using related sedimentary records to constrain the local variability in postglacial landscape evolution. [ABSTRACT FROM AUTHOR]

Objectives: Prediction of large vessel occlusion (LVO) is highly relevant for accurate prehospital transportation triage. The Austrian Prehospital Stroke Scale (APSS) score for LVO prediction was developed using critical synthesis of previously published LVO-scores. The aim of this study was to investigate the accuracy of the APSS and compare it to other LVO-scores. Methods: APSS consists of 5 items: "facial palsy," "motor arm," "language," "motor leg" and "gaze deviation." The score ranges from 0 to 9 points. Data from 741 consecutive stroke patients with acute vessel imaging admitted to an independent comprehensive stroke center was used to test the predictive performance of the APSS in context of other LVO-scores (CPSS, FAST-ED, G-FAST, sNIHSS-EMS and RACE). Results: In the prediction of treatable LVO the APSS showed the highest area under the curve (0.834) with significant difference to CPSS (p = 0.010) and G-FAST (p = 0.006) and showed highest sensitivity (69%) as compared to other LVO scores. Specificity (85%), positive predictive value (75%), negative predictive value (81%) and accuracy (79%) were comparable to other LVO scores. Receiver operating curve analysis revealed an optimal cutoff for LVO prediction at APSS equal to 4 points. Conclusions: The easy assessable 5-item APSS score tended to outperform other LVO scores. Real-life prospective evaluation in prehospital setting is ongoing. [ABSTRACT FROM AUTHOR]

A key objective of health promotion capacity building and professional development programmes is to enhance competencies in the workforce or training participants. The goal of this study was to investigate and validate the psychometric properties of a recently developed self-assessment tool, based on 'The CompHP core competencies framework for health promotion', to establish whether it is suitable for evaluating training. The tool was employed in 2018 to evaluate two different programmes, with 584 participants submitting their assessment and evaluation of 77 different health promotion training courses in a paper and pencil questionnaire. Longitudinal data were available for 148 participants in the programme for workplace health promotion because they completed an online questionnaire beforehand. The reliability and validity of the assessment tool were tested in several confirmatory factor analyses and structural equation models. Structurally, there was a significant increase in health promotion competencies when comparing measurements before and after training. Furthermore, participants were shown to have different levels of competencies due to their prior knowledge, the format of the course or the professional development programme attended but not based on gender, age or sector. The results justify the creation of an overall scale to assess core health promotion competencies that are suitable for evaluating training courses. However, various methodological issues need to be considered in future applications including decisions about the design of the study (e.g. pre–post test, control groups), type of measurements (e.g. general and specific instrument, background information) and depth of analysis (e.g. confirmatory model and invariance testing). [ABSTRACT FROM AUTHOR]

Radiative transfer models (RTM) provide universally applicable, highly accurate prospects for plant parameter retrieval. Due to the ill-posed nature of radiative transfer theory, however, the retrieval of plant parameters requires sophisticated strategies for model inversion. We argue that object-based image analysis (OBIA) works as an effective regularization measure to cope with this ill-posedness. Despite similar findings reported in the literature, OBIA and RTM are rarely used in a combined manner. Additionally, there is a clear lack of software solutions ready for operational usage. Therefore, we propose OBIA4RTM as an approach to combine OBIA and RTM using Python and PostgreSQL/PostGIS spatial databases in a fully Open Geospatial Consortium (OGC) compliant way. First results obtained in agricultural regions in southern Germany and Austria using Sentinel-2 data during the 2017 and 2018 growing season show root mean squared errors (RMSE) in the leaf area index (LAI) of 1.47 m²/m² in the case of silage maize and 1.31 m²/m² in the case of winter cereals. Issues of integrating space and time as well as defining appropriate validation strategies, however, require further research. [ABSTRACT FROM AUTHOR]

Cirque erosion contributes significantly to mountain denudation and is a key element of glaciated mountain topography. Despite long-standing efforts, rates of rockwall retreat and the proportional contributions of low-, mid- and high-magnitude rockfalls have remained poorly constrained. Here, a unique, terrestrial-lidar-derived rockfall inventory (2011–2017) of two glaciated cirques in the Hohe Tauern range, Central Alps, Austria, is analysed. The mean cirque wall retreat rate of 1.9 mm a -1 ranks in the top range of reported values and is mainly driven by enhanced rockfall from the lowermost, freshly deglaciated rockwall sections. Retreat rates are significantly elevated over decades subsequent to glacier downwasting. Elongated cirque morphology and recorded cirque wall retreat rates indicate headward erosion is clearly outpacing lateral erosion, most likely due to the cataclinal backwalls, which are prone to large dip-slope failures. The rockfall magnitude–frequency distribution – the first such distribution derived for deglaciating cirques – follows a distinct negative power law over 4 orders of magnitude. Magnitude–frequency distributions in glacier-proximal and glacier-distal rockwall sections differ significantly due to an increased occurrence of large rockfalls in recently deglaciated areas. In this paper, the second of two companion pieces, we show how recent climate warming shapes glacial landforms, controls spatiotemporal rockfall variation in glacial environments and indicates a transient signal with decadal-scale exhaustion of rockfall activity immediately following deglaciation crucial for future hazard assessments. [ABSTRACT FROM AUTHOR]

In the European Alps, almost half the glacier volume has disappeared over the past 150 years. The loss is reflected in glacier retreat and ice surface lowering even at high altitude. In steep glacial cirques, surface lowering exposes rock to atmospheric conditions probably for the very first time in several millennia. Instability of rockwalls has long been identified as one of the direct consequences of deglaciation, but so far cirque-wide quantification of rockfall at high resolution is missing. Based on terrestrial lidar, a rockfall inventory for the permafrost-affected rockwalls of two rapidly deglaciating cirques in the Central Alps of Austria (Kitzsteinhorn) is established. Over 6 years (2011–2017), 78 rockwall scans were acquired to generate data of high spatial and temporal resolution. Overall, 632 rockfalls were registered, ranging from 0.003 to 879.4 m3 , mainly originating from pre-existing structural rock weaknesses. A total of 60 % of the rockfall volume detached from less than 10 vertical metres above the glacier surface, indicating enhanced rockfall activity over tens of years following deglaciation. Debuttressing seems to play a minor effect only. Rather, preconditioning is assumed to start inside the randkluft (void between cirque wall and glacier) where measured sustained freezing and ample supply of liquid water likely cause enhanced physical weathering and high quarrying stresses. Following deglaciation, pronounced thermomechanical strain is induced and an active layer penetrates into the formerly perennially frozen bedrock. These factors likely cause the observed paraglacial rockfall increase close to the glacier surface. This paper, the first of two companion pieces, presents the most extensive dataset of high-alpine rockfall to date and the first systematic documentation of a cirque-wide erosion response of glaciated rockwalls to recent climate warming. [ABSTRACT FROM AUTHOR]

Background: Eight different PCV2 genotypes with varying prevalence and clinical impact have been described so far. PCV2 infection is still widespread among the vaccinated population and several experimental studies have clearly demonstrated that there is no induction of a 100% cross-protective immunity between the PCV2 genotypes. Hence, PCV2a-based vaccines may be ineffective. In this longitudinal study, the PCV2 genotype and haplotype evolution in Austria in the years 2002 to 2017 was investigated by phylogenetic analysis of 462 bp-long sequences of the capsid protein gene (ORF2). The obtained findings may be of practical relevance for the future development of vaccination strategies. Results: One hundred thirty four of a total of 161 formalin-fixed and paraffin wax-embedded samples could be sequenced successfully. There was no significant influence of storage time on sequencing success or quality. PCV2a (8.2%), PCV2b (77.6%), PCV2d (13.4%), and PCV2g (0.8%) were found. PCV2d was first detected as early as in 2004. PCV2g was described once in 2009. Both global PCV2 genotype shifts were observed. PCV2a occurred with a low prevalence during the first study years only in samples from non-vaccinated swine herds and was gradually replaced by PCV2b until 2011. PCV2b was the most prevalent genotype over the whole study period and was detected in samples from vaccinated and non-vaccinated herds. During the last two study years, the prevalence of PCV2d increased, although at this point almost all herds were vaccinated. The haplotype diversity was high, but the nucleotide diversity was low. Especially for genotype PCV2b, an increase in haplotype diversity could be described during the first study years. Conclusion: Extensive PCV2a-derived vaccination resulted in a reduction of prevalence and in a stabilization of genotype PCV2a, whereas genotypes PCV2b and PCV2d evolved as a consequence of natural and vaccination-induced selection. An ongoing virus circulation may be the result of reduced vaccine-induced protection. [ABSTRACT FROM AUTHOR]

STEPAUT, an Austrian non-interventional study, evaluated the safety and efficacy of everolimus plus exemestane in patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC) recurring/progressing on/after nonsteroidal aromatase inhibitors (NSAIs) in routine clinical practice. Postmenopausal women with HR+, HER2− ABC progressing on/after NSAIs receiving everolimus plus exemestane in accordance with routine practice and the current version of Summary of Product Characteristics were eligible. Planned individual observation period corresponded to the duration of treatment until formal study end. Overall, 236 patients (median age: 65 years) were enrolled at 17 sites across Austria. The median progression-free survival (mPFS) in the overall population was 9.5 months (95% confidence interval [CI]: 8.6–10.7 months). The mPFS (95% CI) in patients who received everolimus 10 and 5 mg was 9.9 months (7.3–11.5 months) and 8 months (4.7–10.7 months), respectively. The median time to progression was numerically longer in patients who had a therapy break (11.9 months, 95% CI: 10.0–14.6 months) versus those who did not have any therapy break (10.7 months, 95% CI: 8.9–12.6 months). Patients experienced grade 1 (53.7%), grade 2 (35.9%), grade 3 (9.9%), grade 4 (0.2%) adverse events (AEs). The most common AEs of any grade were stomatitis, mucositis (53.8%), rash, exanthema (29.7%), loss of appetite, nausea (28.4%). Real-world safety and efficacy data from STEPAUT were consistent with results from BOLERO-2, supporting everolimus plus exemestane as a suitable treatment option for HR+, HER2− ABC recurring/progressing on/after NSAIs. • STEPAUT, an Austrian non-interventional study, evaluated everolimus plus exemestane. • The median progression-free survival in the overall population was 9.5 months. • Majority of the patients had grade 1 (53.7%) to grade 2 (35.9%) adverse events. • Real-world data from STEPAUT were consistent with results from the BOLERO-2. Trial registration: BASG, AGES, NIS002843 [ABSTRACT FROM AUTHOR]

Background: Directly acting antivirals (DAA) against hepatitis C virus (HCV) infection have facilitated sustained virologic response (SVR) rates >90% in clinical studies. Yet, real life data regarding DAA treatment in people who inject drugs (PWIDs) are scarce. We evaluated the effectiveness of glecaprevir/pibrentasvir (G/P) in difficult-to-treat PWIDs with presumed high risk of non-adherence to DAA therapy using the concept of directly observed therapy involving their opioid substitution therapy (OST) facility. Methods: N = 145 patients (m/f: 91/54; median age: 41.1 (IQR 19.5) years; HCV-genotype (GT) 1/2/3/4: 82/1/56/5, GT3: 38.6%; cirrhosis: n = 6; 4.1%) treated with G/P were included. PWIDs at high risk for non-adherence to DAA therapy received HCV treatment together with their OST under the supervision of medical staff ("directly observed therapy", DOT). The effectiveness of G/P given as DOT in PWIDs with presumed high risk of non-adherence to DAA therapy was compared to patients with suspected "excellent compliance" in the "standard setting" (SS) of G/P prescription at a tertiary care center and self-managed G/P intake at home. Treatment duration was 8–16 weeks according to the G/P drug label. Results: DOT-patients (n = 74/145; 51.0%) were younger than SS-patients (median 38.7, IQR 12.5 vs. median 50.6, IQR 20.3 years), all had psychiatric co-morbidities and most had a poor socioeconomic status. 50/74 (67.6%) reported ongoing intravenous drug use (IDU). SVR was achieved in n = 70/74 (94.6%) patients with n = 3 being lost to follow-up (FU) and n = 1 showing nonresponse to therapy. SS-patients achieved SVR in 97.2% (69/71) with n = 1 patient being lost to FU and n = 1 patient with GT3 showing HCV relapse. Conclusion: G/P given as DOT along with OST in PWIDs with high risk of non-adherence to DAA therapy resulted in similarly high SVR rates (94.6%) as in patients with presumed "excellent compliance" under standard drug intake. [ABSTRACT FROM AUTHOR]

Aim: Workplace health promotion (WHP) is being increasingly employed as a corporate strategy, being at its most effective when it is implemented in a high-quality and sustainable way. Based on normative principles, a quality management system for WHP was introduced in Austria in 2004. This article examines the measurement quality to validate this quality assurance system. Subjects and methods: From 2014 to 2017, WHP projects have been assessed rigorously by means of a standardized procedure using 15 quality criteria. The foundations for this are an application submitted by the company, and the decision as to whether a WHP quality certificate is awarded or not is based on the overall assessment. Data are available for the 1131 Austrian companies. Based on theoretical and methodological considerations, the measurement quality was investigated in relation to the overall quality of WHP projects with the help of structural equation models. Results: The confirmatory one-factor analysis revealed satisfactory construct validity (λ ≥ 0.40) and high reliability for the overall scale (α = 0.87), although the fit was not acceptable. The bi-factor analysis with a general factor (GF) and three specific residual factors resulted in good model fit. The GF explained most of the common variance (ECV = 63.9%); the overall scale was also characterized by its high reliability (αGF = 0.90, ωHGF = 0.82). Conclusion: The results justify the creation of an overall scale for assessing the quality of WHP. The mean varied by the year of submission, and there was a significant difference between both small/large enterprises and initial/renewal awards. The measurement tool can be considered a good screening instrument for awarding the WHP quality certificate. [ABSTRACT FROM AUTHOR]

Background: To assess changes in frequency, severity, complications, therapy and outcome of intracerebral hemorrhage in patients treated in stroke units in Austria, we evaluated data from the Austrian Stroke Unit Registry between 2008 and 2016. Methods and findings: Data of 6707 cases of ICH covering a time span of 9 years and including information on age, risk factors, pre-stroke modified Rankin Score (mRS), baseline stroke severity (NIHSS), complications, therapy, functional outcome, and mortality were extracted from the Austrian Stroke Unit Registry. A multivariate regularized logistic regression model and linear models for temporal dependence were computed for analyzing statistical inference and time trends. Bonferroni correction was applied to correct for multiple testing. Between 2008 and 2016, the proportion of ICH admissions to stroke units in Austria declined, with a shift among patients towards older age (>70 years, p = 0.04) and lower admission NIHSS scores. While no significant time trends in risk factors, pre-stroke mRS and medical complications were observed, therapeutic interventions declined significantly (p<0.001). Three-month mortality increased over the years independently (p = 0.003). Conclusions: Despite declining incidence and clinical severity of ICH we observed a clear increase in three-month mortality. This effect seems to be independent of predictors including age, admission NIHSS, pre-morbid MRS, or medical complications. The observations from this large retrospective database cohort study underline an urgent call for action in the therapy of ICH. [ABSTRACT FROM AUTHOR]

Objectives: HIV Pre‐Exposure prophylaxis (PrEP) is a strategy to reduce HIV transmission in people at risk. Aim of this first German‐Austrian PrEP guideline is to provide professional guidance on: when and in whom to use PrEP, recommended laboratory tests before and while on PrEP, selection of drugs, prevention of adverse events as a consequence of missing accompanying medical care, and general handling of PrEP in adults and adolescents. Methods: Commented summary of of the S2k PrEP consensus guidelines released by the German and Austrian HIV medical societies to highlight the key recommendations of the guidelines. Content: Detailed information about effectiveness of PrEP, when and in whom to use PrEP, as well as about additional monitoring of HIV PrEP are included in the HIV PrEP guidelines. Therewith detailed guidance for people being involved in PrEP counseling and associated care is provided. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV)-induced metabolic abnormalities and antiretroviral therapy (ART), genetic factors, most importantly the rs738409 C > G p.I148M variant in the patatin-like phospholipase domain containing 3 (PNPLA3)-gene, as well as hepatitis C virus (HCV) coinfection may all cause hepatic steatosis (HS). However, recent studies suggest a protective effect of HCV infection on HS. Thus, we evaluated HS prior and after HCV eradication in an HIV/HCV-coinfected cohort at the Medical University of Vienna between January 2014 and June 2017. Two hundred forty-seven patients underwent liver stiffness measurement and controlled attenuation parameter (CAP)-based steatosis assessment. A subcohort of 138 patients also had follow-up CAP measurement after HCV eradication by direct-acting antivirals (DAAs). A CAP value ≥248 dB/m defined HS and all CAP values were adapted to compensate for body mass index (BMI) and diabetes mellitus. Among all 247 HIV/HCV-coinfected patients, HS was prevalent in 31%, mean age was 43.3 years, 75% were male, the main ethnicity was Caucasian (96%), and mean BMI was 23.33 kg/m2. Independent risk factors for HS were BMI, years exposed to HIV, PNPLA3 G-alleles, and protease inhibitor (PI) intake. Notably, a significant increase in CAP (from 225 ± 52.9 to 235 ± 50.7 dB/m; p = 0.047) was observed after HCV eradication, whereas patients on PI-containing ART experienced a significant decrease in CAP. Overall, one-third of HIV/HCV-coinfected patients are affected by HS with PI-based ART and PNPLA3 impacting on HS prevalence. While HCV eradication by DAAs increased HS, as assessed by CAP, future studies should account for metabolic syndrome and evaluate whether changes in CAP-based steatosis assessments correspond to a clinically relevant outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the initial termination rate of status epilepticus (SE) in a large observational study and explore associated variables.Methods: Data of adults treated for SE were collected prospectively in centers in Germany, Austria, and Switzerland, during 4.5 years. Incident episodes of 1,049 patients were analyzed using uni- and multivariate statistics to determine factors predicting cessation of SE within 1 hour (for generalized convulsive SE [GCSE]) and 12 hours (for non-GCSE) of initiating treatment.Results: Median age at SE onset was 70 years; most frequent etiologies were remote (32%) and acute (31%). GCSE was documented in 43%. Median latency between SE onset and first treatment was 30 minutes in GCSE and 150 minutes in non-GCSE. The first intravenous compound was a benzodiazepine in 86% in GCSE and 73% in non-GCSE. Bolus doses of the first treatment step were lower than recommended by current guidelines in 76% of GCSE patients and 78% of non-GCSE patients. In 319 GCSE patients (70%), SE was ongoing 1 hour after initiating treatment and in 342 non-GCSE patients (58%) 12 hours after initiating treatment. Multivariate Cox regression demonstrated that use of benzodiazepines as first treatment step and a higher cumulative dose of anticonvulsants within the first period of treatment were associated with shorter time to cessation of SE for both groups.Interpretation: In clinical practice, treatment guidelines were not followed in a substantial proportion of patients. This underdosing correlated with lack of cessation of SE. Our data suggest that sufficiently dosed benzodiazepines should be used as a first treatment step. ANN NEUROL 2019;85:421-432. [ABSTRACT FROM AUTHOR]

• Cerebrospinal fluid CXCL13 is an emerging diagnostic marker for Lyme neuroborreliosis (LNB). • This case report describes very early diagnostic findings in peripheral neuropathy caused by LNB. • CXCL13 failed to aid early diagnosis in this rare manifestation of LNB. The case of a 69-year-old woman with peripheral neuropathy caused by Lyme neuroborreliosis (LNB) in an endemic region in Eastern Austria is reported. The patient had noticed transient numbness of her left leg. On initial examination, she had patchy sensory disturbances of the left lower leg, but ancillary examinations of nerve conduction and cerebrospinal fluid (CSF), including the B-cell chemokine CXCL13, were normal. A re-tap performed 54 days later, following clinical progression with foot drop, widespread lower leg paresthesia, and pain, revealed an increased cell count, autochthonous IgM production, synthesis of Borrelia -specific IgM, and elevated CXCL13. Neurophysiological examinations disclosed an incomplete conduction block, mixed axonal and demyelinating sensorimotor neuropathy, and subacute neurogenic damage of muscles innervated by the peroneal nerve. This case study presents rare evidence of very early diagnostic findings in peripheral neuropathy caused by LNB. These are characterized by insensitivity of CXCL13 in CSF to aid earlier diagnosis and the development of an intrathecal immune response against Borrelia at a later stage. These findings reinforce the need for a re-tap to confirm the diagnosis and facilitate appropriate treatment in this rare manifestation of LNB. [ABSTRACT FROM AUTHOR]

Objective: We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation.Design: Population-based prospective cohort study.Setting: Ten public hospitals in the Austrian province of Styria.Sample: A total of 87 065 neonates delivered in the period 2004-2015.Methods: Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority.Main Outcome Measures: Neonatal composite adverse and severely adverse outcome measures.Results: The odds ratio for severely adverse events during the night-time (22:01-07:29 hours) compared with the daytime (07:30-15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13-1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500-1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events.Conclusions: Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period.Tweetable Abstract: Deliveries during night time lead to a greater number of neonates experiencing severely adverse events. [ABSTRACT FROM AUTHOR]

Abstract: Background: Use of prenatal acupuncture for labor preparation is common, but there is still conflicting evidence with respect to its objective obstetric benefits. There is little information on women's expectations and subjective experiences with acupuncture treatments. Methods: In this retrospective cohort study, a validated questionnaire on women's treatment satisfaction was sent to women who had received prenatal acupuncture at the obstetric clinic of the Medical University of Graz, Austria within the last 3 years. The electronic obstetric database was used to extract detailed clinical and obstetric data of women who received acupuncture and delivered at the hospital. For comparison, obstetric data were matched with a control group of women without prenatal acupuncture, who had given birth at the hospital during the study period. Results: The questionnaire was sent to 150 women, out of which 70 (46.7%) completed and returned the questionnaire. Analysis of the questionnaire indicated good overall satisfaction (mean sum score 26.22 ± 4.72) with acupuncture treatment—97.1% indicated that they were very or quite satisfied. Responders did not differ from nonresponders, except for the time between delivery and questionnaire (P = .015). Comparisons between the deliveries after prenatal acupuncture (n = 144) and the matched control deliveries (n = 576) showed no statistical significant differences in the length of labor and use of analgesics. Conclusion: Prenatal acupuncture is likely to have positive effects on pregnant women, aside from an objective influence on labor duration and pain. [ABSTRACT FROM AUTHOR]

Rationale: Patients with pulmonary hypertension due to left heart disease (PH-LHD) and a diastolic pulmonary vascular pressure gradient ≥ 7 mm Hg, representing PH out of proportion to pulmonary arterial wedge pressure, have pulmonary vascular disease and increased mortality. Little information exists on this condition, recently labeled as "combined pre- and post-capillary PH" (Cpc-PH).Objectives: To investigate epidemiology, risk factors, right ventricular function, and outcomes in patients with chronic heart failure and Cpc-PH.Methods: The study population was identified from a retrospective chart review of a clinical database of 3,107 stable patients who underwent first diagnostic right heart catheterization and from a prospective cohort of 800 consecutive patients at a national university-affiliated tertiary center.Measurements and Main Results: The retrospective cohort had 664 patients with systolic heart failure (SHF) and 399 patients with diastolic heart failure (DHF), 12% of whom were classified as Cpc-PH. The prospective cohort had 172 patients with SHF (14% Cpc-PH) and 219 patients with DHF (12% Cpc-PH). Chronic obstructive pulmonary disease (P = 0.034) and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio (P = 0.015) predicted Cpc-PH in SHF. Younger age (P = 0.004), valvular heart disease (P = 0.046), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure ratio predicted Cpc-PH in DHF (P = 0.016). Right ventricular-pulmonary vascular coupling was worse in Cpc-PH patients (end-systolic elastance to effective arterial elastance [Ees/Ea]: SHF: 1.05 ± 0.25; P = 0.002; DHF: 1.17 ± 0.27; P = 0.027) than in those with isolated post-capillary PH (Ees/Ea: SHF: 1.52 ± 0.51; DHF: 1.45 ± 0.29).Conclusions: Cpc-PH is rare in chronic heart failure. Right ventricular-pulmonary vascular coupling is poor in Cpc-PH and could be one explanation for dismal outcomes. [ABSTRACT FROM AUTHOR]

Background Because of physiological changes, elderly people are much more exposed to the adverse effects of alcohol. Therefore, hazardous drinking is defined at lower levels as compared to younger adults. This work aimed to evaluate the validity of the current cutoff levels of the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questions to detect hazardous drinking in the elderly by using ethyl glucuronide in hair (HEtG). Methods In a border region between Austria and Germany, 344 nursing home residents were included from 33 of the 107 nursing homes. Residents were asked to answer the AUDIT-C questions, hair samples were obtained, and nursing staff members were asked for their assessments of the residents' alcohol consumption. Hair samples were analyzed for HEtG using gas chromatography-mass spectrometry. Receiver-operating characteristic (ROC) curve analysis was performed to determine the validity of cutoff values for the AUDIT-C to detect an alcohol consumption of ≥10 g of alcohol/d. Results A total of 11.3% of the nursing home residents ( n = 344) drank ≥10 g of alcohol/d (4.9% >60 g of alcohol/d, 6.4% 10 to 60 g of alcohol/d, 88.7% <10 g of alcohol/d)). For the drinking limit of ≥10 g of alcohol/d, ROC curve analysis showed a balanced sensitivity and specificity, with an AUDIT-C cutoff of ≥4 for men (sensitivity: 70%, specificity: 83.6%; AUC = 0.823, CI = 0.718 to 0.928, p < 0.001) and ≥2 for women (sensitivity: 73.7%, specificity: 81.9%; AUC = 0.783, CI = 0.653 to 0.914, p < 0.001). Nursing staff ( n = 274) underestimated alcohol consumption and evaluated 40% of the chronic-excessive alcohol consumers (>60 g of alcohol/d) as being abstinent. Conclusions Our data suggest that an AUDIT-C cutoff of ≥4 for men and ≥2 for women can be recommended to detect the consumption of ≥10 g of alcohol/d in the elderly. Because the nursing staff to a large extent underestimates the alcohol consumption among nursing home residents, further teaching of the staff, improvement of screening instruments for the elderly, and the use of objective biomarkers might be helpful for recognizing hazardous drinking and can thus help improve the quality of life of the elderly. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the main cause of death in Austria. However, no systematic information exists regarding characteristics and treatments of contemporary patients with stable coronary artery disease (CAD) in Austria. We assembled two retrospective physicians’ databases to describe demographics, clinical profiles, and therapeutic strategies in patients with stable CAD. In addition, we compared patient profiles of secondary care internists and hospital-based cardiologists with those of general practitioners in a primary care setting outside of hospital. Methods: The study population was identified from retrospective chart review of 1020 patients from 106 primary care physicians in Austria (ProCor II registry), and was merged with a previous similar database of 1280 patients under secondary care (ProCor I registry) to yield a total patient number of 2300. Results: Female patients with stable CAD were older, had more angina and/or heart failure symptoms, and more depression than males. Female gender, type 2 diabetes mellitus, higher CCS class and asthma/COPD were predictors of elevated heart rate, while previous coronary events/revascularization predicted a lower heart rate in multivariate analysis. There were no significant differences with regard to characteristics and management of patients of general practitioners in the primary care setting versus internists in secondary care. Conclusions: Characteristics and treatments of unselected patients with stable ischemic heart disease in Austria resemble the pattern of large international registries of stable ischemic heart disease, with the exception that diabetes and systemic hypertension were more prevalent. [ABSTRACT FROM AUTHOR]

This article examines the ecological risk factors of abuse against older women. Data from 2,880 older women were randomly collected in five European countries (Austria, Belgium, Finland, Lithuania, and Portugal) using a standardized questionnaire. Results indicate that overall 30.1 % older women had at least one experience of abuse in the past year. The findings demonstrate that a single emphasis on personal risk factors (e.g., health, coping) is important but too simple: Abuse is multifaceted and is embedded in environmental (e.g., loneliness, household income) as well as macrocultural contexts (e.g., old age dependency ratio). [ABSTRACT FROM PUBLISHER]

Objective: Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia.Methods: Data were prospectively collected from women diagnosed with placenta praevia in 10 Austrian hospitals in in the province of Styria between 1993 and 2012. We analyzed the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. Differences between women with major placenta praevia (complete or partial placenta praevia) and minor placenta praevia (marginal placenta praevia or low-lying placenta) were evaluated.Results: 328 patients with placenta praevia were identified. The province wide incidence of placenta praevia was 0.15%. Maternal morbidity was high (ante-partum bleeding [42.3%], post-partum hemorrhage [7.1%], maternal anemia [30%], comorbid adherent placentation [4%], and hysterectomy [5.2%]) and neonatal complications were frequent (preterm birth [54.9%], low birth weight <2500 g [35.6%], Apgar-score after five minutes <7 [5.8%], and fetal mortality [1.5%]. Women with major placenta praevia had a significant higher incidence of preterm delivery, birthweight <2500 g and Apgar-score after five minutes <7.Conclusions: Placenta praevia was associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. The extent of placenta praevia was not related with differences regarding risk factors and maternal outcome. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the performance of the logistic organ dysfunction (LOD) system for the assessment of morbidity and mortality in multiple organ dysfunction/failure (MOD/F) in an independent database and to evaluate the use of sequential LOD measurements for the prediction of outcome.Design and Setting: Prospective, multicentric cohort study in 13 adult medical, surgical, and mixed intensive care units (ICUs) in Austria.Patients: A total of 2,893 consecutive admissions to the ICUs.Measurements and Main Results: Patient vital status at ICU and hospital discharge was recorded. Univariate analysis showed that the LOD was able to distinguish between survivors and nonsurvivors (2 vs. 6 median score). Within organ systems, higher levels of the severity of organ dysfunction were consistently associated with higher mortality. For the prediction of hospital mortality, the original prognostic LOD model did not perform well in our patients, as indicated by the goodness-of-fit C statistic. Using multiple logistic regression we developed a prognostic model with a satisfactory fit in our patients. The integration of further measurements during the ICU stay increased discrimination but not calibration.Conclusions: The LOD system is well correlated well with the numbers and levels of organ dysfunctions and discriminates well between survivors and nonsurvivors. It can thus be used to quantify the baseline severity of organ dysfunction. Moreover, after customization of the predictive equation the LOD predicted hospital mortality in our patients with high precision. It thus provides a combined measure of morbidity and mortality for critically ill patients with MOD/F. [ABSTRACT FROM AUTHOR]

Objectives: To validate SAPS II-AM, a recently customized version of the Simplified Acute Physiology Score II (SAPS II) in a larger cohort of Austrian intensive care patients and to evaluate the effect of the customization process on the ratio of observed to expected mortality.Design: Prospective, multicentric cohort study.Patients and Setting: A total of 2,901 patients consecutively admitted to 13 adult medical, surgical, and mixed intensive care units (ICUs) in Austria.Measurements and Results: After the database was divided randomly into a development sample (n = 1,450) and a validation sample (n = 1,451), logistic regression was used to develop a new model (SAPS II-AM2). The original SAPS II, the SAPS IIAM, and the newly developed SAPS II-AM2 were then compared by means of calibration, discrimination and O/E ratios. Differences in O/E ratios before and after customization (deltaO/E) were calculated. The Hosmer-Lemeshow goodness-of-fit H and C statistics revealed poor calibration of the original SAPS II on the database. The new model, SAPS II-AM2, performed better than the SAPS II-AM and excellent in the validation data set. However, mean O/E ratios varied widely among diagnostic categories (range 0.55-1.05 for the SAPS II). Moreover, the deltaO/E of the 13 ICUs ranged from -3.6 % to +25 %.Conclusions: Today's severity scoring systems, such as the SAPS II, are limited by not measuring (and adjusting for) a profound part of what constitutes case mix. Changes in the distribution of patient characteristics (known and unknown) therefore affect prognostic accuracy. First-level customization was not able to solve all these problems. Using O/E ratios for quality of care comparisons one must therefore be critical when using these data and should search for possible confounding factors. In the case of unsatisfactory calibration, customized severity of illness models may be useful as an adjunct for quality control. [ABSTRACT FROM AUTHOR]

Native European passerine birds are frequently clinically inapparent carriers of haemosporidian parasites of the genus Plasmodium. Clinical disease and death are only exceptionally reported. In the present study, tissue samples of 233 wild passerine birds found dead in Eastern Austria were examined by in situ hybridization (ISH) and partial cytochrome B gene sequence analysis for the presence, abundance and taxonomic assignment of Plasmodium spp. In 34 cases (14.6 %), ISH yielded a positive result with large numbers of developmental stages in different cell types of the spleen, liver, brain and lung. The abundance of the tissue stages, which was comparable to fatal cases of avian malaria in penguins, suggested a major contribution to the cause of death. Genetic analysis revealed infections with representatives of three different valid species of Plasmodium, Plasmodium elongatum, Plasmodium lutzi and Plasmodium vaughani. Genetically identical parasite lineages had been found in a previous study in penguins kept in the Vienna zoo, providing evidence for the role of wild birds as reservoir hosts. Further, this study provides evidence that several species of Plasmodium are able to abundantly proliferate in endemic wild birds ultimately resulting in mortalities. [ABSTRACT FROM AUTHOR]

At the start of the First World War, numerous German and Austrian publishers issued editions of patriotic songs intended for use in the home. Such anthologies contained a variety of works, including traditional songs, military tunes, and even newly composed pieces for the conflict. Despite the dozens of collections that were published, this repertoire has received little scholarly attention. The four volumes dedicated expressly to songs concerning the War that appeared in the series 'Musik für Alle' demonstrate why these selections were viewed as appropriate for those defending the home front. [ABSTRACT FROM PUBLISHER]

Background and Purpose: In nursing practice, research results have to undergo a systematic process of transformation. Currently in Austria, there is no empirical data available concerning the actual implementation of research results. An English validated questionnaire was translated into German and tested for validity and reliability. Method: A survey of 178 registered nurses (n = 178) was conducted in a multicenter, quantitative, cross-sectional study in Austria in 2011. Results: Cronbach's alpha values (.82-.92) were calculated for 4 variables ("use," "attitude," "availability," "support") after the reduction of 7 irrelevant items. Exploratory factor analysis was calculated with Kaiser-Meyer-Olkin (KMO) ranging from .78 to .92; the total variance ranged from 46% to 56%. Conclusion: A validated German questionnaire concerning the implementation of research results is now available for the nursing practice. [ABSTRACT FROM AUTHOR]

This article investigates how strong German and weak Austrian cooperative federalism affect women’s policy machineries. We find that it is the federal organization of both polities that has posited engrained advantages for the establishment and the sustainability of women’s policy agencies (WPA). We also find that center/left parties are crucial for sustaining and advancing the role of WPA. However, during economic crises, we see that the women’s policy infrastructure in the strong federal state (Germany) was downsized while Austria’s national social democratic WPA protects subnational institutions. [ABSTRACT FROM PUBLISHER]

Aims: We analysed current carbon (C) stocks in fine root and aboveground biomass of riparian forests and influential environmental parameters on either side of a dike in the Donau-Auen National Park, Austria. Methods: On both sides of the dike, carbon (C) stock of fine roots (CFR) under four dominant tree species and of aboveground biomass (CAB) were assessed by topsoil cores (0-30 cm) and angle count sampling method respectively ( n = 48). C stocks were modeled, performing boosted regression trees (BRT). Results: Overall CFR was 2.8 t ha, with significantly higher C stocks in diked (DRF) compared to flooded riparian forests (FRF). In contrast to CFR, mean CAB was 123 t ha and lower in DRF compared to FRF. However, dike construction was consistently ruled out as a predictor variable in BRT. CFR was influenced by the distance to the Danube River and the dominant tree species. CAB was mainly influenced by the magnitude of fluctuations in the groundwater table and the distances to the river and the low groundwater table. Conclusions: Despite pronounced differences in FRF and DRF, we conclude that there is only weak support that dikes directly influence C allocation in floodplain forests within the time scale considered (110 years). [ABSTRACT FROM AUTHOR]

Despite its widespread availability and known safety and efficacy, a therapy with intravenous thrombolysis is still undergiven. We aimed to identify whether nationwide quality projects-like the stroke registry in Austria-as well as online benchmarking and predefined target values can increase rates of thrombolysis. Therefore, we assessed 6,394 out of 48,462 patients with ischemic stroke from the Austrian stroke registry (study period from March 2003 to December 2011) who had undergone thrombolysis treatment. We defined lower level and target values as quality parameters and evaluated whether or not these parameters could be achieved in the past years. We were able to show that rates of thrombolysis in Austria increased from 4.9 % in 2003 to 18.3 % in 2011. In a multivariate regression model, the main impact seen was the increase over the years [the OR ranges from 0.47 (95 % CI 0.32-0.68) in 2003 to 2.51 (95 % CI 2.20-2.87) in 2011). The predefined lower and target levels of thrombolysis were achieved at the majority of participating centers: in 2011 the lower value of 5 % was achieved at all stroke units, and the target value of 15 % was observed at 21 of 34 stroke units. We conclude that online benchmarking and the concept of defining target values as a tool for nationwide acute stroke care appeared to result in an increase in the rate of thrombolysis over the last few years while the variability between the stroke units has not yet been reduced. [ABSTRACT FROM AUTHOR]

Objectives: Rapid initiation of intravenous thrombolysis improves patient’s outcome in acute stroke. We analyzed inter-center variability and factors that influence the door-to-needle time with a special focus on process measurements in all Austrian stroke units. Methods: Case level data of patients receiving intravenous thrombolysis in the Austrian Stroke Unit Registry were enriched with information of a structured questionnaire on center specific process measures of all Austrian stroke units. Influence of case and center specific variables was determined by LASSO procedure. Results: Center specific median door-to-needle time ranged between 30 and 78 minutes. Between April 2004 and November 2012, 6246 of 57991 patients treated in Austrian stroke units with acute ischemic stroke received intravenous thrombolysis. An onset-to-door time >120 minutes, patients with total anterior circulation stroke, recent year of admission, patient transportation with ambulance crew and emergency physician, the use of point of care tests reduced the door-to-needle time, whereas onset-to-door ≤60 minutes, unknown onset-to-door, patients with an NIHSS ≤4 or posterior circulation stroke, initial admission to a general emergency department, a distant radiology department, primary imaging modality other than plain CT and waiting for the lab results were associated with an increase in door-to-needle time. Case level and center specific factors could explain the inter center variability of door-to-needle times in 31 of 34 stroke units in Austria. Conclusions: In light of our results it seems crucial that every single stroke center documents and critically reviews possibilities of optimizing practice strategies in acute stroke care. [ABSTRACT FROM AUTHOR]

Health promotion (HP) amongst older people is an increasingly prominent policy concern for governments. The development of an evidence-base and the advocacy of effective interventions in the light of this act as legitimation tools for the overall HP phenomenon – assisting the growth of state and non-state funding for public health initiatives for older people. In structuring decision-making as to which individual projects/initiatives receive funding, frameworks for acknowledging efficacy impact on formats of HP work both positively and negatively. Drawing on recent research across the EU and focusing on the specific national contexts of Austria and England, this comparative policy analysis triangulates best-practice modelling, evaluation data and interviews with project coordinators to explore how policy contexts impact on the nature and format of HP interventions. Amidst a developing awareness of what effective practice looks like, successful HP initiatives must advocate their legitimacy within narrow rules of quality, where measurable outcomes have become the keys which unlock financial resources. Findings across both countries suggest that this instrumentalisation of legitimation, driven by economic pressures and bureaucratic generalisability, threatens the rationality of HP. From a Habermasian perspective, tensions emerge between projects’ remaining reflexive towards processes and their need to articulate the ‘success’ of the interventions in a language of outcomes. Over time, in an era where resources are increasingly scarce and competition over these intensifies, a danger exists whereby the instrumentality of HP begins to separate from, and impinge upon, the capacity for projects to think and act holistically. [ABSTRACT FROM PUBLISHER]

Introduction and hypothesis: A presumed high failure rate of conventional procedures for prolapse has been part of the rationale for new surgical approaches. The aim of the present retrospective cohort study was to estimate the reoperation rate for prolapse within 10 years of primary surgery for prolapse. Methods: We identified all patients who underwent primary surgery for prolapse at four large regional centers in Austria in 1997 and 1998. Hospital databases were searched to determine whether patients had been reoperated for prolapse through 2008. Results: A total of 456 patients underwent a primary operation for prolapse in 1997 and 1998. The most common primary operation was vaginal hysterectomy with colporrhaphy (89 %). We identified 13 reoperations for prolapse, for a 10-year reoperation rate of (at least) 2.9 %. The median interval between primary and secondary surgery was 5.5 years (range 1.5-10 years). Conclusion: The reoperation rate for prolapse after primary vaginal hysterectomy and colporrhaphy appears to be modest in this series of patients. [ABSTRACT FROM AUTHOR]