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Purpose: This article investigates the establishment of commitment in pedagogical practices through what are known as 'behavioural contracts'. Such contracts are seen as a participatory element of democratic pedagogy and are linked to the aim of strengthening students' self-determination. The objective is to demonstrate that as a pedagogical phenomenon, contractual pedagogy is oriented towards a practice of self-control achieved through external control, assuming a basis of sovereignty and reason. Methodology: The article provides an investigation of material from an ethnographic research project in Germany on social learning in school-based pedagogical contexts. The study is informed by practice theory, theory of school and theory of social pedagogics. Findings: This article argues that contractual pedagogy as a subjectivising constellation is primarily directed towards re-establishing the pre-existing institutional order. It demonstrates that contractual pedagogy can neither be understood as a particularly participatory method of democratic pedagogy, nor as a governmental power strategy, but as a subjectivising exercise that introduces students to a central tenet in modern societies. Through this, connections are formed between specific forms of (collective) subjectivation. Research implications: Further theoretical and empirical analyses are required, which make other pedagogical impulses, such as an ethics of care or the critique of the subject, fruitful for Democratic Pedagogy.

This paper presents a study on remote learning of primary school children during the first school closures that were imposed in Germany in response to the COVID-19 pandemic in spring 2020. Data were collected at a primary school covering learners from age 6-12 and include a comprehensive survey amongst parents (n=69) as well as interviews with learners (n=17). Employing a mixed-methods approach, we first analyse the parent-survey's quantitative dataset. The analyses demonstrate that using modern technology for teaching and for communication between teachers and learners positively impact learners' motivation and well-being. Multivariate statistics show that teacher-learner contact frequency as well as teaching-learning transparency are predictive towards learner well-being. The subsequent analysis of interview data helps to gain a more nuanced picture on learners' experiences and well-being. Analyses show that learners experience multifaceted worries and concerns, and that one of the most substantial challenges of remote learning lies in a perceived change of teacher expectations. Based on the analyses of both datasets, it is argued that the contact frequency and quality, the proficient use of up-to-date technology, as well as transparency of teachers' expectations positively influence learners' well-being, and that thus, contact quality and transparency can counteract children's worries and concerns.

Purpose: Class council has become a popular approach for character education and democracy learning in German schools. However, it is not clear if the expectations are met in social practice. Approach: The data was gained with an ethnographical multiple method approach within three contrasting secondary schools. The study is informed by practice theory, theory of school and theory of social pedagogics. Findings: Logics of the school and logics of social pedagogy clash in class council. Opportunities for a democratic and social pedagogically framed school are inevitably limited. Class council focusses more on personal development and character education and much less on political or democratic education. Certain forms of class council subtly aim at student's approval of undemocratic practices; therefore, class council sometimes camouflages a de-politicization of the school. Research Implications: A comparison of democracy learning and character education in different pedagogical institutions is recommended for further research. The methodology of reconstructing logics of school and logics of social pedagogy from a practice theoretical and ethnographical perspective should be elaborated. Practical implications: Teachers need reflective competencies in order to recognize the limitations of participation in practice. While aiming at the ideal of the mature, civically engaged and socially competent citizen, the limitations of participation and the responsibilities of societal institutions like schools should be made subject of learning, as well.

Lexical development of bilingual children is influenced by a number of input factors. In the present study, early lexical skills of 25-month old children growing up with Turkish and German were assessed. Parents of 92 children filled out a newly developed list for productive Turkish vocabulary, as well as a vocabulary list for German. A parental questionnaire served to examine the quality and quantity of familial and extra-familial language input. The results showed that children who grow up in a predominantly Turkish-speaking environment subsequently have a larger Turkish vocabulary than German vocabulary. More German input within the family was shown to lead to higher vocabulary scores, but not to a reduction of Turkish vocabulary at this age. Factors predicting vocabulary in both languages included parental language quality and quantity, as well as the number of available books and childcare.

Lexical development in first language (L1) Turkish and second language (L2) German in two- to three-year-old children was examined, using parental vocabulary checklists in Turkish and in German. Children showed strong Turkish dominance in the number of lexical items they produced, which was due to the more frequent exposure to Turkish and higher quality of the input. Their vocabulary in Turkish and German comprised a largely different conceptual make-up, as evidenced by a high conceptual count of items across languages. Translation equivalents made up around 10% of the Total Vocabulary. An exemplary analysis of six noun categories showed that the more domestically oriented categories (Furniture, People) were represented more strongly in Turkish vocabularies, while the Food and Drink category contributed equally to both languages. In Turkish, 18% of words were verbs, whereas in German, verbs constituted only 7% of the children's vocabularies. A comparison between the parent checklists TIGE (developed for Turkish monolingual children in Turkey) and TILDA (developed for Turkish children growing up in Germany) revealed conceptual differences, which can be attributed to culture-specific developments and use of specific lexical items in the two countries. Therefore, language- and culture-specific instruments should be used to assess early vocabulary skills.

Purpose: Risk scores for community-acquired pneumonia (CAP) are widely used for standardized assessment in immunocompetent patients and to identify patients at risk for severe pneumonia and death. In immunocompromised patients, the prognostic value of pneumonia-specific risk scores seems to be reduced, but evidence is limited. The value of different pneumonia risk scores in kidney transplant recipients (KTR) is not known. Methods: Therefore, we retrospectively analyzed 310 first CAP episodes after kidney transplantation in 310 KTR. We assessed clinical outcomes and validated eight different risk scores (CRB-65, CURB-65, DS-CRB-65, qSOFA, SOFA, PSI, IDSA/ATS minor criteria, NEWS-2) for the prognosis of severe pneumonia and in-hospital mortality. Risk scores were assessed up to 48 h after admission, but always before an endpoint occurred. Multiple imputation was performed to handle missing values. Results: In total, 16 out of 310 patients (5.2%) died, and 48 (15.5%) developed severe pneumonia. Based on ROC analysis, sequential organ failure assessment (SOFA) and national early warning score 2 (NEWS-2) performed best, predicting severe pneumonia with AUC of 0.823 (0.747–0.880) and 0.784 (0.691–0.855), respectively. Conclusion: SOFA and NEWS-2 are best suited to identify KTR at risk for the development of severe CAP. In contrast to immunocompetent patients, CRB-65 should not be used to guide outpatient treatment in KTR, since there is a 7% risk for the development of severe pneumonia even in patients with a score of zero. [ABSTRACT FROM AUTHOR]

Purpose: Despite the need to generate valid and reliable estimates of protection levels against SARS-CoV-2 infection and severe course of COVID-19 for the German population in summer 2022, there was a lack of systematically collected population-based data allowing for the assessment of the protection level in real time. Methods: In the IMMUNEBRIDGE project, we harmonised data and biosamples for nine population-/hospital-based studies (total number of participants n = 33,637) to provide estimates for protection levels against SARS-CoV-2 infection and severe COVID-19 between June and November 2022. Based on evidence synthesis, we formed a combined endpoint of protection levels based on the number of self-reported infections/vaccinations in combination with nucleocapsid/spike antibody responses ("confirmed exposures"). Four confirmed exposures represented the highest protection level, and no exposure represented the lowest. Results: Most participants were seropositive against the spike antigen; 37% of the participants ≥ 79 years had less than four confirmed exposures (highest level of protection) and 5% less than three. In the subgroup of participants with comorbidities, 46–56% had less than four confirmed exposures. We found major heterogeneity across federal states, with 4–28% of participants having less than three confirmed exposures. Conclusion: Using serological analyses, literature synthesis and infection dynamics during the survey period, we observed moderate to high levels of protection against severe COVID-19, whereas the protection against SARS-CoV-2 infection was low across all age groups. We found relevant protection gaps in the oldest age group and amongst individuals with comorbidities, indicating a need for additional protective measures in these groups. [ABSTRACT FROM AUTHOR]

This article presents findings from a research project carried out in Germany that looked at practices of and with boys in various educational settings, ranging from early childhood education to young adult vocational education. We refer to "practices of and with boys" in order to grasp the complex dynamics of gender in boys' lives and to avoid the problems associated with calling these practices "masculinities," as is done in most research on boyhood. We present a model that aims to recognize both the (re-)production and the critique and subversion of gender norms and gender inequalities in practices of and with boys. Furthermore, we discuss findings related to practices of and with boys in educational institutions throughout childhood and youth, reflecting on the intersection of institution, age, and gender. [ABSTRACT FROM AUTHOR]

Copyright of Bewährungshilfe is the property of Forum Verlag Godesberg GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Focuses on the quantum atomic model Electronium. Outlines the Bremen teaching approach in which this model is used, and analyzes the learning of two students as they progress through the teaching unit. (Author/MM)

Background: Early during the SARS-CoV-2 pandemic, national population-based seroprevalence surveys were conducted in some countries; however, this was not done in Germany. In particular, no seroprevalence surveys were planned for the summer of 2022. In the context of the IMMUNE-BRIDGE project, the GUIDE study was carried out to estimate seroprevalence on the national and regional levels. Methods: To obtain an overview of the population-wide immunity against SARS-CoV-2 among adults in Germany that would be as statistically robust as possible, serological tests were carried out using self-sampling dried blood spot cards in conjunction with surveys, one by telephone and one online. Blood samples were analyzed for the presence of antibodies to the S and N antigens of SARS-CoV-2. Results: Among the 15 932 participants, antibodies to the S antigen were detected in 95.7%, and to the N antigen in 44.4%. In the higher-risk age groups of persons aged 65 and above and persons aged 80 and above, anti-S antibodies were found in 97,4% and 98.8%, respectively. Distinct regional differences in the distribution of anti-S and anti-N antibodies emerged. Immunity gaps were found both regionally and in particular subgroups of the population. High anti-N antibody levels were especially common in eastern German states, and high anti-S antibody levels in western German states. Conclusion: These findings indicate that a large percentage of the adult German population has formed antibodies against the SARS-CoV-2 virus. This will markedly lower the probability of an overburdening of the health care system by hospitalization and high occupancy of intensive care units due to future SARS-CoV-2 waves, depending on the viral characteristics of then prevailing variants. [ABSTRACT FROM AUTHOR]

Copyright of Zeitschrift für Psychosomatische Medizin und Psychotherapie is the property of Vandenhoeck & Ruprecht GmbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Obesity in the recipient is linked to inferior transplant outcome. Consequently, access to kidney transplantation (KT) is often restricted by body mass index (BMI) thresholds. Bariatric surgery (BS) has been established as a superior treatment for obesity compared to conservative measures, but it is unclear whether it is beneficial for patients on the waiting list. Methods: A national survey consisting of 16 questions was sent to all heads of German KT centers. Current situation of KT candidates with obesity and the status of BS were queried. Results: Center response rate was 100%. Obesity in KT candidates was considered an important issue (96.1%; n = 49/51) and 68.6% (n = 35/51) of departments responded to use absolute BMI thresholds for KT waiting list access with ≥ 35 kg/m2 (45.1%; n = 23/51) as the most common threshold. BS was considered an appropriate weight loss therapy (92.2%; n = 47/51), in particular before KT (88.2%; n = 45/51). Sleeve gastrectomy was the most favored procedure (77.1%; n = 37/51). Twenty-one (41.2%) departments responded to evaluate KT candidates with obesity by default but only 11 (21.6%) had experience with ≥ n = 5 transplants after BS. Concerns against BS were malabsorption of immunosuppressive therapy (39.2%; n = 20/51), perioperative morbidity (17.6%; n = 9/51), and malnutrition (13.7%; n = 7/51). Conclusions: Obesity is potentially limiting access for KT. Despite commonly used BMI limits, only few German centers consider BS for obesity treatment in KT candidates by default. A national multicenter study is desired by nearly all heads of German transplant centers to prospectively assess the potentials, risks, and safety of BS in KT waitlisted patients. [ABSTRACT FROM AUTHOR]

As digital media becomes more central to the lives of adolescents, it also becomes increasingly relevant for their sexual communication. Sexting as an important image-based digital medium provides opportunities for self-determined digital communication, but also carries specific risks for boundary violations. Accordingly, sexting is understood either as an everyday, or as risky and deviant behavior among adolescents. In the affectedness of boundary violations gender plays an important role. However, it is still unclear to what extent digital sexual communication restores stereotypical gender roles and restrictive sexuality norms or, alternatively, enables new spaces of possibility. In this sense, current research points to a desideratum regarding adolescents' orientations toward sexting as a practice between spaces of possibility and boundary violations. This paper discusses the possibilities, but also the risks, of intimate digital communication among adolescents. The main question is, how adolescents themselves perceive sexting practices and how they position themselves between both spaces for possibility and for the exchange of unwanted sexual content. For this purpose, orientations toward normalities and gender of students are reconstructed. To answer these questions, twelve single-sex, group discussions were carried out with students aged 16 and 17 at five different secondary schools in northern Germany. A total of 20 boys and 22 girls took part. The group discussions were structured by a narrative generating guideline. The analysis draws its methodology from the Documentary Method, regarding implicit and explicit forms of knowledge and discourse. It results in a typology of three types with different orientations. The study shows, that most of the students consider sexting to be a risky practice; only one type shows normality in the use of sexting. At the same time, some of the young people are interested in experimenting with image-based intimate digital communication. Further, gender differences in use and affectedness are also documented. In this way, orientations toward gender stereotypes "favor" both the attribution of responsibility to girls, and overlook the responsibility of students who perpetrated the boundary violation. The orientations of adolescents should be taken more into account in research as well as in educational programs for the prevention of sexual violence. [ABSTRACT FROM AUTHOR]

Background Renal transplant recipients have an increased cancer risk. The mammalian target of rapamycin inhibitor sirolimus (SRL) has immunosuppressive and antitumour activities but knowledge about its use in recipients with cancer is limited. Methods We retrospectively analysed 726 renal allograft recipients converted to SRL from 10 German transplant centres. Patient and graft survival were analysed depending on malignancy status prior to conversion and tumour entity. Results Malignancy before conversion to SRL was reported in 230 patients, with 137 patients having skin cancers and 101 having solid cancers. Cancer occurred 4.6 ± 9.4 (median 3.0) years after transplantation. Basal cell carcinoma, squamous cell carcinoma and Bowen's disease were the most prevalent skin cancers, while carcinomas of the kidney, colon and breast were the most prevalent solid cancers before conversion. Patients with prior malignancy were older and had better renal function at conversion compared with patients without a history of cancer. After conversion to SRL, cancer incidence rates (IRs) of all tumours were lower compared with rates before conversion. Cancer IRs after conversion were higher in patients with malignancy before conversion compared with those without. Patient survival was worse in patients with solid cancers compared with patients with skin cancers or without malignancies. Biopsy-proven acute rejections in the first year after conversion were less frequent in patients with malignancy compared with those without. Graft survival and renal function in all cancer types were better than in patients converted to SRL without cancers. Conclusions Conversion to SRL in patients with a history of cancer is safe regarding renal function and graft survival, while patient survival is largely dependent on tumour entity. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of physical activity (PA) as an intervention against anxiety disorders and depression is undeniable in clinical psychology. Therefore, the question arose whether these effects also occur when a fear stimulus, like the COVID-19 pandemic, affects otherwise healthy adolescents. Boredom is closely linked to symptoms of fear and anxiety, but the connection between PA, boredom and fear is partly unclear. Methods: A cross-sectional online study was conducted that involved 122 students. Participants were 13–19 years old (M age = 15.83, SD = 1.73). The survey was available online from April 27th to May 3rd, 2020. At this time, schools in Germany had already been closed for 6 weeks. A self-report questionnaire was used to measure physical activity, boredom, and fear of COVID-19. A multiple linear regression model was conducted. Results: The reported fear of COVID-19 significantly correlates with total PA, quantity of strenuous PA, and boredom. Furthermore, a significant regression equation was found. The variables boredom, PA, and age contribute significantly to predicting the fear of COVID-19 [ R 2 = 0.127, F (3,118) = 6.876, p < 0.000], among adolescents. Conclusion: Our results indicate that there is an association between PA, boredom and the quarantine experience of adolescents. Students who were physically more active, especially with strenuous intensity, did not feel bored and showed less fear of COVID-19. [ABSTRACT FROM AUTHOR]

A long standing question in urbanisation studies queries whether an empirical regularity known as Zipf's law applies to the size ranking of cities within countries or regions. Part of the debate addresses the statistical attributes of the size distribution. More recently, the definition of the territories assigned to cities has become a matter of concern in this context. Since the shape of administrative boundaries may not represent economic entities, analysis of the size ranking among cities defined by municipal territories may be affected by a considerable modifiable areal unit problem. Following a methodical approach that relates to current research on natural cities, we study the extent to which variation in the territory assigned to urban areas in Germany affects basic features of the size ranking. We define urban areas according to variable thresholds of population density across 1 km2 grids by a clustering algorithm. We find a systematic but moderate deviation from Zipf's law suggesting scale economies among urban agglomerations if peripheral zones are included. [ABSTRACT FROM AUTHOR]

Abstract: Working requirements of community mental healthcare professionals in integrated care are complex. There is a lack of research concerning the relation of job satisfaction, working atmosphere and individual characteristics. For the current study, a survey evaluating job satisfaction and working atmosphere of mental healthcare professionals in integrated care was performed. About 321 community mental healthcare professionals were included in the survey; the response rate was 59.5%. The professional background of community mental healthcare professionals included nursing, social work and psychology. Community mental healthcare professionals reported the highest satisfaction with colleagues and the lowest satisfaction with income. Moreover, it could be shown that more responsibility, more recognition and more variety in job tasks lead to an increase of overall job satisfaction. Healthcare for mentally ill patients in the community setting is complex and requires well‐structured care with appropriate responsibilities within the team. A co‐operative relationship among colleagues as well as clearly defined responsibilities seem to be the key for the job satisfaction of community mental healthcare professionals in integrated care. [ABSTRACT FROM AUTHOR]

Objective: Ovarian cysts are a common finding in reproductive-aged females. Most of them are functional cysts that typically resolve spontaneously and require no treatment. However, ovarian cysts may also be adverse events associated with inhibitors of the mammalian target of rapamycin (mTOR). Both approved mTOR inhibitors everolimus and sirolimus are widely used as immunosuppressive agents after organ transplantation. The aim of this study was to compare the effect of mTOR inhibitors vs. non-mTOR inhibitor immunosuppression on the incidence, size and complication rate of ovarian cysts in renal transplant recipients. Material and Methods: We retrospectively analysed 571 consecutive female kidney transplant patients in our centre between 2000 and 2008. The follow-up period was extended through December 31st, 2012. Results: 102 (17.8%) patients receivedmTORinhibitors for at least one month after transplantation.Weidentified 44 women (7.7%) with new ovarian cysts. Ovarian cysts were significantly more frequent among patients receiving mTOR inhibitors (20.5%) than in the control group (4.9%; p < 0.001). Also the hospitalization rate was higher (p = 0.05) in the mTOR group and ten patients (47.6%) requiring surgery. Conclusion: Future prospective studies are required to determine the underlying cause of ovarian toxicity and treatment strategies have to be developed in order to avoid severe complications. [ABSTRACT FROM AUTHOR]

Abstract: This study assessed adherence to prolonged‐release tacrolimus (PR‐T)‐based immunosuppression during routine maintenance of renal transplant recipients in Germany. Patients had received PR‐T for ≥1 month at inclusion. Data were collected during four visits (V): baseline (V1), 6 (V2), 12 (V3), and 18 (V4) months. Composite primary endpoint: nonadherence at V4, defined as self‐reported nonadherence on the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS©), investigator‐rated nonadherence, and/or V4 tacrolimus trough level outside a predefined range. Secondary endpoints: individual BAASIS items, incidence of rejection, kidney function, and safety. Overall, 153 adult kidney recipients (mean [standard deviation] time post‐transplant 5.8 [4.6] years) were included. Nonadherence was high at V4 (67.7% [95% confidence interval 58.9%, 75.6%]). Medication‐taking adherence was 86.9% and 91.3% at V1 and V4, respectively; adherence to timing of medication intake was 58.2% and 58.3%, with little evidence of missed doses/drug holidays. Investigators rated adherence “good” in 85.6% of patients (V4). Two (1.3%) patients had acute rejection episodes. Kidney function remained stable (mean creatinine clearance, V1: 62.1 mL/min; V4: 65.3 mL/min). Investigators rated effectiveness of PR‐T as “very good”/“good” in 91.5% of patients. Most patients (94.7%) found PR‐T dosing more convenient than immediate‐release tacrolimus. PR‐T was well tolerated with high medication persistence. [ABSTRACT FROM AUTHOR]

Background Rituximab is frequently used in solid organ transplantation off-label, especially in patients with renal allografts. Few data are available on the safety aspects of solid organ transplant recipients receiving rituximab. There is a knowledge gap on long-term follow-up data, in particular on infectious complications. Patients and methods A retrospective observational registry study (German Registry on Autoimmune Diseases) comprising a total of 681 patients was conducted. The data of 63 adult kidney transplant recipients who received rituximab between 2006 and 2013 were used in this analysis. Results Median follow-up was 42 (1–109) months. At least 1 severe infection occurred in 57% of patients. The median time between the first rituximab infusion and the first infection was 4 (1–48) months. Of the overall 88 infections, 74 were severe bacterial infections, 5 were severe viral infections, 3 were severe fungal infections, 2 were combined severe bacterial and fungal infections, and 4 were combined severe viral, fungal and bacterial infections. Seven patients died during the observational period, 2 of them due to infectious complications. In the observational period, 1 case of squamous cell carcinoma but no other malignancies were observed. Conclusion Consistent with previous data, a high incidence of infections was observed after rituximab treatment in kidney transplant recipients. Most infections occurred within 6 months after rituximab initiation. With more than 3 years of follow-up, we were able to document a low incidence of secondary malignancies after rituximab with only 1 case in our cohort. [ABSTRACT FROM AUTHOR]

Background A considerable amount of patients with typical atrial flutter develop atrial fibrillation after cavotricuspid isthmus (CTI) ablation. No uniform recommendations are available to guide anticoagulation regimes or electrocardiogram (ECG) monitoring strategies after this procedure. Methods We conducted a web-based survey in electrophysiology (EP) centers in Germany, Switzerland, and Austria. Responses were received from 47 centers. The survey was designed to investigate variations in management of the following: ablation strategy, oral anticoagulation (OAC) management, and ECG monitoring after successful CTI ablation. Results More than 55% of the participating centers assume that at least every third patient will develop atrial fibrillation during follow-up. Despite this assumption, most EP experts (81%) would still stop OAC after CTI ablation even in patients with higher CHADS2-VA2SC-score, or even perform CTI in asymptomatic patients with the purpose to stop OAC (52%). Most experts agree that ECG monitoring is necessary during follow-up. A majority still rely on short-term monitoring tools like resting ECGs (7%) or Holter ECGs (43%), while continuous monitoring by implantable loop recorders (10%) are rarely used for postablation OAC management. Conclusion A majority of the centers stop OAC in patients with higher CHADS2-VA2SC-score after CTI ablation. There is evidence that this practice might not be safe and lead to an increased number of ischemic strokes during follow-up. This reflects the need for prospective studies to allow for clear guidelines regarding these issues. [ABSTRACT FROM AUTHOR]

• Fagus orientalis was introduced to a northern German forest stand ca. 100 years ago. • F. orientalis hybridizes with autochthonous F. sylvatica in the introduced range. • Both species can act as pollen and seed parent. • The necessity and suitability for assisted gene flow management should carefully be evaluated. Fagus sylvatica L., one of the most common Central European deciduous tree species, is one of the species globally suffering from changing and stressful environmental conditions. It has shown symptoms of crown damage, a reduction in growth and increased mortality following recent severe droughts. Fagus orientalis Lipsky, a closely related species with higher drought tolerance, originates from southeastern Europe, Turkey, the Greater Caucasus region, and the Hyrcanian forest. For Germany, F. orientalis has been proposed as an alternative to F. sylvatica by translocation of pre-adapted planting material as a tool to mitigate negative effects of climate change in certain locations. This approach can be beneficial but might also harbor risks. We studied admixtures between the two beech species and the direction of gene flow, taking advantage of F. orientalis trees planted over 100 years ago in the forest district of Memsen, Germany. Additionally, we used a range-wide dataset of F. sylvatica and F. orientalis provenances to determine the origin of the introduced trees. Using a combination of nuclear microsatellites and one chloroplast marker with species-specific variants, we showed that interspecific gene flow was going in both directions. In most cases, F. sylvatica was the pollen donor, likely due to its greater abundance and production of vast amounts of pollen. The planted trees from Memsen originated from the Greater Caucasus region and showed strong genetic divergence from German F. sylvatica populations, clearly differing in leaf morphological traits. In the future, the suitability of different provenances for the mitigation of climate change impacts should be carefully assessed by testing gene flow patterns as well as hybrid performance in additional stands and in comparison to F. sylvatica provenances from southern Europe. [ABSTRACT FROM AUTHOR]

Background: After total knee replacement, overall blood loss is often underestimated, although it exceeds the visible blood loss caused by bleeding into the tissues or into the joint. The use of fibrin sealants during surgery has been suggested to reduce perioperative blood loss and transfusion rates and may be beneficial for patient recovery and the postoperative function of the joint.Methods/design: This will be a single-centre, single-blinded, randomised controlled trial with a parallel design, for which 68 patients undergoing total knee replacement will be recruited and followed up at 3, 6 and 12 months; 34 will be control patients who will receive the standard orthopaedic surgery treatment (electrocoagulation), and the other 34 will receive the same treatment plus 5 ml EVICEL™ applied during surgery and used according to the manufacturer's instructions. The primary objective is to test the null hypothesis that the effect of EVICEL™ for controlling haemostasis and reducing postoperative blood loss in patients undergoing total knee replacement is not superior to the use of electrocoagulation alone. The secondary objective is to show that EVICEL™ reduces the need for transfusion, increases range of motion, improves clinical outcome and wound healing, and reduces the need for analgesics. The tertiary objective is to show that EVICEL™ reduces the costs of total knee replacement treatment.Discussion: So far, studies on the effect of fibrin sealants in total knee replacement have delivered inconsistent and ambivalent results, indicating that there is still a need for high-evidence studies as proposed in the presented study protocol.Trial Registration: German registration number DRKS00007564; date of registration: 26 November 2014. [ABSTRACT FROM AUTHOR]

Background: Trimethoprim/sulfamethoxazole (TMP/SMX) is considered first-line therapy for pneumocystis jiroveci pneumonia (PCP) in renal transplant patients. Alternatives have not been formally studied. Clindamycin-primaquine (C-P) is effective in HIV-associated PCP, but data in renal transplant patients are lacking. Patients and methods: Retrospective cohort study of 57 consecutive renal transplant patients who developed PCP and were treated with C-P ( n = 23) or TMP/SMX ( n = 34). Results: A non-significantly higher failure rate was observed in patients on C-P due to lack of efficacy (30.4 versus 20.6 %, p = 0.545). The difference was more pronounced in severe PCP (60 versus 37.5 %, p = 0.611) and a significantly lower efficacy of C-P was seen when used as salvage therapy. The two patients who had received C-P after not responding to TMP/SMX failed this regimen, but all seven patients who had failed initial treatment with C-P and had been switched to TMP/SMX were cured ( p = 0.028). No treatment-limiting adverse reactions were reported for patients on C-P while six patients (17.6 %) on TMP/SMX developed possibly related treatment-limiting toxicity ( p = 0.071). However, in only two patients adverse events were definitely related to TMP/SMX (5.9 %). Conclusions: Clindamycin-primaquine appears to be safe and well tolerated for treating PCP in renal transplant patients but is probably less effective than TMP/SMX, the standard regimen. However, our data indicates that C-P represents an acceptable alternative for patients with contraindications or treatment emergent toxicities during TMP/SMX use. Notably, TMP/SMX was also acceptably tolerated in most patients. TMP/SMX remains an effective salvage regimen in case of C-P failure. [ABSTRACT FROM AUTHOR]

Aim To investigate the association between periodontal disease severity and cardiorespiratory fitness ( CRF) in a cross-sectional study of sedentary men. Materials & Methods Seventy-two healthy men (45-65 years) who did not join any sport activity and had a preferentially sitting working position were recruited. Periodontal status was recorded and CRF was measured by peak oxygen uptake ( V O2peak) during exercise testing on a cycle ergometer. Physical activity was assessed by a validated questionnaire and data were transformed to metabolic equivalent of task scores. Univariate and multivariate regression analyses were performed to investigate associations. Results Differences between V O2peak levels in subjects with no or mild, moderate or severe periodontitis were statistically significant ( p = 0.026). Individuals with low V O2peak values showed high BMI scores, high concentrations of high-sensitive C-reactive protein, low levels of high-density lipoprotein-cholesterol, and used more glucocorticoids compared to individuals with high V O2peak levels. Multivariate regression analysis showed that high age ( p = 0.090), high BMI scores ( p < 0.001), low levels of physical activity ( p = 0.031) and moderate ( p = 0.087), respectively, severe periodontitis ( p = 0.033) were significantly associated with low V O2peak levels. Conclusions This study demonstrated that moderate and severe periodontitis were independently associated with low levels of CRF in sedentary men aged between 45 and 65 years. [ABSTRACT FROM AUTHOR]

The article discusses the role of the RWI, a research institute in collecting multitude of data for scientific community in Germany. It mentions the basic goal of the FDZ Ruhr, a research data center is provide external researchers access to data collected by the RWI within the research project. It also outlines the planned developments towards the availability of research data.

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Background: Autosomal dominant polycystic kidney disease (ADPKD) is a slowly progressive hereditary disorder that usually leads to end-stage renal disease. Although the underlying gene mutations were identified several years ago, efficacious therapy to curtail cyst growth and prevent renal failure is not available. Experimental and observational studies suggest that the mammalian target of rapamycin (mTOR) pathway plays a critical role in cyst growth. Methods: In this 2-year, double-blind trial, we randomly assigned 433 patients with ADPKD to receive either placebo or the mTOR inhibitor everolimus. The primary outcome was the change in total kidney volume, as measured on magnetic resonance imaging, at 12 and 24 months. Results: Total kidney volume increased between baseline and 1 year by 102 ml in the everolimus group, versus 157 ml in the placebo group (P=0.02) and between baseline and 2 years by 230 ml and 301 ml, respectively (P=0.06). Cyst volume increased by 76 ml in the everolimus group and 98 ml in the placebo group after 1 year (P=0.27) and by 181 ml and 215 ml, respectively, after 2 years (P=0.28). Parenchymal volume increased by 26 ml in the everolimus group and 62 ml in the placebo group after 1 year (P=0.003) and by 56 ml and 93 ml, respectively, after 2 years (P=0.11). The mean decrement in the estimated glomerular filtration rate after 24 months was 8.9 ml per minute per 1.73 m2 of body-surface area in the everolimus group versus 7.7 ml per minute in the placebo group (P=0.15). Drug-specific adverse events were more common in the everolimus group; the rate of infection was similar in the two groups. Conclusions: Within the 2-year study period, as compared with placebo, everolimus slowed the increase in total kidney volume of patients with ADPKD but did not slow the progression of renal impairment. (Funded by Novartis; EudraCT number, 2006-001485-16; ClinicalTrials.gov number, NCT00414440.) N Engl J Med 2010;363:830-40. [ABSTRACT FROM AUTHOR]

This article discusses strategies of constructing masculinity among German school boys and shows the close interrelation of social status, social and symbolic value, and the success or failure of playing with male gender orders. It highlights the important role of the body in these processes. Based on data from ethnographical research the article shows that the body is an actor as well as target in the subordination strategies, which often includes the feminisation of other boys. [ABSTRACT FROM AUTHOR]

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Ultrasound (US) imaging is an important diagnostic tool following renal transplantation. Unfortunately, due to the heterogeneity of the recipients and their multimorbidity, imaging procedures in the early phase after kidney transplantation are difficult and of limited use. We performed a study to evaluate the use of a contrast enhancer for US examination as a standardized method in the follow-up of kidney transplant recipients.The study included 40 recipients: 32 were examined on the 5th to 7th day following transplantation and 8 patients at the time when clinically suspicious findings occurred (acute rejection, tumor, acute tubular necrosis). Following the intravenous application of the contrast medium, pictures were taken during the arterial and parenchymatous phase and compared with conventional B-mode and power Doppler pictures of the same visual plane. Three examiners assessed different parameters of the transplant organ (max. vascularized area, suspected hematomas, tumors, rejection, acute tubular necrosis). Findings were confirmed by histological results of a biopsy if rejection, tumor, or acute tubular necrosis were suspected. Application of ultrasound contrast medium significantly increased visualization of the vascularized kidney area. Also, US findings in the follow-up after acute rejection therapy corresponded with the clinical course; 19 hematomas could be detected with contrast medium compared to only 9 without. With contrast medium a perfusion deficit was detectable in three patients compared to one patient with power Doppler US. Also, US contrast medium helped to detect tumor vascularization in two patients in whom conventional sonography suspected no abnormality. Ultrasound contrast medium enhancement is a reproducible, reliable, and easy to apply method which is superior to conventional sonography in the follow-up after kidney transplantation. This method is also helpful to detect and control acute rejections and to better visualize hematomas, deficits of perfusion, and tumors. [ABSTRACT FROM AUTHOR]

Ten years ago the first laparoscopic living donor nephrectomy (LDN) was performed. Today, LDN is a routine operation in many US-American transplantation centers and an increasing number of centers in Europe are practicing LDN. In this article the different aspects of LDN for donor, kidney, recipient and operating surgeon are evaluated. We performed a literature research concerning LDN and the different aspects. Our own experience, as the largest LDN center in Germany, is part of the evaluation. Laparoscopic extraction of a kidney from a living donor is as safe for the donor as the open approach. At the same time, LDN offers multiple advantages like reduced pain and shorter convalescence. For the donated kidney and the recipient no disadvantages occur from the laparoscopic technique, as long as special intra- and perioperative demands are met. For the operating surgeon multiple developments have expanded the technical armentarium. LDN is safe for donor, recipient and kidney. Central issue of an optimal LDN is sufficient experience with laparoscopic urological techniques. [ABSTRACT FROM AUTHOR]

The interpretative figure of the German Sonderweg has had a varied history. In the nineteenth century, those who spoke of a separate German path to modernity evaluated it as a positive divergence from the "western path", citing the strong bureaucratic state, reforms initiated from above, the Prussian service ethos, "German culture" and the early development of a social welfare state. However, representatives of the first generation of postwar West German historians recast this reading in a negative frame. They viewed the particularities of German history, its structures and experiences, as preconditions that, while not leading directly to National Socialism, did in the long term hamper the development of a liberal democracy in Germany and facilitate the rise of fascism. In this version, the interpretative figure of the German Sonderweg called for a critical stance, but also for a critical review of its associated hypotheses. The Sonderweg paradigm has provided the impetus for at least three strands of research in German historiography: the "long nineteenth century", the history of the bourgeoisie, and comparisons with the West. Yet these have also pointed up the limits of the paradigm's usefulness. Increased attention to cultural dimensions and to comparative and relational history is currently raising different questions -- questions concerned less with "separate" paths than with shared and intertwining ones. The growing temporal distance from National Socialism, together with awareness of a multiply interconnected, cross-European history, has diluted the persuasive force of the Sonderweg thesis and, above all, its orientation on the West. This is not to say, however, that its core concern -- the causes of National Socialism -- has receded into the background. [ABSTRACT FROM AUTHOR]

To evaluate the outcomes of kidney transplantations (KTs) in the Eurotransplant Senior Program (ESP) with a focus on the very old, defined as recipients ≥75 years. This retrospective clinical study included 85 patients, who under the ESP protocol underwent deceased donor kidney transplantation from January 2010 to July 2018 at the Charité–Universitätsmedizin Berlin in Germany. Recipients were divided in three age groups, i.e., Group 65–69, Group 70–74, Group ≥75, and compared. Prognostic risk factors for short and long-term outcomes of kidney transplantations were investigated. Graft survival at 1 and 5 years were respectively 90.7% and 68.0% for group 65–69, 88.9% and 76.2% for Group 70–74, and 100% and 71.4% for Group ≥75. Patient survival at 1 and 5 years were respectively 92.9% and 68.0% for Group 65–69, 85.7% and 61.5% for Group 70–74 and 100% and 62.5% for Group ≥75. Serum creatinine did not significantly differ between the three groups, with the exception of serum creatinine at 1 year. Increased recipient age and prolonged time on dialysis correlated with increased occurrence of postoperative complication. An increase in BMI, pretransplant diabetes mellitus and prolonged time on dialysis correlated with the occurrence of delayed graft function (DGF). History of smoking was identified as an independent risk factor for events of rejection. Increased human leukocyte antigen mismatches (HLA-MM) and prolonged cold ischemia time (CIT) correlated with higher rates of intensive care unit (ICU) treatment. This study supports kidney transplantations for the very old. End-stage renal disease (ESRD) patients ≥75 years of age who underwent kidney transplantation experienced comparable results to their younger counterparts. A comprehensive evaluation of ESRD patients with consideration of prognostic risk factor is the most suitable mean of identifying adequate kidney transplant candidates. [ABSTRACT FROM AUTHOR]

The German political center is often viewed as democratic and moderate, untouched by right-wing outsiders. Evident rightwing terrorism was often treated as a peripheral phenomenon. In 2015, the peak of the refugee movement constituted a challenge for that German political center and was vividly discussed in the media. Expressions such as ‘‘refugee wave’’ or ‘‘crisis’’ dominated the public discussion. These expressions could spur on Othering processes because not only do these expressions carry a negative valence, but they also put a spotlight on categorial ascriptions. Between 2014 and 2018, attacks on refugee shelters in Germany multiplied by five, and votes for right-wing populist parties rose in Europe. The center studies are representative studies that regularly assess rightwing attitudes in the German political center since 2006. In a re-analysis, we investigated attitudes towards refugees in specific. From three studies, run in 2014, 2016, and 2018/19 (total N= 6,021), relevant questions and questionnaires were identified via word stem search. Fourteen scales were deemed as relevant for attitudes towards refugees, including attitudes towards migration and perceived sayability, group-focused enmity, social dominance orientation, and right-wing authoritarianism. Correlations between the participants’ self-categorization as German and European with rejecting attitudes toward refugees are discussed. Further, demographic information was used to assess the distribution of (non-)rejecting attitudes towards refugees depending on region, income, and education. The development of these attitudes and their correlations with other attitudes will be presented. Whilst manifest right-wing attitudes are rare in the German center, aspects of rejection of refugees are shared by up to a third of the participants. Implications for Othering as an iterative process will be discussed. [ABSTRACT FROM AUTHOR]

Psychiatric illnesses such as bipolar disorder, schizophrenia and schizoaffective disorder are severe, disabling disorders associated with decreased Quality Of Life (QOL) and functioning. Stigmatization, co-morbidities, adverse effects of medications and chronic symptoms due to treatment resistance are factors responsible for this association. In this study, we aim to characterize patients with good and poor outcomes according to QOL and functioning scores. Using cluster analysis, we sought to identify longitudinal trajectories and investigate whether levels of QOL and functioning are associated with polygenic risk scores. Determining clusters of patients at higher risk of poorer outcomes is critical to provide early and effective interventions. Longitudinal data was used from the Clinical Research Group 241 and PsyCourse studies in Germany. Participants were phenotyped using a comprehensive battery which included data on socio-demographics, history of illness, symptomatology, QOL and functioning. Data was collected at four equidistant time points over 18 months. The Infinium Psycharray from Illumina was used to genotype patients. The QOL and functioning domain was represented by 28 longitudinally measures items (WHOQOL-BREF; GAF; work status). Dimension reduction of the 28 items by means of Factor Analysis for Mixed Data (FAMD) was applied. This allowed for the computation of abstract data dimensions which were used for calculation of longitudinal trajectories. These trajectories are a representation of the overall status of patients and both the overall level as well as the longitudinal change of this status were used as inputs for k-mean clustering of longitudinal data. This, in turn, resulted in the identification of three distinct subpopulations of patients. A multinomial regression of cluster membership on schizophrenia Polygenic Risk Scores (PRS) (11 p-value thresholds) was performed. Individual trajectories across time on nine dimensions were used for cluster analysis. Together, these dimensions explained 27.13% of variance in the data. These dimensions were mainly driven by QOL items. In a sample of 254 patients, three clusters were observed; cluster A (63%) consisted of participants with the highest average scores for functioning, cluster B (33%) and cluster C (4%) consisting of participants with lower functioning over the course of the longitudinal study. A significantly higher proportion of individuals in cluster B were hospitalized at baseline in comparison to cluster A. Furthermore, individuals in cluster A had a significantly higher GAF score at baseline than those individuals in cluster B. No significant differences were seen for age, center, diagnosis, sex, work status, or duration of illness between the clusters. A nominally significant effect of SZ-PRS on cluster membership was observed from the threshold 0.2 on, however this did not survive FDR correction. In terms of cluster membership, the highest polygenic risk loading was observed for cluster B and the lowest for cluster C. Phenotypic data provides insight to target sufferers of severe mental illness with worse outcomes. Further work is needed to improve methods to deal with missing data and increase sample size. Associations with other biological data will be explored (e.g. microRNA; methylation data; proteomics; imaging data). [ABSTRACT FROM AUTHOR]

The article presents a study analyzing the instances of atherosclerosis of the carotid artery and peripheral nerves in male marathon runners. The study was conducted on 100 male healthy runners aged between 50-75 years and measured their extracoronary atherosclerotic plaque burden and its association with coronary atherosclerosis and cardiovascular risk factors. It discusses the results of the study and concludes the high prevalence of carotid and peripheral atherosclerosis in marathon runners and is related to cardiovascular risk factors and the coronary atherosclerotic burden.

The dietary intake of cadmium was studied among children and adults from Germany. The study area comprised the highly industrialized Ruhr district as well as the North Sea island Amrum. A total of 229 duplicate samples were collected from 49 individuals between December 1994 and May 1995. The sampling period for each participant was either 3 or 7 days. Cadmium concentrations in duplicate samples were measured by atomic absorption spectrometry. The daily cadmium intakes (geometric mean) for 4 different groups of individuals distributed as follows: for small children (mean age: 1.8 years) from the Ruhr district 0.17 μg/(kgbw·day) [range: 0.02–1.62 μg/(kgbw·day)], for children (mean age: 3.8 years) from the Ruhr district 0.49 μg/(kgbw·day) [range: 0.11–2.06 μg/(kgbw·day)], for children (mean age: 3.9 years) living on the North Sea island Amrum 0.35 μg/(kgbw·day) [range: 0.09–1.13 μg/(kgbw·day)] and for adults (mean age: 40.9 years) from the Ruhr district 0.37 μg/(kgbw·day) [range: 0.05–1.32 μg/(kgbw·day)]. Compared to the provisional tolerable weekly intake (PTWI) of 7 μg/(kgbw·week) proposed by the WHO the dietary intake of cadmium was rather high. The geometric mean and maximum intake values for the different groups ranged between 24.3–55.7% and 62.7–120.7 respectively of the PTWI. We therefore conclude, that the cadmium exposure of the population needs to be reduced in order to minimize the risk of adverse health effects related to this metal. [Copyright &y& Elsevier]

Work-related medical rehabilitation is a multimodal, interprofessional program that reduces health-related discrepancies between job capacities and demands in order to support work participation of patients who are at an increased risk of failing to return to work (e. g. due to long-term sickness absence). The review outlines screening for patients who should be reached, diagnostics and treatments during work-related medical rehabilitation and evidence on the effectiveness of these programs. Moreover, tools supporting implementation of work-related medical rehabilitation are discussed., Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: ja; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: ja; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein. Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives: Psychosomatic rehabilitation clinics represent an important branch of care with good treatment results in Germany. So far, however, it is largely unclear which processes underlie the treatment successes. In the partial evaluations of the Hersfeld catamnesis study presented here, recourse is made to the construct of mentalizing ability, which has become very important in recent psychotherapy research. Methods: The mentalization ability of a large sample (N = 559) was assessed with the help of the Mentalization Questionnaire (MZQ), and psychological and somatic complaints were assessed with HEALTH-PSB scale from HEALTH-49 at three points in time, namely at admission, at discharge and in a 6-month catamnesis. Results: Both the total score of the MZQ and all subscores show significant reductions in mentalization deficits in the small effect size range, the HEALTH-PSB in the high effect size range and the catamnesis in the medium effect size range. A regression analysis shows that the reduction in mentalization deficits has a high predictive power for symptom improvement. Conclusions: The results indicate that the construct of mentalization ability is a central target variable in psychosomatic rehabilitation.

Aim of the Study: Existing evaluation studies show the effectiveness of treatments in psychosomatic rehabilitation clinics. However, the clinics are facing new challenges, which can be attributed to the changes in the world of work, for example. At the same time, new patient groups such as older patients are coming more into focus, for whom the clinics are not yet sufficiently prepared. Against this background, an evaluation study was conducted in the Klinik am Hainberg, a psychosomatic rehabilitation clinic, to examine the changes in central dimensions of the outcome in psychosomatic medicine., Method: For the comparison of admission vs. discharge, data are available from a sample of 761 patients, of whom 559 still responded to the 6-month Follow-up) (73% response rate). Five modules of the HEALTH-49 were evaluated., Results: In all modules, improvements were found with medium to large effect sizes at discharge, and with medium effect sizes at 6-month Follow-up. Neither age, nor gender, nor time off work had an influence on the rehabilitation outcome. Only lower education was associated with less improvement., Conclusions: The results show the effectiveness of the treatments studied. The practiced rehabilitation concept seems to be effective even for patient groups that are particularly in focus, such as those with longer work incapacity or also older patients., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Careful analysis of current adjudication reveals increasing demand of adequate record-keeping as well as meticulously documented informed consent forms regarding all aspects of medicine. Although standardized informed consent forms or explicit guidelines for obtaining procedural consent already exist in surgical disciplines there is strong evidence that, however, in neonatology (and paediatric intensive care) these processes are still incomplete and qualitatively insufficiently implemented. Therefore the author discussed all existing information prescriptions with the legal department and quality management of a large German clinic group especially in terms of relevant legislation, recent case law and specialist literature in order to obtain potential for improvement. Based on the results of this audit of expert opinions improved recommendations could be implemented in the daily practise of a department of neonatology and paediatric intensive care on a tertiary level., (© Georg Thieme Verlag KG Stuttgart · New York.)

The present study aimed to investigate the influence of parental problem drinking on implicit and explicit alcohol expectancy of adolescents and young adults (12-24 years). The study was conducted via the Internet, employing a between-subjects design. We measured alcohol expectancy by means of an Implicit Association Test (IAT) and a self-report questionnaire. A short version of the Children of Alcoholics Screening Test (CAST) was used to measure alcohol-related parental problem behavior. Our results showed that increased CAST-scores were correlated with a stronger implicit association between the concepts alcohol and arousal. In contrast, no such relationship was observed between parental problem drinking and self-reported expectancy of alcohol arousal. These findings provide tentative evidence that an implicit cognitive processing bias is implicated in the intergenerational transmission of addictive behaviors., (Copyright © 2011. Published by Elsevier Ltd.)