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Clostridioides difficile is the most important pathogen causing antimicrobial-associated diarrhea and has recently been recognized as a cause of community-associated C. difficile infection (CA-CDI). This study aimed to characterize virulence factors, antimicrobial resistance (AMR), ribotype (RT) distribution and genetic relationship of C. difficile isolates from diverse fecally contaminated environmental sources. C. difficile isolates were recovered from different environmental samples in Northern Germany. Antimicrobial susceptibility testing was determined by E-test or disk diffusion method. Toxin genes (tcdA and tcdB), genes coding for binary toxins (cdtAB) and ribotyping were determined by PCR. Furthermore, 166 isolates were subjected to whole genome sequencing (WGS) for core genome multi-locus sequence typing (cgMLST) and extraction of AMR and virulence-encoding genes. Eighty-nine percent (148/166) of isolates were toxigenic, and 51% (76/148) were positive for cdtAB. Eighteen isolates (11%) were non-toxigenic. Thirty distinct RTs were identified. The most common RTs were RT127, RT126, RT001, RT078, and RT014. MLST identified 32 different sequence types (ST). The dominant STs were ST11, followed by ST2, ST3, and ST109. All isolates were susceptible to vancomycin and metronidazole and displayed a variable rate of resistance to moxifloxacin (14%), clarithromycin (26%) and rifampicin (2%). AMR genes, such as gyrA/B, blaCDD-1/2, aph(3′)-llla-sat-4-ant(6)-la cassette, ermB, tet(M), tet(40), and tetA/B(P), conferring resistance toward fluoroquinolone, beta-lactam, aminoglycoside, macrolide and tetracycline antimicrobials, were found in 166, 137, 29, 32, 21, 72, 17, and 9 isolates, respectively. Eleven "hypervirulent" RT078 strains were detected, and several isolates belonged to RTs (i.e., RT127, RT126, RT023, RT017, RT001, RT014, RT020, and RT106) associated with CA-CDI, indicating possible transmission between humans and environmental sources pointing out to a zoonotic potential. [ABSTRACT FROM AUTHOR]

Background: Most COVID‐19‐associated mucormycosis (CAM) cases are reported from India and neighbouring countries. Anecdotally cases from Europe have been presented. Objective: To estimate the disease burden and describe the clinical presentation of CAM in Germany. Methods: We identified cases through German mycology networks and scientific societies, and collected anonymised clinical information via FungiScope®. Results: We identified 13 CAM cases from six tertiary referral hospitals diagnosed between March 2020 and June 2021. Twelve patients had severe or critical COVID‐19, eleven were mechanically ventilated for a median of 8 days (range 1‐27 days) before diagnosis of CAM. Eleven patients received systemic corticosteroids. Additional underlying medical conditions were reported for all but one patient, five were immunocompromised because of malignancy or organ transplantation, three were diabetic. Eleven patients developed pneumonia. Mortality was 53.8% with a median time from diagnosis of mucormycosis to death of 9 days (range 0–214 days) despite treatment with liposomal amphotericin B and/or isavuconazole in 10 of 13 cases. CAM prevalence amongst hospitalised COVID‐19 patients overall (0.67% and 0.58% in two centres) and those admitted to the intensive care unit (ICU) (1.47%, 1.78% and 0.15% in three centres) was significantly higher compared to non‐COVID‐19 patients (P <.001 for respective comparisons). Conclusion: COVID‐19‐associated mucormycosis is rare in Germany, mostly reported in patients with comorbidities and impaired immune system and severe COVID‐19 treated in the ICU with high mortality compared to mainly rhino‐orbito‐cerebral CAM in patients with mild COVID‐19 in India. Risk for CAM is higher in hospitalised COVID‐19 patients than in other patients. [ABSTRACT FROM AUTHOR]

This paper examines commoning and practices of care from a feminist lens, here implying a focus on interdependencies of various spheres of life as well as social categories of difference. Through examples from two case studies of herders as commoners (the Nyangatom in Ethiopia and the Rechtler_innen in Germany), I establish connections between everyday that are inseparable when it comes to sustaining life and commons, while also highlighting conceptual challenges for feminist commons analysis. [ABSTRACT FROM AUTHOR]

Background: An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM).Methods: This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients.Results: A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors. First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected.Conclusions: Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status. [ABSTRACT FROM AUTHOR]

Objectives: Emerging treatments for relapsed or refractory multiple myeloma (rrMM) have led to increasing options for many patients. This study aimed to assess changes in utilization of these options in Germany with a focus on modern triplet regimens including new agents, such as carfilzomib, ixazomib, elotuzumab and daratumumab, and to evaluate whether this had an impact on rrMM‐related outcomes over time. Methods: The study population consisted of 1255 rrMM patients who were assigned to one of the following 6 treatment groups: immunomodulatory drug (IMiD)‐based doublets, proteasome inhibitor (PI)‐based doublets, daratumumab monotherapy, PI‐IMiD‐based triplets, monoclonal antibodies (mAbs)‐based triplets, or other treatment. Results: Use of triplet‐based therapy regimens increased from 5.9% in 2014 to 31.4% in 2017. In parallel, use of IMiD‐based doublets decreased from 74.3% in 2014 to 37.6% in 2017. Over the same time period, the risk of death decreased by 32% and the risk of hospitalization which was reduced by 30%. The risk for serious adverse events remained unchanged. Conclusions: Between 2014 and 2017, the use of triplet‐based therapy regimens for rrMM in Germany has significantly increased and this was associated with a significant decline in deaths and hospitalizations without an increased incidence of serious adverse events. [ABSTRACT FROM AUTHOR]

Quality assurance is a crucial instrument in modern heath policy. The German Sleep Society (DGSM) established an external structured peer-review quality rating program 10 years ago, which became mandatory for DGSM-accredited sleep centers in 2004. It has already been shown that within this program, process quality items are reliable. All labs provided three case reports based on a complete diagnostic or therapeutic investigation. A total of 149 centers were investigated in 2009, the other 128 in 2010. Each participating center provided three cases including the physician's report, a night protocol, and example epochs of the investigated nights. The ratings for each lab were done by three different reviewers out of 34 highly experienced sleep specialists, at least one of them was specialized in the same field as the lab. Reviewers added comments and suggestions which were forwarded to the labs and, in addition, could request an audit in case of serious concerns. An audit was scheduled, when it was requested by at least two reviewers. An audit was requested in 9% and 8% of the sleep centers, respectively, while 12.3% of all case reports were suggested to show serious concerns. In the second round, items on anamnesis, diagnostic and therapeutic procedures, as well as sleep parameters were rated more often as fully completed than in the first round. In case reports which required an audit, the main flaws were neglected comorbidities, inadequate adherence to diagnostic procedures and therapy planning as well as failures in the assessment of parameters sleep and breathing. Mandatory assessment of process quality by a structured peer-reviewed program revealed sufficient to high quality in the tested sleep centers accredited by the German Sleep Society. The increased number of fulfilled items in 2010 clearly indicates the improving impact giving feedback to the participating sleep centers by making the general outcomes of the peer-review assessment public to them. [ABSTRACT FROM AUTHOR]

Aim Guidelines describing how to carry out a randomised controlled trial (RCT) provide no advice concerning when to measure an intervention effect. Possibly as a result, most papers give no rationales for the time frames chosen for data collection. This paper discusses four general strategies to identify when to collect data. Furthermore, an additional individual strategy concerning the current German young carers project is presented. Background The first German young carers project is being implemented and evaluated in a pilot study's RCT. Organisational difficulties as well as problems accessing the field led to a delay in the research and ended with a change to the overall timeframe for data assessment. This process resulted in a discussion by the research team about whether the shorter timeframe would lead to biased data. Discussion The authors discuss how they reviewed the literature and decided how to determine the best point to conduct follow ups with their study participants. Conclusion The authors conclude that the standard three-month intervals used in RCTs are not necessarily applicable to psychosocial interventions and researchers should determine more appropriate intervals where possible. [ABSTRACT FROM AUTHOR]

Worldwide, ageing societies are bringing challenges for independent living and healthcare. Health-enabling technologies for pervasive healthcare and sensor-enhanced health information systems offer new opportunities for care. In order to identify, implement and assess such new information and communication technologies (ICT) the 'Lower Saxony Research Network Design of Environments for Ageing' (GAL) has been launched in 2008 as interdisciplinary research project. In this publication, we inform about the goals and structure of GAL, including first outcomes, as well as to discuss the potentials and possible barriers of such highly interdisciplinary research projects in the field of health-enabling technologies for pervasive healthcare. Although GAL's high interdisciplinarity at the beginning slowed down the speed of research progress, we can now work on problems, which can hardly be solved by one or few disciplines alone. Interdisciplinary research projects on ICT in ageing societies are needed and recommended. [ABSTRACT FROM AUTHOR]

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Different scholars count 'the number of parties' in different ways, partly because they examine different parts of the political process and for different reasons. Sartori's qualitative approach focused mainly on competition for government, but is now largely supplanted by the quantitative 'effective number of parties' index, which deals with votes and seats. But some quantitative research requires us to look beyond votes and seats. For example, testing proportional and pluralitarian models of democracy requires us to count parties not just in terms of votes and seats but also in terms of legislative and cabinet power. I estimate party shares of legislative and cabinet power to test democratic norms at British and German elections and parliaments. So, the effective number of parties index needs to be, and can be, extended beyond votes and seats alone. [ABSTRACT FROM AUTHOR]

Background: Young people below the age of 18, whose lives are affected by looking after a relative with a disability or long-term illness, are called young carers. Evidence based family oriented support for young carers and their families in Germany is currently being developed. To allow for scientific evaluation, an outcome criterion needs to be chosen. Until today, there are no assessment instruments available, which focus on young carer's specific demands and needs. As HRQOL seems to be an adequate alternative outcome criterion, an integrative review of the literature was carried out to verify this assumption. Methods: The aim of the integrative review was to get information about a) the concept and the common definition of HRQOL in children, b) preferable HRQOL assessment techniques in children, and c) the relevance of HRQOL measures for the population of young carers. An additional aim of the review was to give advice on which instrument fits best to assess young carer's HRQOL in Germany. Searches were conducted in PubMed in order to obtain papers reporting about a) the development or psychometric assessment of instruments measuring HRQOL in children and adolescents up to the age of 18, and b) on the conceptual framework of HRQOL in children. Results: HRQOL is a multidimensional construct covering physical, emotional, mental, social, and behavioural components of well-being and functioning as subjective perceived by a person depending on the cultural context and value system one is living in. Young carer's problems and needs are well covered by these common domains of HRQOL. Since no specific HRQOL-measures are available to address young carers, a generic one has to be chosen which a) has been created for use in children, b) allows self- and proxy-report, and c) has good psychometric testing results. Comparing four generic measures with currently best published psychometric testing results, items of the KIDSCREEN cover young carer's specific problems most accurate. Conclusion: The KIDSCREEN questionnaires seems adequate to evaluate the intervention as their items cover young carer's needs and problems most accurate. [ABSTRACT FROM AUTHOR]

Background: Homeopathy is a highly debated but often used medical treatment. With this cohort study we aimed to evaluate health status changes under homeopathic treatment in routine care. Here we extend former results, now presenting data of an 8-year follow-up. Methods: In a prospective, multicentre cohort study with 103 homeopathic primary care practices in Germany and Switzerland, data from all patients (age >1 year) consulting the physician for the first time were observed. The main outcome measures were: The patients' perceived change in complaint severity (numeric rating scales from 0 = no complaint to 10 = maximal severity) and quality of life as measured by the SF-36 at baseline, and after 2 and 8 years. Results: A total of 3,709 patients were studied, 73% (2,722 adults, 72.8% female, age at baseline 41.0 ± 12.3; 819 children, 48.4% female, age 6.5 ± 4.0) contributed data to the 8-year follow-up. The most frequent diagnoses were allergic rhinitis and headache in adults, and atopic dermatitis and multiple recurrent infections in children. Disease severity decreased significantly (p < 0.001) between baseline, 2 and 8 years (adults from 6.2 ± 1.7 to 2.9 ± 2.2 and 2.7 ± 2.1; children from 6.1 ± 1.8 to 2.1 ± 2.0 and 1.7 ± 1.9). Physical and mental quality of life sores also increased considerably. Younger age, female gender and more severe disease at baseline were factors predictive of better therapeutic success. Conclusion: Patients who seek homeopathic treatment are likely to improve considerably. These effects persist for as long as 8 years. [ABSTRACT FROM AUTHOR]

The article discusses the uncertain outlook for Germany's solar-energy industry. In 2013 Germany's installed capacity for producing solar energy equals that of all other countries combined. However, declining prices for solar equipment have forced several German solar companies to go out of business and made it difficult for others to make important investments in research and development. There has been movement to reduce government subsidies paid to solar companies, as China's solar industry has emerged as the world's biggest and most efficient.

The article looks at the efforts of European counties to attract professionals with proficient technology and engineering skills, focusing on Germany and how its aging population affects its skilled labor market. The author notes how a low national birth rate and booming economy has resulted in shortages of engineers in Germany beginning in 2011. Methods used to retain and acquire engineering employees are reviewed, including the European Union's Blue Card and engineerING citizenship cards.

The article reports on the decision of IBM Corp. to retain nearly 2,000 engineers at its research and development laboratory in Germany. According to Herbert Kircher, director of development and chairman of IBM Deutschland Entwicklung GmbH, the key strengths of the German laboratory are expertise and experience. An annual, day-long event for engineers and researchers is being conducted to share ideas.

Deals with the recruitment of computer experts in Germany. Reason cited for the recruitment strategy; Statistics on German information technology graduates; Issuance of United States-style green cards to non-European Union members.

Features Jenoptik AG. Impact of the company on Jena, a city in Germany; Information on the research park in Jena; Research and development focus of Jenoptik.

The article reports on the launch of the high-technology innovation initiative, called Industrie 4.0, by Industry Science Research Alliance as part of digital transformation strategy for the manufacturing industry in Germany. Topics discussed include the key features of the initiative such as Internet of Things, cloud computing, cyber-physical systems, and big data, purpose of the research alliance formed by electronics giant Siemens, and impact of the initiative on the industry and factories.

Objectives: The aim of the study was to analyze helicopter emergency medical service (HEMS) in comparison to EMS, in respect to patient's mortality and morbidity.Design: From a cohort of traumatized patients (n = 1724) prospectively enrolled in the German trauma registry (DGU-R) at Frankfurt University Hospital from 2009 to 2013, 1646 could be analyzed for in-hospital mortality and short-term outcome (GOS) at discharge and compared between HEMS and EMS.Measurements and Main Results: 129 patients (7.8%) died in the hospital. Unadjusted mortality was significantly lower in the HEMS group compared to EMS (p = 0.001). In a multiple logistic regression analysis after adjustment of variables including reanimation and age as the strongest predictors, in-hospital mortality was significantly reduced in HEMS (p = 0.014, OR = 0.21). Further predictors in the multiple logistic regression analysis were GCS > = 8 (p = 0.001), RRsys (p < 0.001), ISS at Head/Neck > = 3 (p = 0.003), and total ISS > = 9 (p < 0.001). Total rescue time and on scene time were associated with mortality (p < 0.001) but not included in the multiple logistic regression model. Without adjustment, short-term outcome (GOS) was significantly improved (p = 0.014). In a linear model, after adjusting for multiple variables including age, ISS Head/Neck > = 3, ISS Extremities > = 3, GCS > = 8, and RRsys as the strongest predictors (p < 0.001), the association remained significant (p = 0.043). Further predictors in the multiple linear regression analysis were total ISS > = 9 (p = 0.002), ISS abdomen (p = 0.001), and ISS Chest (p = 0.011).Conclusions: A significant improvement for in-hospital survival for HEMS could be demonstrated. Especially in Germany, with a high number of secondary call outs (about 44%) after EMS has already reached the traumatized patient, HEMS must be the first choice for severely injured trauma patients. Dispatch criteria for immediate alarm of HEMS are recommended under practical considerations. [ABSTRACT FROM AUTHOR]

This article recounts the experience of Reinhard Rabenstein, chief technology officer (CTO) of Wincor Nixdorf, in embracing and exploiting change at the German technology company. Wincor offers cash dispensers, electronic cash registers, bottle recycling machines and other systems for banks and retail stores. Under the leadership of Rabenstein, the company continues to shape its vision for technological innovations. Moreover, the company has entered partnerships with other companies to develop new technologies.

The article deals with the progress made by Germany in the research and development of hydrogen fuel-cell. With research projects introduced in the late 1980s, the country has become a leader in Europe in the field of hydrogen fuel cell research. Hydrogen fuel cells produce electricity through the conversion of hydrogen and oxygen into water vapor. The country has initiated a number of research programs to promote hydrogen fuel cells including the National Hydrogen and Fuel Cell Technology Innovation Program (NIP) in 2006. Automobile manufacturers such as Volkswagen and Daimler are expanding their work in hydrogen fuel cell technology.

This article discusses the establishment of a company called 4-Labs by four European micro- and nanotechnology research institutions in 2009. The institutions are the Electronics and Information Technology Lab of the French Atomic Energy Commission in Grenoble, the Swiss Center for Electronics and Microtechnology in Neuchatel, the Microelectronic Group of the German Fraunhofer Institute and the Finnish Technical Research Center in Espoo. The company aims to commercialize research and development services of the institutions and to offer a single point of contact for companies seeking technology support.

The article offers information on "Integrative Production Technology for High-Wage Countries," a research cluster led by production scientists at the Rheinisch-Westfiilische Technische Hochschule (RWTH) Aachen University, a top address for engineering science in Germany. Funded by around 40 million over a five-year period, the cluster is part of the federally-financed Excellence Initiative program that aims to increase German innovation and competitiveness in science and research, including all major research disciplines.

Focuses on the developments in the biotechnology industry in Germany. Information on the BioRegio contest launched by the German government to establish internationally competitive biotechnology clusters; Significance of the launch of technology transfer centers by universities; Potential benefit of the changes in stem cell research restrictions to the BioRiver cluster and the research sector.

Focuses on the potential impact of the economic downturn in Germany on its ability to compete in research-intensive sectors, such as the electronics and chemicals industries. Average annual growth rates for research and development (R&D) outlays in Germany during the second half of the 1990s; International rank of Germany based on combined industry and government R&D spending as a percentage of gross domestic product; Factors that have influenced companies in Germany to cut spending; Potential impact of the declined R&D budgets in the manufacturing sector on Germany's state-owned universities and government-funded research centers.

Presents updates on research and development (R&D) initiatives in Germany as of June 2002. Merger of the country's two largest bodies for information and communication technology; Aims of the merger; Ranking of Germany in total sales of high-technology; Details of a research program launched by Fraunhofer I & C.

Reports on the impact of the economic slowdown on industrial research and development (R&D) spendings in Germany in the 1990s. Industries slashing research budgets; Significance of the trend for Germany's competitive edge; Budget set by the country's minister for science and education for 1996; Plans for increasing funding for the country's leading institutional research centers.

Reports on Germany's establishment of a new innovation ministry to rev up the nation's idling research and development (R&D) machine for the 21st century. Combination of the federal research and education ministries; Industry groups' criticism against German universities and government research institutions; Need for greater collaboration between government and industry research teams.

Details the plans of Germany's Daimler-Benz AG, for R&D centralization for greater output and productivity. Details of the project; Potential of the centralization.

Focuses on Bonn government's attempts to restructure and develop industrial research and development (R&D) in East Germany. Statistics on employment decline in R&D; Government's opinion of it's role in research development; Contents of report by German economics minister, and research minister; Details and results of different programs and measures initiated by government; Establishment of committee modeled on Competitiveness Policy Council (CPC) of United States.

Reports on the Germany's Genetic Technology Law, which aims to reduce bureaucratic hurdles hindering pharmaceutical companies and research institutions, and encourage investment in the genetic technology market. German pharmaceutical industry's genetic research and product development ventures in the United States; Revision of the registration procedure for Security 2 Level genetic research; Shortcomings of the law.

Reports on the partnership of Russia and Germany on science. Emergence of central Europe as the hotbed of scientific innovation; Science and Technical Cooperation (STC) agreement of 1986 for peaceful use of nuclear energy, health care, agriculture and space research; Budget allocations for research; Main thrust on space research; Exodus of Russian scientists.