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Instructional quality is a central element in the context of teaching and learning. However, there is still a lack of clarity on what is meant by good inclusive education. In the present study, N = 24 primary school teachers from Germany were interviewed about their understanding of good inclusive teaching. The results of the qualitative study reveal that there are several factors, which are seen as essential for the quality of inclusive education. The features of good inclusive teaching mentioned by the primary school teachers especially refer to differentiation and individualisation. Furthermore, the interviewed teachers emphasise the support of community and a positive learning climate as important characteristics of good inclusive teaching. The findings of this study also reveal that for some of the teachers, there seems to be no difference between good inclusive teaching and good regular teaching. Other mentioned features for the quality of inclusive education refer to team teaching and the availability of specific framework conditions such as personnel or spatial resources.

Axons undergo Wallerian degeneration distal to a point of injury. Experimental investigations have documented many of the cellular and molecular events that underlie this behaviour. Since relatively little is known about such events in human CNS pathologies and current experimental intervention strategies indicate the possibility of significant axon regeneration along the original degenerated fibre tract, we performed an immunohistochemical investigation of the dynamics of Wallerian degeneration in post mortem spinal cords of patients who died 2 days to 30 years after either cerebral infarction or traumatic spinal cord injury. Neurofilament (NF) staining demonstrated a spatio-temporal pattern of axonal loss within degenerating descending nerve fibre tracts that could be detected close to the lesion as early as 12 days after injury and progressed to an almost complete loss of NF immunoreactivity at survival times of 1 year and longer. Immunohistochemistry for glial fibrillary acidic protein revealed a late astrocytic reaction starting at 4 months after injury in the degenerating tracts, leading to the long-term deposition of a dense astrocytic scar. These events were accompanied by the gradual reduction of myelin basic protein in affected nerve fibre tracts, leading to almost complete loss by 3 years after injury. Since the extracellular matrix molecule chondroitin sulphate proteoglycan (CSPG) is known to be strongly inhibitory for axonal regeneration and to be a major component of gliotic scar tissues, we investigated the possible deposition of CSPG within the degenerating nerve fibre tracts. Apart from a local up-regulation close to the lesion site, our results show no enhanced CSPG expression within degenerated tracts at any survival time. This suggests that despite the apparent lack of CSPG in Wallerian degeneration, the slow reduction of CNS myelin and the long-term deposition of a dense astrocytic scar may present an environment that is non-supportive for axon regrowth

Several substitute products are discussed as a healthier alternative to smoking, thereunder e-cigarettes and smokeless tobacco products, e.g., chewing bags, which are increasingly used in this context. We investigated the acute effects of chewing bags compared to combustible cigarettes and e-cigarettes with and without nicotine on small airways and arterial stiffness in a head-to-head design. This single-center, four-arm cross-overstudy included 20 healthy occasional smokers (25 ± 0.6 years). On four test days, participants consumed one product per day. Before, during, and after consumption, peripheral and central hemodynamic as well as arterial stiffness parameters were measured by Mobil-O-Graph™ (I.E.M., Germany). Resistance and small airway function were assessed by tremoFlo® c-100 (THORASYS Thoracic Medical Systems Inc.). The combustible cigarette and the e-cigarettes with and without nicotine significantly increased the resistance of the small airways (p < 0.05), while chewing bags had no effect. All nicotine containing products (e-cigarette with nicotine, combustible cigarette, chewing bag) as well as the e-cigarette without nicotine significantly increased parameters of hemodynamic and arterial stiffness. Changes in blood pressure and arterial stiffness were similar after smoking, vaping, and using chewing bags. We conclude that e-cigarettes and combustible cigarettes have similar acute harmful effects on small airway dysfunction. All nicotine containing products are associated with an increased cardiovascular risk compared with no product use. [ABSTRACT FROM AUTHOR]

Objective: Many preference‐sensitive decisions have to be made in breast cancer care and little is known about the decision‐making processes between breast cancer patients and the different health care professionals engaged in their treatment. Methods: All female breast cancer patients who underwent surgery in four German breast centers between 07/2016 and 12/2018 were invited to fill in a survey. The decision‐making process was evaluated using the 9‐item Shared Decision Making Questionnaire (SDM‐Q‐9) and a German measure to assess satisfaction with care (ZAPA). The higher the total score (0–100), the higher the experienced degree of participation and satisfaction, respectively. Participants were asked to separately rate consultations with their inpatient hospital doctors, outpatient gynecologists, outpatient oncologists and primary care providers. An overall mean score for the degree of participation and the satisfaction with care was calculated for each patient across all consultations assessed. Differences between the 4 treating physician groups were analyzed as well. Results: Of 1068 approached patients, 563 with a mean age of 62 and a standard deviation (SD) of 12.2 years filled in the survey (response rate: 53%). The overall SDM‐Q‐9 score was 73.8 (SD: 20.8). Older patients stated a higher level of participation than younger, different physician groups were rated quite similarly. Overall satisfaction with care was 87.4 (SD: 15.5). Conclusions: Overall, patients reported to have experienced a high level of shared decision‐making (SDM) and were quite satisfied with their treatment. However, we do not know whether non‐responders might have had different experiences. [ABSTRACT FROM AUTHOR]

Three historic figures from fountains in a park in Neschwitz, Germany Upper Lusatia (Ober Lausitz) had to be dismounted for workshop restoration. The sculptures from G. Knöffler, an important saxonian sculptor, dated about 1740 and show mythical scenes: putti sitting on fish like creatures. Although the sculptures originally were worked out of Cotta Sandstone, their visual appearance prior to restoration was much more like an iron casting than weathered sandstone material. The surface colour showed the typical red brown of rust, the corrosion products of iron. Further inspection by microscopy and SEM verified a considerable 50 µm crust of iron rust deposited all over the surface. In the second part of the twentieth century, the fountains of the park were feeded with water from a small well put down on the castle ground. In that eastern region of Germany, the village of Neschwitz is situated not far away from a lignite mining area. The lowering of the groundwater table, necessary for work in the open coal pits, resulted into dissolution of iron in the groundwater. Such iron rich water was then pumped to the fountains. With contact to air oxidation, the iron precipitated and deposited on the stone surface. The sophisticated stone restoration of the historical monument figures required chemical reduction of the iron by oxalic acid, its dissolution and removal via poulticing. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to assess the changes in segment reporting practices of German listed firms under the new segment reporting standard IFRS 8. Design/methodology/approach – The authors compare hand-collected segment disclosures of German firms in the first IFRS 8 year with those reported in the last IAS 14R year. Findings – The authors do not find substantial changes in the segment disclosures of German firms under IFRS 8. While the number of reportable segments slightly increased, the amount of information disclosed for each reportable segment decreased. The same applies to geographic areas reported as secondary segments under IAS 14R compared to entity-wide disclosures under IFRS 8. Furthermore, even though more country-specific information was provided, many firms still disclosed only broad geographic areas. Research limitations/implications – Future research should extend the analysis to consider more than one year of data following IFRS 8’s adoption and to examine the impact of the standard on smaller firms. Moreover, investigating economic benefits for investors and other financial statement users following IFRS 8’s adoption could be an avenue for future research. Practical implications – The findings indicate that the International Accounting Standards Board’s (IASB) expectations regarding changes in segment reporting practices under IFRS 8 have only partially been met. The results also reveal some cases of segment reporting practice where compliance is at least questionable. Both findings are of interest to standard-setters and regulators. Originality/value – The paper provides new insights into the effects of IFRS 8’s adoption in Germany and thus contributes to the post-implementation review of IFRS 8 carried out by the IASB in 2012/2013. The study sheds light on the consequences of applying the “management approach” to segment reporting, thereby contributing to the theoretical discussion on the adequacy of the different concepts for disclosing segment information. [ABSTRACT FROM AUTHOR]

Aims A substantial percentage of patients with mitral regurgitation (MR) in need of mitral valve repair are currently considered not suitable for conventional surgery. In Germany, the largest cohort of patients studied to date has been treated using a percutaneous, catheter-based approach. We report the acute outcomes of patients enrolled in the investigator-initiated German transcatheter mitral valve interventions (TRAMI) registry. Methods and results Between January 2009 and August 2011, 486 patients [median age 75 (interquartile range 70–80) years; 200 women (41%)] were enrolled in the registry (309 retrospectively and 177 prospectively), with 481 patients (99%) having undergone percutaneous edge-to-edge therapy for MR using the MitraClip. At baseline, 93% of patients were in New York Heart Association (NYHA) functional class III or IV and 71% of patients had a left ventricular ejection fraction (LVEF) ≤50%. Two-thirds of patients presented with functional MR. Procedural success was achieved in 94% of patients, with grade III present in 93% of patients at baseline yet only 6% post-intervention. Retrospective patients were followed for a median of 183 days, prospective patients for a median of 44 days. The periprocedural complication rate was low, with only minor bleedings as the most significant event. In-hospital and post-discharge mortality was 2.5% and 12.5%, respectively. Conclusions Data from the German TRAMI registry suggest that MitraClip therapy is a viable treatment option in daily clinical routine for high surgical risk patients with significant MR. [ABSTRACT FROM AUTHOR]

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To mark the occasion of the 175th anniversary of the Rheinische Naturforschende Gesellschaft in 2009 and of the centennial of the Mainz Natural History Museum in 2010, we present a short account of our present knowledge of the Eckfeld Maar after 20 years of continuous research. This paper does not attempt to include all of the detailed results on the geology of the Eckfeld site or its biota. To date, nearly 250 papers and books have been published since the start of our project An up-to-date list of these publications can be found at . [ABSTRACT FROM AUTHOR]

Background: The best European locality for complete Eocene mammal skeletons is Grube Messel, near Darmstadt, Germany. Although the site was surrounded by a para-tropical rain forest in the Eocene, primates are remarkably rare there, and only eight fragmentary specimens were known until now. Messel has now yielded a full primate skeleton. The specimen has an unusual history: it was privately collected and sold in two parts, with only the lesser part previously known. The second part, which has just come to light, shows the skeleton to be the most complete primate known in the fossil record. Methodology/Principal Findings: We describe the morphology and investigate the paleobiology of the skeleton. The specimen is described as Darwinius masillae n.gen. n.sp. belonging to the Cercamoniinae. Because the skeleton is lightly crushed and bones cannot be handled individually, imaging studies are of particular importance. Skull radiography shows a host of teeth developing within the juvenile face. Investigation of growth and proportion suggest that the individual was a weaned and independent-feeding female that died in her first year of life, and might have attained a body weight of 650- 900 g had she lived to adulthood. She was an agile, nail-bearing, generalized arboreal quadruped living above the floor of the Messel rain forest. Conclusions/Significance: Darwinius masillae represents the most complete fossil primate ever found, including both skeleton, soft body outline and contents of the digestive tract. Study of all these features allows a fairly complete reconstruction of life history, locomotion, and diet. Any future study of Eocene-Oligocene primates should benefit from information preserved in the Darwinius holotype. Of particular importance to phylogenetic studies, the absence of a toilet claw and a toothcomb demonstrates that Darwinius masillae is not simply a fossil lemur, but part of a larger group of primates, Adapoidea, representative of the early haplorhine diversification. [ABSTRACT FROM AUTHOR]

An analysis of the regulations of herbicide use for weed control in non-agricultural/urban amenity areas, including actual pesticide use, was carried out as a joint survey of seven European countries: Denmark, Finland, Germany, Latvia, the Netherlands, Sweden and United Kingdom. Herbicides constitute the major part of the pesticides used in urban amenity areas. Herbicide use on hard surfaces is the largest in terms of volume and potential contamination of surface and groundwater. The aim of the study was to investigate the differences in political interest and public debate on the ‘use of pesticides in public urban amenity areas’, regulations within each country at national, regional and local levels, possible use of alternative weed control methods and the amounts of pesticides used on urban amenity areas. A comparative analysis revealed major differences in political interest, regulations and availability of statistics on pesticide use. Denmark, Sweden, the Netherlands and Germany have, or have had, a strong public and political interest for reducing the use of herbicides to control weeds in urban amenity areas and also have very strict regulations. The UK is currently undergoing a period of increasing awareness and strengthening regulation, while Latvia and Finland do not have specific regulations for weed control in urban amenity areas or on hard surfaces. Statistics on pesticide/herbicide use on urban amenity areas were only available in Denmark and the Netherlands. Developing this kind of information base reveals the differences in herbicide use, regulations and policies in European countries and may enhance the transfer of knowledge on sustainable weed control across countries. [ABSTRACT FROM AUTHOR]

Abstract  In this paper, we explore and discuss the use of the concept of being affected in biomedical decision making processes in Germany. The corresponding German term ‘Betroffenheit’ characterizes on the one hand a relation between a state of affairs and a person and on the other an emotional reaction that involves feelings like concern and empathy with the suffering of others. An example for the increasing relevance of being affected is the postulation of the participation of people with disabilities and chronic or acute diseases in the discourse, as partly realized in the German National Ethics Council or the Federal Joint Committee. Nevertheless, not only on the political level, the resistance against the participation of affected people is still strong; the academic debate seems to be cross-grained, too. Against this background, we explore the meaning and argumentative role of the concept of being affected as it is used by affected and lay people themselves. Our analysis is based on four focus group discussions in which lay people, patients and relatives of patients discuss their attitudes towards biomedical interventions such as organ transplantation and genetic testing. This setting allows for a comparison of how affected and non-affected people are concerned and deliberate about medical opportunities, but also of how they position themselves as being affected or non-affected with respect to (scientific) knowledge and morality. On this basis, we discuss the normative relevance of being affected for the justification of political participation. [ABSTRACT FROM AUTHOR]

The article examines the impact of investment-relevant pension fund regulations and accounting rules on contribution and investment strategies within the context of asset-liability model (ALM). It focuses particularly on the situation and regulations in Germany, Japan, Great Britain, Netherlands, and the U.S. The ALM model reveals that the regulations could affect the funding costs through the choice of investment strategy. Moreover, it is noted that the regulations of strict funding may impel the sponsors to make up funding shortfalls in bad economic times and lead them to invest more.

The article focuses on a study related to seroprevalence of human herpesvirus-8 in different patient groups in Cambodia and Germany. This human herpesvirus type 8 (HHV-8), also called Kaposi's sarcoma-associated herpesvirus, is a gammaherpesvirus that is now linked to several human diseases. Serum samples from 99 consecutive adult Cambodian patients were collected at the National Center for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, Cambodia. Seventy-six patients tested negative for HIV, and 23 tested positive.

Abstract: In 2007 the radio frequency driven negative hydrogen ion source developed at IPP in Garching was chosen by the ITER board as the new reference source for the ITER neutral beam system. In order to support the design and the commissioning and operating phases of the ITER test facilities ISTF and NBTF in Padua, IPP is presently constructing a new test facility ELISE (Extraction from a Large Ion Source Experiment). ELISE will be operated with the so-called “half-size ITER source” which is an intermediate step between the present small IPP RF sources (1/8 ITER size) and the full size ITER source. The source will have approximately the width but only half the height of the ITER source. The modular concept with 4 drivers will allow an easy extrapolation to the full ITER size with 8 drivers. Pulsed beam extraction and acceleration up to 60kV (corresponding to pre-acceleration voltage of SINGAP) is foreseen. The aim of the design of the ELISE source and extraction system was to be as close as possible to the ITER design; it has however some modifications allowing a better diagnostic access as well as more flexibility for exploring open questions. Therefore one major difference compared to the source of ITER, NBTF or ISTF is the possible operation in air. Specific requirements for RF sources as found on IPP test facilities BATMAN and MANITU are implemented [A. Stäbler, et al., Development of a RF-driven ion source for the ITER NBI system, SOFT Conference 2008, Fusion Engineering and Design, 84 (2009) 265–268]. [Copyright &y& Elsevier]

Objectives: The aim of this billing data analysis was to examine the implementation of the second opinion directive in Germany and to investigate how often informing patients about their right to a second opinion (SO) and obtaining a SO are documented., Methods: To examine the frequency of "informing about SO" and "obtaining an SO", insured patients who received an indication for tonsillectomy, tonsillotomy or hysterectomy in 2019 or 2020 were included, as well as insured patients who received an indication for shoulder arthroscopy in Q2-Q3 2020. Data were analyzed descriptively., Results: During the study period, 5307 surgeries were reported for the above-mentioned indications. "Informing about SO" was documented for 121 patients with surgery and "obtaining an SO" was documented for 12 patients with surgery. The proportion of documented "informing about SO" compared to the number of surgeries was highest for tonsillectomy/tonsillotomy<18 years (4%) and lowest for shoulder arthroscopy (0.6%). In total, no patient was documented for both "informing about SO" and "obtaining an SO"., Conclusions: The present billing data analysis shows that information about the right to an SO according to the directive as well as the obtaining of such an SO has not yet been implemented in standard care as required by law., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Second opinion programmes aim to support the patients' decision-making process and to avoid treatments that are unnecessary from a medical perspective. The German second opinion directive, introduced in December 2018, constitutes a new legal framework in statutory health insurance for seeking second opinions for elective procedures and so far includes tonsillectomy, tonsillotomy, hysterectomy and shoulder arthroscopy. The directive mandates physicians who recommend one of the above-mentioned surgeries to inform their patients of their legal right to visit a certified second opinion provider. Since second opinion programmes are a fairly recent phenomenon in Germany, no comprehensive data are yet available on the degree of implementation, users, potential barriers and their effectiveness. We aim to examine the characteristics and the use of second opinion programmes as well as the needs and wishes from the perspective of (potential) users in Germany, with focus on the decision-making process, the patient-physician relationship and the motivation to seek a second opinion, as well as the role of health literacy., Methods and Analysis: Six substudies will include the following stakeholders: (1 and 2) patients with one of the four surgery-indications covered by the directive, (3) patients who electively sought an online-based second opinion, (4) patients with oncological diseases, (5) the general population and (6) medical specialists. A mixed-methods approach will be used, including questionnaires, interviews and focus groups. The data will be evaluated using quantitative descriptive analysis and qualitative content analysis. The integration of the results will take place in the form of a triangulation protocol., Ethics and Dissemination: The study protocol was approved by the Ethics Committee of the Brandenburg Medical School. The findings will be published in peer-reviewed journals and presented at scientific conferences., Competing Interests: Competing interests: DB, SuM, BP, NK, AA, SoM, KV, SL, BC, AF, SvP, DP, CR and EN declare that they have no competing interests. J-CL is the CEO of Medexo, a second opinion provider., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The frequency of tonsil surgery in Brandenburg (BB) during the period from 2013 to 2017 is analyzed. Causes and possible consequences of the trends are discussed., Materials and Methods: An OPS code-based survey is carried out in the 10 ENT hospitals in BB and using the data from the federal states (Federal Statistical Office). In addition, the respective heads of ENT departments are interviewed concerning the indication for tonsillectomy (TE). The average number of operations in 2013/2014 is compared to that in 2017 (BB) and 2016 (federal states)., Results: In 9/10 participating hospitals in BB, 10,302 operations were performed, thereof 58.4% as TE, 19.0% as tonsillotomy (TT), 13.7% as abscess tonsillectomy (abscess TE), and 8.9% other. In BB in 2017 in comparison to 2013/2014, because of the decrease in TE by 45.6%, a total of 21.1% less operations were performed, while TT and abscess TE increased by 32% and 18%, respectively. The average age at surgery was 28.1, 38.1, and 5.9 years for TE, abscess TE, and TT, respectively. The entire trend for Germany until 2016 on the basis of 395,674 cases reflects a decrease in TE (30.7%) and abscess TE (14%), while TT was performed 27.5% more often, resulting in a total decrease of 21.3%. The interviewed persons follow the "justifiable operation indications" of the German guideline from 2015 and adapted their previous practice., Conclusion: Our survey and results indicate that the massive decrease of TE in BB is associated with the "justifiable operation indications" of the 2015 German guidelines on inflammatory diseases of the tonsils. TE is mainly performed in adults. Therefore, research concerning conservative versus surgical treatment for recurrent tonsillitis is urgently needed for this age profile.