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In two studies, children learned simple but adaptive decision strategies from decision feedback. In a probabilistic multi-cue decision task, we investigated children's decision strategies under different feedback conditions. In Study 1 (N = 313), 7- and 9-year-old German children learned the selective decision strategy Take-the-Best. Children learned Take-the-Best equally well in both strict and lenient feedback environments, but worse than adult controls. In Study 2 (N = 246), feedback reinforced either the selective Take-the-Best strategy or the holistic Equal-Weight strategy. Results showed that children adapted to both decision environments. Children used both strategies more or less frequently depending on the feedback structure. Adaptation to the environment favoring Equal-Weight was better overall. This was not because the feedback was more effective, but rather because children, especially the younger ones, tended to use the Equal-Weight strategy even in the absence of feedback. Consistent with this, both studies showed an age effect on strategy use: overall, older children used the selective Take-the-Best strategy more often, while younger children used the holistic Equal-Weight strategy more often. Our results show that feedback can quickly improve decisions and increase the use of adaptive decision strategies in children as young as six years old.

The COVID-19 pandemic required adjustments and limitations in university teaching, thereby challenging teaching concepts in anatomy requiring in-person contact, including the gross anatomy course. Therefore, the present study investigates the impact of COVID-19-associated adjustments on students' perception of the gross anatomy course's importance and quality, students' preferred learning setting and outcome, and their motivation to involve themselves in academic activities, including becoming a future peer-teacher of the course. Using paper-based questionnaires in Ulm, Germany, 397 (response rate: 82.3%) students of the winter term of 2020/2021 were surveyed using quantitative and qualitative items, which were compared with cohorts prior to the pandemic. Students reported a higher global rating on course quality during COVID-19 (pre-COVID-19: 5.3 ± 0.9, during-COVID-19: 5.6 ± 0.7, p < 0.001; 1 = very bad, 6 = very good). Students' perceived importance of the gross anatomy course showed a small but significant increase (pre-COVID-19: 4.2 ± 0.6, during-COVID-19: 4.3 ± 0.6, p < 0.001; 1 = strongly disagree, 6 = strongly agree). Students' motivation to apply as a peer-teacher remained stable, nevertheless, they reported less interest in transferring their knowledge to junior students. Finally, students reported that they spent significantly more learning time alone and their examination grades remained unchanged during the pandemic. Astonishingly, despite radical changes of the teaching environment due to COVID-19, students appreciate the offered teaching and highly valued the gross anatomy course.

The idea of one shared past, can develop identity-building potential. Nevertheless, there are diverse memory practices in plural societies and they are an expression of shared, divided, and conflicting memories. The negotiations of (diverse) past(s) and memories and, consequently, related belonging(s) to so-called 'remembrance communities' take place in historical-political adult education. The article explores the relationship between existing historical knowledge about the Holocaust and National socialist past, discursive practices of representation in remembering pasts, and the negotiation of belonging in historical-political adult education. Using the example of a German orientation course, the contribution indicates that (1) remembering is subject to specific social power relations; (2) that teachers and learners navigate in discursive exchange about histories between the (re-)production of national (state) structuring and the attempt to make diversity visible in historical references; (3) that language skills are central for participating in the production of remembrance; (4) that different stakeholders face diverse challenges in teaching and providing historical-political education for adult migrants. The article addresses a relevant and urgent issue in adult education in migration societies. It, therefore, contributes to providing initial insights into teaching and learning opportunities and challenges that arise in courses about the Holocaust and National socialism in migration societies.

Globalization and digital media have been responsible for societal and educational challenges. There are educational approaches in the field of global learning and media competence that offer options to deal with these challenges. These approaches were combined in a course called 'Global Medial', mainly addressing students of educational subjects (primarily teacher training) at BA/MA level. This course provides online learning-based opportunities for Japanese and German students. With reference to this course, we describe the educational approaches of global learning, media competence and their possible interlinkages. For this description, we use the taxonomy of normative, descriptive and prescriptive. We then outline the first evaluation results of a course that took place in the Autumn term of 2017/2018 and draw conclusions for follow-up courses as well as recommendations for future research.

Purpose: This research aims to investigate the role of project-based-learning within graduate sustainability curricula through the lens of key competence development. Project-based learning has become a widely recommended pedagogy for sustainability education. It is hypothesized that through collaboration, student autonomy and real-world application, students develop key competencies for sustainability. This paper also aims to examine the connection between project-based learning and competence development on a program level from the student perspective. Design/methodology/approach: This two-year comparative case study follows the project-based-learning journeys of nine graduate sustainability students from three programs: the Master's of Sustainability at Arizona State University, the Master's of Sustainability Science at Leuphana University of Lüneburg and the Global Sustainability Science Master's, an ASU and Leuphana collaboration. Over four semesters, the students each took part in four competence-oriented self-assessments and interviews to map their perceived learning throughout their programs. Additional contextual information was gathered from program and course materials and descriptions, instructor interviews and "in vivo" observations. Findings: The defining aspects of project-based learning including collaboration, student autonomy and real-world connection do contribute to students' self-perceived competence development. Student-driven and program-driven project-based learning experiences equally foster this result, as long as the pedagogical challenges of balancing support and student independence associated with each are mitigated through instructor actions, program design or individual student coping skills. Originality/value: The results of this research can support higher education institutions in designing sustainability programs aimed at competence development through project-based learning. The focus on the curricular and program level combined with repeated overtime student-reported attribution to specific courses and activities bridges the gap between individual course case studies and theoretical recommendations for curriculum design. In addition to length and depth, this study also forefronts student experience of curricula as delivered.

Several studies reported a higher prevalence of maladaptive behaviors in children and adolescents with visual impairments (that is, those who are blind or have low vision) compared with typically developing youths. Early studies reported that up to 57% of youths with visual impairments also have mental health problems. These include problems with attention, anxiety, decreased initiative and communication, aggression, and low self-esteem. Some of the children and adolescents with visual impairments develop serious manneristic or stereotypical behaviors (eye poking or rocking) or self injurious behaviors like head hitting or self biting. Specifically, the risk of persistent problem behaviors is elevated in youths who present a combination of visual impairment and intellectual disabilities. The BPI-S is a well-established, informant based behavior-rating instrument that was designed to assess maladaptive behaviors in individuals with intellectual disabilities. A short form (Behavior Problems Inventory-- Short Form, BPI-S; Rojahn et al., 2012a, 2012b) is available. As the BPI-S includes various items that describe behaviors exhibited by youths with visual impairments, it was used in the current study. The purpose of this project was to explore the utility of the BPI-S to describe various forms of maladaptive behaviors in children and adolescents with visual impairments, and to provide data to estimate if there are differences in specific forms of stereotypical, self-injurious, or aggressive or destructive behaviors in youths who are blind as compared to youths with low vision. As an implication for clinical practice, the authors recommend the use of the BPI-S as an instrument to identify youths with visual impairments who are in need of positive behavior support. Practitioners can use the BPI-S to describe the specific form of aggressive, stereotypical, or self-injurious behavior as a target for intervention, and to evaluate the effects of behavioral interventions. However, more research is needed to provide data on the reliability of BPI-S-ratings with children and adolescents with visual impairments and the correspondence with direct observational methods. A behavior rating form like the BPI-S can be seen as a first step for assessment that must be followed by a systematic functional analysis.

Purpose: The aim of the study was to assess the susceptibility to energetic and informational masking in patients with single-sided deafness (SSD) with one normal-hearing (NH) ear and a cochlear implant (CI) in the contralateral ear, understand the effect on speech recognition when spatially separating noise and speech maskers, and investigate the influence of the CI in situations with energetic and informational masking. Method: Speech recognition was measured in the presence of either a modulated speech-shaped noise or one of two competing speech maskers in 11 SSD-CI listeners. The speech maskers were manipulated with respect to fundamental frequency to consider the effect of different voices. Measurements were conducted in the unaided (NH) and aided (NHCI) conditions. Spatial release from masking (SRM) was calculated for each masker type and both listening conditions (NH and NHCI) by subtracting scores of the colocated target and masker condition (S[subscript 0]N[subscript 0]) from the spatially separated target and masker conditions (S[subscript 0]N[subscript [not equal to]0]). Results: Speech recognition was highly variable depending on the type of masker. SRM occurred in the unaided (NH) and aided (NHCI) conditions when the speech masker had the same gender as the target talker. Adding the CI improved speech recognition when this speech masker was ipsilateral to the NH ear. Conclusions: The amount of informational masking is substantial in SSD-CI listeners with both colocated and spatially separated target and masker signals. The contribution of SRM to better speech recognition largely depends on the masker and is considerable when no differences in voices between the target and the competing talker occur. There is only a slight improvement in speech recognition by adding the CI.

Purpose: This paper aims to investigate student experiences and the potential impact of experience-based learning (EBL) in the early phase of graduate sustainability programs through the lens of key competencies. The goal is to provide evidence for the improvement of existing and the thorough design of new EBL formats in sustainability programs. Design/methodology/approach: This comparative case study focuses on the first semester of three graduate sustainability programs at Leuphana University of Lüneburg, Germany and Arizona State University, USA, for two of which EBL was a core feature. The study compares the curricula, the teaching and learning environments and the reported experiences of one student cohort from each of three programs and synthesizes the resulting insights. Student interviews were combined with student self-assessments and supported by in-vivo observations, curriculum designer input, instructor interviews and course materials. MAXQDA was used for data analysis following a grounded theory approach. Findings: EBL influences students' reflective capacity, which impacts the development of key competencies in sustainability. Qualitative analysis found four key themes in relation to the students' learning in EBL settings, namely, discomfort, time-attention relationship, student expectations of instructors and exchange. The intersection of these themes with curricular structure, student dispositions and differing instructor approaches shows how curriculum can either support or interrupt the reflective cycle and thus, holistic learning. Research limitations/implications: With the focus on the first semester only, the students' competence development over the course of the entire program cannot be demonstrated. Learning processes within EBL settings are complex and include aspects outside the control of instructors and curriculum designers. This study addresses only a select number of factors influencing students' learning in EBL settings. Practical implications: Early engagement with EBL activities can push students to leave their comfort zones and question previous assumptions. Designing curricula to include EBL while encouraging strong intra-cohort connections and creating space for reflection seems to be an effective approach to enable the development of key competencies in sustainability. Originality/value: This paper investigates the experiences of students in EBL through a key competence lens. The study combines student self-perceptions, instructor reflections and in-vivo observations. Data collection and analysis were conducted by a researcher not affiliated with the programs. These factors make for a unique study design and with data-driven insights on the seldom researched competence-pedagogy-curriculum connection.

The research in the field of positive psychology is alive for children and adolescents, and especially the effects of intervention studies are promising. While a large number of instruments exist for adults, there is a need for greater attention to basic measurement work of constructs for children. The Satisfaction With Life Scale is one of the most common questionnaires used in the field of positive psychology. Whereas the adult version is translated into many languages, the child version has only been translated into a few languages yet. This is a limitation for countries where young students are not familiar with the English language. The aim of the present study was to translate the Satisfaction With Life Scale--child version (SWLS-C) into German with the use of a backtranslation-proceeding (Study 1) and to validate the questionnaire with a sample of 1,099 students aged 8 to 17 years (Study 2). This included retesting of reliability as well as concurrent and discriminant validity by additionally measuring several established constructs of positive psychology. Model fit indices, internal consistencies, retest reliability as well as concurrent and discriminant validity evidence were satisfying. The German version of the SWLS-C can be used in future studies, but to compare SWLS-C data of different nationalities more translations of the questionnaire as well as crosscultural measurement invariance studies are needed.

Laypeople are increasingly confronted with scientific controversies, as science concerns many aspects of everyday life. In the present study, we investigated how epistemic beliefs regarding the uncertainty of knowledge (i.e. uncertainty beliefs) and invested mental effort during task processing contribute to how individuals evaluate scientific controversies. Forty-four undergraduate university students completed a questionnaire targeting their uncertainty beliefs and a week later worked on a test that required the evaluation of five scientific controversies. Eye-tracking technology was used to measure participants' pupil dilation while reading the controversies as an indicator of individuals' invested mental effort. Results revealed that both uncertainty beliefs and mental effort were positive predictors of individuals' test performance (i.e. their proficient evaluation of the controversies). Furthermore, uncertainty beliefs predicted mental effort. Finally, a mediation analysis revealed that mental effort partially explained the relation between uncertainty beliefs and test performance. We discuss implications of how individuals' epistemic beliefs regarding the uncertainty of knowledge influence the evaluation of conflicting scientific information through mental effort, offering both theoretical clarification and practical recommendations.

This article deals with understandings of change. It attempts to provide a framework for comprehending the hopes and assumptions concerning change that are implicit within global learning. The proposed framework of understanding draws on the theoretical perspectives of 'world society' (Luhmann) and "homo absconditus" (Plessner), and therefore places the proposed framework regarding an understanding of change within the context of an understanding of cultural functionality.

Globalization has an immense effect on education. Education relies on the teacher and the process by which teachers are developed. In this context, the expectations of teacher role and options for teacher preparation today have key roles to play in educating children to become responsible citizens of increasingly multicultural societies and active participants concerning the global challenges in various facets of society. Globalization is one of the most powerful forces shaping the present and future world in which today's children and youth will have to survive, intellectually, to create a sustainable and just world society. Starting from a focused understanding of globalization, this article discusses the competences of global learning, associated competences of global teachers, and perspectives within the teacher training systems of India and Germany.

Visualizations and visual models are of substantial importance for science learning (Harrison and Treagust, 2000), and it seems impossible to study chemistry without visualizations. More specifically, the combination of visualizations with text is especially beneficial for learning when dual coding is fostered (Mayer, 2014). However, at the same time, comprehending the visualizations and visual models appears to be rather difficult for learners (e.g., Johnstone, 2000). This may be one reason for the difficulties students experience especially during the university entry phase, which in a worst-case-scenario can result in high university drop-out rates as they are currently found in science-related study courses (Chen, 2013). In this regard, our study investigates, how the ability to handle and learn with visualizations -- which we call visual model comprehension -- relates to academic success at the beginning of chemistry studies. To do so, we collected the data of 275 chemistry-freshmen during their first university year. Our results show that visual model comprehension is a key factor for students to be successful in chemistry courses. For instance, visual model comprehension is able to predict exam grades in introductory chemistry courses as well as general chemistry content knowledge. Furthermore, our analyses point out that visual model comprehension acts as a mediator for the relation between prior knowledge and (acquired) content knowledge in chemistry studies. Given this obvious importance of visual model comprehension, our findings could give valuable insights regarding approaches to foster chemistry comprehension and learning especially for students at the beginning of their academic career.

Sequences of auditory objects such as one-syllable words or brief sounds disrupt serial recall of visually presented targets even when the auditory objects are completely irrelevant for the task at hand. The "token set size effect" is a label for the claim that disruption increases only when moving from a 1-token distractor sequence (e.g., "AAAAAAAA") to a token set size of 2 (e.g., "ABABABAB") but remains constant when moving from a token set size of 2 to a larger token set size (e.g., "ABCABCAB" or "DAGCFBEH"). Here we show that this claim was incorrect and based on experiments with insufficient statistical power. With sufficient statistical power it can be shown that disruption increases not only when the distractor token set size increases from 1 to 2, but also when it increases from two to eight one-syllable words (Experiment 1) and brief instrumental sounds (Experiment 2). These findings have implications for theories of auditory distraction which differ in their predictions about whether the distractor-induced performance decrement should (a) only be determined by acoustic differences between immediately adjacent distractor tokens (duplex-mechanism account) or (b) gradually increase as a function of the variability in the distractor set (attentional account). The present data are inconsistent with the duplex-mechanism account and support the attentional account.

The close linkage between different institutions is widely recognized as a method of improving teacher education. This paper introduces an attempt to link university teacher training programmes with further teacher education thereby showing the benefits of the approach and factors influencing its success. To enable teachers and student teachers to participate, a blended learning course programme was designed. The findings presented in this article are based on a course evaluation comprising data from 19 teachers and 88 student teachers. The findings indicate that teachers and student teachers benefit in many ways through cooperative learning. For example, both groups appreciated having multiple perspectives and the opportunity to exchange their experiences and opinions. Communication and interaction between teachers and student teachers is significant to make cooperative learning successful. Adequate communication and interaction, satisfying for both participant groups, are crucial for the success of this approach.

Objective: This study aimed to assess subjective and objective parameters of stress among nurses during the COVID-19 pandemic and to examine the recovery effect of a day off. Methods: In this prospective observational trial, we measured heart rate variability (using a wearable device) and perceived stress levels on 3 working days and 1 day off. We obtained the following data using an online questionnaire: working conditions, COVID-19-related problems, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), effort-reward imbalance, and work-family conflict in a sample of German nurses (N = 41). Results: When comparing working days with a day off, we observed a significant difference for physical load (Cohen's d = 0.798, P <.001), mental load (Cohen's d = 0.660, P =.001), emotional exhaustion (Cohen's d = 0.945, P <.001), and overburdening (Cohen's d = 0.585, P =.002) with higher scores on working days. Regarding heart rate variability, we did not find a difference. Correlational analyses revealed a significant association between being afraid to get infected with COVID-19 and lower heart rate variability (r = −0.336, P =.045) and between being afraid to infect relatives and lower heart rate variability (r = −0.442, P =.007). Furthermore, a higher total sum score of work-family conflict was significantly associated with lower heart rate variability (r = −0.424, P =.01). Conclusion: As heart rate variability observations were different from those regarding subjectively perceived stress, further studies are needed to evaluate and differentiate the influence of work stress and other types of stress on heart rate variability. [ABSTRACT FROM AUTHOR]

The general gender discourse has currently revealed gender gaps as early as at preschool age. To analyze developmental differences between boys and girls in Mecklenburg-Western Pomerania, n = 4,251 preschoolers aged 48-83 months were examined by means of the 'Dortmund Developmental Screening for Preschools 3-6' (DESK 3-6). Using the "sex-nonspecific" overall screening norms, sex differences were favoring females at all ages and in all areas of competence (0.18 = |d| = 0.82): fine and gross motor skills, language and cognition, and social development. The application of "sex-specific" norms, however, placed emphasis on diversity within groups instead of sex dichotomies, on the complexity of child development and the individuality of intervention needs: Sex differences were generally negligible, apart from few statistically significant, yet quantitatively small, effects (0.005 = |d| = 0.42). Consequently, competency-based, intersectional, individual-centred rather than sex-based strategies seem promising for preschool programs in northeastern Germany.

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

In 2015, the German Federal Ministry of Education and Research (BMBF) announced that the Science Year 2015 would focus on the "City of the Future". It called for innovative projects from cities and communities in Germany dedicated to exploring future options and scenarios for sustainable development. Among the successful respondents was the city of Lüneburg, located in the north of Germany, which was awarded funding to establish a community learning project to envision a sustainable future ("City of the Future Lüneburg 2030+"). What made Lüneburg's approach unique was that the city itself initiated the project and invited a broad range of stakeholders to participate in a community learning process for sustainable development. The authors of this article use the project as a blueprint for sustainable city development. Presenting a reflexive case study, they report on the process and outcomes of the project and investigate community learning processes amongst different stakeholders as an opportunity for transformative social learning. They discuss outputs and outcomes (intended as well as unintended) in relation to the specific starting points of the project to provide a context-sensitive yet rich narrative of the case and to overcome typical criticisms of case studies in the field.

Purpose: The adaptation of existing questionnaires is a valuable method to make instruments available in multiple languages. It is necessary to assure the quality of an adaptation by following adaptation guidelines. The Cochlear Implant Quality of Life–35 Profile (CIQOL-35 Profile) was developed and validated to measure the functional abilities in English-speaking adult CI users but is not yet available in German. In this study, we performed a cross-cultural adaptation of this instrument to make it applicable in research and rehabilitation with German-speaking patients. Method: This study followed established practice guidelines for translating and adapting hearing-related questionnaires. Professional translators and health care professionals with experience with patients with hearing loss translated all items forward and backward multiple times. A committee reviewed the process and decided when a satisfactory consensus was achieved. Next, we examined the intelligibility of the German version using cognitive interviews with 15 adult CI users. Results: For most items, there was no difficulty with direct translation. In items that turned out to be more difficult to translate, it proved to be very helpful to compare the back translation to the original version, discuss the wording in the committee, and ask the source-language questionnaire developer. During the interviews, issues of comprehension for some phrases were identified. These phrases were changed according to the participant’s questions and suggestions. Conclusions: The CIQOL-35 Profile was successfully adapted into German. The German version of the questionnaire is now available for research and clinical practice. Further validation of the German CIQOL-35 Profile is in progress. [ABSTRACT FROM AUTHOR]

The global COVID-19 pandemic forced changes in everyday life of children and adolescents due to government containment measures, an altered healthcare accessibility and utilization, and public concern about SARS-CoV-2 transmission. Data on the challenges and impact on children and their families with chronic diseases are limited. The primary objectives of this study were to assess (i) concerns for SARS-CoV-2 infection, (ii) perceived effects on health-related and overall quality of life (HRQoL and QoL), and (iii) accessibility and utilization of healthcare, comparing families with chronically ill children to families with healthy children during the second SARS-CoV-2 infection wave in Germany. A caregiver questionnaire was designed and participation offered in the emergency department and outpatient clinic of a German tertiary care children's hospital. 45.9% of the 205 participants were majorly concerned about their children contracting a SARS-CoV-2 infection. Caregivers of chronically ill children (128/205, 62.4%) stated significantly more often a negative impact on their child's QoL (w = 0.17; p = 0.014), while caregivers of chronically ill adolescents over the age of 13 expressed significantly more frequent a negative impact on their child's HRQoL (w = 0.21; p = 0.016). Outpatient appointments for chronically ill children were significantly more often canceled (w = 0.17; p = 0.025). Caregivers of chronically ill children were significantly more likely to report that they would actively delay hospital visits for emerging health issues due to the pandemic (w = 0.12; p = 0.049). Conclusion: Our findings underscore the importance of identifying families with chronically ill children as a vulnerable patient group with higher burdens during the COVID-19 pandemic and potential future pandemics. Healthcare providers may mitigate such burdens by ensuring reliable appointment allocation, offering contactless healthcare options, and providing tailored advice regarding vulnerabilities and preventive measures specific to their chronically ill children. What is Known: • The SARS-CoV-2 pandemic has led to significant restrictions in everyday life and both accessibility and utilization of healthcare for children and adolescents. • Chronically ill children faced exceptional challenges as they depend on regular and functioning medical care, but data comparing the pandemic's impact between chronically ill and healthy children are lacking. What is New: • The perceived impact of the SARS-CoV-2 pandemic on quality of life is more negative for chronically ill children and their health-related quality of life is more often affected compared to healthy children. • Caregivers of chronically ill children would more often delay a visit to their child's doctor during the SARS-CoV-2 pandemic and their medical appointments are more often postponed which both could increase health burdens for such vulnerable patients. [ABSTRACT FROM AUTHOR]

Background: Good vision highly depends on the transparency of the cornea, which is the "windscreen" of the eye. In fact, corneal blindness due to transparency loss is the second most common cause of blindness worldwide, and corneal transplantation is the main cure. Importantly, the cornea is normally avascular but can secondarily be invaded by pathological (blood and lymphatic) vessels due to severe inflammation, and the survival prognosis of a corneal graft mainly depends on the preoperative vascular condition of the recipient's cornea. Whereas transplants placed into avascular recipient beds enjoy long-term survival rates of > 90%, survival rates significantly decrease in pathologically pre-vascularized, so-called high-risk recipients, which account for around 10% of all performed transplants in Germany and > 75% in lower and middle-income countries worldwide. Methods: This parallel-grouped, open-randomized, multicenter, prospective controlled exploratory investigator-initiated trial (IIT) intends to improve graft survival by preconditioning pathologically vascularized recipient corneas by (lymph)angioregressive treatment before high-risk corneal transplantation. For this purpose, corneal crosslinking (CXL) will be used, which has been shown to potently regress corneal blood and lymphatic vessels. Prior to transplantation, patients will be randomized into 2 groups: (1) CXL (intervention) or (2) no pretreatment (control). CXL will be repeated once if insufficient reduction of corneal neovascularization should be observed. All patients (both groups) will then undergo corneal transplantation. In the intervention group, remaining blood vessels will be additionally regressed using fine needle diathermy (on the day of transplantation). Afterwards, the incidence of graft rejection episodes will be evaluated for 24 months (primary endpoint). Overall graft survival, as well as regression of corneal vessels and/or recurrence, among other factors, will be analyzed (secondary endpoints). Discussion: Based on preclinical and early pilot clinical evidence, we want to test the novel concept of temporary (lymph)angioregressive pretreatment of high-risk eyes by CXL to promote subsequent corneal graft survival. So far, there is no evidence-based approach to reliably improve graft survival in the high-risk corneal transplantation setting available in clinical routine. If successful, this approach will be the first to promote graft survival in high-risk transplants. It will significantly improve vision and quality of life in patients suffering from corneal blindness. Trial registration: ClinicalTrials.gov NCT05870566. Registered on 22 May 2023. [ABSTRACT FROM AUTHOR]

Study design: Clinical observational study. Objective: The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years. Material and Methods: 120 patients (72 females and 48 males with median age of 43.0 years [23-60 yrs] underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n = 104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months in 100%, 96% and 77% of the cohort by VAS, NDI, WL-26, Patient's Satisfaction Index (PSI), SF-36, Nurick Score, mJOA, Composite Success Rate, complications, patient's overall satisfaction and analgesics use. Results: Highly significant clinical improvements were observed according to NDI and VAS (P <.0001 (arm); P <.001 (neck); P =.002 (head)) at all time points. Analgetic use could be reduced in 87.1 to 95.2%. Doctor's visits have been reduced in 93.8% after 24 months. Patient's overall satisfaction was high with 78.4 to 83.5% of patients. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed resulting in a revision rate of 1.7% in 2 years. Conclusion: The ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating highly significant clinical improvement and high patient's overall satisfaction with very low revision rates at 2 years. [ABSTRACT FROM AUTHOR]

Social--emotional competences are an important developmental domain for deaf and hard of hearing (DHH) children and early diagnosis of problems is needed to ensure that DHH children receive appropriate support in this domain. In order to explore the usefulness of an instrument, which was recently developed for very young children, two studies in DHH infants and toddlers were conducted from Germany using the Social-Emotional Assessment/Evaluation Measure (Squires et al. (2013). "Social-Emotional Assessment/Evaluation Measure (SEAM)". Baltimore, ML: Brooks). Preliminary analysis of data obtained from a sample of 182 DHH children aged between 2 and 36 months (Study 1) suggests that it provides valid, reliable data and is suitable for use in practice. The data also corroborate well-known findings from other research in deaf education, in particular the role of parental responsivity for the development of social-emotional competences. Study 2 documents the consistency of evaluations of 44 DHH children by their mothers and by early intervention providers using the scales. Overall, the results suggest that this new evaluation instrument has potential applications in deaf educational practice but further research is needed to demonstrate its full value.

Background: Hyalomma marginatum and H. rufipes are two-host tick species, which are mainly distributed in southern Europe, Africa to central Asia but may also be found in Central and Northern Europe through introduction by migratory birds. Methods: Ticks were collected while feeding or crawling on animals and humans, or from the environment, in different regions in Germany, between 2019 and 2021 in a citizen science study and from 2022 to 2023 in the wake of this study. Results: From 2019 to 2023, a total of 212 Hyalomma adult ticks were detected in Germany. This included 132 H. marginatum and 43 H. rufipes ticks sent to research institutions and 37 photographic records that were only identified to genus level. The number of detected ticks varied over the years, with the highest number of 119 specimens recorded in 2019, followed by 57 in 2020. Most of the specimens were collected from horses, while some were collected from other animals, humans or found crawling on human clothes or other objects inside or outside houses. The screening of 175 specimens for Crimean-Congo hemorrhagic fever virus and of 132 specimens for Babesia/Theileria spp. by PCR gave negative results, while human-pathogenic Rickettsia were detected in 44% (77/175) of the total samples. Subsequent amplicon sequencing and phylogenetic analysis of representative samples determined the species of 41 Rickettsia aeschlimannii and one R. slovaca sequences. Conclusions: Analysis of climatic factors indicated a significantly higher probability of Hyalomma occurrence at locations with higher average spring temperature during the years 2019 and 2020 compared to randomly generated pseudo-absence locations. Dry and hot conditions probably facilitated Hyalomma nymphs' survival and molting into adults during these years. [ABSTRACT FROM AUTHOR]

Simple Summary: The number of cancer patients who require an implantable electronic heart device due to their heart disease is steadily increasing. Radiotherapy is an important treatment option for esophageal cancer, in addition to surgery and chemotherapy. Ionizing radiation can lead to serious malfunctions of cardiac devices, including complete loss of function with life-threatening consequences. There is already data in the literature on other types of cancer and radiotherapy. Esophageal cancer is rare, so there is limited information on patients with this cancer who need radiotherapy and have an electronic heart device. We retrospectively analyzed the occurrence of cardiac device malfunction in patients with esophageal cancer in our study between 2012 and 2022. By applying our internal treatment protocol, serious cardiac device malfunctions during, and after radiotherapy could be prevented. It is important to carefully plan and select the energy of the photons. The manufacturer's recommended dose limits should be observed. (1) Background: The prevalence of cancer patients relying on cardiac implantable electronic device (CIED) is steadily rising. The aim of this study was to evaluate RT-related malfunctions of CIEDs. (2) Methods: We retrospectively analyze sixteen patients with esophageal cancer who were treated with radiotherapy between 2012 and 2022 at the University Hospital Heidelberg. All patients underwent systemic evaluation including pre-therapeutic cardiological examinations of the CIED functionality and after every single irradiation. (3) Results: Sixteen patients, predominantly male (14) with a mean age of 77 (range: 56–85) years were enrolled. All patients received 28 fractions of radiotherapy with a cumulative total dose 58.8 Gy. The mean maximum dose at the CIEDs was 1.8 Gy. Following radiotherapy and during the one-year post-radiation follow-up period, there were no registered events associated with the treatment in this evaluation. (4) Conclusion: The study did not observe any severe CIED malfunctions following each radiation fraction or after completion of RT. Strict selection of photon energy and alignment with manufacturer-recommended dose limits appear to be important. Our study showed no major differences in the measured values of the pacing threshold, sensing threshold and lead impedance after RT. [ABSTRACT FROM AUTHOR]

Simple Summary: Capsular contracture is one of the substantial complications of breast cancer patients undergoing post-mastectomy radiotherapy (PMRT) following an immediate implant-based breast reconstruction (IBR). Until now, there has been no therapeutic target to directly treat or manage capsular contracture, which emphasizes the importance of its prevention. A further assessment of risk factors and dosimetric characteristics is needed to minimize the risk and choose the optimal therapy approach. Our study aims to identify the risk factors and dosimetry characteristics associated with capsular contracture. Methods: We retrospectively analyzed 118 women with breast cancer who underwent PMRT following an IBR between 2010 and 2022. Patients were treated with PMRT of 50.0–50.4 Gy in 25–28 fractions. Capsular contracture was categorized according to the Baker Classification for Reconstructed Breasts. Results: After a median follow-up of 22 months, the incidence of clinically relevant capsular contracture (Baker III–IV) was 22.9%. Overall, capsular contracture (Baker I–IV) occurred in 56 patients (47.5%) after a median of 9 months after PMRT. The rate of reconstruction failure/implant loss was 25.4%. In the univariate analysis, postoperative complications (prolonged pain, prolonged wound healing, seroma and swelling) and regional nodal involvement were associated with higher rates of capsular contracture (p = 0.017, OR: 2.5, 95% CI: 1.2–5.3 and p = 0.031, respectively). None of the analyzed dosimetric factors or the implant position were associated with a higher risk for capsular contracture. Conclusion: Postoperative complications and regional nodal involvement were associated with an increased risk of capsular contracture following breast reconstruction and PMRT, while none of the analyzed dosimetric factors were linked to a higher incidence. Additional studies are needed to identify further potential risk factors. [ABSTRACT FROM AUTHOR]

Copyright of Kölner Zeitschrift für Soziologie und Sozialpsychologie ( KZfSS) is the property of Springer Nature 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.)

Adaptive decision making in probabilistic environments requires individuals to use probabilities as weights in predecisional information searches and/or when making subsequent choices. Within a child-friendly computerized environment (Mousekids), we tracked 205 children's (105 children 5-6 years of age and 100 children 9-10 years of age) and 103 adults' (age range: 21-22 years) search behaviors and decisions under different probability dispersions (0.17; 0.33, 0.83 vs. 0.50, 0.67, 0.83) and constraint conditions (instructions to limit search: "yes" vs. "no"). All age groups limited their depth of search when instructed to do so and when probability dispersion was high (range: 0.17-0.83). Unlike adults, children failed to use probabilities as weights for their searches, which were largely not systematic. When examining choices, however, elementary school children (unlike preschoolers) systematically used probabilities as weights in their decisions. This suggests that an intuitive understanding of probabilities and the capacity to use them as weights during integration is not a sufficient condition for applying simple selective search strategies that place one's focus on weight distributions.

Purpose: This paper aims to present an experience-based learning framework that provides a bottom-up, student-centered entrance point for the development of systems thinking, normative and collaborative competencies in sustainability. Design/methodology/approach: The framework combines mental mapping with exploratory walking. It interweaves mapping and walking activities with methodological and theoretical inputs as well as with reflections and discussions. The framework aligns experiential activities, i.e. mental mapping and walking, with learning objectives, i.e. novice-level sustainability competencies. The authors applied the framework for student activities in Phoenix/Tempe and Hamburg/Lüneburg as part of The Global Classroom, a project between Arizona State University in the USA and Leuphana University of Lüneburg in Germany. Findings: The application of the experience-based learning framework demonstrates how students started developing systems thinking (e.g. understanding urban systems as functional entities and across different domains), normative (e.g. using different sustainability principles) and collaborative (e.g. learning across disciplinary, social and cultural differences) competencies in sustainability. Originality/value: The experience-based learning framework contributes to the development of curricular activities for the initial development of sustainability competencies in introductory-level courses. It enables students from different disciplinary, social and cultural backgrounds, e.g. in international education, to collaboratively start developing such competencies. The framework can be adapted to different educational contexts.

Most people believe that time seems to pass more quickly as they age. Building on assumptions of socioemotional selectivity theory, we investigated whether awareness that one's future lifetime is limited is associated with one's experience of time during everyday activities across adulthood in 3 studies. In the first 2 studies (Study 1: N = 608; Study 2: N = 398), participants completed a web-based version of the day reconstruction method. In Study 3 (N = 392) participants took part in a newly developed tomorrow construction method, a web-based experimental method for assessing everyday life plans. Results confirmed that older adults' subjective interpretation of everyday episodes is that these episodes pass more quickly compared with younger adults. The subjective acceleration of time experience in old age was more pronounced during productive activities than during regenerative-consumptive activities. The age differences were partly related to limited time remaining in life. In addition, subjective acceleration of time experience was associated with positive evaluations of everyday activities. Findings suggest that subjective acceleration of time in older adults' daily lives reflects an adaptation to limitations in time remaining in life.

Creating connections between consumers and producers (relational proximity) seems a promising approach to foster sustainable consumption behaviour in international food supply. In this intervention study, we tested three experiential marketing interventions to connect consumers to producers of an international community-supported agriculture (CSA) partnership for coffee (Teikei Coffee). Consumers (N = 136), recruited at a fair for sustainable products and lifestyles in Germany, (a) watched a promotional video about the coffee CSA, (b) attended a presentation of the coffee CSA, or (c) participated in a mindful tasting experience of the CSA coffee. Findings indicate that experiential marketing tools, to varying degrees, indeed create connections from consumers to producers, thereby fostering sustainable consumption behaviour. The findings can inform international food supply marketing efforts aimed at stimulating sustainable consumption. [ABSTRACT FROM AUTHOR]

Objective: Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and long-lasting effects than therapist-prescribed exposure in situ. Method: A multicenter randomized controlled trial, in which 369 PD/AG patients were treated and followed up for 6 months. Patients were randomized to 2 manual-based variants of CBT (T+/T-) or a wait-list control group (WL; n = 68) and were treated twice weekly for 12 sessions. CBT variants were identical in content, structure, and length, except for implementation of exposure in situ: In the T+ variant (n = 163), therapists planned and supervised exposure in situ exercises outside the therapy room; in the T− group (n = 138), therapists planned and discussed patients' in situ exposure exercises but did not accompany them. Primary outcome measures were (a) Hamilton Anxiety Scale, (b) Clinical Global Impression, (c) number of panic attacks, and (d) agoraphobic avoidance (Mobility Inventory). Results: For T+ and T- compared with WL, all outcome measures improved significantly with large effect sizes from baseline to post (range = -0.5 to -2.5) and from post to follow-up (range = -0.02 to -1.0). T+ improved more than T- on the Clinical Global Impression and Mobility Inventory at post and follow-up and had greater reduction in panic attacks during the follow-up period. Reduction in agoraphobic avoidance accelerated after exposure was introduced. A dose-response relation was found for Time x Frequency of Exposure and reduction in agoraphobic avoidance. Conclusions: Therapist-guided exposure is more effective for agoraphobic avoidance, overall functioning, and panic attacks in the follow-up period than is CBT without therapist-guided exposure. Therapist-guided exposure promotes additional therapeutic improvement--possibly mediated by increased physical engagement in feared situations--beyond the effects of a CBT treatment in which exposure is simply instructed. (Contains 3 footnotes, 2 tables, and 3 figures.)

Due to the rapid microbial degradation, ethylene (ethene; C2H4) detection in most soils is difficult. The knowledge about factors favoring the occurrence of C2H4 is mainly based on laboratory experiments which are not necessarily representative for real field conditions in forest soils. We report results from a total of 24 measuring plots in southwest Germany and more than 50,000 gas samples, including long-term forest monitoring sites and other study sites involving liming, artificial soil compaction, and temporary waterlogging. Many of the patterns and influencing factors identified in the laboratory were confirmed. In well-aerated forest soils, C2H4 was detected in 1.3% of the gas samples. C2H4 detection was higher at oxygen (O2) concentrations below 10% in the soil. The effect was positively correlated with bulk density in compacted soils and CO2, CH4, and N2O concentrations—factors that indicate reduced microbial activity and thus also facilitate the detection of C2H4. It could be detected 3.5 times more often in spruce than in beech stands, indicating that plant species plays a role and was not found to follow any distinct spatial or temporal pattern with the exception of seemingly random spatio-temporal clusters of root-born C2H4 near large roots of spruce trees. The long observation period and large dataset of this field study allowed valuable insights into C2H4 occurrence in forest soils under natural conditions supporting the theory that the plant hormone C2H4 is produced as a warning for anaerobic soil areas that are limiting root growth. [ABSTRACT FROM AUTHOR]

Copyright of Die Anaesthesiologie is the property of Springer Nature 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.)

The article focuses on the Pirckheimer-Kabinett, an entity that existed from 1981 to 1990 and beyond, situated in Schloß Burgk, Germany. It explains that the art historian Lothar Lang, also the editor of Marginalien, spearheaded the creation of the "own museum" known as the Neue Galerie. It mentions that this gallery became the Pirckheimer-Kabinett, exhibiting book art, bookplates, and illustrations from 1981 to 1990.

Simple Summary: Pulmonary metastases from different primary tumors are a common issue in the everyday clinical praxis. The resection of lung metastases in patients selected by a multidisciplinary tumor board is a widely accepted surgical procedure that can prolong survival. The aim of the current retrospective study is to investigate postoperative morbidity and mortality after pulmonary metastasectomy, identify risk factors and develop a prognostic score to identify high-risk patients. We identified 1284 patients with lung metastases that were resected with curative intent. For increased postoperative morbidity, we identified cardiovascular comorbidities, major lung resections, repeated pulmonary metastasectomy and open thoracotomy. Based on these factors, the Essen score was developed. We believe that the Essen score is a useful tool to predict postoperative morbidity in patients undergoing pulmonary metastasectomy with curative intent. Background: Pulmonary metastasectomy (PM) is a widely accepted surgical procedure. This study aims to investigate postoperative morbidity and mortality after PM and develop a score to predict high-risk patients. Methods: We retrospectively investigated all patients undergoing a PM in our institution from November 2012 to January 2023. Complications were defined as the diagnosis of any new disease after the PM up to 30 days after the operation. Results: 1284 patients were identified. At least one complication occurred in 145 patients (11.29%). Only one patient died during the hospital stay. Preoperative cardiovascular comorbidities (OR: 2.99, 95% CI: 1.412–3.744, p = 0.01), major lung resections (OR: 2.727, 95% CI: 1.678–4.431, p < 0.01), repeated pulmonary metastasectomy (OR: 1.759, 95% CI: 1.040–2.976, p = 0.03) and open thoracotomy (OR: 0.621, 95% CI: 0.415–0.930, p = 0.02) were identified as independent factors for postoperative complications. Based on the above independent factors for postoperative morbidity, the Essen score was developed (overall correct classification: 94.6%, ROC-Analysis: 0.828, 95% CI: 0.795–0.903). Conclusion: PM is a safe surgical procedure with acceptable morbidity and low mortality. The aim of the Essen score is to identify patients that are associated with risk for postoperative complications after PM. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal liver metastases (CRLM) are the predominant factor limiting survival in patients with colorectal cancer. Multimodal treatment strategies are frequently necessary to achieve total tumor elimination. This study examines the efficacy of liver resection combined with local ablative therapy in comparison to liver resection only, in the treatment of patients with ≥ 4 CRLM. Methods: This retrospective cohort study was conducted at the University Hospital RWTH Aachen, Germany. Patients with ≥ 4 CRLM in preoperative imaging, who underwent curative resection between 2010–2021, were included. Recurrent resections and deaths in the early postoperative phase were excluded. Ablation modalities included radiofrequency or microwave ablation, and irreversible electroporation. Differences in overall- (OS) and recurrence-free-survival (RFS) between patients undergoing combined resection-ablation vs. resection only, were examined. Results: Of 178 included patients, 46 (27%) underwent combined resection-ablation and 132 (73%) resection only. Apart from increased rates of adjuvant chemotherapy in the first group (44% vs. 25%, p = 0.014), there were no differences in perioperative systemic therapy. Kaplan–Meier and log-rank test analyses showed no statistically significant differences in median OS (36 months for both, p = 0.638) or RFS (9 months for combined resection-ablation vs. 8 months, p = 0.921). Cox regression analysis showed a hazard ratio of 0.891 (p = 0.642) for OS and 0.981 (p = 0.924) for RFS, for patients undergoing resection only. Conclusion: For patients with ≥ 4 CRLM, combined resection-ablation is a viable option in terms of OS and RFS. Therefore, combined resection-ablation should be considered for complete tumor clearance, in patients with multifocal disease. [ABSTRACT FROM AUTHOR]

Purpose: Tectonic keratoplasties (TK) are used to treat corneal and scleral perforations and to prevent the loss of the eye. In this study, we retrospectively analyzed indications, surgical procedures, and outcomes of eccentric mini and corneo-scleral tectonic keratoplasties with respect to anatomical survival and clear graft survival rates to identify risk factors for graft failure. Methods: This retrospective study includes 33 eccentric mini (graft diameter <6 mm) and/or corneo-scleral TK of 32 consecutive patients of a total of 41 TK carried out between 2005 and 2020 in the Eye Center, University of Freiburg, Germany, making up 0.7% of all keratoplasties performed during this period (n = 5557). Patient and graft specific data were extracted from medical files. Anatomical survival—defined as achieving integrity of the globe without further surgical interventions—and clear graft survival—defined as persisting graft clarity—were estimated using the Kaplan-Meier method. We also fitted Cox proportional hazard models to account for factors influencing anatomical and clear graft survival. Results: Median duration of anatomical success was 72.5 months (95% confidence interval (CI) 18.1—infinite (inf.)) and median duration of clear graft survival was 29.6 months (95% CI 12.5-Inf.). The 1-year survival rate for anatomical survival was 67.6% (95% CI 52.2% - 87.6%) and for clear graft survival 66.4% (95% CI 50.5%– 87.1%). No enucleation was necessary during this time-period. Non-inflammatory primary causes (n = 14) presented a trend towards better anatomical survival rates (median remained above 0.75 during follow-up) compared to inflammatory primary causes (n = 19, median 18.1 months (95% CI 2.8 - inf.)) and longer clear graft survival (median 29.6 months (95% CI 12.5 - inf.) versus 13.1 months (95% CI 3.2 - inf.)). Corneo-scleral grafts (n = 18) compared to corneal grafts (n = 15) showed a trend towards better anatomical survival (more than 50% of eyes did not fail during follow-up period (95% CI 21.9-Inf. months) versus 18.1 months (95% CI 2.4-Inf.)) and clear graft survival (median 29.6 months (95% CI 12.6-Inf.) versus 6.2 months (95% CI 2.8-Inf.)). Old age (n = 11, 75.2 – 90.1 years) compared to young age (n = 11, 6.2 – 60.2 years) was the only hazard ratio (hazard ratio 0.04 (95% CI 0.002–0.8)) that reached the level of significance (p = 0.03). Conclusion: Eccentric TK is helpful in the successful treatment of a variety of severe eye diseases. Patients at young age, with pre-existing inflammatory conditions or corneal TK are at higher risk for anatomical failure as well as clear graft failure and therefore need to be monitored closely. [ABSTRACT FROM AUTHOR]

Purpose: Damage control orthopaedics (DCO) und early total care (ETC) are well-established strategies for managing severely injured patients. There is no definitive evidence of the superiority of DCO over ETC in polytrauma patients. We conducted this study to assess the probability of a polytraumatised patient undergoing DCO. In addition, the effect of DCO on complications and mortality was investigated. Methods: We analysed data from 12,569 patients with severe trauma (Injury Severity Score ≥ 16) who were enrolled in the trauma registry of the German Trauma Society (TraumaRegister DGU®) from 2009 to 2016 and had undergone surgery for extremity or pelvic fractures. These patients were allocated to a DCO or an ETC group. We used the propensity score to identify factors supporting the use of DCO. For a comparison of mortality rates, the groups were stratified and matched on the propensity score. Results: We identified relevant differences between DCO and ETC. DCO was considerably more often associated with packed red blood cell (pRBC) transfusions (33.9% vs. 13.4%), catecholamine therapy (14.1% vs. 6.8%), lower extremity injuries (72.4% vs. 53.5%), unstable pelvic fractures (41.0% vs. 25.9%), penetrating injuries (2.8% vs. 1.5%), and shock (20.5% vs. 10.8%) and unconsciousness (23.7% vs. 16.3%) on admission. Based on the propensity score, patients with penetrating trauma, pRBC transfusions, unstable pelvic fractures, and lower extremity injuries were more likely to undergo DCO. A benefit of DCO such as reduced complications or reduced mortality was not detected. Conclusion: We could identify some parameters of polytrauma patients used in the trauma registry (Traumaregister DGU®), which led more likely to a DCO therapy. The propensity score did not demonstrate the superiority of DCO over ETC in terms of outcome or complications. It did not appear to adequately adjust for the variables used here. Definitive evidence for or against the use of DCO remains unavailable. [ABSTRACT FROM AUTHOR]

Background: Similar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role. Methods: The study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the 22 German transplant centers were interviewed. After transcription, a qualitative content analysis was performed. Results: We found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected. Conclusions: The results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice. [ABSTRACT FROM AUTHOR]

Purpose: As an important management method of the global healthcare system, diagnosis related groups (DRGs) classify patients into different cost groups and pay more attention to the equitable distribution of medical resources and the quality of medical services. At present, most countries have used DRGs to help medical institutions and doctors to treat patients more accurately, avoid the waste of medical resources, and improve treatment efficiency. Methods: The Web of Science database was searched to collect all relevant literature on DRGs from 2013 to 2022. The literature information was imported into CiteSpace, Vosviewer, and Histcite for data analysis and visualization of the results. Analyze the cooperative relationship among the countries, institutions, journals, and authors. The usage trend of keywords; Highlight the content of the cited articles. Results: The number of articles published in this decade was stable, and the number of citations in 2014 was the highest. The United States and Germany, as the first countries to use the DRGs system, are ahead of other countries in terms of the number and quality of articles. We have carried out content research on the articles with high citations, and summarized the application range of DRGs; classification method; advantages and disadvantages of the application. In general, the development trend of DRGs in foreign countries is to continuously optimize the classification method, expand the scope of application, and improve the application effect. These provide support and reference for the improvement of medical services and the perfection of the medical insurance system. Conclusion: The application of DRGs can improve the quality and efficiency of medical services, and reduce the waste of medical expenses. It can also promote the rational allocation of medical resources and the equity of medical services. In the future, DRGs will pay more attention to the personalized diagnosis and treatment and fine management of patients, and the sharing and standardization of medical data, to promote the development of medical informatization. [ABSTRACT FROM AUTHOR]

Based on "laws" of contagion and similarity, it is understood that people tend to believe that meanings associated with one object may be transferred onto another, and the meanings of the first may "contaminate" the second. The perceived contamination may influence the individual's way of interacting with the object. We aimed to produce a rich description of individual differences that predict intuitive judgments in response to scenarios involving activation of contagion heuristics. Adolescents and adults in Germany completed a survey and provided rated responses to hypothetical scenarios. They also gave open-ended remarks on one scenario: whether they would wear a sweater that had belonged to Adolf Hitler if they were cold. Content analysis produced a composite description of reflections with insights into historical consciousness in contemporary Germany. Also examined was the extent to which quantitative responses were related to demographics, personality characteristics, supernatural beliefs, and responses to other scenarios. [ABSTRACT FROM AUTHOR]

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

Tick-borne encephalitis (TBE) is an infectious disease of the central nervous system. The causative agent is the tick-borne encephalitis virus (TBEV), which is most commonly transmitted by tick bites, but which may also be transmitted through the consumption of raw dairy products or, in rare instances, via infected transfusions, transplants, or the slaughter of infected animals. The only effective preventive option is active immunization. Currently, two vaccines are available in Europe—Encepur® and FSME-IMMUN®. In Central, Eastern, and Northern Europe, isolated TBEV genotypes belong mainly to the European subtype (TBEV-EU). In this study, we investigated the ability of these two vaccines to induce neutralizing antibodies against a panel of diverse natural TBEV-EU isolates from TBE-endemic areas in southern Germany and in regions of neighboring countries. Sera of 33 donors vaccinated with either FSME-IMMUN®, Encepur®, or a mixture of both were tested against 16 TBEV-EU strains. Phylogenetic analysis of the TBEV-EU genomes revealed substantial genetic diversity and ancestry of the identified 13 genotypic clades. Although all sera were able to neutralize the TBEV-EU strains, there were significant differences among the various vaccination groups. The neutralization assays revealed that the vaccination using the two different vaccine brands significantly increased neutralization titers, decreased intra-serum variance, and reduced the inter-virus variation. [ABSTRACT FROM AUTHOR]

Purpose: Due to recent bottlenecks in the apprenticeship market the transition from general schooling into the German employment system has become more and more problematic for many pupils over the past years. In particular, young persons with migrant backgrounds, low academic achievement or missing school graduations need special help from "Managing transition" projects. The purpose of this paper is to present some findings from a formative evaluation of a mentoring project. Design/methodology/approach: The evaluation of the mentoring programme was done in a case study manner. A formative evaluation design with a three-part survey was chosen. The survey also used standardised questionnaires as oral interviews. Findings: In the survey, it could be found that the mentoring programme had many problems to overcome. For example, it did not succeed in building a continuous and trustworthy communication between mentors and pupils. Moreover, the pupils were unsuccessful in getting an apprenticeship training position despite overcoming lethargy in order to start applying. Furthermore, the mentors felt insufficiently prepared with regards to content and methodological design of the mentoring. Research limitations/implications: Considering the small sample (six students and eight mentors), it was quite clear that the evaluation study could not generate a representative analysis. The research should be regarded as an explorative case study only. Practical implications: As a result of the formative evaluation, some recommendations are given that should optimise the continuation and extension of the mentoring programme. Originality/value: The findings of this mentoring programme are useful for people planning to start similar projects because practical problems and possible solutions are mentioned. (Contains 1 table.)

Objective: To evaluate the 5-year real-world benefit–risk profile of fingolimod in patients with relapsing–remitting MS (RRMS) in Germany. Methods: Post-Authorization Non-interventional German sAfety study of GilEnyA (PANGAEA) is a non-interventional real-world study to prospectively assess the effectiveness and safety of fingolimod in routine clinical practice in Germany. The follow-up period comprised 5 years. Patients were included if they had been diagnosed with RRMS and had been prescribed fingolimod as part of clinical routine. There were no exclusion criteria except the contraindications for fingolimod as defined in the European label. The effectiveness and safety analysis set comprised 4032 and 4067 RRMS patients, respectively. Results: At the time of the 5-year follow-up of PANGAEA, 66.57% of patients still continued fingolimod therapy. Annualized relapse rates decreased from baseline 1.5 ± 1.15 to 0.42 ± 0.734 at year 1 and 0.21 ± 0.483 at year 5, and the disability status remained stable, as demonstrated by the Expanded Disability Status Scale mean change from baseline (0.1 ± 2.51), the decrease of the Multiple Sclerosis Severity Score from 5.1 ± 2.59 at baseline to 3.9 ± 2.31 at the 60-months follow-up, and the percentage of patients with 'no change' in the Clinical Global Impression scale at the 60-months follow-up (78.11%). Adverse events (AE) occurring in 75.04% of patients were in line with the known safety profile of fingolimod and were mostly non-serious AE (33.62%) and non-serious adverse drug reactions (50.59%; serious AE 4.98%; serious ADR 10.82%). Conclusions: PANGAEA demonstrated the sustained beneficial effectiveness and safety of fingolimod in the long-term real-world treatment of patients with RRMS. [ABSTRACT FROM AUTHOR]

Background. Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for malignant and nonmalignant diseases that is highly distressing, especially for children. A valid assessment of pediatric patients' distress that is independent from their language skills would be beneficial. Research regarding HSCT-specific self-reporting or rater-reporting instruments is scarce. Method. In this single-center prospective study, pediatric patients and young adolescents undergoing HSCT were screened for mental and somatic distress using PO-Bado (Basic Documentation for Psycho-Oncology) ratings from parents and medical caregivers on eight observations days before, during, and up to 200 days after HSCT. Additionally, the stress biomarkers cortisol and α-amylase were monitored on the same observation days. Results. A total of 39 pediatric and young adult patients with a median age of 9.3 years (range 0.5–19.0), with 18 females (46%) and 21 males, were enrolled. The perceptions of the patients' somatic and mental distress of parents and medical caregivers of patients were significantly correlated (mental subscale ((r(276) = 0.31, p < 0.001., 95% CI of the correlation: (0.20, 0.41)) and somatic subscale ((r(284) = 0.46, p < 0.001., 95% CI of the correlation: 0.36, 0.54)). The time period between the days of transplantation until day +10 was rated as the most mentally and somatically distressing. Conclusions. While the somatic burden declined over time, the mental distress in the patients remained at a stable level, emphasizing the importance of further psychological and psycho-oncological support in these patients. The use of salivary α-amylase as a suitable distress detection marker in pediatric patients undergoing HSCT should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. Methods: This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as the pathogens, in-hospital mortality rate, and length of hospital stay. Data were obtained from the Federal Statistical Office and the Institute for the Hospital Remuneration System database. The ICD-10 codes "M46.2-", "M46.3-" and "M46.4-" were evaluated. Results: The incidence rate of spondylodiscitis increased to 14.4/100,000 inhabitants, with 59.6% cases occurring in patients 70 years or older and affecting mainly the lumbar spine (56.2%). Absolute case numbers increased from 6886 by 41.6% to 9753 in 2020 (IIR = 1.39, 95% CI 0.62–3.08). Staphylococci and Escherichia coli were the most coded pathogens. The proportion of resistant pathogens was 12.9%. In-hospital mortality rates increased to a maximum of 64.7/1000 patients in 2020, intensive care unit treatment was documented in 2697 (27.7%) cases, and the length of stay per case was 22.3 days. Conclusion: The sharply increasing incidence and in-hospital mortality rate of spondylodiscitis highlights the need for patient-centered therapy to improve patient outcomes, especially in the geriatric, frail population, which is prone to infectious diseases. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases are the leading cause of death in industrialized nations. Due to the high number of patients and expensive treatments, according to the Federal Statistical Office (2017) in Germany, cardiovascular diseases account for around 15% of total health costs. Advanced coronary artery disease is mainly the result of chronic disorders such as high blood pressure, diabetes, and dyslipidemia. In the modern obesogenic environment, many people are at greater risk of being overweight or obese. The hemodynamic load on the heart is influenced by extreme obesity, which often leads to myocardial infarction (MI), cardiac arrhythmias, and heart failure. In addition, obesity leads to a chronic inflammatory state and negatively affects the wound-healing process. It has been known for many years that lifestyle interventions such as exercise, healthy nutrition, and smoking cessation drastically reduce cardiovascular risk and have a preventive effect against disorders in the healing process. However, little is known about the underlying mechanisms, and there is significantly less high-quality evidence compared to pharmacological intervention studies. Due to the immense potential of prevention in heart research, the cardiologic societies are calling for research work to be intensified, from basic understanding to clinical application. The topicality and high relevance of this research area are also evident from the fact that in March 2018, a one-week conference on this topic with contributions from top international scientists took place as part of the renowned "Keystone Symposia" ("New Insights into the Biology of Exercise"). Consistent with the link between obesity, exercise, and cardiovascular disease, this review attempts to draw lessons from stem-cell transplantation and preventive exercise. The application of state-of-the-art techniques for transcriptome analysis has opened new avenues for tailoring targeted interventions to very individual risk factors. [ABSTRACT FROM AUTHOR]