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Background: Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings. Methods: In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor. Conclusions: The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP. Trial registration: No trial registration needed. [ABSTRACT FROM AUTHOR]

Scholars are increasingly being asked to share teaching materials, publish in open access journals, network in social media, and reuse open educational resources (OER). The theoretical benefits of Open Educational Practices (OEP) have become understood in the academic community but thus far, the use of OER has not been rapidly adopted. We aim to understand the challenges academics face with in attempting to adopt OEP, and identify whether these are related to or stem from the functionalities afforded by current repositories of OER (ROER). By understanding what academics and experts consider good practices, we can develop guidelines for quality in the development of ROER. In this article we present the findings from a study surveying academics using OER and experts who develop and/or work with ROER. We conclude by suggesting a framework to enhance the development and quality of ROER.

Featured Application: Results provide essential information for the initial design and adaptation potential of Nature-Based Solutions. It may serve as guidance to practitioners and data providers. Flooding events, like in Germany in 2021, highlight the need for re-naturalising banks of rivers and streams to naturally mitigate future flooding. To identify potential areas for Nature-Based Solutions (NBS), the NBS Toolkit—a decision-support tool for Europe—was developed within the H2020 OPERANDUM project. The tool builds on suitability mapping, which is progressively adopted for pre-assessing areas for Nature-Based Solutions. The NBS Toolkit operates with European open-source data, which is available at different spatial resolutions. In this study, we performed a GIS-based analysis to examine the impact of different resolution data on the resulting suitability maps. The results suggest that for large-scale measures such as riparian forest buffers, coarser resolutions are sufficient and may save processing time and capacities. However, fine resolution datasets can bring added value to urban suitability mapping and are of greater importance for small-scale, local Nature-Based Solutions. [ABSTRACT FROM AUTHOR]

Introduction: Wilms tumor (WT) is the most common childhood kidney cancer. It is a rapid growing embryonal tumor in young children and can be diagnosed with and without tumor related symptoms. Methods: We retrospectively analyzed the route to diagnosis of WT treated prospectively according to the SIOP 93‐01/GPOH and 2001/GPOH in Germany between 1993 and 2022. Four routes were defined: diagnosis due to tumor‐related symptoms, incidental diagnosis during another disease, diagnosis by preventive examinations, and diagnosis within a surveillance program. For these groups we compared clinical and tumor characteristics and outcome. Results: Of 2549 patients with WT 1822 (71.5%) were diagnosed by tumor‐related symptoms, 472 (18.5%) incidentally, 213 (8.4%) by preventive medical examinations, and 42 (1.6%) by surveillance. Age, general health status, tumor volume, and local and overall stage varied significantly between these groups. The youngest patients were those diagnosed by preventive medical examination (mean: 1.70 years). These patients also showed the best general health status. Tumor volume at diagnosis (549 mL) and after preoperative chemotherapy (255 mL) was significantly higher for children with tumor‐related symptoms. The highest percentage of local stage I (78.6%) and the lowest percentage of metastatic disease (4.8%) was found in the surveillance group. The outcome of patients was not significantly different, with up to 19.0% relapses in the surveillance group and 3.0% deaths in the group with tumor‐related symptoms. Conclusion: The route to diagnosis of WT correlates with age, general health status, tumor volume, and stage distribution, but does not impact the outcome of patients. Nonetheless, diagnosis without tumor related symptoms results in lower treatment burden and thus improved quality of life. [ABSTRACT FROM AUTHOR]

Gruntkowski and Martinez examined the impact of factors such as perceived risk and perceived usefulness on German consumers' intention to purchase groceries online once the COVID-19 pandemic had subsided. They also compared consumer perceptions before and during the COVID-19 outbreak. This comment shows that Gruntkowski and Martinez's research suffers from a number of problems, the most important of which is the use of an unrepresentative sample. They should therefore have refrained from generalizing their findings to the German population. [ABSTRACT FROM AUTHOR]

Background: Infantile nephropathic cystinosis (INC) is a systemic lysosomal storage disease causing intracellular cystine accumulation, resulting in renal Fanconi syndrome, progressive kidney disease (CKD), rickets, malnutrition, and myopathy. An INC-specific disproportionately diminished trunk length compared to leg length poses questions regarding the functionality of the trunk. Methods: Thus, we prospectively investigated thoracic dimensions and proportions, as well as their clinical determinants in 44 pediatric patients with INC with CKD stages 1–5 and 97 age-matched patients with CKD of other etiology between the ages of 2–17 years. A total of 92 and 221 annual measurements of patients with INC and CKD, respectively, were performed, and associations between anthropometric and clinical parameters were assessed using linear mixed-effects models. Results: Patients with INC exhibited altered chest dimensions that were distinct from CKD controls, characterized by markedly increased chest depth to height and chest depth to chest width ratio z-scores (> 1.0), while those of patients with CKD were only mildly affected (z-score within ± 1.0). Ratio z-scores differed significantly between both patient groups from 2–6 years of age onward. The degree of chest disproportion in INC patients was significantly associated with both the degree of CKD and tubular dysfunction (e.g., low serum phosphate and bicarbonate) across three different age groups (2–6, 7–12, and 13–17 years). Conclusion: Our data show an INC-specific alteration in thoracic shape from early childhood onward, which is distinct from CKD of other etiologies, suggesting early childhood subclinical changes of the musculoskeletal unit of the thoracic cage, which are associated with kidney function. [ABSTRACT FROM AUTHOR]

The creation of synthetic heat pump load profiles is essential for energy system modeling and simulations. This paper proposes a methodology to create synthetic heat pump load profiles based on the k-means algorithm and a data set from water-to-water heat pumps from Hamelin, Germany. The quality of the generated load profiles is shown according to load factors, load distribution curves and the Pearson correlation coefficient, and is also applied on two exemplary geographies in Germany. We publish our work open-source and provide a web-based heat pump load profile generator. [ABSTRACT FROM AUTHOR]

Nonspecific back pain (NSBP) contributes greatly to the overall burden of disease from musculoskeletal conditions. Digital therapeutics (DTx) aims to address the excess demand for movement and exercise therapy resulting from this spectrum of conditions. This study aims to investigate the differential therapeutic response of NSBP to different use profiles of a digital home exercise program. Methods: This study used a PSM model to comparatively assess the achievement of a clinically relevant pain improvement among patients who exhibit a high use (HU), intermediate use (IU), low use (LU), or sub-LU use profile. Sensitivity analyses with commonly accepted thresholds for clinically relevant improvements were conducted. Results: Higher use profiles show a higher probability of achieving a clinically relevant improvement of self-reported pain intensities. Additionally, the achievement of any higher use level is associated with a significant increase in the probability of achieving a clinically relevant improvement. Conclusion: To enable the optimal effectiveness of DTx home exercise programs, an HU use profile should be pursued. This finding is in line with earlier guidance for the achievement of optimal therapeutic benefit from conventional movement and exercise therapy and underscores the importance of a cross-disciplinary effort from patients, healthcare professionals and system stakeholders alike to maximize the therapeutic effect from DTx. [ABSTRACT FROM AUTHOR]

This study investigated how N = 5,126 adolescents (mean age of 15 years) from 18 countries perceive and cope with future- and school-related stress. The adolescents completed the Problem Questionnaire (PQ), which assesses stress, and the Coping Across Situations Questionnaire (CASQ), which assesses three coping styles (reflection/support-seeking, emotional outlet, and withdrawal/denial). Across countries, adolescents reported considerably higher levels of future-related stress than school-related stress. The adolescents actively coped with stressors in both domains and seldom relied on emotional outlet or withdrawal/denial. A clustering of the countries according to socioeconomic criteria and geographical proximity demonstrated that adolescents from the "continental" group of countries showed low stress and high coping. Adolescents in the east/Asia group showed medium stress and low coping and those in the "south" group showed high stress and low coping. Developmental context was more strongly associated with stress perception and coping, style than age or gender, a finding relevant for prevention approaches aiming to endorse positive orientation to the future and improve coping competence. (Contains 4 figures and 4 tables.)

This study surveyed and compared support systems for poor readers in six member states of the European Union (EU). The goal was to identify features of effective support systems. A large-scale questionnaire survey was conducted among mainstream teachers (n = 4,210) and remedial teachers (n = 2,395). Results indicate that the six support systems differed substantially, with effective support systems showing high performance on all variables measured. More specifically, effective support systems were characterized by (a) high levels of both teacher "and" student support and (b) frequent interactions between teachers and remedial teachers as well as between remedial teachers and diagnosticians. The high prevalence of poor reading ability in the current EU member states demonstrates that educational reforms are critically needed. The results of this study provide concrete starting points for improving support systems for poor readers. (Contains 9 figures, 4 tables and 2 notes.)

A comparison between the Netherlands and Germany concerning religious, cultural and ethnic plurality provides interesting insights. Germany has never defined itself as a multicultural society, as was historically the case in the Netherlands. The outcomes of the research are somewhat surprising. Dutch pupils--especially boys--are more negative about plurality than their German contemporaries are. Belonging to a church in Germany appears to be connected to a positive attitude to migrants, while in the Netherlands this is not important at all. (Contains 7 tables and 1 note.)

Individuals with posttraumatic stress disorder (PTSD) are often said to experience strong feelings of revenge. However, there is a need for confirmatory empirical studies. Therefore, in a study of 174 victims of violent crimes, the relation between feelings of revenge and posttraumatic stress reactions was investigated. Feelings of revenge were correlated with intrusion and hyperarousal but not with avoidance. Feelings of revenge explained incremental variance of intrusion and hyperarousal when the variance explained by victimological variables was controlled. The retaliation motive implied in feelings of revenge did not account for the relation between feelings of revenge and posttraumatic stress reactions. However, the relation was moderated by the time since victimization. Therefore, feelings of revenge must presumably be regarded as a maladaptive coping reaction to experienced injustice, but not in the first period after victimization.

Summary: Background: This observational real‐world evidence (RWE) study is based on prospectively collected data from the VEDOIBD registry study. Aim: To compare the effectiveness of vedolizumab and anti‐TNF agents in biologic‐naïve patients with ulcerative colitis (UC) at the end of induction and during maintenance treatment. Methods: Between 2017 and 2020, we enrolled 512 patients with UC starting therapy with vedolizumab or an anti‐TNF agent in 45 IBD centres across Germany. We excluded biologic‐experienced patients and those with missing partial Mayo (pMayo) outcomes; this resulted in a final sample of 314 (182 on vedolizumab and 132 on an anti‐TNF agent). The primary outcome was clinical remission measured using pMayo score; any switch to a different biologic agent was considered an outcome failure (modified ITT analysis). We used propensity score adjustment with inverse probability of treatment weighting to correct for confounding. Results: During induction therapy, clinical remission was relatively low and similar in vedolizumab‐ and anti‐TNF‐treated patients (23% vs. 30.4%, p = 0.204). However, clinical remission rates after two years were significantly higher for vedolizumab‐treated patients than those treated with an anti‐TNF agent (43.2% vs. 25.8%, p < 0.011). Among patients treated with vedolzumab, 29% switched to other biologics, versus 54% who had received an anti‐TNF agent. Conclusion: After two years of treatment, vedolizumab resulted in higher remission rates than anti‐TNF agents. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 (coronavirus disease) pandemic placed a great burden on all health-care resources, especially nurses. The prevalence and underlying risk factors of affective symptoms related to the COVID-19 pandemic have been studied primarily among nurses in intensive care units (ICU) and emergency departments. The aim of this study was to identify at-risk nursing areas by examining the psychological and physical stress values of nurses in different functional areas. Methods: A questionnaire with standardized items was developed to assess psychological and physical stress values. At least 50 nurses with a minimum work experience of 3 years were recruited from the ward, outpatient clinic (OC), intermediate care (IMC) unit, and operating room (OR) of the University Hospital RWTH Aachen. The participants answered the questionnaire by referring to their perceptions before and during the COVID-19 pandemic. Absolute differences and relative trends in psychological and physical stress values were compared within and across functional areas. Results: The ward and OR nurses experienced significant increases in workload (p < 0.001 and p = 0.004, respectively) and time stressors (p < 0.001 and p = 0.043, respectively) during the COVID-19 pandemic. Regardless of functional area, the nurses showed strong tendencies toward increases in subclinical affective symptoms. After adjustments for age, sex, working in a shift system, the treatment of patients with COVID-19, and the impact of the COVID-19 pandemic on personal life, the values for working with pleasure decreased significantly among the ward (p = 0.001) and OR nurses (p = 0.009) compared with the OC nurses. In addition, the ward (p < 0.001) and OR nurses (p = 0.024) were significantly more likely to express intent to leave their profession than OC nurses. Conclusions: The IMC nurses showed good adaptation to the exacerbated situation caused by the COVID-19 pandemic. The ward nurses, followed by the OR nurses, were the most vulnerable to mental and physical exhaustion, which threatened the nurses' resilience and retention in the wake of the COVID-19 pandemic. Therefore, intervention programs must specifically address the professional and emotional needs of ward and OR nurses to prepare the health-care system for future crises. [ABSTRACT FROM AUTHOR]

Copyright of SIRIUS - Zeitschrift fur Strategische Analysen is the property of De Gruyter 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.)

Uses Abel and McQueen's (1992) theoretical framework of resources, orientations, and behaviors, to examine social class influences on adolescent socialization in Sweden, Germany, and Great Britain. Finds that lifestyle socialization in adolescence is social-class based, but allows for transitional variations within social-class boundaries. Elements of social class are powerful and pervasive in relation to resources and behaviors. (Author/KB)

Copyright of GMS Hygiene & Infection Control is the property of German Medical Science Publishing House gGmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Recombinant human growth hormone (rhGH) is frequently used for treatment of short stature in children with chronic kidney disease (CKD) prior to kidney transplantation (KT). To what extent this influences growth and transplant function after KT is yet unknown. Methods: Post-transplant growth (height, sitting height, leg length) and clinical parameters of 146 CKD patients undergoing KT before the age of 8 years, from two German pediatric nephrology centers, were prospectively investigated with a mean follow-up of 5.56 years. Outcome in patients with (rhGH group) and without (non-prior rhGH group) prior rhGH treatment was assessed by the use of linear mixed-effects models. Results: Patients in the rhGH group spent longer time on dialysis and less frequently underwent living related KT compared to the non-prior rhGH group but showed similar height z-scores at the time of KT. After KT, steroid exposure was lower and increments in anthropometric z-scores were significantly higher in the rhGH group compared to those in the non-prior rhGH group, although 18% of patients in the latter group were started on rhGH after KT. Non-prior rhGH treatment was associated with a faster decline in transplant function, lower hemoglobin, and higher C-reactive protein levels (CRP). After adjustment for these confounders, growth outcome did statistically differ for sitting height z-scores only. Conclusions: Treatment with rhGH prior to KT was associated with superior growth outcome in prepubertal kidney transplant recipients, which was related to better transplant function, lower CRP, less anemia, lower steroid exposure, and earlier maturation after KT. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Hospital-level COVID-19 testing strategies may require rapid changes depending on the dynamics of local epidemiology. A COVID-19 outbreak in a hospital near the authors' institution, a Geriatric Medicine centre in Berlin, Germany, prompted the implementation of comprehensive SARS-CoV-2 testing. Serial nasopharyngeal swabs were collected from all patients and staff and analysed for SARS-CoV-2 virus RNA using quantitative real-time PCR. In total, 11 of 84 patients (13.1%) and 1 of 147 employees (0.68%) tested positive. Of the 11 positive patients, 9 (81.8%) were asymptomatic at the time of testing. The data were used as the basis for adjusting local COVID-19 containment measures. Only one staff-to-staff transmission was observed, and there was no patient-to-patient, patient-to-staff or staff-to-patient transmission. Three patients infected with SARS-CoV2 died, two deaths being attributable to advanced malignant disease and one to COVID-19–associated myocarditis. In conclusion, universal SARS-CoV-2 testing revealed a cluster of predominantly asymptomatic infections, enabled appropriate local COVID-19 containment decisions and presumably contributed to the prevention of in-hospital SARS-CoV-2 transmission. [ABSTRACT FROM AUTHOR]

The homeownership rate in Germany is one of the lowest among advanced economies. To better understand this fact, we evaluate the role of specific housing policies that tend to discourage homeownership. In comparison to other countries with higher homeownership such as the United States, Germany has an extensive social housing sector with broad eligibility criteria, high transfer taxes when buying real estate, and no tax deductions for mortgage interest payments by owner-occupiers. We build a life-cycle model with uninsurable income and housing risks and endogenous homeownership in order to quantify the policy impact on homeownership and welfare. Adjusting all three policies has a strong impact on housing tenure choices, closing the gap in homeownership rates between Germany and the United States by about two thirds. At the same time, household welfare would be reduced by moving to a policy regime with low transfer taxes, but it would improve in the absence of social housing, in particular, when coupled with housing subsidies for low-income households. [ABSTRACT FROM AUTHOR]

The article offers information on the new forms of theory and types of criticism such as antitheory and the literary text from object-oriented ontology. It further discusses spirit of rapprochement between philosophy and literature; the British and German romanticism of the late eighteenth and early nineteenth century; the metaphysics of the classical depiction of text; and the relative lack of autonomy, stability, coherence and identity afforded to fundamental depiction of text.

Purpose: Acute, isolated intracranial dissection (ICD) represents a rare and challenging cause of acute stroke. DSA is considered to be the gold standard imaging modality in patients with ICD. The role of novel, high-resolution (HR) compressed-sensing (CS) time-of-flight (TOF) MRA techniques in ICDs is unclear. Methods: A 22-year-old male patient with an isolated right ICA/MCA intracranial dissection underwent "conventional" 3-T TOF MRA, HR CS TOF MRA and also DSA including digital rotational angiography. Results: Unlike the "conventional" TOF MRA, HR CS TOF MRA provided comparable image quality to rotational angiography and a dissection membrane was clearly visible in both techniques. Conclusion: In this single case study, we demonstrated the feasibility of a novel HR CS TOF in a case of an acute isolated intracranial ICA/MCA dissection, which needs to be validated in a larger case series. [ABSTRACT FROM AUTHOR]

Background: During spontaneous breathing trial, low-pressure support is thought to compensate for endotracheal tube resistance, but it actually should provide overassistance. Automatic tube compensation is an option available in the ventilator to compensate for flow-resistance of endotracheal tube. Its effects on patient effort have been poorly investigated. We aimed to compare the effects of low-pressure support and automatic tube compensation during spontaneous breathing trial on breathing power and lung ventilation distribution. Results: We performed a randomized crossover study in 20 patients ready to wean. Each patient received both methods for 30 min separated by baseline ventilation: pressure support 0 cmH2O and automatic tube compensation 100% in one period and pressure support 7 cmH2O without automatic tube compensation in the other period, a 4 cmH2O positive end-expiratory pressure being applied in each. Same ventilator brand (Evita XL, Draeger, Germany) was used. Breathing power was assessed from Campbell diagram with esophageal pressure, airway pressure, flow and volume recorded by a data logger. Lung ventilation distribution was assessed by using electrical impedance tomography (Pulmovista, Draeger, Germany). During the last 2 min of low-pressure support and automatic compensation period breathing power and lung ventilation distribution were measured on each breath. Breathing power generated by the patient's respiratory muscles was 7.2 (4.4–9.6) and 9.7 (5.7–21.9) J/min in low-pressure support and automatic tube compensation periods, respectively (P = 0.011). Lung ventilation distribution was not different between the two methods. Conclusions: We found that ATC was associated with higher breathing power than low PS during SBT without altering the distribution of lung ventilation. [ABSTRACT FROM AUTHOR]

Objective: Recently, a cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for beat-to-beat calculation of BP values has been validated over a short time period. However, it remains unknown how values obtained with this device compare with standard ambulatory measurements over a 24-hour period. We hypothesised that BP values measured by a cuffless PTT device (TestBP) are comparable with measurements by a standard upper arm cuff-based BP device (RefBP) in clinical practice over 24 hours.Methods: Between May and December 2017, 71 individuals were prospectively included. Cuffless using the Somnotouch-NIBP (Somnomedics GmbH, Randersacker, Germany) and cuff-based standard 24-hour BP measurements were performed simultaneously on the left and right arm, respectively. The first RefBP measurement was used as calibration measurement for the TestBP.Results: Mean (±SD) age was 49.3 (15.1) years, and 51% were male. Mean 24-hour BP for TestBP and RefBP were 140.8 (20.0) versus 134.0 (17.3) mm Hg for systolic (p<0.0001) and 85.8 (14.1)versus79.3 (11.7) mm Hg for diastolic (p<0.0001) measurements, respectively. Mean absolute systolic and diastolic disagreements between TestBP and RefBP were 10.2 (7.2) and 8.2 (5.5) mm Hg, respectively. The number (percentage) of absolute differences between the mean 24-hour BP values of the TestBP and RefBP within 5, 10 and 15 mm Hg were 23 (32.4), 43 (60.6) and 54 (74.6) for systolic and 24 (33.8), 51 (71.8) and 65 (91.6) for diastolic measurements, respectively.Conclusion: In clinical practice over 24 hours, there was a significant difference between the TestBP and RefBP with higher systolic and diastolic BP measured with the cuffless PTT device. Reasons for this difference need to be investigated.Clinical Trial Registration: NCT03054688; Results. [ABSTRACT FROM AUTHOR]

• Travel demand generator for anywhere in Germany. • Open-source and requires only OpenStreetMap data as input. • Output is wholly disaggregated spatially and temporally. • Validated with household travel survey data. • Architecture designed for transferability to other regions. This paper introduces OMOD (OpenStreetMap Mobility Demand Generator), a new open-source activity-based mobility demand generation tool. OMOD uses a data-driven approach, calibrated with household travel survey data, to generate a population of agents with detailed daily activity schedules that state what activities each agent plans to conduct, where, and for how long. The temporal aspect of the output is wholly disaggregated, while the spatial aspect is given on the level of individual buildings. In contrast to other existing models, OMOD is freely available, open-source, works out-of-the-box, can be applied to anywhere in Germany with the ambition to widen the scope to other countries, and only requires freely available OpenStreetMap (OSM) data from the user. With OMOD, it is easy for non-experts to create realistic mobility demand, which can be used in transportation studies, energy system modeling, communications system research, et cetera. This paper describes OMOD's architecture and validates the model for three cities ranging from 200,000 to 2.5 million inhabitants. [ABSTRACT FROM AUTHOR]

Theoretical background: Social media have become an essential part of young people's lives. At the same time, negative effects of these on mental health have been observed in past studies. However, it is still unclear whether the amount of time or the pattern of use is accountable for these negative effects. Compulsive usage patterns characterise addictive social media use, while non-addictive use is characterised by voluntary usage patterns. The present study aims to analyse the associations between the amount of time spent with social media, addictive social media use, and depressive symptoms. Method: The study investigates cross-sectional data from N = 513 students aged 11 to 19 years (M = 12.91, SD = 1.02) in 39 classes (18 high schools) in Germany. Hierarchical linear modelling was applied to investigate the predictive influence of amount of time spent with social media and addictive social media use on depressive symptomatology. Results: Addictive social media use was identified as a significant predictor of depressive symptomatology, explaining 17% of the variance in depressive symptomatology. Amount of time spent with social media failed to explain a significant amount of variance in depressive symptomatology after controlling for addictive social media use. Discussion and conclusion: The present results suggest that the amount of time spent with social media alone is not responsible in promoting depressive symptoms in children and adolescents, but rather the addictive social media use. Thus, addictive social media use is a potential risk for the mental health of children and adolescents. In order to avoid negative consequences of social media use in the future, interventions and prevention should focus in particular on the usage pattern of social media use. [ABSTRACT FROM AUTHOR]

Background: Children with chronic kidney disease are frequently born small for gestational age (SGA) and prone to disproportionately short stature. It is unclear how SGA affects growth after kidney transplantation (KTx). Methods: Linear growth (height, sitting height, and leg length) was prospectively investigated in a cohort of 322 pediatric KTx recipients, with a mean follow-up of 4.9 years. Sitting height index (ratio of sitting height to total body height) was used to assess body proportions. Predictors of growth outcome in KTx patients with ( n = 94) and without ( n = 228) an SGA history were evaluated by the use of linear mixed-effects models. Results: Mean z-scores for all linear body dimensions were lower in SGA compared with non-SGA patients ( p < 0.001). SGA patients presented with higher target height deficit and degree of body disproportion ( p < 0.001). The latter was mainly due to reduced leg growth during childhood. Pubertal trunk growth was diminished in SGA patients, and the pubertal growth spurt of legs was delayed in both groups, resulting in further impairment of adult height, which was more frequently reduced in SGA than in non-SGA patients (50 % vs 18 %, p < 0.001). Use of growth hormone treatment in the pre-transplant period, preemptive KTx, transplant function, and control of metabolic acidosis were the only potentially modifiable correlates of post-transplant growth in SGA groups. By contrast, living related KTx, steroid exposure, and degree of anemia proved to be correlates in non-SGA only. Conclusions: In children born SGA, growth outcome after KTx is significantly more impaired and affected by different clinical parameters compared with non-SGA patients. [ABSTRACT FROM AUTHOR]

Background: Birch pollen allergy and concomitant plant food sensitization are well documented in Europe. However, there are currently no data available on pollen-associated plant food sensitization or even pollen allergy in tropical Africa. Our study aimed to investigate Bet v 1- and Bet v 2-associated plant food sensitization in atopic patients from Uganda and compare it with sensitization rates in German patients. Methods: Sera from 83 Ugandan and 97 German atopic patients were analysed using UniCAP100™ for allergen-specific IgE against the birch tree pollen allergens Bet v 1 and Bet v 2 as well as the plant foods hazelnut, apple, kiwi, pea, peach, cherry, litchi, peanut, and soy. Results: As expected, sensitization to Bet v 1 and cross-reactive plant food allergens was more common in German atopic patients. In contrast, the prevalence of sensitization against Bet v 2 was remarkably similar in Ugandan and German patients. Interestingly, in Ugandan patients we found IgE-mediated sensitization against plant foods such as hazelnut, pea, peach, cherry, and litchi that are neither cultivated nor consumed in Uganda. Conclusions: For Ugandan atopic patients, sensitization against the Bet v 2 allergen (a plant profilin) may explain cross-reactivity to several plant foods which are not consumed in Uganda. Additionally, it is probable that sensitization of Ugandan atopics to alder pollen (Alnus acuminata, plant family Betulaceae) caused serological cross-reactivity with Betula verrucosa-related allergens. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Nodular lymphocyte-predominant Hodgkin lymphoma ( NLPHL) is a rare lymphoma entity. We performed a matched-pair analysis to evaluate the prognostic impact of several histopathological features in this distinct Hodgkin lymphoma subtype. Lymph node samples of NLPHL patients were tested for CD15, IgD, phosphorylated STAT6, ICOS and Epstein-Barr virus status of the malignant lymphocyte-predominant cells as well as epithelioid cell clusters and activated T cells in the microenvironment. None of these features was associated with a particular clinical outcome. However, patients presenting with epithelioid cell clusters showed a non-significant trend towards a lower relapse rate, justifying further evaluation of this marker. [ABSTRACT FROM AUTHOR]

It is well established in the literature on social stratification in educational attainment that children with high socio-economic status choose more academically demanding educational tracks than their peers, particularly if their prior school performance was poor. Much less is known about whether they stay on demanding secondary school tracks after such ambitious track choices or whether they downgrade to lower tracks. This study makes two contributions to the literature on compensatory advantage (CA): First, we evaluate whether high parental education compensates for a low academic preparedness and thereby reduces the risk of downgrading from the academic track of secondary school in Germany. Second, we try to identify the underlying mechanisms: The CA could either be attributed to children catching up academically or to different reactions to poor performance on the academic track. We follow the educational trajectories of 2371 children who transferred to the academic track in 2010 using survival analysis. In line with CA, we find that among the children with low academic preparedness, those with high parental education are less likely to downgrade to a lower track. The differences in downgrading by academic preparedness and parental education can be partially attributed to the performance on the academic track. However, we do not find evidence for the proposed compensatory mechanisms. Neither the association between academic preparedness and performance on the academic track nor the association between performance on the academic track and the risk of downgrading is weaker for children with higher parental education. Instead, CA seems to result from the average advantages of having highly educated parents being more relevant for children at the edge of downgrading. [ABSTRACT FROM AUTHOR]

In recent years, electric vehicles have consolidated their position as the primary decarbonization tool in the transport sector. In several countries, registration numbers approach or have already exceeded the one million mark. This development brings with it new opportunities and problems for regional as well as national power systems. Current research analyzes these two spatial levels separately. However, this practice has its limitations when we are interested in controlled charging. Optimal behavior with regards to objectives on one spatial level often comes with ramifications on another. This study quantifies this effect on a case study of Germany 2030. We optimize unidirectional electric vehicle charging on both the national and county level. The resulting peak load and renewable integration amount are evaluated. We find that national optimization can completely avoid national peak loads and integrate an additional 10.8 TW h of renewables. However, we have to accept average peak load increases of 23% at transmission grid substations, exceeding even our results for uncontrolled charging. These regional peaks are avoided if optimization is conducted county by county. In this case, the national peak load increase is also minor, but the renewable integration potential is reduced by 3.6 TW h. • Develop an optimization approach for analyzing smart charging potentials with high spatial resolutions. • Use the model to assess the impacts of EVs on the German power system. • Additional mid-day charging infrastructure can reduce but not avoid evening peaks. • Regional smart charging avoids local and national peak loads. • Maximizing nationwide renewable integration creates large regional peaks. [ABSTRACT FROM AUTHOR]

Background: We analyzed the impact of birth parameters and parental height on long-term growth outcome in children with chronic kidney disease (CKD) stage 3-5. Methods: Linear growth was prospectively investigated in 509 children, with a mean follow-up of 4.1 years. Growth outcome was categorized in (i) poor growth (PG): height standard deviation score (SDS) during follow-up < −2.0 and/or actual or previous growth hormone (GH) treatment, and (ii) good growth (GG): height SDS ≥ −2.0 and no need for GH. A multivariate binary logistic regression model was constructed for predictors of PG outcome. Results: PG was observed in 55 % of patients. The rate of pre-term and small for gestational age birth was significantly higher in children with PG compared to GG (43.2 vs. 25.6 % and 36.8 vs. 18.9 %; p < 0.001). Children with PG had significantly lower average values for gestational age, birth weight, length, and head circumference, umbilical cord pH, Apgar scores, and parental height than children with GG. Birth length, umbilical cord pH, and parental height were significant independent predictors of PG outcome (sensitivity 72.8 %, specificity 69.3 %). Conclusions: Birth parameters and parental height are independent predictors of growth outcome in children with CKD. [ABSTRACT FROM AUTHOR]

Background: The attainment of normal growth and maturation remains a major challenge in the management of children and adolescents requiring renal replacement therapy (RRT). Methods: We compared growth and maturation in 384 German children with RRT who were followed between 1998 and 2009 with 732 children who were enrolled in the European Dialysis and Transplant Association (EDTA) Registry from 1985 to 1988; of these children, 78 and 88 %, respectively, were transplanted. Results: The data on the German patients included in the EDTA registry did not differ significantly from those of the patients from other European countries. Overall, the mean height standard deviation score (SDS) has improved over the past 20 years from −3.03 to −1.80 ( p < 0.001). Until the age of 6 years, the difference in height SDS was not significant, whereas it improved significantly in adolescence (−3.40 vs. −1.52; p < 0.001). Significant improvements in the delay of the pubertal growth spurt, age at menarche, bone maturation and body mass index (BMI) were noted in the recent German group compared to the EDTA group (each p < 0.001). Conclusions: Our findings demonstrate a marked improvement of growth and maturation in paediatric patients on RRT during the past 20 years. [ABSTRACT FROM AUTHOR]

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Background: Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous behavioral disorder commonly found in children, with serious lifetime health and social consequences for both children and their parents. Public awareness of ADHD in Germany has increased in the past decade, but little is known about the costs of treating newly diagnosed patients in clinical practice. Objective: This study aimed to describe the resource utilization and treatment costs of patients aged 6 to 17 years with newly diagnosed ADHD, using patient data from a German sickness fund, and to quantify resource utilization by drug treatment and treatment persistence. Methods: To identify patients with newly diagnosed ADHD, the second largest German sickness fund was utilized. Complete claims data of all de-identified patients meeting eligibility criteria for 2007 and 2008 were extracted. Patients were divided into 1 of 3 treatment groups: drug treatment-persistent, drug treatment- nonpersistent, and nondrug treatment. The differences in costs and resource utilization are reported in a descriptive manner, with paired and unpaired 2-sample Wilcoxon tests used. Results: Of 3407 newly diagnosed patients with ADHD, 1105 (32%) received an ADHD-specific drug following diagnosis; the remaining 2302 comprised the nondrug treatment group. Of the total number of drugtreated patients, 1-year observational data were available for only 786 methylphenidate users (71%). Of these, 503 patients (64%) comprised the drug treatment- persistent group (those having at least 1 prescription every 3 months during the 12 months following their first ADHD prescription) and 283 (36%) comprised the drug treatment-nonpersistent group. After excluding those patients with <12 months of follow-up, 1779 patients (52%) were included in the nondrug-treatment group. Outpatient visits and the number of drug prescriptions and associated costs were highest in the drug treatment-persistent group (P = 0.05); however, the number of hospital admissions and days spent in-hospital were lowest in this group. Significant average savings of €187/y in overall costs (P = 0.05) were noted for the drug treatment- persistent group compared with the drug treatment- nonpersistent group. These mean savings were €739/y and €552/y (drug treatment-persistent group and drug treatment-nonpersistent group, respectively) compared with nondrug-treated patients. Conclusions: There are potential cost-savings benefits when patients are treatment persistent. Therefore, future disease-management programs might consider treatment persistence as potentially reducing overall payer costs. Additionally, the clinical and psychosocial situations of patients and their families should be taken into account. [ABSTRACT FROM AUTHOR]

The article examines the social market model of capitalism in Germany and compares its economic growth versus Great Britain after the 2008 financial crisis. It looks at the efforts to harmonise laws in Great Britain with draft directives on worker participation in the European Union. An overview of a recommendation of the Bullock Committee on labour relations is presented. Emphasis on enhanced employee influence in correcting flaws of corporate governance is also given.

Background: Friedreich's Ataxia (FRDA) is a neurodegenerative disorder that causes progressive damage to the central and peripheral nervous systems having a significant impact upon quality of life. With little information in the literature, cross-sectional observational studies were conducted in the UK and Germany to collect data on resource use and the burden of the disease on individuals and their caregivers. Methods: Cross-sectional observational studies were conducted in the UK and Germany to estimate the burden of FRDA on individuals and on the respective healthcare systems. A total of 75 individuals in the UK and 28 in Germany were recruited to the study. Participants in both countries were asked to complete a Patient and Caregiver Information Form (PCIF), regarding access to, and use of, healthcare resources, and the impact FRDA has on their lifestyle. In Germany, doctors were asked to complete a Patient Record Form (PRF). Analyses of annual direct and indirect resource utilization were conducted for both countries while costs were calculated for the UK only. These figures were compared to the costs associated with Parkinson's disease; one of the most common neurodegenerative conditions and the one most similar in terms of disease progression. Results: The results showed that the annual burden of FRDA is significant and falls on the health and social care sectors, on society, on caregivers and on the individuals themselves. In the UK FRDA had a total annual cost per person of between £11,818 and £18,774 depending on whether the cost of long-term unemployment was included. Typically the largest component of direct costs is associated with professional care. Given the high proportion of children and young adults recruited and the long disease duration, (typically 40-50 years for FRDA, compared with 20 years for Parkinson's disease), these figures may underestimate the true burden of the disease. Conclusion: It is hoped that these estimates of resource utilization, can help in understanding the previously unquantified burden of FRDA. Given the long disease duration, management strategies should seek to minimise the impact of the condition on individuals and their caregivers, while maximising quality of life. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the habitat use and spatial distribution of the common buzzards (Buteo buteo) in Schleswig-Holstein, northern Germany in the autumn of 2000. The aim of the study is to evaluate the buzzards' territoriality and its effects for their use of space. The methods used in the study are multivariate Poison regression analysis and randomization tests. The study showed that territorial sedentary breeding pairs displaced nonbreeders and wintering birds into suboptimal habitats.

Objective Integrin α2β1 functions as a major receptor for type I collagen on different cell types, including fibroblasts and inflammatory cells. Although in vitro data suggest a role for α2β1 integrin in regulating both cell attachment and expression of matrix-degrading enzymes such as matrix metalloproteinases (MMPs), mice that lack the α2 integrin subunit ( Itga2−/− mice) develop normally and are fertile. We undertook this study to investigate the effect of Itga2 deficiency in 2 different mouse models of destructive arthritis: the antigen-induced arthritis (AIA) mouse model and the human tumor necrosis factor α (TNFα)-transgenic mouse model. Methods AIA was induced in the knee joints of Itga2−/− mice and wild-type controls. Human TNF-transgenic mice were crossed with Itga2−/− mice and were assessed clinically and histopathologically for signs of arthritis, inflammation, bone erosion, and cartilage damage. MMP expression, proliferation, fibroblast attachment, and ERK activation were determined. Results Under arthritic conditions, Itga2 deficiency led to decreased severity of joint pathology. Specifically, Itga2−/− mice showed less severe clinical symptoms and dramatically reduced pannus formation and cartilage erosion. Mice lacking α2β1 integrin exhibited reduced MMP-3 expression, both in their sera and in fibroblast-like synoviocytes (FLS), due to impaired ERK activation. Further, both the proliferation and attachment of FLS to cartilage were partially dependent on α2β1 integrin in vitro and in vivo. Conclusion Our findings suggest that α2β1 integrin contributes significantly to inflammatory cartilage destruction by promoting fibroblast proliferation and attachment and MMP expression. [ABSTRACT FROM AUTHOR]

Auditory perception with cochlear implants (CIs) enables the majority of deaf children with normal learning potential to develop (near) age-appropriate spoken language. As a consequence, a large proportion of children now attend mainstream education from an early stage. The acoustical environment in kindergartens and schools, however, might be detrimental for children with hearing loss. This paper considers the progress and needs of children with CIs in mainstream education, using the Screening Instrument for Targeting Educational Risk and the assessment of mainstream progress. Academic skills develop quite swiftly, while on the other hand, communicative skills lag behind. The needs of children with CIs are rather subtle and their communicative abilities which show delay may be camouflaged by good speech, spoken language, and academic skills that are at a higher level than observed in the past. One reason for the delay in communicative difficulties may be the difficulty for deaf children with implants to learn incidentally or from informal interactions in noisy classrooms. These findings are considered relevant for the practice in mainstream settings. The more subtle the needs of these children with CIs, the more difficult it is for the educational environment to provide effective support. The authors argue for an ongoing teacher training programme that focuses on these issues. [ABSTRACT FROM AUTHOR]

This paper discusses aspects related to the green technology sector (GT sector) in Germany. In a first step institutional reforms enabling diffusion of green technologies are analyzed. Cost arguments are also taken into account. In a second step a theoretical model developed by Tanguay et al. (Public Choice 120:1-27, ) is modified in order to evaluate the efficiency of the institutional setting in a political economy framework. The model is able to show that command and control policies (CCPs) are accompanied by cost-inefficiencies depending on the political weight of technology related interests groups. We further come to the result that relatively high marginal production costs may generate suboptimal high diffusion of a certain GT j. For relatively low marginal production costs policy induced demand may also be too low. [ABSTRACT FROM AUTHOR]

. This paper studies ethnic discrimination in Germany's labour market with a correspondence test. We send two similar applications to each of 528 advertisements for student internships, one with a Turkish-sounding and one with a German-sounding name. A German name raises the average probability of a callback by about 14%. Differential treatment is particularly strong and significant in smaller firms at which the applicant with the German name receives 24% more callbacks. Discrimination disappears when we restrict our sample to applications including reference letters which contain favourable information about the candidate's personality. We interpret this finding as evidence for statistical discrimination. [ABSTRACT FROM AUTHOR]

An essay is presented on the life and works of German scholar Aby Warburg who illuminates the importance of material forms of writing even in the digital era. It states that Warburg defied the wish of his family to remain kosher or Jew after his arrival at the University of Bonn. It says that the religion issue of Warburg haunted him during his collapse, in which Warburg says that at the bottom of his soul he is a Christian. It explores the engagement of Warburg in Hopi language and people.