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Political theorists tend to dismiss the concept of constitutional patriotism for two main reasons. On the one hand, constitutional patriotism — understood as a post- national, universalist form of democratic political allegiance — is rejected on account of its abstract quality. On the otherhand, it is argued that constitutional patriotism, while apprearing universalist, is in fact particular through and through. According to this genealogical critique, it is held that constitutional patriotism might have been appropriate in the context when it originated — namely West Germany, a half-nation with a deeply compromised sense of nationality on account of the Nazi past — but it is not universally applicable. This article reconstructs the origins of constitutional patriotism arguing that both the 'protective' and state- centred patriotism of Dolf Sternberger, and the 'purifying' patriotism of Jurgen Habermas — focused mainly on the public sphere — can indeed be understood as relying on 'supplements of particularily'. However, there are also normative connections between universalist constitutional morality and militant democracy on the one hand, and universalist constitutionalist morality and an imperative to remember on the other. Thus, the genealogical critique by itself is insufficient to invalidate the idea of constitutional patriotism. [ABSTRACT FROM AUTHOR]

The cost-benefit ratio of heathland maintenance measures was assessed in the Lueneburg Heath nature reserve in North-West Germany. This nature reserve contains large areas of heathland and is of substantial ecological and historical importance. The heathland can only be preserved by regular maintenance. For this assessment the costs of the maintenance measures were traced and a survey of visitors was carried out. The willingness-to-pay of the visitors for the heathland maintenance was determined as an assessment of the benefit created. Furthermore, the social acceptance of each maintenance measure was examined as this variable can influence the economic data considerably. These aspects represent a basis for the assessment of the net costs and benefits and for the calculation of the net present value (NPV) provided by the maintenance of the area. The results show a substantial positive net benefit of the heathland maintenance as a whole and varying acceptance of the different maintenance measures. [ABSTRACT FROM AUTHOR]

This article analyses the peculiar nature of the political thought of the leading activists of the German '68. It first discusses—and then partially dismisses—a number of common interpretations of the 'events', not least because previous accounts have paid insufficient attention to the actual political thought of the protagonists of '68. Three strands of '68 theorizing (and their limits) are then analysed: the legal road to socialism proposed by the 'Marburg school' of Wolfgang Abendroth, the anti-parliamentarianism of Johannes Agnoli and the anti-authoritarian guerilla strategy against 'integral étatism' put forward by Rudi Dutschke and Hans-Jürgen Krahl. Political thought in turn has to be understood as necessarily interacting with the 'events' of '68. When the main theories were unable to locate a new revolutionary subject and to solve the much-debated question of how to organize the movement, '68 intellectuals put their faith in events, occasions and direct action to reshape theory. In the end, this strategy yielded further (terrorist) 'events', a large left-wing counter-milieu largely free from theory and a persistent group ideology of personal convictions, also largely divorced from theorizing. [ABSTRACT FROM AUTHOR]

The article focuses on constitutional patriotism during the Bonn Republic, which refers to a form of political belonging centered on democratic principles and the achievements of the West German constitution. The German citizenship law was amended ten years after unification in 1990. Integration focused on the notion that immigrants must assimilate to the German "Leitkultur," coined by German political scientist Bassam Tibi in 1997.

The article presents information on the economic situation of Germany in the 21st century with special attention to the effect of the European financial crisis and the role of the European Union. Other topics mentioned in this article include welfare states, the German exports, and the German economic policy.

Background Because of the increasing numbers of congenital patients surviving into adulthood, early diagnosis and prevention of acquired cardiovascular disease is reasonable. The aim of this study was to detect diagnostic subgroups of adults with congenital heart disease (ACHD) that have increased carotid intima-media thickness (cIMT), a subclinical marker of cardiovascular damage. Methods and Results This study enrolled 831 ACHD patients (392 women, aged 38.8±11.7 years) from May 2015 to February 2019 at their regular outpatient visit. Far wall cIMT was measured using a semiautomatic ultrasound system at 4 angles. Age, sex, height, weight, blood pressure, smoking status, and antihypertensive medication were registered and entered in a multiple linear regression model to compare diagnostic subgroups to 191 healthy controls (111 women, aged 36.7±13.5 years). There were no significant differences in cIMT of ACHD (0.538±0.086 mm) compared with healthy controls (0.541±0.083 mm; P =0.649) after adjusting for the aforementioned covariates. Only patients with coarctation of the aorta showed significantly higher cIMT values (0.592±0.075 mm; P <0.001) compared with healthy controls. In addition, ACHD patients who were men ( P =0.032), older ( P <0.001), and were prescribed antihypertensive medications ( P =0.003) were all found to have thicker cIMT values. Conclusions Overall, we determined that within the ACHD cohort, only those patients with a history of coarctation have higher cIMT values. To better determine the mechanism of abnormal vasculature, further basic research is needed.

Aims: Age-related cardiovascular diseases are a relevant risk in the aging population of adults with congenital heart diseases (ACHD). Risk factors such as the metabolic syndrome (MetS) impact the risk of increased carotid intima-media thickness (cIMT) and thereby long-term cardiovascular diseases. The aim of the study was to assess MetS in ACHD and outline a possible association to cIMT., Methods and Results: In total, 512 ACHD (43.0 ± 9.6 years, 48.9% female) were screened for MetS by the standards of the International Diabetes Federation, and their cIMT by ultrasound from January 2017 to June 2019. MetS was prevalent in 72 (14.1%) of the ACHD population (34 female, 15.5%). Regarding severity class, patients with simple forms of CHD had a MetS prevalence of 11.8%, moderate 16.7%, and severe 13.8%. ACHD with MetS had significantly increased cIMT compared to ACHD without MetS (ACHD with MetS: 0.587 ± 0.079 mm, ACHD without MetS: 0.560 ± 0.087 mm, mean difference: 0.028 mm, P = .013). Such a difference in vascular structure corresponds to roughly five years of normal vascular aging of the vessels., Conclusion: ACHD with MetS have a thicker cIMT compared to ACHD without MetS. Screening for MetS and targeting risk factors in ACHD might help to prevent structural alterations of the vessels at an early stage., (© 2019 Wiley Periodicals, Inc.)

Background: With increased long-term survival, children with congenital heart disease (CHD) are at increased risk of early-onset adult cardiovascular disease. Carotid intima-media thickness (cIMT) is a surrogate marker of atherosclerosis. The aim of this present study was to detect high-risk diagnostic subgroups by measuring cIMT and determine its correlates in children with CHD and subgroups of CHD compared with healthy controls., Methods: This cross-sectional study enrolled 385 patients (138 girls) aged 5 to 18 years (12.3 ± 3.3) who were recruited between May 2015 and June 2017. cIMT was measured using B-mode ultrasound. Height, weight, body mass index, age, mean arterial pressure, pulse-wave velocity, and central systolic blood pressure were assessed as possible risk factors. For subgroup analyses, the patients were divided according to the type of their heart defects. Furthermore, patient data were compared with 86 healthy controls (35 girls, 12.8 ± 2.5 years) measured in the same time frame with identical ultrasound protocol., Results: Patients with CHD showed higher cIMT values (cIMT = 0.464 ± 0.039 mm) than healthy controls (cIMT = 0.449 ± 0.045 mm; P = 0.003), even after adjusting for sex, age, height, and weight differences. The highest cIMT values were found in children with coarctation of the aorta (cIMT = 0.486 ± 0.040 mm; P < 0.001) and transposition of the great arteries after arterial switch (cIMT 0.488 ± 0.041 mm; P < 0.001). No correlation was detected between cIMT and mean arterial pressure or pulse-wave velocity, but with central systolic blood pressure (P = 0.015; r = 0.150)., Conclusions: Children with CHD have increased cIMT compared with healthy controls, particularly those with coarctation of aorta and transposition of the great arteries., (Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Cervical dystonia is managed mainly by repeated botulinum toxin injections. We aimed to establish whether pallidal neurostimulation could improve symptoms in patients not adequately responding to chemodenervation or oral drug treatment., Methods: In this randomised, sham-controlled trial, we recruited patients with cervical dystonia from centres in Germany, Norway, and Austria. Eligible patients (ie, those aged 18-75 years, disease duration ≥3 years, Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] severity score ≥15 points) were randomly assigned (1:1) to receive active neurostimulation (frequency 180 Hz; pulse width 120 μs; amplitude 0·5 V below adverse event threshold) or sham stimulation (amplitude 0 V) by computer-generated randomisation lists with randomly permuted block lengths stratified by centre. All patients, masked to treatment assignment, were implanted with a deep brain stimulation device and received their assigned treatment for 3 months. Neurostimulation was activated in the sham group at 3 months and outcomes were reassessed in all patients after 6 months of active treatment. Treating physicians were not masked. The primary endpoint was the change in the TWSTRS severity score from baseline to 3 months, assessed by two masked dystonia experts using standardised videos, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00148889., Findings: Between Jan 19, 2006, and May 29, 2008, we recruited 62 patients, of whom 32 were randomly assigned to neurostimulation and 30 to sham stimulation. Outcome data were recorded in 60 (97%) patients at 3 months and 56 (90%) patients at 6 months. At 3 months, the reduction in dystonia severity was significantly greater with neurostimulation (-5·1 points [SD 5·1], 95% CI -7·0 to -3·5) than with sham stimulation (-1·3 [2·4], -2·2 to -0·4, p=0·0024; mean between-group difference 3·8 points, 1·8 to 5·8) in the intention-to-treat population. Over the course of the study, 21 adverse events (five serious) were reported in 11 (34%) of 32 patients in the neurostimulation group compared with 20 (11 serious) in nine (30%) of 30 patients in the sham-stimulation group. Serious adverse events were typically related to the implant procedure or the implanted device, and 11 of 16 resolved without sequelae. Dysarthria (in four patients assigned to neurostimulation vs three patients assigned to sham stimulation), involuntary movements (ie, dyskinesia or worsening of dystonia; five vs one), and depression (one vs two) were the most common non-serious adverse events reported during the course of the study., Interpretation: Pallidal neurostimulation for 3 months is more effective than sham stimulation at reducing symptoms of cervical dystonia. Extended follow-up is needed to ascertain the magnitude and stability of chronic neurostimulation effects before this treatment can be recommended as routine for patients who are not responding to conventional medical therapy., Funding: Medtronic., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Declining activity in children over the past decades is thought to be one of the main risk factors for an early development of exercise intolerance and obesity. Taking this background into account, this prospective study investigated the seasonal change of children's physical activity and its association with objective measures of exercise capacity., Methods: A total of 96 children from two schools in Munich (42 girls, age 12.4 ± 0.8 y) underwent a cardiopulmonary exercise test (CPET) and an assessment of their daily activities (school sport, club sport, leisure sport) twice. Baseline testing was conducted in summer 2011. Follow-up examination was performed during winter 2012., Results: From summer to winter, self-reported sporting activity decreased from 10.6 ± 4.1 to 8.5 ± 4.3 h/wk (P < 0.001) as school sport (P < 0.001) and leisure sport activities (P = 0.002) decreased, but the activity associated with club sport did not (P = 0.700). In parallel, peak oxygen uptake (VO2) declined from 102.0 ± 17.5 to 96.9 ± 17.9 % of predicted (P < 0.001). This decline in VO2 was associated with a reduction in overall sporting activity (r = 0.234; P < 0.032)., Conclusion: Enhancing sporting activity in children during winter might be important to maintaining their exercise capacity.

Purpose: In computed tomography (CT), metal objects in the region of interest introduce data inconsistencies during acquisition. Reconstructing these data results in an image with star shaped artifacts induced by the metal inconsistencies. To enhance image quality, the influence of the metal objects can be reduced by different metal artifact reduction (MAR) strategies. For an adequate evaluation of new MAR approaches a ground truth reference data set is needed. In technical evaluations, where phantoms can be measured with and without metal inserts, ground truth data can easily be obtained by a second reference data acquisition. Obviously, this is not possible for clinical data. Here, an alternative evaluation method is presented without the need of an additionally acquired reference data set., Methods: The proposed metric is based on an inherent ground truth for metal artifacts as well as MAR methods comparison, where no reference information in terms of a second acquisition is needed. The method is based on the forward projection of a reconstructed image, which is compared to the actually measured projection data., Results: The new evaluation technique is performed on phantom and on clinical CT data with and without MAR. The metric results are then compared with methods using a reference data set as well as an expert-based classification. It is shown that the new approach is an adequate quantification technique for artifact strength in reconstructed metal or MAR CT images., Conclusions: The presented method works solely on the original projection data itself, which yields some advantages compared to distance measures in image domain using two data sets. Beside this, no parameters have to be manually chosen. The new metric is a useful evaluation alternative when no reference data are available.

Objective: The purpose of this longitudinal study was to assess improvements in exercise performance and quality of life in patients with Ebstein anomaly after surgical intervention., Methods: In 21 patients with Ebstein anomaly (between 6 and 59 years of age; 16 female, 5 male) who underwent surgery for tricuspid regurgitation and, if present, closure of an interatrial shunt, a cardiopulmonary exercise test and a quality-of-life assessment by the Medical Outcomes Study 36 item short form was performed prior to and 6 to 18 months after surgery., Results: After surgery, peak oxygen uptake increased from 68.4% of predicted to 77.3% of predicted (P = .009), and ventilatory efficiency (VE/VCO(2) slope) improved from 32.5 to 29.3 (P = .001). In 14 patients with additional interatrial shunt closure, oxygen saturation improved from 95% to 99% at rest (P = .003) and from 88% to 99% under peak exercise (P = .003). Improvements in VE/VCO(2) slope were similar in patients who had undergone primary surgery (P = .005) or reoperation (P = .018). Increase in exercise capacity was also similar in both groups but failed significance in both (primary surgery, P = .064; reoperation, P = .063). There was no difference between tricuspid valve repair and replacement in the short-term follow-up. Self-estimated quality of life was fairly good prior to and after surgery. Only in the single question about health transition at follow-up did the patients confirm an improved situation after surgery., Conclusions: Patients with Ebstein anomaly and severe tricuspid regurgitation draw clinical benefit from surgical intervention as measured on exercise testing. This holds true for primary surgery and for reoperation., (Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Aims: previous studies have established an association between exercise intolerance and increased morbidity and mortality in congenital heart disease patients. We aimed to clarify if exercise intolerance is associated with poor outcome in Fontan patients and to identify risk factors for mortality, transplantation, and cardiac-related hospitalization., Methods and Results: a total of 321 Fontan patients (57% male, mean age 20.9 ± 8.6 years) who underwent cardiopulmonary exercise testing (CPET) at four major European centres between 1997 and 2008 were included. During a median follow-up of 21 months, 22 patients died and 6 patients underwent cardiac transplantation (8.7%), resulting in an estimated 5-year transplant-free survival of 86%. Parameters of CPET were strongly related to increased risk of hospitalization, but-with the exception of heart rate reserve-unrelated to risk of death or transplantation. In contrast, patients with clinically relevant arrhythmia had a 6.0-fold increased risk of death or transplantation (P < 0.001). Furthermore, patients with atriopulmonary/-ventricular Fontan had a 3.7-fold increased risk of death or transplantation compared with total cavopulmonary connection patients (P= 0.009). The combination of clinically relevant arrhythmia, atriopulmonary/-ventricular Fontan, and signs of symptomatic or decompensated heart failure was associated with a particularly poor outcome (3-year mortality 25%)., Conclusion: on short-term follow-up, most parameters of CPET are associated with increased risk of hospitalization but not death or transplantation in contemporary Fontan patients. Only decreased heart rate reserve and a history of clinically relevant arrhythmia, atriopulmonary/-ventricular Fontan, and/or heart failure requiring diuretic therapy are associated with poor prognosis, potentially identifying patients requiring medical and/or surgical attention.