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Synthetic cannabinoids become increasingly popular as a supposedly safe and legal alternative to cannabis. In order to circumvent the German New Psychoactive Substances Law, producers of so-called herbal mixtures rapidly design new substances with structural alterations that are not covered by the law. Acting as full agonists not only at the cannabinoid receptors 1 and 2, synthetic cannabinoids might have not only desired mental but also serious physical adverse effects. However, knowledge of adverse effects of specific substances is sparse and incomplete. This also accounts for 5F-Cumyl-PEGACLONE, a synthetic cannabinoid, which has been detected regularly in Germany in recent years. By using an animal model, the isolated perfused Langendorff heart, the study at hand aimed on finding out more about possible cardiovascular adverse effects of 5F-Cumyl-PEGACLONE. Hearts of male Wistar rats, which were excised postmortem, were exposed to two different concentrations of 5F-Cumyl-PEGACLONE: 13 hearts were exposed to 50 ng/ml and 12 hearts were exposed to 100 ng/ml. Thirteen control hearts were merely exposed to an additional amount of buffer solution. Functional parameters heart rate, minimal and maximum left ventricular pressure and coronary flow were documented at pre-defined time points during and after the administration of 5F-Cumyl-PEGACLONE/additional buffer solution. Electrocardiograms (ECGs) were documented throughout the experiments and evaluated afterwards. Kruskal–Wallis analysis was performed for each functional parameter as well as for the duration of the QRS complexes and the duration of RR intervals as derived from the ECGs. Furthermore, a multivariate analysis, comprising all functional and ECG parameters, was performed. Kruskal–Wallis analysis revealed only single significant p-values for QRS duration and minimum left ventricular pressure that did not pass a Bonferroni test. The results of the multivariate approach were also comparably homogeneous, but still the model correctly recognized hearts exposed to 100 ng/ml of 5F-Cumyl-PEGACLONE more often than hearts exposed to the low concentration of 5F-Cumyl-PEGACLONE or additional buffer solution. Evaluation of the ECGs presented single cases of ST depression and QT prolongation. Though certainly not unambiguous, these findings support the assumption that 5F-Cumyl-PEGACLONE can cause severe, if not lethal, cardiac adverse effects like arrhythmias or myocardial infarctions especially if it is consumed in combination with other drugs like alcohol or if the consumer suffers from pre-existing heart diseases. [ABSTRACT FROM AUTHOR]

Prior to the world-wide dominance of F. ×ananassa in strawberry production, native species had been cultivated in European gardens for centuries. Especially the musk strawberry (F. moschata) had been highly appreciated due to its fruit size and extraordinary aroma. Detailed studies on the diversity of the species' fruit aroma are lacking, although breeding aims to improve strawberry aroma by complex crossings during recent years. Today a few cultivars, abandoned synanthropic occurrences and native populations of this species exist in Germany. Here we characterised aroma profiles of F. moschata accessions by analysing Volatile Organic Compounds. In particular, differences between native and cultivated accessions as well as the diversity in aroma profiles of native populations were investigated. Profiles of Volatile Organic Compounds were analysed by immersion stir bar sorptive extraction-gas chromatography-quadrupol mass spectrometry (imm-SBSE-GC-qMS). These data were compared with a genetic characterisation of samples based on eight microsatellite loci using univariate and multivariate statistical analyses. High amounts of furanones and the key compound methyl anthranilate were characteristic for the aroma profile of F. moschata. We detected a considerable diversity of Volatile Organic Compounds among accessions of F. moschata, particularly among genetically distinct samples from the same population. Native accessions contained more terpenoids but less esters and were moderately differentiated from cultivated samples. The observed patterns of Volatile Organic Compounds indicate that cultivated accessions had been selected for favourable aroma profiles and thus showing traces of domestication. Moreover, native populations harbour a great diversity of Volatile Organic Compounds, which could be also considered for future breeding efforts. [ABSTRACT FROM AUTHOR]

As part of a third-party funded project, expert opinions according to the Istanbul Protocol (IP) standards were compiled in Germany on a larger scale for the first time. The assessment process was initiated for 130 project participants. Statistical analysis on numerous variables was performed to test the impact of the expert opinions, foremost of the forensic medical expert opinions, on the individuals' asylum proceedings. The variables were drawn from forensic medical expert opinions and reports of findings, questionnaires for the study participants' counsellors in the project and a query on the asylum status of the study participants. Regression analysis and bivariate analysis on two dependent variables—subjective impact on the asylum procedure from the counsellors' point of view and objective change in the asylum status—were performed to test for an influence on asylum procedures. No statistically significant results were obtained for the objective change of the study participants' asylum status. For the subjective dependent variable, a positive prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and highest IP grade; a negative prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and use of IP grading. Apart from the statistical analysis, a positive effect of the assessment on the psychosocial well-being of the study participants could be demonstrated. The results differed from other European studies which demonstrated a correlation between the objective outcome of an asylum procedure (asylum status) and, for example, specific types of violence or the number of documented injuries. Differences also occurred in the use of the plausibility grades proposed by the IP, which questions their use in cases in which the reported torture happened a relevant time ago. Therefore, compiling individually worded evaluations instead of using the IP grading system—if possible, by an experienced forensic physician—is recommended in this scenario. Still, the assessment of alleged torture experiences should follow the IP guidelines, since psychological assessments are of especially high importance in cases with healed physical injuries and since the results also demonstrated a positive effect on the psychosocial well-being of the study participants. [ABSTRACT FROM AUTHOR]

Purpose: In Germany, colorectal robot-assisted surgery (RAS) has found its way and is currently used as primary technique in colorectal resections at our clinic. We investigated whether RAS can be extensively combined with enhanced recovery after surgery (ERAS®) in a large prospective patient group. Methods: Using the DaVinci Xi surgical robot, all colorectal RAS from 09/2020 to 01/2022 were incorporated into our ERAS® program. Perioperative data were prospectively recorded using a data documentation system. The extent of resection, duration of the operation, intraoperative blood loss, conversion rate, and postoperative short-term results were analyzed. We documented the postoperative duration of Intermediate Care Unit (IMC) stay and major and minor complications according to the Clavien–Dindo classification, anastomotic leak rate, reoperation rate, hospital-stay length, and ERAS® guideline adherence. Results: One hundred patients (65 colon and 35 rectal resections) were included (median age: 69 years). The median durations of surgery were 167 min (colon resection) and 246 min (rectal resection). Postoperatively, four patients were IMC-treated (median stay: 1 day). In 92.5% of the colon and 88.6% of the rectum resections, no or minor complications occurred postoperatively. The anastomotic leak rate was 3.1% in colon and 5.7% in rectal resection. The reoperation rate was 7.7% (colon resection) and 11.4% (rectal resection). The hospital stay length was 5 days (colon resection) and 6.5 days (rectal resection). The ERAS® guideline adherence rate was 88% (colon resection) and 82.6% (rectal resection). Conclusion: Patient perioperative therapy per the multimodal ERAS® concept is possible without any problems in colorectal RAS, leading to low morbidity and short hospital stays. [ABSTRACT FROM AUTHOR]

Background: Workplace violence is widespread, but studies on workplace violence against health professions in outpatient settings are sparse. We aimed to examine, for the first time, the prevalence of workplace violence against medical assistants as well as potential sociodemographic, occupational and health-related correlates of the exposure to workplace violence. Methods: We used data from a survey (03–05/2021) among medical assistants in Germany (n = 424). We assessed the 12–month prevalence (yes/no) of verbal violence, physical violence, and sexual harassment as well as the types of perpetrators of workplace violence. Further, information was gathered on sociodemographic (e.g., age, educational level), occupational (e.g., years in job), and mental health-related factors (i.e., anxiety, depression). The 12–month prevalences of the different types of workplace violence were merged into a single variable ("any workplace violence" vs. none) for association analysis. We ran multivariable Poisson regression models to examine potential associations between sociodemographic and occupational correlates (i.e., independent variables) with any workplace violence as dependent variable and in addition between any workplace violence (independent variable) and dichotomized mental health as dependent variable. Results: Overall, 59.4% of the medical assistants reported verbal violence, 5.9% reported physical violence, 3.8% reported sexual harassment, and 60.1% reported any workplace violence in the previous 12 months. Patients were reported to be the main perpetrators, followed by patients' relatives. Younger age, being single, and working in a medical care center were sociodemographic and occupational correlates of workplace violence (PRs ≥ 1.27). Workplace violence was significantly associated with mental health variables (PRs ≥ 1.72). Conclusion: Medical assistants experience workplace violence, in particular verbal violence. To devise preventive measures, prospective studies are needed to confirm the potential risk groups for workplace violence and the potential mental health sequels of workplace violence observed in our study. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of modern perioperative treatment concepts has been demonstrated in several studies and meta-analyses. Despite good evidence, limited implementation of the fast track (FT) concept is still a widespread concern. To assess the status quo in Austrian and German hospitals, a survey on the implementation of FT measures was conducted among members of the German Society of General and Visceralsurgery (DGAV), the German Society of Coloproctology (DGK) and the Austrian Society of Surgery (OEGCH) to analyze where there is potential for improvement. Methods: Twenty questions on perioperative care of colorectal surgery patients were sent to the members of the DGAV, DGK and OEGCH using the online survey tool SurveyMonkey®. Descriptive data analysis was performed using Microsoft Excel. Results: While some of the FT measures have already been routinely adopted in clinical practice (e.g. minimally invasive surgical approach, early mobilization and diet buildup), for other components there are discrepancies between current recommendations and present implementation (e.g. the use of local nerve blocks to provide opioid-sparing analgesia or the use of abdominal drains). Conclusion: The implementation of the FT concept in Austria and Germany is still in need of improvement. Particularly regarding the use of abdominal drains and postoperative analgesia, there is a tendency to stick to traditional structures. To overcome the issues with FT implementation, the development of an evidence-based S3 guideline for perioperative care, followed by the founding of a surgical working group to conduct a structured education and certification process, may lead to significant improvements in perioperative patient care. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has led to global changes in healthcare systems. The purpose of this study was to investigate the effects on surgical care of patients. Methods: We performed a retrospective analysis of routine data from the largest hospital group in Germany (68 acute hospitals). Included were inpatients who underwent cholecystectomy between March 19, 2020 (beginning of the first lockdown in Germany) and September 22, 2020. These patients were compared with those treated in the same interval in 2019. Results: In the 2020 study period, 4035 patients met the inclusion criteria (2019: 4526 patients). During the first lockdown, there was a significant reduction in the number of cholecystectomies performed (51.1% decrease). More patients with a higher risk profile underwent urgent operations, which were accompanied by a significant increase in conversion from laparoscopic to open cholecystectomy. The patients were treated as inpatients for a longer duration than 2019, and the mortality rate increased significantly to 1.3% (2019: 0.1%). The complication rate also showed a significant increase. After the end of the first lockdown, daily admission rates normalized very quickly. However, it was not possible to fully address the backlog of operations. Conclusion: There is still a "patient stagnation" 6 months after the first German lockdown. Extrapolated to the national level, this corresponds to almost 21,000 fewer cholecystectomies performed in Germany in 2020. It remains to be seen whether surgical rates will return to pre-pandemic levels and whether complications will arise in the future due to the lack of operations. [ABSTRACT FROM AUTHOR]

Population genetic and ecological data may help to control invasive plants, which are considered a major threat to natural habitats. In contrast to expected bottleneck events, genetic diversity of such invasive populations may be high due to extensive propagule pressure or admixture. The ecological impact of invasive species has been broadly evaluated in the field; however, long‐term studies on the fate of invasive plants are scarce.We analysed genetic diversity and structure in invasive Spiraea tomentosa populations in eastern Germany and western Poland using Amplified Fragment Length Polymorphism. Potential hybridization between co‐occurring diploid Sp. tomentosa and tetraploid Sp. douglasii was investigated using Flow Cytometry. The genetic analyses were complemented by data from a 13‐year vegetation study in an area invaded by these Spiraea species.We found no evidence for hybridization between Spiraea species. In populations of Sp. tomentosa both genetic diversity (He = 0.26) and genetic structure (ΦPT = 0.27) were high and comparable to other outcrossing woody plants. Low levels of clonality, presence of seedlings and new patches in sites that had been colonized over the last 13 years imply that populations spread via sexual reproduction. In all habitat types, native species diversity declined following Sp. tomentosa invasion. However, detailed aerial mapping of a forest reserve with ongoing succession revealed that Spiraea spp. populations have declined over a 10‐year period.Despite its potential for dispersal and negative effects on native plant communities, invasive Spiraea populations may be controlled by increasing canopy cover in forest habitats. [ABSTRACT FROM AUTHOR]

Background: Majority of active tuberculosis (TB) cases in children in low-incidence countries are due to rapid progression of infection (latent TB infection (LTBI)) to disease. We aimed to assess common practice for managing paediatric LTBI in Austria, Germany and Switzerland prior to the publication of the first joint national guideline for paediatric TB in 2017. Methods: Online-based survey amongst pediatricians, practitioners and staff working in the public health sector between July and November 2017. Data analysis was conducted using IBM SPSS. Results: A total of 191 individuals participated in the survey with 173 questionnaires included for final analysis. Twelve percent of respondents were from Austria, 60% from Germany and 28% from Switzerland. Proportion of children with LTBI and migrant background was estimated by the respondents to be >50% by 58%. Tuberculin skin test (TST) and interferon-γ-release-assay (IGRA), particularly Quantiferon-gold-test, were reported to be used in 86% and 88%, respectively. In children > 5 years with a positive TST or IGRA a chest x-ray was commonly reported to be performed (28%). Fifty-three percent reported to take a different diagnostic approach in children ≤ 5 years, mainly combining TST, IGRA and chest x-ray for initial testing (31%). Sixty-eight percent reported to prescribe isoniazid-monotherapy: for 9 (62%), or 6 months (6%), 31% reported to prescribe combination therapy of isoniazid and rifampicin. Dosing of isoniazid and rifampicin below current recommendations was reported by up to 22% of respondents. Blood-sampling before/during LTBI treatment was reported in >90% of respondents, performing a chest-X-ray at the end of treatment by 51%. Conclusion: This survey showed reported heterogeneity in the management of paediatric LTBI. Thus, regular and easily accessible educational activities and national up-to-date guidelines are key to ensure awareness and quality of care for children and adolescents with LTBI in low-incidence countries. [ABSTRACT FROM AUTHOR]

Background: During the early phase of the Covid-19 pandemic, reductions of hospital admissions with a focus on emergencies have been observed for several medical and surgical conditions, while trend data during later stages of the pandemic are scarce. Consequently, this study aims to provide up-to-date hospitalization trends for several conditions including cardiovascular, psychiatry, oncology and surgery cases in both the in- and outpatient setting. Methods and findings: Using claims data of 86 Helios hospitals in Germany, consecutive cases with an in- or outpatient hospital admission between March 13, 2020 (the begin of the "protection" stage of the German pandemic plan) and December 10, 2020 (end of study period) were analyzed and compared to a corresponding period covering the same weeks in 2019. Cause-specific hospitalizations were defined based on the primary discharge diagnosis according to International Statistical Classification of Diseases and Related Health Problems (ICD-10) or German procedure classification codes for cardiovascular, oncology, psychiatry and surgery cases. Cumulative hospitalization deficit was computed as the difference between the expected and observed cumulative admission number for every week in the study period, expressed as a percentage of the cumulative expected number. The expected admission number was defined as the weekly average during the control period. A total of 1,493,915 hospital admissions (723,364 during the study and 770,551 during the control period) were included. At the end of the study period, total cumulative hospitalization deficit was -10% [95% confidence interval -10; -10] for cardiovascular and -9% [-10; -9] for surgical cases, higher than -4% [-4; -3] in psychiatry and 4% [4; 4] in oncology cases. The utilization of inpatient care and subsequent hospitalization deficit was similar in trend with some variation in magnitude between cardiovascular (-12% [-13; -12]), psychiatry (-18% [-19; -17]), oncology (-7% [-8; -7]) and surgery cases (-11% [-11; -11]). Similarly, cardiovascular and surgical outpatient cases had a deficit of -5% [-6; -5] and -3% [-4; -3], respectively. This was in contrast to psychiatry (2% [1; 2]) and oncology cases (21% [20; 21]) that had a surplus in the outpatient sector. While in-hospital mortality, was higher during the Covid-19 pandemic in cardiovascular (3.9 vs. 3.5%, OR 1.10 [95% CI 1.06–1.15], P<0.01) and in oncology cases (4.5 vs. 4.3%, OR 1.06 [95% CI 1.01–1.11], P<0.01), it was similar in surgical (0.9 vs. 0.8%, OR 1.06 [95% CI 1.00–1.13], P = 0.07) and in psychiatry cases (0.4 vs. 0.5%, OR 1.01 [95% CI 0.78–1.31], P<0.95). Conclusions: There have been varying changes in care pathways and in-hospital mortality in different disciplines during the Covid-19 pandemic in Germany. Despite all the inherent and well-known limitations of claims data use, this data may be used for health care surveillance as the pandemic continues worldwide. While this study provides an up-to-date analysis of utilization of hospital care in the largest German hospital network, short- and long-term consequences are unknown and deserve further studies. [ABSTRACT FROM AUTHOR]

Rivers and floodplains provide many regulating, provisioning and cultural ecosystem services (ES) such as flood risk regulation, crop production or recreation. Intensive use of resources such as hydropower production, construction of detention basins and intensive agriculture substantially change ecosystems and may affect their capacity to provide ES. Legal frameworks such as the European Water Framework Directive, Bird and Habitats Directive and Floods Directive already address various uses and interests. However, management is still sectoral and often potential synergies or trade‐offs between sectors are not considered. The ES concept could support a joint and holistic evaluation of impacts and proactively suggest advantageous options. The river ecosystem service index (RESI) method evaluates the capacity of floodplains to provide ES by using a standardized five‐point scale for 1 km‐floodplain segments based on available spatial data. This scaling allows consistent scoring of all ES and their integration into a single index. The aim of this article is to assess ES impacts of different flood prevention scenarios on a 75 km section of the Danube river corridor in Germany. The RESI method was applied to evaluate scenario effects on 13 ES with the standardized five‐point scale. Synergies and trade‐offs were identified as well as ES bundles and dependencies on land use and connectivity. The ratio of actual and former floodplain has the strongest influence on the total ES provision: the higher the percentage and area of an active floodplain, the higher the sum of ES. The RESI method proved useful to support decision‐making in regional planning. [ABSTRACT FROM AUTHOR]

In this study we present a unique 10 year climatology of severe convective storm tracks for a large European area covering Germany, France, Belgium and Luxembourg. For the period 2005–2014, a high-resolution hail potential composite of 1×1 km2 is produced from two-dimensional radar reflectivity and lightning data. Individual hailstorm tracks as well as their physical properties, such as radar reflectivity along the tracks, were reconstructed for the entire time period using the Convective Cell Tracking Algorithm (CCTA2D). A sea-to-continent gradient in the number of hail days per year is found to be present over the whole domain. In addition, the highest number of severe storms is found on the leeward side of low mountain ranges such as the Massif Central in France and the Swabian Jura in southwest Germany. A latitude shift in the hail peak month is observed between the northern part of Germany, where hail occurs most frequently in August, and southern France, where the maximum amount of hail is 2 months earlier. The longest footprints with high reflectivity values occurred on 9 June 2014 and on 28 July 2013 with lengths reaching up to 500 km. Both events were associated with hailstones measuring up to 10 cm diameter, which caused damage in excess of EUR 2 billion. [ABSTRACT FROM AUTHOR]

Background: Diverticular disease is one of the more common abdominal disorders. In 2016, approximately 130 000 patients received inpatient treatment for diverticular disease in Germany. The disease has a number of subtypes, each of which has an appropriate treatment. In this article, we present the current surgical indications and optimal timing of surgery for diverticular disease. Methods: This review is based on publications that were retrieved by an extensive, selective search in Medline and the Cochrane Library (1998-2018) for studies and guidelines with information on the indications for surgery in diverticular disease. Results: Studies of evidence grades 2 to 4 were available. Patients receiving a diagnosis of freely perforated diverticulitis and peritonitis (Classification of Diverticular Disease [CDD] type 2c) should be operated on at once. Covered perforated diverticulitis with a macroabscess (>1 cm, CDD type 2b) may be an indication for elective surgery after successful conservative treatment. New evidence from a randomized, controlled trial suggests that elective surgery should also be considered for patients with chronic recurrent diverticulitis (CDD type 3b). The decisive factor in such cases is the impairment of the quality of life for the individual patient. Elective surgery is indicated in chronic recurrent diverticulitis with complications (fistulae, stenoses). Asymptomatic diverticulosis (CDD type 0) and uncomplicated diverticulitis (CDD type 1) are not surgical indications. Likewise, in diverticular hemorrhage (CDD type 4), surgery is only indicated in exceptional cases, when conservative treatment fails. Conclusion: The surgical indication and the proper timing of surgery depend on the type of disease that is present. Future studies should more thoroughly investigate the effect of surgery on the quality of life in patients with the various types of diverticular disease. [ABSTRACT FROM AUTHOR]

In this study we present a unique 10-year climatology of severe convective storm tracks for a larger European area covering Germany, France, Belgium and Luxembourg. For the period 2005-2014, a high-resolution hail potential composite of 1 by 1 km2 is produced from two-dimensional reflectivity radar data and lightning data. Individual hailstorm tracks as well as their physical properties, such as radar reflectivity along the tracks were reconstructed for the entire time period using the Convective Cell Tracking Algorithm (CCTA2D). A sea-to-continent gradient in the number of hail days is present over the whole domain. In addition, the highest number of severe storms is found on the leeward side of low mountain ranges such as near the Massif Central in France and the Swabian Jura in southwest Germany. A latitude shift in the hail peak month is observed between the northern part of Germany where hail occurs most frequently in August, and southern France where the maximum of hail occurs two months earlier. The spatially most extended footprints with high reflectivity values occurred on 9 June 2014 and on 28 July 2013 with lengths reaching several hundreds of kilometers. Both events implied hailstones measuring up to 10 cm which caused damage in excess of 2 Billions Euros. [ABSTRACT FROM AUTHOR]

Background: Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 µg/m³ for fine dust particles smaller than 2.5 µm [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany. Methods: This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS). Results: Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mortality rises approximately 7% for every incremental long-term exposure to 5 µg/m³ PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 µg/m³ of PM2 5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits. Conclusion: It is very important for public health that the current EU standards for fine dust particles smaller than <2.5 µg are markedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO. [ABSTRACT FROM AUTHOR]

A century ago, Edmund Randerath (1899-1961), who was one of the pioneers in nephrology that provided indirect experimental proof for the glomerular origin of proteinuria, was born. In the first decades of this century, the concept prevailed that "nephrosis" was a process of primary tubular cell degeneration. In contrast to prevailing opinion, he interpreted these changes to be the result of the uptake and storage of serum proteins after they had been filtered in the glomerulus. Edmund Randerath proved the glomerular origin of proteinuria by astute experiments in amphibia. In the salamander, an intraperitoneal injection of albumin provoked the supposedly "degenerative" changes of tubular epithelial cells in only those nephrons that drained the coelomic cavity and were devoid of glomeruli, but not in those nephrons that were closed and attached to glomeruli. This observation provided incontrovertible evidence that the presence of serum proteins in tubular fluid was a prerequisite for the development of the tubular epithelial cell changes typically seen in nephrotic patients. [ABSTRACT FROM AUTHOR]

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Objectives: The educational climate in which future doctors are trained is an important aspect of medical education. In contrast to human medicine, it has been rather neglected in dental educational research. The aim of the study was to supplement this lack by applying and validating the Dundee Ready Education Environment Measure (DREEM) for the first time in a German-speaking sample of dental students. Methods: All dental students at the Medical Faculty of Heinrich-Heine-University Düsseldorf were asked to complete a German adaptation of the DREEM and the Düsseldorf Mission Statement Questionnaire (DMSQ) in a paper-pencil survey. Data from 205 participants were analysed. Psychometric validation included analysis of item homogeneity and discrimination, test reliability, criterion and construct validity (convergent, factorial). Results: DREEM item parameters were satisfactory, reliability (α = 0.87) and convergent validity (r = 0.66 with DMSQ) were also high. Factor analyses, however, yielded dimensions which did not fully correspond to the original DREEM subscales. Overall perception of the educational environment was positive (DREEM total score = 122.95 ± 15.52). Students in the clinical part of course rated the atmosphere more negatively, but their academic self-perception more positively than preclinical students. Conclusions: Showing satisfactory psychometric properties, DREEM proved suitable for assessing educational environments among dental students. Given the right circumstances, e.g., small and early clinically oriented classes, traditional curricula can generate positive environments. [ABSTRACT FROM AUTHOR]

The age of the victim plays a crucial role for the legal implications concerning pornography. Judges therefore often call on forensic experts to verify the age of individuals depicted on photographs or videos. However, there is no scientifically established protocol available for forensic practice in such cases. The conventional methods such as the evaluation of secondary sexual characteristics provide unsatisfactory results particularly when the legally relevant ages for child pornography (i.e. 14 and 18 years) are concerned. To overcome these limits, a European research group has explored the applicability of facial proportions as an age indicator on images. In this pilot study, standardized facial images of 353 females and 20 males from four age groups (6, 10, 14 and 18 years) were randomly selected for the metric analysis from a large data set including German, Italian and Lithuanian subjects. In this sample, several indices extracted from the frontal and lateral photographs were closely correlated to their respective indices taken from the living individuals. Furthermore, age-related changes were identified for indices taken from the photographs. The discriminant analysis showed that for the pooled sample, 60.3% of the cases were correctly classified into the respective age group. The percentage of correctly classified cases increased in the respective country samples as follows: 69.9% for Germany, 69.4% for Lithuania and 80.5% for Italy. The present study suggests that the metric assessment of the face may be used for age estimation on images. Nonetheless, more work needs to be done in order to verify the reliability of these findings on a large sample. [ABSTRACT FROM AUTHOR]

Aims: The teachers' perspectives of the educational environment have as yet only been sparsely considered. This study aimed at validating the first German version of the Dundee Ready Education Environment Measure (DREEM) from the points of view of both students and teachers. Methods: Data from 1119 students and 258 teachers were available for analysis. Psychometric validation included the analysis of homogeneity and discrimination at item level as well as reliability (Cronbach's α), criterion and construct validity at test level. Effect sizes were calculated and the independent samples t-test was used for statistical inference testing of mean differences between two groups. Results: Item characteristics were satisfactory in both samples. Reliability was high with α == 0.92 (students) and 0.94 (teachers), respectively. Factor analyses revealed five dimensions which slightly diverged from the five subscales postulated by the DREEM authors though. The environment was evaluated significantly ( p < 0.001) more positively by teachers ( M == 117.63) than by students ( M == 109.75). Further significant differences were observed with regard to gender, mother language, stage of studies and previous professional training among others. Conclusions: With convincing psychometric properties at item and test levels, the suitability of DREEM not only for students but also for teachers to assess the educational environment has been demonstrated. [ABSTRACT FROM AUTHOR]

We used multiple regression, path analysis and non-parametric selection surface visualisation to investigate natural and sexual selection and, in addition, cross-sectional female choice statistics to analyse female choice in a wild population of the field cricket Gryllus campestris L. in central Germany. Adults (167 males, 75 females) were individually marked and followed daily over the entire adult stage. Two morphological traits (pronotum width, body condition) and two behavioural traits (burrow occupation time, daily displacement) were measured for each male and used in selection analyses. Individuals mated multiply and male mating success was strongly right skewed with less than 6% of the population achieving 50% of the copulations. In males, analysis of natural selection in terms of lifespan revealed positive directional selection on burrow occupation time and stabilising selection on daily displacement. Analysis of sexual selection in term of mating success showed positive directional selection on pronotum width and lifespan. Path analysis confirmed the close association between natural and sexual selection and illustrated indirect effects of the behavioural variables on mating success via their effect on lifespan. Multiple regression analysis further indicated positive quadratic (disruptive) sexual selection on lifespan but the non-parametric cubic spline regression showed this to be an artefact of the quadratic approach. In fact, lifespan was under “threshold selection” i.e. it was not under selection below a threshold and under positive directional sexual selection above the threshold. A positive correlational selection gradient between lifespan and body condition revealed that a high body condition is advantageous among long-lived males. Female choice statistics showed that females chose large and heavy males in the beginning of the season only and that choosiness decreases with increasing distance to potential alternative mates. Our findings highlight the benefits of combining several analytical methods to uncover selection patterns and to avoid misinterpretations based on single methods. [ABSTRACT FROM AUTHOR]

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The confrontation with critically ill newborns, infants and small children is rare and poses a particular challenge for the medical team. Confident technical and non-technical skills are essential for successful emergency treatment. Paediatric simulators facilitate a didactic infrastructure, linking textbook theory with experience-based practice. To summarize the current status of paediatric simulation in Germany, Austria and Switzerland an online survey of all associated centres was conducted. Paediatric simulation is currently available at 24 centres, which have 39 paediatric simulators available, including 8 for newborns, 26 for infants and 5 for children. A certain congruence of standards is detectable among these centres and most instructors have completed a specialized instructor training. Of the instructors 26% are specialized nursing personnel and 67% are physicians of which most are paediatricians and anaesthesiologists. Many centres (38%) operate solely by means of the enthusiastic dedication of the employees who organize various activities during their free time. Nearly all centres (92%) place particular emphasis on non-technical skills which include the interpersonal aspects of crisis resource management. Video-supported debriefing is considered to be the basis for effective training. Within the scope of the recently established PaedSim project the curricula of paediatric simulation courses should be more structured and internationally standardized, thereby increasing both efficacy and sustainability of these training programs. [ABSTRACT FROM AUTHOR]

We analyze whether superstar effects (disproportionate income effects) exist in the deep-pocket market for quality gastronomy in Germany, and what factors determine the stars' rents. In quality gastronomy, the stars can be the restaurant chefs. Building on Rosen's (1981) and Adler's (1985) central theories on star effects, we explore two potential sources of stardom. Following Rosen (1981) , we test if quality differences between the chefs' performances have a direct effect on financial rewards (“direct superstar effect”). Following Adler (1985) , we assess the income effect of a media presence of chefs (“classical Superstar effect”). Through this, we deal with an economic issue of general interest: does it pay more to develop your skills in your core business to perfection, or to maintain the current level of skills and invest in self-marketing? Analyzing a sample of 288 restaurants, for potential star effects by differences in quality, we find that higher quality increases chefs' revenues. Yet, revenues do not increase disproportionately, and achieving higher quality requires substantial investments in exquisite ingredients, excellent staff and prime ambience. This problem, also called the “agony of the stars”, has manifested itself in the bankruptcies of European three-star restaurants in recent years. As regards potential star effects by differences in media presence, we observe a positive impact of TV appearances on financial rewards. Yet, these income effects are moderate as well, so there is neither a direct, nor a classical superstar effect in quality gastronomy. We argue that although both perfection of skills and self-marketing have similarly positive income effects, self-marketing seems both the less risky and the less stressful way to enhance income. [ABSTRACT FROM AUTHOR]

The contribution describes the efforts of the Library Association of Thuringia (as part of the German Library Association) that led to the passing of the Library Law by the parliament of Thuringia on the 4th of july. The contribution starts with the outline for a library law by the Library Association from spring 2006. In addition the „library speech“ at Weimar from the Federal President Horst KShler in 2007 and the recommendations of the inquiry commission „Culture in Germany“ of the German Parliament in the respect of libraries are discussed. The Library Law itself is critically discussed and also the shortcomings are mentioned. [ABSTRACT FROM AUTHOR]

The Hypertension and Diabetes Screening and Awareness (HYDRA) study is a cross-sectional point-prevalence study performed in September 2001; 45 125 primary care attendees were recruited from a representative nationwide sample of 1912 primary care practices in Germany. Around 42% of all patients presenting in these practices had hypertension (WHO definition). In approximately 70% of these patients, hypertension was diagnosed by doctors and 84% of diagnosed patients were on antihypertensive medication, but in less than 30% of treated patients was blood pressure controlled (< 140/90 mmHg). The control rate in all patients presenting with hypertension (including those patients unrecognized) was as low as 19%. The present analysis aimed to find explanations for this unsatisfactory outcome of hypertension control. The main finding was that the rate of diagnosis of hypertension is alarmingly low in young people, probably due to insufficient blood pressure screenings. The data further indicated that doctors still set their target of treatment according to outdated guidelines and that doctors still orientate their treatment primarily with regard to the diastolic pressure. These insights into the causes of unsatisfactory hypertension control may help to direct future educational programmes designed to improve hypertension management specifically to these deficits and thereby to improve control rates. [ABSTRACT FROM AUTHOR]

Examines the relation between viable mold levels indoors and allergic sensitization in German school children to study the effects of ambient air pollutants on respiratory health and atopic diseases. Determination whether allergic sensitization in children is associated with higher fungal spore count in settled house dust sampled from living room floors.

Presents the findings of a study which sought to determine the effects of cadmium on measures of immune-system, by use of a health survey in the eastern regions of Germany which were heavily polluted. Age range of students surveyed; Examination of the relationship between urinary cadmium content and blood immunoglobulin levels; Conclusion drawn by investigators regarding the immunoglobulin pattern observed in exposed children.

The article discusses a program developed in Schleswig-Holstein, Germany, to help combat unemployment. Modell der Innovations- und Personalentwicklungsgesellschaften (IPEG) was developed to move in to help when businesses close or there are widespread layoffs. The organization develops individual career plans, serves as a bridge when job losses threaten, and guides clients to initiate their own IPEG.

The article focuses on German social security policy and highlights the interaction between East and West German states after German reunification in 1990. The issue of combining and streamlining social security is discussed and social benefits such as pension insurance, unemployment insurance, and health policy and insurance are examined.

Nitrogen (N) delivered by rivers causes severe eutrophication in many coastal waters, and its turnover and retention are therefore of major interest. We set up a mass balance along a 582 km river section of a large, N-rich lowland river to quantify N retention along this river segment and to identify the underlying processes. Our assessments are based on four Lagrangian sampling campaigns performed between 2011 and 2013. Water quality data served as a basis for calculations of N retention, while chlorophyll-a and zooplankton counts were used to quantify the respective primary and secondary transformations of dissolved inorganic N into biomass. The mass balance revealed an average N retention of 17 mg N m−2 h−1 for both nitrate N (NO3–N) and total N (TN). Stoichiometric estimates of the assimilative N uptake revealed that, although NO3–N retention was associated with high phytoplankton assimilation, only a maximum of 53% of NO3–N retention could be attributed to net algal assimilation. The high TN retention rates in turn were most probably caused by a combination of seston deposition and denitrification. The studied river segment acts as a TN sink by retaining almost 30% of the TN inputs, which shows that large rivers can contribute considerably to N retention during downstream transport. [ABSTRACT FROM AUTHOR]

The article reports on a conference on scholarly publishing, copyright, and fair use in Germany, held in Berlin, Germany, on October 25, 2012. The papers presented at the conference, some of which are presented in this issue of the journal, covered such topics as the history of copyright reform efforts in Germany, copyright limitations and exceptions, and the relationship between publishers and libraries.

The article announces the sixth annual Thuringian Library Prize which awards 10,000 DM for the best overall performance of a public library. The chairman of the Thuringian Library Association in Hesse, Germany is Dr. Frank Simon-Ritz, who spoke of the libraries' role as a partner in education and life-long learning.

Examines the rationale and design of trial improving life expectancy and quality of life in type 2 diabetics on hemodialysis in Germany. Level of cardiovascular mortality; Benefits from lipid-lowering therapy; Factors on the genesis of vascular lesions.

• Synanthropic and native populations of Fragaria moschata were genetically separated • Synanthropic populations are genetically much less diverse than native ones • The non-native populations contained clones with a wide distribution across Germany • Synanthropic occurrences were separated into a northern and a southern cluster • Northerly and southerly distributed cultivars were assigned to these two clusters Former and present cultivation of plant species impacts their distribution patterns and today's composition of floras. If native and feral populations are overlapping, the local status of a species remains often questionable. The musk strawberry (Fragaria moschata) is such an example: It is native to Central Europe but has been extensively cultivated until the end of 19th century. The border between native and synanthropic distribution runs presumably from Northeastern to Southwestern Germany. To analyse the relationship between native and synanthropic populations of F. moschata , we performed a population genetic analysis using seven microsatellite markers: We compared native populations from Germany and the Czech Republic, proposed synanthropic occurrences from Germany and cultivars of F. moschata from the germplasm repository "Professor Staudt Collection". Synanthropic populations were genetically less diverse than native ones and consisted often of one clone only. The results revealed four clones frequently found in synanthropic populations across Germany and moreover, we detected a clear genetic separation between synanthropic and native populations. Furthermore, synanthropic populations were differentiated in a Northern and a Southern German cluster, each comprising cultivars of Northern or Southern European origin as well. We conclude that the synanthropic populations in Germany were actively spread by humans. Dispersal of these populations is extremely limited due to fragmentation and the lack of mating partners. Synanthropic populations were not established by collecting nearby native occurrences but are rather related to different cultivation centres in Europe. [ABSTRACT FROM AUTHOR]

Background: Current approaches to coronary artery disease (CAD) and acute myocardial infarction (MI) may not be well represented in most primary prevention trials of sudden cardiac death (SCD)., Methods: The contemporary and ongoing registry of the Rostock infarction network (Drip & Ship) represents a well-defined cohort of patients subjected to percutaneous coronary intervention (PCI) for ST-elevation infarction (STEMI) and served as the database for both candidates for an ICD for primary prevention of SCD and for sudden death (SCD) or ventricular tachycardia (VT) during follow-up., Results: A total of 855 consecutive patients were treated with PCI for STEMI or NSTEMI in the region of Rostock (Germany) between 2001 and 2004. While all cause mortality was still 17.2%, the SCD rate was low at 1.3% during 728 ± 366 days of follow-up. Within that time 85 patients (9.9%) developed an indication for ICD therapy due to an impaired LV function (LVEF ≤ 35%) and heart failure. Univariate predictors of an ICD indication were delayed reperfusion (p = 0.001), a high creatine kinase (CK) max (p = 0.009), a persistent wide QRS complex (p = 0.001), previous cerebrovascular events (p = 0.033), and chronic renal failure (p = 0. 001). However, only 16.5% of these patients qualifying for an ICD actually received an ICD; nevertheless, the actual SCD rate was only 3.5%, while 5.4% (46 patients) suffered VTs or ventricular fibrillation (VF). The SCD/VT rate in the entire infarct population was associated with time to reperfusion (0.032), left bundle-branch block (0.002), a longer history of CAD (0.032), and VT during follow-up., Conclusion: While mortality in patients with STEMI is still alarming even with PCI, the risk of SCD may be considerably decreased even in patients with an LVEF below 35%. With the current approach to primary prevention of sudden cardiac death, approximately 10% of postinfarction patients qualify for ICD therapy; however this may only reach a quarter of patients prone to SCD.

Objective: This study examined the wishes of nursing home residents concerning their life situation in the nursing home., Methods: Using a qualitative study design, a representative sample of nursing home residents (n = 1656) of 24 nursing homes in a city situated in the eastern part of Germany were interviewed., Results: The analyses of residents' wishes lead to major domains such as the quality of care, interpersonal contact, architecture and organization of the house, diversification, financial support, as well as themes like health and death and the wish to leave the nursing home. Residents focus on an individualized approach to care., Conclusions: Nursing home residents' views support the need to improve the psychological and social aspects of the quality of care. Implications of and consequences for the organization of care and concepts of nursing are discussed.