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Teaching multilingual learning groups is an important part of the professional activity of primary teachers in Germany, placing high demands on their occupational professionalism. The aim of this article is to analyse the effects of educational and occupational influencing factors on the beliefs of teachers regarding multilingualism as a facet of pedagogical professionalism. The data is based on the 'BLUME-study', in which primary teachers (N = 123) were asked about their beliefs regarding multilingualism. A linear regression model was used to analyse the extent to which the teachers' beliefs are influenced: (a) by participating in learning opportunities on 'German as a Second Language (GSL)' in teacher training; (b) through experiences with multilingual students in teaching; (c) by participating in training on multilingualism in professional practice; and (d) by undertaking language-sensitive school programmes. Therefore, we analyse influencing factors drawn from both the university phase and the occupational phase of teacher professionalisation. The results show that the use of learning opportunities on the topic of 'GSL' in pre-service training and in in-service training as well as the positive evaluation of contact experiences in teaching lead to supportive beliefs towards multilingualism.

Background: Despite the challenging curriculum, medicine is a popular study program. We propose McClelland's Motive Disposition Theory (MDT) as a possible theory for explaining medical students motivation. The theory describes how individuals differ in their behaviour due to their varying manifestations of certain motives. The three motives can thus influence the students behaviour and academic success. Using these motives, complimented with an altruism- and a freedom motive, this study was aimed at investigating young adults' explicit motives to study medicine. In addition, we also wanted to find out whether there are gender differences in motives and other variables such as empathy, emotional intelligence and academic self-concept. Methods: Over 20 universities across Germany were contacted and asked to share the online study with their first semester medical students in the winter term 2022/23, which resulted in a final N = 535. We used validated and reliable measurements, including a self-created and piloted questionnaire covering medicine-specific explicit motives. Results: Comparing the mean scores between motives, we found that the altruism motive was the strongest motive (M = 5.19), followed by freedom (M = 4.88), affiliation (M = 4.72) and achievement (M = 4.59). The power motive achieved the lowest score (M = 3.92). Male students scored significantly higher for power (M = 4.24) than females did (M = 3.80, p <.001), while female students found affiliation more important (M = 4.81) than male students did (M = 4.59, p =.016). Female participants scored significantly higher for emotional intelligence (p =.010) and several personality aspects, including empathy (p <.001), but showed a significantly lower academic self-concept (p =.033), compared to their male colleagues. Nonetheless, the effect sizes were mostly small to medium. Conclusions: Our findings suggest that first-year medical students are primarily motivated by humanitarian factors to study medicine, compared to motives related to money or power. This is mostly in line with earlier studies using qualitative approaches, showing that MDT can be applied to explain explicit motives in medical students. Trial registration: The longitudinal project, which this study was part of, was registered via OSF (https://archive.org/details/osf-registrations-mfhek-v1) on the 28th of September 2022 under the title "Transformation of emotion and motivation factors in medical students during the study progress: A multicenter longitudinal study". [ABSTRACT FROM AUTHOR]

Millions of Ukrainians have been displaced by the Russian war on Ukraine, with over one million alone coming to Germany since the beginning of the war. Data from the second survey wave of the IAB-BiB/FReDA-BAMF-SOEP Survey of Ukrainian Refugees in Germany study show that as of the beginning of 2023, an increasing share of Ukrainian refugees plan on staying in Germany for the longer term. Around three quarters have found private accommodation and a similarly large share have already attended or are currently attending German language courses. Eighteen percent of the 18 to 64 year olds are employed; of the rest, over two thirds intend to start working immediately or within the next year. While almost all refugee children and adolescents of school age are attending a general or vocational school in Germany, only six out of ten children between three and six years old are attending daycare. To increase refugees' social participation and, in light of the high share of mothers among them, childcare options should be improved. This would facilitate participation in integration and language courses as well as the path to employment. In addition, it is crucial to quickly decide on the extension of Ukrainian refugees' right of residence, which is currently limited until March 2024, thus making their legal status more certain and planning possible. [ABSTRACT FROM AUTHOR]

Emergent literacy activities are considered to be important for promoting children's emergent literacy skills. However, little research exists, especially in Germany, regarding how often such activities occur and in what context. The purpose of this study was to determine the extent of emergent literacy activities occurring in the final preschool year, and their dependence on structural characteristics. Ninety-six children (mean age = 5.9) from 50 preschools in two German federal states were observed in their final preschool year. Results show that emergent literacy activities relating to print materials play a minor role, whereas activities involving oral language play a major role, compared with other activities in children's preschool experience. Results also indicate a significant link between child-related, family and distal characteristics (i.e. geographic location and federal state affiliation) and the frequency of emergent literacy activities. (Contains 1 figure, 5 tables and 1 note.)

Copyright of Discourse: Journal of Childhood & Adolescense Research / Diskurs Kindheits- und Jugendforschung is the property of Verlag Barbara Budrich GmbH 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.)

In a protein reduction feeding trial (Study 1) on a commercial broiler farm in northern Germany, it was attempted to be shown that research results from station tests on protein reduction can be transferred to agricultural practice. In a second study, the limits of the N reduction were tested in a research facility. In Study 1, commercial standard feeds were fed to the control group (variant 1:210,000 animals; n = 5 barns). In the test group (variant 2:210,000 animals; n = 5 barns), the weighted mean crude protein (CP) content was moderately reduced by 0.3%. The nitrogen reduction in the feed did not affect performance (feed intake (FA), daily gain (DG), feed conversion (FCR)), but nitrogen conversion rate increased from approx. 61% to approx. 63%. The solid litter weight was reduced by 12% and nitrogen excretion by 9% (p < 0.05). Significantly healthier footpads were due to lower water intake (−4%; p < 0.05) and a numerically drier bedding. In Study 2, responses of treatments (1250 broiler per variant; n = 5) showed that sharper N-lowering (−1.5% CP; weighted average) did not impair performance either, but N-conversion improved and N-excretions decreased significantly. Converted to a protein reduction of one percentage point, the N excretions were able to be reduced by 22% in Study 1 and 18% in Study 2. Feeding trials in the commercial sector, such as the present Study 1, should convince feed mills and farmers to allow the latest scientific results to be used directly and comprehensively in commercial ration design. [ABSTRACT FROM AUTHOR]

This study describes the first wave of the IAB-BiB/FReDA-BAMF-SOEP Survey on Ukrainian Refugees in Germany, a unique panel dataset based on over 11,000 interviews conducted between August and October 2022. The aim of the IAB-BiB/FReDA-BAMF-SOEP Survey is to provide a data-infrastructure for theorydriven and evidence-based research on various aspects of integration among Ukrainian refugees in Germany, the second most important destination country in the EU after Poland, hosting over a million people who arrived in Germany shortly after the Russian invasion of Ukraine. Based on the survey, this study also provides first insights into demographic, educational, linguistic, occupational, and social characteristics of this population. The analyses revealed that the refugee population comprised mostly young and educated individuals, with a significant proportion of females without partners and female-headed separated families. While German language skills were limited, about half of Ukrainian refugees had attended or were attending language courses. However, the integration process faced significant challenges, as the participation of children in day-care was relatively low, and the self-reported life satisfaction was markedly below the average of the German population. The study highlights the need for targeted policy measures to address such issues. Additionally, policies may aim at harnessing the high potential of the Ukrainian refugees for the German labor market. Given that a substantial proportion would like to stay in Germany permanently, policymakers should take note of these findings and aim to facilitate their long-term integration process to ensure that these refugees may thrive in Germany. [ABSTRACT FROM AUTHOR]

Abstract Over recent decades a growing number of well-documented records from terrestrial last interglacial sites across central Europe have substantially improved our understanding of Eemian climate and landscape dynamics. Despite this progress, there are also large areas from which little information is available, thus constituting significant paleo-geographic gaps in the last interglacial record. Among the regions with still inadequate paleo-environmental information is the maritime-influenced area of NE-Germany at the southern margin of the Eemian (Baltic) Sea. Here we present first results from a geological investigation of a new last interglacial site, recently discovered during archaeological excavations near Beckentin (SW-Mecklenburg). The study area is located approximately 25 km to the south of the maximum MIS-2 ice limit of the Scandinavian Ice Sheet in NE-Germany, and thus lies outside the Weichselian belt of glaciation. Based on lithostratigraphic and sedimentological logging, complemented by geochemical (XRF) and palynological investigations, we divide the local succession into three sections: (1) a basal facies comprising Saalian till and associated glaciofluvial sand, overlain by section (2) consisting of a fen peat which grades into laminated organic to minerogenic mud. The organic deposits of section (2) preserve a near complete Eemian pollen inventory, encompassing pollen zones (PZ) I to VI (Menke and Tynni 1984). Above this rest poorly sorted periglacial sands (section 3) with ventifacts and evidence for cryogenic deformation. Geochronological results from 230Th/U dating of the buried organic-rich deposits at Beckentin, show that these units accumulated in a former dead ice depression between 118 ± 7/6 ka and 114 ± 6/5 ka during the Eemian Interglacial. High-resolution optically stimulated luminescence (OSL) profiling, undertaken with a portable luminescence reader, reveals a significant hiatus between the lacustrine fines and overlying periglacial cover sand. Five OSL ages obtained from these cover sediments and the sand-filling of an ice-wedge cast show that these strata formed between during the last glacial - interglacial transition. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Allograft rejection (AR), chronic allograft injury (CAI) and acute tubular necrosis (ATN) can lead to renal allograft dysfunction after kidney transplantation. Interstitial fibrosis/tubular atrophy (Banff classification 2005) describes chronic allograft injury with no specific etiology, thus explaining the common final endpoint of various (immunologic and non immunologic) etiologies. The aim of this study was to evaluate correlations between the Doppler sonographic RI-values and histopathological changes of renal allografts biopsies during rejection, acute tubular necrosis and chronic allograft injury as well as the influence of donor and recipient features on the intrarenal RI-values. METHODS: 102 allograft biopsies and ultrasound reports of 69 patients with kidney transplantation performed at the hospital Klinikum rechts der Isar (Technische Universität München, Germany) between 2009 and 2013 were analyzed retrospectively (41 biopsies of living donors, 61 biopsies of deceased donors). Chronic allograft injury was described using the IFTA (interstitial fibrosis and tubular atrophy) or the ECAI score (extended chronic allograft injury score). The ECAI score was built out of the chronic histological lesions glomerulopathy, interstitial fibrosis, tubular atrophy and fibrous intimal thickening (cg + ci + ct + cv) of the BANFF scoring. RESULTS: Intrarenal RI-values were significantly higher in patients with allograft rejection than without rejection (median 0,79 vs. 0,73; inter quartile range: 0,20 vs. 0,13; p = 0,018). The same was found for T-and non-T cell mediated rejection (median 0,78 vs. 0,73; inter quartile range 0,20 vs. 0,13; p = 0,039). There were no significant differences in the RI-values between the subtypes of T-cell mediated rejection (type IA-IIB). Furthermore, there were no significant differences of RI-values regarding antibody-mediated rejection (present vs. not present) or type of rejection (T-cell- vs. antibody mediated rejection). Patients with rejection and simultaneously chronic allograft injury showed significantly higher RI-values than patients with only chronic allograft injury. Analyses using the IFTA or the ECAI score showed comparable results (IFTA p = 0,043; Score p = 0,021). The intrarenal RI-value was neither able to detect chronic allograft injury nor to distinguish between acute tubular necrosis and rejection. The intrarenal RI-value showed a significant correlation with recipient age (p < 0,001) but not with donor features. CONCLUSION: In summary, the intrarenal RI-value can indicate a rejection but gives no clear hint to acute tubular necrosis and cannot differentiate from it. Since patients with rejection can have normal RI-values, a biopsy should always be performed in case of suspected rejection. The intrarenal RI-value has no unambiguous validity to determine intrinsic values of the renal allograft, but should rather be understood and interpreted as a systemic parameter influenced by multiple factors. [ABSTRACT FROM AUTHOR]

Here we present a multi-proxy investigation of the Klein Klütz Höved ( KKH) coastal cliff section in northeastern Germany, involving lithofacies analysis, micromorphology, micropalaeontology, palynology and luminescence dating of quartz and feldspar. We subdivide the local stratigraphy into three depositional phases. (i) Following a Saalian advance ( MIS 6) of the Scandinavian Ice Sheet, the penultimate deglaciation (Termination II) at the site occurred between c. 139 and 134 ka, leading to the establishment of a braided river system and lacustrine basins under arctic-subarctic climate conditions. (ii) In the initial phase of the Eemian interglacial lacustrine deposits were formed, containing warm-water ostracods and a pollen spectrum indicating gradual expansion of woodlands eventually containing thermophile deciduous forest elements. A correlation of the local pollen assemblages with Eemian reference records from central Europe suggests that fewer than 750 years of the last interglacial period are preserved at KKH. The occurrence of brackish ostracods dates the onset of the Eemian marine transgression at the section at c. 300-750 years after the beginning of the last interglacial period. (iii) Directly above the Eemian record a ~10-m-thick sedimentary succession of MIS 2 age was deposited, implying a significant hiatus of c. 90 ka encompassing the time from middle and upper MIS 5e to late MIS 3. During the Late Weichselian, KKH featured a depositional shift from (glacio-)lacustrine to subglacial to recessional terminoglacial facies, with the first documented Weichselian ice advance post-dating 20±2 ka. Overall, the KKH section represents an exceptional sedimentary archive for palaeoenvironmental reconstructions, covering the period from the Saalian glaciation and subsequent Termination II to the early Eemian and Late Weichselian. The results refine the existing palaeogeographical and geochronological models of the late Quaternary history in the southwestern Baltic Sea area and allow correlations with other reference records in a wider area. [ABSTRACT FROM AUTHOR]

Background: Worldwide approximately 7,000 rare diseases have been identified. Accordingly, 4 million individuals live with a rare disease in Germany. The mean time to diagnosis is about 6 years and patients receive several incorrect diagnoses during this time. A multiplicity of factors renders diagnosing a rare disease extremely difficult. Detection of shared phenomena among individuals with different rare diseases could assist the diagnostic process. In order to explore the demand for diagnostic support and to obtain the commonalities among patients, a nationwide Delphi survey of centers for rare diseases and patient groups was conducted. Methods: A two-step Delphi survey was conducted using web-based technologies in all centers for rare diseases in Germany. Moreover, the leading patient support group, the German foundation for rare diseases (ACHSE), was contacted to involve patients as experts in their disease. In the survey the experts were invited to name rare diseases with special need for diagnostic improvement. Secondly, communal experiences of affected individuals were collected. Results: 166 of 474 contacted experts (35%) participated in the first round of the Delphi process and 95 of 166 (57%) participated in the second round. Metabolic (n = 74) and autoimmune diseases (n = 39) were ranked the highest for need for diagnostic support. For three diseases (i.e. scleroderma, Pompe’s disease, and pulmonary arterial hypertension), a crucial need for diagnostic support was explicitly stated. A typical experience of individuals with a rare disease was stigmatization of having psychological or psychosomatic problems. In addition, most experts endured an ‘odyssey’ of seeing many different medical specialists before a correct diagnosis (n = 38) was confirmed. Conclusion: There is need for improving the diagnostic process in individuals with rare diseases. Shared experiences in individuals with a rare disease were observed, which could possibly be utilized for diagnostic support in the future. [ABSTRACT FROM AUTHOR]

A new representative survey of a total of 4,500 recently arrived refugees to Germany conducted by the Institute for Employment Research (IAB), the Research Centre of the Federal Office for Migration and Refugees (BAMF-FZ), and the German Socio-Economic Panel (SOEP) at the German Institute for Economic Research (DIW Berlin) has generated an entirely new database for analyzing forced migration and the integration of refugees into German society. The findings we present here are based on the first part of the survey, in which over 2,300 people were interviewed. In addition to the causes of forced migration, the survey captures data on escape routes and educational and vocational biographies. Respondents also answered questions about their values, attitudes, and personality traits, as well as their integration into the German job market and education system. The results show that the threats of war, violence, and persecution were their primary reasons for migration, and that the costs and risks of migration are high. The refugees show extreme heterogeneity in educational backgrounds. The share of respondents who arrived in Germany with vocational or university degrees is low. However, these refugees have high aspirations when it comes to education. And in terms of values, they have more in common with the German population than with the populations of their respective countries of origin. The integration of refugees into the job market and education system has just begun, but Germany's integration policy measures are starting to have a perceptible impact. [ABSTRACT FROM AUTHOR]

Objective. To assess the efficacy and safety of 12-week treatment with ketoprofen in ultradeformable phospholipid vesicles in patients with OA knee pain and to compare the efficacy with that of ketoprofen-free vehicle and celecoxib.Methods. A multicentre, double-blind controlled study in which patients with knee OA and moderate pain were randomized to one of the six arms: topical ketoprofen 50 or 100 mg in ultradeformable vesicles (IDEA-033), 2.2 or 4.4 g ketoprofen-free vehicle (TDT 064), oral celecoxib 100 mg or matching oral placebo, all bd. The primary outcome was change from baseline in the WOMAC pain subscale at week 12.Results. A total of 1395 patients received treatment. Baseline mean WOMAC pain scores ranged from 4.7 to 4.8 across groups. The mean reduction in WOMAC pain score at week 12 was −1.9 (−40.8%) for ketoprofen 50 mg, −1.9 (−40.9%) for ketoprofen 100 mg, −1.9 (−39.8%) for 2.2 g TDT 064, −1.8 (−37.8%) for 4.4 g TDT 064, −1.9 (−40.4%) for celecoxib and −1.4 (−29.3%) for oral placebo. IDEA-033 was not statistically superior to TDT 064. All topical treatments were statistically superior to oral placebo and non-inferior to celecoxib. The most frequent types of treatment-related adverse events reported were gastrointestinal for oral (15.9% for celecoxib) and dermal for topical applications (12.2% for ketoprofen 100 mg).Conclusion. IDEA-033 was not superior to ketoprofen-free vehicle, but both formulations were superior to oral placebo and non-inferior to celecoxib in reducing OA knee pain.Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov/, NCT00716547. [ABSTRACT FROM PUBLISHER]

Information about several papers discussed at the conference "Victims of International Crimes," held October 6 to October 8, 2011 at the University of Marburg in Marburg, Germany, is presented. Topics considered include the victims' rights movement in Guatemala, rape committed by the Red Army in Germany following World War II, and peace and reconciliation in Rwanda. Speakers included Michael J. Kelly, Boris Barth, and Raquel Aldana.

The article discusses the relationship between the Italian communist party (Pci) and the German social democrats and communist governments (Spd), beginning in the late 1960s, with a focus on the leadership of party activists Enrico Berlinguer and Willy Brandt. Topics discussed include changes in the relationship between the Pci and the Spd in the period between the late 1960s and the early 1990s, the Pci shift from communism to international socialism, and the impact of the changes occurring in Soviet Politics.

1. Cyclical parthenogens, organisms switching between sexual and asexual mode of reproduction, are common in aquatic habitats. In permanent waterbodies with year-round persistence of populations, the relevance of sexually produced resting eggs for population dynamics and structure is still largely unexplored. 2. The aim of this study was to investigate the importance of recruitment from resting eggs to Daphnia spp. in a deep dimictic reservoir with overwintering populations (Saidenbach Reservoir, Germany). We linked field studies on Daphnia population dynamics, hatching rates and diapausing egg abundances in the sediment with allozyme analysis of the genetic variability of both the pelagic population and hatchlings from resting eggs. 3. We found higher hatching rates at intermediate depths (10-18 m), although highest diapausing egg abundances were found in the deeper parts of the reservoir. From the extensive field data, we calculated a population budget for the main basin of the reservoir, which showed that hatched daphnids accounted for <1% of the total abundance and explained only a tiny fraction of population growth. 4. The genetic composition (MultiLocus Genotypes, MLG) of the pelagic population was relatively stable throughout the stratified period with up to five among 39 detected MLGs attaining frequencies >5% per date. From 11 MLGs differentiated among hatched daphnids, three were recovered in the pelagic population in perceptible, albeit low frequencies (1-4%). 5. We conclude that the contribution of hatched animals to the spring population dynamics is negligible in situations with an overwintering population present and will only become relevant if densities are extremely low. In this type of system, the significance of the resting egg bank is presumably mainly related to the maintenance of genetic diversity. [ABSTRACT FROM AUTHOR]

Background: Broadly available digital and mobile health applications (also known as mHealth) have recently gained increasing attention by the vascular community, but very little is known about the dissemination and acceptance of such technologies in certain target populations. The current study aimed to determine the user behaviour and acceptance of such digital technologies amongst patients with peripheral arterial disease (PAD). Methods: A cross-sectional survey of consecutively treated inpatients at 12 university institutions, as well as one non-university institution, was conducted. All admitted patients with symptomatic PAD were surveyed for 30 consecutive days within a flexible timeframe between 1 July and 30 September 2021. The factors associated with smartphone use were estimated via backward selection within a logistic regression model with clustered standard errors. Results: A total of 326 patients participated (response rate 96.3%), thereof 102 (34.0%) were treated for intermittent claudication (IC, 29.2% women, 70 years in median) and 198 were treated for chronic limb-threatening ischaemia (CLTI, 29.5% women, 70 years in median). Amongst all of the patients, 46.6% stated that they had not changed their lifestyle and health behaviour since the index diagnosis (four years in median), and 33.1% responded that they were not aware of the reasons for all of their medication orders. Amongst all those surveyed, 66.8% owned a smartphone (IC: 70.6%, CLTI: 64.1%), thereof 27.9% needed regular user support. While 42.5% used smartphone apps, only 15.0% used mobile health applications, and 19.0% owned wearables. One out of five patients agreed that such technologies could help to improve their healthy lifestyle. Only higher age was inversely associated with smartphone possession. Conclusions: The current survey showed that smartphones are prevalent amongst patients with peripheral arterial disease, but only a small proportion used mobile health applications and a considerable number of patients needed regular user support. Almost half of the patients did not change their lifestyle and one third were not aware of the reasons for their medication orders, emphasising room for improvement. These findings can further help to guide future projects using such applications to identify those target populations that are reachable with digital interventions. [ABSTRACT FROM AUTHOR]

Copyright of Komplementaere und Integrative Medizin is the property of Elsevier B.V. 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.)

This article discusses the disparity surrounding German cinema from 1933-1945 and its being considered with deep contempt from film historians and with nostalgic glorification from audiences. After World War II, its appeal to the public was reaffirmed at screenings and then later on television. Despite all attempts at relativization, film historians have not budged from their verdict and basic premise. Cinema was considered propaganda, false escapism, and aesthetic mediocrity. The question of the role of film in a society marked by modernization processes is described.

Today, the number of known viruses infecting methanogenic archaea is limited. Here, we report on a novel lytic virus, designated Blf4, and its host strain Methanoculleus bourgensis E02.3, a methanogenic archaeon belonging to the Methanomicrobiales, both isolated from a commercial biogas plant in Germany. The virus consists of an icosahedral head 60 nm in diameter and a long non-contractile tail of 125 nm in length, which is consistent with the new isolate belonging to the Siphoviridae family. Electron microscopy revealed that Blf4 attaches to the vegetative cells of M. bourgensis E02.3 as well as to cellular appendages. Apart from M. bourgensis E02.3, none of the tested Methanoculleus strains were lysed by Blf4, indicating a narrow host range. The complete 37 kb dsDNA genome of Blf4 contains 63 open reading frames (ORFs), all organized in the same transcriptional direction. For most of the ORFs, potential functions were predicted. In addition, the genome of the host M. bourgensis E02.3 was sequenced and assembled, resulting in a 2.6 Mbp draft genome consisting of nine contigs. All genes required for a hydrogenotrophic lifestyle were predicted. A CRISPR/Cas system (type I-U) was identified with six spacers directed against Blf4, indicating that this defense system might not be very efficient in fending off invading Blf4 virus. [ABSTRACT FROM AUTHOR]

Shows how difficult it was for German film propagandists to create a trustworthy answer to Britain's `The Battle of the Somme.' Importance of the difference between fiction and non-fiction films; Relation between the filmmaker, the reality he depicts and the image that results from his activity.

• Methane adsorption is analyzed for 12 shale samples up to 15 MPa and from 35 to 120. • Temperature and pressure dependent adsorption layer densities are modeled. • Variable, rather than constant, densities improve predictions of absolute adsorption. Black shale source rocks have become a key natural gas resource in the US and China. Unlike in conventional hydrocarbon reservoirs, a significant fraction of the gas in shales is adsorbed onto the inordinate specific surface areas (SSA) of micropores inside organic matter with densities exceeding those of bulk gas by an order of magnitude. Yet, the distribution of adsorbed versus bulk gas remains poorly understood. Experiments measure excess adsorption isotherms, which are corrected to absolute adsorption amounts by a factor that involves the density, ρ abs , of the adsorption layer(s). Constant values of ρ abs are widely used in the literature but, we argue, are inconsistent with the pressure- and temperature-dependence of adsorption behavior. In this work, we propose a more reliable approach that assumes a constant volume of each adsorption layer that can be determined from the SSA of the substrate. We measure nine high-pressure methane excess adsorption isotherms up to 15 MPa for three shale samples from China and Germany at temperatures of 65, 75, and 95 °C, and low-pressure carbon dioxide and nitrogen isotherms to estimate the SSA. We also investigate another 24 isotherms at 35 , 50 , and 65 °C for 8 Chinese shale samples and 3 isotherms at 60 , 90 , and 120 °C for an Argentinian shale sample from the literature. A new variation of the multi-layer Ono-Kondo lattice model is introduced to derive the temperature and pressure dependent adsorption layer densities, which are subsequently used to obtain the absolute adsorption isotherms of interest. This practical methodology has the potential to significantly improve our estimates of shale gas-in-place resources, and adsorption modeling more broadly. [ABSTRACT FROM AUTHOR]

Climate instability in the Eemian Interglacial is gaining more and more evidence. One of such oscillations in the Beckentin record is indicated by the disappearance of the Cladocera and changes in macroremains at the beginning of E4a (Corylus phase). They confirm the shallowing of the reservoir, probably caused by climate changes, but not reflected in the palynological record. However, a significant oscillation observed in the first half of the E5 (Carpinus phase), ~5860 years after the boreal forests subsided and ~6290 years after the onset of interglacial forestation, suggests that, although not being an analogue of the OHO (Older Holsteinian Oscillations) in MIS 11c and the 8.2 ka cold event in the Holocene, it is very similar to these oscillations. The Eemian oscillation was noted also in the Bispingen profile in northern Germany, ~6500 years after the interglacial forestation. However, the course of vegetation changes there differs from that in Beckentin. The analysis of macroremains and Cladocera confirms the disappearance of rush and water vegetation in the water reservoir at that time in Beckentin. These results confirm that numerous climatic oscillations could have occurred in the Eemian Interglacial. [ABSTRACT FROM AUTHOR]

Oscillation of an ice sheet can be accompanied by earthquakes due to local reactivation of pre-existing faults related to the ice loading. A sufficiently large magnitude of an earthquake can trigger seismic waves that may strongly deform susceptible sediment layers and can cause the development of soft-sediment deformation structures (SSDS). Morphological and structural features of SSDS within a glaciolacustrine succession exposed at the coastal cliff on Gnitz Peninsula (Usedom Island) in NE Germany indicate that they must have developed due to glacial isostatic adjustment, which was suggested earlier by Hoffmann and Reicherter (2012). Here we present detailed micro- and meso-scale SSDS within internally deformed layers interpreted as seismites, liquefaction and re-liquefaction sedimentological imprints on Gnitz Peninsula. New optically stimulated luminescence dating results indicate that the most probable time span of corresponding earthquake occurrence is between 23.2 and 14.6 ka. The interpretation of SSDS 'trapped' in layers as seismites is strongly supported by modelling of glacially induced Coulomb failure stress changes in this region. Our results point to a set of probably pre-Quaternary faults which were locally reactivated in the area of Gnitz Peninsula during the last glacial maximum. • Low intraplate seismicity was affected by tectonic activity in the Late Pleistocene. • Modelling suggests glacial loading-induced stresses as fault reactivation trigger. • At least two earthquake periods were identified. • Reoriented soft-sediment deformation structures infilled with injection structures indicate re-liquefaction. • Aftershocks or following earthquakes caused re-liquefaction of prone sediments. [ABSTRACT FROM AUTHOR]

Abstract: The German trade network of pig holdings and related enterprises for the time period of 01 June 2006–31 December 2008 was analyzed. Available data comprised of the entire German trade information with about 121,287 pig premises and their links in the pork production chain (breeders to slaughter houses). During the study period, 330,000 trade connections between premises were recorded. Communities which are large scale structures comprising of premises which are in close trade contact with each other were detected by modularity maximization. Almost 97% of the pig holdings could be assigned to one of nine major communities. Contacts between communities are rare. Trade communities do not only form spatial clusters, but were also associated with specific regions within the territory of Germany. Communities are to some extent separated by ‘trade borders’, which may impede disease spread. Interestingly, the trade borders often failed to match with administrative borders of the German federal states. This finding is important, because it illustrates the need for new strategies of cross-border disease management strategies. [ABSTRACT FROM AUTHOR]

Objective: Several reports have addressed sex disparities in peripheral arterial occlusive disease (PAOD) treatment with inconclusive or even conflicting results. However, most previous studies have neither been sufficiently stratified nor used matching or weighting methods to address severe confounding. In the present study, we aimed to determine the disparities between sexes after percutaneous endovascular revascularization (ER) for symptomatic PAOD., Methods: Health insurance claims data from the second-largest insurance fund in Germany, BARMER, were used. A large cohort of patients who had undergone index percutaneous ER of symptomatic PAOD from January 1, 2010 to December 31, 2018 were included in the present study. The study cohort was stratified by the presence of intermittent claudication, ischemic rest pain, and wound healing disorders. Propensity score matching was used to adjust for confounding through differences in age, treated vessel region, comorbidities, and pharmacologic treatment. Sex-related differences regarding cardiovascular event-free survival, amputation-free survival, and overall survival within 5 years of surgery were determined using Kaplan-Meier time-to-event curves, log-rank test, and Cox regression analysis., Results: In the present study, 50,051 patients (47.2% women) were identified and used to compose a matched cohort of 35,232 patients. Among all strata, female patients exhibited lower mortality (hazard ratio [HR], 0.69-0.90), fewer amputations or death (HR, 0.70-0.89), and fewer cardiovascular events or death (HR, 0.78-0.91). The association between female sex and improved long-term outcomes was most pronounced for the patients with intermittent claudication., Conclusions: In the present propensity score-matched analysis of health insurance claims, we observed superior cardiovascular event-free survival, amputation-free survival, and overall survival during 5 years of follow-up after percutaneous ER in women with symptomatic PAOD. Future studies should address sex disparities in the open surgical treatment of PAOD to illuminate whether the conflicting data from previous reports might have resulted from insufficient stratification of the studies., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim of the Study: To identify work contents, roles and tasks of peer workers in mental health services in the German-speaking part of Switzerland., Methods: A survey was conducted among peers in the German-speaking part of Switzerland., Results: Most respondents stated that they work mainly in specialized services in the treatment of people with psychoses and affective disorders and in direct contact with service users. "Building bridges" between service users and professionals, conveying hope and confidence, empowerment as well as support in symptom management was most frequently indicated as a work activity. The majority of respondents have job descriptions that correspond to their activities., Conclusions: For mental health services, the challenge is to integrate the new professional group of peers workers as well as possible without undermining their proximity to the service users or their possibly critical perspective with regard to the existing practice., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Even though tumours are considered to occur frequently in pet hamsters, there is only a small number of scientific reports in current literature., Methods: Pathological reports from 177 hamsters were evaluated., Results: Of these, 78 were male and 75 were female. Median age of affected hamsters was 12 months (range 2-34). Integumental tumours were the most common neoplasms (62%, 109/177). As far as species was known, the number of Syrian hamsters (52%, 30/58) affected by tumours seemed to be lower than the number of affected dwarf hamsters (85%, 47/55). Tumours of the hematopoietic system were the second most frequently neoplasms (17%, 30/177). Relative number of neoplasms of the endocrine system, tumours of the digestive system (1.7%, 3/177) and other tumours (4%, 7/177 each) was low. The majority of integumental tumours were epithelial (66%; 91/126)., Conclusion: This study aimed to analyze data from veterinary surgeries and pathological institutes about the occurrence of spontaneous tumours in Syrian hamsters and dwarf hamsters to give information about the frequency of tumours, prognosis and survival time. This is the first study about tumours in pet hamsters in Germany so far., (© 2021 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).

There are ca. 8 million persons with diabetes mellitus living in Germany. A late sequelae of diabetes is the diabetic foot syndrome (DFS), the prevalence of which is greatly increasing. It comprises all alterations of the foot as a result of diabetic polyneuropathy as well as microvascular and macrovascular (peripheral arterial occlusive disease, PAOD) alterations. Many of the ca. 250,000 newly diagnosed diabetic foot ulcers per year become chronic wounds. Despite intensive efforts for prevention, early diagnosis and adequate wound care, ca. 13,000 persons with diabetes undergo major limb amputation in Germany every year. With consistent treatment in interdisciplinary centers and by exhausting all possible methods of wound treatment, pressure relief as well as arterial revascularization, the major amputation rate in patients with diabetic foot problems can be reduced by 80%. With a suitable strategy of prevention, the recurrence rate of foot ulcers would be reduced.

Background: Limited data on the prevalence and medical care of sickle cell disease (SCD) in Germany are available. Here, we make use of a patient registry to characterize the burden of disease and the treatment modalities for patients with SCD in Germany., Procedure: A nationwide German registry for patients with SCD documents basic data on diagnosis and patient history retrospectively at the time of registration. A prospective annual documentation provides more details on complications and treatment of SCD. For the current analyses, data of 439 patients were available., Results: Most patients had homozygous SCD (HbSS 75.1%, HbS/β-thalassemia 13.2%, and HbSC 11.3%). The median age at diagnosis was 1.9 years (interquartile range, 0.6-4.4 years), most patients were diagnosed when characteristic symptoms occurred. Sepsis and stroke had affected 3.2% and 4.2% of patients, respectively. During the first year of observation, 48.3% of patients were admitted to a hospital and 10.1% required intensive care. Prophylactic penicillin was prescribed to 95.6% of patients with homozygous SCD or HbS/β thalassemia below the age of six and hydroxycarbamide to 90.4% of patients above the age of two years. At least one annual transcranial Doppler ultrasound was documented for 74.8% of patients between 2 and 18 years., Conclusion: With an estimated number of at least 2000, the prevalence of SCD in Germany remains low. Prospectively, we expect that the quality of care for children with SCD will be further improved by an earlier diagnosis after the anticipated introduction of a newborn screening program for SCD., (© 2019 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals, Inc.)

Objective: People often feel anxious prior to performance situations, and this can lead to performance decrements. Thus, applying effective emotion regulation strategies could be crucial for achieving maximum performance., Method: We investigated the relation between dispositional precompetition emotion regulation and competition performance. Participants were 310 table tennis players (240 men, M age  = 39.07, SD = 15.99). Self-reported emotion regulation behavior was matched with objective performance data., Results: We found that positive cognitive change strategies were positively related and negative cognitive change strategies were negatively related to winning in competitions. Furthermore, athletes with a higher performance status more often used situation modification, positive cognitive change, and response modulation strategies., Conclusions: Our findings contribute to personality research by providing evidence for the (non)effectiveness of certain emotion regulation strategies., (© 2019 Wiley Periodicals, Inc.)

Introduction:: In this pilot study, we used indocyanine green fluorescence angiography during hemodialysis access surgery. The aim was to evaluate its relevance as a diagnostic tool to visualize changes in hand microperfusion., Patients and Methods:: In this prospective single-center study, 47 adult patients (33 male, 14 female) with renal disease (24 preemptive, 23 endstage) were enrolled. Surgical creation of an arteriovenous fistula was performed (22 forearm, 25 upper arm). Microperfusion of the ipsilateral hand and fingers was evaluated intraoperatively using indocyanine green fluorescence angiography. We compared the cumulated microperfusion parameters ingress (In) and ingress rate (InR) before and after opening of the anastomosis. To compare the dimension of microcirculatory decline, we calculated the ratios of the parameters (RatioIn and RatioInR) after to those before anastomosis opening., Results:: The cumulated microperfusion parameters In and InR showed a significant decrease after completion of anastomosis and declamping. This effect has been seen in all patients for the hand and for each finger consecutively. During follow-up (mean 4.6, range 3-11 months), 5 patients (10.6%) complained about hemodialysis access-induced distal ischemia. The ratio of intraoperative microperfusion in those five hemodialysis access-induced ischemia patients was significantly lower compared to asymptomatic patients (RatioIn 0.23 vs 0.58, p = 0.001, and RatioInR 0.25 vs 0.62, p = 0.003)., Conclusion:: Intraoperative fluorescence angiography could visualize the deterioration of ipsilateral hand microperfusion after surgical creation of an arteriovenous fistula. It seems to be a promising tool to detect patients at risk for hemodialysis access-induced distal ischemia early in the peri- or even intraoperative stage.

Viruses are ubiquitous in the biosphere and greatly affect the hosts they infect. It is generally accepted that members of every microbial taxon are susceptible to at least one virus, and a plethora of bacterial viruses are known. In contrast, knowledge of the archaeal virosphere is still limited. Here, a novel lytic archaeal virus is described, designated "Drs3", as well as its host, Methanobacterium formicicum strain Khl10. This hydrogenotrophic methanogenic archaeon and its virus were isolated from the anaerobic digester of an experimental biogas plant in Germany. The tailed virus has an icosahedral head with a diameter of approximately 60 nm and a long non-contractile tail of approximately 230 nm. These structural observations suggest that the new isolate belongs to the family Siphoviridae, but it could not be assigned to an existing genus. Lysis of the host Khl10 was observed 40-44 h after infection. Lysis of the type strain Methanobacterium formicicum DSMZ 1535 was not observed in the presence of Drs3, pointing towards resistance in the type strain or a rather narrow host range of this newly isolated archaeal virus. The complete 37-kb linear dsDNA genome of Drs3 contains 39 open reading frames, only 12 of which show similarity to genes with predicted functions.

Objective: Dysnatremia may have an impact on outcomes in critically ill patients, but this has not been widely investigated in surgical ICU patients. We investigated the epidemiology of dysnatremia in a large cohort of surgical ICU patients and evaluated the possible influence of the time of acquisition of dysnatremia and fluctuations in serum sodium concentrations on hospital mortality in these patients., Design: Retrospective analysis., Setting: Fifty-bed surgical ICU., Patients: All patients admitted to the ICU between January 2004 and January 2009., Measurements and Main Results: Hyponatremia was defined as a serum sodium concentration <135 mmol/L and hypernatremia as a serum sodium concentration >145 mmol/L. Of the 10,923 surgical ICU patients included in the study, 1,215 (11.2%) had hyponatremia and 277 (2.5%) had hypernatremia at admission to the ICU. Among patients with normonatremia at admission to the ICU (n = 9431), the prevalence of ICU-acquired dysnatremia was 31.3%. Dysnatremia present at ICU admission (odds ratio 2.53; 95% confidence interval 2.06-3.12; p < .001) and ICU-acquired dysnatremia (odds ratio 2.06; 95% confidence interval 1.71-2.48; p < 0.001) were independently associated with an increased risk of in-hospital death compared to normonatremia. Dysnatremia at ICU admission (odds ratio 1.23; 95% confidence interval 1.01-1.50) was associated with a higher risk of in-hospital death, compared with ICU-acquired dysnatremia. Fluctuation in serum sodium concentration was also independently associated with an increased risk of in-hospital mortality, in patients who remained normonatremic (>6 mmol/L/ICU stay) and in those with dysnatremia (>12 mmol/L/24 hrs or >12 mmol/L/ICU stay)., Conclusions: Dysnatremia was common in surgical ICU patients and was independently associated with an increased risk of in-hospital death in these patients. Dysnatremia at ICU admission was associated with a higher risk of death compared with ICU-acquired dysnatremia. Fluctuations in serum sodium concentrations were independently associated with an increased risk of in-hospital death, even in patients who remained normonatremic during the ICU stay.

The natural history of infections with many human papillomavirus (HPV) types is poorly understood. Here, we describe for the first time the age- and sex-dependent antibody prevalence for 29 cutaneous and five mucosal HPV types from 15 species within five phylogenetic genera (alpha, beta, gamma, mu, nu) in a general population. Sera from 1,797 German adults and children (758 males and 1,039 females) between 1 and 82 years (median 37 years) were analysed for antibodies to the major capsid protein L1 by Luminex-based multiplex serology. The first substantial HPV antibody reactions observed already in children and young adults are those to cutaneous types of the genera nu (HPV 41) and mu (HPV 1, 63). The antibody prevalence to mucosal high-risk types, most prominently HPV 16, was elevated after puberty in women but not in men and peaked between 25 and 34 years. Antibodies to beta and gamma papillomaviruses (PV) were rare in children and increased homogeneously with age, with prevalence peaks at 40 and 60 years in women and 50 and 70 years in men. Antibodies to cutaneous alpha PV showed a heterogeneous age distribution. In summary, these data suggest three major seroprevalence patterns for HPV of phylogenetically distinct genera: antibodies to mu and nu skin PV appear early in life, those to mucosal alpha PV in women after puberty, and antibodies to beta as well as to gamma skin PV accumulate later in life.

Background: Overworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking., Method: Of 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36)., Results: A significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales., Conclusions: Behavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.

Background: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, 'mindfulness', is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients., Methods: The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differential Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R)., Results: Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism., Conclusions: This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients., (2007 S. Karger AG, Basel)

Objective: The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders., Method: In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed., Results: According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales., Conclusions: BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.

Background: Suicide attempts by adolescents continue to be a major public health problem. The purpose of this study was to examine the difference in the family functioning and sociopsychopathological risk factor relationship between female bulimic adolescents with suicidal ideation only, and those who attempted suicide., Methods: A group of 211 patients were observed for 12 months. Data from 63 subjects (SUG [suicide group], age 17.2 +/- 1.3 years) who had attempted suicide were then compared with 148 (control group, age 18.1 +/- 1.5 years) who had expressed suicidal ideation but did not follow through., Results: Those in the suicide attempt group had been exposed more frequently to physical/sexual violence in childhood. As adults they either lived alone or were dissatisfied with their partnership. The frequency of borderline personality disorders and depressive disorders in this group was significant. Psychosomatic symptoms, disturbed coenesthesia, substance abuse, social impairment and interference with their perception of their own life circumstances, as well as their job performance, often preceded the suicide attempt. Nine genuine risk factors that occurred significantly more often in the SUG were calculated out of all the stress factors using stepwise logistic regression: 'as a child I was even hit with a stick or whip', 'I had no set orientation in life', 'I had a feeling of loneliness despite family and friends', 'I could not relax', 'incapable of dealing with the public', 'I do not like to be touched', 'parents have psychiatric disorders', 'misuse of stimulants', and 'as a child I felt lonely' (odds ratio, 10.56-1.90)., Conclusion: Adverse family experiences and multiple sociopsychopathological factors may increase the risk of suicide in female bulimic adolescents.

Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.

Whether the treatment results in inpatient psychotherapy are significantly influenced by the patient's motivation is a subject of discussion. The goal of this study was to assess whether the primary motivation for therapy in depressive women influences the results of psychotherapeutic treatment. In a prospective study, the monitored results from 64 female inpatients (32 who were highly motivated to enter therapy, and 32 who were minimally motivated) were compared to each other. The period of observation was six weeks. As instruments of assessment, the Fragebogen zur Therapiemotivation (FMP) (Questonnaire on Motivation for Entering Therapy) and the Beck Depression Inventory (BDI) were aministered upon admission; after the fourth and sixth weeks of therapy, the Veränderungsfragebogen des Erlebens und Verhaltens (VEV) (Questionnaire of Changes in Experience and Behavior) was administered as well. All patients who had applied for a pension were found in the group of less motivated patients and consolidated into a subgroup. The analysis was carried out according to the intent-to-treat principle. The variance analysis for the repeat measurements showed significant differences on all the FMP scales and on the BDI (all P< 0.001). The measurements with VEV likewise resulted in a significant difference (P< 0.01). The subgroup of "pension patients" showed significantly less change in all three of the above measurements. Patients with depressive symptomology who essentially are relatively highly motivated for therapy could profit significantly more from inpatient psychosomatic treatment than those who are less motivated. Establishing and developing motivation prior to inpatient hospitalization could possibly contribute to more efficient and cost-effective clinical treatment. Where legal proceedings pertaining to a pension are pending, relatively less motivated patients fare significantly worse not only in their motivational development for therapy, but also in their final treatment results. It should be noted, however, that the relatively small random sample, the restricted blinding, which was only partially possible, could have led to possible distortions.

Among elderly patients with depressive disorders, restrictions of the ability to function socially apparently linger long after the depressive symptoms abate. In a 16-week long, prospective, controlled study on 30 elderly, depressed patients who were still living at home (response rate, 93.3%), we wanted to find out whether recovering the ability to function socially takes a different course through integrative treatment than it does subsequent to purely psychopharmacological therapy. We used the Beck Depression Inventory (BDI) and the Social Adaptation Self-Evaluation Scale (SASS) to measure our results. Both forms of therapy did afford a relatively rapid reduction of depressive symptoms, however, the integrative treatment not only led to a more expeditious reduction of the BDI score [in the fourth week (P<0.05) and starting with the eighth week (P<0.01)] but was also the only one that led to a significant improvement in the ability to function socially [in the 12th week, P<0.05; in the 16th week, P<0.01]. These findings could contribute to improved treatment and rehabilitation of elderly patients, thereby prolonging the periods in their lives in which they can live independently.

Whether the primary motivation for entering therapy significantly influences the results of inpatient psychotherapeutic treatment is subject to debate. The purpose of this study was to examine this question in women with generalized anxiety disorder. The monitored results from 54 female inpatients (29 who were highly motivated to enter therapy and 25 who were minimally motivated) were compared. The questionnaire for measuring psychotherapy motivation (FMP), the symptom checklist (SCL-90-R) and the questionnaire for measuring change of experience and behavior (VEV) were used to assess motivation and results of treatment. The patients were tested at admission and after the fourth and sixth weeks of therapy, at which time the patients with high primary motivation showed a significantly more marked reduction of anxiety symptoms (SCL-90-R, P < 0.01). These patients also had better test results on the VEV (P < 0.01). However, both quantitative and qualitative improvements in motivation for therapy were observed among the less motivated patients, and this improvement did not differ from that of the highly motivated group on most scales of the FMP (P < 0.05 to P = 0.43). Highly motivated patients with generalized anxiety disorder can profit significantly more from inpatient psychosomatic treatment than those who have less primary motivation. However, less motivated patients can show significant positive changes in developing motivation for therapy, as well as in the final results of treatment. Establishing and developing motivation prior to hospitalization might contribute to more efficient and cost-effective clinical treatment.

Background: There is a lack of information about factors associated with in-hospital death and the impact of neurological complications on early outcome for patients with stroke treated in community settings. We investigated predictors for in-hospital mortality and attributable risks of death after ischemic stroke in a pooled analysis of large German stroke registers., Methods: Stroke patients admitted to hospitals cooperating within the German Stroke Registers Study Group (ADSR) between January 1, 2000, and December 31, 2000, were analyzed. The ADSR is a network of regional stroke registers, combining data from 104 academic and community hospitals throughout Germany. The impact of patients' demographic and clinical characteristics, their comorbid conditions, and the treating hospital expertise in stroke care on in-hospital mortality was analyzed using Cox regression analysis. Attributable risks of death for medical and neurological complications were calculated., Results: A total of 13 440 ischemic stroke patients were included. Overall in-hospital mortality was 4.9%. In women, higher age (P<.001), severity of stroke defined by number of neurological deficits (P<.001), and atrial fibrillation (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.0-1.6) were independent predictors for in-hospital death. In men, diabetes (HR, 1.3; 95% CI, 1.0-1.8) and previous stroke (HR 1.4; 95% CI, 1.0-1.9) had a significant negative impact on early outcome in addition to the factors identified for women. The complication with the highest attributable risk proportion was increased intracranial pressure, accounting for 94% (95% CI, 93.9%-94.1%) of deaths among patients with this complication. Pneumonia was the complication with the highest attributable proportion of death in the entire stroke population, accounting for 31.2% (95% CI, 30.9%-31.5%) of all deaths. More than 50% of all in-hospital deaths were caused by serious medical or neurological complications (54.4%; 95% CI, 54.3%-54.5%)., Conclusions: Substantial differences were found in the impact of comorbid conditions on early outcome for men and women. Programs aiming at an improvement in short-term outcome after stroke should focus especially on a reduction of pneumonia and an early treatment of increased intracranial pressure.

Posttraumatic stress disorder (PTSD) can now be applied to patients who have just had intensive care treatment. The authors tested whether the reliability of the diagnosis depends on the measuring instrument used and whether the occurrence of PTSD is related to the presence of preexisting psychic disorders or to a worsening of the patients' general condition. The authors examined 41 former patients of an intensive care unit (ICU) with the Posttraumatic Scale (PTSS-10) and, afterward, with the Structured Clinical Interview (SCID). Screening with PTSS-10 showed that 17.07% of the patients met the recommended threshold for probable diagnosis of PTSD of 35 or more points. With SCID, PTSD could be confirmed in 9.76% of the cases. Patients with a prior psychiatric disease showed more frequent (P < .02) occurrences of PTSD. The severity of their Acute Physiology and Chronic Health Evaluation System II (Apache II) scores had no significant influence. PTSS-10 can be used for a preliminary diagnostic orientation. With the PTSD module of the SCID, a structured diagnostic tool is available. Almost twice as many PTSD cases were diagnosed among the subjects with the PTSS-10 as with SCID. Post-ICU PTSD occurred more frequently among patients with prior psychiatric diseases; however, it was not dependent on exacerbation of the patient's Apache II scores., (Copyright 2004 Sage Publications)

Aim: To assess the perpetrators of sexual abuse in childhood, forms of simultaneous abuse, and characteristics of the families of origin, and the possible effects of abuse on health in adult life., Methods: A cross sectional study conducted between 1998 and 2002 included a random group of 936 inpatients (723 women) aged (mean+/-standard deviation) 41.0+/-2.5 years at the psychosomatic clinic in Simbach, Germany. The following questionnaires, previously validated in German, were used to assess the patients: Questionnaire for Life Story and Partnership, Scale for Survey of Quality of Life, Existential Orientation Scale, Leipzig Incidence and Psychological Stress Questionnaire, Questionnaire for Assessment of One's Own Body, Survey of Life Satisfaction, Frankfurt Physical Concept Scale, Giessen Complaint Survey, and the Survey for Collection of Health Behavior Data. We compared the inpatients who had been sexually abused in their childhood (n=250) with other psychiatric inpatients in the control group (n=486)., Results: Out of 250 sexually abused patients, 25.7% were victimized by fathers/stepfathers, 4% by mothers/stepmothers, 12.4% by aunts or uncles, 10% by brothers or sisters, 7.6% by grandmothers/grandfathers, 30.1% by family acquaintances, and 29.3% by strangers. Unlike the parents of patients in the control group, the parents of sexually abused patients had more conflicts, especially over alcohol consumption (p<0.001) and extramarital affairs (p<0.001), they divorced more frequently during the first seven years of the patient's life (p<0.001), and had more underlying emotional (p<0.001) and physical illnesses (p=0.006). Significantly more sexually abused patients reported having poor concentration (odds ratio [OR]=5.03; 95% confidence interval [CI]=1.98-9.70; p<0.001) and sexual handicaps (OR=5.16; 95% CI=1.81-11.39; p<0.001), tended to hide their body (OR=3.65; 95% CI=1.69-7.30; p<0.001), abused illicit drugs (OR=2.38; 95% CI=1.08-6.01; p<0.001), had borderline personality disorder (OR=4.21; 95% CI=2.44-8.40; p<0.001), and suicidal ideation (OR=2.87; 95% CI=1.71-5.96; p<0.001)., Conclusion: The patients who were sexually abused in childhood had significantly less satisfactory lives and more frequent psychiatric illnesses, suicidal ideation, disturbed social functioning and perception of the body, and psychosomatic diseases.

This study was performed on a clinic group of patients (n = 1000, 83.9% responder) to test characteristics of persons who switched psychotherapists on three or more occasions (n = 74). Compared with the group of minor variation, these patients had higher rates of psychosomatic symptoms, lower systemic operativeness, a dissatisfying sexuality, tended towards alcohol and pharmaceutical abuse, and had significant higher exposure in infancy to violence and sexual abuse (all p < 0.01 after Bonferroni correction). Psychosocial factors including early experience in forming relationships in addition to current factors appear to play a decisive role in a person's dropout liability as well as the attitude to therapy.