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Purpose: The aim of this project was to provide an overview of the epidemiology of primary salivary gland carcinomas (SGC) in terms of incidence, distribution of clinicopathological features and survival in one of the largest cancer registries in Europe. Methods: Data were collected from patients with SGC of the major salivary glands registered in the population-based state cancer registry (Landeskrebsregister LKR) in North Rhine-Westphalia (NRW), Germany from 01/01/2009 to 12/31/2018. Age standardization of incidence was performed and relative survival estimates were computed by sex, histological group, age group and T-, N-, and M-stage. Results: A total of 1680 patients were included in this analysis. The most frequent tumor localization was the parotid gland (78%). Adenocarcinoma (not otherwise specified) was the most common tumor entity (18.5%). Most tumors were found in stages T1–T3 (29% T1; 29% T2; 28% T3). The age-standardized incidence rate (ASR) for SGC was 0.65/100,000 and remained stable during the observation period. There was an age-dependent incidence increasing especially from the age 70 years and onwards. The overall 5-year relative survival (RS) for all patients with SGC was 69.2%. RS was 80–95.6% for T1–2 stage tumors, 60.3% for T3, 47.3% for T4 stage, 87.4% for N0 and 51.2% for N1–2, 74.4% for M0 and 44.9% for M1. Conclusion: Age-standardized incidence for SGC has been stable for the observed 10-year period. Smaller tumors and those without lymph node or distant metastases had a better RS than more advanced tumors. [ABSTRACT FROM AUTHOR]

The differential cross sections of 9Be(3He,3He 0)9Be elastic scattering and of the 9Be(3He,p 0,1,2,3,4+5,6,7)11B reactions have been determined in the energy range from 1.6 to 6 MeV at six backward angles from 120° to 170°, with a step of 10°. The experiments were performed at the 4 MV Dynamitron Tandem Laboratory of the Central Unit for Ion Beams and Radionuclides of the Ruhr University Bochum in Germany. The obtained datasets have been validated through benchmarking experiments, at 8 beam energies, using a thick, high-purity, beryllium foil. The results of the present work are compared with existing ones from literature and any discrepancies observed are discussed. [ABSTRACT FROM AUTHOR]

Findings on the emergence and interpretation of early object representation in the first year of life diverge widely between designs that employ looking times versus action-based measures. As a promising new approach, pupillometry has produced evidence for object permanence at 18 months of age, but not younger as of yet. In the current study, we (re)investigated object permanence following occlusion events in a pupillometric violation-of-expectation paradigm optimized for younger infants. During each trial, infants observed a toy object's occlusion and prompt reveal in the expected condition or its absence in the unexpected condition. Across two experiments, we show that 10- and 12-month-old infants' (total N = 82) pupils dilate in response to unexpected object disappearances relative to expected appearances. Control analyses revealed no differences between the scenes before the experimental manipulation, excluding perceptual interpretations. We further report an age-dependent effect of condition on pupil responses, with unexpected outcomes triggering greater pupil dilation in the older group. These results provide positive pupillometric evidence in support of object permanence in the context of a violation-of-expectation paradigm at 10 and 12 months of age., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: This study aims to provide a broad overview of the epidemiology of cancer of the paranasal sinuses (PSC) in Germany. The data include information on incidence, staging, clinicopathological features and survival from one of the largest cancer registries in Europe., Methods: Population-based data on PSC diagnosed from January 1st, 2009 until December 31st, 2019 were retrieved from the German Centre for Cancer Registry Data (ZfKD). Age standardized incidence was calculated and relative survival estimates were computed by sex, histological subtype, age group and T-, N-, and M-Stage., Results: In total, 3975 cases were included in this study. The age-adjusted incidence rate (ASR) for PSC was 0.3/100,000 which remained stable during the observation period. The most frequent tumor localization was the maxillary sinus (41.9 %) and the most common histological subtype was keratinizing squamous cell carcinoma (kSCC) (44.3 %). All subtypes were predominantly found in the maxillary sinus except for adenocarcinoma and neuroendocrine carcinomas (SNEC), which were most frequently located in the ethmoidal sinus. The majority of the patients with a known T stage was diagnosed in tumor stage T4 (60.8 %). The overall 5-year relative survival (RS) for all patients with PSC was 52 %. RS dropped from 93 % for T1 stage tumors to 39 % for T4 tumors. RS was 58 % for N0 and 31 % for N+ cases, 54 % for M0 and 27 % for M1 cases., Conclusion: Age-adjusted incidence for PSC is low and has been stable for the observed 11-year period. RS decreases continuously with increasing T-, N- and M-stage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To assess the safety, tolerability, and effectiveness of the intravenous immunoglobulin (IVIG) Intratect 50 g/L in immunoglobulin replacement therapy (IgRT) in a prospective, large-scale non-interventional study (NIS). The analysis focused upon patients with secondary immunodeficiency (SID), the most frequent indication for IgRT in this NIS., Materials and Methods: Patients were enrolled at 123 centers in Germany. Each patient received IVIG as prescribed by the physician, guided by the Summary of Product Characteristics. Data were acquired from medical records and patients' questionnaires., Results: In the NIS, 3,563 patients were documented. The main indication for IgRT was SID (73.2%), followed by primary immunodeficiency (14.7%), immune thrombocytopenia (5.8%), and other indications (6.2%). Among the SID patients, 52.9% were male, mean age was 66.5 years, and most (63.8%) were IVIG-naïve. Their annual infection rate improved from 3.7 before documentation in the NIS to 1.1 during the first year of the study. IgG trough plasma levels increased during treatment (> 6 g/L: 44.5% of SID patients at study entry and 64.8% in long-term treatment) and were associated with a trend toward reduced infection rate (p = 0.08). A 1-year infection analysis showed a significantly lower infection risk in the medium- and high-dose groups than in the low-dose group (p = 0.028 and p = 0.017, respectively). Patients' treatment satisfaction and quality of life improved from baseline. Adverse drug reactions (ADRs) in SID occurred at a low frequency with 0.8% at infusion level. On the patient level, ADRs occurred in 251 (15.3%) SID patients, with chills (7.4%) and pyrexia (0.9%) reported most frequently., Conclusion: Effectiveness, safety, and quality of life confirmed the positive benefit-risk profile of IgRT. Higher IVIG dosages per body weight led to higher IgG plasma trough levels, in turn leading to reduced infection rates. Obese patients may need body-weight-adjusted treatment to reduce the risk of infection.

Background: A parotid abscess (PA) is a complication of an acute bacterial parotitis with a potentially life-threatening course. To date, data on the diagnosis and therapy of PA is sparse and mostly consists of case reports or case series. Therefore, this study aimed at comprehensively analyzing the microbiological spectrum and the therapeutic management in a bi-institutional setting., Methods: A retrospective clinical chart review was performed to identify all patients surgically treated for PA at two tertiary care centers in Germany. Data on demographics, clinical management and microbiological data including species identification, pathogenicity, type of antibiotic therapy, adjustment of antibiotics, antibiotic sensitivity testing, and smear test results were extracted. Intervention-related variables and etiology were analyzed for their statistical association with outcome variables., Results: Overall, 85 patients were included. Most patients (92.9%) underwent surgical incision. Around half of the patients (45.9%) were treated under local anesthesia. No facial nerve palsy was observed. The most frequently detected pathogens were Streptococci (n = 23), followed by Staphylococcus aureus (n = 6) including one case of methicillin-resistant Staphylococcus aureus. Most patients (68.2%) received an aminopenicillin ± beta-lactamase inhibitor as empiric antibiotic therapy. In 6 cases the antibiotic therapy was modified after receiving the antibiogram. Four patients (5.2%) presented with recurrent PA. Etiology was idiopathic (42.4%), followed by tumorous (12.9%), obstructive, and immunosuppressive (each 11.8%). Patients with a dental focus (p = 0.007) had a longer duration of hospitalization., Conclusion: The results show that the surgical therapy of PA under local anesthesia is safe. A dental examination should routinely be performed to rule out a dental focus. Obtaining a microbiological specimen in order to modify antibiotic therapy if necessary and a histopathological specimen to rule out a tumorous etiology is obligate., (© 2024. The Author(s).)

Station RN33 on Mount Schauinsland near Freiburg, Germany, is part of the International Monitoring System monitoring radioxenon in air ( 131m Xe, 133 Xe, 133m Xe, and 135 Xe) for verification of the Comprehensive Nuclear Test Ban Treaty. Here, we present data from phase II testing of a new system, Xenon International at RN33, July 14th, 2021 to Jan 22nd, 2022, together with SPALAX data from the same time period. Radioxenon could be detected in 473 of 719 samples, among them many multiple isotope detections. Activity concentrations of spiked and selected environmental samples were verified by laboratory reanalysis. The sensitivity of Xenon International for radioxenons is up to one order of magnitude better for the metastable isotopes than that of the SPALAX, with a shorter sampling duration of 6 h., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Michael Howard reports a relationship with Teledyne Brown Engineering Inc that includes: employment. Aaron Orr reports a relationship with Teledyne Brown Engineering Inc that includes: employment. Ryan Sayne reports a relationship with Teledyne Brown Engineering Inc that includes: employment. Editor of this journal - Andreas Bollhöfer., (Copyright © 2022. Published by Elsevier Ltd.)

Forest dieback due to climate change has severe consequences for the sensitive environments of mountain forests which provide important ecosystem services for local communities, lowlands inhabitants, and visitors. However, this phenomenon is sometimes hard to identify for the lay public as it can manifest as a slow-onset phenomenon with rather inconspicuous signals or as large-scale disturbances like in the case of bark beetle outbreaks. The aim of this contribution is to analyze whether lay people perceive climate change-induced forest dieback in the landscape or not and what kind of damage they identify. To address this issue, we carried out a cross-comparison case-study in two mountain areas in France and Germany. To analyze the data, we introduce an innovative variable clustering approach to identify different groups of respondents based on their perception of climate change and forest dieback. Five groups of respondents-illustrating different degrees of worry-were identified in each case study: the non-alarmist, the carefree, the least informed, the worried, and the alarmist. These results show that both phenomena are not perceived as distant but as happening here and now; and that their perceptions are influenced by local contexts and personal experiences. We finally show that public perception of forest dieback has influenced the agenda setting on the enactment of new forest policies. Perception of climate change and forest dieback impacts: A graphical representation of the typologies., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Many countries, such as Germany, struggle to vaccinate enough people against COVID-19 despite the availability of safe and efficient vaccines. With new variants emerging and the need for booster vaccinations, overcoming vaccination hesitancy gains importance. The research to date has revealed some promising, albeit contentious, interventions to increase vaccination intention. However, these have yet to be tested for their effectiveness in increasing vaccination rates., Methods & Results: We conducted a preregistered survey experiment with N = 1,324 participants in Germany in May/June 2021. This was followed by a series of emails reminding participants to get vaccinated in August and concluded with a follow-up survey in September. We experimentally assess whether debunking vaccination myths, highlighting the benefits of being vaccinated, or sending vaccination reminders decreases hesitancy. In the survey experiment, we find no increase in the intention to vaccinate regardless of the information provided. However, communicating vaccination benefits over several weeks reduced the likelihood of not being vaccinated by 9 percentage points, which translates into a 27% reduction compared to the control group. Debunking vaccination myths and reminders alone also decreased the likelihood, yet not significantly., Discussion: Our findings suggest that if soft governmental interventions such as information campaigns are employed, highlighting benefits should be given preference over debunking vaccination myths. Furthermore, it seems that repeated messages affect vaccination action while one-time messages might be insufficient, even for increasing vaccination intentions. Our study highlights the importance of testing interventions outside of survey experiments that are limited to measuring vaccination intentions-not actions-and immediate changes in attitudes and intentions-not long-term changes., Competing Interests: The authors have declared that no competing interests exist.

Objective: To investigate whether implementation recommendations derived from the German guidelines "Prevention of coercion" can be implemented on acute psychiatric wards by means of implementation consultants into ward work and if this contributes to an increased level of adherence to guideline intervention recommendations approved by the DGPPN (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde)?, Material and Methods: Two medical or nursing experts advised ward teams on the implementation of three individually selected recommendations from the guidelines in a structured consulting process over 6 months. The degree of implementation of the recommendations was assessed before and after the intervention by the ward teams together with the implementation consultants using a tool developed for this purpose (PreVCo rating tool)., Results: A total of five wards responsible for compulsorily admitted patients took part in the pilot study; three of them completed the intervention. On all three wards, implementation of the guideline recommendations improved for both selected and unselected recommendations. The strategy of using implementation consultants as well as the application of the PreVCo rating tool were well accepted and considered feasible by both the treatment teams and the implementation consultants., Conclusion: This pilot study showed that an implementation of recommendations on psychiatric wards derived from the German guidelines "Prevention of coercion" supported by implementation consultants is feasible, well acceptable among treatment teams and can lead to positive changes. The sample of five wards with diverse patient profiles was convincing. The efficacy in terms of reduction of coercive measures is currently being investigated in a randomized controlled trial on 55 psychiatric wards in different parts of Germany, with an intervention based on this pilot study., (© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: The COVID-19 pandemic has affected healthcare systems worldwide. Data on the impact on otolaryngological clinics and private practices is sparse. This study aimed to present data on healthcare worker (HCW) screening, status of HCW, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic., Methods: Otolaryngological private practices and hospital-based departments were surveyed nationwide using an online questionnaire. Participating facilities were recruited via the German Society for Oto-Rhino-Laryngology and the German Association for Otolaryngologists in Bavaria., Results: 365 private practices (2776 employees) and 65 hospitals (2333 employees) were included. Significantly more hospitals (68.7%) than practices (40.5%) performed pre-interventional testing in their outpatients (p < 0.00). Most inpatients were tested in practices and hospitals (100.0% and 95.0%; p = 0.08). HCW screening was performed in 73.7% of practices and in 77.3% of hospitals (p = 0.54). Significantly more HCW infections were reported in private practices (4.7%) than in hospital (3.6%; p = 0.03). The private or home environment was the most frequent source of infection among HCW in hospitals (44%) and practices (63%). The use of PPE increased over the course of the pandemic. The number of procedures and the revenue decreased in 2020., Conclusion: The rate of pre-interventional testing among outpatients in otolaryngological practices is low and HCW infections were found to be more frequent in practices than in hospitals. In addition, a high rate of infections in otolaryngological HCW seems to stem from the private or home environment., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Forest dieback due to climate change poses a risk to mountain forests throughout the world, and has severe consequences in terms of lost ecosystem services for forest stakeholders. This contribution aims to analyze how forest stakeholders perceive forest dieback, and the way in which they adapt to it. We conducted qualitative in-depth interviews in three mid-mountain case study areas in France, Germany, and China, enabling a cross-comparison of different settings affected by forest dieback. Results show that forest dieback is not a new phenomenon for stakeholders who consider that it has increased over the last few decades, due to rising temperatures and extreme weather events. In all survey areas, respondents consider forest dieback as tangible proof of climate change, identifying context-specific impacts with varying levels of severity. Cause-effect relationships are not easy to establish. Forest stakeholders are unable to determine whether climate change is a triggering or aggravating factor. For adaptive strategies, respondents can be grouped into three main profiles: proactive, reactive, and wait-and-see forest owners. These types of stakeholders differ in terms of their investment capacities, economic dependency, emotional attachment to forests, knowledge level, and capacity to obtain actionable information through participation in institutional networks.

Social media data are increasingly utilised as a low-cost alternative to visitor surveys in characterising nature-based recreation. However, the information available on individual users is limited and typically does not include provenance, restricting the potential applications and impact of the data. Here we investigate a methodology to estimate social media visitors' home locations at various spatial scales and apply it to the entire network of national parks in Germany. We compare predicted visitor provenance to representative onsite survey data and explore group-specific spatial and temporal patterns of recreation as characterised by users' geotagged photographs. Results show that photograph metadata can be used to assign home locations with accuracies between 62 and 89% depending on spatial scale implemented. Said social media-based predictions are reasonably well representative of the surveyed visitor structure in German national parks with Flickr visitor-days composed of 19% local, 62% non-local German and 19% international visits., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: The number of individuals requesting medical treatment for gender dysphoria has increased significantly within the past years. Our purpose was to examine current biographic and socio-demographic characteristics and aspects of legal gender reassignment., Design: Medical files from n = 350 individuals of a German Endocrine outpatient clinic were collected from 2009 to 2017 and analysed retrospectively., Results: Ratio of transwomen to transmen equates to 1:1.89 with a remarkable increase of transmen by the year 2013, showing a reversal of gender distribution compared with previous studies for the first time. Use of illegal substances or self-initiated hormone therapy was rare (4.6 and 2.1%). Satisfaction with gender-affirming hormone therapy was significantly higher in transmen than in transwomen (100% vs 96.2%, P = .005). Use of antidepressants declined significantly after onset of hormone treatment in transmen (13% vs 7%; P = .007). The number of individuals with a graduation diploma was only about half as high as in the general population (14.3% vs 27.3%), whereas unemployment rate was more than twice as high (14% vs 6.9%). Median latency between application for legal gender reassignment and definitive court decision was 9 months., Conclusions: Our data provide possible indications for a decline of psychosocial burden in individuals diagnosed with gender dysphoria over the last years. However, affected individuals are still limited in their occupational and financial opportunities as well as by a complex and expensive procedure of legal gender reassignment in Germany., (© 2019 John Wiley & Sons Ltd.)

Objective: Structured doctoral programs in medicine are intended to contribute to the quality of medical dissertations/doctoral theses by providing scientific skills and also inspire doctoral candidates to pursue a career in research. Here we present the potential contributions of the doctoral program "Experimental Medicine" of Ulm University with regard to the increase of individual quality indicators, e. g., the duration and evaluation of the doctoral theses as well as the study participants' scientific career intentions and current field of activity., Methods: All previous participants of the doctoral program (N = 144) were contacted as well as medical graduates with an experimental doctorate as individual doctorate (control group) (N = 559) who had submitted a doctoral thesis in the same period. The response rate was 55.4 % (N = 72) among program participants versus 21.7 % (N = 116) in the control group. Information on the doctoral thesis process, scientific and professional careers and quality indicators were collected in an online survey and compared statistically using U-tests or Chi-square tests. The participants' evaluation of the program and their confidence in scientific competences, rated on a 5-point rating scale, were outlined descriptively., Results: Program participants were satisfied with the supervision of their work (M 2.17; SD 0.84). According to the participants' evaluation, particular support was given to increase competence in scientific presentations (M 1.9; SD 0.83), in literature research (M 2.21; SD 0.96) and in the critical appraisal of scientific publications (M 2.28; SD 0.91). However, they felt comparatively less competent regarding the selection of research methods (M 3.21; SD 1.11) and the application of statistical methods (M 3.53; SD 1.13). Program participants needed less time to complete their doctoral theses than the control group (median 4 years versus 5 years) and received the overall grade of "summa cum laude" (excellent) more frequently (22.9 % versus 2.7 %). In comparison, their doctoral theses were more often part of third-party funded projects (59 % versus 36.1 %). In addition, the participants more frequently wished to pursue a habilitation (29.2 % versus 13.3 %) or aspire to an academic career (13.9 % versus 1.7 %)., Conclusions: Despite methodological limitations, the results support the structured doctoral program, particularly with regard to the duration and evaluation of the doctorate. The program should be further optimized, though, with respect to specific aspects, particularly in terms of "career paths in research"., (Copyright © 2019. Published by Elsevier GmbH.)

Purpose: This study aimed to assess the effectiveness of a care management intervention in improving self-management behavior in multimorbid patients with type 2 diabetes; care was delivered by medical assistants in the context of a primary care network (PCN) in Germany., Methods: This study is an 18-month, multi-center, two-armed, open-label, patient-randomized parallel-group superiority trial (ISRCTN 83908315). The intervention group received the care management intervention in addition to the usual care. The control group received usual care only. The primary outcome was the change in self-care behavior at month 9 compared to baseline. The self-care behavior was measured with the German version of the Summary of Diabetes Self-Care Activities Measure (SDSCA-G). A multilevel regression analysis was applied., Results: We assigned 495 patients to intervention (n = 252) and control (n = 243). At baseline, the mean age was 68 ±11 years, 47.8% of the patients were female and the mean HbA1c was 7.1±1.2%. The primary analysis showed no statistically significant effect, but a positive trend was observed (p = 0.206; 95%-CI = -0.084; 0.384). The descriptive analysis revealed a significantly increased sum score of the SDSCA-G in the intervention group over time (P = 0.012) but not in the control group (p = 0.1973)., Conclusion: The sum score for self-care behavior markedly improved in the intervention group over time. However, the results of our primary analysis showed no statistically significant effect. Possible reasons are the high baseline performance in our sample and the low intervention fidelity. The implementation of this care management intervention in PCNs has the potential to improve self-care behavior of multimorbid patients with type 2 diabetes., Competing Interests: The authors have declared that no competing interests exist.

Background: Care management interventions in the German health-care system have been evaluated with promising results, but further research is necessary to explore their full potential in the context of multi-morbidity. Our aim in this trial is to assess the efficacy of a primary care practice network-based care management intervention in improving self-care behaviour among patients with type 2 diabetes mellitus and multiple co-occurring chronic conditions., Methods/design: The study is designed as a prospective, 18-month, multicentre, investigator-blinded, two-arm, open-label, individual-level, randomized parallel-group superiority trial. We will enrol 582 patients with type 2 diabetes mellitus and at least two severe chronic conditions and one informal caregiver per patient. Data will be collected at baseline (T0), at the primary endpoint after 9 months (T1) and at follow-up after 18 months (T2). The primary outcome will be the differences between the intervention and control groups in changes of diabetes-related self-care behaviours from baseline to T1 using a German version of the revised Summary of Diabetes Self-Care Activities (SDSCA-G). The secondary outcomes will be the differences between the intervention and control groups in: changes in scores on the SDSCA-G subscales, glycosylated haemoglobin A level, health-related quality of life, self-efficacy, differences in (severe) symptomatic hypoglycaemia, cost-effectiveness and financial family burden. The intervention will be delivered by trained health-care assistants as an add-on to usual care and will consist of three main elements: (1) three home visits, including structured assessment of medical and social needs; (2) 24 structured telephone monitoring contacts; and (3) self-monitoring of blood glucose levels after T1 in 3-month intervals. The control group will receive usual care. The confirmatory primary analysis will be performed following the intention-to-treat (ITT) principle. The efficacy of the intervention will be quantified using two-level linear regression stratified by type of medical treatment adjusted for baseline values on the SDSCA-G. Secondary analyses will be performed according to the ITT principle. In health economic evaluations, we will estimate the incremental cost-effectiveness ratios., Discussion: We hope that the results of this study will provide insights into the efficacy of practice network-based care management among patients with complex health-care needs., Trial Registration: Current Controlled Trials ISRCTN 83908315 (ISRCTN assigned 25 February 2014).

Cardiovascular diseases (CVD) are a major public health concern as they are the leading cause of death in developed countries. Primary care is considered to be the ideal setting for CVD prevention. Therefore, more than 4,000 German primary care physicians (PCPs) were asked about their attitudes towards and their activities regarding the prevention of CVD in the nationwide ÄSP-kardio Study. The focus of the study was on health behavior modification. Two thirds of the participating PCPs stated that they routinely provided brief inventions to assist patients in reducing both their tobacco (72%) and alcohol (61%) consumption, to encourage them to increase their levels of physical activity (72%), and to assist them in adjusting to a more healthy diet (66%), and in achieving a healthy body weight (69%). However, only between 23% (quitting smoking) and 49% (diet modification) of PCPs felt that they had been successful in helping patients modify their lifestyles. Insufficient reimbursement, cultural diversity and a lack of time were reported to be the most problematic barriers to successful intervention in the primary care setting. Despite these obstacles, the majority of German PCPs was engaged in prevention and health behavior intervention to reduce the incidence and progression of CVD.

Objectives: The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population., Design: Cross-sectional study., Setting: Primary care chart registry sample., Participants: 3,242 non-demented GP patients aged 75-89 years., Measurements: GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard)., Results: The sensitivity of GPs to detect MCI was very low (11-12%) whereas their specificity amounts to 93-94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients' degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCI-domains were impaired., Conclusion: The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.

The aim of this study was to more precisely map a previously reported quantitative trait locus (QTL) affecting somatic cell score on Bos taurus autosome 2 by increasing the number of markers fourfold, analysing more families and exploiting within-population linkage disequilibrium (LD). A granddaughter design of 10 German Holstein grandsire families with 1121 progeny tested sons was used. Twenty-six markers with an average marker spacing of 3.14 cM were genotyped along 81.6 cM. Linkage analysis (LA) was performed using variance-component methodology. The incorporation of LD was first done using variance-component methods followed by regression on marker alleles. LA revealed genome-wide significance (LOD > 3) at 15 contiguous marker-intervals, with the maximum test-statistic between DIK2862 and BMS778 and a 1-lod drop-off interval of 38 cM. While the variance-component methods could not detect any LD, two individual markers with a significant effect (ILSTS098, p < 0.05; BMS778, p < 0.01) were found by regression analysis. Compared with previous results QTL-localisation was substantially narrowed; further fine-mapping should focus on the close vicinity of BMS778.

Linkage, linkage disequilibrium, and combined linkage and linkage disequilibrium analyses were performed to map quantitative trait loci (QTL) affecting calving and conformation traits on Bos taurus autosome 18 (BTA18) in the German Holstein population. Six paternal half-sib families consisting of a total of 1,054 animals were genotyped on 28 genetic markers in the telomeric region on BTA18 spanning approximately 30 Mb. Calving traits, body type traits, and udder type traits were investigated. Using univariately estimated breeding values, maternal and direct effects on calving ease and stillbirth were analyzed separately for first- and further-parity calvings. The QTL initially identified by separate linkage and linkage disequilibrium analyses could be confirmed by a combined linkage and linkage disequilibrium analysis for udder composite index, udder depth, fore udder attachment, front teat placement, body depth, rump angle, and direct effects on calving ease and stillbirth. Concurrence of QTL peaks and a similar shape of restricted log-likelihood ratio profiles were observed between udder type traits and for body depth and calving traits, respectively. Association analyses were performed for markers flanking the most likely QTL positions by applying a mixed model including a fixed allele effect of the maternally inherited allele and a random polygenic effect. Results indicated that microsatellite marker DIK4234 (located at 53.3 Mb) is associated with maternal effects on stillbirth, direct effects on calving ease, and body depth. A comparison of effects for maternally inherited DIK4234 alleles indicated a favorable, positive correlation of maternal and direct effects on calving. Additionally, the association of maternally inherited DIK4234 marker alleles with body depth implied that conformation traits might provide the functional background of the QTL for calving traits. For udder type traits, the strong coincidence of QTL peaks and the position of the QTL in a region previously reported to harbor QTL for somatic cell score indicated that effects of QTL for udder type traits might be correlated with effects of QTL for udder health traits on BTA18. Our results suggest that loci in the middle to telomeric region on BTA18 with effect on conformation traits may also contribute to the genetic variance of calving and udder health traits. Further analyses are required to identify the causal mutations affecting conformation and calving traits and to investigate the correlation of effects for loci associated with conformation, calving, and udder health traits.

Trauma and immunosuppressed patients are at risk for cytomegalovirus (CMV) disease. Attributing pathogenicity in burn patients remains difficult and controversial because data are sparse. In this work, we surveyed U.S. and German burn centers and evaluated them for awareness, perceptions, diagnosis, and treatment of CMV in patients with burn injury. A total of 58% German (G) and 21% U.S. centers responded. CMV infection incidence was 1:280 G and 1:870 U.S. A total of 41% G and 78% U.S. burn centers considered CMV to be of minor importance and 41% G and 13% U.S. centers considered CMV to be of significant importance. A total of 70% G and 97% U.S. centers performed no admission screening. When testing, 70% G and 19% U.S. centers used serology; 52% G and 25% U.S. centers used body fluid viral isolation; and 43% G and 6% U.S. centers used leukocyte CMV-DNA analysis. A total of 72% G and 48% U.S. centers distinguished infection from disease. Human CMV disease was diagnosed by CMV-DNA (82% G, 19% U.S.), direct virus isolation (43% G, 13% U.S.), or RNA detection (26% G, 0% U.S.). A total of 43% G and 19% U.S. would treat the established disease. Establishing consistent guidelines for screening, diagnosis, and treatment seems prudent in caring for the immunocompromised burn patient.

Erectile dysfunction is a common disease of men. It is associated with various comorbidities and has a prevalence of about 50% in the 7th decade. Erectile dysfunction often affects the quality of life of the patient and his partner, and it is very important to offer adequate therapy that respects the individual circumstances of each patient. The mandatory diagnostic work-up includes a medical and psychosexual history, a physical examination and routine laboratory tests. Besides psychotherapy, oral pharmacotherapy with oral PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) is the most effective therapy for erectile dysfunction and is superior to centrally acting drugs (yohimbine). In cases of failure or contraindication of oral pharmacotherapy, local pharmacotherapy is the second-line therapy. The third-line options are vacuum erectile devices and penile implants, and these have a high patient satisfaction. New therapeutic strategies such as anti-serotoninergic substrates and growth hormone offer a promising future for the therapy of erectile dysfunction but remain to be evaluated.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an increasingly recognized autosomal dominant disorder that leads to cerebrovascular manifestations in early adulthood. This study delineates the phenotypic spectrum and the natural history of the disease in 102 affected individuals from 29 families with biopsy-proven CADASIL. Recurrent ischemic episodes (transient ischemic attack [TIA] or stroke) were the most frequent presentation found in 71% of the cases (mean age at onset, 46.1 years; range, 30-66 years; SD, 9.0 years). Forty-eight percent of the cases had developed cognitive deficits. Dementia (28%) was frequently accompanied by gait disturbance (90%), urinary incontinence (86%), and pseudobulbar palsy (52%). Thirty-nine patients (38%) had a history of migraine (mean age at onset, 26.0 years; SD, 8.2 years), which was classified as migraine with aura in 87% of the cases. Psychiatric disturbances were present in 30% of the cases, with adjustment disorder (24%) being the most frequent diagnosis. Ten patients (10%) had a history of epileptic seizures. To delineate the functional consequences of ischemic deficits, we studied the extent of disability in different age groups. The full spectrum of disability was seen in all groups older than age 45. Fifty-five percent of the patients older than age 60 were unable to walk without assistance. However, 14% in this age group exhibited no disability at all. Kaplan-Meier analysis disclosed median survival times of 64 years (males) and 69 years (females). An investigation of the 18 multiplex families revealed marked intrafamilial variations.