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Abstract Background Despite promising outcomes of treatment with anti-programmed cell death (PD)-1/PD-ligand (L)1 agents in combination with platinum-doublet chemotherapy (PDC) in the first-line setting, a significant unmet medical need remains in patients with PD-L1-unselected non-small cell lung cancer (NSCLC). Methods This multicenter, open-label, phase 1b study comprising dose-confirmation and dose-expansion parts investigated the combination of spartalizumab and various PDC regimens, with or without canakinumab, in treatment-naïve patients with PD-L1-unselected, metastatic NSCLC. The primary objectives were to determine maximum tolerated dose (MTD) and/or recommended dose for expansion (RDE) of spartalizumab, with or without canakinumab, in combination with PDC in the dose-confirmation part and antitumor activity of spartalizumab in the dose-expansion part. Results The MTD/RDE of spartalizumab was 300 mg every 3 weeks (Q3W) when administered with either gemcitabine (1250 mg/m2)/cisplatin (75 mg/m2) (group A; no dose-limiting toxicities [DLTs]), pemetrexed (500 mg/m2)/cisplatin (group B; 2 DLTs: grade 2 posterior reversible encephalopathy syndrome and grade 4 hyponatremia), or paclitaxel (200 mg/m2)/carboplatin area under the curve 6 min*mg/mL (group C; 1 DLT: grade 4 neutropenic colitis). The RDE of canakinumab combined with spartalizumab and pemetrexed/cisplatin (group E; no DLTs) was 200 mg Q3W (no dose-expansion part was initiated). No new safety signals were identified. In groups A, B, C, and E, the overall response rates were 57.6%, 55.3%, 51.5%, and 57.1%, respectively. Group B compared with other groups had the longest median progression-free survival (10.4 months vs. 6.2–7.5 months), overall survival (29.7 months vs. 16.1–21.0 months), and duration of response (30.1 months vs. 6.0-8.2 months). Conclusions The combination of spartalizumab and PDC, with or without canakinumab, was well tolerated across treatment groups. The antitumor activity across treatment groups was comparable with that of pembrolizumab and pemetrexed combination. Canakinumab did not appear to improve the antitumor activity when combined with spartalizumab, pemetrexed and cisplatin. Trial registration The trial was registered in Clinicaltrials.gov with identifier no. NCT03064854. Date of Registration: 06 February 2017.

Objective To explore core elements from Teachers’ Relational Competence in general practice literature regarding building relationships in consultations, specifying actions doctors take to create and maintain relationship quality with patients. This systematic literature review aims to map and propose a similar framework for the doctor-patient relationship.Background The doctor-patient relationship, a well-researched yet complex field, often lacks clear descriptions. In recent definitions of patient-centred medicine, the responsibility of this relationship falls on the doctor, though how both relationship and responsibility is enacted needs clarification. Pedagogical literature on the student-teacher relationship provides a framework for relational competence, incorporating the needs and interactions between teacher and student and their alignment with institutional goals.Methods A systematic review of two databases yielded 1256 hits. After screening, 15 studies were included and assessed. A qualitative synthesis was conducted through iterative and thematic deductive analysis.Results Four relationally competent attitudes identified were: Attention to emotion, Devotion, Mentalization, and Time-oriented presence. Four relationally competent actions identitfied were: Being open, Attunement, Offering Support, and Using humor. Additionally, Trust and Continued connectedness were found as components of both attitudes and actions.Conclusion An explanatory framework for professional relational competence for GPs includes concrete actions and specific attitudes before and during consultations. These consist of four key attitudes and four categories of actions with several subgroups of actions. Two additional components to the framework was found.

Abstract Background The COVID-19 pandemic negatively impacted tuberculosis (TB) treatment services, including directly observed therapy (DOT) programs used to promote medication adherence. We compared DOT adherence embedded in a research study before and after COVID-19 lockdowns in South Africa. Methods We analyzed data from 263 observational study participants undergoing drug susceptible (DS)-TB DOT between May 2017 to March 2022. Participants enrolled before October 2019 were considered ‘pre-COVID-19’ and those enrolled after September 2020 were considered ‘post-COVID-19 lockdown groups. Negative binomial regression models were used to compare DOT non-adherence rates between the two lockdown groups. We then conducted a sensitivity analysis which only included participants enrolled in the immediate period following the first COVID-19 lockdown. Results DOT non-adherence rate was higher in the post-COVID-19 lockdown group (aIRR = 1.42, 95% CI = 1.04–1.96; p = 0.028) compared to pre-COVID-19 lockdown period, adjusting for age, sex, employment status, household hunger, depression risk, and smoked substance use. DOT non-adherence was highest immediately following the initial lockdown (aIRR = 1.74, 95% CI = 1.17–2.67; p = 0.006). Conclusion The COVID-19 lockdowns adversely effected adherence to TB DOT in the period after lockdowns were lifted. The change in DOT adherence persisted even after adjusting for socioeconomic and behavioral variables. We need a better understanding of what treatment adherence barriers were exacerbated by COVID-19 lockdowns to improve outcomes in post-pandemic times. Trial registration ClinicalTrials.gov Registration Number: NCT02840877. Registered on 19 July 2016.

Introduction The prevalence of sleep disorders and use of sleep medication, particularly melatonin, are rising among adolescents and young adults (13–24 years). In Denmark, melatonin is approved for use in children with autism and ADHD up to 18 years of age, with other prescriptions being off-label in these age groups. The perspectives of medical practitioners on prescribing sleep medications to this age group remain largely unexplored.Aim This study aims to investigate the considerations of general practitioners (GPs) and child and adolescent psychiatrists (psychiatrists) when prescribing and deprescribing sleep medications for 13–24-year-olds.Methods We conducted qualitative semi-structured interviews with 10 GPs and six psychiatrists. Data were analyzed using an inductive approach.Results Psychiatrists typically prescribed melatonin with the expectation that deprescription would occur in general practice. Despite the universal goal of deprescription, it was hindered by various challenges. GPs identified patient motivation and a clear focus on deprescription as facilitative factors and expressed a need for enhanced emphasis on these aspects in general practice.Discussion and implications The findings align with existing prescription trends and literature on factors that promote and inhibit deprescription. The study underscores the complexities of deprescribing sleep medications for adolescents and young adults, suggesting the need for expanded guidelines and enhanced continuing education for GPs.Conclusions The research highlights significant discrepancies among medical practitioners regarding the deprescription process of sleep medications for young individuals, complicated by multiple factors. This underscores the need for better guidelines and further studies.

In the decade of global ecological restoration efforts, Brazil intends to restore 12 million hectares of degraded areas. This will require an ample offer of seeds of native species, unavailable on the current market, which is partly due to inadequate legislation. We reviewed the literature on native seed production and the specific legislation in Brazil, and compared with rules of other countries to identify good examples to be followed. We first verified a lack of regulation concerning the seed collection in natural environments in Brazil, which contrasts with the Society of Ecological Restoration (SER) recommendations. Best practices for seed collection should be developed by environmental agencies. Second, the scarcity of accredited laboratories for native seed quality analysis is a limitation in Brazil. The development of strategies for streamlined accreditation that align with SER's quality standards for native seeds meant for restoration purposes is an important step. Furthermore, the regulation of the trade of seed mixtures in Brazil is currently restrictive and requires a revision of norms to facilitate their use, as the case in the European Union. The mixtures directly harvested from remnants are promising to promote restoration, especially of grassy ecosystems. Another aspect is the establishment of Seed Transfer Zones (STZs) to promote the use of locally adapted ecotypes and to ensure the conservation of genetic diversity in restoration. Our study indicates how examples from other countries and the SER guidelines can guide advances in Brazilian legislation and streamline the development of a seed supply chain for ecological restoration.

Im inklusiven Unterricht kommt einer pädagogischen Diagnostik besondere Relevanz zu, die auf formativ ausgerichtete diagnostische Zugänge setzt und die Optimierung von Lehr-Lern-Prozessen durch die Bereitstellung möglichst passgenauer Lernangebote zum Ziel hat. Mittel­punkt dieses Beitrags bilden (1) die Frage nach den diagnostischen Zugängen, die Lehrkräfte beschreiben, um im inklusiven Unterricht Erkenntnisse über Lernende zu gewinnen und (2) die Einordnung dieser im Rahmen einer pädagogischen, formativ ausgerichteten Diagnostik nach Zielsetzung und Zeitpunkt der Erkenntnisgewinnung. Der Beitrag basiert auf einer Interviewstu­die, in welcher vier Sonderpädagog:innen und fünf Fachlehrkräfte zu diagnostischen Zugängen im inklusiven Unterricht befragt wurden. Die Interviewauswertung erfolgte mittels Qualitativer Inhaltsanalyse. Die Ergebnisse weisen darauf hin, dass Lehrkräfte zur Diagnostik schulform- und professionsübergreifend häufig individualisierenden Unterricht, implizit auch lehrkraftge­lenkte Phasen nutzen. Zudem werden in den Interviews informelle Methoden und die Schüler:in­nen-Lehrkraft-Beziehung als diagnostisch bedeutsam eingeschätzt. Bei der Beschreibung diag­nostischer Zugänge sind formative Aspekte vorherrschend. Abstract In inclusive education, pedagogical diagnostics is particularly relevant, as it relies on formative diagnostic approaches and aims to optimize teaching-learning processes by providing learning opportunities that are appropriate to the learners needs. This article focuses on (1) the question of the diagnostic approaches that teachers describe in order to gain insights about learners in inclusive education and (2) the classification of these in the context of pedagogical, formative diagnostics according to the objectives and timing of diagnostics. The article is based on an interview study in which four special education teachers and five subject teachers were asked about diagnostic approaches in inclusive education. The interviews were evaluated using quali­tative content analysis. The results indicate that teachers often use individualized instruction and implicitly use teacher-directed phases for diagnostics across school types and professions. In addition, informal methods and the pupil-teacher relationship are seen as diagnostically sig­nificant in the interviews. In the description of diagnostic approaches formative aspects are pre­dominant.

Abstract Background Despite progress understanding the mechanisms underlying tumor spread, metastasis remains a clinical challenge. We identified the choline-producing glycerophosphodiesterase, EDI3 and reported its association with metastasis-free survival in endometrial cancer. We also observed that silencing EDI3 slowed cell migration and other cancer-relevant phenotypes in vitro. Recent work demonstrated high EDI3 expression in ER-HER2+ breast cancer compared to the other molecular subtypes. Silencing EDI3 in ER-HER2+ cells significantly reduced cell survival in vitro and decreased tumor growth in vivo. However, a role for EDI3 in tumor metastasis in this breast cancer subtype was not explored. Therefore, in the present work we investigate whether silencing EDI3 in ER-HER2+ breast cancer cell lines alters phenotypes linked to metastasis in vitro, and metastasis formation in vivo using mouse models of experimental metastasis. Methods To inducibly silence EDI3, luciferase-expressing HCC1954 cells were transduced with lentiviral particles containing shRNA oligos targeting EDI3 under the control of doxycycline. The effect on cell migration, adhesion, colony formation and anoikis was determined in vitro, and significant findings were confirmed in a second ER-HER2+ cell line, SUM190PT. Doxycycline-induced HCC1954-luc shEDI3 cells were injected into the tail vein or peritoneum of immunodeficient mice to generate lung and peritoneal metastases, respectively and monitored using non-invasive bioluminescence imaging. Metabolite levels in cells and tumor tissue were analyzed using targeted mass spectrometry and MALDI mass spectrometry imaging (MALDI-MSI), respectively. Results Inducibly silencing EDI3 reduced cell adhesion and colony formation, as well as increased susceptibility to anoikis in HCC1954-luc cells, which was confirmed in SUM190PT cells. No influence on cell migration was observed. Reduced luminescence was seen in lungs and peritoneum of mice injected with cells expressing less EDI3 after tail vein and intraperitoneal injection, respectively, indicative of reduced metastasis. Importantly, mice injected with EDI3-silenced cells survived longer. Closer analysis of the peritoneal organs revealed that silencing EDI3 had no effect on metastatic organotropism but instead reduced metastatic burden. Finally, metabolic analyses revealed significant changes in choline and glycerophospholipid metabolites in cells and in pancreatic metastases in vivo. Conclusions Reduced metastasis upon silencing supports EDI3’s potential as a treatment target in metastasizing ER-HER2+ breast cancer.

Abstract Background Family psychosocial challenges during the early years of a child’s life are associated with later mental and physical health problems for the child. An increased psychosocial focus on parents in routine child developmental assessments may therefore be justified. Methods Participants in this qualitative study included 11 mothers and one parental couple (mother and father) with children aged 9–23 months. Participants were recruited to Project Family Wellbeing through their general practice in Denmark. Twelve interviews were conducted, transcribed and analysed with a deductive approach. The topic guide drew on the core components of the Health Belief Model, which also served as a framework for the coding that was conducted using thematic analysis. Results Results are presented in four themes and 11 subthemes in total. Parents welcome discussion of their psychosocial circumstances during their child’s developmental assessments. Clinicians’ initiatives to address psychosocial challenges and alignment of parents’ and clinicians’ expectations may be required to allow this discussion. A flowing conversation, an open communication style and a trustful relationship facilitate psychosocial discussion. Barriers included short consultation time, concerns about how information was used and when parents found specific psychosocial aspects stigmatising or irrelevant to discuss. Conclusion Enquiry about the family’s psychosocial circumstances in routine developmental assessments is acceptable among parents. Alignment of clinical and parental expectations of developmental assessments could facilitate the process. Future research should examine the predictive validity of the various components of developmental assessments. Trial registration This is a qualitative study. The study participants are part of the cohort from Project Family Wellbeing (FamilieTrivsel). The project’s trial registry number: NCT04129359. Registered October 16th 2019.

Grassy ecosystems occupy 27% of Brazilian territory and have historically been neglected in conservation efforts and studies about biodiversity. The Campos Sulinos region in Southern Brazil includes open formations in the Pampa and Atlantic Forest domains. This region has the smallest coverage by protected areas in the country and presents high levels of biodiversity and endemism. Besides, this region is under threat due to croplands and exotic tree plantations. Here, we compile a plant population genetics and phylogeography dataset from published studies focusing on species native to the Campos Sulinos to synthesize findings in plant evolution and genetics to better understand the dynamics of genetic diversity in this open ecosystem. We found 58 works on 51 plant species, published from 2005 to 2022. Most studies used only one kind of molecular marker and few loci. The climatic changes during the Pleistocene are likely the main speciation driver either due to the dynamics between grassland and forest or marine transgressions. Overall, high genetic variability and clear structuring of populations were found for the species studied. Regions with high genetic diversity do not coincide with protected areas. We reinforce the necessity of considering high intraspecific genetic diversity and population structure into both conservation and restoration planning, as well as in research within the Campos Sulinos.

Abstract Background Despite recommendations against psychotropic medication in older nursing homes residents with behavioral and psychological symptoms of dementia (BPSD), antidepressants and other psychotropic drugs are still prescribed. We performed a cluster-randomized controlled trial to evaluate the effect of a complex intervention aiming to promote the deprescribing of antidepressants in institutionalized older persons with dementia. To understand the underlying mechanisms of trial outcomes, we conducted a process evaluation exploring the interventions implementation, areas of impact, and contextual factors. The aim of this study was to explore the implementation process and the key factors that promoted and inhibited intervention implementation in the care home setting (Clinicaltrials.gov: NCT04985305. Registered 30 July 2021). Methods Qualitative interviews were conducted between August 2022 and February 2023 with four general practitioners and eight nursing home staff from four associated nursing homes in the Capital Region of Denmark. We coded the interview data according to the four constructs of the Normalization Process Theory (coherence, cognitive participation, collective action, and reflexive monitoring). Results There was a common understanding of the intervention aim. We observed a raised awareness concerning the deprescription of antidepressants among healthcare professionals with good collaboration (coherence). An overall buy-in to a deprescribing mentality was seen (cognitive participation). There were barriers to the GPs and nursing home staff’s use of the intervention elements and how they implemented it, but to some, a common language was created (collective action). Professionals overall valued the idea of deprescribing, but lack of time, high staff turnover, and low education level among nursing home staff hampered the integration (reflexive monitoring). Conclusion Successful implementation seemed to be dependent on the quality of the relationship between the single GP and the single nursing home professional. A common deprescribing mentality promoted the uptake of the intervention. However, several barriers related to lack of resources hindered implementation. It is imperative to adapt complex interventions to the available resources and context.

Abstract Globally, coastal communities experience flood hazards that are projected to worsen from climate change and sea level rise. The 100-year floodplain or record flood are commonly used to identify risk areas for planning purposes. Remote communities often lack measured flood elevations and require innovative approaches to estimate flood elevations. This study employs observation-based methods to estimate the record flood elevation in Alaska communities and compares results to elevation models, infrastructure locations, and sea level rise projections. In 46 analyzed communities, 22% of structures are located within the record floodplain. With sea level rise projections, this estimate increases to 30–37% of structures by 2100 if structures remain in the same location. Flood exposure is highest in western Alaska. Sea level rise projections suggest northern Alaska will see similar flood exposure levels by 2100 as currently experienced in western Alaska. This evaluation of record flood height, category, and history can be incorporated into hazard planning documents, providing more context for coastal flood exposure than previously existed for Alaska. This basic flood exposure method is transferable to other areas with similar mapping challenges. Identifying current and projected hazardous zones is essential to avoid unintentional development in floodplains and improve long-term safety.

Abstract Legal reserve areas (LRAs) are a fundamental part of the Brazilian conservation strategy, together with permanent preservation areas. The LRAs are intended to maintain biodiversity and can be managed sustainably. When these areas are home to ecosystems that depend on fire and grazing, such as native grasslands and savannas, management practices that are suitable for their conservation and for dealing with the effects of global climate change should be adopted. However, this subject is still poorly discussed in Brazil, and public policies are not clear on this matter. This review article describes the grassland and savanna ecosystems in Brazil, the legal aspects related to the management of LRAs, the current and future climate scenarios, and the relationship between climate and fire risk. It also presents a review about the use of fire and grazing in grassland and savanna ecosystems, the legal challenges related to their application in LRAs, and the use of geotechnologies to monitor these practices. The conclusion is that grazing and fire, as management tools, are adequate for LRA functions, as long as they are practiced in accordance with legal and scientifically based standards to avoid the negative effects of their incorrect use.

Abstract As most rare diseases, intermediate uveitis lacks reliable endpoints necessary for randomized clinical trials. Therefore, we investigated longitudinal changes of retinal and choriocapillaris perfusion on optical coherence tomography angiography (OCT-A) in intermediate uveitis and their prognostic value for future best corrected visual acuity (BCVA) and central retinal thickness (CRT). In this retrospective, longitudinal cohort study eyes of patients with intermediate uveitis were imaged by swept-source OCT-A (macula-centered 3 × 3 mm; PLEX Elite 9000, Zeiss) and stratified into clinically stable, worsened and improved based on changes in clinical parameters. Superficial (SRL) and deep retinal layers (DRL) were automatically analyzed for vessel density (VD) and choriocapillaris layer for non-perfused area (CCNPA) using ImageJ. Mixed-effects regression analysis controlling for age, sex, and OCT-A signal strength index (SSI) was used to evaluate the prognostic value of OCT-A parameters. 91 eyes (62 stable, 12 worsened, and 17 improved) were included in the analysis and mean follow-up time was 296 days. Longitudinal changes of VD were different between all three groups (p = 0.002 for SRL and p = 0.017 for DRL). Clinically worsened eyes showed a decrease in VD (− 0.032 ± 0.055 for SRL and − 0.027 ± 0.025 for DRL), whereas clinically improved eyes showed an increase in VD (0.037 ± 0.039 for SRL and 0.001 ± 0.023 for DRL). No difference was found for CCNPA. When controlling for age, sex, and SSI, observed differences held true in clinically worsened eyes for DRL (p = 0.011) and in clinically improved eyes for SRL (p = 0.002). An increase of CCNPA in clinically worsened eyes (p = 0.03) compared to clinically stable and improved eyes was evident. Predictive analysis revealed an association of VD in SRL and DRL at baseline with BCVA at follow-up (p = 0.039 and p = 0.047, respectively) and of VD in SRL at baseline with CRT at follow-up (p = 0.046). Alterations in retinal perfusion on OCT-A in intermediate uveitis are partly reversible and OCT-A VD may serve to predict future BCVA and CRT. Thus, perfusion parameters on OCT-A might aid monitoring and serve as prognostic imaging-biomarker.

BackgroundIn sub-Saharan Africa the birth rate among teenage mothers is the highest in the world. In 2021, there would be 6,114,000 births for 15–19-year-olds in this part of the world. In Cameroon, the fertility rate among adolescents aged 15–19 is 24%. However, there is a significant lack of data on the mental health of teenage mothers. Given the biopsychosocial conditions of the perinatal period and adolescence, we hypothesise that the prevalence of mental disorders and the risk of suicide is very high in Cameroon. The aim is therefore to determine the prevalence of perinatal mental disorders and suicide risk among adolescent mothers in urban areas of Cameroon.MethodsFollowing ethical approval of the submitted protocol, we recruited adolescent mothers and data were collected using diagnostic interviews based on the DSM-5, PDM-2 and MINI guidelines. The types of sampling used were typical and incidental. Data were tabulated with Epidata 3.1 and processed with SPSS 25.Results66.4% of adolescent mothers were diagnosed with a mental disorder and 27.4% with suicidal risk. It was found that there was a link between mental disorders and suicidal risk (p

Introduction: Patients with metastatic NSCLC (mNSCLC) treated with immune checkpoint inhibitors in clinical practice may often not meet the strict inclusion criteria of clinical trials. Our aim was to assess the trial eligibility of patients with mNSCLC treated with pembrolizumab monotherapy in real-world and to compare the outcome of “trial-ineligible” and “potentially trial-eligible” patients. Methods: Data from the prospective, clinical research platform CRISP were used to compare patient characteristics, treatment, and outcome of patients with programmed cell death-ligand 1 tumor proportion score greater than or equal to 50% tumors treated with pembrolizumab monotherapy who are deemed either “potentially trial-eligible” or “trial-ineligible” according to inclusion and exclusion criteria of the registrational studies (KEYNOTE-024 and -042). Results: Of 746 patients included, 343 patients (46.0%) were classified as “trial-ineligible” and had significantly worse outcomes compared with “potentially trial-eligible” patients (n = 403, 54.0%): median progression-free survival: 6.2 (95% confidence interval [CI]: 5.2–8.4) versus 10.3 (95% CI: 8.4–13.8) months, hazard ratio (trial-ineligible versus potentially trial-eligible) of 1.43 (95% CI: 1.19–1.72), p less than 0.001; median overall survival: 15.9 (95% CI: 11.4–20.3) versus 25.3 (95% CI: 19.8–30.4) months, hazard ratio of 1.36 (95% CI: 1.10–1.67), p equals 0.004. Conclusions: Our data reveal that a considerable proportion of patients with mNSCLC are not eligible to participate in a clinical trial and were found to have worse outcomes than potentially trial-eligible patients, whose outcomes were comparable with those obtained from pivotal clinical trials. This is of substantial clinical relevance for physicians discussing outcomes to be expected with their patients and stresses the need for real-world effectiveness analyses.

Background: Creating a holistic picture of children and youth who suffer from acquired aphasia or another (developmental) language disorders is very difficult due to missing diagnostic instruments covering participation. Szenario-Kids is a new diagnostic instrument to measure multimodal communication abilities in everyday life situations of children and youth aged 6 to 16 years. Aims: We aimed to examine feasibility and psychometric properties of the model-based Szenario-Kids in the healthy population, to build the basis for later test evaluation in the language-impaired patient group. Method: Szenario-Kids was administered to n = 57 children and youth without communication deficits (mean age 9.16 years; German as native language). The diagnostic instrument was presented twice within two weeks, complemented by standardized diagnostic instruments to cover all communication modalities and enable correlation of performance between tests. Results: Data analysis showed good practicability, satisfying parallelism of test versions A and B (p = 0.098-0.845), acceptable to excellent reliability (Cronbach's [alpha] = 0.781-0.920) and high interrater reliability (ICC = 0.733-0.960), very strong test-retest correlation (r = 0.736-0.893) and moderate to strong concurrent validity (r = -0.475-0.611; p [less than or equal to] 0.01). Conclusions: The analysis of feasibility and psychometric properties revealed promising results for the group without communication deficits. Neurolinguistic underpinnings can be explained within our Multimodal Communication Model (MCM). Thus, the evaluation of Szenario-Kids in language-impaired children and youth is a next step.

Reliabilität, operationalisiert als Übereinstimmung zwischen Codie- rern, ist gemeinhin akzeptiert als eine notwendige Voraussetzung für Validität in der quan- titativen Inhaltsanalyse. Diese Sichtweise beruht auf der Annahme, dass für jedes Vorkom- men einer gemessenen Variable exakt eine korrekte Klassifizierung bestimmt werden kann. Entgegen dieser Annahme argumentieren wir hier, dass divergierende Klassifizierungen auch aufgrund von im Text verankerten Mehrdeutigkeiten entstehen können, welche nicht als Messfehler zu verstehen sind, sondern vielmehr relevante Eigenschaften des analysier- ten Materials widerspiegeln. Entsprechend entwerfen wir einen Begriff valider Nichtüber- einstimmung im Klassifizierungsprozess, welcher es erlaubt zwischen textuell verankerten, replizierbaren Mehrdeutigkeiten und Replikationsfehlern, welche die Reliabilität der Mes- sung unterminieren, zu unterscheiden. Wir unterscheiden drei in der Textanalyse weit ver- breitete Formen von Mehrdeutigkeiten – begründet in Unter-Spezifizierung, Informations- überschuss, sowie der Austauschbarkeit von Klassifizierungsmöglichkeiten – welche valide Nichtübereinstimmung zur Folge haben, aber bislang keine hinreichende Beachtung im inhaltsanalytischen Methodenkanon gefunden haben. Aufgrund einer Diskussion mögli- cher Implikationen dieser Auslassung skizzieren wir geeignete Strategien für den Umgang mit valider Nichtübereinstimmung in der inhaltsanalytischen Forschung.

Abstract Background The COVID-19 pandemic brought attention to a need for rapid testing of large populations. Experiences from community-based testing settings show that there can be workload difficulties, logistical challenges and socioeconomic downsides to large scale Polymerase Chain Reaction (PCR) testing. Alternative testing arenas have therefore been considered. Rapid point-of-care (POC) PCR test methods have since been developed and could have potential to surveille viral respiratory infections. It is, however, unknown if PCR testing can be successfully implemented routinely in general practice. The aim of this study was to assess factors that enable and inhibit the implementation of point-of-care PCR testing for acute respiratory tract infection in general practice. Methods Fourteen general practices in the east Zealand area in Denmark were included in the study and given access to POC PCR testing equipment during a flu season. The participating clinics were initially trained in the use of a POC PCR testing device and then spent 6 weeks testing it. We conducted qualitative interviews with general practitioners (GPs) and their staff, before and after the testing period, specifically focusing on their clinical decision-making and internal collaboration in relation to POC PCR testing. We used normalization process theory to design the interview guides and to analyze the data. Results Professionals reported no clinical need for a POC PCR testing device in a non-pandemic clinical setting. Results were delivered faster, but this was only timesaving for the patient and not the GP, who had to perform more tasks. Conclusion In its current form, the added diagnostic value of using POC PCR testing in general practice was not sufficient for the professionals to justify the increased work connected to the usage of the diagnostic procedure in daily practice. Trial registration n/a.

Laminar flow offers significant potential for increasing the energy efficiency of future transport aircraft. At the Cluster of Excellence SE2A—Sustainable and Energy-Efficient Aviation—the laminarization of the wing by means of hybrid laminar flow control (HLFC) is being investigated. The aim is to maintain the boundary layer as laminar for up to 80% of the chord length of the wing. This is achieved by active suction on the leading edge and the rear part of the wing. The suction panels are constructed with a thin micro-perforated skin and a supporting open-cellular core structure. The mechanical requirements for this kind of sandwich structure vary depending on its position of usage. The suction panel on the leading edge must be able to sustain bird strikes, while the suction panel on the rear part must sustain bending loads from the deformation of the wing. The objective of this study was to investigate the energy absorption properties of a triply periodic minimal surface (TPMS) structure that can be used as a bird strike-resistant core in the wing leading edge. To this end, cubic-sheet-based gyroid specimens of different polymeric materials and different geometric dimensions were manufactured using additive manufacturing processes. The specimens were then tested under quasi-static compression and dynamic crushing loading until failure. It was found that the mechanical behavior was dependent on the material, the unit cell size, the relative density, and the loading rate. In general, the weight-specific energy absorption (SEA) at 50% compaction increased with increasing relative density. Polyurethane specimens exhibited an increase in SEA with increasing loading rate, as opposed to the specimens of the other investigated polymers. A smaller unit cell size induced a more consistent energy absorption, due to the higher plateau force.

Background: The outstanding capabilities of modern Positron Emission Tomography (PET) to highlight small tumor lesions and provide pathological function assessment are at peril from image quality degradation caused by respiratory and cardiac motion. However, the advent of the long axial field-of-view (LAFOV) scanners with increased sensitivity, alongside the precise time-of-flight (TOF) of modern PET systems, enables the acquisition of ultrafast time resolution images, which can be used for estimating and correcting the cyclic motion. Methods: 0.25 s so-called [18F]FDG PET histo image series were generated in the scope of for detecting respiratory and cardiac frequency estimates applicable for performing device-less data-driven gated image reconstructions. The frequencies of the cardiac and respiratory motion were estimated for 18 patients using Short Time Fourier Transform (STFT) with 20 s and 30 s window segments, respectively. Results: The Fourier analysis provided time points usable as input to the gated reconstruction based on eight equally spaced time gates. The cardiac investigations showed estimates in accordance with the measured pulse oximeter references (p = 0.97) and a mean absolute difference of 0.4 ± 0.3 beats per minute (bpm). The respiratory frequencies were within the expected range of 10–20 respirations per minute (rpm) in 16 out of 18 patients. Using this setup, the analysis of three patients with visible lung tumors showed an increase in tumor SUVmax and a decrease in tumor volume compared to the non-gated reconstructed image. Conclusions: The method can provide signals that were applicable for gated reconstruction of both cardiac and respiratory motion, providing a potential increased diagnostic accuracy.