Search

Zusammenfassung Ziel der Studie Zur Aufrechterhaltung des in der psychosomatischen Rehabilitationsmaßnahme erzielten Effektes ist eine psychosomatische Reha-Nachsorge bei den meisten Rehabilitanden indiziert. Aufgrund der geringen wohnortnahen Versorgung mit Nachsorgetherapeuten ist die Nutzung digitaler Angebote eine Möglichkeit, um einen ortsunabhängigen Zugang zu ermöglichen. Ziel der Studie war die Evaluation der therapeutischen Effekte einer webbasierten Nachsorge im Vergleich zu einer Face-to-face-(F2F)-Therapie (beides auf konzeptioneller Basis des Curriculum Hannover) in der Äquivalenzstudie und zu keiner standardisierten Nachsorge (Care as usual, CAU) in der Überlegenheitsstudie. Methodik 300 Rehabilitanden mit Indikation zur psychosomatischen Nachsorge wurden bei Verfügbarkeit eines wohnortnahen Nachsorge-Angebotes der Äquivalenzstudie zugewiesen und anschließend in F2F- oder Online-Nachsorge randomisiert. Ohne wohnortnahes Angebot wurden die Teilnehmenden der Überlegenheitsstudie zugewiesen und in Online- oder CAU-Gruppe randomisiert. Die Outcomes (primär: psychische und somatoforme Beschwerden, sekundär: Subskalen des HEALTH-49, Erwerbstätigkeitsprognose, Arbeitsfähigkeit) wurden durch Online-Fragebögen am Ende der Reha, 9 bzw. 12 und 15 bzw. 18 Monate nach der Reha erhoben und durch multiple Imputation mit Intention-To-Treat-Analysen ausgewertet. Für das primäre Outcome erfolgte zusätzlich eine Sensitivitätsanalyse auf Basis des vollständigen Datensatzes. Ergebnisse Nach Ausschluss nonadhärenter Studienteilnehmer erfolgte die Auswertung von n=142 Rehabilitanden in der Äquivalenzstudie und n=111 in der Überlegenheitsstudie. Es wurden in der Äquivalenzstudie keine signifikanten Unterschiede (d=0,28 bzw. 0,10 bei ITT-Analysen; d=0,09 bzw. 0,03 bei Auswertung nur des vollständigen Datensatzes) zwischen Online- und F2F-Nachsorge in Bezug auf kurz- bzw. langfristige psychische und somatoforme Beschwerden gefunden. In der Überlegenheitsstudie sanken langfristig psychische und somatoforme Beschwerden in der Online-Gruppe, während sie in der CAU-Gruppe zu T2 erst sanken (d=0,56) und zu T3 wieder stiegen (d=0,72). Dieser Befund wurde durch die Analyse des vollständigen Datensatzes validiert (d=0,12), während in der Online-Gruppe die Beschwerden zu T3 anstiegen (d=0,10). Schlussfolgerung Webbasierte psychosomatische Nachsorge scheint nach den Ergebnissen der vorliegenden Studie einen längerfristigen Vorteil für Rehabilitanden ohne Zugang zur bisherigen Nachsorge zu haben. Im Vergleich zu der F2F-Durchführung kann sie als äquivalent angesehen werden.

Die Fachpflegenden in der Anästhesie verfügen über ein hohes Maß an beruflicher Handlungskompetenz. Damit tragen sie entscheidend zur Patientensicherheit bei. Der folgende Beitrag gibt einen Überblick über die Qualifikation und Zielsetzung der Fachpflege und ihr umfangreiches Aufgabengebiet im operativen Umfeld.

Der Arbeitsplatz OP hat sich in den letzten Jahren abermals rasant entwickelt im Hinblick auf die Quantität und Qualität der Operationen, die technische Ausstattung sowie die Komplexität der Versorgungsprozesse. Um in diesem Hochrisikobereich die Patientensicherheit zu gewährleisten, müssen die beteiligten Berufsgruppen über vielfältige Kompetenzen verfügen.

BACKGROUND Patients with post-COVID/long-COVID symptoms need support, and health care professionals need to be able to provide evidence-based patient care. Digital interventions can meet these requirements, especially if personal contact is limited. OBJECTIVE We reviewed evidence-based digital interventions that are currently available to help manage physical and mental health in patients with post-COVID/long-COVID symptoms. METHODS A scoping review was carried out summarizing novel digital health interventions for treating post-COVID/long-COVID patients. Using the PICO (population, intervention, comparison, outcome) scheme, original studies were summarized, in which patients with post-COVID/long-COVID symptoms used digital interventions to help aid recovery. RESULTS From all scanned articles, 8 original studies matched the inclusion criteria. Of the 8 studies, 3 were “pretest” studies, 3 described the implementation of a telerehabilitation program, 1 was a post-COVID/long-COVID program, and 1 described the results of qualitative interviews with patients who used an online peer-support group. Following the PICO scheme, we summarized previous studies. Studies varied in terms of participants (P), ranging from adults in different countries, such as former hospitalized patients with COVID-19, to individuals in disadvantaged communities in the United Kingdom, as well as health care workers. In addition, the studies included patients who had previously been infected with COVID-19 and who had ongoing symptoms. Some studies focused on individuals with specific symptoms, including those with either post–COVID-19 or long-term symptoms, while other studies included patients based on participation in online peer-support groups. The interventions (I) also varied. Most interventions used a combination of psychological and physical exercises, but they varied in duration, frequency, and social dimensions. The reviewed studies investigated the physical and mental health conditions of patients with post-COVID/long-COVID symptoms. Most studies had no control (C) group, and most studies reported outcomes (O) or improvements in physiological health perception, some physical conditions, fatigue, and some psychological aspects such as depression. However, some studies found no improvements in bowel or bladder problems, concentration, short-term memory, unpleasant dreams, physical ailments, perceived bodily pain, emotional ailments, and perceived mental health. CONCLUSIONS More systematic research with larger sample sizes is required to overcome sampling bias and include health care professionals’ perspectives, as well as help patients mobilize support from health care professionals and social network partners. The evidence so far suggests that patients should be provided with digital interventions to manage symptoms and reintegrate into everyday life, including work.

Zusammenfassung Ziel der Studie Zur Aufrechterhaltung der in der psychosomatischen Rehabilitationsmaßnahme erzielten Effekte ist eine psychosomatische Reha-Nachsorge bei den meisten Rehabilitanden indiziert. Auf Grund der derzeitig geringen wohnortnahen Versorgung mit durch die Deutsche Rentenversicherung zur Nachsorge zugelassenen Psychotherapeuten (sog. Nachsorgetherapeuten) sind webbasierte Nachsorge-Angebote eine gleichwertige Alternative zu analogen Angeboten. Die vorliegende Arbeit klärt, bei welchen Merkmalen eine webbasierte Nachsorge empfohlen werden kann und wie diese webbasierten Formate insbesondere in Bezug auf die therapeutische Beziehung durch die Teilnehmenden bewertet werden. Methodik 142 psychosomatische Rehabilitanden wurden bei Verfügbarkeit eines wohnortnahen Angebotes der analogen Nachsorge oder der webbasierten Nachsorge randomisiert zugewiesen (Äquivalenzstudiendesign). Die Testvariablen wurden durch Fragebögen erhoben und zum Teil stratifiziert nach Alter und Geschlecht analysiert. Ergebnisse Für männliche Teilnehmende ergeben sich keine signifikanten Unterschiede zwischen den beiden Nachsorge-Formaten (webbasierte vs. analoge Nachsorge). Frauen scheinen langfristig geringere Werte für Depressivität aufzuweisen, wenn sie an der webbasierten Nachsorge teilnehmen im Vergleich zur analogen Nachsorge. Teilnehmende bis 50 Jahren profitieren signifikant mehr von der webbasierten Nachsorge als Teilnehmende über 50 Jahre. Die Qualität der therapeutischen Beziehung wird in beiden Nachsorge-Formaten gleich gut beurteilt. Diskussion Webbasierte Nachsorge-Angebote bieten insbesondere angesichts der zunehmenden Digitalisierung des Gesundheitswesens im Rahmen der Corona-Pandemie die Möglichkeit, Patienten wohnortunabhängig und mit gleichem Nutzen wie analoge Angebote zu versorgen. Eine therapeutische Beziehung kann aus Patientensicht in beiden Formaten hergestellt werden. Bei der Indikationsstellung sind demografische Faktoren wie das Alter und Geschlecht zu beachten. Schlussfolgerung Therapeuten sollten die Empfehlung einer webbasierten Nachsorge besonders für jüngere Patienten und für Frauen aussprechen, während Männern und älteren Patienten beide Formate gleichermaßen empfohlen werden können. Therapeuten, die eine webbasierte Nachsorge anbieten, sollten vorab, wie in der vorliegenden Arbeit geschehen, zu technischen und inhaltlichen Aspekten geschult werden.

In order to maintain the effect achieved in the psychosomatic rehabilitation measure, psychosomatic rehabilitation aftercare is indicated for most rehabilitation patients. Due to the low availability of aftercare therapists close to home, the use of digital offers is a possibility to enable access independent of location. The aim of the study was to evaluate the therapeutic effects of web-based aftercare in comparison to face-to-face (F2F) therapy (both on the conceptual basis of the Curriculum Hannover) in the equivalence study and to no standardized aftercare (care as usual, CAU) in the superiority study.300 rehabilitation patients with an indication for psychosomatic aftercare were assigned to the equivalence study if an aftercare service close to home was available and then randomized to F2F or online aftercare. Without a service close to home, the participants were assigned to the superiority study and randomized to online or CAU group. The outcomes (primary: psychological and somatoform complaints, secondary: subscales of the HEALTH-49, employment prognosis, ability to work) were assessed by online questionnaires at the end of rehabilitation, 9 or 12 and 15 or 18 months after rehabilitation and evaluated with multiple imputation and intention-to-treat-analyses. For the primary outcome, a sensitivity analysis was also carried out on the basis of the completed dataset.After excluding non-adherent participants, n=142 participants were evaluated in the equivalence study and n=111 in the superiority study. In the equivalence study, no significant differences (d=0,28 and 0,10 with ITT-analyses; d=0,09 and 0,03 with completed dataset) were found between online and F2F follow-up with regard to short-term and long-term psychological and somatoform complaints. In the superiority study, long-term psychological and somatoform complaints decrease in the online group, while in the CAU group they first decreased at T2 (d=0,56) and increased again at T3 (d=0,72). The latter finding is confirmed with the analysis of the completed dataset (d=0,12), while an increase was seen in the online group at T3 (d=0,10).According to the results of the present study, web-based psychosomatic aftercare seems to have a longer-term advantage for rehabilitants without access to previous aftercare. Compared to F2F implementation, it can be considered equivalent.Zur Aufrechterhaltung des in der psychosomatischen Rehabilitationsmaßnahme erzielten Effektes ist eine psychosomatische Reha-Nachsorge bei den meisten Rehabilitanden indiziert. Aufgrund der geringen wohnortnahen Versorgung mit Nachsorgetherapeuten ist die Nutzung digitaler Angebote eine Möglichkeit, um einen ortsunabhängigen Zugang zu ermöglichen. Ziel der Studie war die Evaluation der therapeutischen Effekte einer webbasierten Nachsorge im Vergleich zu einer Face-to-face-(F2F)-Therapie (beides auf konzeptioneller Basis des Curriculum Hannover) in der300 Rehabilitanden mit Indikation zur psychosomatischen Nachsorge wurden bei Verfügbarkeit eines wohnortnahen Nachsorge-Angebotes der Äquivalenzstudie zugewiesen und anschließend in F2F- oder Online-Nachsorge randomisiert. Ohne wohnortnahes Angebot wurden die Teilnehmenden der Überlegenheitsstudie zugewiesen und in Online- oder CAU-Gruppe randomisiert. Die Outcomes (primär: psychische und somatoforme Beschwerden, sekundär: Subskalen des HEALTH-49, Erwerbstätigkeitsprognose, Arbeitsfähigkeit) wurden durch Online-Fragebögen am Ende der Reha, 9 bzw. 12 und 15 bzw. 18 Monate nach der Reha erhoben und durch multiple Imputation mit Intention-To-Treat-Analysen ausgewertet. Für das primäre Outcome erfolgte zusätzlich eine Sensitivitätsanalyse auf Basis des vollständigen Datensatzes.Nach Ausschluss nonadhärenter Studienteilnehmer erfolgte die Auswertung von n=142 Rehabilitanden in der Äquivalenzstudie und n=111 in der Überlegenheitsstudie. Es wurden in der Äquivalenzstudie keine signifikanten Unterschiede (d=0,28 bzw. 0,10 bei ITT-Analysen; d=0,09 bzw. 0,03 bei Auswertung nur des vollständigen Datensatzes) zwischen Online- und F2F-Nachsorge in Bezug auf kurz- bzw. langfristige psychische und somatoforme Beschwerden gefunden. In der Überlegenheitsstudie sanken langfristig psychische und somatoforme Beschwerden in der Online-Gruppe, während sie in der CAU-Gruppe zu T2 erst sanken (d=0,56) und zu T3 wieder stiegen (d=0,72). Dieser Befund wurde durch die Analyse des vollständigen Datensatzes validiert (d=0,12), während in der Online-Gruppe die Beschwerden zu T3 anstiegen (d=0,10).Webbasierte psychosomatische Nachsorge scheint nach den Ergebnissen der vorliegenden Studie einen längerfristigen Vorteil für Rehabilitanden ohne Zugang zur bisherigen Nachsorge zu haben. Im Vergleich zu der F2F-Durchführung kann sie als äquivalent angesehen werden.

Background Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS. Methods This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated. Discussion This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population. Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022

In order to maintain the effects achieved during the psychosomatic rehabilitation, according aftercare is indicated for most rehabilitation patients. Due to the current low supply of aftercare psychotherapists (so-called aftercare therapists) licensed by the German Pension Insurance web-based aftercare provides an equivalent alternative to analogue (in person) offers. This study clarifies which characteristics indicate that web-based aftercare is particularly recommended and how web-based formats are evaluated by participants, especially with regard to the therapeutic relationship.142 psychosomatic rehabilitation patients were randomly assigned to analogue aftercare or web-based aftercare if a service close to their home was available (equivalence study design). Test variables were collected by questionnaires and analyzed stratified for age and gender.For male participants, there are no significant differences between the two aftercare formats. Women appear to have lower long-term depression scores when participating in web-based aftercare. Participants till the age 50 benefit significantly more from web-based aftercare than rehabilitants above age 50, The quality of the therapeutic relationship is rated equally well in both aftercare formats.Particularly in view of the increasing digitization of healthcare in times of the corona pandemic, web-based aftercare services offer the possibility of providing patients with aftercare independent of the availability of analogue-services and with the same benefits as analog therapies. Demographic factors such as age and sex must be taken into account when determining the indication.Therapists should recommend web-based aftercare especially for younger patients and for women, while men and older patients can be recommended both services equally. Therapists who offer web-based aftercare should be trained in advance on technical and content-related aspects, as was done in the present work.Zur Aufrechterhaltung der in der psychosomatischen Rehabilitationsmaßnahme erzielten Effekte ist eine psychosomatische Reha-Nachsorge bei den meisten Rehabilitanden indiziert. Auf Grund der derzeitig geringen wohnortnahen Versorgung mit durch die Deutsche Rentenversicherung zur Nachsorge zugelassenen Psychotherapeuten (sog. Nachsorgetherapeuten) sind webbasierte Nachsorge-Angebote eine gleichwertige Alternative zu analogen Angeboten. Die vorliegende Arbeit klärt, bei welchen Merkmalen eine webbasierte Nachsorge empfohlen werden kann und wie diese webbasierten Formate insbesondere in Bezug auf die therapeutische Beziehung durch die Teilnehmenden bewertet werden.142 psychosomatische Rehabilitanden wurden bei Verfügbarkeit eines wohnortnahen Angebotes der analogen Nachsorge oder der webbasierten Nachsorge randomisiert zugewiesen (Äquivalenzstudiendesign). Die Testvariablen wurden durch Fragebögen erhoben und zum Teil stratifiziert nach Alter und Geschlecht analysiert.Für männliche Teilnehmende ergeben sich keine signifikanten Unterschiede zwischen den beiden Nachsorge-Formaten (webbasierte vs. analoge Nachsorge). Frauen scheinen langfristig geringere Werte für Depressivität aufzuweisen, wenn sie an der webbasierten Nachsorge teilnehmen im Vergleich zur analogen Nachsorge. Teilnehmende bis 50 Jahren profitieren signifikant mehr von der webbasierten Nachsorge als Teilnehmende über 50 Jahre. Die Qualität der therapeutischen Beziehung wird in beiden Nachsorge-Formaten gleich gut beurteilt.Webbasierte Nachsorge-Angebote bieten insbesondere angesichts der zunehmenden Digitalisierung des Gesundheitswesens im Rahmen der Corona-Pandemie die Möglichkeit, Patienten wohnortunabhängig und mit gleichem Nutzen wie analoge Angebote zu versorgen. Eine therapeutische Beziehung kann aus Patientensicht in beiden Formaten hergestellt werden. Bei der Indikationsstellung sind demografische Faktoren wie das Alter und Geschlecht zu beachten.Therapeuten sollten die Empfehlung einer webbasierten Nachsorge besonders für jüngere Patienten und für Frauen aussprechen, während Männern und älteren Patienten beide Formate gleichermaßen empfohlen werden können. Therapeuten, die eine webbasierte Nachsorge anbieten, sollten vorab, wie in der vorliegenden Arbeit geschehen, zu technischen und inhaltlichen Aspekten geschult werden.

Controlling chiral magnetic domains in a multiferroic material is promising for applications in spintronics or data storage devices. The authors study the electric-field driven relaxation of multiferroic domains in NaFeGe${}_{2}$O${}_{6}$ as a function of temperature and electric field over several decades in time. An astonishingly simple combination of an Arrhenius-like temperature dependence with a Merz law for the electric-field dependence describes the relaxation times with only two parameters, indicating that multiferroic relaxation is essentially determined by domain-wall motion.

Background Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention’s impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine. Objective This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered. Methods In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1. Results There were no significant differences between the groups regarding dropout rates (χ21=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51). Conclusions While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients’ challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients. Trial Registration ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842

In single crystals of orthorhombic alpha-AlOOH, known also as mineral diaspore, χ(3)-nonlinear lasing by stimulated Raman scattering (SRS) and Raman-induced four-wave mixing (RFWM) is investigated. Picosecond pumping at 1.064 µm wavelength produces a broadband Stokes and anti-Stokes frequency comb with up to 25 SRS- and RFWM-generated emission lines. All observed Stokes and anti-Stokes lasing components in the visible and near-IR are identified and attributed to a single SRS-promoting vibration mode with ωSRS ≈ 445 cm−1. The first Stokes steady-state Raman gain coefficient in the visible spectral range is estimated to a value not less than 0.36 cm GW−1.

The recently discovered material ${\mathrm{Cs}}_{3}{\mathrm{Fe}}_{2}{\mathrm{Br}}_{9}$ contains ${\mathrm{Fe}}_{2}{\mathrm{Br}}_{9}$ bi-octahedra forming triangular layers with hexagonal stacking along the $c$ axis. In contrast to isostructural Cr-based compounds, the zero-field ground state is not a nonmagnetic $S=0$ singlet-dimer state. Instead, the ${\mathrm{Fe}}_{2}{\mathrm{Br}}_{9}$ bi-octahedra host semiclassical $S=\frac{5}{2}\phantom{\rule{4pt}{0ex}}{\mathrm{Fe}}^{3+}$ spins with a pronounced easy-axis anisotropy along $c$, and interestingly, the intradimer spins are ordered ferromagnetically. The high degree of magnetic frustration due to (various) competing intradimer and interdimer couplings leads to a surprisingly rich magnetic phase diagram. The zero-field ground state is already reached via an intermediate phase, and the high-field magnetization and thermal expansion data for $H\ensuremath{\parallel}c$ identify 10 different ordered phases. Among them are phases with constant magnetization of $\frac{1}{3}$, respectively $\frac{1}{2}$, of the saturation value, and several transitions are strongly hysteretic with pronounced length changes, reflecting strong magnetoelastic coupling.

The efficacy of internet and mobile-based interventions (IMIs) has been demonstrated with different mental health disorders, but little is known about the mediating effect of phobic anxiety on activity and participation and the differential effect of age. The current study tested a moderated mediation model with short-term change in phobic anxiety mediating between treatment (IMI vs. face-to-face, F2F) and long-term change in activity and participation, and age of patients moderating this mediation. Participants (N = 142) were recruited from psychosomatic rehabilitation clinics and randomized into the IMI psychosomatic aftercare or F2F psychosomatic aftercare. Moderated mediation analyses were conducted using R software. Results showed that the long-term treatment effects of activity and participation (βc = −0.18, p = 0.034, βc’ = −0.13, p = 0.145) were improved through the successful decrease of phobic anxiety (βa = −0.18, p = 0.047, βb = 0.37, p = 0.010). Older patients benefited equally from both IMI and F2F interventions regarding short-term treatment change in phobic anxiety, while younger participants benefited more from IMI (βAge*Treatment = 0.20, p = 0.004). IMIs targeting mental disorders can improve activity and participation along with phobic anxiety, especially in younger individuals. The needs of older patients should be considered with the development and improvement of IMIs.

BACKGROUND Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention’s impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine. OBJECTIVE This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered. METHODS In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1. RESULTS There were no significant differences between the groups regarding dropout rates (χ21=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51). CONCLUSIONS While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients’ challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients. CLINICALTRIAL ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842

Im 6. Teil unserer Serie stellen wir Ihnen einen Standard aus der Gynäkologie vor. Unsere Autorin beschreibt, welche Materialien für die Mamma-Probeexzision (PE) gerichtet werden müssen, wie die Patientin gelagert wird und was bei der Histologie zu beachten ist.

The tetragonal polar barium antimony tartrate trihydrate, Ba[Sb2((+)C4H2O6)2]·3H2O, was grown to large single crystals of optical quality and several cm dimensions. A vibrational spectroscopy study, thermal expansion measurements and a determination of the pyroelectric properties were performed and possibilities for phase matching for second harmonic generation (SHG) were analysed. The crystals show a remarkable high pyroelectric coefficient, a moderate anisotropy of thermal expansion and allow for type I and type II phase matching for collinear SHG. A redetermination of the crystal structure of Ba[Sb2((+)C4H2O6)2]·3H2O at 150 K is given in addition, together with the vibrational spectra and crystal structures of two new related compounds, Ba[As2((+)C4H2O6)2]·3H2O and Ba[Sb2((+)C4H2O6)2]·4H2O, determined at the same temperature.

LiCuVO4 is a model system of a 1D spin-1/2 chain that enters a planar spin-spiral ground state below its Néel temperature of 2.4 K due to competing nearest and next nearest neighbor interactions. The spin-spiral state is multiferroic with an electric polarization along the a axis which has been proposed to be caused purely by the spin supercurrent mechanism. With external magnetic fields in c direction TN can be suppressed down to 0 K at 7.4 T. Here we report dynamical measurements of the polarization from P(E)-hysteresis loops, magnetic field dependent pyro-current and non-linear dielectric spectroscopy as well as thermal expansion and magnetostriction measurements at very low temperatures. The multiferroic transition is accompanied by strong anomalies in the thermal expansion and magnetostriction coefficients and we find slow switching times of electric domain reversal. Both observations suggest a sizable magnetoelastic coupling in LiCuVO4. By analyzing the non-linear polarization dynamics we derive domain sizes in the nm range that are probably caused by Li defects.

The crystal and magnetic structures of multiferroic $\mathrm{LiFe}{({\mathrm{WO}}_{4})}_{2}$ were investigated by temperature and magnetic-field-dependent specific heat, susceptibility, and neutron diffraction experiments on single crystals. Considering only the two nearest-neighbor magnetic interactions, the system forms a ${J}_{1}, {J}_{2}$ magnetic chain, but more extended interactions are sizable. Two different magnetic phases exhibiting long-range incommensurate order evolve at ${T}_{\text{N}1}\ensuremath{\approx}22.2\phantom{\rule{0.16em}{0ex}}\mathrm{K}$ and ${T}_{\text{N}2}\ensuremath{\approx}19\phantom{\rule{0.16em}{0ex}}\mathrm{K}$. First, a spin-density wave develops with moments lying in the $ac$ plane. In its multiferroic phase below ${T}_{\text{N}2}, \mathrm{LiFe}{({\mathrm{WO}}_{4})}_{2}$ exhibits a spiral arrangement with an additional spin component along $b$. Therefore, the inverse Dzyaloshinskii-Moriya mechanism fully explains the multiferroic behavior in this material. A partially unbalanced multiferroic domain distribution was observed even in the absence of an applied electric field. For both phases only a slight temperature dependence of the incommensurability was observed, and there is no commensurate phase emerging at low temperature or at finite magnetic fields up to $6\phantom{\rule{0.16em}{0ex}}\mathrm{T}$. $\mathrm{LiFe}{({\mathrm{WO}}_{4})}_{2}$ thus exhibits a simple phase diagram with the typical sequence of transitions for a type-II multiferroic material.

The structural distortion and magnetoelastic coupling induced through commensurate magnetism has been investigated by neutron diffraction in structurally related ${\mathrm{MnWO}}_{4}$ and $\mathrm{NaFe}{({\text{WO}}_{4})}_{2}$. Both systems exhibit a competition of incommensurate spiral and commensurate spin up-up-down-down ordering along the magnetic chains. In the latter commensurate phases, the alternatingly parallel and antiparallel arrangement of ${\mathrm{Fe}}^{3+}$ or ${\mathrm{Mn}}^{2+}$ moments leads to sizable bond-angle modulation and thus to magnetic dimerization. For $\mathrm{NaFe}{({\text{WO}}_{4})}_{2}$ this structural distortion has been determined to be strongest for the low-field up-up-down-down arrangement, and the structural refinement yields a bond-angle modulation of $\ifmmode\pm\else\textpm\fi{}1.15(16)$ degrees. In the commensurate phase of ${\mathrm{MnWO}}_{4}$, superstructure reflections signal a comparable structural dimerization and thus strong magneto-elastic coupling different to that driving the multiferroic order. Pronounced anharmonic second- and third-order reflections in the incommensurate and multiferroic phase of ${\mathrm{MnWO}}_{4}$ result from tiny commensurate fractions that can depin multiferroic domains.

This paper reports reports on the spin-orbit exciton and its crystal-field splitting in $\ensuremath{\alpha}$-RuCl${}_{3}$, as observed in Raman and infrared spectroscopy and show the onset of a j=1/2 scenario and signatures of dominant Kitaev exchange.

We present a study of the dielectric, structural, and magnetic properties of the multiferroic or linear magnetoelectric substitution series ${[{({\mathrm{NH}}_{4})}_{1\ensuremath{-}x}{\mathrm{K}}_{x}]}_{2}[\mathrm{Fe}{\mathrm{Cl}}_{5}({\mathrm{H}}_{2}\mathrm{O})]$. Pyroelectric currents, magnetic susceptibilities, and thermodynamic properties were examined on large single crystals of the erythrosiderite compounds and detailed magnetic-field versus temperature phase diagrams are derived for three different substitution levels. With increasing potassium concentration the material is tuned from a multiferroic ($x\ensuremath{\le}0.06$) to a linear magnetoelectric ($x\ensuremath{\ge}0.15$) ground state. In contrast to the respective pure parent compounds with $x=0$ or 1, however, the ferroelectric or linear magnetoelectric polarization in none of the substituted samples is switchable by external electric fields because these samples exhibit a significant electric polarization already above the magnetic ordering transition. The polarization arises at a higher-lying structural phase transition that is examined by THz spectroscopy, and, on a deuterated pure single crystal, by comprehensive neutron-diffraction experiments. The structural phase transition is attributed to an ordering of ${\mathrm{NH}}_{4}^{+}$ tetrahedra but does not break inversion symmetry in the pure material, while a finite K content causes pyroelectricity.

chi((3))-nonlinear optical interactions in two melilite-type stimulated Raman scattering (SRS)-active non-centrosymmetric crystals, Ca(2)MgSi(2)O(7)and Ca2Ga2SiO7, formerly known as Nd3+-laser media, are presented. Under picosecond pumping at 1.064 and 0.532 mu m cascaded and cross-cascaded effects occur in these tetragonal silicates. Besides the SRS-promoting phonon modes with energy of omega(SRS1)approximate to 908 cm(-1)and omega(SRS2)approximate to 668 cm(-1)for Ca2MgSi2O7, and omega(SRS1)approximate to 720 cm(-1)and omega(SRS2)approximate to 550 cm(-1)for Ca2Ga2SiO7, respectively, combined phonon modes are observed. For Ca(2)MgSi(2)O(7)new data in a broad wavelength range of refractive indices and their dispersion are given as well. The observed chi((3))-nonlinear properties expand the functionality of the studied silicates and foreshadow their use in self-frequency Raman laser converters (self-SRS lasers).

Application of the scanning probe microscopy techniques, such as Piezoresponse Force Microscopy (PFM), opens a possibility to re-visit the ferroelectrics previously studied by the macroscopic electrical testing methods and establish a link between their local nanoscale characteristics and integral response. Here, we report the nanoscale PFM studies and phase field modeling of the static and dynamic behavior of the domain structure in the well-known ferroelectric material - lead germanate, Pb5Ge3O11 (PGO). Several unusual phenomena were revealed: (1) domain formation during the paraelectric-to-ferroelectric phase transition, which exhibits an atypical cooling rate dependence; (2) unexpected electrically-induced formation of the oblate domains due to the preferential domain walls motion in the directions perpendicular to the polar axis, contrary to the typical domain growth behavior observed so far; (3) absence of the bound charges at the 180 head-to-head (H-H) and tail-to-tail (T-T) domain walls, which typically exhibit a significant charge density in other ferroelectrics due to the polarization discontinuity. This strikingly different behavior is rationalized by the phase field modeling of the dynamics of uncharged H-H and T-T domain walls. Our results provide a new insight into the emergent physics of the ferroelectric domain boundaries, revealing unusual properties not exhibited by conventional Ising-type walls.

Raman and terahertz spectroscopy, combined with exact diagonalization studies, reveal the nature of the high-field phase of the proximate Kitaev material $\ensuremath{\alpha}$-RuCl${}_{3}$ as a partially polarized quantum disordered state. The state is characterized by a gapped multiparticle continuum, out of which a two-particle bound state emerges, together with a well-defined single-particle excitation at low energy. The results underline the unusual nature of the high-field phase, and the important role of Kitaev and off-diagonal interactions in $\ensuremath{\alpha}$-RuCl${}_{3}$.

In the quest for realizations of quantum spin liquids, the exploration of Kitaev materials - spin-orbit entangled Mott insulators with strong bond-directional exchanges - has taken center stage. However, in these materials the local spin-orbital j=1/2 moments typically show long-range magnetic order at low temperature, thus defying the formation of a spin-liquid ground state. Using resonant inelastic x-ray scattering (RIXS), we here report on a proximate spin liquid regime with clear fingerprints of Kitaev physics in the magnetic excitations of the honeycomb iridates alpha-Li2IrO3 and Na2IrO3. We observe a broad continuum of magnetic excitations that persists up to at least 300K, more than an order of magnitude larger than the magnetic ordering temperatures. We prove the magnetic character of this continuum by an analysis of the resonance behavior. RIXS measurements of the dynamical structure factor for energies within the continuum show that dynamical spin-spin correlations are restricted to nearest neighbors. Notably, these spectroscopic observations are also present in the magnetically ordered state for excitation energies above the conventional magnon excitations. Phenomenologically, our data agree with inelastic neutron scattering results on the related honeycomb compound RuCl3, establishing a common ground for a proximate Kitaev spin-liquid regime in these materials., Comment: 13 pages, 14 figures

Clusters of single spins form the relevant spin entities in the formation of long-range magnetic order in spin cluster Mott insulators. Such type of spin order bears resemblance to molecular crystals, and we therefore may expect a prototypical spin wave spectrum which can be divided into low-energy external and high-energy internal cluster spin wave modes. Here, we study high-energy spin cluster excitations in the spin cluster Mott insulator Cu$_{2}$OSeO$_{3}$ by means of spontaneous Raman scattering. Multiple high-energy optical magnon modes are observed, of which the Raman-activity is shown to originate in the Elliot-Loudon scattering mechanism. Upon crossing the long-range ordering transition temperature the magnetic modes significantly broaden, corresponding to scattering from localized spin excitations within the spin clusters. Different optical phonon modes show a strong temperature dependence, evidencing a strong magnetoelectric coupling between optical phonons and the high-energy spin cluster excitations. Our results support the picture that Cu$_{2}$OSeO$_{3}$ can be regarded as a solid-state molecular crystal of spin nature.

α-LiAlSi2O6, known as mineral spodumene, is introduced as a novel SRS-active crystal with monoclinic symmetry C2/c. Under picosecond laser excitation Raman-induced steady-state χ(3)-nonlinear generation in the visible and near-IR is observed in the crystals. All recorded Stokes and anti-Stokes high-order lasing components are identified and correspond to three SRS-promoting phonon modes with ωSRS1 ≈ 709 cm−1, ωSRS2 ≈ 357 cm−1 and ωSRS3 ≈ 1074 cm−1. On the basis of the results of a spontaneous Raman scattering study they were assigned to vibrations of the tetrahedral [SiO4] groups of the silicate chains and lattice modes of Li-O or Al-O of the crystal structure. A brief review in tabular form of so far known SRS-active natural crystals (minerals) is given as well.

In den letzten beiden Ausgaben haben wir einen Überblick über die organisatorischen Herausforderungen der Zeitarbeit gegeben und geschildert, welche Vor- und Nachteile die Arbeitnehmerüberlassung aus Sicht der OP-Leitung hat. Im letzten Teil unserer Miniserie berichtet eine festangestellte OP-Pflegende über ihre Erfahrungen mit Honorarkräften im OP.

Im Notfall muss jeder Handgriff sitzen. Das gilt erst recht für Notfälle, bei denen sehr viele schwerverletzte Menschen eingeliefert werden. Um sich dafür zu rüsten, wurden am Klinikum Konstanz in einem realitätsnahen Szenario die Behandlungsabläufe im OP durchgespielt.