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To assess the spatiotemporal evolution of the heterotrophic dinoflagellate Noctiluca scintillans in the North Sea, the Helgoland Roads time series and Continuous Plankton Recorder survey were analysed using generalized additive models. Over the last decades, blooms of N. scintillans have occurred more frequently and intensively in many regions. This harmful algal bloom forming species can alter food webs, reduce ecosystem productivity, and lead to economic losses while causing lower aquacultural yields. After the 1990s, N. scintillans abundances have significantly increased by 1.65-fold and a significant prolongation of the bloom window was found (from 27.5 to 98 days in recent decades) off the island of Helgoland, Germany. Significant correlations were found between bloom initiation and nutrients, as well as light availability since these factors lead to increased prey availability. Highest abundances of N. scintillans were associated with water temperatures around 17 °C and wind speed below 6 ms-1 causing dense surface accumulations. Solar radiation of more than 200 Wm-2 was identified as a main driver for post-bloom conditions as it can deteriorate the cells and lead to the decline of N. scintillans abundances. In the southern North Sea, N. scintillans occurrences have intensified and spread since the 1980s with hotspots identified as the coastal waters adjacent to the estuaries of the Elbe and Rhine rivers.

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Children with Type 1 diabetes (T1D) and their parent-caregivers often experience diabetes distress due to the daily demands of diabetes management. Regular screening for diabetes distress is needed to prevent the deterioration of metabolic control and the development of mental health disorders. The aim of this analysis was to examine the psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) and for caregiver burden in Parents (P-PAID-C). Data were collected from 136 children aged 7-12 years (46.7% females) and 304 parents (Mage = 42.9 (SD 6.1) years; 78% mothers) by using linguistically translated questionnaires in a multicenter study. Confirmatory factor analysis and correlational analyses were conducted. Results confirmed the two-factor model for the PAID-C and the four-factor model for the P-PAID-C with a slight modification. Cronbach's αs for children and parents were 0.88 and 0.92, respectively. The PAID-C and P-PAID-C scores had small positive associations with HbA1c (rs = .220 and .139, respectively, all p < .05) and strong inverse association with the KIDSCREEN-10 index (r = -.643 and -.520, respectively, all p < .001). P-PAID-C scores increased with increasing depressive symptoms measured in nine-item Patient Health Questionnaire among parents (rs = .534, p < .001). The scores produced by the German PAID-C and P-PAID-C were reliable and valid in measuring diabetes burdens. These German versions of PAID can be utilized to assess diabetes-specific distress and to design interventions for children and their parents experiencing high levels of diabetes distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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Infections with multidrug-resistant gram-negative bacterial species are a great concern in clinics in Germany. By limiting therapeutic options dramatically, these bacteria pose a significant threat to patient health and cause extensive pressure on hygiene systems and patient management. In Germany, the recommendations on how to deal with these bacteria are called MRGN classification, using the terms 3MRGN and 4MRGN for bacteria resistant to three or four major classes of antibiotics. To be resistant to this large number of antibiotics and become classified as 3MRGN or 4MRGN, bacterial strains need to acquire multiple resistance mechanisms with beta-lactamases, especially carbapenemases, being the most important ones. According to established surveillance systems like national reporting systems, KISS or the National Reference Centre, multidrug-resistant bacteria are constantly on the rise in Germany. Although several novel therapeutic options have been approved recently, these bacteria represent a constant challenge and it may be necessary to discuss if the present hygiene recommendations need an update for an efficient and targeted prevention of transmission.

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The aim of the interdisciplinary S2k guideline "Acute infectious gastroenteritis in infants, children and adolescents" is to summarise the current state of knowledge on the clinical presentation, diagnosis, treatment, prevention and hygiene of acute infectious gastroenteritis, including nosocomial gastrointestinal infections, in infants, children and adolescents on the basis of scientific evidence, to evaluate it by expert consensus and to derive practice-relevant recommendations from it. The guideline provides a corridor for action for frequent decisions. It also serves the purpose of evidence-based further education and training and is thus intended to improve the medical care of children with acute gastroenteritis. In particular, the guideline aims to avoid unnecessary hospitalisation of children with AGE and to take preventive measures to avoid and spread infection.

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Since the 1990s, cases of serious violence and abuse, particularly sexual abuse in educational and social institutions of the Catholic Church, have been reported in numerous countries, including Ireland, the United States, and Australia. In many countries, commissions have been set up to investigate the widespread cases of abuse that could not be prosecuted under criminal law. The testimonies of survivors and other witnesses are used by the commissions of inquiry in their work. Since 2016 the Independent Inquiry into Child Sexual Abuse in Germany has collected more than 2,500 reports from survivors of child sexual abuse. Forty-four testimonies were analyzed in a study seeking to understand more about lifetime abuse. In an explorative analysis, aspects of time as a key category in the reports were identified using the structured content analysis method. The results highlight the importance of time in the reports and during all phases of the survivors' lives. Overall, four themes are relevant: (a) the identification of turning points, (b) time to make sense of what happened, (c) the practice of waiting, and (d) time-bound experiences of testifying.

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This document reports a brief update to the previously published protocol of the MinDial study.Trial registration German Clinical Trials Register DRKS00029691. Registered on 12 Sept. 2022, https://drks.de/search/en/trial/DRKS00029691 .

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The Hippocratic oath is such an enduring icon of medical morality that physicians in Nazi Germany invoked it to protest Euthanasie, the systematized killing of weak or sick children, people with incurable diseases, hospitalized criminals (a category applicable to gays), geriatric patients, long-term patients, patients not of German blood (Jews and Romani), and people with disabilities. Several expert witnesses at the 1945 Nuremberg Medical Trial also cited the oath to condemn Nazi physicians' abuse of human research subjects. Noting these invocations, in 1947 the physicians who founded the World Medical Association modernized the Hippocratic oath to convey to future medical students its foundational precepts: benefitting the sick, not harming them, not breaching confidentiality, and not treating patients unjustly, irrespective of their gender or social status. This article presents a historically accurate reading of the oath's strange-seeming passages to show that it does not prohibit abortion, euthanasia (medical aid in dying), or surgery. The article also contends that oath-swearing remains an important asset in teaching clinicians their role responsibilities, and that its ethics supports women's rights to reproductive health care and can valorize challenges to venture-capitalist and for-profit managements that prioritize profitability over providing quality health care for patients.

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Complementary feeding is a critical milestone for parents, who must decide the extent to which they feed their infants with homemade foods (HMFs) or commercial infant foods (CIFs). The current study focused on how parents perceive and evaluate CIFs and what drives them to use these products. Understanding the wide variety of factors that influence parents' decisions to use CIFs as a food source is crucial to helping them make more balanced food choices for their infants. Data from an online survey with 858 German parents revealed their negative perceptions of CIFs, particularly in terms of nutritional quality and texture, and concerns that CIFs contain higher levels of pesticides and heavy metals compared to HMFs, despite acknowledging the expertise of the infant nutrition industry. These perceptions were likely to be driven by the 'natural-is-better' belief and parents' desire for control over the ingredients in their infants' meals, contributing to their skepticism towards CIFs. Additionally, our study found that while many parents know traditional nutrition guidelines, they are less familiar with recent updates. Parents' benefit beliefs about CIFs and parents' trust in the food industry strongly influenced the use of CIFs, while infant age and parent gender had a less strong, yet significant influence on CIFs consumption. Overall, the present study offers new quantitative insights into the factors that motivate parents to use CIFs. Furthermore, it underscores the need for health authorities to improve their communication strategies towards parents concerning new dietary guidelines.

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INTRODUCTION: Increase in health IT adoption is often driven by financial support through the state. In 2020, the German Hospital Future Law passed Parliament with a schedule to see potential effects in 2023. The research question of the present study thus was if there were differences between 2017 and 2023 in selected application areas eligible for funding by the law. METHODS: Availability and percentage of use in clinical units was measured in a panel of 172 hospitals for these areas. A linear mixed model with repeated measures yielded a significant increase in "medication management" and "discharge management". RESULTS AND DISCUSSION: In "medication management", hospitals in a group as compared to single hospitals tripled the percentage of clinical units using IT systems for this purpose. Not-for-profit hospitals doubled their IT systems for "discharge management" when compared to for-profit hospitals. CONCLUSION: Whether these changes can be attributed to the Hospital Future Law is debatable due to severe delays in various fields, particularly in making funding available. There is room for speeding up particularly the administrative funding process and finally demonstrating results that are proportional to the government money invested.

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BACKGROUND: In the context of the telematics infrastructure, new data usage regulations, and the growing potential of artificial intelligence, cloud computing plays a key role in driving the digitalization in the German hospital sector. METHODS: Against this background, the study aims to develop and validate a scale for assessing the cloud readiness of German hospitals. It uses the TPOM (Technology, People, Organization, Macro-Environment) framework to create a scoring system. A survey involving 110 Chief Information Officers (CIOs) from German hospitals was conducted, followed by an exploratory factor analysis and reliability testing to refine the items, resulting in a final set of 30 items. RESULTS: The analysis confirmed the statistical robustness and identified key factors contributing to cloud readiness. These include IT security in the dimension "technology", collaborative research and acceptance for the need to make high quality data available in the dimension "people", scalability of IT resources in the dimension "organization", and legal aspects in the dimension "macroenvironment". The macroenvironment dimension emerged as particularly stable, highlighting the critical role of regulatory compliance in the healthcare sector. CONCLUSION: The findings suggest a certain degree of cloud readiness among German hospitals, with potential for improvement in all four dimensions. Systemically, legal requirements and a challenging political environment are top concerns for CIOs, impacting their cloud readiness.

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INTRODUCTION: The Medical Informatics Initiative (MII) in Germany has pioneered platforms such as the National Portal for Medical Research Data (FDPG) to enhance the accessibility of data from clinical routine care for research across both university and non-university healthcare settings. This study explores the efficacy of the Medical Informatics Hub in Saxony (MiHUBx) services by integrating Klinikum Chemnitz gGmbH (KC) with the FDPG, leveraging the Fast Healthcare Interoperability Resources Core Data Set of the MII to standardize and harmonize data from disparate source systems. METHODS: The employed procedures include deploying installation packages to convert data into FHIR format and utilizing the Research Data Repository for structured data storage and exchange within the clinical infrastructure of KC. RESULT: Our results demonstrate successful integration, the development of a comprehensive deployment diagram, additionally, it was demonstrated that the non-university site can report clinical data to the FDPG. DISCUSSION: The discussion reflects on the practical application of this integration, highlighting its potential scalability to even smaller healthcare facilities and to pave the way to access to more medical data for research. This exemplary demonstration of the interplay of different tools provides valuable insights into technical and operational challenges, setting a precedent for future expansions and contributing to the democratization of medical data access.

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Individual health data is crucial for scientific advancements, particularly in developing Artificial Intelligence (AI); however, sharing real patient information is often restricted due to privacy concerns. A promising solution to this challenge is synthetic data generation. This technique creates entirely new datasets that mimic the statistical properties of real data, while preserving confidential patient information. In this paper, we present the workflow and different services developed in the context of Germany's National Data Infrastructure project NFDI4Health. First, two state-of-the-art AI tools (namely, VAMBN and MultiNODEs) for generating synthetic health data are outlined. Further, we introduce SYNDAT (a public web-based tool) which allows users to visualize and assess the quality and risk of synthetic data provided by desired generative models. Additionally, the utility of the proposed methods and the web-based tool is showcased using data from Alzheimer's Disease Neuroimaging Initiative (ADNI) and the Center for Cancer Registry Data of the Robert Koch Institute (RKI).

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INTRODUCTION: 16 million German-language free-text laboratory test results are the basis of the daily diagnostic routine of 17 laboratories within the University Hospital Erlangen. As part of the Medical Informatics Initiative, the local data integration centre is responsible for the accessibility of routine care data for medical research. Following the core data set, international interoperability standards such as FHIR and the English-language medical terminology SNOMED CT are used to create harmonised data. To represent each non-numeric laboratory test result within the base module profile ObservationLab, the need for a map and supporting tooling arose. STATE OF THE ART: Due to the requirement of a n:n map and a data safety-compliant local instance, publicly available tools (e.g., SNAP2SNOMED) were insufficient. Concept and Implementation: Therefore, we developed (1) an incremental mapping-validation process with different iteration cycles and (2) a customised mapping tool via Microsoft Access. Time, labour, and cost efficiency played a decisive role. First iterations were used to define requirements (e.g., multiple user access). LESSONS LEARNED: The successful process and tool implementation and the described lessons learned (e.g., cheat sheet) will assist other German hospitals in creating local maps for inter-consortia data exchange and research. In the future, qualitative and quantitative analysis results will be published.

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INTRODUCTION: With the establishment of the Data Sharing Framework (DSF) as a distributed business process engine in German research networks, it is becoming increasingly important to coordinate authentication, authorization, and role information between peer-to-peer network components. This information is provided in the form of an allowlist. This paper presents a concept and implementation of an Allowlist Management Application. STATE OF THE ART: In research networks using the DSF, allowlists were initially generated manually. CONCEPT: The Allowlist Management Application provides comprehensive tool support for the participating organizations and the administrators of the Allowlist Management Application. It automates the process of creating and distributing allowlists and additionally reduces errors associated with manual entries. In addition, security is improved through extensive validation of entries and enforcing review of requested changes by implementing a four-eyes principle. IMPLEMENTATION: Our implementation serves as a preliminary development for the complete automation of onboarding and allowlist management processes using established frontend and backend frameworks. The application has been deployed in the Medical Informatics Initiative and the Network University Medicine with over 40 participating organizations. LESSONS LEARNED: We learned the need for user guidance, unstructured communication in a structured tool, generalizability, and checks to ensure that the tool's outputs have actually been applied.

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INTRODUCTION: The German Central Health Study Hub is a service that was initially developed at short notice during the COVID-19 pandemic. Since then, it has been expanded in scope, content, active users and functionality. The service is aimed at two main audiences: data provider and data consumers. The former want to share research data from clinical, public health and epidemiological studies and related documents according to the FAIR criteria for research data, and the latter want to find and ultimately reuse relevant research data in the above areas. METHODS: The service connects both groups via graphical and programmatic interfaces. A sophisticated information model is employed to describe and publish various research data objects while obeying data protection and fulfilling FAIR requirements. The service is being developed in a demand-driven manner with extensive user interaction. RESULTS: A free-to-use service, built on open-source software (Dataverse, MICA, Keycloak), accessible via a web-browser. In close collaboration with users several features (ranging from collection to group items to combined data capture via API and UI) were created. The adoption of the service increases continuously and results in over 1,970 research data objects in June 2024. CONCLUSION: The service fills a marked gap and connects both user groups, yet it still needs to be improved in various dimensions (features, content, usage). The impact on the community needs to be further assessed. Despite recent legislative changes (GDNG, EHDS), the system improves the findability of sensitive data, provides a blueprint for similar systems and shows how to create a useful and user-friendly service together with users.

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INTRODUCTION: To support research projects that require medical data from multiple sites is one of the goals of the German Medical Informatics Initiative (MII). The data integration centers (DIC) at university medical centers in Germany provide patient data via FHIR® in compliance with the MII core data set (CDS). Requirements for data protection and other legal bases for processing prefer decentralized processing of the relevant data in the DICs and the subsequent exchange of aggregated results for cross-site evaluation. METHODS: Requirements from clinical experts were obtained in the context of the MII use case INTERPOLAR. A software architecture was then developed, modeled using 3LGM2, finally implemented and published in a github repository. RESULTS: With the CDS tool chain, we have created software components for decentralized processing on the basis of the MII CDS. The CDS tool chain requires access to a local FHIR endpoint and then transfers the data to an SQL database. This is accessed by the DataProcessor component, which performs calculations with the help of rules (input repo) and writes the results back to the database. The CDS tool chain also has a frontend module (REDCap), which is used to display the output data and calculated results, and allows verification, evaluation, comments and other responses. This feedback is also persisted in the database and is available for further use, analysis or data sharing in the future. DISCUSSION: Other solutions are conceivable. Our solution utilizes the advantages of an SQL database. This enables flexible and direct processing of the stored data using established analysis methods. Due to the modularization, adjustments can be made so that it can be used in other projects. We are planning further developments to support pseudonymization and data sharing. Initial experience is being gathered. An evaluation is pending and planned.

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INTRODUCTION: The German Medical Text Project (GeMTeX) is one of the largest infrastructure efforts targeting German-language clinical documents. We here introduce the architecture of the de-identification pipeline of GeMTeX. METHODS: This pipeline comprises the export of raw clinical documents from the local hospital information system, the import into the annotation platform INCEpTION, fully automatic pre-tagging with protected health information (PHI) items by the Averbis Health Discovery pipeline, a manual curation step of these pre-annotated data, and, finally, the automatic replacement of PHI items with type-conformant substitutes. This design was implemented in a pilot study involving six annotators and two curators each at the Data Integration Centers of the University Hospitals Leipzig and Erlangen. RESULTS: As a proof of concept, the publicly available Graz Synthetic Text Clinical Corpus (GRASSCO) was enhanced with PHI annotations in an annotation campaign for which reasonable inter-annotator agreement values of Krippendorff's α ≈ 0.97 can be reported. CONCLUSION: These curated 1.4 K PHI annotations are released as open-source data constituting the first publicly available German clinical language text corpus with PHI metadata.

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