Search Results (183)

Objectives: Frailty, reflecting reduced physiological reserve, has emerged as a predictor of postoperative outcomes in neurosurgery and may provide greater prognostic value than age. In chronic subdural hematoma (cSDH), prospective data remain scarce. This study investigates the association between preoperative frailty, assessed using the Clinical Frailty Scale (CFS), and postoperative recovery in cSDH patients. Methods: In this ongoing prospective single-center cohort study, 78 consecutive patients (≥60 years) with cSDH were enrolled between August 2022 and October 2024. After exclusion of four conservatively managed patients, 74 surgically treated patients were included in the analysis. Frailty was defined as Clinical Frailty Scale (CFS) ≥ 5. The primary outcome was the Glasgow Outcome Scale-Extended at 6 months (GOSE6). Secondary outcomes included GOSE at discharge (GOSE0) and three months (GOSE3), revision surgery, intensive care unit (ICU) admission, and mortality after six months. Results: Higher CFS scores significantly correlated with poorer outcome at 6 months (r = −0.68, p_adj = 0.011). In regression analysis, frailty (p < 0.001), age (p_adj = 0.014), and revision surgery (p_adj = 0.009) were significant predictors of outcome. Frailty was associated with a reduced likelihood of a good neurological outcome (OR = 0.02, 95% CI: [0.004, 0.085]). Frail patients had significantly poorer outcomes at all timepoints (all p_adj = 0.014) and none achieved a favorable outcome (GOSE ≥ 6). Six-month mortality was significantly higher in frail patients compared to non-frail patients (32% vs. 4%, p_adj = 0.048, relative risk RR = 3.29, 95% CI [1.67, 5.78]). Conclusions: Our interim results suggest that preoperative frailty, as measured by the CFS, is strongly associated with poorer neurological recovery and higher mortality following surgical treatment of cSDH. Frailty assessment may facilitate individualized treatment strategies and improve risk stratification beyond age or comorbidity burden. Full article

Urban flood modelling in heavily engineered catchments requires model structures that capture not only surface runoff processes but also hydraulic infrastructure and operational controls. This study applies a TELEMAC-2D rain-on-grid framework to two urban sub-catchments of the Emscher River (North Rhine-Westphalia, Germany) to quantify the relative effects of surface calibration, explicit infrastructure representation, and operational rules on the simulated flood response. A stepwise model development workflow was implemented, including land use-based calibration of Manning’s n and SCS Curve Numbers, explicit integration of culverts and bridges, and rule-based representation of retention basins and pumping stations. Model performance was evaluated using hydrograph shape, peak discharge, peak timing, event volume, and inundation behaviour across different antecedent moisture conditions (AMC). The results show that surface calibration alone was insufficient to consistently reproduce observed hydrographs. In the Rossbach sub-catchment area, integrating retention basins, pumping stations, and operational rules improved model performance from NSE = −0.129 under AMC I to NSE = 0.773 under AMC III. RMSE decreased from 3.380 to 1.515 m³ s⁻¹, peak discharge error from −6.198 to −0.492 m³ s⁻¹, and volume bias from −0.664 to +0.038. A targeted, routing-focused calibration further improved timing behaviour but increased volume bias, indicating residual deficiencies in the representation of rapid urban conveyance pathways. The findings show that reliable urban flood simulation in infrastructure-rich catchments depends not only on calibrating surface parameters but also on explicitly representing hydraulic structures, operational controls, and antecedent wetness conditions. Full article

Germany’s global competitiveness, historically rooted in its high-quality education system, is threatened by a severe investment backlog in its public-school infrastructure. While national estimates of this deficit are substantial, the literature lacks a granular empirical analysis at the municipal level, where fiscal responsibility for these assets primarily lies. This study provides an exploratory municipal level analysis of school infrastructure investment gaps using evidence from n = 30 large municipalities in North Rhine Westphalia (NRW), Germany. Using a mixed methods approach, we conduct a cross-sectional analysis integrating demographic, fiscal, and real estate data and introduce a composite “Need Score” to identify high need municipalities. The analysis identifies associations between investment backlogs and selected demographic, fiscal, and institutional indicators and evaluates the financial feasibility—but not the causal necessity—of private capital participation in educational infrastructure. Our findings reveal a profound structural underfunding, with planned municipal investments covering less than 10% of the estimated backlog. The backlog is weakly correlated with GDP growth but not significantly predicted by other common socio-economic indicators, highlighting the limitations of macro-level diagnostics. Conversely, a higher share of private school enrolment is significantly associated with a lower public investment backlog (r = −0.51, p < 0.05). A detailed financial case study demonstrates that investments in educational real estate can deliver stable, positive returns (IRR of 4.5–19.8%), under specific contractual assumptions. The paper concludes by discussing the conditions under which private capital may constitute a viable component of educational infrastructure provision within appropriate governance frameworks. Full article

Hepatitis E virus (HEV) is the leading cause of hepatitis globally and poses particular risks for immunocompromised individuals. Mandatory screening of blood donations for HEV RNA and retrospective individual testing of previous donations (lookback investigations) following a reactive result have been implemented in several countries to protect these patients. This includes Germany, where a sensitivity limit of 2000 IU/mL applies to index donations. In total, 334 HEV RNA-positive blood donations were detected at our blood donation service between 2018 and 2024. Lookback testing was applied in 211 cases, revealing previous HEV RNA-positive donations in 23.1% of donors (n = 48, 76 donations). Although 16 of these retrospectively tested HEV RNA-positive donations have already been transfused, no transfusion-transmitted HEV infection has been reported. The HEV RNA viral load in the lookback donation was below 50 IU/mL in 72.4% of cases. Routine testing effectively prevents highly viremic blood products entering the supply, significantly reducing the infection risk. While the administration of virus particles with low-viremic products cannot be ruled out, the remaining risk appears to be minimal and has been deemed so far acceptable for the safety of blood products. The lookback strategy further supports the screening strategy by retrospectively identifying blood products from low-viremic donations and enabling appropriate risk management. Full article

Long-term stability of dam infrastructure is crucial for flood protection, water resource management, and drinking water supply. In many regions, the increasing impact of climate change and structural aging necessitates advanced monitoring approaches for embankment and gravity dams. PSI has emerged as a valuable technique for detecting surface deformation rates with millimeter precision. This study presents a comprehensive monitoring concept that combines satellite-based PSI analyses with the first operational use of ECRs at dam sites in North Rhine-Westphalia (NRW), Germany. Over a period of more than two years, ECRs were observed under real-world conditions using Sentinel-1 data. Compared to traditional passive reflectors, ECRs offer improved signal stability and a compact design, making them particularly suitable for confined or sensitive dam environments. The analysis of displacement time series confirms the suitability of ECRs for long-term deformation monitoring in complex dam settings. Intercomparison of two PSI time series demonstrated high internal consistency (correlation > 0.9, RMSE < 1 mm), while validation against in situ measurements confirmed millimeter-level agreement with RMSE values between 2 and 5 mm and correlations up to 0.7. In addition, a dedicated web-based platform was developed to provide processed ECR-based PSI results to dam operators, offering interactive visualizations, time-series access, and standardized downloads. This integration of advanced interferometric synthetic aperture radar (InSAR) methods, innovative hardware, and user-oriented service delivery marks a significant step toward operational dam monitoring using satellite remote sensing. Full article

The urgency of global sustainability challenges increased policy attention to Education for Sustainable Development (ESD), particularly in relation to Sustainable Development Goal 4.7, which calls for the systematic integration of sustainability competences across education systems. This article examines how organisational and structural approaches to continuous professional development (CPD) can support the institutionalisation of ESD beyond individual teacher training. The article adopts a case-based analytical approach drawing on programme documentation and evaluation data from two initiatives coordinated by the teacher training department of the District Government of Arnsberg in North Rhine-Westphalia, Germany: the Erasmus+ consortium EFFORT-A, which links international mobility with school development processes, and the regional programme WIRkstatt Zukunft, which implements the Whole School Approach through modular training and school-based consultancy. The analysis indicates that multi-level governance, structured networking, leadership engagement, and formal contracting mechanisms are associated with the integration of ESD within school cultures, curricula, and organisational routines. Challenges are identified regarding resource allocation, policy coherence, and the long-term sustainability of project-based formats. The article concludes that sustained ESD implementation requires CPD systems that combine international perspectives with regionally anchored support structures and align individual professional learning with institutional development strategies, offering recommendations for policymakers and educational leaders. Full article

Background and Objective: Despite advances in operative techniques and perioperative care, complications following coronary artery bypass grafting (CABG) remain an important cause of postoperative morbidity and organ dysfunction. This study aimed to evaluate the association between preoperative epicardial adipose tissue (EAT) thickness measured using computed tomography and postoperative morbidity and mortality in patients undergoing isolated CABG, and to explore whether EAT thickness may serve as a potential imaging-based risk marker for postoperative complications. Materials and Methods: The study was a retrospective single-center observational cohort study. Patients who underwent isolated coronary artery bypass grafting between 1 January 2019 and 2 January 2023, and had available preoperative computed tomography (CT) imaging were retrospectively reviewed. Epicardial adipose tissue thickness was measured on CT images at three predefined anatomical regions, yielding two parameters: total EAT thickness and right ventricular EAT thickness. Postoperative complications were evaluated using established definitions, with atrial fibrillation (AF) assessed according to European Society of Cardiology (ESC) criteria and acute kidney injury defined based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results: Patients who developed postoperative complications after coronary artery bypass grafting tended to have thicker epicardial adipose tissue. Increased total epicardial adipose tissue thickness was associated with postoperative paroxysmal atrial fibrillation, whereas greater right ventricular epicardial adipose tissue thickness was associated with postoperative acute kidney injury. Multivariable analysis confirmed that both total and right ventricular epicardial adipose tissue thickness were independently associated with postoperative complications (total EAT: OR 1.74, 95% CI 1.10–2.76; right ventricular EAT: OR 2.03, 95% CI 1.31–3.15). ROC analysis showed modest discrimination for postoperative atrial fibrillation (AUC 0.69) and acceptable discrimination for acute kidney injury (AUC 0.79). No association was observed between epicardial adipose tissue measurements and postoperative mortality. Conclusions: Increased preoperative epicardial adipose tissue thickness was associated with several early postoperative complications following coronary artery bypass grafting, including atrial fibrillation, acute kidney injury, and in-hospital infection. Preoperative epicardial adipose tissue thickness measured by computed tomography may represent a potentially useful imaging-based risk marker for early postoperative complications following isolated CABG, although confirmation in larger prospective studies is required. Full article

Persistent organic pollutants (POPs) are globally distributed toxic contaminants. Since 1990, mosses have been used in the UNECE European Moss Survey as cost-effective biomonitors of atmospheric deposition. This study provides the first predictive maps of POP concentrations in mosses, revealing nationwide contamination patterns across Germany. As a case study within the Moss Survey, predictive models were built from POP concentrations measured at 21 sites in 2020 and combined with environmental and land-use data. Random Forest analyses explained more than 20% of the variance for seven of eleven POP groups, yielding robust spatial estimates, particularly for PAH, BDE 209, and DBDPE, despite moderate systematic differences. Explanatory power was limited for PCDD/F, PCDD/F TEQ values, DPTE, and HBBz, while HBCD, PBDE, DP, and PBT showed a moderate performance. A comparison with geostatistical reference maps indicated moderate to good concordance, though regional uncertainties persisted. Industrialized regions such as North Rhine–Westphalia, Rhine Neckar, Halle/Leipzig, and Saarland emerged as consistent hotspots, whereas rural and forested areas showed lower contamination. The findings highlight the value of moss surveys for spatial POP assessment and underscore the need for additional predictors, especially atmospheric deposition, and for integrating Random Forest models with geostatistical approaches such as regression kriging to enhance predictive accuracy. Full article

Introduction: Thoracic angiosarcoma is a very rare and malignant disease. This study examined the incidence and survival of thoracic angiosarcomas with special focus on primary and secondary angiosarcomas. Methods: Data from the population-based North Rhine-Westphalia (NRW) cancer registry in Germany covering the years 2008–2023 were analyzed, including primary and secondary thoracic angiosarcoma (ICD-O-3: morphology 9120/3, topography C34, C38, C44.51, C49.3, C50), and reported age-standardized incidence rates (using the Old European Standard population) and survival analyses (Kaplan–Meier curves). Results: A total of 421 cases of thoracic angiosarcoma were analyzed, and 90.0% of the patients were female (n = 379). Age-standardized incidence rates of thoracic angiosarcoma were 0.25 per million per year for male patients (SE 0.0) and 1.5 per million per year for female patients (SE 0.1). All male patients had primary angiosarcoma (n = 42). Among female patients, the majority of cases were second primary tumors (n = 262, 69.1%). The 5-year overall survival (OS) for the cohort study was 38.5% (SE 2.6). Stratified by sex, OS was 41.1% (SE 2.8) for women and 12.0% (SE 5.4) for men. Among female patients, OS was 40.9% (SE 4.1) for primary and 41.8% (SE 3.8) for second primary angiosarcoma. The worst OS occurred among patients with angiosarcoma of the lung (men 20.0% (SE 12.7)) and of the mediastinum, heart and pleura (men 4.7% (SE 4.5)) The OS for women was 0%; all females died within 2.2 years after diagnosis of angiosarcoma with these topographies. Conclusions: Thoracic angiosarcoma is a rare condition with a poor prognosis. Irrespective of whether their disease is classified as primary or second primary, women with angiosarcoma have a better prognosis than men. Topography seems to be the most determining prognostic factor in this disease. Full article

Background: The COVID-19 pandemic disrupted access to routine dermatologic care and may have delayed melanoma diagnosis and management. Evidence on the post-pandemic period and on hospital-based referral cohorts remains limited. We assessed melanoma presentations before, during and after the pandemic in three skin cancer centers in North Rhine-Westphalia, Germany. Methods: We conducted a multicenter retrospective cohort study of inpatients with cutaneous melanoma grouped into Phase 1 (February 2017–February 2020), Phase 2 (March 2020–March 2023), and Phase 3 (April 2023–May 2024). The primary endpoint was Breslow tumor thickness (TT) among invasive melanomas, analyzed using multivariable log-linear regression adjusted for center, age, sex, anatomic site, and histologic subtype. Secondary endpoints included T category and AJCC stage distributions (including stage 0/Tis), macroscopic primary tumor specimen dimensions (area and volume; available cases), staging work-up and sentinel lymph node biopsy (SLNB) indicators, and exploratory laboratory parameters (LDH, S100, CRP) and dermal mitotic rate. Results: We included 2960 patients (Phase 1: 1162; Phase 2: 1251; Phase 3: 547). Median TT among invasive melanomas was 1.1 mm (IQR 0.6–2.3), 1.1 mm (0.5–2.4), and 1.0 mm (0.5–2.3) across phases (p = 0.037). In adjusted models among invasive tumors, TT did not increase (Phase 2 vs. Phase 1: 0.97, 95% CI 0.90–1.04; Phase 3 vs. Phase 1: 0.94, 0.86–1.03). AJCC stage 0 decreased from 7.7% and 6.1% to 2.0%; adjusted OR Phase 3 vs. Phase 1: 0.24 (95% CI 0.13–0.46). Within invasive tumors, the distribution of T categories (T1a–T4) and AJCC stages I–IV was similar across periods. Among cases with available macroscopic primary tumor specimen dimensions, median area and volume were higher during and after the pandemic (area p = 0.030; volume p = 0.042), but period effects attenuated in models adjusted for TT. Exploratory analyses suggested a higher proportion of elevated LDH and a lower proportion of elevated S100 across periods, while CRP and dermal mitotic rate showed no clear period shift. Conclusions: In this large melanoma inpatient cohort, the pandemic period was not associated with thicker invasive melanomas after covariate adjustment. However, a persistent reduction in stage 0/Tis presentations in the post-pandemic period suggests ongoing disruption or shifting of early detection and referral pathways. Exploratory increases in macroscopic tumor dimensions may point to changes not captured by thickness alone, but require cautious interpretation given missingness and potential documentation effects. Full article

Background: European population-based cancer registries (PBCRs) provide the foundation for monitoring skin cancer, yet registration practices and coverage vary, particularly for non-melanoma skin cancer (NMSC). Methods: We conducted a narrative review combining descriptive analyses of European Cancer Information System (ECIS) outputs with evidence from the European Network of Cancer Registries (ENCR) Working Group on NMSC and from national reports. A targeted PubMed search (2015–2025) assessed scientific usage of European registry data. Results: Nearly 200 PBCRs operate across about 40 European countries, with heterogeneous structures and timeliness. The ECIS estimated 101,500 incident cutaneous melanomas (CM) in the European Union in 2022. Long-term data from Nordic countries show a tenfold increase in CM incidence over the last six decades, with recent plateauing in younger cohorts. NMSC registration remains inconsistent: some countries record both cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC), others record cSCC only, and several omit NMSC entirely. Consequently, Europe-wide NMSC figures are not available from the ECIS. Global estimates exclude BCC and understate the true burden, which is likely between 1 and 1.6 million incident cases annually in Europe. The PubMed search identified 538 European registry-based publications on skin cancer (2015–2025). Conclusions: Melanoma registration in Europe is robust, but NMSC remains under-registered. Priorities include harmonized definitions and counting rules, better integration of outpatient and pathology data, streamlined EU-level reporting, digital/AI-enabled case ascertainment, and sentinel regions to generate reliable NMSC estimates. Full article

According to the WHO classification of tumors, neuroendocrine neoplasms (NENs) of the esophagus are esophageal “epithelial neoplasms with neuroendocrine differentiation, including well-differentiated neuroendocrine tumours (NETs), poorly differentiated neuroendocrine carcinomas (NECs), and mixed neuroendocrine–non-neuroendocrine neoplasms (MiNENs)—an umbrella category including mixed adenoneuroendocrine carcinoma (MANEC)” [...] Full article

With the advancement of digitization in the era of Industry 4.0 (I4.0), highly automated, semi-autonomous, and fully autonomous systems are emerging. Within this context, multi-agent systems (MAS) offer a promising approach for automating tasks and processes based on autonomous agents that work together in an overall system to increase the degree of system autonomy stepwise in a modular and flexible way. A critical research challenge is determining how these agents can collaboratively engage with both other agents and human operators to facilitate the gradual transition from automated to fully autonomous industrial systems. To close transparency and connectivity gaps, this study contributes with a framework for the collaboration of agents and humans in increasingly autonomous MAS based on a Digital Twin (DT). The framework specifies a standards-based data model for MAS representation and proposes to introduce a DT infrastructure as a service layer for system coordination, supervision, and interaction. To demonstrate the feasibility and assess the quality of the framework, it is implemented and evaluated in a case study in a real-world industrial scenario. Although additional long-term evaluations across different contexts are needed, the assessment of functional completeness and selected quality attributes show that the proposed framework provides a solid technical foundation that facilitates a transparent and seamless collaboration between agents and humans within increasingly autonomous industrial MAS. Full article

In this paper we provide the Group Contribution parameters for acetylenes and aromatic nitro compounds fitting with a recently developed Group Contribution method with chemical accuracy (1 kcal/mol) for the heat of formation of organics. These additional parameters widen the applicability of the Group Contribution method. We also provide further G4 quantum calculated values as reference when no experimental data are available and compare to previously reported G4 data. Full article

Heterofermentative lactic acid bacteria (LABhe) can help to increase aerobic stability of silages. As high dry matter silages are especially prone to aerobic deterioration, the question was whether an in vitro test could help to select for LABhe with tolerance to these conditions, that is, to high osmolality. A medium proven for homofermentative lactic acid bacteria (LABho) with high sugar concentration was applied in vitro while validating the results in high DM grass silages in situ. The pH was measured at 0, 24, 36 and 48 h or after 5 d as indicator for the bacterial fermentation activity and compared. As a result, LABhe showed to be far less susceptible to high DM and osmolality respectively, compared to LABho. It was concluded that the in vitro test allows for qualitative assessment of the osmotolerance of LABhe, but not for quantitative ranking between LABhe strains. Full article