Background In addition to sociodemographic factors, action-theoretical constructs, such as technology acceptance and competence play an important role in technology use.

Objective This study aimed to examine the associations between technology use, sociodemographic factors, action-theoretical constructs, and technology interest.

Material and methods Data were collected from 585 study participants aged over 60 years from 14 surveys conducted between 2014 and 2020. A structural equation model was used to explain the relationships.

Results The structural equation model with covariates of survey year, age, gender, and education (n = 585) yielded the following fit indices: comparative fit index (CFI) = 0.918, Tucker-Lewis index (TLI) = 0.894, Root Mean Square Error of Approximation (RMSEA) = 0.056 [95 % confidence interval: 0.050–0.063], Standardized Root Mean Square Residual (SRMR) = 0.079, χ2 = 3051.936 (p < 0.001), χ2/degrees of freedom (df) = 18.499. The strongest associations with technology use were found for technology acceptance and competence. Additionally, technology competence showed a significant association with technology interest. Gender and technology interest were not related to technology use but it was observed that men had higher levels of technology acceptance, control, competence, and interest.

Discussion Taking technology competence beliefs into account plays a crucial role in understanding the technology usage and interest of older individuals. Additionally, gender-specific differences in the theoretical constructs of action and interest in technology have been revealed in the context of the digital divide.

The use of different pathways in the treatment of rheumatoid arthritis has led to a significant decrease in the number of treatment-resistant patients. In this context, interleukin (IL)-6 inhibition has filled an important gap in rheumatoid arthritis treatment with its effectiveness and safety in both monotherapy and combinations. The process of IL-6 inhibition initiated with IL-6 receptor blockers has prompted questions regarding the potential impact and safety of different inhibitions of this pathway, such as the direct blockade of IL-6. Following the termination of the development of sirukumab because of mortality data in early studies, the investigation of olokizumab, which targets a different region of the IL-6 cytokine, has renewed the hope in this area and the safety concerns have been largely alleviated by the open-label extension data. In addition, the efficacy and safety of tocilizumab and sarilumab have led to a rapid investigation of biosimilars and new potent IL-6 receptor blockers. A comprehensive understanding of mechanisms of this pathway with further long-term clinical data and basic research may provide a decisive impact on selecting the appropriate mechanism as the first choice in personalized treatments.

The surgical treatment of gastric carcinoma has progressed significantly in the past few decades. A major milestone was the establishment of multimodal therapies for locally advanced tumours. Improvements in the technique of endoscopic resection have supplanted surgery in the early stages of many cases of gastric cancer. In cases in which an endoscopic resection is not possible, surgical limited resection procedures for the early stages of carcinoma are an equal alternative to gastrectomy in the field of oncology. Proximal gastrectomy is extensively discussed in this context. Whether proximal gastrectomy leads to a better quality of life and better nutritional well-being than total gastrectomy depends on the reconstruction chosen. The outcome cannot be conclusively assessed at present. For locally advanced stages, total or subtotal gastrectomy with D2 lymphadenectomy is now the global standard. A subtotal gastrectomy requires sufficiently long tumour-free proximal resection margins. Recent data indicate that proximal margins of at least 3 cm for tumours with an expansive growth pattern and at least 5 cm for those with an infiltrative growth pattern are sufficient. The most frequently performed reconstruction worldwide following gastrectomy is the Roux-en-Y reconstruction. However, there is evidence that pouch reconstruction is superior in terms of quality of life and nutritional well-being. Oncological gastric surgery is increasingly being performed laparoscopically. The safety and oncological equivalency were first demonstrated for early carcinomas and then for locally advanced tumours, by cohort studies and RCTs. Some studies suggest that laparoscopic procedures may be advantageous in early postoperative recovery. Robotic gastrectomy is also increasing in use. Preliminary results suggest that robotic gastrectomy may have added value in lymphadenectomy and in the early postoperative course. However, further studies are needed to substantiate these results. There is an ongoing debate about the best treatment option for gastric cancer with oligometastatic disease. Preliminary results indicate that certain patient groups could benefit from resection of the primary tumour and metastases following chemotherapy. However, the exact conditions in which patients may benefit have yet to be confirmed by ongoing trials.

Purpose The animated activity questionnaire (AAQ) is a computer-based measure of activity limitations. To answer a question, patients choose the animation of a person performing an activity that matches their own level of limitation. The AAQ has not yet been tested for suitability to be applied as computer-adaptive test (CAT). Thus, the objective of this study was to develop and evaluate an AAQ-based CAT to facilitate the application of the AAQ in daily clinical care.

Methods Patients (n = 1408) with hip/knee osteoarthritis from Brazil, Denmark, France, The Netherlands, Norway, Spain, and the UK responded to all 17 AAQ items. Assumptions of item-response theory (IRT) modelling were investigated. To establish item parameters for the CAT, a graded response model was estimated. To evaluate the performance of post-hoc simulated AAQ-based CATs, precision, test length, and construct validity (correlations with well-established measures of activity limitations) were evaluated.

Results Unidimensionality (CFI = 0.95), measurement invariance (R2-change < 2%), and IRT item fit (S-X2 p > .003) of the AAQ were supported. Performing simulated CATs, the mean test length was more than halved (≤ 8 items), while the range of precise measurement (standard error ≤ 0.3) was comparable to the full AAQ. The correlations between original AAQ scores and three AAQ-CAT versions were ≥ 0.95. Correlations of AAQ-CAT scores with patient-reported and performance measures of activity limitations were ≥ 0.60.

Conclusion The almost non-verbal AAQ-CAT is an innovative and efficient tool in patients with hip/knee osteoarthritis from various countries, measuring activity limitations with lower respondent burden, but similar precision and construct validity compared to the full AAQ.

In chronic spontaneous urticaria (CSU), wheals, angioedema, or both appear spontaneously for > 6 weeks. Current recommended treatment options for urticaria target mast cell mediators such as histamine, or activators, such as autoantibodies. The goal of CSU treatment is to treat the disease until it is gone as effectively and safely as possible. As no cure is available for CSU as of now, the treatment is aimed at continuously suppressing disease activity, with complete control of the disease and a normalization of quality of life. To achieve this, pharmacological treatment should be continued until no longer needed. Treatment of CSU should follow the basic principles of treating as much as needed and as little as possible taking into consideration that the activity of the disease may vary. Since CSU is a disease with spontaneous remission, it is hard to tell, in patients with complete control and no signs or symptoms, when medication is no longer needed. The current international guideline for urticaria suggests that the treatment can be stepped down once a patient is free of signs and symptoms. Other reasons for stepping down the treatment of CSU patients include safety concerns or issues, pregnancy or wanting to become pregnant, and economic factors. As of now, it is unclear over which period, with what intervals and with which dosages CSU treatment should be stepped down. Guidance on this is needed for all recommended therapies: (i) standard-dosed second-generation H1-antihistamine (sgAH), (ii) higher than standard-dosed sgAH, (iii) standard-dosed omalizumab, (iv) higher than standard-dosed omalizumab, and (v) cyclosporine. However, there is a lack of controlled trials on the step down and discontinuation of these treatments. Here, we aim to provide a summary of what is known and what needs to be investigated in further studies, based on our own experience and real-world evidence.

While some scholars see the Sustainable Development Goals (SDGs) as an example of environmentally friendly development approaches that reconnect development with biospheric preconditions, others argue that they mask ongoing contestation. This article begins with a multi‐level governance perspective on the “green goals” of the 2030 Agenda and the importance of local action for their implementation. The focus is on Europe, where municipal sustainability governance was found to be concentrated and where the environment is most likely prioritized. Against this backdrop, I analyze which policy measures the European Union, nation states, regions, and municipalities in Europe name in the reviews submitted to the UN High‐Level Political Forum to achieve environmental targets. I show that although the environment is not a priority of SDG implementation at any policy level, municipalities are occasionally leading the way in environmental action both horizontally, with site‐specific measures, and vertically, with multi‐level measures.

Evidence for the effectiveness of physical activity (PA) in the treatment of depression prevails for outpatients with mild and moderate symptom levels. For inpatient treatment of severe depression, evidence-based effectiveness exists only for structured and supervised group PA interventions. The Step Away from Depression (SAD) study investigated the effectiveness of an individual pedometer intervention (PI) combined with an activity diary added to inpatient treatment as usual (TAU). In this multicenter randomized controlled trial, 192 patients were randomized to TAU or TAU plus PI. The two primary outcomes at discharge were depression-blindly rated with the Montgomery-& ANGS;sberg Depression Rating Scale (MADRS)-and average number of daily steps measured by accelerometers. Secondary outcomes were self-rated depression and PA, anxiety, remission and response rates. Multivariate analysis of variance (MANOVA) revealed no significant difference between both groups for depression and daily steps. Mean MADRS scores at baseline were 29.5 (SD = 8.3) for PI + TAU and 28.8 (SD = 8.1) for TAU and 16.4 (SD = 10.3) and 17.2 (SD = 9.9) at discharge, respectively. Daily steps rose from 6285 (SD = 2321) for PI + TAU and 6182 (SD = 2290) for TAU to 7248 (SD = 2939) and 7325 (SD = 3357). No differences emerged between groups in secondary outcomes. For severely depressed inpatients, a PI without supervision or further psychological interventions is not effective. Monitoring, social reinforcement and motivational strategies should be incorporated in PA interventions for this population to reach effectiveness.

Objectives and background Congenital malformations of the kidney and urinary tract (CAKUT) have a prevalence of 4–60 in 10,000 livebirths and constitute for 40–50% of all end stage pediatric kidney disease. CAKUT can have a genetic background due to monogenetic inherited disease, such as PKD or ciliopathies. They can also be found in combination with extra-renal findings as part of a syndrome. Upon detection of genitourinary malformations during the fetal anomaly scan the question arises if further genetic testing is required. The purpose of this study was to determine the phenotypic presentation of CAKUT cases and the results of exome analysis (WES).

Methods This is a retrospective analysis of 63 fetal cases with a diagnosis of CAKUT or DSD at a single center between August 2018 and December 2022.

Results A total of 63 cases (5.6%) out of 1123 matched CAKUT phenotypes including renal parenchyma malformations. In 15 out of 63 WES analysis a pathogenic variant was detected (23.8%). In fetuses with isolated CAKUT the rate of detecting a pathogenic variant on exome sequencing was five out of 44 (11.4%). Ten out of 19 fetuses (52.6%) that displayed extra-renal findings in combination with CAKUT were diagnosed with a pathogenic variant.

Conclusions WES provides an increase in diagnosing pathogenic variants in cases of prenatally detected CAKUT. Especially in fetuses with extra-renal malformations, WES facilitates a gain in information on the fetal genotype to enhance prenatal counselling and management.

There is currently no causal treatment available for Parkinson's disease (PD). However, the use of glial cell line-derived neurotrophic factor (GDNF) to provide regenerative effects for neurons is promising. Such approaches require translational delivery systems that are functional in diseased tissue. To do so, we used a non-viral Sleeping Beauty (SB) transposon system to overexpress GDNF in adipose tissue-derived mesenchymal stromal cells (adMSCs). Entrapment of cells in fibrin hydrogel was used to boost potential neurorestorative effects. Functional GDNF-adMSCs were able to secrete 1066.8 & PLUSMN; 169.4 ng GDNF/120,000 cells in vitro. The GDNF-adMSCs were detectable for up to 1 month after transplantation in a mild 6-hydroxydopamine (6-OHDA) hemiparkinson male rat model. Entrapment of GDNF-adMSCs enabled GDNF secretion in surrounding tissue in a more concentrated manner, also tending to prolong GDNF secretion relatively. GDNF-adMSCs entrapped in hydrogel also led to positive immunomodulatory effects via an 83% reduction of regional IL-1 beta levels compared to the non-entrapped GDNF-adMSC group after 1 month. Furthermore, GDNF-adMSC-treated groups showed higher recovery of tyrosine hydroxylase (TH)-expressing cells, indicating a neuroprotective function, although this was not strong enough to show significant improvement in motor performance. Our findings establish a promising GDNF treatment system in a PD model. Entrapment of GDNF-adMSCs mediated positive immunomodulatory effects. Although the durability of the hydrogel needs to be extended to unlock its full potential for motor improvements, the neuroprotective effects of GDNF were evident and safe. Further motor behavioral tests and other disease models are necessary to evaluate this treatment option adequately.

Background Extrahepatic transection of the right hepatic artery and right portal vein before parenchymal dissection is a widely used standard for minimal invasive right hepatectomy. Hereby, hilar dissection represents a technical difficulty. We report our results of a simplified approach in which the hilar dissection is omitted and the line of dissection is defined with ultrasound.

Methods Patients undergoing minimally invasive right hepatectomy were included. Ultrasound-guided hepatectomy (UGH) was defined by the following main steps: (1) ultrasound-guided definition of the transection line, (2) dissection of the liver parenchyma according to the caudal approach, (3) intraparenchymal transection of the right pedicle and (4) of the right liver vein, respectively. Intra- and postoperative outcomes of UGH were compared to the standard technique. Propensity score matching was performed to adjust for parameters of perioperative risk.

Results Median operative time was 310 min in the UGH group compared to 338 min in the control group (p = 0.013). No differences were observed for Pringle maneuver duration (35 min vs. 25 min; p = ns) nor postoperative transaminases levels (p = ns). There was a trend toward a lower major complication rate in the UGH group (13 vs. 25%) and a shorter median hospital stay (8 days vs. 10 days); however, both being short of statistical significance (p = ns). Bile leak was observed in zero cases of UGH compared to 9 out of 32 cases (28%) for the control group (p = 0.020).

Conclusions UGH appears to be at least comparable to the standard technique in terms of intraoperative and postoperative outcomes. Accordingly, transection of the right hepatic artery and right portal vein prior to the transection phase can be omitted, at least in selected cases. These results need to be confirmed in a prospective and randomized trial.

This paper reviews 11 current and previous international and some selected national hypertension guidelines regarding sex and gender-related differences. Those differences can be attributed to biological sex and to gender differences that are determined by socially constructed norms. All reviewed guidelines agree on a higher hypertension prevalence in men than in women. They also concur that evidence does not support different blood pressure thresholds and targets for treatment between men and women. Differences refer in addition to the differences in epidemiological aspects to differences in some morphometric diagnostic indices, e.g., left ventricular mass or the limits for daily alcohol intake. Concerning practical management, there are hardly any clear statements on different procedures that go beyond the consensus that blockers of the renin-angiotensin system should not be used in women of childbearing age wishing to become pregnant. Some further sex-specific aspects are related to differences in tolerability or drug-specific side effects of BP-lowering drugs. There is also a consensus about the need for blood pressure monitoring before and during the use of contraceptive pills. For management of pregnancy, several guidelines still recommend no active treatment in pregnant women without severe forms of hypertension, despite a wide consensus about the definition of hypertension in pregnancy. A disparity in treatment targets when treating severe and non-severe hypertension in pregnancy is also observed. Overall, sex-specific aspects are only very sparsely considered or documented in the evaluated guidelines highlighting an unmet need for future clinical research on this topic.

Purpose Concomitant chemoradiation followed by repeat (dose-deescalated) irradiation has become standard of care in treating childhood diffuse intrinsic pontine glioma (DIPG) during first line treatment and at first progression. Progression after re-irradiation (re-RT) is in most cases symptomatic and either treated systemically with chemotherapy or new innovative approaches including targeted therapy. Alternatively, the patient receives best supportive care. Data on second re-irradiation in DIPG patients with second progression and good performance status are sparse. This is a case report of second short-term re-irradiation to shed further light on this option.

Methods Retrospective case report of a 6-year-old boy with DIPG receiving a second course of re-irradiation (with 21.6 Gy) as part of an individual multimodal approach in a patient with very low symptom burden.

Results The second course of re-irradiation was feasible and well tolerated. No acute neurological symptoms or radiation-induced toxicity occurred. Overall survival was 24 months after initial diagnosis.

Conclusion A second course of re-irradiation can be an additional tool in patients with progressive disease after first- and second-line irradiation. It is unclear whether and to what extent it contributes to progression-free survival prolongation and if—since our patient was asymptomatic—progression-associated neurological deficits can be alleviated.

Hintergrund Die Sepsis ist eine häufige und lebensbedrohliche Komplikation einer akuten Infektion. In der Notfallmedizin hat sich zum Screening auf Sepsis der Quick Sequential-Organ-Failure-Assessment(qSOFA)-Score etabliert. Bereits mit der Einführung des Scores wurde dessen schwache Sensitivität kritisiert. Nun fordern aktuelle Leitlinien, den qSOFA-Score nicht mehr zum Screening auf Sepsis einzusetzen. Als eine Alternative wird der National Early Warning Score 2 (NEWS2) vorgeschlagen.

Ziel der Arbeit In einer Subanalyse einer Kohorte von notfallmedizinischen Patient*innen soll die diagnostische Aussagekraft des qSOFA-Scores und des NEWS2 zur Erkennung einer Sepsis verglichen werden. Zusätzlich soll gezeigt werden, inwieweit mithilfe von abweichenden Vitalparametern bereits eine Risikoerhöhung für eine Sepsis ableitbar ist.

Methodik Mittels AUROC (Area Under Receiver Operating Characteristics) und Odds Ratios wurden die Scores bzw. die Vitalparameter auf ihre Fähigkeit untersucht, septische Patient*innen zu erkennen.

Ergebnisse Von 312 eingeschlossenen Patient*innen wurde bei 17,9 % eine Sepsis diagnostiziert. Der qSOFA-Score erkannte eine Sepsis mit einer AUROC von 0,77 (NEWS2 0,81). Für qSOFA fand sich eine Sensitivität von 57 % (Spezifität 83 %), für NEWS2 96 % (Spezifität 45 %). Die Analyse der einzelnen Vitalparameter zeigte, dass unter Patient*innen mit einer akuten Infektion eine Vigilanzminderung als deutliches Warnsignal für eine Sepsis zu werten ist.

Diskussion In der Notfallmedizin sollte qSOFA nicht als alleiniges Tool für das Screening auf Sepsis verwendet werden. Bei Verdacht auf eine akute Infektion sollten grundsätzlich sämtliche Vitalparameter erfasst werden, um das Vorliegen einer akuten Organschädigung und somit einen septischen Krankheitsverlauf frühzeitig zu erkennen.

Purpose The aim of this in vitro study was to quantify and compare changes of the enamel surface caused by periodical use of different air-polishing powders during multibracket therapy.

Methods Bovine high-gloss polished enamel specimens were air-polished using an AIR-FLOW® Master Piezon with maximum powder and water settings. Each specimen was blasted with sodium bicarbonate (AIR-FLOW® Powder Classic, Electro Medical Systems, Munich, Germany) and erythritol (AIR-FLOW® Powder Plus, Electro Medical Systems). Blasting duration was adapted to the powders’ cleaning efficacy and corresponded to 25 air-polishing treatments in a patient with braces. A spindle apparatus ensured uniform guidance at a distance of 4 mm and a 90° angle. Qualitative and quantitative assessments were performed with the use of low vacuum scanning electron microscopy. Following external filtering and image processing, arithmetical square height (Sa) and root mean square height (Sq) were determined.

Results Both prophy powders caused a significant increase in enamel roughness. Surfaces blasted with sodium bicarbonate (Sa = 64.35 ± 36.65 nm; Sq = 80.14 ± 44.80 nm) showed significantly (p < 0.001) higher roughness than samples treated with erythritol (Sa = 24.40 ± 7.42 nm; Sq = 30.86 ± 9.30 nm). The observed defects in enamel structure caused by sodium bicarbonate extended across prism boundaries. Prism structure remained intact after air-polishing with erythritol.

Conclusion Both applied air-polishing powders led to surface alterations. Despite shorter treatment times, sodium bicarbonate was significantly more abrasive than erythritol. Clinicians must compromise between saving time and abrasively removing healthy enamel.

Background Aneurismal subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke that, despite improvement through therapeutic interventions, remains a devastating cerebrovascular disorder that has a high mortality rate and causes long-term disability. Cerebral inflammation after SAH is promoted through microglial accumulation and phagocytosis. Furthermore, proinflammatory cytokine release and neuronal cell death play key roles in the development of brain injury. The termination of these inflammation processes and restoration of tissue homeostasis are of utmost importance regarding the possible chronicity of cerebral inflammation and the improvement of the clinical outcome for affected patients post SAH. Thus, we evaluated the inflammatory resolution phase post SAH and considered indications for potential tertiary brain damage in cases of incomplete resolution.

Methods Subarachnoid hemorrhage was induced through endovascular filament perforation in mice. Animals were killed 1, 7 and 14 days and 1, 2 and 3 months after SAH. Brain cryosections were immunolabeled for ionized calcium-binding adaptor molecule-1 to detect microglia/macrophages. Neuronal nuclei and terminal deoxyuridine triphosphate-nick end labeling staining was used to visualize secondary cell death of neurons. The gene expression of various proinflammatory mediators in brain samples was analyzed by quantitative polymerase chain reaction.

Results We observed restored tissue homeostasis due to decreased microglial/macrophage accumulation and neuronal cell death 1 month after insult. However, the messenger RNA expression levels of interleukin 6 and tumor necrosis factor α were still elevated at 1 and 2 months post SAH, respectively. The gene expression of interleukin 1β reached its maximum on day 1, whereas at later time points, no significant differences between the groups were detected.

Conclusions By the herein presented molecular and histological data we provide an important indication for an incomplete resolution of inflammation within the brain parenchyma after SAH. Inflammatory resolution and the return to tissue homeostasis represent an important contribution to the disease’s pathology influencing the impact on brain damage and outcome after SAH. Therefore, we consider a novel complementary or even superior therapeutic approach that should be carefully rethought in the management of cerebral inflammation after SAH. An acceleration of the resolution phase at the cellular and molecular levels could be a potential aim in this context.

Background Critical infrastructure (CRITIS) in hospitals has become the focus of resilience research due to the impact of the COVID-19 pandemic and also the events in Ukraine. This foundational research examines overall contexts, categorizing and quantifying them. Previous research examined limited scale damage situations with little CRITIS involvement: Worst case studies are missing. The vulnerabilities of the CRITIS of one or more countries will likewise be a prime target for attack in current and future conflicts or criminal extortion, this is especially true in the healthcare sector. Therefore, detailed research with a black swan scenario is necessary in this field.

Objective The aim of the study was to create and validate a categorized and weighted model for the self-assessment of the resilience of critical infrastructure in German hospitals at different levels of care before the exemplary scenario of a prolonged supraregional power blackout.

Material and methods Using an explorative design, experts from 8 hospitals of different care levels performed an expert-based qualitative system analysis to develop, weight and test the model. The resilience index was then calculated using adapted interdependence analyses in a Vester influence matrix.

Results A total of 7 categories and 24 subcategories of hospital CRITIS were identified. There are several key elements: rank 1 of active elements is the emergency power system (E1), and for passive elements, it is the nursing staff (P2). This means that the emergency power system has the greatest impact on all other areas and the nursing staff are most dependent on all others for their work. The most critical elements, because they are most intertwined in the overall system, are the situation center/command staff (Z1) and technical staff (P3), on which the entire system depends. From the weighted individual elements of CRITIS, an overall resilience for a hospital can be calculated (resilience index). The developed model can be used by hospital crisis experts as part of a self-assessment to provide a basis for risk management, financial planning, technical planning, personnel planning or crisis and disaster management.

Conclusion The categorization and quantification of critical infrastructure (CRITIS) in hospitals with the aim of resilience documentation and optimization is possible. The model that has been developed allows rapid adaptation to changing initial situations and increases in resilience that can be realized in the short and medium term.

Emergency and crisis preparedness is a dynamic process, which has been combined here with the further development of critical infrastructure. Consequently, there can be no final state to be achieved but only a certain best possible framework within which the hospital as a business enterprise can operate. The classification of the categories in the model must also be constantly further developed and adapted to the current status. Once the explorative and qualitative basic research has been completed, it is necessary in a further step to subject the model, which has been validated by experts, to a broader review. Ideally, this will be done using quantitative methods and a significantly larger sample.

Hintergrund Krankenhäuser müssen sich als kritische Infrastruktur (KRITIS) auf terroristische Anschläge sowie Amoklagen einstellen und mögliche Schadensabwehrmaßnahmen vorbereiten, da sie leicht zu treffende Ziele mit hoher Symbolkraft darstellen.

Methode In der vorliegenden Arbeit wurde die terroristische Bedrohungslage anhand einer Auswertung der Terrorist Event Database (TED) für den Zeitraum 1970–2017 quantifiziert. Darüber hinaus wurden die Bedrohungsperzeption sowie die getroffenen Vorbereitungen mittels einer Online-Umfrage unter den Leitenden deutscher Notaufnahmen erfasst.

Ergebnisse Die Auswertung der TED zeigt international einen Anstieg der terroristischen Angriffe auf medizinische Einrichtungen mit Schwerpunkt in Ländern im (Bürger‑)Kriegszustand sowie in den USA. Der Einsatz von Explosivstoffen führte im untersuchten Zeitraum zu einer hohen Anzahl an Verletzten und Toten. Die Online-Befragten empfanden eine Vorbereitung der Klinik auf terroristische Szenarien in ihren Krankenhausalarm- und -einsatzplänen (KAEP) überwiegend als wichtig. In den bestehenden KAEP waren entsprechende Maßnahmen dennoch häufig nicht etabliert. Nur in 59,4 % wurde die Verletztenversorgung im Rahmen eines terroristischen Angriffs und nur in 34 % die Sicherung der Infrastruktur behandelt.

Schlussfolgerung Deutsche Kliniken sollten sich als kritische Infrastruktur sowie als mögliches Ziel terroristischer Anschläge verstehen und sich auf terroristische Bedrohungen vorbereiten. Viele günstig umzusetzende Maßnahmen sind in den Kliniken nicht ausgeschöpft und sollten zeitnah sowohl in den KAEP als auch in den Alltag integriert werden.

Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.

Context. Despite the ever-increasing number of known exoplanets, no uncontested detections have been made of their satellites, known as exomoons.

Aims. The quest to find exomoons is at the forefront of exoplanetary sciences. Certain space-born instruments are thought to be suitable for this purpose. We show the progress made with the CHaracterising ExOPlanets Satellite (CHEOPS) in this field using the HD 95338 planetary system. We present a novel methodology as an important step in the quest to find exomoons.

Methods. We utilised ground-based spectroscopic data in combination with Gaia observations to obtain precise stellar parameters. These were then used as input in the analysis of the planetary transits observed by CHEOPS and the Transiting Exoplanet Survey Satellite (TESS). In addition, we searched for the signs of satellites primarily in the form of additional transits in the Hill sphere of the eccentric Neptune-sized planet HD 95338b in a sequential approach based on four CHEOPS visits. We also briefly explored the transit timing variations of the planet.

Results. We present refined stellar and planetary parameters, narrowing down the uncertainty on the planet-to-star radius ratio by a factor of ten. We also pin down the ephemeris of HD 95338b. Using injection-and-retrieval tests, we show that a 5σ detection of an exomoon would be possible at RMoon = 0.8 R⊕ with the methodology presented here.

Conclusions. We exclude the transit of an exomoon in the HD 95338 system with RMoon ≈0.6 R⊕ at the 1σ level. The algorithm used for finding the transit-like event can be used as a baseline for other similar targets, observed by CHEOPS or other missions.

Drymaria (Caryophyllaceae) is here considered to contain 56 species plus 19 infraspecific taxa, excluding autonyms. In the current study, all effectively published names of Drymaria were compiled, and information about their taxonomy, distribution, and nomenclatural types is provided. In addition, an overview of the taxonomic history of Drymaria is presented. As a result, one neotype, 15 lectotypes, and the type for the genus Mollugophytum are newly designated. Altogether, 188 names were treated, of which 52 are heterotypic and 50 are homotypic synonyms. An additional 10 names were either unresolved or are now considered to belong to other genera. A brief assessment of the distribution of the respective taxa is also provided, including the examination of herbarium specimens and specimen images, which indicates that two regions possess high levels of endemism—Mexico with 20 species and the Andes with 14 species. There are few studies that assess the conservation status of Drymaria species, and only 10 species and two varieties have had IUCN Red List assessments.