Validation of the Patient Health Questionnaire‐4 for longitudinal mental health evaluation in elite Para athletes

Background Despite the increasing amount of research regarding mental health in elite athletes in recent years, athletes with impairments are hardly represented. Due to this lack of data and the significant need of athlete-specific mental health screening tools, a continuous mental health monitoring program for elite Para athletes was implemented. Objective Validation of the Patient Health Questionnaire-4 (PHQ-4) as a suitable tool for continuous mental health evaluation in elite Para athletes. Design A 43-week prospective observational cohort study. Setting Online questionnaire, provided weekly via web browser and mobile app. Participants Seventy-eight Para athletes preparing for Paralympic Summer and Winter Games. Interventions Not applicable. Main Outcome Measures Weekly PHQ-4 scores, stress level, and mood. Results With a mean weekly response rate of 82.7% (SD = 8.0), 2149 PHQ-4, 2159 stress level and 2153 mood assessments were completed. Mean PHQ-4 score among all participating athletes was 1.2 (SD = 1.8; 95% confidence interval [CI], [1.1–1.3]). Individual weekly scores ranged from 0 to 12 and showed significant floor effects, with 54% of the scores being zero. PHQ-4 scores were significantly higher among female athletes and team sport members (p < .001). Internal consistency of the PHQ-4 was satisfying, Cronbach's α being 0.839. There were significant cross-sectional as well as longitudinal correlations of PHQ-4 and stress level as well as mood values (p < .001). 39.7% of all athletes (n = 31) had at least one positive screen for mental health symptoms. Conclusions The PHQ-4 was shown to be a valid tool for mental health surveillance in elite Para athletes. Significant correlations of the PHQ-4 and stress level as well as mood were shown. High weekly response rates among participating athletes indicated good acceptance of the program. The weekly monitoring allowed for the identification of individual fluctuations and could identify potential athletes at risk for mental health problems when combined with clinical follow-up

Engagiert, engagierter... Fernstudent! Die Bedeutung von Ressourcen und Engagement im Fernstudium

Das Fernstudium stellt besondere Anforderungen an die Studierenden. Es fordert eine selbstregulierte Lernstruktur sowie ein Zeitmanagement, die es erlauben, Studium, Familie und Berufstätigkeit miteinander zu vereinen. Zudem sind meist mehrere Jahre zwischen Schule und Studium vergangen. So liegt die Vermutung nahe, dass gerade bei Studierenden an einer Fernuniversität das Engagement (Bakker, Schaufeli, Leiter & Taris, 2008) besonders bedeutsam ist. Für die Betrachtung dieses Sachverhaltes wurde die Utrecht Work Engagement Scale für Studierende (UWES-S) (Schaufeli, Martinez, Pinto, Salanova & Bakker, 2002) herangezogen. Mit deren Übersetzung ins Deutsche wurde das Studienengagement Fernunistudierenden untersucht. Ferner wurde die Grundannahme des Job-Demands-Resources-Modells (JD-R) (Schaufeli & Bakker, 2004; Bakker & Demerouti, 2007), dass Ressourcen einen durch Engagement vermittelten Einfluss auf den Studienerfolg besitzen (Hakanen, Schaufeli & Ahola, 2008), von uns auf den Studienkontext übertragen. Gerade für Fernstudierende interessante und relevante Ressourcen könnten z.B. die wahrgenommene allgemeine und studienkontextbezogene soziale Unterstützung, die Selbstwirksamkeitserwartung und die erlebte Autonomie bei der Einteilung des Studiums sein. In dieser Studie wurden von uns die folgenden Fragestellungen untersucht: Kann die Übersetzung und Anpassung der UWES-S für unseren Kontext als valide bezeichnet werden? Unterscheiden sich Fernstudierende von Studierenden an Präsenzuniversitäten im Engagement (unabhängig vom Alter)? Gibt es zwischen im Fernstudium relevanten Ressourcen und dem Studienerfolg einen Zusammenhang, der durch das Studienengagement vermittelt wird

Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample

Introduction: The COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures. Methods: The mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age. Results: Seventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p < 0.0001; 0.39 < r < 0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and Mental Health in Para-Athletes During COVID-19 a stress level, respectively. Reduced physical activity was significantly (p < 0.0001) associated with higher PHQ-4 values in the general population sample. Discussion: Lower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population

Validation of the Brief Confusion Assessment Method for screening delirium in elderly medical patients in a German emergency department

Background Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German‐speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. Methods We implemented the bCAM into practice in a German interdisciplinary high‐volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrolled. The bCAM showed 93.8% specificity (95% confidence interval [CI] = 90.0%–96.5%) and 65.2% sensitivity (95% CI = 49.8%–78.7%). Positive and negative likelihood ratios were 10.5 and 0.37, respectively, while the odds ratio was 28.4. Delirium was missed in 10 of 16 cases, since the bCAM did not indicate altered levels of consciousness and disorganized thinking. The level of agreement with the criterion standard increased for patients with low cognitive performance. Conclusion This was the first study evaluating the bCAM for a German ED and when performed by EPs during routine work. The bCAM showed good specificity, but only moderate sensitivity. Nevertheless, application of the bCAM most likely improves the delirium detection rate in German EDs. However, it should only be applied by trained physicians to maximize diagnostic accuracy and hence improve the bCAM's sensitivity. Future studies should refine the bCA

Nutrient stoichiometry and land use rather than species richness determine plant functional diversity

Ajuts: Deutsche Forschungsgemeinschaft. Grant Numbers: FI 1246/6-1, HO 3830/2-1, KL 2265/5-1 - TRY initiative on plant traits DIVERSITAS/Future Earth and the German Centre for Integrative Biodiversity Research (iDiv) Halle-Jena-Leipzig - Open Access Publication Fund of University of Muenster.Plant functional traits reflect individual and community ecological strategies. They allow the detection of directional changes in community dynamics and ecosystemic processes, being an additional tool to assess biodiversity than species richness. Analysis of functional patterns in plant communities provides mechanistic insight into biodiversity alterations due to anthropogenic activity. Although studies have consi-dered of either anthropogenic management or nutrient availability on functional traits in temperate grasslands, studies combining effects of both drivers are scarce. Here, we assessed the impacts of management intensity (fertilization, mowing, grazing), nutrient stoichiometry (C, N, P, K), and vegetation composition on community-weighted means (CWMs) and functional diversity (Rao's Q) from seven plant traits in 150 grasslands in three regions in Germany, using data of 6 years. Land use and nutrient stoichiometry accounted for larger proportions of model variance of CWM and Rao's Q than species richness and productivity. Grazing affected all analyzed trait groups; fertilization and mowing only impacted generative traits. Grazing was clearly associated with nutrient retention strategies, that is, investing in durable structures and production of fewer, less variable seed. Phenological variability was increased. Fertilization and mowing decreased seed number/mass variability, indicating competition-related effects. Impacts of nutrient stoichiometry on trait syndromes varied. Nutrient limitation (large N:P, C:N ratios) promoted species with conservative strategies, that is, investment in durable plant structures rather than fast growth, fewer seed, and delayed flowering onset. In contrast to seed mass, leaf-economics variability was reduced under P shortage. Species diversity was positively associated with the variability of generative traits. Synthesis. Here, land use, nutrient availability, species richness, and plant functional strategies have been shown to interact complexly, driving community composition, and vegetation responses to management intensity. We suggest that deeper understanding of underlying mechanisms shaping community assembly and biodiversity will require analyzing all these parameters

Perspektiven der Sozialen Landwirtschaft unter besonderer Berücksichtigung der Entwicklungen in Italien

This volume presents the current scientific debate, innovative projects and approaches of Social Agriculture in Italy and in the German-speaking area. The work is aimed at professionals from social services, health and education, students of social sciences and agricultural economics, and those responsible for social policies, regional development, organic farming and eco-social transformation.; Diese Publikation stellt aktuelle wissenschaftliche Diskurse, innovative Projekte und Konzepte der Sozialen Landwirtschaft in Italien und im deutschsprachigen Raum vor. Sie richtet sich an Fachkräfte des Sozial,- Gesundheits- und Bildungswesens, Studierende des Sozialwesens und der Agrarwirtschaft, Verantwortliche der Sozialpolitik und Regionalentwicklung, der biologischen Landwirtschaft und der öko-sozialen Transformation. ; Questo volume presenta l’attuale dibattito scientifico, progetti innovativi e approcci dell’Agricoltura Sociale in Italia e nell’area germanofona. Il lavoro si rivolge a professionisti dei servizi sociali, della sanità e dell’istruzione, a studenti delle scienze sociali e di economia agraria e ai responsabili delle politiche sociali, dello sviluppo regionale, dell’agricoltura biologica e della trasformazione eco-sociale

Solving the chemical master equation using sliding windows

<p>Abstract</p> <p>Background</p> <p>The chemical master equation (CME) is a system of ordinary differential equations that describes the evolution of a network of chemical reactions as a stochastic process. Its solution yields the probability density vector of the system at each point in time. Solving the CME numerically is in many cases computationally expensive or even infeasible as the number of reachable states can be very large or infinite. We introduce the sliding window method, which computes an approximate solution of the CME by performing a sequence of local analysis steps. In each step, only a manageable subset of states is considered, representing a "window" into the state space. In subsequent steps, the window follows the direction in which the probability mass moves, until the time period of interest has elapsed. We construct the window based on a deterministic approximation of the future behavior of the system by estimating upper and lower bounds on the populations of the chemical species.</p> <p>Results</p> <p>In order to show the effectiveness of our approach, we apply it to several examples previously described in the literature. The experimental results show that the proposed method speeds up the analysis considerably, compared to a global analysis, while still providing high accuracy.</p> <p>Conclusions</p> <p>The sliding window method is a novel approach to address the performance problems of numerical algorithms for the solution of the chemical master equation. The method efficiently approximates the probability distributions at the time points of interest for a variety of chemically reacting systems, including systems for which no upper bound on the population sizes of the chemical species is known a priori.</p

Persistent Megalocystic Ovary Following in Vitro Fertilization in a Postpartum Patient with Polycystic Ovarian Syndrome

SummaryObjectiveOvarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months.Case ReportA 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed “kissing ovaries”, which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts.ConclusionWith the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery