Hochschule Hannover

Despite agrowing proportion of women in surgery, there is asignificant underrepresentation in clinical and academic leadership positions. The mechanisms are still poorly understood. The German Congress of Visceral Medicine, as the largest interdisciplinary medical congress in German-speaking countries, provides asuitable platform for investigating gender-specific representation patterns. The aim of this study was to analyze the gender distribution in various congress functions between 2013 and 2024 in order to identify potential structural inequalities. The gender distribution of speakers and chairs at the German Congress of Visceral Medicine from 2013 to 2024 was analyzed based on the official congress programs. After excluding gastroenterological, endoscopic and interdisciplinary sessions, the visceral surgery sessions were analyzed in the categories of abstract sessions, plenary sessions and industry symposia. The analysis revealed asignificant increase in the number of female speakers (r2 = 0.585; p = 0.006) and chairs (r2 = 0.777; p < 0.001). The proportion of female speakers significantly increased in both plenary sessions (r2 = 0.600, p = 0.005) and abstract sessions (r2 = 0.445, p = 0.025). An increase in the number of female chairs was also observed for plenary sessions (r2 = 0.796; p < 0.001) and abstract sessions (r2 = 0.678; p = 0.002). Parity could not be achieved except for chairs of abstract sessions. At industry symposia, speakers were male in 88-100%, and chairs were male in 100% of all cases. The congress presidency was held by men in 10out of 11years (92%). The Walter Kausch Medal and the Rudolf Pichlmayr Medal went exclusively to men (100%). The analysis reveals apersistent underrepresentation of female surgeons in prestigious conference roles. Women were predominantly represented in less visible formats, indicating structural barriers. Following the introduction of transparent selection procedures and gender parity requirements, asignificant increase in female participation was observed. These results suggest that targeted institutional measures are suitable for promoting the representation of women in academic surgery and reducing existing imbalances.

The National Health Insurance Scheme (NHIS) in Nigeria aims to improve access to healthcare and reduce out-of-pocket payments, yet persistent dissatisfaction with NHIS-provided services threatens enrollee retention and scheme sustainability. This study assessed satisfaction and willingness to retain NHIS membership among enrollees at a tertiary hospital in Ebonyi State and explored implications for community-based health insurance policy and service-delivery reform. We conducted a convergent parallel mixed-methods study comprising a survey of 376 NHIS enrollees attending outpatient clinics at Alex Ekwueme University Teaching Hospital, Abakaliki, and in-depth phenomenological interviews with with 20 enrollees (10 males, 10 females, aged 24-68years, NHIS enrolment 5-11years). Convenience sampling was used. Satisfaction with NHIS services was measured using a 4-point Likert scale, and associations with willingness to retain membership were examined using chi-square tests, Cramér's V and predictive Lambda at p<0.05. Qualitative data were analysed thematically with MAXQDA to contextualise service-delivery experiences and retention decisions. Respondents (n=376; age 21-65years) were predominantly middle-aged, female, married, tertiary educated and employed as civil servants, with most reporting access to healthcare. Overall, 61.8% of enrollees were satisfied with NHIS services, and satisfaction strongly predicted willingness to retain membership (Χ2=121.14, df=1; Cramér's V=0.57; p<0.0001); 74.4% of those willing to retain membership reported being satisfied. Predictive Lambda indicated that knowing satisfaction status substantially improved prediction of retention (λ[A from B]=0.83 vs. λ[B from A]=0.79). Qualitative findings highlighted long waiting times, drug stock-outs, bureaucratic inefficiencies and poor provider-patient interactions as major sources of dissatisfaction, particularly among rural and lower-income enrollees. This single-centre mixed-methods study shows that while nearly two-thirds of NHIS enrollees were satisfied with the quality and affordability of scheme-provided services, persistent service-delivery gaps and administrative bottlenecks undermine retention intentions. Policy adjustments that prioritise improving service delivery, addressing administrative inefficiencies and strengthening provider-patient relationships are likely to enhance satisfaction and retention within the NHIS. These findings also offer practical insights for the design and scaling of community-based health insurance and related service-delivery reforms in similar mixed urban-rural settings, and for advancing equity-focused progress towards universal health coverage and related Sustainable Development Goals.

Das Gesundheitswesen steht wie kaum ein anderer Sektor vor tiefgreifenden Veränderungen. Getrieben durch die steigenden Anforderungen der VUKA-Welt – gekennzeichnet durch Volatilität, Unsicherheit, Komplexität und Ambiguität – werden Organisationen gezwungen, sich anzupassen. Agilität gilt als einer der Schlüssel, um dieser Welt zu begegnen. Doch wie viel Agilität vertragen standardisierte Strukturen, wie sie insbesondere im Gesundheitswesen durch gesetzliche Vorgaben, Qualitätsmanagementsysteme und patientensicherheitskritische Prozesse vorgegeben sind?

Zusammenfassung Institutionelle Schutzkonzepte zum Schutz von Kindern und Jugendlichen in pädagogischen Kontexten zielen auf einen langfristig angelegten Organisationsentwicklungsprozess. Als grundlegend wird hierfür die Etablierung einer Kultur der Achtsamkeit erachtet. Anhand empirischen Materials aus dem Forschungsverbund „Entwicklung und Wirkung von Schutzkonzepten in Schulen im Längsschnitt“ (2021–2024) werden in dem Beitrag die Perspektiven von Schüler*innen auf das Organisationsklima dargestellt. Auf der Grundlage von acht Gruppendiskussionen mit Schüler*innen der Jahrgangsstufen sieben und acht wurden mittels der dokumentarischen Methode drei sinngenetische Typen rekonstruiert, die anhand ihrer Orientierungsgehalte auf ein breites Spektrum der Wahrnehmung des Schulklimas hinweisen und dabei stets eine Selbstverortung der Befragten, insbesondere im Verhältnis zu den Pädagog*innen, vornehmen. Sichtbar werden unterschiedliche Betrachtungsweisen des aufgeworfenen Spannungsfeldes von Autonomie und Abhängigkeit. Hinsichtlich der Entwicklung und Implementierung von Schutzkonzepten ist die pädagogische Praxis vor dem Hintergrund der Ergebnisse herausgefordert, die vielfältigen Positionierungen und Perspektiven der jungen Menschen zu berücksichtigen. Der konsequente Einbezug ihrer (impliziten) Sichtweisen und Verortungen, so die Annahme, führt zu einer nachhaltigeren und wirksameren Umsetzung präventiver und intervenierender Schutzmaßnahmen.

Targeted mastitis treatment concepts are the most scientifically validated approaches to comply with the prudent use of antimicrobials. However, this approach is still a challenge for many farmers, who often lack experience with it. Another option for more prudent use of antibiotics in mastitis therapy could be the initial treatment with a nonsteroidal anti-inflammatory drug (NSAID) for nonsevere mastitis. A randomized, multiherd, noninferiority study was carried out to compare 2 treatments of nonsevere mastitis cases. The animals in the studied group were treated with systemic NSAID (ketoprofen [KE]; KE group; n = 104), followed by antibiotic (AB) treatment only in cases without clinical improvement, and the animals in the reference group (AB group) received an intramammary AB (n = 118). The study included 222 cases of nonsevere clinical mastitis on 3 conventional dairy farms in northern Germany between November 2022 and November 2023. Study outcomes were clinical cure at d 5, bacteriological cure, clinical mastitis recurrence in a period of 60 d, and new infection risk. Mixed logistic regression was used to analyze the effect of treatment on outcomes. The noninferiority assumption was checked with the CI of the treatment difference for clinical cure at d 5, calculating using the LSM and their SD. With regard to the clinical cure on d 5, the treatment in the KE group was inferior. Clinical cure (84.7% [100/118] and 61.5% [64/104]) and bacteriological cure (79.3% [73/92] and 61.2% [41/67]) were significantly higher in the AB group than in the KE group. The risks for recurrent cases (7.3% [8/109] and 15.7% [14/89]) were significantly lower in the AB group than in the KE group. The new infection risk did not differ significantly between the treatment groups (6.8% [8/118] in the AB group and 6.7% [7/104] in the KE group). In 87% of the cases (n = 90) of the KE group, a subsequent antibiotic treatment was not necessary to reach clinical cure on d 5. The use of KE as the sole initial treatment for nonsevere mastitis led to a reduction of antibiotic doses by 86%. Our findings revealed that systemic treatment with KE resulted in lower clinical and bacteriological cure rates, higher recurrence rates of clinical mastitis, and an elevated risk of new infections compared with the antibiotic-treated group. Nevertheless, in more than 85% of cases treated with KE, additional intramammary antibiotic treatment was unnecessary. Thus, this treatment concept represents an alternative in mastitis treatment that promoted the deliberate and selective use of antibiotics but has limitations in terms of treatment efficacy in mastitis. A targeted mastitis concept based on the identification of the bacterium involved could help to select cases to be treated with KE alone and therefore overcome this limitation.

Our communication systems face a constant threat of cyberattacks. Advanced attacks go beyond the capabili-ties of established detection methods. Threat Hunting (TH), a hypothesis-driven, analyst-centric approach, is one technique for detecting advanced persistent threat (APT) activities. However, it can be resource-intensive, require specialized expertise, and may not always produce immediate or clear results. In addition to TH, anomaly detection is also a way to detect APT activities, but it suffers from a high false positive rate (FPR). We explore combining TH with anomaly detection to address the high FPR in anomaly detection, reduce the analyst's workload, and improve hunting success. Our approach, FUDD, a TH framework that applies graph-based anomaly detection on log data to detect APT activities, provides the threat hunter with an anomaly report based on a hypothesis. The anomaly report makes unusual behavior visible, potentially validating the initial hypothesis and facilitating the evolution and generation of more specific hypothe-ses. Our evaluation involves instantiating FUDD and applying it to two DARPA Transparent Computing sample datasets. Our results show that analysts can use the report's top <tex xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">$k$</tex> anomalies to identify attacks based on an initially very broad hypothesis. Besides attacks, the report also highlights other unusual system behavior. . which helps enhance the system's overall security.

Abstract Physical activity has consistently been associated with improved colon cancer survival, yet the biological mechanisms for this association are not yet fully understood. We investigated the transcriptome of colon tumors and tumor-adjacent visceral adipose tissue (VAT) in relation to colon cancer patients’ physical activity levels. Methods: Fresh-frozen tumor and VAT samples were collected from 134 stage I-III colon cancer patients recruited at Huntsman Cancer Institute, Utah, and Heidelberg University Hospital, Germany, and profiled with bulk RNA sequencing. Habitual physical activity levels were self-reported by the International Physical Activity Questionnaire and patients were classified as either active (&amp;gt;7.5 metabolic equivalents per week (MET hrs/week), or 150 minutes/week of moderate to vigorous activity) or as inactive (&amp;lt; 2.5 MET hrs/week or &amp;lt;1 hour of light activity). To evaluate robustness and consistency of findings, patients were also categorized as &amp;gt;7.5 MET hrs/week vs. &amp;lt; 3.5 MET hrs/week. Normalized differentially expressed genes were identified (DESeq2 R package) and analyses were adjusted for age, sex, body mass index (BMI), study site and tumor stage. Gene set enrichment analysis identified enriched pathways within the 2024 Hallmark gene sets. Significance was assessed using false discovery rate padj &amp;lt;0.05. Results: Active patients (n=57) were on average younger (61+14 years vs. 64+14 years), with less disease severity (84% Stage II/III, 95% Stage II/III), lower BMI (26.8+5 kg/m2 vs. 32.1+7 kg/m2) compared to inactive patients (n=55). There were 21 and 27 significant gene sets (padj &amp;lt;0.05) in colon tumor tissue and VAT, respectively, when comparing active to inactive patients. Colon tumors of active patients displayed downregulation of oncogenic pathways relative to the inactive patients, including epithelial mesenchymal transition and angiogenesis (|Normalized Enrichment Score (NES)|&amp;gt;1.5, padj &amp;lt; 0.05). Tumors from active patients also exhibited downregulation of oxidative phosphorylation (|NES|&amp;gt;1.5, padj &amp;lt; 0.05) relative to inactive patients. VAT of active patients had significantly upregulated oxidative phosphorylation, fatty acid metabolism and glycolysis relative to inactive patients (|NES|&amp;gt;1.4, padj &amp;lt; 0.05). These tumor and adipose gene set results were consistent across the comparison of &amp;gt;7.5 MET hrs/week vs. &amp;lt; 3.5 MET hrs/week. Conclusions: Colon tumors from patients meeting or exceeding physical activity guidelines displayed significant downregulation of oncogenic pathways relative to tumors from inactive patients. Similarly, VAT of active patients had transcriptional profiles promoting metabolic pathways. These findings suggest that physical activity levels meeting or exceeding the current guidelines are associated with favorable gene expression both in tumors and tumor-adjacent VAT. Citation Format: Victoria Maria Bandera, Caroline Himbert, Elaine M. Glenny, Tengda Lin, Sheetal Hardikar, Aik Choon Tan, Jennifer Ose, Victoria Damerell, Patricia Erickson, Richard Viskochil, Christy Warby, Olena Aksonova, Chris Stubben, David Nix, Kenneth Boucher, Peter Schirmacher, Ildiko Strehli, Alejandro Sanchez, Jolanta Jedrzkiewicz, Lyen C. Huang, Vaia Florou, Jessica N. Cohan, Alexander Brobeil, Hans-Ulrich Kauczor, Christoph Kahlert, Meghana Karchi, Elizabeth H. Wood, Doratha A. Byrd, Erin M. Siegel, Adetunji T. Toriola, David Shibata, Christopher I. Li, Jane C. Figueiredo, Biljana Gigic, Jatin Roper, Stephen D. Hursting, Cornelia M. Ulrich. Physical activity levels are associated with transcriptomic pathways in colon tumors and tumor-adjacent visceral adipose tissue: Results from the ColoCare Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 3726.

Primary ciliary dyskinesia (PCD) is a multisystem disease caused by dysfunction of motile cilia. It is characterized by chronic mucus retention of the upper and lower airways. This results in a destructive lung disease with the development of bronchiectasis. There are a very few evidence-based therapies for patients with PCD. Most treatment concepts are based on other respiratory diseases or expert opinion. This article is about the physiotherapy care of patients with PCD and provides an overview of recommendations from the current literature as well as many years of experience in the physiotherapy treatment of patients with PCD. Currently, no curative therapy for PCD exists. Symptomatic treatment with a focus on mucus management is relevant. This includes inhalation, mobilization of mucus, physical activity and the targeted use of medical aids for chest clearance as well as rehabilitation. Whenever possible, specialized therapists should provide guidance for physiotherapy.