University of Mannheim

Minimally invasive liver surgery has rapidly evolved in recent years. In addition to the laparoscopic liver resection (LLR), robot-assisted liver resection (RLR) is increasingly gaining in importance; however, although the robotic-assisted approach offers clinical benefits, particularly in complex procedures, it remains amatter of debate. The aim of this study was to present the development, perioperative outcomes, key challenges, and insights from over 500 minimally invasive liver resections performed at aspecialized high-volume center. It focused on the comparison between LLR and RLR based on the IWATE difficulty score. Aretrospective single-center analysis of 526 consecutive elective minimally invasive liver resections (2018-2024) was conducted. All cases were stratified using the IWATE score. The LLR and RLR were compared in terms of operative parameters, conversion rate and postoperative complications. Additionally, the annual procedural development was analyzed. The RLR was established in 2021 and accounted for over 50% of all minimally invasive liver resections by 2024. Compared to LLR, RLR was associated with significantly reduced intraoperative blood loss as well as lower conversion and complication rates, particularly in technically demanding resections. Despite an increasing proportion of advanced/expert resections, the rate of major complications could be reduced over time. Minimally invasive liver resections can be safely performed at high-volume centers. The robotic-assisted technique offers specific advantages especially in complex resections, with respect to complication rates, reduced conversion rates and decreased blood loss. Akey success factor in the implementation of robotic liver surgery is the pre-existing expertise in laparoscopic techniques, which significantly shortened the learning curve. The use of standardized techniques such as the scissor hepatectomy may have contributed to the comparatively low rate of bile leaks observed in RLR.

Summary Trade conflicts, geopolitical tensions, digital disruption, and the climate crisis pose major challenges for the European Union (EU) and its Member States. As called for in the Draghi Report, industrial policy measures can increase competitiveness, strengthen resilience, and facilitate the twin transformation. This article explores ways in which competition policy can be realigned to better accommodate industrial policy objectives. It presents options with which legislatures and competition authorities can respond to current challenges, reconcile conflicting objectives, and adapt the decision-making framework. It then considers elements of a competition-oriented industrial policy, understood as an evidence-based, targeted approach in which competition serves both as a guiding principle and as a control variable.

ABSTRACT Even though stress appraisals determine employees' states and behaviors at work, knowledge of their antecedents is limited. This research project integrates sleep research into the transactional stress theory to explain how sleep, as a key factor shaping employees' resource availability, relates to employees' appraisals of their job demands. We examine relationships between sleep characteristics (sleep duration, sleep quality, and chronotype) and stress appraisals (challenge, hindrance, and threat) at the intraindividual and interindividual levels. In the main study (144 employees, 937 days, and 2428 surveys), we used an experience sampling design to examine the relevance of sleep for dynamic within‐person fluctuations (i.e., morning levels and within‐day changes) and stable between‐person differences (i.e., mean during the experience sampling phase) in stress appraisals. In an additional sample for robustness checks (278 employees), we tested the replicability of stable between‐person relationships using a two‐wave design. Results revealed that sleep quality is linked to more favorable appraisals (i.e., lower hindrance and threat appraisals and partly higher challenge appraisal). Furthermore, daily sleep quality and employees' chronotype related to dynamic within‐day changes in threat appraisals (i.e., trajectories). Accordingly, we underscore the role of sleep for employees' functioning at work by explicitly connecting sleep to the stress appraisal process.

Abstract Progressive parties often advocate pro-immigration policies but do not attract equal support from all immigrant groups. Why is this the case? This study examines immigrants’ support for green parties, a key progressive party family in Western Europe. Our findings reveal that immigrants from established democracies are more likely to support green parties compared to those from (post-)authoritarian regimes. We attribute this disparity to socialization: Individuals from established democracies, where post-materialist values and environmental politics are more prominent, are more attuned to green issues. This heightened salience influences their political preferences after migration. Using entropy balancing on cross-national European surveys, we document this green support gap and provide evidence for our proposed mechanism. These results inform debates on how political preferences travel across contexts and the socialization effects of political institutions.

The European Union’s (EU) Cohesion Policy is one of the main instruments to tackle the economic struggle of left-behind regions, however, only little is known about the awareness and the opinion of citizens towards this regional policy. This article examines how awareness of EU regional policies and spending preferences varies across occupations. We argue that differences in awareness across occupations are attributable to skill and responsibility differences and divergent work logics. Our analysis of a harmonized Eurobarometer dataset ( N = 82,365) provides evidence for differences in EU funding awareness and spending preferences across occupational groups, which correspond to their own material interests. In addition, citizens indicate preferences for funding decisions to be made at the most local level.

Abstract National policies significantly shape resource allocation and priorities in EdTech development. This paper presents insights from six countries through a systems thinking perspective. Drawing on lessons from the COVID-19 pandemic, the authors explore how national policies evolved in response to global EdTech trends. Each country offers unique approaches as case studies. China emphasizes digital transformation and the use of artificial intelligence in teacher education. Germany focuses on enhancing student media literacy through school initiatives. Japan accelerates digitalization through cross-ministerial efforts to address educational disparities. Italy emphasizes the updating of school curricula, tertiary offerings, and digital innovation projects. Norway underscores teacher autonomy and innovative methods for digital literacy, while the United States focuses on academic recovery and addressing the challenges posed by new forms of digital divide. The case studies offer insights into global EdTech trends while cautioning against viewing the field as monolithic. The authors synthesize key strategies in national priorities and practices and provide recommendations for an ethical and effective approach to EdTech development.

Despite the increasing use of coronary computed tomographic angiography (CCTA) in patients with known or suspected coronary artery disease (CAD), comparatively little is known about its predictive value for adverse events or clinical applicability of volumetric plaque analysis. To assess the incremental prognostic value of quantitative CAD measures in symptomatic outpatients without known CAD. This post hoc analysis involved a prospective randomized clinical trial conducted across 193 clinical sites in North America. Participants were symptomatic outpatients without known CAD who were randomized to receive CCTA. The trial was conducted from July 27, 2010, to October 31, 2014, and the data analyzed for this report from January 2021 to July 2024. Core laboratory-based quantitative plaque measures, including total plaque volume (TPV), calcified (CPV) and noncalcified (NCPV) plaque volume, low-attenuation plaque volume (LAPV), total plaque burden (TPB), and noncalcified plaque burden (NCPB), normalized with vessel volume. The primary outcome was major adverse cardiovascular events MACE (composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina). Optimal predictive cut points for plaque measures were identified using Euclidean distance methods and tested in multivariable Cox regression models. Among 4267 patients, the mean (SD) age was 60.4 (8.2) years; 2199 patients (51.5%) were female and 2068 (48.5%) were male. The median (IQR) TPV was 39.8 mm3 (0-167) mm3. Patients with TPV at the median or higher were older (mean [SD] age, 62.1 [8.4] vs 58.7 [7.5] years for those with lower than median TPV), more likely to be male (1286/2133 [60.3%] vs 782/2134 [36.6%], respectively), and had higher median (IQR) atherosclerotic cardiovascular disease risk scores (14.4 [8.8-24.0] vs 7.9 [4.5-13.4], respectively). TPB showed similar demographic associations. Both TPB and NCPB independently predicted MACE after adjusting for clinical risk factors, statin use, and qualitative CCTA findings (TPB: adjusted HR [aHR], 1.18; 95% CI, 1.05-1.34; P = .006; NCPB: aHR, 1.20; 95% CI, 1.05-1.37; P = .007). Optimal cutoffs of TPV 87 mm3 or greater, TPB 35% or greater, and NCPB 20% or greater were each associated with nearly a 2-fold increase in MACE risk (TPV: aHR, 2.07; 95% CI, 1.24-3.49; TPB: aHR, 1.96; 95% CI, 1.21-3.17; and NCPB: aHR, 1.77; 95% CI, 1.12-2.82). In symptomatic patients without known CAD, coronary plaque volumes and burdens are low but are related to CAD risk factors and independently predictive of MACE. The clinical utility of quantitative CCTA-based cardiovascular risk estimation in early CAD requires prospective evaluation. ClinicalTrials.gov Identifier: NCT01174550.

Natural killer (NK) cells exert cytotoxicity against transformed and infected cells. In human sepsis, a suppressive NK cell receptor signature and defective effector molecule expression have been described. However, the transcriptional mechanisms underlying this phenotype remain poorly defined. We analyzed microarray-based transcriptomic profiles of isolated peripheral NK cells from patients with sepsis, patients with systemic inflammatory response syndrome (SIRS), and presurgical controls. Enrichment analyses of canonical pathways, biological processes, and cellular compartments were performed. Differential gene expression was validated in an independent cohort using a multiplex branched-DNA assay. Functional signal transducer and activator of transcription (STAT) phosphorylation responses ex vivo and proliferation marker expression were assessed by flow cytometry in independent patient samples. NK cells from patients with sepsis displayed transcriptional signatures indicative of DNA replication stress, endoplasmic reticulum (ER) stress, altered cytoskeletal dynamics, and vesicle trafficking. Despite enrichment of proliferation-associated transcriptional programs, NK cells showed no increase in Ki-67 expression, indicating impaired proliferative activity. In contrast, NK cells from patients with SIRS exhibited downregulation of immune signaling pathways. This study identifies early stress-associated transcriptional programs and impaired subcellular organization in circulating NK cells during sepsis. Dysregulated DNA replication and ER stress responses, along with altered vesicle trafficking linked to impaired small guanosine triphosphatase (GTPase) signaling, may contribute to NK cell dysfunction in sepsis and may inform the development of NK cell-based immunotherapeutic strategies in critical illness.

The intention-behaviour gap (IBG) remains a persistent challenge in health psychology. While intentions are widely recognized as proximal determinants of behaviour, they frequently fail to translate into action. This conceptual review aims to critically evaluate dominant models of the IBG and propose a dynamic, multidimensional reconceptualization of intention-behaviour processes. This conceptual review critically evaluates dominant models of the IBG-the Explained Variance Approach and the Action Control Framework. Special emphasis is placed on methodological constraints associated with between-person research designs, which inadequately capture the temporal and contextual variability of behavioural enactment. Theoretical and empirical limitations are identified in existing IBG models, including their failure to address intra-individual fluctuations, situational contingencies and the time-indexed nature of behavioural regulation. In response, we propose a framework emphasizing intensive longitudinal designs, within-person assessment, ecological momentary methods and person-specific modelling techniques to better capture intention-behaviour dynamics. To close the IBG, future research should integrate dynamic methodologies and real-time interventions that align with situational and motivational states. We advocate for context-sensitive strategies, such as just-in-time adaptive interventions and implementation intentions, to enhance behavioural enactment. This reconceptualization offers a pathway towards more precise theory and effective intervention in health behaviour change.