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Misinformation surrounding crises poses a significant challenge for public institutions. Understanding the relative effectiveness of different types of interventions to counter misinformation, and which segments of the population are most and least receptive to them, is crucial. We conducted a preregistered online experiment involving 5228 participants from Germany, Greece, Ireland, and Poland. Participants were exposed to misinformation on climate change or COVID-19. In addition, they were pre-emptively exposed to a prebunk, warning them of commonly used misleading strategies, before encountering the misinformation, or were exposed to a debunking intervention afterwards. The source of the intervention (i.e. the European Commission) was either revealed or not. The findings show that both interventions change four variables reflecting vulnerability to misinformation in the expected direction in almost all cases, with debunks being slightly more effective than prebunks. Revealing the source of the interventions did not significantly impact their overall effectiveness. One case of undesirable effect heterogeneity was observed: debunks with revealed sources were less effective in decreasing the credibility of misinformation for people with low levels of trust in the European Union (as elicited in a post-experimental questionnaire). While our results mostly suggest that the European Commission, and possibly other public institutions, can confidently debunk and prebunk misinformation regardless of the trust level of the recipients, further evidence on this is needed.

We explore the common attributes of political conflicts in which scientific findings have a central role, using the COVID-19 pandemic as a case study, but also drawing on long-standing conflicts over climate change and vaccinations. We analyze situations in which the systematic spread of disinformation or conspiracy theories undermines public trust in the work of scientists and prevents policy from being informed by the best available evidence. We also examine instances in which public opposition to scientifically grounded policy arises from legitimate value judgments and lived experience. We argue for the public benefit of quick identification of politically motivated science denial, and inoculation of the public against its ill effects.

A sample environment and manipulation tool is presented for single‐particle X‐ray experiments in an aqueous environment. The system is based on a single water droplet, positioned on a substrate that is structured by a hydrophobic and hydrophilic pattern to stabilize the droplet position. The substrate can support several droplets at a time. Evaporation is prevented by covering the droplet by a thin film of mineral oil. In this windowless fluid which minimizes background signal, single particles can be probed and manipulated by micropipettes, which can easily be inserted and steered in the droplet. Holographic X‐ray imaging is shown to be well suited to observe and monitor the pipettes, as well as the droplet surface and the particles. Aspiration and force generation are also enabled based on an application of controlled pressure differences. Experimental challenges are addressed and first results are presented, obtained at two different undulator endstations with nano‐focused beams. Finally, the sample environment is discussed in view of future coherent imaging and diffraction experiments with synchrotron radiation and single X‐ray free‐electron laser pulses. Micropipette aspiration has been combined with a windowless hydrated sample environment for single‐particle X‐ray analysis. A water droplet serves as a `chamber', covered by a mineral oil to prevent evaporation. In the droplet, particles can be aspirated and manipulated by one or two micropipettes. The system was evaluated on two undulator beamlines, using grains, giant lipid vesicles, colloids and macrophages as test objects. Holographic near‐field images were recorded.

Imaging the entire cardiomyocyte network in entire small animal hearts at single cell resolution is a formidable challenge. Optical microscopy provides sufficient contrast and resolution in 2d, however fails to deliver non-destructive 3d reconstructions with isotropic resolution. It requires several invasive preparation steps, which introduce structural artefacts, namely dehydration, physical slicing and staining, or for the case of light sheet microscopy also clearing of the tissue. Our goal is to provide 3d reconstructions of the cardiomyocyte network in entire hydrated murine hearts, and to develop a methodology for quantitative analysis of heart pathologies based on X-ray phase contrast computed tomography (XPCT). We have used XPCT at two beamlines of the extremely brilliant source (EBS) at the European Synchrotron Radiation Facility (ESRF) to scan wild-type murine hearts at high resolution, as well as a series of murine hearts of different pathological models, at reduced resolution and higher throughput. All hearts were obtained from the small animal facility of the university medical center in Göttingen. The hearts were fixed in formalin, stored and measured non-destructively in phosphate buffer solution. The high resolution dataset allows to discern individual cardiomyocytes in the tissue. All datasets have been analyzed using semi-automated image segmentation of the ventricles, rotation into a common coordinate system, classification into different anatomical compartments, and finally the structure tensor approach. A 3d streamline representation of the cardiomyocyte orientation vector field is provided. The different cardiovascular disease models are analysed based on metrics derived from the 3d structure tensor. An entire hydrated murine heart has been covered at an isotropic voxel size of 1.6 μ m (distributed over several volumes). A binned and fused dataset of this heart is available at 3.2 μ m, and has been analyzed by the structure tensor approach to yield the ventricular cardiomyocyte network or mesh, i.e. the aggregation of the cardiomyocyte chains in particular in the ventricular wall. Semi-automatic determination of structural metrics is already achieved and the corresponding tools and resulting data are made publically available. XPCT using extremely brilliant undulator radiation is close to achieve single cell reconstruction in an entire small animal organ.

X‐rays can penetrate deeply into biological cells and thus allow for examination of their internal structures with high spatial resolution. In this study, X‐ray phase‐contrast imaging and tomography is combined with an X‐ray‐compatible optical stretcher and microfluidic sample delivery. Using this setup, individual cells can be kept in suspension while they are examined with the X‐ray beam at a synchrotron. From the recorded holograms, 2D phase shift images that are proportional to the projected local electron density of the investigated cell can be calculated. From the tomographic reconstruction of multiple such projections the 3D electron density can be obtained. The cells can thus be studied in a hydrated or even living state, thus avoiding artifacts from freezing, drying or embedding, and can in principle also be subjected to different sample environments or mechanical strains. This combination of techniques is applied to living as well as fixed and stained NIH3T3 mouse fibroblasts and the effect of the beam energy on the phase shifts is investigated. Furthermore, a 3D algebraic reconstruction scheme and a dedicated mathematical description is used to follow the motion of the trapped cells in the optical stretcher for multiple rotations. Biological cells in suspension are manipulated using an optical stretcher and imaged using X‐ray phase‐contrast tomography.

Nudges receive growing attention as an effective concept to alter people's decisions without significantly changing economic incentives or limiting options. However, being often very subtle and covert, nudges are also criticized as unethical. By not being transparent about the intention to influence individual choice they might be perceived as limiting freedom of autonomous actions and decisions. So far, empirical research on this issue is scarce. In this study, we investigate whether nudges can be made transparent without limiting their effectiveness. For this purpose we conduct a laboratory experiment where we nudge contributions to carbon emission reduction by introducing a default value. We test how different types of transparency (i.e. knowledge of the potential influence of the default, its purpose, or both) influence the effect of the default. Our findings demonstrate that the default increases contributions, and information on the potential influence, its purpose, or both combined do not significantly influence the default effect. Furthermore, we do not find evidence that psychological reactance interacts with the influence of transparency. Findings support the policy-relevant claim that nudges (in the form of defaults) can be transparent and yet effective.

The acceptability of electronic mental (e-mental) health apps has already been studied. However, the attitudes of medical experts, students, and patients taking into account their knowledge of and previous experiences with e-mental health apps have not been investigated. The aim of this study was to explore the attitudes, expectations, and concerns of medical experts, including physicians, psychotherapists and nursing staff, students of medicine or psychology, and patients toward e-mental health apps when considering their knowledge of and former experiences with e-mental health apps. This cross-sectional quantitative and qualitative survey was based on a self-developed questionnaire. A total of 269 participants were included (104 experts, 80 students, and 85 patients), and 124 eligible participants answered a paper version and 145 answered an identical online version of the questionnaire. The measures focused on existing knowledge of and experiences with e-mental health apps, followed by a question on whether electronic health development was generally accepted or disliked. Further, we asked about the expectations for an ideal e-mental health app and possible concerns felt by the participants. All items were either presented on a 5-point Likert scale or as multiple-choice questions. Additionally, 4 items were presented as open text fields. Although 33.7% (35/104) of the experts, 15.0% (12/80) of the students, and 41.2% (35/85) of the patients knew at least one e-mental health app, few had already tried one (9/104 experts [8.7%], 1/80 students [1.3%], 22/85 patients [25.9%]). There were more advocates than skeptics in each group (advocates: 71/104 experts [68.3%], 50/80 students [62.5%], 46/85 patients [54.1%]; skeptics: 31/104 experts [29.8%], 20/80 students [25.0%], 26/85 patients [30.6%]). The experts, in particular, believed, that e-mental health apps will gain importance in the future (mean 1.08, SD 0.68; 95% CI 0.94-1.21). When asked about potential risks, all groups reported slight concerns regarding data security (mean 0.85, SD 1.09; 95% CI 0.72-0.98). Patient age was associated with several attitudes toward e-mental health apps (future expectations: r=-0.31, P=.005; total risk score: r=0.22, P=.05). Attitudes toward e-mental health apps correlated negatively with the professional experience of the experts (r (94)=-0.23, P=.03). As opposed to patients, medical experts and students lack knowledge of and experience with e-mental health apps. If present, the experiences were assessed positively. However, experts show a more open-minded attitude with less fear of risks. Although some risks were perceived regarding data security, the attitudes and expectations of all groups were rather positive. Older patients and medical experts with long professional experience tend to express more skepticism. German Clinical Trials Register DRKS00013095; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00013095.

Background Cardiac patients face a higher risk of developing depression or anxiety, displaying a bidirectional risk-relationship. While previous studies have focused on specific cardiac subgroups, such as heart failure (HF) populations, our study investigates a broad cardiac population to explore cofactors most strongly correlating with depressive or anxious symptoms. Methods A total of n  = 511 patients (mean age 63.57 ± 15.86 years, 41.9% female, 58.1% male) with heterogenous admission diagnoses admitted to the “Siebeck” ward of the Centre of Internal Medicine at the University Hospital Heidelberg were retrospectively analyzed. Psychiatric symptoms were quantified using the Patient Health Questionnaire-9-item depression module (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7) and the Short Form-36 (SF-36) to evaluate health-related quality of life (HRQoL). Regression analyses included the variables sex, age, HF (mild, moderate and severe), the presence of an implanted cardioverter defibrillator (ICD), former or current cardiac decompensation (CD), cardiomyopathy (CM), and diabetes mellitus (DM) as predictors. A p  < 0.05 was considered statistically significant. Results Younger age (PHQ-9: β = -0.117, p = 0.012; GAD-7: β = -0.205, p  < 0.001) and female sex (PHQ-9: β = 0.118, p  = 0.01; GAD-7: β = 0.164, p  < 0.001) were significantly associated with elevated PHQ-9 and GAD-7 scores. CD (β = 0.149, p  = 0.001), an ICD (β = 0.15, p  = 0.002), and comorbid DM (β = 0.095, p  = 0.036) were significantly associated with higher depression scores, while an ICD additionally correlated with more anxiety (β = 0.112, p  = 0.024). Lower physical HRQoL was present in patients with DM (β = -0.163, p  = 0.001) and CD (β = -0.147, p  = 0.004). Relatively low adjusted R² values in the regression models reflect that only a small proportion of the variance in PHQ-9 (R² = 0.094) and GAD-7 (R² = 0.079) can be explained. Although severe HF was associated with higher PHQ-9 scores, the multivariate regression analyses did not confirm a significant association. Conclusions Depressive and anxious symptoms, as well as physical HRQoL, are more strongly linked to specific clinical characteristics than to HF severity itself. Instead, younger age, female sex, CD, an ICD, and comorbid DM showed stronger associations with significantly increased depressive symptoms and lower HRQoL, while those with an ICD additionally described higher levels of anxiety. These findings support targeted psychosocial screening in these high-risk cardiac subgroups.

Background Oncological esophageal surgery has evolved significantly in the last decades. From open esophagectomy over (hybrid) minimally invasive surgery, nowadays, robot-assisted minimally invasive esophagectomy (RAMIE) approaches are applied. Current techniques require an analysis of possible advantages and disadvantages indicating the direction towards a novel gold standard. Methods Robot-assisted Ivor Lewis esophagectomies, performed in the period from April 2017 to June 2019 in five German centers (Berlin, Cologne, Hamburg, Kiel, Mainz), were included in this study. Pre-, intra-, and postoperative parameters were assessed. Cases were grouped for hybrid (H-RAMIE) versus totally robot-assisted (T-RAMIE) approaches. Postoperative parameters and complications were compared using risk ratios. Results A total of 175 operations were performed as T-RAMIE and 67 as H-RAMIE. Patient age (median age 62 years) and sex (83.1% male) were similarly distributed in both groups. Median duration of esophagectomy was significantly lower in the T-RAMIE group (385 versus 427 min, p < 0.001). The risks of “overall morbidity” (32.0 versus 47.8%; risk ratio [RR], 95% confidence interval (CI): 1.5, 1.1–2.1; p = 0.026), “anastomotic leak” (10.3 versus 22.4%; RR, CI: 2.2, 1.2–4.1; p = 0.020), and “respiratory failure” (1.1 versus 7.5%; RR, CI: 6.5, 1.3–32.9; p = 0.019) were significantly higher in case of H-RAMIE. Conclusions In the five participating German centers, T-RAMIE was the preferred procedure (72.3% of operations). In comparison to H-RAMIE, T-RAMIE was associated with a significantly reduced risk of postoperative morbidity, anastomotic leak, and respiratory failure as well as a significantly reduced time necessary for esophagectomy.

A considerable number of reports have been published on the feasibility, techniques, and early postoperative results of robotic-assisted oesophageal surgery. However, these are mostly smaller case series, suggesting that the robot-assisted Ivor Lewis procedure is still in the implementation phase and far from being standardised. Oesophageal surgeons from seven robotic university centres in Germany, experienced in both minimally invasive and robot-assisted minimally invasive surgery, took part in a workshop on robot-assisted surgery. An intensive exchange of opinions and experiences, followed by a step-by-step re-enactment of the operation in a cadaver lab, enabled us to develop a standardised robot-assisted Ivor Lewis surgical workflow, which is presented here. Systematic and objective comparison of experiences and results using a robot-assisted Ivor Lewis procedure has made it possible to develop a standardised surgical workflow that is now clinically applied in our centres. It is hoped that standardisation of this procedure will help to maintain patient safety, prevent medical errors, and facilitate the learning curve, while introducing robotic surgery into a centre.