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The world faces urgent sustainability challenges and international agreements call for policy change. CO2 pricing is an effective way to reduce greenhouse gas emissions and allows us to find innovative ways to cover these emission sources, addressing environmental, economic, and social sustainability through the targeted use of revenues. In order to design a publicly acceptable pricing concept, this study empirically examines the public perceptions of CO2 pricing in Germany, preferred revenue recycling schemes, and socio-psychological differences following its national implementation. In a choice-based conjoint measurement, we simulated the interplay of influencing factors (revenue reinvestment, climate effects, and scale of action) in a comprehensible choice task (n = 1209). The results show that revenue reinvestment has the highest importance for the acceptance of CO2 pricing, followed by the climate effect, and confirm that the individual financial burden is a significant obstacle to achieving government climate goals. The findings help policymakers to understand the public’s motives and demands for accepted carbon pricing options, and support management recommendations for policy and governance to work towards a sustainable transformation. However, to achieve global sustainability outcomes, it is imperative that such studies are conducted worldwide, as comparisons with previous studies reveal local differences in needs and preferences.

The world faces urgent sustainability challenges and international agreements call for policy change. CO[sub.2] pricing is an effective way to reduce greenhouse gas emissions and allows us to find innovative ways to cover these emission sources, addressing environmental, economic, and social sustainability through the targeted use of revenues. In order to design a publicly acceptable pricing concept, this study empirically examines the public perceptions of CO[sub.2] pricing in Germany, preferred revenue recycling schemes, and socio-psychological differences following its national implementation. In a choice-based conjoint measurement, we simulated the interplay of influencing factors (revenue reinvestment, climate effects, and scale of action) in a comprehensible choice task (n = 1209). The results show that revenue reinvestment has the highest importance for the acceptance of CO[sub.2] pricing, followed by the climate effect, and confirm that the individual financial burden is a significant obstacle to achieving government climate goals. The findings help policymakers to understand the public’s motives and demands for accepted carbon pricing options, and support management recommendations for policy and governance to work towards a sustainable transformation. However, to achieve global sustainability outcomes, it is imperative that such studies are conducted worldwide, as comparisons with previous studies reveal local differences in needs and preferences.

Objectives: In this study, we explored crucial factors that explain a person's attitude toward and his or her assessment of telemedical systems. Special focus lies on the link between the perspective of physicians (telemedicine users) and technicians (telemedicine designers) to find potential barriers hindering the broad application of telemedical systems in hospitals and doctors’ offices. Methods: A survey among medical professionals (n = 34), technical professionals (n = 39), and a control group (n = 44) was conducted. The collected data were assessed in terms of domain knowledge, attitudes toward telemedicine, and potential implementation barriers. Results: Participants favored the conventional method over telemedical monitoring in regards to privacy, security, and time efficiency. In contrast, telemedicine was preferred with reference to efficiency of data analysis, long-term care, and emergency adequacy. Significant differences between the professional groups were found regarding perceived cost effectiveness, patients’ compliance, privacy protection, and false alarm sensitivity. Medical professionals exhibited the most reluctance toward using telemedical treatments. Conclusions: The perceived drawbacks are attributed to a general uncertainty about the reliability of telemedical systems, in combination with concerns about personal data privacy, security, and loss of control. The reported fear of not being able to correctly use and handle the systems assumes a low usability of devices. To acquaint medical professionals with the benefits and limitations of telemedical systems, telemonitoring and tele-treatment should be included in the education of medical personnel at an early stage.

Background Men are at a significantly higher risk of dying by suicide than women. At the same time, they are less likely to seek help compared to women, alongside other risk factors. The aim of this qualitative study is to examine the facilitating and inhibiting aspects that affect help-seeking in men who have attempted suicide in order to inform gender-specific suicide prevention. Methods Fourteen qualitative, problem-centered interviews were conducted with men who have had at least one suicide attempt in their life. Facilitating and inhibiting aspects for help-seeking were analyzed using structuring qualitative content analysis. Results Facilitating aspects for seeking help include access to professional support, social resources, favorable psychological resources, positive experiences with the support system, and symptom burden. Inhibiting aspects include perceived inaccessibility of professional support, psychological aspects that hinder help-seeking, negative experiences with the support system, stigma/guilt and shame, and hegemonic masculinity norms. Conclusions The findings regarding inhibiting and facilitating aspects offer various avenues to improve men’s access to psychiatric and psychosocial support systems, as well as to advance gender-specific suicide prevention at the intra-individual level (e.g., strengthening favorable psychological resources), the interpersonal level (e.g., training gatekeepers for men with few social resources), and the societal level (e.g., availability of psychosocial support).

We studied tree height in stands of high-Andean Polylepis forests in two cordilleras near Cuzco (Peru) with respect to variations in human impact and climatic conditions, and compared air and soil temperatures between qualitatively defined dry and humid slopes. We studied 46 forest plots of 100 m(2) of five Polylepis species at 3560-4680 m. We measured diameter at breast height (dbh) and tree height in the stands (1229 trees in total), as well as air and soil temperatures in a subset of plots. The data was analyzed combining plots of given species from different sites at the same elevation (±100 m). There was no elevational decrease of mean maximum tree height across the entire data set. On humid slopes, tree height decreased continuously with elevation, whereas on dry slopes it peaked at middle elevations. With mean maximum tree heights of 9 m at 4530 m on the humid slopes and of 13 m at 4650 m on the dry slopes, we here document the tallest high-elevation forests found so far worldwide. These highest stands grow under cold mean growing season air temperatures (3.6 and 3.8°C on humid vs. dry slopes) and mean growing season soil temperatures (5.1 vs. 4.6°C). Mean annual air and soil temperature both decreased with elevation. Dry slopes had higher mean and maximum growing season air temperatures than humid slopes. Mean annual soil temperatures did not significantly differ and mean annual air temperatures only slightly differed between slopes. However, maximum air temperatures differed on average by 6.6 K between dry and humid slopes. This suggests that the differences in tree height between the two slopes are most likely due to differences in solar radiation as reflected by maximum air temperatures. Our study furthermore provides evidence that alpine Polylepis treelines grow under lower temperature conditions than global high-elevation treelines on average, suggesting that Polylepis species may have evolved special physiological adaptations to low temperatures.

Rationale Steroid profiles in combination with a corticotropin stimulation test provide information about steroidogenesis and its functional reserves in critically ill patients. Objectives We investigated whether steroid profiles before and after corticotropin stimulation can predict the risk of in-hospital death in sepsis. Methods An exploratory data analysis of a double blind, randomized trial in sepsis (HYPRESS [HYdrocortisone for PRevention of Septic Shock]) was performed. The trial included adult patients with sepsis who were not in shock and were randomly assigned to placebo or hydrocortisone treatment. Corticotropin tests were performed in patients prior to randomization and in healthy subjects. Cortisol and precursors of glucocorticoids (17-OH-progesterone, 11-desoxycortisol) and mineralocorticoids (11-desoxycorticosterone, corticosterone) were analyzed using the multi-analyte stable isotope dilution method (LC–MS/MS). Measurement results from healthy subjects were used to determine reference ranges, and those from placebo patients to predict in-hospital mortality. Measurements and main results Corticotropin tests from 180 patients and 20 volunteers were included. Compared to healthy subjects, patients with sepsis had elevated levels of 11-desoxycorticosterone and 11-desoxycortisol, consistent with activation of both glucocorticoid and mineralocorticoid pathways. After stimulation with corticotropin, the cortisol response was subnormal in 12% and the corticosterone response in 50% of sepsis patients. In placebo patients ( n  = 90), a corticotropin-stimulated cortisol-to-corticosterone ratio > 32.2 predicted in-hospital mortality (AUC 0.8 CI 0.70–0.88; sensitivity 83%; and specificity 78%). This ratio also predicted risk of shock development and 90-day mortality. Conclusions In this exploratory analysis, we found that in sepsis mineralocorticoid steroidogenesis was more frequently impaired than glucocorticoid steroidogenesis. The corticotropin-stimulated cortisol-to-corticosterone ratio predicts the risk of in-hospital death. Trial registration Clinical trial registered with www.clinicaltrials.gov Identifier: NCT00670254. Registered 1 May 2008, https://clinicaltrials.gov/ct2/show/NCT00670254 .

ObjectiveThe persistence of pathogenic microorganisms in root canals is the most common reason for the failure of root canal treatment and the necessity of a root filling treatment, which results in an uncertain prognosis due to technical complexity and the variety of highly adaptable microorganisms.This study evaluated the effect of passive ultrasonic irrigation (PUI) on the outcome of the microbial analysis of root canal-treated teeth with persistent or recurrent apical inflammation in vivo.Materials and methodsSample collection was performed after root filling removal (sample S1, control group) and after PUI with NaCl (sample S2) using sterile paper points. In total, 19 samples were obtained. Quantification was performed by means of serial dilution of the samples. Subcultivated pure cultures were identified using MALDI-TOF MS complemented by the Vitek-2-System or PCR, followed by sequencing of the 16S rRNA gene. The results of the samples (S1 and S2) were evaluated regarding their bacterial count and composition.ResultsThe total count of bacteria and the number of aerobic/facultative anaerobic microorganisms significantly increased in the S2-samples after application of PUI. The number of obligate anaerobic microorganisms showed an increase after PUI, although it was not significant. We detected 12 different aerobic/facultative anaerobic microorganisms before PUI, and in 21 cases after PUI. Two different obligate anaerobic microorganisms were found in S1 samples compared to nine different species in S2 samples.ConclusionsPUI is a powerful method for detaching bacteria in infected root canals and enables a more precise analysis of the etiology of persistent endodontic infections.Clinical relevanceThis study indicates that PUI exerts a positive cleansing effect and adds to the accessibility of microorganisms during the application of bactericidal rinsing solution in root canal treatments.

The impact of school-closings on adolescents’ mental health and well-being in the management of the ongoing COVID-19 pandemic is subject to ongoing public debate. Reliable data to inform a balanced discussion are limited. Drawing on a large ongoing multi-site project in Germany, we assessed differences in self-reported psychopathology in a matched convenience-sample of adolescents assessed pre- (November 26, 2018 to March 13, 2020; n  = 324) and post the first lockdown (March 18, 2020 to August 29, 2020; n  = 324) early 2020 in Germany. We found no evidence for an increase in emotional and behavioral problems, depression, thoughts of suicide or suicide attempts, eating disorder symptoms, or a decrease in general health-related quality of life. Reported suicide plans significantly decreased from 6.14 to 2.16%. Similarly, conduct problems decreased in the post-lockdown period. Family risk-factors did not moderate these findings. The influence of socioeconomic status on emotional and behavioral problems as well as depression decreased during the lockdown. Based on the present findings, the first school-closing in Germany had no immediate and severe impact on adolescents’ well-being. However, caution is warranted as our data covers a fairly small, affluent sample over a limited time-span and long-term consequences cannot be ruled out.