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Precipitation in Europe shows natural fluctuations that differ considerably between seasons and geographical regions. A number of studies have linked local or seasonal rainfall variability to various long-distance air pressure differences in north–south or west–east direction. This paper presents the first continent-wide analysis of European rainfall variability on a month-by-month and country-by-country basis. We calculated Pearson r values for unsmoothed monthly rainfall data of 39 European countries over the period 1950–2019 with five potential climatic drivers, namely the North Atlantic Oscillation (NAO), the Arctic Oscillation (AO), the North Sea Caspian Pattern (NCP), and two indices of Mediterranean Oscillation (MOI2, WeMOI). For a variety of countries and months we found substantial and statistically significant r values of up to r = 0.7 and more. The dynamic temporal-spatial evolution of the Pearson correlations was mapped out across the continent, tracking the gradual or abrupt expansion, displacement and subsequent waning of the various effects over the course of the year. The correlation analysis was complemented by best subset multiple regression, controlling for intercorrelation of the potential drivers. Our results may help to improve short- to midterm rainfall prognoses in Europe and provide important calibration data for the further refinement of climate models.

Sunshine hours (SSH) is an important meteorological parameter, loosely linked to temperature and precipitation, and highly relevant for various sectors such as agriculture or solar energy. Previous studies have already identified a correlation of European SSH with the thermal state of the North Atlantic. This paper investigates this relationship further by studying annual and monthly SSH of seven long-term Central European SSH series and comparing them to the Atlantic Multidecadal Oscillation (AMO) using Fourier Transformation, Monte Carlo simulation and non-linear optimization. The Fourier spectra of our annual SSH series have their strongest and highly significant peaks in the known AMO period of ~ 50 to ~ 80 years, supporting the hypothesis that European SSH and the AMO are linked. The optimized sinusoids of the seven SSH and the AMO series with these periods show substantial correlations with the corresponding data ( r  = 0.42–0.55 for SSH and 0.71 for the AMO). Extrapolating the sinusoids, we project a gradual decline in SSH across Central Europe by 9–16% from its current maximum over the next three decades, particularly pronounced in northern regions.

Background Over the past two decades, most cancer vaccines have failed to be developed clinically. The lack of efficient priming with specific tumor antigens and/or weak adjuvants may explain this poor success rate. MVX-ONCO-1, a personalized cell-based vaccine, combines inactivated autologous tumor cells and encapsulated allogeneic human cells genetically engineered to produce granulocyte–macrophage colony stimulating factor (GM-CSF). This unique technology allows sustained local delivery of strong adjuvant at the vaccination site. The combination of inactivated autologous tumor cells and potent local adjuvant delivery addresses these two unmet critical steps and may recapitulate in patients the successful combination observed in experimental models. Methods The SAKK 11/16, a Phase IIa trial with Overall Survival (OS) as the primary endpoint was the first efficacy study evaluating MVX-ONCO-1. Patients with Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (R/M HNSCC) progressing after at least one line of systemic therapy were enrolled with 50% of patients alive at 26 weeks as the primary objective. Results In this hard-to-treat population, SAKK 11/16 met the primary endpoint, with 68.8% of patients alive at 6 months. The median OS was 11.4 months, with 32% of the patients alive after 18 months. Complete and partial responses were observed on MVX-ONCO-1 monotherapy. Moreover, all patients who developed a positive DTH reaction to their tumor cells upon vaccination survived at 12 months. Additionally, patients living for more than 12 months had higher circulating antibody titers against tumor-associated antigens. Explorative analysis looking at median OS from the start of anti-PD-1 therapy was 21.7 months. In addition, no new safety signals with no systemic adverse events (AE) related to the treatment and no manufacturing issues were observed in this multicenter trial. Conclusions These findings suggest that MVX-ONCO-1 can induce a coordinated immune response with clinical benefits as a standalone treatment, leading to prolonged survival. This effect may be enhanced by previous exposure to immune checkpoint inhibitors. Trial registration (ClinicalTrials.gov): NCT02999646.

Background The prevention of postoperative complications is of prime importance after complex elective abdominal operations. Preoperative patient education may prevent postoperative complications and improve patients’ wellbeing, but evidence for its efficacy is poor. The aims of the PEDUCAT trial were (a) to assess the impact of preoperative patient education on postoperative complications and patient-reported outcomes in patients scheduled for elective complex visceral surgery and (b) to evaluate the feasibility of cluster randomization in this setting. Methods Adult patients (age ≥ 18 years) scheduled for elective major visceral surgery were randomly assigned in clusters to attend a preoperative education seminar or to the control group receiving the department’s standard care. Outcome measures were the postoperative complications pneumonia, deep vein thrombosis (DVT), pulmonary embolism, burst abdomen, and in-hospital fall, together with patient-reported outcomes (postoperative pain, anxiety and depression, patient satisfaction, quality of life), length of hospital stay (LOS), and postoperative mortality within 30 days after the index operation. Statistical analysis was primarily by intention to treat. Results In total 244 patients (60 clusters) were finally included (intervention group 138 patients; control group 106 patients). Allocation of hospital wards instead of individual patients facilitated study conduct and reduced confusion about group assignment. In the intervention and control groups respectively, pneumonia occurred in 7.4% versus 8.3% ( p  = 0.807), pulmonary embolism in 1.6% versus 1.0% ( p  = 0.707), burst abdomen in 4.2% versus 1.0% ( p  = 0.165), and in-hospital falls in 0.0% versus 4.2% of patients ( p  = 0.024). DVT did not occur in any of the patients. Mortality rates (1.4% versus 1.9%, p  = 0.790) and LOS (14.2 (+/− 12.0) days versus 16.1 (+/− 15.0) days, p  = 0.285) were also similar in the intervention and control groups. Conclusions Cluster randomization was feasible in the setting of preoperative patient education and reduced the risk of contamination effects. The results of this trial indicate good postoperative outcomes in patients undergoing major visceral surgery without superiority of preoperative patient education compared to standard patient care at a high-volume center. However, preoperative patient education is a helpful instrument not only for teaching patients but also for training the nursing staff. Trial registration German Clinical Trials Registry, DRKS00004226 . Registered on 23 October 2012. Registered 8 days after the first enrollment.

A large body of research suggests that during learning motor skills, focusing on environmental effects of the movement (external focus) generally leads to better performance than focusing on one’s own body (internal focus). The functionality hypothesis states, in contrast, that the superiority of any attentional focus is task dependent. The present study aimed to test the predictions of the latter and searched for underlying mechanisms and task characteristics for one or the other focus being more functional. In Experiment 1, we examined whether the internal focus is superior in a difficult body-oriented balance task. In Experiment 2, we added visual feedback and investigated whether this would enhance the functionality of the external focus. In both experiments, the participants stood one-legged on a balance board and had to shift their centre of pressure (COP) to predefined target points. Per instruction, they were asked to interpret their attentional focus on the COP as either internal (the sole of the foot) or external (the platform). In Experiment 1, the external focus was induced through a mental image. The internal focus group performed significantly better, thereby supporting the functionality hypothesis. In Experiment 2, the COP was dynamically visualized on a screen. The internal focus superiority vanished. We suggest that the internal focus is more functional in motor-learning situations that provide more effect information through body-internal senses than through body-external senses. In these cases, the external focus hampers learning because it is associated with additional cognitive load.

Background In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasibility and the impact of preoperative patient education on postoperative morbidity, mortality and quality of life in patients scheduled for elective major visceral surgery. Methods/design PEDUCAT is designed as a cluster-randomized controlled pilot study. The experimental group will visit a standardized preoperative seminar to learn how best to behave after surgery in addition to being given a standard information brochure, whereas the control group will only receive the information brochure. Outcome measures such as postoperative morbidity, postoperative pain, postoperative anxiety and depression, patient satisfaction, quality of life, length of hospital stay and postoperative mortality will be evaluated. Statistical analysis will be based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison, adjusting for age, center and quality of life before surgery. This is a pilot study to show the feasibility of the concept. Nevertheless, the planned sample size of n = 204 is large enough to show an effect with power of 90% and a significance level of 5%. Trial registration German Clinical Trial Register number: DRKS00004226 .

Two cross-sectional questionnaire studies were conducted to replicate and extend previous research on the existential guilt reaction. In Study I, gender was considered as a privilege. Male student participants (N = 141) were confronted with the low proportion of women in high-ranking positions and asked to appraise this situation. Self-reported behavior, behavioral intentions, and appeal to authorities aimed at advancing equal opportunities for both genders served as criterion variables. Path analyses were performed to explore the correlation structure among the variables. Self-reported behavior depended most strongly on behavioral intentions and on belief in control. Behavioral intentions depended most strongly on existential guilt. This effect accords to previous existential guilt research. Ethnicity and education were considered as privileges in Study II. Privileged Paraguayan students (N = 80) were confronted with the disadvantageous living conditions of Indians and Campesinos. They were asked to appraise the situation. Behavioral intentions and appeal to authorities directed at improving the living conditions of Indians and Campesinos served as criteria. As in Study I, existential guilt was the strongest predictor of behavioral intentions. Study II revealed the role of values in the process of existential guilt and prosocial behavior. This is a new research finding. Indirect effects of the two values of universalism and benevolence on behavioral intentions were obtained. The effect of universalism was mediated by existential guilt and moral outrage, the effect of benevolence was mediated by injustice and existential guilt. Tradition had a negative indirect effect on behavioral intentions. This effect was mediated by justification of deprivation and probably means that adherence to tradition eases the justification of traditionally existing social inequalities in a society.[PUBLICATION ABSTRACT]

In peripheral spatial cueing paradigms, exogenous attentional capture is commonly observed after salient onset cues or with cues contingent on target characteristics. We proposed that exogenously captured attention disrupts the selectivity to target features. We tested this by experimentally emulating the everyday observation that in a viewing situation in which the observer is monitoring a stationary display fort change to occur, the onset of a salient stimulus (onset cue) or a change in a stationary stimulus similar to the expected one (contingent cue) has a distracting effect. As predicted, we found that both types of cues reduced the target detection sensitivity but enhanced the bias to respond in a go-nogo-paradigm. With the onset cue, the sensitivity loss was more pronounced at the side of the cue, whereas the contingent cue affected both sides likewise. Moreover, the effects of the onset cue interacted with the task difficulty: the more selectivity a task required the more immune it was against disruption, but the more likely was a response. We concluded that onset capture disrupts selective attention by adding noise to the processing of the target location. The effects of contingent capture could be explained with cue-target confounding. Finally, we suggest a new model of attentional capture in which exogenous and endogenous components interact in a dynamic way.