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Purpose ADHD is regarded as a neurodevelopmental disorder associated with deficits in executive functions (EF). The presence of these deficits is associated with increased symptom severity. However, so far there is little knowledge, whether deficits in EFs relate to a reduced health-related quality of life (HRQoL) in children with ADHD. Methods Hence, n  = 100 children with a confirmed ADHD diagnosis were compared with a non-cases group ( n  = 100) with regard to their HRQoL (6–12 years old). The clinical group was divided into ADHD-specific drug treatment intake (drug treatment: n  = 42; no drug treatment: n  = 58) or deficits in EF ( n  = 29; no deficits in EF: n  = 71). Results Children with ADHD (without medication) reported a significantly worse HRQoL than healthy children ( d  = .72), when controlled for age and sex. Even if they were treated with drug treatment, they reported a lower HRQoL than the non-case group in the area Family ( d  = .53). Drug treatment of ADHD leads to a significant difference in HRQoL in school area ( d  = .39). Children with ADHD and EF problems reported impairments in the social context of HRQoL compared to healthy children ( d  = .51 to .70). In addition, a significant negative association between set-shifting and HRQoL in children with ADHD (without drug treatment) was demonstrated ( r  = − .27 to r  = − .35). Conclusions By assessing the HRQoL, an impairment in the functioning of children with ADHD can be detected, which is essential for the diagnosis. Furthermore, executive problems have an influence on the social sphere, which should be clarified and improved in therapy with the involvement of parents.

Objective: Despite a substantial increase in total methylphenidate (MPH) prescriptions in Germany over the last 20 years, and the introduction of modified release MPH (MR MPH) and atomoxetine (ATX), remarkably little is known about treatment patterns of attention- deficit/hyperactivity disorder (ADHD) in individual patients. Methods: Usage patterns of ADHD drugs in children and adolescents in Germany were analyzed using data from one large German health insurance including >7,200,000 members. Of those, 6210 ADHD patients newly diagnosed in 2005 were followed for a maximum of 4 years. Kaplan–Meier estimates were calculated for onset and discontinuation of ADHD drug treatment. Predictors of time until drug treatment initiation were assessed by Cox regression. Results: During follow-up, 52.0% of ADHD subjects (53.4% of boys, 47.5% of girls) received ADHD drug treatment. The majority of them (91.6%) were started on MPH, with immediate release MPH (IR MPH) being the initial treatment choice in 75.3%. In these subjects, change to drug treatment with MR MPH in the first year occurred in 48% by switch or addition. Significant predictors of drug treatment were behavioral and emotional disorders (HR=1.13; 95% CI 1.03–1.24) and a diagnosis of ADHD with conduct disorder (HR=1.21, 95% CI 1.12–1.32), whereas young age showed a protective effect. After 6, 12, and 24 months of treatment initiation, 22.4%, 43.4%, and 66.3% of treated girls, and 17.8%, 36.1%, and 54.1% of treated boys had discontinued ADHD treatment. Conclusion: Drug treatment of ADHD was relatively common in Germany and more frequent in boys than in girls. IR MPH was the predominant treatment choice at treatment initiation. Approximately 20% of treated subjects discontinued drug treatment within the first 6 months, with girls stopping drug treatment earlier than boys. The reasons for early drug discontinuation need to be further explored.

Background Methylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication. Methods We used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression. Results In 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls. Conclusions Besides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.

Objective: The purpose of this study was to estimate the prevalence and incidence of new diagnoses of attention-deficit/hyperactivity disorder (ADHD) and assess drug treatment of ADHD in the 3–17 year age group in Germany. Method: We analysed data from the German Pharmacoepidemiological Research Database (GePaRD) for the years 2004–2006. The GePaRD includes claim records of 14,000,000 members of four statutory health insurances, representing 17% of the German population. The assessment of ADHD diagnoses was based on International Classification of Diseases version 10 (ICD-10) codes in outpatient and hospital data. Results: In 2005, the age-standardized prevalence and incidence of new diagnoses were 2.5% and 9/1000 person-years, respectively. Both measures were 3–4 times higher for males than for females. Incidence of new ADHD diagnoses increased linearly up to the age of 8 years for boys and 9 years for girls and decreased abruptly thereafter. In the calendar quarter of the initial ADHD diagnosis, 9.4% (95% confidence interval [CI] 8.9–9.8%) received methylphenidate or atomoxetine and 36.8% (95% CI 36.1–37.6%) received at least one prescription of either drug within the first year. Initiation of drug treatment and choice of drug were similar for both sexes. Conclusions: ADHD is a common condition among children and youth in Germany. There are substantial differences by sex in the prevalence and incidence of new ADHD diagnoses, but only a small difference in drug treatment among those diagnosed with ADHD. A relatively low percentage of children receives drug treatment in the first year after the initial diagnosis of ADHD.

Alpine lakes support unique communities which may respond with great sensitivity to climate change. Thus, an understanding of the drivers of the structure of communities inhabiting alpine lakes is important to predict potential changes in the future. To this end, we sampled benthic macroinvertebrate communities and measured environmental variables (water temperature, dissolved oxygen, conductivity, pH, nitrate, turbidity, blue-green algal phycocyanin, chlorophyll-a) as well as structural parameters (habitat type, lake size, maximum depth) in 28 lakes within Hohe Tauern National Park, Austria, between altitudes of 2,000 and 2,700 m a.s.l. The most abundant macroinvertebrate taxa that we found were Chironomidae and Oligochaeta . Individuals of Coleoptera , Diptera , Hemiptera , Plecoptera , Trichoptera , Tricladida , Trombidiformes , Veneroida were found across the lakes and determined to family level. Oligochaeta were not determined further. Generalized linear modeling and permanova were used to identify the impact of measured parameters on macroinvertebrate communities. We found that where rocky habitats dominated the lake littoral, total macroinvertebrate abundance and family richness were lower while the ratio of Ephemeroptera , Plecoptera and Trichoptera (EPT) was higher. Zoo- and phytoplankton densities were measured in a subset of lakes but were not closely associated with macroinvertebrate abundance or family richness. With increasing elevation, macroinvertebrate abundances in small and medium-sized lakes increased while they decreased in large lakes, with a clear shift in community composition (based on families). Our results show that habitat parameters (lake size, habitat type) have a major influence on benthic macroinvertebrate community structure whereas elevation itself did not show any significant effects on communities. However, even habitat parameters are likely to change under climate change scenarios (e.g. via increased erosion) and this may affect alpine lake macroinvertebrates.

Ultraviolet radiation (UVR) is an environmental stressor in several ecosystems and can affect organisms’ survival and reproduction, and community structure. Rotifers cope with UVR stress adopting preventive behavioral and metabolic mechanisms. However, the demonstration of an immediate behavioral response in rotifers is missing. We investigated the short-term response of rotifers to UVR, by combining video analysis and movement ecology methods, in three common species: Brachionus calyciflorus, Keratella cochlearis, and Keratella quadrata. We recorded the behavior of B. calyciflorus (both sexes), K. quadrata, and K. cochlearis (females) exposed to white light, and to intermittent cycles of UVR (30:30 s). Individual trajectories were extracted from videos with open-source software. We found that B. calyciflorus females exposed to UVR exhibited strong negative phototaxis with increased swimming speed, and a weak positive phototaxis in males. Keratella cochlearis and K. quadrata showed a weaker response. Our study reveals a species-specific behavioral response to UVR in rotifers. Furthermore, we highlight how sexual dimorphism in B. calyciflorus does not only occur in morphology and movement, but also in behavioral traits. Our results help to understand zooplankton community dynamics by providing a mechanistic explanation of UVR response in one major zooplankton taxonomic group.

The optimal treatment for patients with asymptomatic carotid artery stenosis is under debate. Since best medical treatment (BMT) has improved over time, the benefit of carotid endarterectomy (CEA) or carotid artery stenting (CAS) is unclear. Randomised data comparing the effect of CEA and CAS versus BMT alone are absent. We aimed to directly compare CEA plus BMT with CAS plus BMT and both with BMT only. SPACE-2 was a multicentre, randomised, controlled trial at 36 study centres in Austria, Germany, and Switzerland. We enrolled participants aged 50–85 years with asymptomatic carotid artery stenosis at the distal common carotid artery or the extracranial internal carotid artery of at least 70%, according to European Carotid Surgery Trial criteria. Initially designed as a three-arm trial including one group for BMT alone (with a randomised allocation ratio of 2·9:2·9:1), the SPACE-2 study design was amended (due to slow recruitment) to become two substudies with two arms each comparing CEA plus BMT with BMT alone (SPACE-2a) and CAS plus BMT with BMT alone (SPACE-2b); in each case in a 1:1 randomisation. Participants and clinicians were not masked to allocation. The primary efficacy endpoint was the cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years. The primary safety endpoint was any stroke or death from any cause within 30 days after CEA or CAS. The primary analysis was by intention-to treat, which included all randomly assigned patients in SPACE-2, SPACE-2a, and SPACE-2b, analysed using meta-analysis of individual patient data. We did two-step hierarchical testing to first show superiority of CEA and CAS to BMT alone then to assess non-inferiority of CAS to CEA. Originally, we planned to recruit 3640 patients; however, the study had to be stopped prematurely due to insufficient recruitment. This report presents the primary analysis at 5-year follow-up. This trial is registered with ISRCTN, number ISRCTN78592017. 513 patients across SPACE-2, SPACE-2a, and SPACE-2b were recruited and surveyed between July 9, 2009, and Dec 12, 2019, of whom 203 (40%) were allocated to CEA plus BMT, 197 (38%) to CAS plus BMT, and 113 (22%) to BMT alone. Median follow-up was 59·9 months (IQR 46·6–60·0). The cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years (primary efficacy endpoint) was 2·5% (95% CI 1·0–5·8) with CEA plus BMT, 4·4% (2·2–8·6) with CAS plus BMT, and 3·1% (1·0–9·4) with BMT alone. Cox proportional-hazard testing showed no difference in risk for the primary efficacy endpoint for CEA plus BMT versus BMT alone (hazard ratio [HR] 0·93, 95% CI 0·22–3·91; p=0·93) or for CAS plus BMT versus BMT alone (1·55, 0·41–5·85; p=0·52). Superiority of CEA or CAS to BMT was not shown, therefore non-inferiority testing was not done. In both the CEA group and the CAS group, five strokes and no deaths occurred in the 30-day period after the procedure. During the 5-year follow-up period, three ipsilateral strokes occurred in both the CAS plus BMT and BMT alone group, with none in the CEA plus BMT group. CEA plus BMT or CAS plus BMT were not found to be superior to BMT alone regarding risk of any stroke or death within 30 days or ipsilateral stroke during the 5-year observation period. Because of the small sample size, results should be interpreted with caution. German Federal Ministry of Education and Research (BMBF) and German Research Foundation (DFG).

This study examines the effects of sodium carboxymethyl cellulose (NaCMC) on the performance of graphite anodes in lithium‐ion batteries, focusing on variations in degrees of substitution (DS), molecular weights (MW), and gel particles. The results indicate that the best electrochemical performance is achieved by balancing the residual water content introduced by NaCMC while maintaining the anode's volume resistivity. A NaCMC with a low molecular weight and DS of 0.7 shows the best results for this particular formulation. An impurity (in batteries yet unreported)in NaCMC is also reported that significantly impacts electrochemical performance, called gel particles. By reducing the gel particles, cell performance is enhanced by 5%, without further optimization of the formulation. It is highlighted that both DS and MW influence electrode properties. A decrease in DS enhances adhesion but negatively affects volume resistivity. Increasing the MW improves adhesive strength and reduces interfacial resistivity due to greater chain entanglements. Higher gel particle levels negatively impact electrode properties, making low‐gel NaCMC more effective for better adhesion and resistance. Water retention in electrodes again is influenced by both DS and MW. Higher DS leads to increased water retention due to greater hydrophilicity, while high MW contributes to this effect through enhanced entanglements. Sodium carboxymethyl cellulose (NaCMC) polymer properties, namely, the degree of substitution, molecular weight, and an in batteries unpublished impurity, are investigated with regard to their impact on the electrode properties. The gained knowledge then is transferred to further understand the resulting cell performance and understand key figures to optimize the cell performance.