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Our understanding of the western honeybee (Apis mellifera) predominantly stems from studies conducted within beekeeping environments, leaving the presence and characteristics of honeybees outside managed settings largely unexplored. In this study, we examined the habitats, nesting sites, and survival rates of free‐living colonies through personal monitoring of nest sites in Munich (N = 107) and the coordination of Citizen Science monitoring across Germany (N = 423). Within 7 years, we collected 2555 observations on 530 nest sites from 311 participants, including the authors. Overall, we found that 31% of the occupied nest sites were in buildings and 63% in mature trees, with clear preferences for specific tree species. Nesting preferences differed between urban, rural, and forested areas. On average, only 12% of the personally monitored colonies in Munich survived annually, a figure that aligns well with other published studies in Germany but contrasts sharply with the significantly higher survival rates resulting from Citizen Science reports (29%)—a discrepancy likely driven by certain reporting biases. We found that Citizen Science yielded significantly fewer updates per colony, underreported abandoned sites, and that 46% of overwintering reports overlapped with the swarming season and had to be excluded. To gain reliable survival data in Citizen Science projects, consistency and timing of reports need particular attention and regional swarming should be monitored as well. This study enhances our understanding of the ecological dynamics, liminal state, and conservation needs of free‐living honeybee cohorts, addresses potential Citizen Science monitoring biases, and suggests standardized data collection protocols for future monitoring projects. The preservation of mature trees with suitable cavities, as well as the provision of additional nesting sites, is key for sustaining free‐living honeybee cohorts and should be integrated into conservation strategies, urban planning, and forest management. ABSTRAKT Unser Verständnis der Westlichen Honigbiene (Apis mellifera) basiert überwiegend auf Forschung, die unter imkerlichen Bedingungen durchgeführt wurde, während das Vorkommen und die Lebensweise von Honigbienen abseits menschlicher Haltungsformen weitgehend unerforscht sind. Für die vorliegende Studie wurden die Lebensräume, Nistplätze und Überlebensraten freilebender Völker durch eigene Beobachtungen in München (N = 107) sowie durch die Koordination eines Citizen‐Science‐Monitorings in ganz Deutschland (N = 423) untersucht. Über sieben Jahre sammelten 311 Mitwirkende, einschließlich der Autoren, insgesamt 2555 Beobachtungen an 530 Standorten. Die Nistplätze befinden sich zu 31% in Gebäuden und zu 63% in alten Bäumen, wobei eine deutliche Präferenz für bestimmte Baumarten erkennbar ist. Die Nistpräferenzen unterscheiden sich zwischen urbanen, ländlichen und bewaldeten Gebieten. Im Durchschnitt überleben jährlich nur 12% der durch die Autoren in München beobachteten Völker. Während andere Studien vergleichbar geringe Überlebensraten in Deutschland bestätigen, weichen die deutlich höheren Überlebensraten unserer Citizen‐Science‐Meldungen (29%) davon ab – ein Unterschied, der durch Meldebiases verursacht wird. Wir stellten fest, dass im Rahmen von Citizen Science signifikant weniger Statusmeldungen pro Volk gemacht und Standorte, an denen Völker gestorben sind, seltener gemeldet wurden. Ausserdem überlappten 46% der Überwinterungsmeldungen mit der Schwarmzeit und mussten daher ausgeschlossen werden. Deshalb sind Konsistenz und Zeitpunkt der Beobachtung zentral, um verlässliche Überlebensdaten zu sammeln; zudem sollte die regionale Schwarmzeit berücksichtigt werden. Die vorliegende Studie soll unser Verständnis der Ökologie, des liminalen Status und der Schutzbedürftigkeit freilebender Honigbienenvölker verbessern, thematisiert potenzielle Verzerrungen in Citizen‐Science‐Daten und schlägt ein standardisiertes Monitoringprotokoll für zukünftige Projekte vor. Der Erhalt alter Bäume mit geeigneten Höhlen sowie die Bereitstellung zusätzlicher Nistplätze sind entscheidend für den Fortbestand freilebender Honigbienenvölker und sollten in Naturschutzstrategien, Stadtplanung und Forstwirtschaft Berücksichtigung finden. In this study we examined the habitats, nesting sites, and survival rates of free‐living colonies through personal monitoring of nest sites in Munich (N = 107) and the coordination of Citizen Science monitoring across Germany (N = 423). On average, only 12% of the personally monitored colonies in Munich survived annually, a figure that aligns well with other published studies in Germany but contrasts sharply with the significantly higher survival rates resulting from Citizen Science reports (29%)—a discrepancy likely driven by certain reporting biases. This study enhances our understanding of the ecological dynamics, liminal state, and conservation needs of free‐living honeybee cohorts, addresses potential Citizen Science monitoring biases, and suggests standardized data collection protocols for future monitoring projects.

Subjects with mild to moderate hearing loss today often receive hearing aids (HA) with open-fitting (OF). In OF, direct sound reaches the eardrums with minimal damping. Due to the required processing delay in digital HA, the amplified HA sound follows some milliseconds later. This process occurs in both ears symmetrically in bilateral HA provision and is likely to have no or minor detrimental effect on binaural hearing. However, the delayed and amplified sound are only present in one ear in cases of unilateral hearing loss provided with one HA. This processing alters interaural timing differences in the resulting ear signals. In the present study, an experiment with normal-hearing subjects to investigate speech intelligibility in noise with direct and delayed sound was performed to mimic unilateral and bilateral HA provision with OF. The outcomes reveal that these delays affect speech reception thresholds (SRT) in the unilateral OF simulation when presenting speech and noise from different spatial directions. A significant decrease in the median SRT from -18.1 to -14.7 dB SNR is observed when typical HA processing delays are applied. On the other hand, SRT was independent of the delay between direct and delayed sound in the bilateral OF simulation. The significant effect emphasizes the development of rapid processing algorithms for unilateral HA provision.

Background Intraoperative hemodynamic management is intended to ensure adequate tissue perfusion and oxygen delivery and eventually help avoid organ injury. However, the optimal strategy for intraoperative hemodynamic management in patients having non-cardiac surgery remains unclear. We here report the protocol of a trial designed to test the hypothesis that personalized intraoperative hemodynamic management targeting preoperative baseline cardiac index reduces the incidence of a composite outcome of major postoperative complications and death within 7 days after surgery compared to routine hemodynamic management in high-risk patients having elective major abdominal surgery. Methods The PELICAN trial is an international multicenter randomized trial in 1,128 high-risk patients having elective major abdominal surgery. The individual preoperative baseline cardiac index is determined with the patient being awake and resting in the supine position using noninvasive bioreactance. Patients are randomized to personalized hemodynamic management (intervention) or to routine hemodynamic management (control) during surgery. In patients assigned to personalized hemodynamic management, intraoperative cardiac index is maintained at least at the preoperative baseline cardiac index. In patients assigned to routine hemodynamic management, it is performed as per anesthesiologist preference (with blinded cardiac index monitoring). The primary outcome is the incidence of a composite outcome (“any event versus none”) of acute kidney injury, acute myocardial injury (including myocardial infarction), non-fatal cardiac arrest, severe infectious complications, and death within 7 days after surgery. Discussion Our trial will determine whether personalized intraoperative hemodynamic management targeting preoperative baseline cardiac index reduces the incidence of major postoperative complications and death within 7 days in high-risk patients having elective major abdominal surgery compared to routine hemodynamic management. Trial registration ClinicalTrials.gov Identifier NCT05648279. Registered on 5 December 2022.

Short chain fatty acids (SCFAs) are generated by the degradation and fermentation of complex carbohydrates, (i.e., dietary fiber) by the gut microbiota relevant for microbe–host communication. Here, we present a method for the quantification of SCFAs in fecal samples by liquid chromatography tandem mass spectrometry (LC-MS/MS) upon derivatization to 3-nitrophenylhydrazones (3NPH). The method includes acetate, propionate, butyrate, and isobutyrate with a run time of 4 min. The reproducible (coefficients of variation (CV) below 10%) quantification of SCFAs in human fecal samples was achieved by the application of stable isotope labelled internal standards. The specificity was demonstrated by the introduction of a quantifier and qualifier ions. The method was applied to investigate the pre-analytic stability of SCFAs in human feces. Concentrations of SCFA may change substantially within hours; the degree and kinetics of these changes revealed huge differences between the donors. The fecal SCFA level could be preserved by the addition of organic solvents like isopropanol. An analysis of the colon content of mice either treated with antibiotics or fed with a diet containing a non-degradable and -fermentable fiber source showed decreased SCFA concentrations. In summary, this fast and reproducible method for the quantification of SCFA in fecal samples provides a valuable tool for both basic research and large-scale studies.

Hemodynamic assessment is crucial after heart transplantation (HTX) or left ventricular assist device (LVAD) implantation. Gold-standard is invasive assessment via thermodilution (TD). Noninvasive pulse contour analysis (NPCA) is a new technology that is supposed to determine hemodynamics completely noninvasive. We aimed to validate this technology in HTX and LVAD patients and conducted a prospective single-center cohort study. In total, 28 patients were prospectively enrolled (HTX: n = 10, LVAD: n = 18). Bland-Altman analysis revealed a mean bias of +1.05 l/min (limits of agreement ± 4.09 l/min, percentage error 62.1%) for cardiac output (CO). In LVAD patients, no adequate NPCA signal could be obtained. In 5 patients (27.8%), any NPCA signal could be detected, but was considered as low signal quality. In conclusion, according to our limited data in a small cohort of HTX and LVAD patients, NPCA using the CNAP Monitor seems not to be suitable for noninvasive evaluation of the hemodynamic status.

The number of patients waiting for heart transplantation (HTX) is increasing. Thus, identification of outcome-relevant factors is crucial. This study aimed to identify perioperative factors associated with days alive and out of hospital (DAOH)—a patient-centered outcome to quantify life impact—after HTX. This retrospective cohort study screened 187 patients who underwent HTX at university hospital Duesseldorf, Germany from September 2010 to December 2020. The primary endpoint was DAOH at 1 year. Risk factors for mortality after HTX were assessed in univariate analysis. Variables with significant association were entered into multivariable quantile regression. In total, 175 patients were included into analysis. Median DAOH at 1 year was 295 (223–322) days. In univariate analysis the following variables were associated with reduced DAOH: recipient or donor diabetes pre-HTX, renal replacement therapy (RRT), VA-ECMO therapy, recipient body mass index, recipient estimated glomerular filtration rate (eGFR) and postoperative duration of mechanical ventilation. After adjustment, mechanical ventilation, RRT, eGFR and recipient diabetes showed significant independent association with DAOH. This study identified risk factors associated with reduced DAOH at 1-year after HTX. These findings might complement existing data for outcome of patients undergoing HTX.

Understanding the decision-making behavior of machine learning models is essential in domains where individual predictions matter, such as medical diagnosis or sports analytics. While explainable artificial intelligence (XAI) methods such as SHAP provide instance-level feature attributions, they mainly summarize typical decision behavior and offer limited support for systematically exploring atypical yet correctly classified cases. In this work, we introduce the Classification Outlier Variability Score (COVAS), a framework designed to support hypothesis generation through the analysis of explanation variability. COVAS operates in the explanation space and builds directly on SHAP value representations. It quantifies how strongly an individual instance’s SHAP-based explanation deviates from class-specific attribution patterns by aggregating standardized SHAP deviations into a single score. Consequently, the applicability of COVAS inherits the model- and data-agnostic properties of SHAP, provided that explanations can be computed for the underlying model and data. We evaluate COVAS on publicly available datasets from the medical and sports domains. The results show that COVAS reveals explanation-space outliers not captured by feature-space outlier detection or prediction uncertainty measures. Robustness analyses demonstrate stability across parameter choices, class imbalance, model initialization, and model classes. Overall, COVAS complements existing XAI techniques by enabling targeted instance-level inspection and facilitating XAI-guided hypothesis formulation.

Background The number of patients treated with extracorporeal membrane oxygenation (ECMO) devices is increasing. Anticoagulation therapy is crucial to prevent thrombosis during ECMO therapy. Predominantly, heparin has been used as primary anticoagulant but direct thrombin inhibitors (DTI) have been established as alternatives. The aim of this systematic review and meta-analysis was to evaluate clinical outcomes in patients treated with heparin compared to different DTI during ECMO. Methods A systematic search was conducted. Full scientific articles were sought for inclusion if heparin anticoagulation was compared to DTI (argatroban/bivalirudin) in ECMO patients. Risk of bias was assessed by Newcastle Ottawa scale. Primary endpoint was in-hospital mortality. Bleeding events, thrombotic events, hours of ECMO support, days of hospital stay, percentage of time within therapeutic range and time to therapeutic range were extracted from full texts as secondary endpoints. Results were presented as Forrest-plots. GRADE was used for confidence assessment in outcomes. Results Systematic search identified 4.385 records, thereof 18 retrospective studies for a total of 1942 patients, complied with the predefined eligibility criteria:15 studies investigated bivalirudin and 3 studies investigated argatroban versus heparin. Risk of bias was high for most studies. In-hospital mortality, major bleeding events and pump-related thrombosis were less frequent in DTI group as compared to heparin [mortality—OR 0.69, 95% CI 0.54–0.86; major bleeding—OR 0.48, 95% CI 0.29–0.81; pump thrombosis—OR 0.55, 95% CI 0.40–0.76]. Additionally, percentage of time within therapeutic range was higher for DTI [SMD 0.54, 95% CI 0.14–0.94]. GRADE approach revealed a very low level of certainty for each outcome. Conclusion In this meta-analysis, DTI and especially bivalirudin showed beneficial effects on clinical outcomes in ECMO patients as compared to heparin . However, due to the lack of randomized trials, certainty of evidence is low. Trial Registration This systematic review and meta-analysis was prospectively registered at PROSPERO data base (reference number CRD42021237252 ). Graphical Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients suffering from refractory cardiogenic shock. Thromboembolic complications (TeC) are common in VA-ECMO patients and are associated with increased morbidity and mortality. Valid markers to predict TeC in VA-ECMO patients are lacking. The present study investigated the predictive value of baseline Fibrinogen–Albumin-Ratio (FAR) for in-hospital TeC in patients undergoing VA-ECMO. This retrospective cohort study included patients who underwent VA-ECMO therapy due to cardiogenic shock at the University Hospital Duesseldorf, Germany between 2011 and 2018. Main exposure was baseline FAR measured at initiation of VA-ECMO therapy. The primary endpoint was the in-hospital incidence of TeC. In total, 344 patients were included into analysis (74.7% male, mean age 59 ± 14 years). The in-hospital incidence of TeC was 34%. Receiver operating characteristics (ROC) curve of FAR for in-hospital TeC revealed an area under the curve of 0.67 [95% confidence interval (CI) 0.61–0.74]. Youden index determined a cutoff of 130 for baseline FAR. Multivariate logistic regression revealed an adjusted odds-ratio of 3.72 [95% CI 2.26–6.14] for the association between FAR and TeC. Baseline FAR is independently associated with in-hospital TeC in patients undergoing VA-ECMO. Thus, FAR might contribute to the prediction of TeC in this cohort.

The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasing, but mortality remains high. Early assessment of prognosis is challenging and valid markers are lacking. This study aimed to investigate Neutrophil–Lymphocyte Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Procalcitonin (PCT) for early assessment of prognosis in patients undergoing VA-ECMO. This retrospective single-center cohort study included 344 consecutive patients ≥ 18 years who underwent VA-ECMO due to cardiogenic shock. Main exposures were NLR, PLR and PCT measured within 24 h after VA-ECMO initiation. The primary endpoint was all-cause in-hospital mortality. In total, 92 patients were included into final analysis (71.7% male, age 57 ± 14 years). In-hospital mortality rate was 48.9%. Receiver operating characteristics (ROC) curve revealed an area under the curve (AUC) of 0.65 [95% confidence interval (CI) 0.53–0.76] for NLR. The AUCs of PLR and PCT were 0.47 [95%CI 0.35–0.59] and 0.54 [95%CI 0.42–0.66], respectively. Binary logistic regression showed an adjusted odds ratio of 3.32 [95%CI 1.13–9.76] for NLR, 1.0 [95%CI 0.998–1.002] for PLR and 1.02 [95%CI 0.99–1.05] for PCT. NLR is independently associated with in-hospital mortality in patients undergoing VA-ECMO. However, discriminative ability is weak. PLR and PCT seem not to be suitable for this purpose.