Management of herpesvirus reactivations in patients with solid tumours and hematologic malignancies: update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) on herpes simplex virus type 1, herpes simplex virus type 2, and varicella zoster virus

Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 “Antiviral prophylaxis in patients with solid tumours and haematological malignancies” focusing on herpes simplex virus and varicella zoster virus.

Development of the German Immigration Policy after 2015

Germany is seen and presented by itself as a welcome country. It is a country of immigration. First, there was the “Gastarbeiter” period when within agreements made by Germany and southern European states several thousand worker arrived in Germany and most of them made the country their permanent home. The country experienced another migration wave when the former Central-European countries became members of the European Union. In 2015, similar to other European States, Germany too experienced a migration-shock which resulted in a political-social turmoil in the German society. Not only politicians, but average people faced the same never-seen-before challenge on different levels, due to the number of migrants arriving in short term onto the territory of the state: one in the everyday life of its community, one in the political and legal perspective. Irrespectively of their reactions or adaptation methods, one common point of these actors was that they had to come to terms with the fact that a huge number of irregular migrants will stay long-term in Germany. However, the wave challenged the “welcome” country attitude both at political and at societal level. The author argues that roles, namely, the country affected by the migration wave, and the country being a leading European Union Member State became contradicted because of the measures introduced after 2015. This is underlined by the normative analysis of the main measures in this article, but because migration policy overlaps other policy areas, for example integration policy, interior policy, these measures touch upon different issues.

One Year of the COVID-19 Pandemic in Dental Medical Facilities in Germany: A Questionnaire-Based Analysis

(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60–100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.

Best Practice Guideline – DEGUM Recommendations on Breast Ultrasound – Part I – Examination technique, DEGUM ultrasound criteria, and documentation

For many years, breast ultrasound has been used in addition to mammography as an important method for clarifying breast findings. However, differences in the interpretation of findings continue to be problematic 1 2. These differences decrease the diagnostic accuracy of ultrasound after detection of a finding and complicate interdisciplinary communication and the comparison of scientific studies 3. In 1999, the American College of Radiology (ACR) created a working group (International Expert Working Group) that developed a classification system for ultrasound examinations based on the established BI-RADS classification of mammographic findings under consideration of literature data 4. Due to differences in content, the German Society for Ultrasound in Medicine (DEGUM) published its own BI-RADS-analogue criteria catalog in 2006 3. In addition to the persistence of differences in content, there is also an issue with formal licensing with the current 5th edition of the ACR BI-RADS catalog, even though the content is recognized by the DEGUM as another system for describing and documenting findings. The goal of the Best Practice Guideline of the Breast Ultrasound Working Group of the DEGUM is to provide colleagues specialized in senology with a current catalog of ultrasound criteria and assessment categories as well as best practice recommendations for the various ultrasound modalities.

GERMANY’S FAR-RIGHT TERRORISM AND THE TIMID NSU CASE VERDICT

As we have explained in detail in our analysis of last year, the Nationalist Socialist Underground (NSU) far-right terror group, between 2000 and 2007, murdered ten people in Germany . Eight of the victims belonged to Germany's more than three million Turkish community. The last victim was a German policewoman who was gunned down in 2007. This terror cell carried out also several robberies and bombings in this period. Between 1998 and 2011, they robbed 11 banks in Saxony towns of Chemnitz, Zwickau, one bank in Stralsund, Mecklenburg-West Pomerania, and two banks in Arnstadt and Eisenach in Thuringia . As it was given the details in our mentioned last year's analysis Beate Zschäpe, Uwe Mundlos and Uwe Böhnhardt were the nucleus of the National Socialist Underground. Only a couple of hours later, the third member of the group, Beate Zschäpe, set fire to the group's flat in Zwickau, left the scene, and mailed about twelve prepared envelopes containing copies of DVDs claiming responsibility for their acts to newspapers, mosques, parties and one right-wing extremist mail order company, and stayed hidden for several days before turning herself in to the police, accompanied by her lawyer. Searching the debris of the flat, investigators found more weapons, among others the pistol of the first nine murders, and a laptop containing copies of the video claiming responsibility. As a result, the last surviving member of the NSU Beate Zschäpe was charged with co-founding a terrorist organization and the complicity in ten murders, two bombings and fourteen bank robberies .The NSU trial began on 6 May 2013 in the 6th Criminal Division of Munich's Higher Regional Court and Beate Zschäpe together with the four suspected accomplices deemed to be in the "close periphery" of the NSU trio, including Ralf Wohlleben and André Eminger, were tried. Zschäpe is accused of 10 murders, arson, forming a terrorist organization and membership of a terrorist organization. After nearly a five-year trial, the Munich Higher Regional Court has issued the verdict on 11 June 2018. Beate Zschäpe was found guilty of being complicit in 10 murders, 43 attempted murders, 2 severe bombing attacks and 15 bank and other robberies, and sentenced to life in prison . Carsten Schultze, a juvenile at the time, was found guilty of handing the pistol and silencer to the NSU, and was sentenced to three years. Last but not least, André Eminger was given only two years and six months for helping a terrorist group and was released, having already served his prison time during the trial . Meanwhile, many held a minute of silence for NSU's victims before the verdict was read out . The verdict of the Munich Court has been widely criticized, especially for the light sentences given to the already very limited number of accomplices of these serious crimes. The Munich court, almost after two years of its verdict, published the reasoning of its judgement on 21 April 2020. According to the report of Deutsche Welle, the lawyer of one of the plaintiffs whose father was killed by the NSU suggests that the main purpose of the case was not only to convict the only surviving core member of the NSU. Per the report, the BfV identified 32,080 right-wing extremists in Germany in 2019, up from 24,100 the year before. The BfV classified 13,000 of these cases as prepared to use violence, 300 more than in 2018. The report underlines the increase in racism, right-wing extremism, anti-Semitism in Germany, and considers these areas as the biggest threat to security in Germany. There is no doubt that the German government and a large segments of the German society are fighting seriously against terrorist acts that started to emerge in parallel with the rise of the far-right. At this point, it is necessary to add the serious rise in Islamophobia to the list of threats to security in Germany mentioned by the German authorities. In this context, it is also possible to name Islamophobia as anti-Muslim racism. A video titled "Anti-Muslim racism on the rise in Germany" prepared and broadcasted by DW News on 17 September 2020 is a useful start in studying this issue.In the light of the foregoing, as a concluding remark, the following question comes to mind: Did the timid verdict of the Munich Court on the NSU case play a role in the recent increase of number of right-wing extremists and rise in far-right terrorist acts in Germany? It is considered that investigating an answer to this question through an academic research can contribute to elucidating the reasons for the recent rise of the far right in Germany. On the other hand, recent revelations of confirmed infiltration of right wing extremists into the police force as well as the military structure and intelligence units is a most worrisome development that necessitate an even more scrutinizing follow up to this article.

Treatment of classic mid-trimester preterm premature rupture of membranes (PPROM) with oligo/ anhydramnion between 22 – 26 weeks’ gestation by means of continuous amnioinfusion: a randomized multicentric prospective controlled TRIAL

Background: The classic mid-trimester preterm premature rupture of membranes (PPROM), is defined as rupture of fetal membranes prior to 28 weeks’ gestation (WG) with oligo/ anhydramnion, complicates approximately 0.4-0.7% of all pregnancies and is associated with very high neonatal mortality and morbidity.Antibiotics have limited success to prevent bacterial growth, chorioamnionitis and fetal inflammation. The repetitive amnioinfusion doesn’t work because of immediately fluid lost after the intervention. The continuous amnioinfusion through the transabdomianal port system or catheter in patients with classic PPROM shows promise by flush out of bacteria and inflammatory components from the amniotic cavity, replacing amniotic fluid and thus prolonging PPROM-to-delivery interval.Aim: This multicenter trial tests the effect of continuous amnioinfusion on the neonatal survival without the typical major morbidities, like severe bronchopulmonary dysplasia, intraventricular hemorrhage, cystic periventricular leukomalacia and necrotizing enterocolitis one year after the delivery.Methods/Design: randomized multicenter trial; two-arm parallel design. Control group: PPROM patients between 22/0 (20/0) -26/0 WG treated with antibiotics and corticosteroids in accordance to guidelines of German Society of Obstetrics and Gynecology (standard PPROM therapy). In the interventional group the standard PPROM therapy will be complemented by “Amnion Flush Method” with the amnioinfusion of artificial amniotic fluid (up to 100 ml/h, 2400 ml/day).Subjects: 68 patients with classic PPROM between 22/0 (20/0)-26/0 WG.TRIAL-registration: ClinicalTrials.gov ID: NCT04696003 and German Clinical Trials Register: DRKS00024503, January 2021.The trial is approved by the Ethic committee of the Martin-Luther University Halle-Wittenberg (2020-185, January 25, 2021).

Weaning in der neurologischen Frührehabilitation (NFR)

Weaning in neurological early rehabilitation represents an important participation goal that can be achieved in up to 90% of cases after an average of two to three weeks of weaning through a combination of intensive care and rehabilitative interventions. The weaning process should be based on a standardized weaning protocol, with which a gradual expansion of spontaneous breathing phases can be achieved. The German Society for Neurorehabilitation (DGNR) has taken the special features of prolonged weaning in NFR into account in a separate guideline.

A Black-Box yet To Be Opened: Multi-level Processes During Migrants’ Organizational Socialization

Migrants entering a new country also search for belonging. Through employment, migrants work in organizations and experience socialization in these new contexts. Thereby, organizations offer migrants a wide range of possibilities for identification and are thus places to regain a sense of belonging. We rely on prior research showing what migrants experience during the process of organizational socialization to organizational identification, more specifically through (a) sense-making which (b) provides self-esteem and self-enhancement, and (c) reduces uncertainty. Furthermore, we also investigate the interplay of various in-groups (multiple cultures) and levels (micro, meso, macro) that migrants identify with. Consequently, we follow a cross-level approach to identity in and beyond organizations and combine migration, organizational, and intercultural research. Based on a qualitative interview study in Germany, we highlight how positive organizational identification results not only in companies’ workforce retention but also in migrants’ increased societal identification. Moreover, we emphasize the important role German colleagues play in the socialization process across various levels. They serve as socialization agents being individual interaction partners and team members, but also representatives of professional cultures and of the German society. In sum, our research yields important theoretical and practical implications. We provide interesting avenues for future research to uncover the complex interrelationships in more detail, open up the black-box of organizational socialization, and rely on interdisciplinarity in a complementary way. Human Resources Management could consider identification as a multi-layered opportunity, recognize the potentials of migrants’ identification, and thus strive for the sustainable development of their competencies.