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Evidence for Longitudinally Polarized W Bosons in the Electroweak Production of Same-Sign W Boson Pairs in Association with Two Jets in p p Collisions at s = 13 TeV with the ATLAS Detector
No full textThis Letter reports the first evidence of electroweak production of same-sign W boson pairs where at least one of the W bosons is longitudinally polarized and the most stringent constraint to date for the production of two longitudinally polarized same-sign W bosons. The dataset used corresponds to an integrated luminosity of 140 fb − 1 of proton-proton collisions at a center-of-mass energy of 13 TeV, collected with the ATLAS detector during run 2 of the Large Hadron Collider. The study is performed in final states including two same-sign leptons (electrons or muons), missing transverse momentum, and at least two jets with a large invariant mass and a large rapidity difference. Two independent fits are performed targeting the production of same-sign W bosons with at least one, or two longitudinally polarized W bosons. The observed (expected) significance of the production with at least one longitudinally polarized W boson is 3.3 (4.0) standard deviations. An observed (expected) 95% confidence level upper limit of 0.45 (0.70) fb is reported on the fiducial production cross section of two longitudinally polarized same-sign W bosons.CERN http://dx.doi.org/10.13039/100012470TRIUMF http://dx.doi.org/10.13039/100012419Institut National de Physique Nucléaire et de Physique des Particules http://dx.doi.org/10.13039/501100012441Karlsruhe Institute of Technology http://dx.doi.org/10.13039/100009133Instituto Nazionale di Fisica Nucleare http://dx.doi.org/10.13039/501100004007Brookhaven National Laboratory http://dx.doi.org/10.13039/100006231Agencia Nacional de Promoción Científica y Tecnológica http://dx.doi.org/10.13039/501100003074Australian Research Council http://dx.doi.org/10.13039/501100000923Bundesministerium für Wissenschaft, Forschung und Wirtschaft http://dx.doi.org/10.13039/501100003413Austrian Science Fund http://dx.doi.org/10.13039/501100002428Arizona-Nevada Academy of Science http://dx.doi.org/10.13039/100011590Conselho Nacional de Desenvolvimento Científico e Tecnológico http://dx.doi.org/10.13039/501100003593Fundação de Amparo à Pesquisa do Estado de São Paulo http://dx.doi.org/10.13039/501100001807Natural Sciences and Engineering Research Council of Canada http://dx.doi.org/10.13039/501100000038National Research Council Canada http://dx.doi.org/10.13039/501100000046Canada Foundation for Innovation http://dx.doi.org/10.13039/501100000196Agencia Nacional de Investigación y Desarrollo http://dx.doi.org/10.13039/501100020884Chinese Academy of Sciences http://dx.doi.org/10.13039/501100002367Ministry of Science and Technology of the People’s Republic of China http://dx.doi.org/10.13039/501100002855National Natural Science Foundation of China http://dx.doi.org/10.13039/501100001809Ministerstvo Školství, Mládeže a T?lovýchovy http://dx.doi.org/10.13039/501100001823Danmarks Grundforskningsfond http://dx.doi.org/10.13039/501100001732Centre National de la Recherche Scientifique http://dx.doi.org/10.13039/501100004794Commissariat à l’Énergie Atomique et aux Énergies Alternatives http://dx.doi.org/10.13039/501100006489Bundesministerium für Bildung und Forschung http://dx.doi.org/10.13039/501100002347Helmholtz-Gemeinschaft http://dx.doi.org/10.13039/501100001656Max-Planck-Gesellschaft http://dx.doi.org/10.13039/501100004189Food and Health Bureau http://dx.doi.org/10.13039/501100005407Israel Science Foundation http://dx.doi.org/10.13039/501100003977Ministry of Education, Culture, Sports, Science and Technology http://dx.doi.org/10.13039/501100001700Japan Society for the Promotion of Science http://dx.doi.org/10.13039/501100001691Centre National pour la Recherche Scientifique et Technique http://dx.doi.org/10.13039/501100006319Nederlandse Organisatie voor Wetenschappelijk Onderzoek http://dx.doi.org/10.13039/501100003246Fundação para a Ciência e a Tecnologia http://dx.doi.org/10.13039/501100001871Institutul de Fizic? Atomic? http://dx.doi.org/10.13039/501100019278Javna Agencija za Raziskovalno Dejavnost RS http://dx.doi.org/10.13039/501100004329National Research Foundation http://dx.doi.org/10.13039/501100001321Ministerio de Ciencia e Innovación http://dx.doi.org/10.13039/501100004837Vetenskapsrådet http://dx.doi.org/10.13039/501100004359Knut och Alice Wallenbergs Stiftelse http://dx.doi.org/10.13039/501100004063National Science Foundation http://dx.doi.org/10.13039/100000001Türkiye Enerji, Nükleer ve Maden Ara?t?rma Kurumu http://dx.doi.org/10.13039/100020381Science and Technology Facilities Council http://dx.doi.org/10.13039/501100000271U.S. Department of Energy http://dx.doi.org/10.13039/100000015British Columbia Knowledge Development Fund http://dx.doi.org/10.13039/501100007711Canarie http://dx.doi.org/10.13039/100008313H2020 European Research Council http://dx.doi.org/10.13039/100010663European Regional Development Fund http://dx.doi.org/10.13039/501100008530Horizon 2020 Framework Programme http://dx.doi.org/10.13039/100010661Ministero dell’Istruzione, dell’Università e della Ricerca http://dx.doi.org/10.13039/501100003407European Commission http://dx.doi.org/10.13039/501100000780Agence Nationale de la Recherche http://dx.doi.org/10.13039/501100001665Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659Research Grants Council, University Grants Committee http://dx.doi.org/10.13039/501100002920European Social Fund http://dx.doi.org/10.13039/501100004895United States-Israel Binational Science Foundation http://dx.doi.org/10.13039/501100001742Narodowe Centrum Nauki http://dx.doi.org/10.13039/501100004281Narodowa Agencja Wymiany Akademickiej http://dx.doi.org/10.13039/501100014434’la Caixa’ Foundation http://dx.doi.org/10.13039/100010434Centres de Recerca de Catalunya http://dx.doi.org/10.13039/100015439Generalitat de Catalunya http://dx.doi.org/10.13039/501100002809Generalitat Valenciana http://dx.doi.org/10.13039/501100003359Göran Gustafssons Stiftelser http://dx.doi.org/10.13039/100016408Royal Society http://dx.doi.org/10.13039/501100000288Leverhulme Trust http://dx.doi.org/10.13039/501100000275Fondo Nacional de Desarrollo Científico y Tecnológico http://dx.doi.org/10.13039/501100002850Grantová Agentura České Republiky http://dx.doi.org/10.13039/501100001824Ministry of Education, Youth and Science http://dx.doi.org/10.13039/501100003335BARD http://dx.doi.org/10.13039/501100001269Baden-Württemberg Stiftung http://dx.doi.org/10.13039/100008316Norges Forskningsråd http://dx.doi.org/10.13039/501100005416Ministerstwo Edukacji i Nauki http://dx.doi.org/10.13039/501100004569Federación Española de Enfermedades Raras http://dx.doi.org/10.13039/501100002924Carl Tryggers Stiftelse för Vetenskaplig Forskning http://dx.doi.org/10.13039/501100002805Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung http://dx.doi.org/10.13039/501100001711Neubauer Family Foundation http://dx.doi.org/10.13039/100019099NDGF http://dx.doi.org/10.13039/100024502NL-T1PICRALYerPhIMinciencias http://dx.doi.org/10.13039/100022965DNSRCSRNSFGGSRI http://dx.doi.org/10.13039/501100003448RGCThe Nella and Leon Benoziyo Center for High Energy Physics, Weizmann Institute of ScienceRCNMNiSW http://dx.doi.org/10.13039/501100004569MESTDMSSRMIZŠSERICantons of Bern and GenevaMOSTCRCDRACICSC-NextGenerationEUInvestissements d’ Avenir LabexAvH Foundation http://dx.doi.org/10.13039/100005156NSRFMINERVAItalian Center for High Performance ComputingBig Data and Quantum ComputingICSC http://dx.doi.org/10.13039/10002304
Influence of Sex and Diagnosis on Clinical Variables and Neurocognitive Performance in Severe Mental Illness. Results From the PsyCourse Study
No full textABSTRACT Introduction Bipolar disorder (BD) and schizophrenia (SZ) are serious mental illnesses (SMI) with overlapping symptoms but distinct differences in onset and course. Sex differences are an area of growing interest in SMI. This study aims to examine potential interactions between sex and diagnosis across a broad range of variables, to compare males and females within SZ and BD, and to investigate sex‐specific group differences. Methods A total of 1516 individuals were included in a cross‐sectional study using baseline data from the multicenter PsyCourse Study, including BD ( n = 543), SZ ( n = 517), and healthy controls (HC) ( n = 456). Sociodemographic characteristics, clinical symptoms, psychosocial functioning, quality of life, neurocognitive performance, and somatic comorbidities were assessed. Generalized linear models were used to analyze differences between groups and sexes. False Discovery Rate (FDR) and Bonferroni post hoc comparisons were performed. Results Significant interactions were identified in age ( p = 0.001), age at treatment ( p = 0.05), illness duration ( p = 0.03), illicit drug use ( p = 0.01), and smoking ( p = 0.05). Differences in substance use were observed across groups and sexes, with the highest rates found in males with SZ. The BD group showed better functioning and neurocognitive performance compared with the SZ group. Within the BD group, females reported better performance in verbal memory ( p = 0.003) and psychomotor speed ( p < 0.001) than males. Moreover, both females and males with SMI showed higher rates of thyroid alterations compared with HC ( p = 0.01 for females and p = 0.002 for males). Conclusions Significant sex differences were observed in substance use and somatic comorbidities. Interactions between diagnosis and sex underscore the importance of considering both factors in clinical assessments. These findings highlight the need to tailor sex‐specific treatment for each patient. Further research is needed to explore the role of sex hormones and other biological and societal factors in the presentation and course of these disorders.Deutsche Forschungsgemeinschaft https://doi.org/10.13039/50110000165
Activation Energy of Organic Matter Decomposition in Soil and Consequences of Global Warming
No full textABSTRACT The activation energy ( E a ) is the minimum energy necessary for (bio)chemical reactions acting as an energy barrier and defining reaction rates, for example, organic matter transformations in soil. Based on the E a database of (i) oxidative and hydrolytic enzyme activities, (ii) organic matter mineralization and CO 2 production, (iii) heat release during soil incubation, as well as (iv) thermal oxidation of soil organic matter (SOM), we assess the E a of SOM transformation processes. After a short description of the four approaches to assess these E a values—all based on the Arrhenius equation—we present the E a of chemical oxidation (79 kJ mol −1 , based on thermal oxidation), microbial mineralization (67 kJ mol −1 , CO 2 production), microbial decomposition (40 kJ mol −1 , heat release), and enzyme‐catalyzed hydrolysis of polymers and cleavage of mineral ions of nutrients (33 kJ mol −1 , enzyme driven reactions) from SOM. The catalyzing effects of hydrolytic and oxidative enzymes reduce E a of SOM decomposition by more than twice that of its chemical oxidation. The E a of enzymatic cleavage of mineral ions of N, P, and S from their organic compounds is 9 kJ mol −1 lower (corresponding to 40‐fold faster reactions) than the hydrolysis of N‐, P‐, and S‐free organic polymers. In soil, where organic compounds are physically protected and enzymes are partly deactivated, microbial mineralization is ~140‐fold faster compared to its pure chemical oxidation. Because processes with higher E a are more sensitive to temperature increase, global warming will accelerate the decomposition of stable organic compounds and boost the C cycle much stronger than the cycling of nutrients: N, P, and S. Consequently, the stoichiometry of microbially utilized compounds in warmer conditions will shift toward organic pools with higher C/N ratios. This will decouple the cycling of C and nutrients: N, P, and S. Overall, the E a of (bio)chemical transformations of organic matter in soil enables to assess process rates and the inherent stability of SOM pools, as well as their responses to global warming.National Key Research and Development Program of China https://doi.org/10.13039/50110001216
A Convergent Adaptive Finite Element Stochastic Galerkin Method Based on Multilevel Expansions of Random Fields
No full textPotential of the World Health Organization’s Skin NTDs App to Support and Improve the Detection of Skin-Related Neglected Tropical Diseases: Protocol for a Performance Evaluation and Feasibility Study in Senegal
No full textBackground The World Health Organization (WHO) roadmap aims to control, eliminate, or eradicate neglected tropical diseases (NTDs) by promoting innovation in prevention, diagnosis, and treatment. In this context, mobile health (mHealth) tools could play an important role in improving health care across the globe, including for skin-related NTDs. One such tool is the WHO Skin NTDs App (currently available in its beta version), which utilizes artificial intelligence (AI) algorithms to classify skin lesion images and offers diagnostic suggestions and management information to bolster early detection at primary care levels. However, to harness the full potential of this and similar mHealth tools, additional insights into their diagnostic performance and potential implementation avenues in settings with limited access to trained dermatologists are essential. Objective The objective of our mixed methods study is to test the functionality, operability, and potential of the AI-supported diagnostic component of the WHO Skin NTDs App (beta version) to support the detection of skin NTDs and common skin conditions in Senegal. Methods We are conducting a diagnostic accuracy study combined with a qualitative preimplementation usability exploration. For the quantitative component, we will collect and analyze approximately 800 skin lesion images from patients presenting to the dermatology unit at the Thiès regional hospital in Senegal. Each lesion will be independently assessed by the AI-based WHO Skin NTDs App and by a dermatologist who will provide a diagnosis serving as the reference standard. Performance metrics, including accuracy, sensitivity, specificity, precision, F1-score, and area under the receiver operating characteristic curve, will be calculated for each diagnostic category to evaluate the app’s ability to detect skin-related NTDs. In parallel, we will conduct semistructured in-depth interviews with a purposive sample of 70-80 stakeholders, including policymakers, health care workers, community leaders, dermatologists, and members of leprosy-affected communities. Interviews will explore perceptions of the app’s usability, acceptability, and potential barriers and facilitators to its adoption within Senegal’s health system. Thematic analysis will be used to interpret qualitative data. Findings will help inform the design of an app-based intervention to be piloted in future community-level studies. Results We expect the results to provide detailed insights into the feasibility and potential of the WHO Skin NTDs App to support and improve the detection of skin NTDs and common skin conditions at the community level in Senegal. We started data collection in August 2024, with the first results expected to be available in 2025. Conclusions Our study will assess the performance and potential use of the WHO Skin NTDs App to detect skin NTDs and common skin conditions in Senegal, outlining its potential role in supporting early diagnoses and enhancing public health responses. Trial Registration German Clinical Trials Register DRKS00034297; https://drks.de/search/de/trial/DRKS00034297/details International Registered Report Identifier (IRRID) DERR1-10.2196/6942
Atomic‐Scale Investigation of an Asymmetric Strontium Titanate Grain Boundary
No full textAbstract Grain boundaries (GBs) in oxide perovskites significantly influence their functional properties. This study examines the atomic‐scale structure and composition of a faceted asymmetric grain boundary in strontium titanate (SrTiO 3 ) using scanning transmission electron microscopy (STEM), atom probe tomography (APT), and density functional theory (DFT). STEM and APT reveal an atomically sharp boundary with asymmetric and symmetric facets, marked by strong Sr depletion over a width of less than 1 nm. STEM‐EELS shows Ti concentration variations of up to 20% between facets, while APT constrains this variation to less than 10%. DFT +U calculations of a symmetric Σ5 facet confirm that Sr depletion minimizes boundary energy while maintaining Ti content. The variation in Ti suggests cation mobility that enables local energy minimization. Differences in facet surface energies likely drive Ti redistribution, offering strategies for GB structure control. This combined experimental–theoretical approach provides key insights into the structure and energy landscape of GBs in SrTiO 3 , aiding in the prediction of their impact on ionic and electronic transport
IMPACT OF AMPUTATION LEVEL AND VAULTING ON LOADING PARAMETERS DURING LEVEL GROUND WALKING
No full textBACKGROUND: Previous studies show that during level walking, the load on the contralateral side increases with more proximal amputation levels. Furthermore, a typical compensation mechanism, vaulting on the contralateral side, may also influence the load. However, no study has compared the load applied to the contralateral side across more than two different amputation levels. OBJECTIVE: The objectives of this study were to analyze the biomechanical impact of different lower limb amputation levels and vaulting on the load applied to the locomotor system. METHODOLOGY: Gait data from 82 individuals with different amputation levels (44 transtibial (TT), 30 transfemoral (TF), and 8 hip disarticulation (HD)) were retrospectively analyzed in this study. Peak knee adduction, flexion and extension moments, vertical ground reaction force peaks, and force rates were statistically analyzed between different amputation levels and between two groups “TF with vaulting” and “TF without vaulting”. FINDINGS: As the level of amputation increases, walking speed decreases and asymmetry of stance duration increases. TF individuals with vaulting tend to walk faster than those without vaulting. The first peak of vertical ground reaction forces, the peak knee adduction and extension moments increase, and the peak knee flexion moments decrease with higher amputation level. The higher the amputation level, the curve of the vertical ground reaction force becomes significantly steeper during the first 5% of the gait cycle (GC). The first peak of ground reaction forces, the knee flexion, extension and adduction moments tend to be higher in TF individuals with vaulting. CONCLUSION: In summary, a higher lower limb amputation level can increase loading on the contralateral limb and contribute to a higher incidence of vaulting during gait. The effect of vaulting as a compensation pattern leads to an additional increase in contralateral limb loading. Layman's Abstract Gait characteristics in people using lower limb prostheses deviate from normal gait patterns in individuals without amputation. Furthermore, some people with amputation rise onto the toes of their intact side (a movement known as vaulting) as a compensatory mechanism during walking, which helps them clear the ground on the prosthetic side. In people with lower limb amputation, the load applied to the intact side during level walking is higher compared to able-bodied individuals, and it increases as the level of amputation progresses from below the knee to hip disarticulation. No previous study has compared the load applied to the intact side across more than two different amputation levels. The aims of the present study were to analyze the influence of the amputation level and of vaulting on the load applied to the lower limb. Therefore, we analyzed previously collected gait data from 82 individuals with amputation (44 transtibial, 30 transfemoral, and 8 with hip disarticulation). As the level of amputation increases, walking speed decreases and individuals tend to spend more time on the intact side than the prosthetic side during each gait cycle. Individuals with transfemoral amputation who use vaulting as a compensatory movement tend to walk faster than those who do not use this strategy and experience higher forces on the intact limb. As the level of amputation increases, most of the forces applied to the body during level walking also increase. Furthermore, vaulting is more common in individuals with higher amputation levels. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/44416/33698 How To Cite: Pröbsting E, Schmalz T, Bellmann M. Impact of amputation level and vaulting on loading parameters during level ground walking. Canadian Prosthetics & Orthotics Journal. 2025; Volume 8, Issue 1, No. 2. Https://doi.org/10.33137/cpoj.v8i1.44416 Corresponding Author: Eva Pröbsting, Dipl.-Ing (FH)Affiliation: Clinical Research and Services, Research Biomechanics, Ottobock SE & Co. KGaA, Göttingen, Germany.E-Mail: [email protected] ID: https://orcid.org/0000-0002-6349-299
General health survey in patients with small abdominal aortic aneurysm
No full textBackground Abdominal aortic aneurysm (AAA) is a dynamic disease characterized by a continuous diameter progression. AAA may therefore be categorized in early-stage disease (small diameter AAA) and late-stage disease (large diameter AAA). To date, there is no effective therapy for patients in early stages, resulting in disease-specific stressors. This study was designed to quantify these stressors using a specifically designed questionnaire. Methods A self-designed 17-item questionnaire with categorical response options was distributed to patients with small AAA. The aim of the approach was to gain a deeper understanding of patients' quality of life (QoL), psychological state and attitudes towards hypothetical future treatment options. Results 122 patients were contacted, 63 of whom consented to participate in the study. The study cohort was predominantly older than 65 years, 84% were male and 56% had been diagnosed with small-size AAA less than 1 year ago. In summary, the AAA diagnosis has a significant impact on all aspects of personal health perception, including physical, social and mental health. The overall QoL was found to be impaired compared to the situation before the AAA diagnosis for most of the respondents, and the current treatment options were considered unsatisfactory. The majority of small AAA patients surveyed would be open to new (invasive) therapies to stop disease progression. Conclusion The diagnosis of AAA leads to a reduction in QoL, which impairs the physical, social and mental health, particularly affecting mental health. Patients would welcome treatment options in early stages of their disease
Spatial access to palliative care units in Germany: integrated analysis of availability and accessibility using the E2SFCA method
No full textZusammenfassung Einleitung Demografischer Wandel und steigende Patient*innenzahlen sind Herausforderungen für einen wohnortnahen Zugang zu Palliativstationen. Verfügbarkeit und Erreichbarkeit als Dimensionen des räumlichen Zugangs, in bisherigen Studien meist isoliert voneinander betrachtet, werden mittels der Methode „Enhanced Two-Step Floating Catchment Area“ (E2SFCA) integriert, um durch ein realistischeres Bild der Versorgungssituation regionale Unterschiede zu identifizieren. Methoden Auf Gemeindeebene wurde mithilfe der E2SFCA-Methode ein Zugangsindex ( Z i ) berechnet. Grundlage bildeten Daten zur Bevölkerung, zu Bettenkapazitäten und zur Erreichbarkeit innerhalb von 30 min Fahrzeit. Der Index wurde in Quintile unterteilt und den Kategorien niedriger (Q1, Q2), mittlerer (Q3) und hoher Zugang (Q4, Q5) zugeordnet. Ergebnisse Der Zugang zu den 372 in Deutschland identifizierten Palliativstationen variiert stark zwischen und innerhalb von städtischen und ländlichen Gebieten. In dünn besiedelten Gebieten führen Versorgungsangebote zu einem überdurchschnittlichen Zugang. Zugleich entstehen in weiter entfernten Gemeinden lange Fahrzeiten (Beispiel Mecklenburg-Vorpommern). Städtische Regionen erreichen durch eine hohe Angebotsdichte häufig hohe Zugangsindices. Eine hohe Bevölkerungsdichte führt bei bestehendem Angebot zu einem durchschnittlichen Zugang (Beispiel Nordrhein-Westfalen). Diskussion und Fazit Die meisten Menschen in Deutschland könnten Palliativstationen in 30 min erreichen, mit regional großen Unterschieden. Die erstmals für Palliativstationen angewandte E2SFCA-Methode bietet eine präzisere Analyse als Studien, die sich an landkreisbezogenen Bettenkapazitäten und Einwohnerzahlen orientieren. Um die tatsächliche Versorgung abzubilden, muss die Versorgungssituation in Gebieten mit schlechtem Zugang detailliert untersucht werden.Abstract Introduction Demographic change and rising patient numbers pose challenges for local access to palliative care units. Availability and accessibility as dimensions of spatial access, which have mostly been considered separately in previous studies, are integrated using the method “Enhanced Two-Step Floating Catchment Area” (E2SFCA) in order to identify regional differences by providing a more realistic picture of the care situation. Methods At the community level, an access index ( Z i ) was calculated using the E2SFCA method. It was based on population data , bed capacity, and accessibility within a 30-minute drive. The index was divided into quintiles and assigned to categories with low (Q1, Q2), medium (Q3), and high access index (Q4, Q5). Results Access to the 372 palliative care units identified in Germany varies greatly between and within urban and rural areas. In sparsely populated areas, care services lead to above-average access. At the same time, long travel times arise in more remote communities (e.g., Mecklenburg-Western Pomerania). Urban regions often achieve high access indices due to a high density of services. A high population density results in average access when services are available (e.g., North Rhine-Westphalia). Discussion and conclusion Most people in Germany could reach palliative care units within 30 min, with large regional differences. The E2SFCA method, applied for the first time to palliative care units, offers a more precise analysis than studies based on district-specific bed capacities and number of inhabitants. In order to reflect the actual regional care situation, the care provision in areas with poor access must be examined in detail.Zusammenfassung Einleitung Demografischer Wandel und steigende Patient*innenzahlen sind Herausforderungen für einen wohnortnahen Zugang zu Palliativstationen. Verfügbarkeit und Erreichbarkeit als Dimensionen des räumlichen Zugangs, in bisherigen Studien meist isoliert voneinander betrachtet, werden mittels der Methode „Enhanced Two-Step Floating Catchment Area“ (E2SFCA) integriert, um durch ein realistischeres Bild der Versorgungssituation regionale Unterschiede zu identifizieren. Methoden Auf Gemeindeebene wurde mithilfe der E2SFCA-Methode ein Zugangsindex ( Z i ) berechnet. Grundlage bildeten Daten zur Bevölkerung, zu Bettenkapazitäten und zur Erreichbarkeit innerhalb von 30 min Fahrzeit. Der Index wurde in Quintile unterteilt und den Kategorien niedriger (Q1, Q2), mittlerer (Q3) und hoher Zugang (Q4, Q5) zugeordnet. Ergebnisse Der Zugang zu den 372 in Deutschland identifizierten Palliativstationen variiert stark zwischen und innerhalb von städtischen und ländlichen Gebieten. In dünn besiedelten Gebieten führen Versorgungsangebote zu einem überdurchschnittlichen Zugang. Zugleich entstehen in weiter entfernten Gemeinden lange Fahrzeiten (Beispiel Mecklenburg-Vorpommern). Städtische Regionen erreichen durch eine hohe Angebotsdichte häufig hohe Zugangsindices. Eine hohe Bevölkerungsdichte führt bei bestehendem Angebot zu einem durchschnittlichen Zugang (Beispiel Nordrhein-Westfalen). Diskussion und Fazit Die meisten Menschen in Deutschland könnten Palliativstationen in 30 min erreichen, mit regional großen Unterschieden. Die erstmals für Palliativstationen angewandte E2SFCA-Methode bietet eine präzisere Analyse als Studien, die sich an landkreisbezogenen Bettenkapazitäten und Einwohnerzahlen orientieren. Um die tatsächliche Versorgung abzubilden, muss die Versorgungssituation in Gebieten mit schlechtem Zugang detailliert untersucht werden.Abstract Introduction Demographic change and rising patient numbers pose challenges for local access to palliative care units. Availability and accessibility as dimensions of spatial access, which have mostly been considered separately in previous studies, are integrated using the method “Enhanced Two-Step Floating Catchment Area” (E2SFCA) in order to identify regional differences by providing a more realistic picture of the care situation. Methods At the community level, an access index ( Z i ) was calculated using the E2SFCA method. It was based on population data , bed capacity, and accessibility within a 30-minute drive. The index was divided into quintiles and assigned to categories with low (Q1, Q2), medium (Q3), and high access index (Q4, Q5). Results Access to the 372 palliative care units identified in Germany varies greatly between and within urban and rural areas. In sparsely populated areas, care services lead to above-average access. At the same time, long travel times arise in more remote communities (e.g., Mecklenburg-Western Pomerania). Urban regions often achieve high access indices due to a high density of services. A high population density results in average access when services are available (e.g., North Rhine-Westphalia). Discussion and conclusion Most people in Germany could reach palliative care units within 30 min, with large regional differences. The E2SFCA method, applied for the first time to palliative care units, offers a more precise analysis than studies based on district-specific bed capacities and number of inhabitants. In order to reflect the actual regional care situation, the care provision in areas with poor access must be examined in detail
