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Reproductive self-determination and regulation of termination of pregnancy in Germany: current controversies and developments
Full text linkIn Germany, efforts to reform current legislation governing access to termination of pregnancy (TOP) have recently gained momentum. In 2023, the German Federal Government appointed a ‘Commission on Reproductive Self-Determination and Reproductive Medicine’, which released recommendations to revise legislation of TOP in April 2024. Currently, TOP is unlawful under the German Criminal Code, with exemptions from punishment for TOP performed within the first 12 weeks of pregnancy following mandatory counselling. Additional exemptions exist in case of criminological or medical-social indications.
The Commission report recommends the decriminalisation of early-stage TOP and potential abolition of the mandatory counselling requirement. It further recommends a revision of the medical-social indication, due to a lack of clarity in its interpretation. This indication allows for TOP beyond 12 weeks of pregnancy, where there is danger to the pregnant woman’s life or health.
This paper provides an overview of Germany’s current TOP regulation and the Commission’s recommendations, with a particular focus on the ethical and legal challenges posed by the application of the current medical-social indication in cases of fetal anomalies. We argue that while legislative clarity is important, maintaining a broad interpretation of the medical-social indication is crucial to prevent undue restrictions on TOP access at later gestations.
The Commission report represents a promising step forward in changes for TOP legislation in Germany, and we welcome its call for legal reform. However, given the outcome of the recent federal election in February 2025, it is unlikely that the revision of TOP legislation will be part of the new government’s agenda
Think sepsis, write sepsis, code sepsis – patient characteristics associated with sepsis (under-)coding in administrative health data
No full textPurpose: Sepsis is a leading cause of morbidity and mortality, yet its documentation and coding in administrative health data remain unreliable. Accurate coding is essential for epidemiological surveillance, quality assurance, and reimbursement. This study aims to identify patient characteristics associated with under-diagnosis and under-coding of sepsis in German inpatient administrative health data (IAHD).
Methods: This secondary analysis of the multicenter OPTIMISE study included 10,334 hospital cases from ten German hospitals (2015-2017). Sepsis cases were identified via structured chart review and compared to ICD-coded diagnoses. Logistic regression and classification tree analyses were used to determine predictors of under-diagnosis and under-coding, including ICU admission, organ dysfunction, and infection source.
Results: Among 1,310 cases fulfilling severe sepsis-1 criteria, only 30.7% were correctly coded. The strongest predictor for coding accuracy was explicit mention of sepsis in the medical chart (OR 19.58). ICU treatment, organ dysfunction severity, and mechanical ventilation were also associated with higher coding rates, while pneumonia as the infection source was linked to a lower probability of sepsis being named and coded.
Conclusion: Sepsis coding in administrative data is frequently inaccurate. Explicit naming of sepsis and severity markers strongly influence correct coding. As Germany introduces mandatory sepsis quality assurance in 2026, targeted interventions - including enhanced clinician documentation and electronic coding support - are essential to improve coding reliability and patient care
Estimation and extension of CARMA processes with applications to energy markets
No full textIn this thesis, we explore continuous-time autoregressive moving-average (CARMA) processes, with a particular focus on estimation procedures, their applications in energy markets, and an extension that incorporates exogenous influences. We propose a two-step estimation procedure in which we maximize the log-likelihood function, derived from the Kalman filter on the basis of previously estimated initial values. In numerous simulation studies, we identify various numerical problems in the estimators, but will also provide key adjustments to improve the estimation results. Our study includes applications to the Singapore energy market, where we conduct a comprehensive analysis of wholesale electricity prices from an hourly point of view. Our analysis highlights the advantages of incorporating likelihood-based optimization within the Kalman filtering framework compared to solely using transformation-based parameters. Furthermore, we introduce CARMA processes with exogenous influences (CARMAX), which extend classical CARMA models by incorporating exogenous variables modeled as deterministic functions. Through numerical simulations and applications to various German energy datasets, we offer insights into the impact of external factors on stochastic modeling. Additionally, we provide implementations of our analysis in R
EARL Theranostics Centre of Excellence certification: raising the standard of targeted radionuclide therapy care in Europe and beyond
No full textThe European Association of Nuclear Medicine Forschungs GmbH (EARL) has long supported standardisation and quality assurance in clinical molecular imaging and radionuclide therapies through accredited benchmarking programmes. In 2023, EARL expanded this mission by launching the Theranostics Centre of Excellence (CoE) network, designed to promote a harmonised, high-quality framework for centres delivering targeted radionuclide therapy (TRT). As this field evolves rapidly and its clinical demand increases, the need for robust, evidence-based quality structures becomes stronger.
The Theranostics CoE programme was developed to provide a clear, scalable pathway that guides centres in achieving and sustaining high standards of theranostic practice, regardless of their size, indication spectrum, or organisational model. Rather than a single certification step, the CoE framework establishes a continuum of quality standards. Centres can demonstrate compliance with essential requirements while also having the opportunity to progress toward more advanced competencies as their clinical, technical, and organisational capabilities grow.
Following the successful pilot phase of the Level 1 (“Qualified”) Theranostics CoE programme, we recently introduced the Level 2 certification, the “Advanced Theranostics Centre of Excellence”. In this letter, we would like to (1) briefly outline the principles of the EARL Theranostics CoE framework; (2) articulate why a tiered system is essential for ensuring safe, reproducible, and patient-centred theranostic care across Europe and beyond; and (3) describe the evidence and analysis that led to the implementation of more stringent requirements in Level 2
