@article{KurotschkaTiedemannWolfetal.2021, author = {Kurotschka, Peter Konstantin and Tiedemann, Elena and Wolf, Dominik and Thier, Nicola and Forster, Johannes and Liese, Johannes G. and Gagyor, Ildiko}, title = {Management of common infections in German primary care: a cross-sectional survey of knowledge and confidence among General Practitioners and outpatient pediatricians}, series = {Antibiotics}, volume = {10}, journal = {Antibiotics}, number = {9}, issn = {2079-6382}, doi = {10.3390/antibiotics10091131}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246272}, year = {2021}, abstract = {Outpatient antibiotic use is closely related to antimicrobial resistance and in Germany, almost 70\% of antibiotic prescriptions in human health are issued by primary care physicians (PCPs). The aim of this study was to explore PCPs, namely General Practitioners' (GPs) and outpatient pediatricians' (PDs) knowledge of guideline recommendations on rational antimicrobial treatment, the determinants of confidence in treatment decisions and the perceived need for training in this topic in a large sample of PCPs from southern Germany. Out of 3753 reachable PCPs, 1311 completed the survey (overall response rate = 34.9\%). Knowledge of guideline recommendations and perceived confidence in making treatment decisions were high in both GPs and PDs. The two highest rated influencing factors on prescribing decisions were reported to be guideline recommendations and own clinical experiences, hence patients' demands and expectations were judged as not influencing treatment decisions. The majority of physicians declared to have attended at least one specific training course on antibiotic use, yet almost all the participating PCPs declared to need more training on this topic. More studies are needed to explore how consultation-related and context-specific factors could influence antibiotic prescriptions in general and pediatric primary care in Germany beyond knowledge. Moreover, efforts should be undertaken to explore the training needs of PCPs in Germany, as this would serve the development of evidence-based educational interventions targeted to the improvement of antibiotic prescribing decisions rather than being focused solely on knowledge of guidelines.}, language = {en} } @article{DichtlForsterOrmannsetal.2020, author = {Dichtl, Karl and Forster, Johannes and Ormanns, Steffen and Horns, Heidi and Suerbaum, Sebastian and Seybold, Ulrich and Wagener, Johannes}, title = {Comparison of β-D-Glucan and galactomannan in serum for detection of invasive aspergillosis: retrospective analysis with focus on early diagnosis}, series = {Journal of Fungi}, volume = {6}, journal = {Journal of Fungi}, number = {4}, issn = {2309-608X}, doi = {10.3390/jof6040253}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-216298}, year = {2020}, abstract = {The early diagnosis of invasive aspergillosis (IA) relies mainly on computed tomography imaging and testing for fungal biomarkers such as galactomannan (GM). We compared an established ELISA for the detection of GM with a turbidimetric assay for detection of the panfungal biomarker β-D-glucan (BDG) for early diagnosis of IA. A total of 226 serum specimens from 47 proven and seven probable IA cases were analysed. Sensitivity was calculated for samples obtained closest to the day of IA-diagnosis (d0). Additional analyses were performed by including samples obtained during the presumed course of disease. Most IA cases involved the respiratory system (63\%), and Aspergillus fumigatus was the most frequently isolated species (59\%). For proven cases, sensitivity of BDG/GM analysis was 57\%/40\%. Including all samples dating from -6 to +1 weeks from d0 increased sensitivities to 74\%/51\%. Sensitivity of BDG testing was as high as or higher than GM testing for all subgroups and time intervals analysed. BDG testing was less specific (90-93\%) than GM testing (99-100\%). Combining BDG and GM testing resulted in sensitivity/specificity of 70\%/91\%. Often, BDG testing was positive before GM testing. Our study backs the use of BDG for diagnosis of suspected IA. We suggest combining BDG and GM to improve the overall sensitivity.}, language = {en} } @article{ForsterDichtlWagener2022, author = {Forster, Johannes and Dichtl, Karl and Wagener, Johannes}, title = {Lower beta-1,3-D-glucan testing cut-offs increase sensitivity for non-albicans Candida species bloodstream infections}, series = {Mycoses}, volume = {65}, journal = {Mycoses}, number = {5}, doi = {10.1111/myc.13421}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-276515}, pages = {500 -- 507}, year = {2022}, abstract = {Purpose Fungal biomarkers support early diagnosis of invasive fungal infections. In this study, we evaluated the impact of a recent update to the manufacturer-recommended cut-off for beta-1,3-D-glucan (BDG) testing (Fujifilm Wako BDG assay) on sensitivity and specificity for the detection of candidemia. Additionally, we compared the performance with tests for Candida antigen (Ag by Serion ELISA antigen Candida, Virion\Serion) and anti-mannan antibodies (Ab by Hemkit Candida IHA, Ravo Diagnostika). Methods Sera of 82 patients with candidemia, which were sampled with a maximum distance of ±14 days from the date of sampling of the corresponding positive blood cultures, were retrospectively analysed for BDG, Ag and Ab. Results of BDG testing were compared with results from sera of 129 patients with candidemia from a different hospital. Results Sensitivity of BDG testing (47\%) was higher than for Ag (17\%) or Ab (20\%). By combining Ag and Ab testing, sensitivity was raised to 32\%. Lowering the cut-off of BDG from 11 pg/ml to the newly recommended cut-off of 7 pg/ml resulted in a significant increase in sensitivity (47\% vs 58\%, p = .01 and 63\% vs 71\% p < .01). At both centres, the increase was significant in NAC but not in C. albicans candidemia. No significant effects on specificity were observed. Conclusion BDG testing outperformed Ag and Ab testing and its combination. Lowering the BDG cut-off had no significant impact on specificity. The increase in sensitivity can be mainly attributed to a gain in sensitivity for non-albicans Candida species bloodstream infections.}, language = {en} } @article{ZiebellRodriguesForsteretal.2023, author = {Ziebell, Philipp and Rodrigues, Johannes and Forster, Andr{\´e} and Sanguinetti, Joseph L. and Allen, John JB. and Hewig, Johannes}, title = {Inhibition of midfrontal theta with transcranial ultrasound explains greater approach versus withdrawal behavior in humans}, series = {Brain Stimulation}, volume = {16}, journal = {Brain Stimulation}, number = {5}, doi = {10.1016/j.brs.2023.08.011}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349890}, pages = {1278-1288}, year = {2023}, abstract = {Highlights • Transcranial ultrasound neuromodulation/stimulation (TUS) is a growing field. • We conducted a double-blind sham-controlled within-subjects large sample TUS study. • Right prefrontal cortex TUS inhibits midfrontal theta electroencephalography (MFT). • TUS MFT inhibition explains greater approach versus withdrawal in a virtual T-maze. • This distinct TUS-MFT-behavior link merits future basic and applied research. Abstract Recent reviews highlighted low-intensity transcranial focused ultrasound (TUS) as a promising new tool for non-invasive neuromodulation in basic and applied sciences. Our preregistered double-blind within-subjects study (N = 152) utilized TUS targeting the right prefrontal cortex, which, in earlier work, was found to positively enhance self-reported global mood, decrease negative states of self-reported emotional conflict (anxiety/worrying), and modulate related midfrontal functional magnetic resonance imaging activity in affect regulation brain networks. To further explore TUS effects on objective physiological and behavioral variables, we used a virtual T-maze task that has been established in prior studies to measure motivational conflicts regarding whether participants execute approach versus withdrawal behavior (with free-choice responses via continuous joystick movements) while allowing to record related electroencephalographic data such as midfrontal theta activity (MFT). MFT, a reliable marker of conflict representation on a neuronal level, was of particular interest to us since it has repeatedly been shown to explain related behavior, with relatively low MFT typically preceding approach-like risky behavior and relatively high MFT typically preceding withdrawal-like risk aversion. Our central hypothesis is that TUS decreases MFT in T-maze conflict situations and thereby increases approach and reduces withdrawal. Results indicate that TUS led to significant MFT decreases, which significantly explained increases in approach behavior and decreases in withdrawal behavior. This study expands TUS evidence on a physiological and behavioral level with a large sample size of human subjects, suggesting the promise of further research based on this distinct TUS-MFT-behavior link to influence conflict monitoring and its behavioral consequences. Ultimately, this can serve as a foundation for future clinical work to establish TUS interventions for emotional and motivational mental health.}, language = {en} } @article{DichtlKocForsteretal.2021, author = {Dichtl, Karl and Koc, {\"O}zlem and Forster, Johannes and Scharf, Christina and Suerbaum, Sebastian and Andrassy, Joachim and Wagener, Johannes and Schroeder, Ines}, title = {An invasive infection caused by the thermophilic mold Talaromyces thermophilus}, series = {Infection}, volume = {49}, journal = {Infection}, number = {6}, issn = {0300-8126}, doi = {10.1007/s15010-021-01648-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308970}, pages = {1347-1353}, year = {2021}, abstract = {Background Increasing incidence of invasive infections caused by rare fungi was observed over the recent years. Case Here, we describe the first reported case of an infection caused by the thermophilic mold Talaromyces thermophilus. Cultivation and, hence, identification of this fastidious organism is challenging since standard incubation conditions are not sufficient. Retrospective analysis of patient samples and in vitro experiments demonstrated that testing for fungal antigens, i.e., the cell wall components galactomannan and β-1,3-D-glucan, is a promising tool.}, language = {en} } @phdthesis{Forster2016, author = {Forster, Johannes}, title = {Variational Approach to the Modeling and Analysis of Magnetoelastic Materials}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-147226}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2016}, abstract = {This doctoral thesis is concerned with the mathematical modeling of magnetoelastic materials and the analysis of PDE systems describing these materials and obtained from a variational approach. The purpose is to capture the behavior of elastic particles that are not only magnetic but exhibit a magnetic domain structure which is well described by the micromagnetic energy and the Landau-Lifshitz-Gilbert equation of the magnetization. The equation of motion for the material's velocity is derived in a continuum mechanical setting from an energy ansatz. In the modeling process, the focus is on the interplay between Lagrangian and Eulerian coordinate systems to combine elasticity and magnetism in one model without the assumption of small deformations. The resulting general PDE system is simplified using special assumptions. Existence of weak solutions is proved for two variants of the PDE system, one including gradient flow dynamics on the magnetization, and the other featuring the Landau-Lifshitz-Gilbert equation. The proof is based on a Galerkin method and a fixed point argument. The analysis of the PDE system with the Landau-Lifshitz-Gilbert equation uses a more involved approach to obtain weak solutions based on G. Carbou and P. Fabrie 2001.}, subject = {Magnetoelastizit{\"a}t}, language = {en} } @article{GrabenhenrichReichFischeretal.2014, author = {Grabenhenrich, Linus B. and Reich, Andreas and Fischer, Felix and Zepp, Fred and Forster, Johannes and Schuster, Antje and Bauer, Carl-Peter and Bergmann, Renate L. and Bergmann, Karl E. and Wahn, Ulrich and Keil, Thomas and Lau, Susanne}, title = {The Novel 10-Item Asthma Prediction Tool: External Validation in the German MAS Birth Cohort}, series = {PLOS ONE}, volume = {9}, journal = {PLOS ONE}, number = {12}, issn = {1932-6203}, doi = {10.1371/journal.pone.0115852}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114202}, pages = {e115852}, year = {2014}, abstract = {Background: A novel non-invasive asthma prediction tool from the Leicester Cohort, UK, forecasts asthma at age 8 years based on 10 predictors assessed in early childhood, including current respiratory symptoms, eczema, and parental history of asthma. Objective: We aimed to externally validate the proposed asthma prediction method in a German birth cohort. Methods: The MAS-90 study (Multicentre Allergy Study) recorded details on allergic diseases prospectively in about yearly follow-up assessments up to age 20 years in a cohort of 1,314 children born 1990. We replicated the scoring method from the Leicester cohort and assessed prediction, performance and discrimination. The primary outcome was defined as the combination of parent-reported wheeze and asthma drugs (both in last 12 months) at age 8. Sensitivity analyses assessed model performance for outcomes related to asthma up to age 20 years. Results: For 140 children parents reported current wheeze or cough at age 3 years. Score distribution and frequencies of later asthma resembled the Leicester cohort: 9\% vs. 16\% (MAS-90 vs. Leicester) of children at low risk at 3 years had asthma at 8 years, at medium risk 45\% vs. 48\%. Performance of the asthma prediction tool in the MAS-90 cohort was similar (Brier score 0.22 vs. 0.23) and discrimination slightly better than in the original cohort (area under the curve, AUC 0.83 vs. 0.78). Prediction and discrimination were robust against changes of inclusion criteria, scoring and outcome definitions. The secondary outcome 'physicians' diagnosed asthma at 20 years' showed the highest discrimination (AUC 0.89). Conclusion: The novel asthma prediction tool from the Leicester cohort, UK, performed well in another population, a German birth cohort, supporting its use and further development as a simple aid to predict asthma risk in clinical settings.}, language = {en} } @misc{Forster2013, type = {Master Thesis}, author = {Forster, Johannes}, title = {Mathematical Modeling of Complex Fluids}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-83533}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {This thesis gives an overview over mathematical modeling of complex fluids with the discussion of underlying mechanical principles, the introduction of the energetic variational framework, and examples and applications. The purpose is to present a formal energetic variational treatment of energies corresponding to the models of physical phenomena and to derive PDEs for the complex fluid systems. The advantages of this approach over force-based modeling are, e.g., that for complex systems energy terms can be established in a relatively easy way, that force components within a system are not counted twice, and that this approach can naturally combine effects on different scales. We follow a lecture of Professor Dr. Chun Liu from Penn State University, USA, on complex fluids which he gave at the University of Wuerzburg during his Giovanni Prodi professorship in summer 2012. We elaborate on this lecture and consider also parts of his work and publications, and substantially extend the lecture by own calculations and arguments (for papers including an overview over the energetic variational treatment see [HKL10], [Liu11] and references therein).}, subject = {Variationsrechnung}, language = {en} } @article{ForchertPotapovaPanettaetal.2022, author = {Forchert, Leandra and Potapova, Ekaterina and Panetta, Valentina and Dramburg, Stephanie and Perna, Serena and Posa, Daniela and Resch-Marat, Yvonne and Lupinek, Christian and Rohrbach, Alexander and Grabenhenrich, Linus and Icke, Katja and Bauer, Carl-Peter and Hoffman, Ute and Forster, Johannes and Zepp, Fred and Schuster, Antje and Wahn, Ulrich and Keil, Thomas and Lau, Susanne and Vrtala, Susanne and Valenta, Rudolf and Matricardi, Paolo Maria}, title = {Der p 23-specific IgE response throughout childhood and its association with allergic disease: A birth cohort study}, series = {Pediatric Allergy and Immunology}, volume = {33}, journal = {Pediatric Allergy and Immunology}, number = {7}, doi = {10.1111/pai.13829}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287181}, year = {2022}, abstract = {Background The Dermatophagoides pteronyssinus molecule Der p 23 is a major allergen whose clinical relevance has been shown in cross-sectional studies. We longitudinally analysed the trajectory of Der p 23-specific IgE antibody (sIgE) levels throughout childhood and youth, their early-life determinants and their clinical relevance for allergic rhinitis and asthma. Methods We obtained sera and clinical data of 191 participants of the German Multicentre Allergy Study, a prospective birth cohort. Serum samples from birth to 20 years of age with sIgE reactivity to Der p 23 in a customised semiquantitative microarray were newly analysed with a singleplex quantitative assay. Early mite exposure was assessed by measuring the average content of Der p 1 in house dust at 6 and 18 months. Results Der p 23-sIgE levels were detected at least once in 97/191 participants (51\%). Prevalence of Der p 23 sensitisation and mean sIgE levels increased until age 10 years, plateaued until age 13 years and were lowest at age 20 years. Asthma, allergic rhinitis (AR) and atopic dermatitis (AD) were more prevalent in Der p 23-sensitised children, including those with monomolecular but persistent sensitisation (11/97, 11\%). A higher exposure to mites in infancy and occurrence of AD before 5 years of age preceded the onset of Der p 23 sensitisation, which in turn preceded a higher incidence of asthma. Conclusions Der p 23 sensitisation peaks in late childhood and then decreases. It is preceded by early mite exposure and AD. Asthma and AR can occur in patients persistently sensitised to Der p 23 as the only mite allergen, suggesting the inclusion of molecular testing of Der p 23-sIgE for subjects with clinical suspicion of HDM allergy but without sIgE to other major D.pt. allergens.}, language = {en} } @article{StreckGaalForsteretal.2021, author = {Streck, Laura Elisa and Gaal, Chiara and Forster, Johannes and Konrads, Christian and Hertzberg-Boelch, Sebastian Philipp von and Rueckl, Kilian}, title = {Defining a synovial fluid white blood cell count threshold to predict periprosthetic infection after shoulder arthroplasty}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {1}, issn = {2077-0383}, doi = {10.3390/jcm11010050}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-252275}, year = {2021}, abstract = {Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm\(^3\) showed a sensitivity of 87\% and a specificity of 88\% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76\% and a specificity of 100\%. Conclusions: A threshold of 2800 leucocytes/mm\(^3\) in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI.}, language = {en} }