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To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample.
School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016–2018 and included: (i) the ‘all-families’ component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the ‘high-risk families’ component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016–2017) and a text-messaging intervention (2017–2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention.
Primary schools and municipalities in six European countries.
Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain).
The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 ‘all families’ and 2230 ‘high-risk families’ were measured at baseline.
The Feel4Diabetes-intervention is expected to provide evidence-based results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.
To demonstrate the application of economics to health care preparedness by estimating the financial return on investment in a substate regional emergency response team and to develop a financial model aimed at sustaining community-level disaster readiness.
Economic evaluation methods were applied to the experience of a regional Pennsylvania response capability. A cost-benefit analysis was performed by using information on funding of the response team and 17 real-world events the team responded to between 2008 and 2013. By use of the results of the cost-benefit analysis as well as information on the response team’s catchment area, a risk-based insurance-like membership model was built.
The cost-benefit analysis showed a positive return after 6 years of investment in the regional emergency response team. Financial modeling allowed for the calculation of premiums for 2 types of providers within the emergency response team’s catchment area: hospitals and long-term care facilities.
The analysis indicated that preparedness activities have a positive return on their investment in this substate region. By applying economic principles, communities can estimate their return on investment to make better business decisions in an effort to increase the sustainability of emergency preparedness programs at the regional level. (Disaster Med Public Health Preparedness. 2015;9:344–348)
A layered composite coating material with favorable properties for application as a transparent conductor is presented. It is composed of layers of three nanoscopic materials, namely zinc oxide nanoparticles, single wall nanotubes, and graphene oxide nanosheets. The electrically conducting layer consists of single wall nanotubes (SWNTs). The layer of zinc oxide nanoparticles acts as a primer. It increases the adhesion and the stability of the films against mechanical stresses. The top layer of graphene oxide enhances the conductivity of such coatings. Such three-layer composite coatings show better conductivity (without compromising transparency) and improved mechanical stability compared to pure SWNT films. The processes used in the preparation of such coatings are easily scalable.
Noninversion tillage with tine- or disc-based cultivations prior to crop establishment is the most common way of reducing tillage for arable cropping systems with small grain cereals, oilseed rape, and maize in Europe. However, new regulations on pesticide use might hinder further expansion of reduced-tillage systems. European agriculture is asked to become less dependent on pesticides and promote crop protection programs based on integrated pest management (IPM) principles. Conventional noninversion tillage systems rely entirely on the availability of glyphosate products, and herbicide consumption is mostly higher compared to plow-based cropping systems. Annual grass weeds and catchweed bedstraw often constitute the principal weed problems in noninversion tillage systems, and crop rotations concurrently have very high proportions of winter cereals. There is a need to redesign cropping systems to allow for more diversification of the crop rotations to combat these weed problems with less herbicide input. Cover crops, stubble management strategies, and tactics that strengthen crop growth relative to weed growth are also seen as important components in future IPM systems, but their impact in noninversion tillage systems needs validation. Direct mechanical weed control methods based on rotating weeding devices such as rotary hoes could become useful in reduced-tillage systems where more crop residues and less workable soils are more prevalent, but further development is needed for effective application. Owing to the frequent use of glyphosate in reduced-tillage systems, perennial weeds are not particularly problematic. However, results from organic cropping systems clearly reveal that desisting from glyphosate use inevitably leads to more problems with perennials, which need to be addressed in future research.
Somatic cell count (SCC) is generally regarded as an indicator of udder health. A cut-off value of 100×103 cells/ml is currently used in Germany to differentiate between normal and abnormal secretion of quarters. In addition to SCC, differential cell counts (DCC) can be applied for a more detailed analysis of the udder health status. The aim of this study was to differentiate somatic cells in foremilk samples of udder quarters classified as normal secreting by SCC <100×103 cells/ml. Twenty cows were selected and 72 normal secreting udder quarters were compared with a control group of six diseased quarters (SCC >100×103 cells/ml). In two severely diseased quarters of the control group (SCC of 967×103 cells/ml and 1824×103 cells/ml) Escherichia coli and Staphylococcus aureus were detected. DCC patterns of milk samples (n=25) with very low SCC values of ⩽6·25×103 cells/ml revealed high lymphocyte proportions of up to 92%. Milk cell populations in samples (n=41) with SCC values of (>6·25 to ⩽25)×103 cells/ml were also dominated by lymphocytes (mean value 47%), whereas DCC patterns of milk from udder quarters (n=6) with SCC values (>25 to ⩽100)×103 cells/ml changed. While in samples (n=3) with SCC values of (27–33)×103 cells/ml macrophages were predominant (35–40%), three milk samples with (43–45)×103 cells/ml indicated already inflammatory reactions based on the predominance of polymorphonuclear leucocytes (PMN) (54–63%). In milk samples of diseased quarters PMN were categorically found as dominant cell population with proportions of ⩾65%. Macrophages were the second predominant cell population in almost all samples tested in relationship to lymphocytes and PMN. To our knowledge, this is the first study evaluating cell populations in low SCC milk in detail. Udder quarters classified as normal secreting by SCC <100×103 cells/ml revealed already inflammatory processes based on DCC.
The flavonol quercetin, is one of the major flavonoids found in edible plants. The bioavailability of quercetin in humans may be influenced by the food matrix in which it is consumed as well as by its chemical and physical form. The objective of the present study was to investigate the biokinetics of quercetin from quercetin-enriched cereal bars and quercetin powder-filled hard capsules. In a randomised, single-blinded, diet-controlled cross-over study, six healthy women aged 22–28 years took a single oral dose of approximately 130 mg quercetin equivalents from either quercetin-enriched cereal bars (containing 93·3 % quercetin aglycone plus 6·7 % quercetin-4′-glucoside) or quercetin powder-filled hard capsules (100 % quercetin aglycone). Blood samples were drawn before and after quercetin administration over a 24 h period. The concentrations of quercetin and its monomethylated derivatives, isorhamnetin (3′-O-methyl quercetin) and tamarixetin (4′-O-methyl quercetin), were measured by HPLC with fluorescence detection after plasma enzymatic treatment. The systemic availability as determined by comparing the plasma concentration–time curves of quercetin was found to be five times and the cmax values six times higher after ingestion of 130 mg quercetin by quercetin-enriched cereal bars than after ingestion by quercetin capsules. In contrast, tmax did not differ significantly between the two treatments. The cmax values for isorhamnetin and tamarixetin were four and nine times higher after ingestion of quercetin by quercetin-enriched cereal bars than after ingestion by quercetin capsules. In conclusion, quercetin from quercetin-enriched cereal bars is significantly more bioavailable than from quercetin powder-filled hard capsules.
“The future of Germany was the question of questions and had to be looked at in its own terms. It was Germany that twice in a quarter-century had generated world war,” wrote Walt W. Rostow in 1972, when he analyzed the unfolding of the Cold War in Germany. Rostow, national security adviser to President Lyndon B. Johnson in the 1960s, had been personally involved in the planning of American policies toward Germany in 1946. He was aware of the fear, the despair, and the hatred that German warfare, German occupation of Europe, and German atrocities had stirred up. But by 1947 most American decisionmakers had shifted their worries from Germany to the Soviet Union.
How did this change come about? Why did the insoluble questions of joint occupation lead directly into the Cold War in Germany? And how should we assess this historical event from the vantage point of the early twenty-first century? These are the leading questions of this chapter.
Germany is our problem
“Germany is our problem,” wrote Secretary of the Treasury Henry Morgenthau in 1945. The measures to curb German power were many and they seemed justified: military government and an unlimited period of occupation; abolition of the German armed forces and elimination of the country’s industrial war potential; de-Nazification and punishment of all Germans involved in Nazi crimes; reparations to the Soviet Union on a gigantic scale as well as to the Western countries in order to restore – at least partly – the damages caused by Germany. In addition to occupation and security controls, radical structural changes seemed necessary. All sorts of recipes were on the table: “dismemberment” of the German Reich that, since its founding by Bismarck, in 1866 and 1871, had played a semi-hegemonic role in Europe and had ruled Europe from 1940 to 1944; the annexation of large portions of eastern and western Germany; a sharp reduction in the economic potential of this industrial giant; international control of the Ruhr; deep, perhaps revolutionary, reforms in many realms of economy, society, and administration; elimination of the economic, cultural, and administrative “old” elites that had joined up with Hitler’s party; reeducation.
To assess the proportion of children being stunted and underweight-for-age at 3, 9 and 15 months in Lambaréné, Gabon, using the WHO child growth standards released in 2006 as compared with the Centers for Disease Control and Prevention (CDC) 2000 and the National Center for Health Statistics (NCHS) 1978 child growth charts/references.
Design and setting
Prospective birth cohort in Lambaréné, Gabon.
Two hundred and eighty-nine children from birth to 15 months of age.
Weight and length were recorded at 3, 9 and 15 months. Corresponding Z scores for stunting and underweight-for-age were calculated for the three different standards/references. Children with a height-for-age or weight-for-age below –2 sd of the corresponding reference median (Z score ≤−2) were classified as stunted or underweight-for-age, respectively.
With the new WHO 2006 standards a higher proportion (4·0 %) of 3-month-old infants were underweight compared with the CDC (1·0 %) or the NCHS (0·7 %) child growth charts/references. In contrast to the NCHS references or the CDC charts, this proportion did not increase from 3 to 9 months or from 9 to 15 months. The proportion of children being stunted was highest (above 20 %) with the WHO 2006 standards at all three ages. Again, in contrast to the old standards, this proportion did not increase from 3 to 9 months or from 9 to 15 months.
The present results show considerably different growth faltering patterns for Gabonese children depending on the growth charts used to assess the prevalence of stunting and underweight. Shifting to the new WHO child growth standards may have important implications for child health programmes.
We study the action of a real reductive group G on a real submanifold X of a Kähler manifold Z. We suppose that the action of G extends holomorphically to an action of the complexified group and that with respect to a compatible maximal compact subgroup U of the action on Z is Hamiltonian. There is a corresponding gradient map where is a Cartan decomposition of . We obtain a Morse-like function on X. Associated with critical points of are various sets of semistable points which we study in great detail. In particular, we have G-stable submanifolds Sβ of X which are called pre-strata. In cases where is proper, the pre-strata form a decomposition of X and in cases where X is compact they are the strata of a Morse-type stratification of X. Our results are generalizations of results of Kirwan obtained in the case where and X=Z is compact.
Questions remain about the long-term health impacts of the 1991 Gulf War on its veterans.
To measure psychological disorders in Australian Gulf War veterans and a military comparison group and to explore any association with exposure to Gulf War-related psychological stressors.
Prevalences of DSM–IV psychological disorders were measured using the Composite International Diagnostic Interview. Gulf War-related psychological stressors were measured using a service experience questionnaire.
A total of 31% of male Gulf War veterans and 21% of the comparison group met criteria for a DSM–IVdisorder first present in the post-Gulf War period. The veterans were at greater risk of developing post-Gulf War anxiety disorders including post-traumatic stress disorder, affective disorders and substance use disorders. The prevalence of such disorders remained elevated a decade after deployment. The findings can be explained partly as a ‘war-deployment effect‘. There was a strong dose–response relationship between psychological disorders and number of reported Gulf War-related psychological stressors.
Service in the 1991 Gulf War is associated with increased risk of psychological disorders and these are related to stressful experiences.
Thomas Mann is among the greatest of German prose writers, and was the first German novelist to reach a wide English-speaking readership since Goethe. Novels such as Buddenbrooks, The Magic Mountain, and Doktor Faustus attest to his mastery of subtle, distanced irony, while novellas such as Death in Venice reveal him at the height of his mastery of language. In addition to fresh insights about these best-known works of Mann, this volume treats less-often-discussed works such as Joseph and His Brothers, Lotte in Weimar, and Felix Krull, as well as his political writings and essays. Mann himself was a paradox: his role as family-father was both refuge and façade; his love of Germany was matched by his contempt for its having embraced Hitler. While in exile during the Nazi period, he functioned as the prime representative of the "good" Germany in the fight against fascism, and he has often been remembered this way in English-speaking lands. But a new view of Mann is emerging half a century after his death: a view of him as one of the great writers of a modernity understood as extending into our 21st century. This volume provides sixteen essays by American and European specialists. They demonstrate the relevance of his writings for our time, making particular use of the biographical material that is now available.Contributors: Ehrhard Bahr, Manfred Dierks, Werner Frizen, Clayton Koelb, Helmut Koopmann, Wolfgang Lederer, Hannelore Mundt, Peter Pütz, Jens Rieckmann, Hans Joachim Sandberg, Egon Schwarz, and Hans Vaget.Herbert Lehnert is Research Professor, and Eva Wessell is lecturer in Humanities, both at the University of California, Irvine.
TheCompanion to the Works of Thomas Mann is meant for readers of Thomas Mann's works who want to become familiar with the present state of scholarly discussion of his texts. We mean to address scholars, teachers, students of German or comparative literature, but we also want to include the many readers of Mann's writings in the English-speaking world who do not read German. For this reason quotations of Mann's texts were paraphrased or translated whenever it was possible without loss of meaning. Often, the German original was provided as well when the flavor of the original text made a quotation in German imperative.
We have chosen the original German texts, not the various English translations, as the basis for our discussion. Thus references are always to the German edition (the thirteen-volume edition of 1960–1974, since the new Frankfurt edition is just beginning to appear). For this reason, the titles of Mann's works are given in their original form and only translated the first time they occur in each essay. Most English renderings of Mann's texts are by the individual contributors. Some contributors have used existing translations if they were close enough to Mann's meaning.
Although we attribute equal importance to Mann's shorter narratives, we wanted to distinguish those clearly from the long novels. Publication records are often confusing. “Der Tod in Venedig,” for example, was designated a “Novelle” in its first printings. First published in the journal Neue Rundschau in 1911, it appeared in 1912 as a privately printed book (to add to the confusion: the text is a slightly older version than the one in the first printing) and in 1913 as a publicly available book with the revised text of the first printing. In 1922 it was included in a volume called “Novellen” with Mann's approval. Even though the title of this work is often quoted in italics, we decided to treat the work as a novella and place its title in quotation marks. We did the same with all the other shorter narratives, including “Herr und Hund” and “Die vertauschten Köpfe.” The latter works appeared first in book form but were subsequently included in collected volumes of stories.