Familie - Generation - Institution. Generationenkonzepte in der Vormoderne

Dieser Band versammelt Beiträge zu Generationenbeziehungen und Generationenkonzepten in der Vormoderne, die auf eine Tagung des DFG-Graduiertenkollegs 'Generationenbewusstsein und Generationenkonflikte in Antike und Mittelalter' in Bamberg zurückgehen. Die behandelten Untersuchungsgegenstände reichen von den antiken Diadochenreichen über die ottonische Königsfamilie des 10. und 11. Jahrhunderts bis zum frühneuzeitlichen Landadel Westfalens. Dabei werden historische, literaturwissenschaftliche und soziologische Fragestellungen aufgegriffen, um den Erkenntniswert des Konzepts 'Generation' interdisziplinär zu diskutieren.This volume brings together contributions on generational relations and concepts of generation in Early Modernity given on the occasion of a conference organized at Bamberg by the Research Training Group of the German Research Foundation (DFG) 'Generational Awareness and Generational Conflicts in Antiquity and the Middle Ages'. The topics ranged from the ancient Diadoch kingdoms to the history of the Ottonian royal family of the 10th and 11th centuries and the early modern landed gentry in Westfalia. Addressing questions from historical, literary and social studies the validity of the concept of 'generation' was discussed among scholars and students from a variety of disciplines

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Benefits and Harms of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

Sodium-glucose co-transporter 2 inhibitors (SGLT2-i) are a novel drug class for the treatment of diabetes. We aimed at describing the maximal benefits and risks associated with SGLT2-i for patients with type 2 diabetes.Systematic review and meta-analysis.We included double-blinded, randomised controlled trials (RCTs) evaluating SGLT2-i administered in the highest approved therapeutic doses (canagliflozin 300 mg/day, dapagliflozin 10 mg/day, and empagliflozin 25 mg/day) for ≥12 weeks. Comparison groups could receive placebo or oral antidiabetic drugs (OAD) including metformin, sulphonylureas (SU), or dipeptidyl peptidase 4 inhibitors (DPP-4-i). Trials were identified through electronic databases and extensive manual searches. Primary outcomes were glycated haemoglobin A1c (HbA1c) levels, serious adverse events, death, severe hypoglycaemia, ketoacidosis and CVD. Secondary outcomes were fasting plasma glucose, body weight, blood pressure, heart rate, lipids, liver function tests, creatinine and adverse events including infections. The quality of the evidence was assessed using GRADE.Meta-analysis of 34 RCTs with 9,154 patients showed that SGLT2-i reduced HbA1c compared with placebo (mean difference -0.69%, 95% confidence interval -0.75 to -0.62%). We downgraded the evidence to 'low quality' due to variability and evidence of publication bias (P = 0.015). Canagliflozin was associated with the largest reduction in HbA1c (-0.85%, -0.99% to -0.71%). There were no differences between SGLT2-i and placebo for serious adverse events. SGLT2-i increased the risk of urinary and genital tract infections and increased serum creatinine, and exerted beneficial effects on bodyweight, blood pressure, lipids and alanine aminotransferase (moderate to low quality evidence). Analysis of 12 RCTs found a beneficial effect of SGLT2-i on HbA1c compared with OAD (-0.20%, -0.28 to -0.13%; moderate quality evidence).This review includes a large number of patients with type 2 diabetes and found that SGLT2-i reduces HbA1c with a notable increased risk in non-serious adverse events. The analyses may overestimate the intervention benefit due bias

Validation of the Short Version (TLS-15) of the Triangular Love Scale (TLS-45) Across 37 Languages

Love is a phenomenon that occurs across the world and affects many aspects of human life, including the choice of, and process of bonding with, a romantic partner. Thus, developing a reliable and valid measure of love experiences is crucial. One of the most popular tools to quantify love is Sternberg’s 45-item Triangular Love Scale (TLS-45), which measures three love components: intimacy, passion, and commitment. However, our literature review reveals that most studies (64%) use a broad variety of shortened versions of the TLS-45. Here, aiming to achieve scientific consensus and improve the reliability, comparability, and generalizability of results across studies, we developed a short version of the scale—the TLS-15—comprised of 15 items with 5-point, rather than 9-point, response scales. In Study 1 (N = 7,332), we re-analyzed secondary data from a large-scale multinational study that validated the original TLS-45 to establish whether the scale could be truncated. In Study 2 (N = 307), we provided evidence for the three-factor structure of the TLS-15 and its reliability. Study 3 (N = 413) confirmed convergent validity and test–retest stability of the TLS-15. Study 4 (N = 60,311) presented a large-scale validation across 37 linguistic versions of the TLS-15 on a cross-cultural sample spanning every continent of the globe. The overall results provide support for the reliability, validity, and cross-cultural invariance of the TLS-15, which can be used as a measure of love components—either separately or jointly as a three-factor measure

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Der Effekt von Stress auf die Übernahmeperformanz beim hochautomatisierten Fahren

Während die beeinträchtigende Wirkung von Stress auf die Sicherheit im Straßenverkehr in Studien zum manuellen Fahren bereits belegt wurde, ist die Rolle von Stress auf die Übernahmeperformanz beim hochautomatisierten Fahren noch unbekannt. Daher untersuchte die vorliegende Masterarbeit die Fragestellung, inwieweit sich verschiedene Stresslevel auf die Übernahmeperformanz auswirken. Hierzu wurde eine Fahrsimulatorstudie mit 30 Teilnehmenden am Deutschen Zentrum für Luft- und Raumfahrt in Braunschweig durchgeführt. Das Stressniveau der Probanden wurde mittels vier Versuchsbedingungen variiert, in denen die Probanden ohne Zeitdruck (WorkloadBedingung), unter Zeitdruck Herausforderungs-Bedingung) oder mit Zielblockierung unter Zeitdruck (Frustrations-Bedingung) eine Abwandlung der Surrogate Reference Task während des hochautomatisierten Fahrens ausführen sollten. Zusätzlich gab es eine Kontrollbedingung ohne Zweitaufgabe. Im Anschluss an das hochautomatisierte Fahren mit/ohne Zweitaufgabe mussten die Probanden die Kontrolle über das Fahrzeug nach Aufforderung übernehmen. Die Zweitaufgabe erhöhte das Stressempfinden sowie positive bzw. negative Affekte in der Herausforderungs- bzw. Frustrations-Bedingung. Im Hinblick auf die Übernahmeperformanz ergab sich, dass die Probanden in der HerausforderungsBedingung signifikant länger brauchten, um ihren Blick auf die Straße zu richten. Ausbleibende Effekte für die Frustrations-Bedingung auf die Übernahmeperformanz könnten damit erklärt werden, dass das induzierte Niveau an Distress und Frustration relativ gering war und somit nicht ausgereicht hat, um einen leistungsmindernden Effekt von Stress zum Vorschein zu bringen. Weitere Forschung mit höheren Stressniveaus ist erforderlich

Road Users’ Reports on Danger Spots: The Crowd as an Underestimated Expert?

As part of the project EDDA+ (Early Detection of Dangerous Areas in road traffic using smart data), a web-based crowdsourcing platform has been launched on which road users can report danger spots they face in everyday traffic. Whereas official police collision data can only be used reactively, these user reports are intended to warn other road users and provide road safety stakeholders with detailed information for proactive measures. Since this approach is relatively novel, the present pilot study aimed to evaluate the validity of these subjective road user reports. A quasi-randomized sample of N = 77 danger spots distributed over four major German cities was audited using a 70-item objective road safety deficit inventory to identify infrastructural deficits. Based on these items, an overall rating of objective hazardousness for each danger spot was derived. In more than half of the audited danger spots, infrastructural deficits were identified in the audit (=confirmed hazard). In another quarter of audited dangers spots, the reported hazard could not be identified without any doubt due to a lack of infrastructural deficit or detailed information about the nature of the hazard (=uncertain, no certain match between audit and report). Our analysis further revealed that an increased number of road user interactions for the respective danger spot yielded a higher likelihood of confirmation of a danger spot’s hazardousness. Descriptively, pedestrians and bicyclists were most often mentioned as exposed to danger, with the most prevalent nature of danger being areas with poor visibility and misconduct by drivers. The results were blended with police collision data in the next step. We did not find a significant relationship between our danger spots’ rating and the number of collisions at the respective spot. Our results indicate that reports of danger spots and the increased user related activity can serve as an indicator for the early detection of road traffic hazards

Road Users&rsquo; Reports on Danger Spots: The Crowd as an Underestimated Expert?

As part of the project EDDA+ (Early Detection of Dangerous Areas in road traffic using smart data), a web-based crowdsourcing platform has been launched on which road users can report danger spots they face in everyday traffic. Whereas official police collision data can only be used reactively, these user reports are intended to warn other road users and provide road safety stakeholders with detailed information for proactive measures. Since this approach is relatively novel, the present pilot study aimed to evaluate the validity of these subjective road user reports. A quasi-randomized sample of N = 77 danger spots distributed over four major German cities was audited using a 70-item objective road safety deficit inventory to identify infrastructural deficits. Based on these items, an overall rating of objective hazardousness for each danger spot was derived. In more than half of the audited danger spots, infrastructural deficits were identified in the audit (=confirmed hazard). In another quarter of audited dangers spots, the reported hazard could not be identified without any doubt due to a lack of infrastructural deficit or detailed information about the nature of the hazard (=uncertain, no certain match between audit and report). Our analysis further revealed that an increased number of road user interactions for the respective danger spot yielded a higher likelihood of confirmation of a danger spot&rsquo;s hazardousness. Descriptively, pedestrians and bicyclists were most often mentioned as exposed to danger, with the most prevalent nature of danger being areas with poor visibility and misconduct by drivers. The results were blended with police collision data in the next step. We did not find a significant relationship between our danger spots&rsquo; rating and the number of collisions at the respective spot. Our results indicate that reports of danger spots and the increased user related activity can serve as an indicator for the early detection of road traffic hazards