Quality assessment, inclusive community development, and collective learning: An institutional perspective from Germany

This article reviews the German discourse on quality of life, quality assurance, and outcome measurement in services for persons with intellectual disabilities. Following institutional assumptions of path dependencies in organizational development, it is argued that concepts such as quality assurance must be understood in the context of the national support system development. For the Federal Republic of Germany, it can be noted that previous approaches to quality assurance of services based on measurement and evaluation tools have not been the drivers of innovation for inclusion. The driving forces behind reforms in the field of disability originated from the three angles of the social service structure (people with disabilities, statutory welfare agencies, and service providers). Policies of key actors were not part of a consistent reform strategy. However, the main elements of the inclusive philosophies of the disability rights movement became hegemonial and led to national legislation that prioritizes person-centered support arrangements in inclusive settings. With regard to governance arrangements in Germany and the idiosyncrasies of local disability fields, it is suggested that there should be a conceptualization of quality assurance in a multilevel approach as “local quality dialogues for collective learning.

Malate plays a crucial role in starch metabolism, ripening, and soluble solid content of tomato fruit and affects postharvest softening

Despite the fact that the organic acid content of a fruit is regarded as one of its most commercially important quality traits when assessed by the consumer, relatively little is known concerning the physiological importance of organic acid metabolism for the fruit itself. Here, we evaluate the effect of modifying malate metabolism in a fruit-specific manner, by reduction of the activities of either mitochondrial malate dehydrogenase or fumarase, via targeted antisense approaches in tomato (Solanum lycopersicum). While these genetic perturbations had relatively little effect on the total fruit yield, they had dramatic consequences for fruit metabolism, as well as unanticipated changes in postharvest shelf life and susceptibility to bacterial infection. Detailed characterization suggested that the rate of ripening was essentially unaltered but that lines containing higher malate were characterized by lower levels of transitory starch and a lower soluble sugars content at harvest, whereas those with lower malate contained higher levels of these carbohydrates. Analysis of the activation state of ADP-glucose pyrophosphorylase revealed that it correlated with the accumulation of transitory starch. Taken together with the altered activation state of the plastidial malate dehydrogenase and the modified pigment biosynthesis of the transgenic lines, these results suggest that the phenotypes are due to an altered cellular redox status. The combined data reveal the importance of malate metabolism in tomato fruit metabolism and development and confirm the importance of transitory starch in the determination of agronomic yield in this species.Fil: Centeno, Danilo C.. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Osorio, Sonia. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Nunes Nesi, Adriano. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Bertolo, Ana L. F.. Cornell University; Estados UnidosFil: Carneiro, Raphael T.. Cornell University; Estados UnidosFil: Araújo, Wagner L.. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Steinhauser, Marie Caroline. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Michalska, Justyna. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Rohrmann, Johannes. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Geigenberger, Peter. Technische Universitat München; AlemaniaFil: Oliver, Sandra N.. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Stitt, Mark. Max Planck Institute Of Molecular Plant Physiology; AlemaniaFil: Carrari, Fernando Oscar. Instituto Nacional de Tecnología Agropecuaria. Centro de Investigación en Ciencias Veterinarias y Agronómicas. Instituto de Biotecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rose, Jocelyn K. C.. Cornell University; Estados UnidosFil: Fernie, Alisdair R.. Max Planck Institute Of Molecular Plant Physiology; Alemani

Cost-effectiveness of physical activity interventions in cancer survivors of developed countries: a systematic review

Physical activity has been shown to improve survival and quality of life of cancer patients. Due to differences in patient populations, healthcare settings, and types of intervention, cost-effectiveness analyses of physical activity interventions in cancer survivors are difficult to compare. Available evidence from breast cancer survivor research has shown inconsistent results, and transfer of results to other types of cancer is not straightforward. This paper systematically reviewed current evidence on the cost-effectiveness of physical activity interventions in cancer survivors independent of cancer type compared to usual care or another experimental intervention.; The literature search was conducted in seven databases and enhanced by a search for gray literature. Eligible studies were restricted to developed countries and assessed using the CHEERS, CHEC, and PHILIPS checklists. The study protocol was pre-published in PROSPERO.; Seven studies, five cost-utility, and two combined cost-utility/cost-effectiveness analyses fully met the inclusion criteria. They covered eight different types of cancer and various interventions. The cost-effectiveness analyses were of moderate to high methodological quality. A high probability of cost-effectiveness was reported in two analyses. One intervention appeared to be not cost-effective, and one to be cost-effective only from an organizational perspective. Three other analyses reported a cost-effectiveness better than US$ 101,195 (Euro 80,000) per QALY gained.; Physical activity interventions in cancer survivors of developed countries were cost-effective in some but not all clinical trials reviewed.; Cost-effectiveness of physical activity interventions appear to depend upon the intensity of the activity

Evaluation of the obesity genes FTO and MC4R and the type 2 diabetes mellitus gene TCF7L2 for contribution to stroke risk: the Mannheim-Heidelberg stroke study

Objective: Studies evaluating genetic markers for vascular risk and risk of stroke are limited, and none of them evaluated obesity genes. The objective was to investigate the genetic markers related to obesity genes FTO and MC4R and the gene of type 2 diabetes mellitus TCF7L2 for their contribution to risk of stroke and transient ischemic attacks (TIA). Methods: We recruited 379 consecutive patients with stroke/TIA and 379 healthy population-based controls. The single-nucleotide polymorphisms (SNPs) rs9937053 (FTO), rs2229616 (MC4R V103I), rs17782313 (188kb downstream of MC4R), and rs7903146 (TCF7L2) were evaluated for association with stroke using logistic regression analyses. Results: The odds ratios for stroke/TIA were 1.14 (95%CI 0.91-1.42) for rs9937053/FTO, 1.11 (95%CI 0.49-2.51) for rs2229616/MC4R, 1.05 (95%CI 0.82-1.3) for rs17782313/MC4R, and 0.99 (95%CI 0.78-1.25) for rs7903146/TCF7L2. Further exploration revealed that male patients with the T allele of rs7903146/TCF7L2 had a worse clinical outcome compared with male patients carrying the C allele. Conclusion: The observed trends of obesity risk alleles for risk of stroke/TIA as well as the possible sex-specific differences in clinical outcomes found for the TCF7L2 (rs7903146) require replication in future studies. Our study demonstrates that candidate gene studies for common stroke may benefit from focusing on polymorphisms that predispose to vascular risk

Angiogenic factors and acute-phase proteins in serum samples of preeclampsia and HELLP patients: a matched-pair analysis

To investigate the serum level distribution of angiogenic markers (PlGF, endoglin, sFlt-1) and acute-phase proteins (SAA, CRP) in patients with HELLP syndrome or preeclampsia (PE) including matched controls

Two different coercivity lattices in Co/Pd multilayers generated by single-pulse direct laser interference lithography

We report on magnetic structuring of Co/Pd multilayer films with strong perpendicular magnetic anisotropy by single-pulse direct laser interference lithography technique. Multibeam laser interference generates patterns of various types. The intense laser irradiation at interference maxima causes chemical intermixing at Co/Pd interfaces, leading to local changes in magnetic properties such as the creation of pinning centers and the reduction in the strength of magnetic anisotropy. We use magnetic force microscopy and Kerr microscopy to study the magnetization reversal processes in the patterned samples and find that the structures show three distinctly different behaviors depending on the intensity of the laser used for irradiation