Interventions for Tobacco Prevention and Control in Humanitarian Settings: A Scoping Review.

INTRODUCTION: Tobacco usage is an epidemic as statistics point towards smoking as the second leading cause of death. Populations experiencing humanitarian emergencies may experience a higher propensity for tobacco, alcohol, and other substance abuse disorders. This review aimed to map tobacco prevention and control interventions in humanitarian settings. METHODS: The search for this scoping review was conducted in six databases and supplemented with a gray literature search. Articles were screened at title-abstract and full-text by two pairs of authors, and data was abstracted by three individuals independently. An adapted diffusion of governance framework is used to discuss the findings. RESULTS: A total of 26 articles were included from the searches conducted in the databases and grey literature. The interventions targeted all age groups. The documents retrieved from the grey literature search were classified as population-based interventions, as they were not restricted to a particular group of individuals. Interventions were delivered at various locations, using different methods and engaging multiple stakeholders. Interventions assessed were grouped into packaging, labeling, and other policy interventions (pricing and taxes). CONCLUSION: There are few tobacco prevention and control interventions in the humanitarian context. The diffusion of governance perspective in implementing these interventions in humanitarian settings provides a cue for inter-sectoral cooperation among different stakeholders and disciplines beyond the health sector. Our review recommends exploring complementarity between the demand and supply side interventions for tobacco control. IMPLICATIONS: The scoping review has highlighted various tobacco prevention and control efforts in humanitarian settings. The interventions were delivered using various modes, and yet the burden of smoking is higher among the humanitarian population. Further research may use impact evaluation techniques to assess the impact of these interventions to facilitate the re-design of the implementation approach and policy priorities.

Macroscopic dynamics of the ferroelectric smectic [Formula: see text] phase with [Formula: see text] symmetry.

We present the macroscopic dynamics of ferroelectric smectic A, smectic [Formula: see text], liquid crystals reported recently experimentally by three groups. In this fluid and orthogonal smectic phase, the macroscopic polarization, [Formula: see text], is parallel to the layer normal thus giving rise to [Formula: see text] overall symmetry for this phase in the spatially homogeneous limit. A combination of linear irreversible thermodynamics and symmetry arguments is used to derive the resulting dynamic equations applicable at sufficiently low frequencies and sufficiently long wavelengths. Compared to non-polar smectic A phases, we find a static cross-coupling between compression of the layering and bending of the layers, which does not lead to elastic forces, but to elastic stresses. In addition, it turns out that a reversible cross-coupling between flow and the magnitude of the polarization modifies the velocities of both, first and second sound. At the same time, the relaxation of the polarization gives rise to dissipative effects for second sound at the same order of the wavevector as for the sound velocity. We also analyze reversible cross-coupling terms between elongational flow and electric fields as well as temperature and concentration gradients, which lend themselves to experimental detection. Apparently this type of terms has never been considered before for smectic phases. The question how the linear [Formula: see text] coupling in the energy alters the macroscopic response behavior when compared to usual non-polar smectic A phases is also addressed.

External concentration gradients can drive a propagating wave in a coherently layered system of nanosheets.

We present a model for the dynamics observed recently by Sano et al. [Nat. Commun. 12, 6771 (2021)] in a coherently layered system made up of sheetlike colloidal particles (nanosheets) subjected to an external concentration gradient. Adding a new macroscopic variable characteristic for the nonequilibrium situation encountered in the experiments to the hydrodynamics of smectic A liquid crystals, we show that all salient dynamic features observed in the experiments can be accounted for. For this nonequilibrium phenomenon, we identify the symmetry of the underlying ground state as undulating smectic A-like layering and the applied concentration gradient applied in the layer planes as the nonequilibrium driving force. As a result of our analysis, we find a coherent motion of undulating layers generated by a Helfrich-Hurault type instability propagating at a fixed velocity in accordance with the observations. If the coherence of the layering is lost, there is no longer any coherent propagation to be expected-as is also observed.

District-Level Mortality Convergence in Reunified Germany: Long-Term Trends and Contextual Determinants.

The mortality gap between former East and West Germany decreased rapidly in the decade following the reunification of the country in 1990. However, because no previous study has estimated life expectancy (e0) over time for all German districts, the extent of mortality convergence across districts and its determinants are largely unknown. We used a novel relational Bayesian model to estimate district e0 in Germany during 1997-2016, examined mortality convergence using a novel convergence groups approach, and explored the role of selected district characteristics in the process. Differences in e0 between German districts decreased for both sexes during 1997-2016, mainly driven by rapid mortality improvements in eastern German districts. However, considerable heterogeneity in district-level e0 trajectories within federal states was evident. For example, district clusters in northwestern Germany showed increasing e0 disadvantage, which led to a north-south divergence in mortality. A multinomial regression analysis showed a robust association between the e0 trajectory and the district-level tax base and long-term unemployment but not with hospital density. Thus, an equitable "leveling up" of health seems possible with policies investing in places and the people who inhabit them.

Characterization of time-dependence for dissipative solitons stabilized by nonlinear gradient terms: Periodic and quasiperiodic vs chaotic behavior.

We investigate the properties of time-dependent dissipative solitons for a cubic complex Ginzburg-Landau equation stabilized by nonlinear gradient terms. The separation of initially nearby trajectories in the asymptotic limit is predominantly used to distinguish qualitatively between time-periodic behavior and chaotic localized states. These results are further corroborated by Fourier transforms and time series. Quasiperiodic behavior is obtained as well, but typically over a fairly narrow range of parameter values. For illustration, two examples of nonlinear gradient terms are examined: the Raman term and combinations of the Raman term with dispersion of the nonlinear gain. For small quintic perturbations, it turns out that the chaotic localized states are showing a transition to periodic states, stationary states, or collapse already for a small magnitude of the quintic perturbations. This result indicates that the basin of attraction for chaotic localized states is rather shallow.

A two-fluid model for the macroscopic behavior of polar nematic fluids and gels in a nonchiral or a chiral solvent.

We present the macroscopic dynamics of polar nematic liquid crystals in a two-fluid context. We investigate the case of a nonchiral as well as of a chiral solvent. In addition, we analyze how the incorporation of a strain field for polar nematic gels and elastomers in a solvent modifies the macroscopic dynamics. It turns out that the relative velocity between the polar subsystem and the solvent gives rise to a number of cross-coupling terms, reversible as well as irreversible, unknown from the other two-fluid systems considered so far. Possible experiments to study those novel dynamic cross-coupling terms are suggested. As examples we just mention that gradients of the relative velocity lead, in polar nematics to heat currents and in polar cholesterics to temporal changes of the polarization. In polar cholesterics, shear flows give rise to a temporal variation in the velocity difference perpendicular to the shear plane, and in polar nematic gels uniaxial stresses or strains generate temporal variations of the velocity difference.

Ferromagnetic nematics: A macroscopic two-fluid description.

We present the macroscopic dynamic description of a ferromagnetic nematic, where the nematic part and the magnetic part can move relative to each other. The relative velocity that describes such movements can be a slowly relaxing variable. Its couplings to the nematic and the magnetic degrees of freedom are particularly interesting since the symmetry properties (behavior under spatial inversion and time reversal) of the three vectorial quantities involved are all different. As a consequence, a number of new crosscouplings involving the relative velocity exist. Some of them are discussed in more detail. First, we demonstrate that transverse temperature gradients generate transverse relative velocities and, vice versa, that transverse relative velocities give rise to temperature gradients. Second, we show that a simple shear flow in the relative velocity with the preferred direction in the shear plane can lead in a stationary situation to a tilt of the magnetization.

Dissipative solitons stabilized by nonlinear gradient terms: Time-dependent behavior and generic properties.

We study the time-dependent behavior of dissipative solitons (DSs) stabilized by nonlinear gradient terms. Two cases are investigated: first, the case of the presence of a Raman term, and second, the simultaneous presence of two nonlinear gradient terms, the Raman term and the dispersion of nonlinear gain. As possible types of time-dependence, we find a number of different possibilities including periodic behavior, quasi-periodic behavior, and also chaos. These different types of time-dependence are found to form quite frequently from a window structure of alternating behavior, for example, of periodic and quasi-periodic behaviors. To analyze the time dependence, we exploit extensively time series and Fourier transforms. We discuss in detail quantitatively the question whether all the DSs found for the cubic complex Ginzburg-Landau equation with nonlinear gradient terms are generic, meaning whether they are stable against structural perturbations, for example, to the additions of a small quintic perturbation as it arises naturally in an envelope equation framework. Finally, we examine to what extent it is possible to have different types of DSs for fixed parameter values in the equation by just varying the initial conditions, for example, by using narrow and high vs broad and low amplitudes. These results indicate an overlapping multi-basin structure in parameter space.

Health literacy and body mass index: a population-based study in a South-Eastern European country.

BACKGROUND: The relationship of health literacy (HL) with objective measures including anthropometric measurements remains an under-researched topic to date. OBJECTIVE: To assess the association between body mass index (BMI) and HL among Albanian adults. METHODS: A cross-sectional study was conducted in Tirana, Albania, in 2012-2014 including a population-based sample of 1154 individuals aged ≥18 years. HL was assessed by the use of HLS-EU-Q instrument. Anthropometrics included measurement of weight and height based on which BMI was calculated. Information on socio-demographic characteristics was also collected. Logistic regression was employed to assess the independent association of BMI and HL controlling all socio-demographic factors. RESULTS: One-fifth of the participants reported an inadequate HL level, whereas almost one-third (31%) reported an excellent HL level. About 41% of study participants were overweight and further 22% were obese. In multivariate analysis, there was evidence of a strong and significant association between BMI and HL: the odds of overweight/obesity were two times higher (OR = 2.0, 95% CI = 1.3-3.1) among inadequate HL individuals compared with excellent HL participants. CONCLUSION: Our findings, pertinent to a transitional country in the South East Europe, point to a strong, consistent and highly significant association between BMI and HL, irrespective of a wide array of socio-demographic characteristics.

Organ transplantation and the European Union, 2009-2015 developments.

This article provides a high-level picture of the developments in organ transplantation in the European Union (EU) between 2009 and 2015. This was the period during which the European Commission and EU 28 member states developed an EU Action Plan on organ donation and transplantation. This plan was adopted by the European Commission in 2008, following calls for policy action to increase transplant numbers. It set out priority actions for member states and European Commission to address. This article describes the three main approaches used by the European Commission and National Competent Authorities to develop this action plan. We also present a quantitative comparison of 2015 and 2008 transplant data, based on the Newsletter Transplant by the Council of Europe (CoE) and the Spanish National Transplant Agency (ONT). This comparison shows contributions of different EU Member States, as well as of different donation and transplant programs to the overall increase of 4597 transplants per year (+16.4%). While another evaluation study of the action plan reported a strong positive impact of the action plan, it is beyond the remit of this publication to demonstrate a causal relationship between the EU Action Plan and the increase in number of organ transplants.

Mortality convergence in the enlarged European Union: a systematic literature review.

BACKGROUND: The high mortality rates in the European Union (EU) Member States that acceded in 2004 sparked political interest in mortality convergence. Whether mortality is converging in the EU remains unclear. We reviewed the literature on mortality convergence in the post-2004 EU territory as a whole. We also explored whether the study designs influenced the results and whether any determinants of mortality convergence had been empirically examined. METHODS: A systematic literature review was performed. Our search included scientific databases and the websites of international governmental institutions and European demographic research institutes. RESULTS: We uncovered 94 unique records and included seven studies that reported on 36 analyses. There was marked methodological heterogeneity, including in the convergence measures (beta and sigma convergence). All of the beta convergence analyses found narrowing mortality differentials, whereas most of the sigma convergence analyses found widening mortality differentials. The results are robust to the units of analysis and mortality and dispersion measures. Our results also suggest that there is a lack of evidence on the determinants of mortality convergence in the EU. CONCLUSIONS: There is general agreement that the EU regions and the Member States with high initial mortality rates improved the fastest, but this trend did not lead to overall mortality convergence in the EU. The harmonization of mortality convergence measures and research into determinants of mortality convergence are needed to support future EU cohesion policy. Policy-makers should consider supporting areas that have moderate but stagnant mortality rates, in addition to those with high mortality rates.

Dissipative soliton stabilization by several nonlinear gradient terms.

We study a single cubic complex Ginzburg-Landau equation with nonlinear gradient terms analytically and numerically. This single equation allows for the existence of stable dissipative solitons exclusively due to nonlinear gradient terms. We shed new light on the feedback loop, leading to dissipative solitons (DSs) by analyzing a mechanical analog as a function of the magnitude of the amplitude. In addition, we present analytic results incorporating four nonlinear gradient terms and derive necessary conditions for the existence of DSs. We also elucidate in detail for the case of the Raman contribution the scaling behavior for the limit of the vanishing Raman term.

Comparability in Cross-National Health Research Using Insurance Claims Data: The Cases of Germany and The Netherlands.

OBJECTIVE: Comparison is a key method in learning about what works in health and healthcare. We discuss the importance of comparability in cross-national health research using health insurance claims data, develop a framework to systematically asses these threats and apply it to the German (DaTraV) and Dutch (Vektis) national-level insurance claims datasets. METHODS: We propose a framework of threats to the comparability of health insurance claims databases, which includes three domains: (1) representation of populations compared, (2) data sources and data processing and (3) database contents and availability for research purposes. We apply the framework to analyze the comparability of DaTraV and Vektis databases using publicly available information (organization's websites, scientific publications) and our experiences from an interregional project on rare diseases (EMRaDi). RESULTS: Both databases were created for the same purpose (morbidity-based risk adjustment) and use the same underlying sources of data. Differences in population representation and uncertainty about data processing procedures represent potential sources of incomparability. Access for research purposes is feasible in both databases but may be subject to long processing time. CONCLUSIONS: We find important threats to the comparability of the Dutch and German national insurance claims databases and by extension to validity of any comparative health studies that rely on them. Standard adjustment techniques, making more information available about data collection and processing procedures and adding more diagnosis-related descriptors offer ways to overcome the identified threats to comparability.

A dynamic preferred direction model for the self-organization dynamics of bacterial microfluidic pumping.

It is known that some flagellated bacteria like Serratia marcescens, when deposited and affixed onto a surface to form a "bacterial carpet", self-organize in a collective motion of the flagella that is capable of pumping fluid through microfluidic channels. We set up a continuum model comprising two macroscopic variables that is capable of describing this self-organization mechanism as well as quantifying it to the extent that an agreement with the experimentally observed channel width dependence of the pumping is reached. The activity is introduced through a collective angular velocity of the helical flagella rotation, which is an example of a dynamic macroscopic preferred direction. Our model supports and quantifies the view that the self-coordination is due to a positive feedback loop between the bacterial flagella and the local flow generated by their rotation. Moreover, our results indicate that this biological active system is operating close to the self-organization threshold.

Ethics, health policy-making and the economic crisis: a qualitative interview study with European policy-makers.

BACKGROUND: The economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from. The aim of this research was to assess the relevance of ethics and to highlight ethical dimensions in decision-taking by policy-makers with regard to policy and priority-setting in health systems posed by the economic crisis. METHODS: Semi-structured qualitative interviews were conducted with eight European policy-makers from six countries. RESULTS: All interviewees recalled difficult and strenuous situations where they had to prioritise between distinct areas to focus on and invest in, for example around choices between prioritising medications, health professional staffing, care specific equipment, or urgent infrastructure issues. Values could be identified which they deemed as important within the policy-making process, such as trust and responsibility. They explicitly expressed the need for ethical tools and assistance in terms of policy advice for reaching morally sustainable decisions in health policy matters. CONCLUSIONS: The study showed that ethical concepts and values frequently come into play in health policy-making, and that ethics is highly relevant in policy-makers' daily decision-taking, yet that they lack ethical guidance on what to base their decisions. The study is of relevance since it can provide future decisions on austerity-related issues with an ethical underpinning and could identify areas of moral concern.

Cubic and tetragonal liquid crystal phases composed of non-chiral molecules: Chirality and macroscopic properties.

We discuss the symmetry properties as well as the macroscopic behavior of the cubic liquid crystal phases showing large chiral domains of either hand in some non-chiral compounds reported recently in the group of Tschierske. These phases are tricontinuous. While they have O or I432 symmetry in each chiral domain, the overall symmetry is [Formula: see text] as there is no net chirality for compounds composed of non-chiral molecules. It turns out that a rather similar type of phase has also been reported for triblock copolymers. Here we analyze in detail the macroscopic static and dynamic behavior of such phases and we predict, among other results, that they show the analog of static and dissipative Lehmann-type effects in their chiral domains. A description of a cubic liquid crystalline phase of Th symmetry, which has not yet been found experimentally, is also included. Suggestions for experiments are outlined to identify such a phase. In addition, we discuss tetragonal liquid crystalline phases of D4h and D4 (I422) symmetry as they have been reported last year experimentally in connection to the Q phase.

Influence of tetrahedral order on ferromagnetic gel phases.

We investigate the macroscopic dynamics of gels with tetrahedral/octupolar symmetry, which possess in addition a spontaneous permanent magnetization. We derive the corresponding static and dynamic macroscopic equations for a phase, where the magnetization is parallel to one of the improper fourfold tetrahedral symmetry axes. Apart from elastic strains, we take into account relative rotations between the magnetization and the elastic network. The influence of tetrahedral order on these degrees of freedom is investigated and some experiments are proposed that are specific for such a material and allow to indirectly detect tetrahedral order. We also consider the case of a transient network and predict that stationary elastic shear stresses arise when a temperature gradient is applied.

Continuum model of magnetic field induced viscoelasticity in magnetorheological fluids.

An effective macroscopic model of magnetorheological fluids in the viscoelastic regime is proposed. Under the application of an external magnetic field, columns of magnetizable particles are formed in these systems. The columns are responsible for solidlike properties, such as the existence of elastic shear modulus and yield stress, and are captured by the strain field, while magnetic properties are described by the magnetization. We investigate the interplay of these variables when static shear or normal pressure is imposed in the presence of the external magnetic field. By assuming a relaxing strain field, we calculate the flow curves, i.e., the shear stress as a function of the imposed shear rate, for different values of the applied magnetic field. Focusing on the small amplitude oscillatory shear, we study the complex shear modulus, i.e., the storage and the loss moduli, as a function of the frequency. We demonstrate that already such a minimal model is capable of furnishing many of the key physical features of these systems, such as yield stress, enhancement of the shear yield stress by pressure, threshold behavior in the spirit of the frequently employed Bingham law, and several features in the frequency dependence of storage and loss moduli.

Application of EASY-Care Standard 2010 instrument in a population-based survey in transitional Kosovo.

BACKGROUND: The aim of this study was to assess the health needs and priorities of older people in Kosovo, the newest state in Europe striving for a functional democracy after the breakdown of former Yugoslavia and the following war in the region. METHODS: A cross-sectional study was conducted in Kosovo in 2011 including a nationwide representative sample of 1890 individuals aged ≥65 years (949 men, mean age: 73 ± 6 years; 941 women, mean age: 74 ± 7 years; overall response rate: 84%). All individuals were administered the full version of EASY-Care Standard 2010 instrument, inquiring about the need for support in activities of daily living ('independence'), the 'risk of breakdown in care' (leading to emergency admission to hospital) and the 'risk of falls'. RESULTS: The degree of 'independence' was lower, whereas the 'risk of breakdown in care' and the 'risk of falls' were significantly higher in: older women; the oldest individuals (≥85 years); rural residents; participants living alone; those perceiving themselves as poor; participants who could not access medical care; those who perceived their general health status as poor; and older people who reported at least one chronic condition. CONCLUSIONS: This is one of the very few reports from Southeast European region informing about the health needs and priorities of older people in a large and representative population-based sample of older men and women. The poor health status of older people, especially evident in the socio-demographic disadvantaged categories, should raise the awareness of policymakers and decision-makers for appropriate health and social care of elderly in Kosovo and in other European countries.