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Do childcare institutions affect gender norms of individuals? I examine the introduction of childcare services and their impact on voters' support of policies promoting maternal employment. I address the inherent endogeneity between institutions and attitudes by exploiting regional variation in the regulations and provision of childcare for school children outside of regular school hours. My results show that the expansion of childcare for school children increases voters' support of policies promoting maternal employment. This indicates a direct effect of local institutions on voters' attitudes. I additionally show that as public costs of the new facilities increase, support of additional policies promoting maternal employment decreases.

Global sulfate production plays a key role in aerosol radiative forcing; more than half of this production occurs in clouds. We found that sulfur dioxide oxidation catalyzed by natural transition metal ions is the dominant in-cloud oxidation pathway. The pathway was observed to occur primarily on coarse mineral dust, so the sulfate produced will have a short lifetime and little direct or indirect climatic effect. Taking this into account will lead to large changes in estimates of the magnitude and spatial distribution of aerosol forcing. Therefore, this oxidation pathway-which is currently included in only one of the 12 major global climate models-will have a significant impact on assessments of current and future climate.

Within the framework of the RACEPAC (Radiation–Aerosol–Cloud Experiment in the Arctic Circle) project, the Arctic aerosol, arriving at a ground-based station in Tuktoyaktuk (Mackenzie River delta area, Canada), was characterized during a period of 3 weeks in May 2014. Basic meteorological parameters and particle number size distributions (PNSDs) were observed and two distinct types of air masses were found. One type were typical Arctic haze air masses, termed accumulation-type air masses, characterized by a monomodal PNSD with a pronounced accumulation mode at sizes above 100 nm. These air masses were observed during a period when back trajectories indicate an air mass origin in the north-east of Canada. The other air mass type is characterized by a bimodal PNSD with a clear minimum around 90 nm and with an Aitken mode consisting of freshly formed aerosol particles. Back trajectories indicate that these air masses, termed Aitken-type air masses, originated from the North Pacific. In addition, the application of the PSCF receptor model shows that air masses with their origin in active fire areas in central Canada and Siberia, in areas of industrial anthropogenic pollution (Norilsk and Prudhoe Bay Oil Field) and the north-west Pacific have enhanced total particle number concentrations (NCN). Generally, NCN ranged from 20 to 500 cm−3, while cloud condensation nuclei (CCN) number concentrations were found to cover a range from less than 10 up to 250 cm−3 for a supersaturation (SS) between 0.1 and 0.7 %. The hygroscopicity parameter κ of the CCN was determined to be 0.23 on average and variations in κ were largely attributed to measurement uncertainties. Furthermore, simultaneous PNSD measurements at the ground station and on the Polar 6 research aircraft were performed. We found a good agreement of ground-based PNSDs with those measured between 200 and 1200 m. During two of the four overflights, particle number concentrations at 3000 m were found to be up to 20 times higher than those measured below 2000 m; for one of these two flights, PNSDs measured above 2000 m showed a different shape than those measured at lower altitudes. This is indicative of long-range transport from lower latitudes into the Arctic that can advect aerosol from different regions in different heights.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Background The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC‐F) questionnaire is a well‐established instrument for screening of sarcopenia and sarcopenia‐related functional impairments. As it is based on self‐reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy‐reported version of the SARC‐F for both ad‐hoc as well as retrospective screening for severe sarcopenia‐related functional impairments. Methods Patients aged ≥60 years completed the SARC‐F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy‐reported SARC‐F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC‐F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non‐inferiority analyses, results of both the patient‐reported and proxy‐reported SARC‐F were correlated with the SPPB total score as well as the results of the chair‐rise test subcategory; the respective correlation coefficients were tested against each other. Results One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy‐reported SARC‐F identified patients at high risk for sarcopenia‐related functional impairment with a sensitivity of 0.81 (ad‐hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad‐hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad‐hoc proxy‐reported SARC‐F and the retrospective proxy‐reported SARC‐F in both cohorts. The proxy‐reported SARC‐F showed a non‐inferior correlation with the SPPB compared with the patient‐reported SARC‐F for ad‐hoc (P = <0.001) as well as retrospective screening for severe sarcopenia‐related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026). Conclusions Proxy‐reported SARC‐F is a valid instrument for both ad‐hoc as well as retrospective screening for sarcopenia‐related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions.

Background: After a diet- or surgery induced weight loss almost 1/3 of lost weight consists of fat free mass (FFM) if carried out without additional therapy. Exercise training and a sufficient supply of protein, calcium and vitamin D is recommended to reduce the loss of FFM. Objective: To investigate the effect of exercise training, protein, calcium, and vitamin D supplementation on the preservation of FFM during non-surgical and surgical weight loss and of the combination of all interventions together in adults with obesity. Methods: A systematic review was performed with a pairwise meta-analysis and an exploratory network meta-analysis according to the PRISMA statement. Results: Thirty studies were included in the quantitative analysis. The pairwise meta-analysis showed for Exercise Training + High Protein vs. High Protein a moderate and statistically significant effect size (SMD 0.45; 95% CI 0.04 to 0.86), for Exercise Training + High Protein vs. Exercise Training a high but statistically not significant effect size (SMD 0.91; 95% CI -0.59 to 2.41) and for Exercise Training alone vs. Control a moderate but statistically not significant effect size (SMD 0.67; 95% CI -0.25 to 1.60). In the exploratory network meta-analysis three interventions showed statistically significant effect sizes compared to Control and all of them included the treatment Exercise Training. Conclusions: Results underline the importance of exercise training and a sufficient protein intake to preserve FFM during weight loss in adults with obesity. The effect of calcium and vitamin D supplementation remains controversial and further research are needed.

Purpose: Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient's treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy. Patients and Methods: PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged [greater than or equal to]70 years with [greater than or equal to]2 chronic conditions and regular intake of [greater than or equal to]5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients' understanding of the task. Results: Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 ([+ or -] 6.0) years, a median score of 28 (range 25-30) points on the Mini-Mental State Examination, and a mean of 11.6 ([+ or -] 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 ([+ or -] 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants. Conclusion: Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy. Keywords: geriatric pharmacotherapy, medication priorities, multimorbidity, multiple chronic conditions, patient-centered, preference assessment

The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were \"medication willingness\" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, \"MediMol\" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.

Sulfate aerosols have the greatest radiative impact on climate systems. Harris et al. (p. 727 ) report that the oxidation of sulfur dioxide gas, catalyzed by natural transition metal ions mostly on the surface of coarse mineral dust, is the dominant pathway for sulfate production in clouds. In view of the growing sulfur dioxide emissions from large, industrializing countries, including this process in climate models should improve the agreement between models and observations. Transition metal ions catalyze most of the oxidation of sulfur dioxide that occurs in clouds. Global sulfate production plays a key role in aerosol radiative forcing; more than half of this production occurs in clouds. We found that sulfur dioxide oxidation catalyzed by natural transition metal ions is the dominant in-cloud oxidation pathway. The pathway was observed to occur primarily on coarse mineral dust, so the sulfate produced will have a short lifetime and little direct or indirect climatic effect. Taking this into account will lead to large changes in estimates of the magnitude and spatial distribution of aerosol forcing. Therefore, this oxidation pathway—which is currently included in only one of the 12 major global climate models—will have a significant impact on assessments of current and future climate.