Horizontaler und vertikaler Föderalismus während einer Pandemie : erste Erfahrungen aus den Massnahmen zur Eindämmung der Covid-19-Krise in der Schweiz

Horizontaler und vertikaler Föderalismus – ein Grundelement des Schweizer Staatssystems. Die heterogene Konstellation des föderalen Systems liegt der hohen kantonalen Autonomie zu Grunde und prägt den Schweizer Föderalismus mit einer grossen Diversität und einem schwachen Zentralstaat. Die Zusammenarbeit zwischen und unter den Staatsebenen ist eine grundsätzliche Voraussetzung, damit das System leistungsfähig und wirkungsvoll funktioniert. Doch jene Zusammenarbeit und Vielfalt schien durch die Covid-19-Pandemie erschüttert. Vor diesem Hintergrund untersucht die vorliegende Bachelorarbeit das föderale Zusammenspiel von Bund und Kantonen während der Covid-19-Pandemie. Dabei werden erste Erfahrungen aus der Bewältigung der Krise gewonnen. Aus diesem Grund wird folgender Frage nachgegangen: «Welche Lehren lassen sich im Zusammenhang mit den getroffenen Massnahmen zur Eindämmung der ersten und zweiten Covid-19-Welle hinsichtlich des horizontalen und vertikalen Föderalismus ziehen?». Zur Beantwortung dieser Fragestellung wird der theoretische Hintergrund der föderalen Strukturen des Schweizer Systems aufgearbeitet. Des Weiteren wird der Föderalismus anwendungsbezogen auf die Covid-19-Krise analysiert. Dabei erfolgt die Untersuchung mittels einer Literaturrecherche. Darüber hinaus werden drei qualitative Experteninterviews durchgeführt, um die vorhandenen Erkenntnisse zu ergänzen sowie weiteres, spezifisches Fachwissen zu erschliessen. Durch die Analyse des horizontalen und vertikalen Föderalismus während der Covid-Krise konnten folgende Erkenntnisse gewonnen und die Forschungsfrage wie folgt beantwortet werden: Der Föderalismus hat in der Krisenbewältigung zu Herausforderungen geführt, dennoch ist er nicht gescheitert. Gleichwohl war er um einiges zentralistischer strukturiert, als dies im Schweizer System üblich ist. Nichtsdestotrotz haben die grundlegenden Prinzipien des Föderalismus funktioniert. So konnte unter anderem die Subsidiarität und die kantonale Vielfalt zu einer effizienten und angemessenen Bewältigung der Krise beigetragen. Die Untersuchung der Zusammenarbeitsstrukturen hat hervorgebracht, dass Zeit ein substanzielles Element im föderalen System ist. Die föderalen Abläufe zwischen Bund und Kantonen waren jedoch nicht auf eine solche Geschwindigkeit, wie sie die Pandemie bedingte, getrimmt. Dazu beigetragen hat auch ein Defizit im Rollenverständnis der Krisengremien. In der Zusammenarbeit zwischen den Ebenen entstanden Zuständigkeits- und Kompetenzverflechtungen sowie unklare Abläufe und Doppelspurigkeiten. Es wäre jedoch verfehlt, den Föderalismus aufgrund dessen anzuzweifeln und ihn in seiner Struktur zu verändern. Vielmehr hat die Pandemie gezeigt, dass die horizontale und vertikale Zusammenarbeit in Krisenzeiten entscheidend ist. Im Wesentlichen hat sie gut funktioniert. Dennoch gilt es für die Zukunft, einfachere und schlankere Strukturen zu schaffen. Die föderalen Abläufe wie auch die Zuständigkeiten und Kompetenzen zwischen dem Bund, den Kantonen und den Konferenzen müssen umfassend geklärt werden. Im Allgemeinen gilt es, die Vernetzung der Ebenen zu optimieren und zu stärken

Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution.

BACKGROUND Different surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft. PURPOSE To evaluate the midterm results of primary surgical repair and suture augmentation to treat KD. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed. RESULTS The mean difference in pre- to postinjury Tegner scores was -2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament-Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7-mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments (P = .007, .004, and .006, respectively). CONCLUSION Primary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage

Increasing the attractiveness of surgical disciplines for students: Implications of a robot-assisted hands-on training course for medical education

BackgroundStructured implementation of robot-assisted surgery in the field of medical education is lacking. We assessed students' interest in robot-assisted surgery and tested if the implementation of a hands-on robotic course into the curriculum could increase the interest to join a surgical discipline in general and especially in female students, since women are clearly underrepresented in surgical disciplines.MethodsAfter a prostate cancer focused seminar, 100 students were 1:1 randomized into two groups. Group B: Baseline characteristics and professional interest were assessed prior and after a hands-on robotic course, using a da Vinci® console with simulator (da Vinci® Surgical training, Intuitive Surgical Inc., USA). Group A served as post-interventional consistency control group, received the questionnaire only once after the hands-on training.ResultsThe male to female ratio of students was 54% and 46%. The interest to turn into urology/surgery, categorized as yes”, “no”, “maybe” changed from 18 to 16%, 36 to 30% and 46 to 54% respectively after the hands-on robotic course (p < 0.001). Also, the positive attitude towards the surgical field significantly increased (20 vs. 48%; p < 0.001). Comparing male and female students, virtually identical proportions (23 vs. 23%) opted for joining urology or surgery as a discipline, whereas rejection (45 vs. 25%) and perchance (32 vs. 50%) of that notion differed between genders (p = 0.12).ConclusionOur results demonstrate great demand for implementing robotic training into medical education for an up-to-date curriculum. Although the decision process on career choice is widely multifactorial, stereotypes associated with surgical disciplines should be eliminated. This could have a particularly positive effect on the recruitment of female medical students since women are clearly underrepresented in surgical disciplines although currently and with increasing proportions, more female students are enrolled in medical schools then male

Differential Response of Pentanal and Hexanal Exhalation to Supplemental Oxygen and Mechanical Ventilation in Rats

High inspired oxygen during mechanical ventilation may influence the exhalation of the previously proposed breath biomarkers pentanal and hexanal, and additionally induce systemic inflammation. We therefore investigated the effect of various concentrations of inspired oxygen on pentanal and hexanal exhalation and serum interleukin concentrations in 30 Sprague Dawley rats mechanically ventilated with 30, 60, or 93% inspired oxygen for 12 h. Pentanal exhalation did not differ as a function of inspired oxygen but increased by an average of 0.4 (95%CI: 0.3; 0.5) ppb per hour, with concentrations doubling from 3.8 (IQR: 2.8; 5.1) ppb at baseline to 7.3 (IQR: 5.0; 10.8) ppb after 12 h. Hexanal exhalation was slightly higher at 93% of inspired oxygen with an average difference of 0.09 (95%CI: 0.002; 0.172) ppb compared to 30%. Serum IL-6 did not differ by inspired oxygen, whereas IL-10 at 60% and 93% of inspired oxygen was greater than with 30%. Both interleukins increased over 12 h of mechanical ventilation at all oxygen concentrations. Mechanical ventilation at high inspired oxygen promotes pulmonary lipid peroxidation and systemic inflammation. However, the response of pentanal and hexanal exhalation varies, with pentanal increasing by mechanical ventilation, whereas hexanal increases by high inspired oxygen concentrations

The first annual meeting of the Nippon Hoken-Gakkai (Insurance Institute of Japan)

The effects of manipulated dental occlusion on body posture has been investigated quite often and discussed controversially in the literature. Far less attention has been paid to the influence of dental occlusion position on human movement. If human movement was analysed, it was mostly while walking and not while running. This study was therefore designed to identify the effect of lower jaw positions on running behaviour according to different dental occlusion positions.Twenty healthy young recreational runners (mean age = 33.9±5.8 years) participated in this study. Kinematic data were collected using an eight-camera Vicon motion capture system (VICON Motion Systems, Oxford, UK). Subjects were consecutively prepared with four different dental occlusion conditions in random order and performed five running trials per test condition on a level walkway with their preferred running shoes. Vector based pattern recognition methods, in particular cluster analysis and support vector machines (SVM) were used for movement pattern identification.Subjects exhibited unique movement patterns leading to 18 clusters for the 20 subjects. No overall classification of the splint condition could be observed. Within individual subjects different running patterns could be identified for the four splint conditions. The splint conditions lead to a more symmetrical running pattern than the control condition.The influence of an occlusal splint on running pattern can be confirmed in this study. Wearing a splint increases the symmetry of the running pattern. A more symmetrical running pattern might help to reduce the risk of injuries or help in performance. The change of the movement pattern between the neutral condition and any of the three splint conditions was significant within subjects but not across subjects. Therefore the dental splint has a measureable influence on the running pattern of subjects, however subjects individuality has to be considered when choosing the optimal splint condition for a specific subject

Clinical and genetic profile of patients enrolled in the Transthyretin Amyloidosis Outcomes Survey (THAOS):14-year update

Abstract Background Transthyretin amyloidosis (ATTR amyloidosis) is a rare, life-threatening disease caused by the accumulation of variant or wild-type (ATTRwt amyloidosis) transthyretin amyloid fibrils in the heart, peripheral nerves, and other tissues and organs. Methods Established in 2007, the Transthyretin Amyloidosis Outcomes Survey (THAOS) is the largest ongoing, global, longitudinal observational study of patients with ATTR amyloidosis, including both inherited and wild-type disease, and asymptomatic carriers of pathogenic TTR mutations. This descriptive analysis examines baseline characteristics of symptomatic patients and asymptomatic gene carriers enrolled in THAOS since its inception in 2007 (data cutoff: August 1, 2021). Results This analysis included 3779 symptomatic patients and 1830 asymptomatic gene carriers. Symptomatic patients were predominantly male (71.4%) and had a mean (standard deviation [SD]) age of symptom onset of 56.3 (17.8) years. Val30Met was the most common genotype in symptomatic patients in South America (80.9%), Europe (55.4%), and Asia (50.5%), and more patients had early- versus late-onset disease in these regions. The majority of symptomatic patients in North America (58.8%) had ATTRwt amyloidosis. The overall distribution of phenotypes in symptomatic patients was predominantly cardiac (40.7%), predominantly neurologic (40.1%), mixed (16.6%), and no phenotype (2.5%). In asymptomatic gene carriers, mean (SD) age at enrollment was 42.4 (15.7) years, 42.4% were male, and 73.2% carried the Val30Met mutation. Conclusions This 14-year global overview of THAOS in over 5000 patients represents the largest analysis of ATTR amyloidosis to date and highlights the genotypic and phenotypic heterogeneity of the disease. ClinicalTrials.gov Identifier: NCT00628745.http://deepblue.lib.umich.edu/bitstream/2027.42/173793/1/13023_2022_Article_2359.pd

The structure of the deubiquitinase USP15 reveals a misaligned catalytic triad and an open ubiquitin-binding channel

© 2018 Ward et al. Ubiquitin-specific protease 15 (USP15) regulates important cellular processes, including transforming growth factor β (TGF-β) signaling, mitophagy, mRNA processing, and innate immune responses; however, structural information on USP15's catalytic domain is currently unavailable. Here, we determined crystal structures of the USP15 catalytic core domain, revealing a canonical USP fold, including a finger, palm, and thumb region. Unlike for the structure of paralog USP4, the catalytic triad is in an inactive configuration with the catalytic cysteine ∼10 Å apart from the catalytic histidine. This conformation is atypical, and a similar misaligned catalytic triad has so far been observed only for USP7, although USP15 and USP7 are differently regulated. Moreover, we found that the active-site loops are flexible, resulting in a largely open ubiquitin tail-binding channel. Comparison of the USP15 and USP4 structures points to a possible activation mechanism. Sequence differences between these two USPs mainly map to the S1' region likely to confer specificity, whereas the S1 ubiquitin-binding pocket is highly conserved. Isothermal titration calorimetry monoubiquitin- and linear diubiquitin-binding experiments showed significant differences in their thermodynamic profiles, with USP15 displaying a lower affinity for monoubiquitin than USP4. Moreover, we report that USP15 is weakly inhibited by the antineoplastic agent mitoxantrone in vitro A USP15-mitoxantrone complex structure disclosed that the anthracenedione interacts with the S1' binding site. Our results reveal first insights into USP15's catalytic domain structure, conformational changes, differences between paralogs, and small-molecule interactions and establish a framework for cellular probe and inhibitor development

A 15-year consolidated overview of data in over 6000 patients from the Transthyretin Amyloidosis Outcomes Survey (THAOS)

Background Transthyretin amyloidosis (ATTR amyloidosis) is a progressive, multisystemic, life-threatening disease resulting from the deposition of variant or wild-type (ATTRwt amyloidosis) transthyretin amyloid fibrils in various tissues and organs.Methods Established in 2007, the Transthyretin Amyloidosis Outcomes Survey (THAOS) is the largest ongoing, global, longitudinal, observational study of patients with ATTR amyloidosis, including both hereditary and wild-type disease, and asymptomatic carriers of pathogenic TTR mutations. This analysis describes the baseline characteristics of symptomatic patients and asymptomatic gene carriers enrolled in THAOS since its inception in 2007 (data cutoff: August 1, 2022), providing a consolidated overview of 15-year data from the THAOS registry.Results This analysis included 4428 symptomatic patients and 1707 asymptomatic gene carriers. The majority of symptomatic patients were male (70.8%) with a mean (standard deviation [SD]) age at symptom onset of 56.6 (17.9) years. Compared with the 14-year analysis, V30M remained the most prevalent genotype in Europe (62.2%), South America (78.6%), and Japan (74.2%) and ATTRwt remained most common in North America (56.2%). Relative to the 14-year analysis, there was an increase of mixed phenotype (from 16.6 to 24.5%) and a reduction of predominantly cardiac phenotype (from 40.7 to 31.9%). The proportion of patients with predominantly neurologic phenotype remained stable (from 40.1 to 38.7%). Asymptomatic gene carriers were 58.5% female with a mean age at enrollment of 41.9 years (SD 15.5).Conclusions This overview of > 6000 patients enrolled over 15 years in THAOS represents the largest registry analysis of ATTR amyloidosis to date and continues to emphasize the genotypic and phenotypic heterogeneity of the disease. Nearly a quarter of the symptomatic population within THAOS was mixed phenotype, underscoring the need for multidisciplinary management of ATTR amyloidosis.Trial registrationClinicalTrials.gov Identifier: NCT00628745

Contributions of feature shapes and surface cues to the recognition and neural representation of facial identity

A full understanding of face recognition will involve identifying the visual information that is used to discriminate different identities and how this is represented in the brain. The aim of this study was to explore the importance of shape and surface properties in the recognition and neural representation of familiar faces. We used image morphing techniques to generate hybrid faces that mixed shape properties (more specifically, second order spatial configural information as defined by feature positions in the 2D-image) from one identity and surface properties from a different identity. Behavioural responses showed that recognition and matching of these hybrid faces was primarily based on their surface properties. These behavioural findings contrasted with neural responses recorded using a block design fMRI adaptation paradigm to test the sensitivity of Haxby et al.'s (2000) core face-selective regions in the human brain to the shape or surface properties of the face. The fusiform face area (FFA) and occipital face area (OFA) showed a lower response (adaptation) to repeated images of the same face (same shape, same surface) compared to different faces (different shapes, different surfaces). From the behavioural data indicating the critical contribution of surface properties to the recognition of identity, we predicted that brain regions responsible for familiar face recognition should continue to adapt to faces that vary in shape but not surface properties, but show a release from adaptation to faces that vary in surface properties but not shape. However, we found that the FFA and OFA showed an equivalent release from adaptation to changes in both shape and surface properties. The dissociation between the neural and perceptual responses suggests that, although they may play a role in the process, these core face regions are not solely responsible for the recognition of facial identity

Perceptual face processing in developmental prosopagnosia is not sensitive to the canonical location of face parts

Individuals with developmental prosopagnosia (DP) are strongly impaired in recognizing faces, but it is controversial whether this deficit is linked to atypical visual-perceptual face processing mechanisms. Previous behavioural studies have suggested that face perception in DP might be less sensitive to the canonical spatial configuration of face parts in upright faces. To test this prediction, we recorded event-related brain potentials (ERPs) to intact upright faces and to faces with spatially scrambled parts (eyes, nose, and mouth) in a group of ten participants with DP and a group of ten age-matched control participants with normal face recognition abilities. The face-sensitive N170 component and the vertex positive potential (VPP) were both enhanced and delayed for scrambled as compared to intact faces in the control group. In contrast, N170 and VPP amplitude enhancements to scrambled faces were absent in the DP group. For control participants, the N170 to scrambled faces was also sensitive to feature locations, with larger and delayed N170 components contralateral to the side where all features appeared in a non-canonical position. No such differences were present in the DP group. These findings suggest that spatial templates of the prototypical feature locations within an upright face are selectively impaired in DP