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

Disentangling Quantum and Classical Contributions in Hybrid Quantum Machine Learning Architectures

Quantum computing offers the potential for superior computational capabilities, particularly for data-intensive tasks. However, the current state of quantum hardware puts heavy restrictions on input size. To address this, hybrid transfer learning solutions have been developed, merging pre-trained classical models, capable of handling extensive inputs, with variational quantum circuits. Yet, it remains unclear how much each component -- classical and quantum -- contributes to the model's results. We propose a novel hybrid architecture: instead of utilizing a pre-trained network for compression, we employ an autoencoder to derive a compressed version of the input data. This compressed data is then channeled through the encoder part of the autoencoder to the quantum component. We assess our model's classification capabilities against two state-of-the-art hybrid transfer learning architectures, two purely classical architectures and one quantum architecture. Their accuracy is compared across four datasets: Banknote Authentication, Breast Cancer Wisconsin, MNIST digits, and AudioMNIST. Our research suggests that classical components significantly influence classification in hybrid transfer learning, a contribution often mistakenly ascribed to the quantum element. The performance of our model aligns with that of a variational quantum circuit using amplitude embedding, positioning it as a feasible alternative

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

Fratura femoral em pessoa idosa: dependência dos cuidados de enfermagem

Highlights The age range of elderly people who fracture their femur is over 80 years old, resulting from falls from their height. The use of the patient classification system allows for better team management, taking into account the care needs of each patient. The indicators with the highest rates were: body care, eliminations, motility, and ambulation. The elderly had an average hospital stay of 7 days. Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance. How to cite this article: de Souza, Augusto Baisch; de Oliveira, Daniela Tonroller; Carvalho, Sidiclei Machado; Wolf, Jonas Michel; Maurer, Tiago Claro; Rosso, Lucas Henrique. Femoral fracture in the elderly: dependence on nursing care. Revista Cuidarte. 2024;15(1):e3186.  http://dx.doi.org/10.15649/cuidarte.3186Introducción: Debido al envejecimiento de la población, los procesos de enfermería se están adaptando a estos pacientes, quienes requieren un alto grado de cuidado y orientación. Objetivo: Analizar el grado de dependencia de los cuidados de enfermería por parte de pacientes ancianos (65 años o más) con fracturas de fémur. Materiales y Métodos: Estudio retrospectivo, con enfoque cuantitativo, realizado en un hospital privado desde abril de 2021 a abril de 2022. La muestra está compuesta por 41 pacientes, se analizaron datos epidemiológicos y grado de dependencia de los cuidados de enfermería al ingreso, media hospitalización y alta, según el SCP. Resultados: Compuesto por 41 pacientes, edad promedio de 84 años y predominio del sexo femenino (75,61%). En cuanto a las fracturas, hubo mayor ocurrencia de caídas desde la altura y predominio de las fracturas de cuello, con un tiempo promedio hasta la cirugía menor a 16 horas. Predominaron la Hipertensión Arterial Sistémica y la Diabetes Mellitus. El promedio de las valoraciones del SCP fue de 24,26 en la 1ª, 26,12 en la 2ª y 26,24 en la 3ª. El tiempo en hospitalización fue de 7 días y no hubo fallecimientos.      Discusión: Los hallazgos sobre datos sociodemográficos, motivos de caídas, localización, comorbilidades, grado de dependencia y duración de hospitalización son similares a los disponibles en las bases de datos. Se diferencian en términos de mejor calidad, tiempo hasta la cirugía y resultado clínico.  Conclusión: El estudio presenta conocimientos específicos para la realización del cuidado en el proceso de enfermería hospitalaria, permitiendo así sistematizar la asistencia en equipo. Como citar este artículo: de Souza, Augusto Baisch; de Oliveira, Daniela Tonroller; Carvalho, Sidiclei Machado; Wolf, Jonas Michel; Maurer, Tiago Claro; Rosso, Lucas Henrique. Femoral fracture in the elderly: dependence on nursing care. Revista Cuidarte. 2024;15(1):e3186.  http://dx.doi.org/10.15649/cuidarte.3186Highlights A faixa etária dos idosos que fraturam o fêmur é maior do que 80 anos, ocorridas por quedas de própria altura. O uso do sistema de classificação de pacientes permite o melhor gerenciamento da equipe, pela vista panorâmica da necessidade de cuidado de cada paciente. Os indicadores que apresentaram maiores índices foram: cuidado corporal, eliminações, motilidade e deambulação. Os idosos apresentaram tempo médio de permanência em meio hospitalar de 7 dias. Introdução: Em virtude do envelhecimento da população, os processos de enfermagem estão se adaptando a esses pacientes, os quais necessitam de elevado grau de cuidado e orientação. Objetivo: Analisar o grau de dependência aos cuidados de enfermagem por pacientes idosos (65 anos ou mais) com fratura de fêmur. Materiais e Métodos: Estudo retrospectivo, com abordagem quantitativa, realizado em um hospital privado no período de abril de 2021 a abril de 2022. A amostra compreende 41 pacientes, analisados dados epidemiológicos e grau de dependência dos cuidados de enfermagem na admissão, meio da internação e alta, conforme o SCP. Resultados: Composto por 41 pacientes, idade média de 84 anos e predomínio do sexo feminino (75,61%). Sobre a fratura, verificou-se maior ocorrência por queda da própria altura e predominância de fratura de colo, com tempo médio até cirurgia menor que 16 horas. Hipertensão Arterial Sistêmica e Diabetes Mellitus foram predominantes. A média das avaliações do SCP apresentou 24,26 na 1ª, 26,12 na 2ª e 26,24 na 3ª. O tempo de permanência hospitalar foi de 7 dias e não houve nenhum óbito. Discussão: Os achados sobre os dados sociodemográficos, motivos das quedas, localização, comorbidades, grau de dependência e tempo de permanência hospitalar assemelham-se com os disponibilizados em bancos de dados. Diferem-se, em melhor qualidade, sob tempo até cirurgia e desfecho clínico. Conclusões: O estudo apresenta conhecimentos específicos para realizar o cuidado do processo de enfermagem intra-hospitalar, permitindo, assim, a sistematização da assistência da equipe. Como citar este artigo: de Souza, Augusto Baisch; de Oliveira, Daniela Tonroller; Carvalho, Sidiclei Machado; Wolf, Jonas Michel; Maurer, Tiago Claro; Rosso, Lucas Henrique. Femoral fracture in the elderly: dependence on nursing care. Revista Cuidarte. 2024;15(1):e3186.  http://dx.doi.org/10.15649/cuidarte.318

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

Antiresorptive agents enhance ossification of free flap reconstructions of the mandible: a radiological retrospective cohort study

Background: The aim of this study was to investigate the effect of antiresorptive agents on the ossification of reconstructed mandibles by free bone grafts for the first time. Methods: A total of 38 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs. The study group (n = 13) had segmental resection of the mandible and free bone flap reconstruction due to medication-related osteonecrosis of the jaw (MRONJ). The control group (noMRONJ, n = 25) comprised segmental mandibular resections and free bone flap reconstructions due to tumors, chronic osteomyelitis, or trauma without any radiation. Ossification time and influencing factors were evaluated. Results: Both duration of surgery (346 ± 90 min. vs. 498 ± 124 min.; p < 0.001) and hospitalization (8.7 ± 2.8 days vs. 13.4 ± 5.3 days, p = 0.006) were shorter in the MRONJ group compared to the noMRONJ group. Ossification after mandibular reconstruction was significantly faster in the MRONJ study group [224 days, interquartile range (IQR) 175–287] compared to the control group (288 days, IQR 194–445; p < 0.001). Moreover, good initial contact between the segments resulted in faster ossification (p < 0.001) in the MRONJ group. Ossification rate between original and grafted bone or between grafted bone segments only did not differ in both the study and control groups (MRONJ, p = 0.705 vs. control, p = 0.292). The type of antiresorptive agent did not show any significance for ossification. The rate of wound healing disturbances did also not differ between the study and control groups (p = 0.69). Conclusion: Advanced MRONJ (stage 3) can be resected and reconstructed safely with free microvascular bone flaps. Antiresorptive agents enhance the ossification of the bone segments. Optimal initial contact of the bone segments accelerates bone healing. Surgery and hospitalization are markedly shortened in this vulnerable group of MRONJ patients compared to oncologic patients

Femoral fracture in the elderly: dependence on nursing care

Introduction: Due to the aging of the population, nursing processes have been adapted to these patients, who require a high level of care and guidance. Objective: Analyzing the degree of dependence on nursing care by elderly patients (65 years or older) with femur fractures. Materials and Methods: retrospective, with a quantitative approach, carried out in a private hospital from April 2021 to April 2022. The sample comprehends 41 patients, analyzed epidemiological data and degree of dependence Study of nursing care during hospitalization, environment of hospitalization and discharge, according to the SCP. Results: Composed of 41 patients, mean age of 84 years and female predominance (75.61%). With regard to fractures, there was a greater occurrence due to falls from standing height and predominance of neck fractures, with an average time until surgery of less than 16 hours. Systemic Arterial Hypertension and Diabetes Mellitus were predominant. The average of the SCP estimates presented 24.26 in the 1st, 26.12 in the 2nd and 26.24 in the 3rd. The length of hospital stay was 7 days and no deaths were reported. Discussion: The findings on sociodemographic data, reasons for falls, location, comorbidities, degree of dependence and length of hospital stay are similar to those available in databases. They differ, in better quality, under time until surgery and clinical. Conclusions: The study presents specific knowledge to carry out the care of the intra-hospital nursing process, thus allowing the systematization of the team's assistance

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