Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Electroanatomic reconstruction of the left atrium, pulmonary veins, and esophagus compared with the "true anatomy" on multislice computed tomography in patients undergoing catheter ablation of atrial fibrillation

BACKGROUND: Current concepts of catheter ablation for atrial fibrillation (AF) commonly use three-dimensional (3D) reconstructions of the left atrium (LA) for orientation, catheter navigation, and ablation line placement. OBJECTIVES: The purpose of this study was to compare the 3D electroanatomic reconstruction (Carto) of the LA, pulmonary veins (PVs), and esophagus with the true anatomy displayed on multislice computed tomography (CT). METHODS: In this prospective study, 100 patients undergoing AF catheter ablation underwent contrast-enhanced spiral CT scan with barium swallow and subsequent multiplanar and 3D reconstructions. Using Carto, circumferential plus linear LA lesions were placed. The esophagus was tagged and integrated into the Carto map. RESULTS: Compared with the true anatomy on CT, the electroanatomic reconstruction accurately displayed the true distance between the lower PVs; the distances between left upper PV, left lower PV, right lower PV, and center of the esophagus; the longitudinal diameter of the encircling line around the funnel of the left PVs; and the length of the mitral isthmus line. Only the distances between the upper PVs, the distance between the right upper PV and esophagus, and the diameter of the right encircling line were significantly shorter on the electroanatomic reconstructions. Furthermore, electroanatomic tagging of the esophagus reliably visualized the true anatomic relationship to the LA. On multiple tagging and repeated CT scans, the LA and esophagus showed a stable anatomic relationship, without relevant sideward shifting of the esophagus. CONCLUSION: Electroanatomic reconstruction can display with high accuracy the true 3D anatomy of the LA and PVs in most of the regions of interest for AF catheter ablation. In addition, Carto was able to visualize the true anatomic relationship between the esophagus and LA. Both structures showed a stable anatomic relationship on Carto and CT without relevant sideward shifting of the esophagus.

Evaluation of magnetic resonance colonography at 3.0 Tesla regarding diagnostic accuracy and image quality

OBJECTIVES: To assess magnetic resonance (MR)-colonography (MRC) for detection of colorectal lesions using two different T1w three-dimensional (3D)-gradient-recalled echo (GRE)-sequences and integrated parallel data acquisition (iPAT) at a 3.0 Tesla MR-unit. MATERIALS AND METHODS: In this prospective study, 34 symptomatic patients underwent dark lumen MRC at a 3.0 Tesla unit before conventional colonoscopy (CC). After colon distension with tap water, 2 high-resolution T1w 3D-GRE [3-dimensional fast low angle shot (3D-FLASH), iPAT factor 2 and 3D-volumetric interpolated breathhold examination (VIBE), iPAT 3] sequences were acquired without and after bolus injection of gadolinium. Prospective evaluation of MRC was performed. Image quality of the different sequences was assessed qualitatively and quantitatively. The findings of the same day CC served as standard of reference. RESULTS: MRC identified all polyps >5 mm (16 of 16) in size and all carcinomas (4 of 4) correctly. Fifty percent of the small polyps and in 92% (376 of 408) for the VIBE. The 3D-FLASH sequence showed a 3-fold increase in signal-to-noise ratio (8 +/- 3.3 standard deviation (SD) in lesions without contrast enhancement (CE); 24.3 +/- 7.8 SD after CE). For the 3D-VIBE sequence, signal-to-noise ratio doubled in the detected lesions (147 +/- 54 SD without and 292 +/- 168 SD after CE). Although image quality was ranked lower in the VIBE, the image quality score of both sequences showed no statistical significant difference (chi > 0.6). CONCLUSIONS: MRC using 3D-GRE-sequences and iPAT is feasible at 3.0 T-systems. The high-resolution 3D-FLASH was slightly preferred over the 3D-VIBE because of better image quality, although both used sequences showed no statistical significant difference.

The keratinocyte in epidermal renewal and defence

Traditionally, keratinocytes have been considered inert constituents of the multilayered epidermis. Today's understanding has fundamentally changed. The keratinocyte is now recognized as an active player in epidermal renewal with key functions in the skin's immune defence. Under homeostatic conditions, keratinocyte progenitor cells are believed to divide symmetrically or asymmetrically, that is they continue to proliferate or go on to terminally differentiate and build up the overlaying epidermis. The fine-tuned process of epidermal renewal relies on an extraordinary network of signalling cascades which are governed by keratinocyte-receptor interactions with the environment through paracrine and autocrine circuits. Opposing this coordinated homeostatic process are signals of wounding and inflammation. They alter the fate of the keratinocyte and its response to the environment through changes in adhesion molecules and surface receptors, in addition to triggering an immediate inflammatory keratinocyte response in terms of secretion of cytokines, chemokines and antimicrobial peptides. If uncontrolled, the fundamental changes imposed by wounding and inflammation upon the homeostatic programme can lead to severe skin lesions including chronic inflammatory disorders. This review will describe the current knowledge of the regulatory signalling network which allows the keratinocyte to actively impact both epidermal homeostasis and the inflammatory response.

Weathering geochemistry and Sr-Nd fingerprints of equatorial upper Nile and Congo muds

This study investigates processes of sediment generation in equatorial central Africa. An original, complete and integrated mineralogical-geochemical database on silt-sized sediments derived from different parent rocks (basalt, granite, gneiss, metapsammite, sandstone) along the East African Rift from 5°S in Tanzania to 5°N in Sudan is presented and used to assess the incidence of diverse factors controlling sediment composition (source-rock lithology, geomorphology, hydraulic sorting, grain size, recycling), with particular emphasis on chemical weathering.

Interplay between temperature, fish partial migration and trophic dynamics

Whereas many studies have addressed the mechanisms driving partial migration, few have focused on the consequences of partial migration on trophic dynamics, and integrated studies combining the two approaches are virtually nonexistent. Here we show that temperature affects seasonal partial migration of cyprinid fish from lakes to predation refuges in streams during winter and that this migration in combination with temperature affects the characteristics and phenology of lower trophic levels in the lake ecosystem. Specifically, our six-year study showed that the proportion of fish migrating was positively related to lake temperature during the pre-migration growth period, i.e. during summer. Migration from the lake occurred later when autumn water temperatures were high, and timing of return migration to the lake occurred earlier at higher spring water temperatures. Moreover, the winter mean size of zooplankton in the lake increased with the proportion of fish being away from the lake, likely as a consequence of decreased predation pressure. Peak biomass of phytoplankton in spring occurred earlier at higher spring water temperatures and with less fish being away from the lake. Accordingly, peak zooplankton biomass occurred earlier at higher spring water temperature, but relatively later if less fish were away from the lake. Hence, the time between phyto- and zooplankton peaks depended only on the amount of fish being away from the lake, and not on temperature. The intensity of fish migration thereby had a major effect on plankton spring dynamics. These results significantly contribute to our understanding of the interplay between partial migration and trophic dynamics, and suggest that ongoing climate change may significantly affect such dynamics.

Evaluation of 9 biomarkers for predicting 10-year cardiovascular risk in patients undergoing coronary angiography: findings from the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study.

BACKGROUND Conventional factors do not fully explain the distribution of cardiovascular outcomes. Biomarkers are known to participate in well-established pathways associated with cardiovascular disease, and may therefore provide further information over and above conventional risk factors. This study sought to determine whether individual and/or combined assessment of 9 biomarkers improved discrimination, calibration and reclassification of cardiovascular mortality. METHODS 3267 patients (2283 men), aged 18-95 years, at intermediate-to-high-risk of cardiovascular disease were followed in this prospective cohort study. Conventional risk factors and biomarkers were included based on forward and backward Cox proportional stepwise selection models. RESULTS During 10-years of follow-up, 546 fatal cardiovascular events occurred. Four biomarkers (interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D) were retained during stepwise selection procedures for subsequent analyses. Simultaneous inclusion of these biomarkers significantly improved discrimination as measured by the C-index (0.78, P = 0.0001), and integrated discrimination improvement (0.0219, P<0.0001). Collectively, these biomarkers improved net reclassification for cardiovascular death by 10.6% (P<0.0001) when added to the conventional risk model. CONCLUSIONS In terms of adverse cardiovascular prognosis, a biomarker panel consisting of interleukin-6, neutrophils, von Willebrand factor, and 25-hydroxyvitamin D offered significant incremental value beyond that conveyed by simple conventional risk factors.

Warm Conveyor Belts in the ERA-Interim Dataset (1979–2010): Part I: Climatology and Potential Vorticity Evolution

A global climatology of warm conveyor belts (WCBs) is presented for the years 1979–2010, based on trajectories calculated with Interim ECMWF Re-Analysis (ERA-Interim) data. WCB trajectories are identified as strongly ascending air parcels (600 hPa in 2 days) near extratropical cyclones. Corroborating earlier studies, WCBs are more frequent during winter than summer and they ascend preferentially in the western ocean basins between 25° and 50° latitude. Before ascending, WCB trajectories typically approach from the subtropics in summer and from more midlatitude regions in winter. Considering humidity, cloud water, and potential temperature along WCBs confirms that they experience strong condensation and integrated latent heating during the ascent (typically >20 K). Liquid and ice water contents along WCBs peak at about 700 and 550 hPa, respectively. The mean potential vorticity (PV) evolution shows typical tropospheric values near 900 hPa, followed by an increase to almost 1 potential vorticity unit (PVU) at 700 hPa, and a decrease to less than 0.5 PVU at 300 hPa. These low PV values in the upper troposphere constitute significant negative anomalies with amplitudes of 1–3 PVU, which can strongly influence the downstream flow. Considering the low-level diabatic PV production, (i) WCBs starting at low latitudes (<40°) are unlikely to attain high PV (due to weak planetary vorticity) although they exhibit the strongest latent heating, and (ii) for those ascending at higher latitudes, a strong vertical heating gradient and high absolute vorticity are both important. This study therefore provides climatological insight into the cloud diabatic formation of significant positive and negative PV anomalies in the extratropical lower and upper troposphere, respectively.

Socio-economic atlas of Kenya: Depicting the national population census by county and sub-location

The Socio-Economic Atlas of Kenya is the first of its kind to offer high-resolution spatial depictions and analyses of data collected in the 2009 Kenya Population and Housing Census . The combination of geographic and socio-eco - nomic data enables policymakers at all levels, development experts, and other interested readers to gain a spatial understanding of dynamics affecting Kenya. Where is the informal economic sector most prominent? Which areas have adequate water and sanitation? Where is population growth being slowed effectively? How do education levels vary throughout the country? And where are poverty rates lowest? Answers to questions such as these, grouped into seven broad themes, are visually illustrated on high-resolution maps. By supplying precise information at the sub-location level and summarizing it at the county level, the atlas facilitates better planning that accounts for local contexts and needs. It is a valuable decision-support tool for government institutions at different administrative levels, educational institutions, and others. Three organizations – two in Kenya and one in Switzerland – worked together to create the atlas: the Kenya National Bureau of Statistics (KNBS), the Nanyuki-based Centre for Training and Integrated Research in ASAL Development (CETRAD), and the Centre for Development and Environment (CDE) at the University of Bern. Close cooperation between KNBS, CETRAD, and CDE maximized synergies and knowledge exchange.

Mobilities and Pottery Production Archaeological and Anthropological Perspectives

Our workshop aims at a deeper understanding of various itineraries of pottery and dif-ferent forms of human mobilities in which pottery is relevant, bringing together archae-ological and anthropological perspectives. For thousands of years, pottery has been an important part of many societies’ material culture and therefore a major research topic in both disciplines. In past and present societies the material existence of ceramic vessels is informed by various movements across time and space but also by periods of stasis: from the mo-ment of their production until their exclusion from daily practices, either disposed as waste, excluded as funerary objects or stored as collectibles. In their seemingly endless material durability, ceramic vessels might outlive their human producers, distributors or consumers and travel farther and longer. Still they are embedded in the regimes of human mobility, ranging from daily subsistence-based mobility to long-term migrations. In such processes, pottery shifts between spatial, temporal, social, economic and cultural contexts. Thereby ceramic vessels are appropriated and integrated in new contexts of action and meaning, sometimes leading to material transformations. This workshop takes place in the context of our archaeological research project „Mobili-ties, Entanglements and Transformations in Neolithic Societies on the Swiss Plateau (3900-3500 BC)“ to which our PhDs are connected. We address the above outlined topic by analysing the production of pottery. Based on dendrochronologically dated settle-ments between 3900 and 3500 BC, two regional pottery styles and their local variations are well known, Pfyn and Cortaillod. The vessels share the same habitus and were made of clays and temper deriving from the settlements’ surroundings. However, some vessels specific to other pottery styles are also present on the sites. They are characteristic for pottery styles known from more or less far off regions (Michelsberg, Munzingen or Néo-lithique Moyen Bourguignon). Some of them were travelling objects, as their non local raw materials show. Others seem to have been produced locally, pointing to long-term mobility and a change of residence from neighbouring social groups.

Linking Landscape Protection and Nature Conservation: Switzerland’s Experience with Protected Mire Landscapes

Since 1987, Switzerland’s Federal Inventory of Mire Landscapes of Particular Beauty and National Importance has provided an instrument for the integration of nature conservation and landscape protection. Mires and mire landscape protection are strictly regulated. However, research results show that neither the goals of mire protection nor those of mire landscape protection are being achieved. The reasons for this are manifold and, in particular, have to do with a lack of coordination between the various policy areas that shape mire environments and mire landscapes. There are several key challenges involving different political and administrative levels. At the national level, mechanisms must be devised that enable differentiated regional implementation of national sectoral policies. In the context of cantonal structure planning, regional nature conservation and landscape protection priorities should be established based on existing regional potentials vis-à-vis the natural environment and landscapes (including protected biotopes and landscapes). At the regional level (spanning multiple communes), integrated planning instruments and governance structures should be developed so that implementation of national and cantonal sectoral policies may be harmonized under the umbrella of regional and integrated development plans. These adjustments to Switzerland’s institutional system are necessary to enable far-reaching integration of nature conservation and landscape protection when setting regional policy priorities. This would strengthen the protection of mire landscapes and other integrative instruments such as regional nature parks of national importance.

Forest regeneration capacity and its enhancement by forest management and silviculture in Cabo Delgado

SDC has been involved in rural development in Cabo Delgado for more than 30 years. Shortly after the independence of Mozambique, projects in water supply and integrated rural development were initiated. The silvoagropastoral project FO9 based in Mueda was a very early experience in forestry in Cabo Delgado. Andreas Kläy was responsible for the forestry sector in FO9 for 3 years in the early 1980s and had an opportunity to initiate an exchange of ideas and experience in rural development theory and approaches with Yussuf Adam, who was doing research in human anthropology and history in the province. 25 years later, the current situation of forest management in Cabo Delgado was reassessed, with a specific focus on concessions in the North. The opportunity for a partnership between the MITI SA, the University of Eduardo Mondlane, and CDE was created on the basis of this preliminary study1. The aim of this partnership is to generate knowledge and develop capacity for sustainable forest management. The preliminary study showed that “…we have to face weaknesses and would like to start a learning process with the main institutions, organisations, and stakeholder groups active in forest management and research in the North of Cabo Delgado. This learning process will involve studies supported by competent research institutions and workshops …” The specific objectives of ESAPP project Q804 are the following: 1. Contribute to understanding of the forestry sector; 2. Capacity development for professionals and academics; 3. Support for the private sector and the local forest service; 4. Support data generation at Cabo Delgado's Provincial Service; 5. Capacity development for Swiss academic institutions (CDE and ETHZ). A conceptual planning platform was elaborated as a basis for cooperation and research in the partnership (cf. Annex 1). The partners agreed to work on two lines of research: biophysical and socio-economic. In order to ensure a transdisciplinary approach, disciplinary research is anchored in common understanding in workshops based on the LforS methods. These workshops integrate the main stakeholders in the local context of the COMADEL concession in Nangade District managed by MITI SA, and take place in the village of Namiune. The research team observed that current management schemes consist mainly of strategies of nature mining by most stakeholders involved. Institutional settings - formal and informal - have little impact due to weak capacity at the local level and corruption. Local difficulties in a remote rural area facilitate external access to resources and are perpetuated by the loss of benefits. The benefits of logging remain at the top level (economic and political elites). The interests of the owners of the concession in stopping the loss of resources caused by this regime offers a unique opportunity to intervene in the logic of resource degradation and agony in rural development and forest management.