The SAKK cancer-specific geriatric assessment (C-SGA): a pilot study of a brief tool for clinical decision-making in older cancer patients

BACKGROUND Recommendations from international task forces on geriatric assessment emphasize the need for research including validation of cancer-specific geriatric assessment (C-SGA) tools in oncological settings. The objective of this study was to evaluate the feasibility of the SAKK Cancer-Specific Geriatric Assessment (C-SGA) in clinical practice. METHODS A cross sectional study of cancer patients >=65 years old (N = 51) with pathologically confirmed cancer presenting for initiation of chemotherapy treatment (07/01/2009-03/31/2011) at two oncology departments in Swiss canton hospitals: Kantonsspital Graubunden (KSGR N = 25), Kantonsspital St. Gallen (KSSG N = 26). Data was collected using three instruments, the SAKK C-SGA plus physician and patient evaluation forms. The SAKK C-SGA includes six measures covering five geriatric assessment domains (comorbidity, function, psychosocial, nutrition, cognition) using a mix of medical record abstraction (MRA) and patient interview. Five individual domains and one overall SAKK C-SGA score were calculated and dichotomized as below/above literature-based cut-offs. The SAKK C-SGA was evaluated by: patient and physician estimated time to complete, ease of completing, and difficult or unanswered questions. RESULTS Time to complete the patient questionnaire was considered acceptable by almost all (>=96%) patients and physicians. Patients reported slightly shorter times to complete the questionnaire than physicians (17.33 +/- 7.34 vs. 20.59 +/- 6.53 minutes, p = 0.02). Both groups rated the patient questionnaire as easy/fairly easy to complete (91% vs. 84% respectively, p = 0.14) with few difficult or unanswered questions. The MRA took on average 8.32 +/- 4.72 minutes to complete. Physicians (100%) considered time to complete MRA acceptable, 96% rated it as easy/fairly easy to complete. Individual study site populations differed on health-related characteristics (excellent/good physician-rated general health KSGR 71% vs. KSSG 32%, p = 0.007). The overall mean C-SGA score was 2.4 +/- 1.12. Patients at KSGR had lower C-SGA scores (2.00 +/- 1.19 vs. 2.81 +/- 0.90, p = 0.009) and a smaller proportion (28% vs.65%, p = 0.008) was above the C-SGA cut-off score compared to KSSG. CONCLUSIONS These results suggest the SAKK C-SGA is a feasible practical tool for use in clinical practice. It demonstrated discriminative ability based on objective geriatric assessment measures, but additional investigations on use for clinical decision-making are warranted. The SAKK C-SGA also provides important usable domain information for intervention to optimize outcomes in older cancer patients.

HIV infection disrupts the sympatric host-pathogen relationship in human tuberculosis

The phylogeographic population structure of Mycobacterium tuberculosis suggests local adaptation to sympatric human populations. We hypothesized that HIV infection, which induces immunodeficiency, will alter the sympatric relationship between M. tuberculosis and its human host. To test this hypothesis, we performed a nine-year nation-wide molecular-epidemiological study of HIV-infected and HIV-negative patients with tuberculosis (TB) between 2000 and 2008 in Switzerland. We analyzed 518 TB patients of whom 112 (21.6%) were HIV-infected and 233 (45.0%) were born in Europe. We found that among European-born TB patients, recent transmission was more likely to occur in sympatric compared to allopatric host-pathogen combinations (adjusted odds ratio [OR] 7.5, 95% confidence interval [95% CI] 1.21-infinity, p = 0.03). HIV infection was significantly associated with TB caused by an allopatric (as opposed to sympatric) M. tuberculosis lineage (OR 7.0, 95% CI 2.5-19.1, p<0.0001). This association remained when adjusting for frequent travelling, contact with foreigners, age, sex, and country of birth (adjusted OR 5.6, 95% CI 1.5-20.8, p = 0.01). Moreover, it became stronger with greater immunosuppression as defined by CD4 T-cell depletion and was not the result of increased social mixing in HIV-infected patients. Our observation was replicated in a second independent panel of 440 M. tuberculosis strains collected during a population-based study in the Canton of Bern between 1991 and 2011. In summary, these findings support a model for TB in which the stable relationship between the human host and its locally adapted M. tuberculosis is disrupted by HIV infection.

Die Implementation einer Intervention zur Veränderung des Selbstkonzepts im Sportunterricht

Bei Studien zur Selbstkonzeptentwicklung fehlt meist der Hinweis auf die Programmumsetzung oder Implementation. Diesem Defizit der Implementationskontrolle nimmt sich die vorliegende Studie an und befasst sich mit der Messung und Erklärung der Implementationshäufigkeit im Rahmen einer Intervention zu Selbstkonzept förderndem Sportunterricht (NLehrer = 16, NSchüler = 309). Die Ergebnisse zeigen, dass Lehrpersonen eine individuumsorientierte, reflexive Sportvermittlung im Sportunterricht einsetzen. Die Implementationshäufigkeit der Lehrpersonen hängt von deren Berufserfahrung ab. Eine häufigere Implementation geht bei Schülerinnen und Schülern mit einer stärkeren Veränderung des Körperselbstwerts, jedoch nicht des sportbezogenen Fähigkeitsselbstkonzepts, einher.

Two-dimensional supramolecular polymers: controlled formation and visualization on the surface

Self – assembly is a powerful tool for the construction of highly organized nanostructures. Therefore, the possibility to control and predict pathways of molecular ordering on the nanoscale level is a critical issue for the production of materials with tunable and adaptive macroscopic properties. 2D polymers are attractive objects for the field of material sciences due to their exceptional properties. [1] As shown before, amphiphilic oligopyrenotides (produced via automated solid-phase synthesis) form rod–like supramolecular polymers in water. [2] These assemblies form 1D objects. [3] By applying certain changes to the design of the oligopyrenotide units the dimensionality of the formed assemblies can be influenced. Herein, we demonstrate that Py3 (see Figure 1) forms defined supramolecular assemblies under thermodynamic conditions in water. To study Py3 self-assembly, we carried out whole set of spectroscopic (UV/vis, fluorescence, DLS) and microscopic experiments (AFM). The obtained results suggest that oligopyrenotides with the present type of geometry and linker length leads to formation of 2D supramolecular assemblies.

Zum Einfluss von primären und sekundären Effekten der sozialen Herkunft beim zweiten schulischen Übergang in der Schweiz. Ein Vergleich unterschiedlicher Dekompositions- und Operationalisierungsmethoden

Aufgrund des meritokratischen Prinzips sollte die soziale Herkunft idealerweise keinen Einfluss auf den Erwerb höherer Bildung ausüben. Diverse Studien zeigen jedoch, dass in der Schweiz ein starker Zusammenhang zwischen der sozialen erkunftsschicht und dem erreichten Bildungsabschluss besteht. In diesem Artikel wird untersucht, wie sich die soziale Herkunft auf die Wahrscheinlichkeit, das Gymnasium nach Ende der obligatorischen Schulzeit zu besuchen, auswirkt und wie viele Prozent des Gesamteffektes durch den primären und den sekundären Herkunftseffekt erklärt werden können. Dabei wird berücksichtigt, wie sich das Ausmass dieser Effekte durch die Nutzung verschiedener Operationalisierungen oder unterschiedlicher Dekompositionsmethoden verändert. Es zeigt sich, dass unter Berücksichtigung wichtiger Kontrollvariablen wie dem besuchten schulischen Leistungsniveau Kinder aus einer hohen Schicht eine um 6 Prozentpunkte höhere Wahrscheinlichkeit haben, das Gymnasium zu besuchen, als Kinder aus einer tiefen Schicht. Wird dieser Gesamteffekt dekomponiert, beträgt der primäre Herkunftseffekt gut 20 Prozent.

Rechtsmittel gegen Entscheide des juge d'appui bei der internationalen Schiedsgerichtsbarkeit der Schweiz

The author examines whether and by which means the decisions handed down by the State judge giving his support to the arbitral proceeding (juge d'appui) may be appealed. Every relevant Article in the PILA (Private International Law Act) is addressed and analyzed in this regard (Art. 179(2) and (3), Art. 180(3), Art. 183(2), Art. 184(3) and Art. 185) by reference to the present legal doctrine and case law. Concerning the stages of appeal, the view is held that by direct or analogous application of Art. 356(2) CPC (Civil Procedure Code) the juge d'appui has jurisdiction as the sole instance of the Canton to render decisions in support of the arbitral tribunal. On the federal level however, the parties shall have the right to appeal against these decisions by filing a civil law appeal before the Swiss Federal Supreme Court, with the exception of most decisions given by juge d'appui within the meaning of Art. 180(3) PILA. As to this federal appeal, it is established that the case law of the Swiss Federal Supreme Court under the FTA (Act on the Federal Tribunal) indicates the Court's inclination to qualify both negative and positive decisions issued by the juge d'appui as final decisions in terms of Art. 90 FTA. In reference to the upcoming revision of the PILA's 12th Chapter the author concludes that the legislator might implement some clarifications in the current legal framework. It seems particularly advisable to ensure that all relevant Articles in the PILA regarding decisions of the juge d'appui explicitly reference to Art. 356(2) CPC. Moreover, the author is of the opinion that it would also be expedient to specify the

La philanthropie: alliée ou concurrente des politiques sociales étatiques (I, 1880-1945)

La philanthropie joue actuellement un rôle très important en Suisse. On estime que la moitié des personnes domiciliées en Suisse est active dans le champ d’action du bénévolat. Toutefois, cet objet d’études a longtemps été délaissé par les historiens. Ces deux panels viseront à rendre compte des recherches récentes en s’intéressant à la dimension comparative et transnationale de la philanthropie en Suisse de 1880 à nos jours. Deux dimensions seront privilégiées. D’une part, l’accent sera mis sur les rapports entre les associations philanthropiques privées et l’Etat social. Les études tendent le plus souvent à mettre l’accent sur l’opposition, dans le domaine social, entre activités de bienfaisance ou de bénévolat et les politiques publiques. Or, les relations entre ces deux pôles ne se résument pas à cette opposition et oscillent, selon les lieux et les périodes, entre coopération étroite et concurrence acharnée, à moins que ne s’instaure, comme cela semble le cas de la Suisse, une division du travail plus ou moins institutionnalisée. D’autre part, une attention toute particulière sera mise sur les jeux d’échelle. Les activités des associations philanthropiques couvrent des espaces géographiques très différents : certaines se concentrent sur un quartier urbain, d’autres se focalisent sur l’ensemble de la planète. Toutefois, nous postulons que cette spatialisation ne se confine pas à un antagonisme local/global. Bien au contraire, les différentes échelles – locale, nationale, globale ou transnationale – interagissent étroitement. Des contributions d’historiens étrangers permettront d’inscrire le cas suisse dans une perspective comparative.

2013 Doctoral Workshop on Distributed Systems

The Doctoral Workshop on Distributed Systems was held at Les Plans-sur-Bex, Switzerland, from June 26-28, 2013. Ph.D. students from the Universities of Neuchâtel and Bern as well as the University of Applied Sciences of Fribourg presented their current research work and discussed recent research results. This technical report includes the extended abstracts of the talks given during the workshop.