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.

Association between cannabis use and sexual risk behavior among young heterosexual adults

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16-24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.

Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire

OBJECTIVES: The aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire. METHODS: The 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8-18 years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo's logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach's alpha. RESULTS: Responses were obtained from n = 22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA = 0.068, CFI = 0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81-1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach's alpha = 0.78-0.84 for individual dimensions). CONCLUSIONS: There was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies.

An integrated approach for reconstructing surface models of the proximal femur from sparse input data for surgical navigation

A patient-specific surface model of the proximal femur plays an important role in planning and supporting various computer-assisted surgical procedures including total hip replacement, hip resurfacing, and osteotomy of the proximal femur. The common approach to derive 3D models of the proximal femur is to use imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). However, the high logistic effort, the extra radiation (CT-imaging), and the large quantity of data to be acquired and processed make them less functional. In this paper, we present an integrated approach using a multi-level point distribution model (ML-PDM) to reconstruct a patient-specific model of the proximal femur from intra-operatively available sparse data. Results of experiments performed on dry cadaveric bones using dozens of 3D points are presented, as well as experiments using a limited number of 2D X-ray images, which demonstrate promising accuracy of the present approach.

Handbook of Swiss Politics

Approaching Switzerland as a “laboratory” for democracy, this Handbook contributes to a refined understanding of the res publica. Over the years, the Handbook of Swiss Politics has established itself as a classic work. This new and extended second edition of the Handbook comprises 32 chapters, all by leading Swiss political scientists. The contributors write about fundamentals, institutions, interest groups, political parties, new social movements, the cantons and municipalities, elections, popular votes, policy processes and public policies. They address several important issues in the current international debates, such as the internationalization of domestic politics, multi-level governance, and the role of metropolitan agglomerations. Nine new chapters enrich this second, completely updated version. The section on public policies has been significantly extended, and covers a dozen of policy domains. Grounded on the latest scientific knowledge, this volume also serves as an indispensable reference for a non-academic audience of decision-makers, diplomats, senior officials and journalists.

The Long Tail of the Rainbow Serpent: New Technologies and the Protection and Promotion of Traditional Cultural Expressions

New technologies, in particular those stemming from digitisation, allow amongst other things the production of perfect copies, instantaneous and ubiquitous distribution of and easy access to information with no real location restrictions. The effects of these technological advances have largely been perceived as negative for the protection of traditional cultural expressions (TCE), both because of the peculiarities of the digital networked environment and because of the lack of appropriate intellectual property protection models for TCE. The purpose of this article is, while accounting for the diversity and complexity of issues related to TCE, to reveal a more positive side of digital technologies. It shows the potential of these to be proactively applied and the further reaching possibilities for designing an efficient multi-level and multi-faceted toolbox for the protection and promotion of TCE in the digital ecology.

Focal adhesion kinase is a load-dependent governor of the slow contractile and oxidative muscle phenotype

Striated muscle exhibits a pronounced structural-functional plasticity in response to chronic alterations in loading. We assessed the implication of focal adhesion kinase (FAK) signalling in mechano-regulated differentiation of slow-oxidative muscle. Load-dependent consequences of FAK signal modulation were identified using a multi-level approach after electrotransfer of rat soleus muscle with FAK-expression plasmid vs. empty plasmid-transfected contralateral controls. Muscle fibre-targeted over-expression of FAK in anti-gravitational muscle for 9 days up-regulated transcript levels of gene ontologies underpinning mitochondrial metabolism and contraction in the transfected belly portion. Concomitantly, mRNA expression of the major fast-type myosin heavy chain (MHC) isoform, MHC2A, was reduced. The promotion of the slow-oxidative expression programme by FAK was abolished after co-expression of the FAK inhibitor FAK-related non-kinase (FRNK). Elevated protein content of MHC1 (+9%) and proteins of mitochondrial respiration (+165-610%) with FAK overexpression demonstrated the translation of transcript differentiation in targeted muscle fibres towards a slow-oxidative muscle phenotype. Coincidentally MHC2A protein was reduced by 50% due to protection of muscle from de-differentiation with electrotransfer. Fibre cross section in FAK-transfected muscle was elevated by 6%. The FAK-modulated muscle transcriptome was load-dependent and regulated in correspondence to tyrosine 397 phosphorylation of FAK. In the context of overload, the FAK-induced gene expression became manifest at the level of contraction by a slow transformation and the re-establishment of normal muscle force from the lowered levels with transfection. These results highlight the analytic power of a systematic somatic transgene approach by mapping a role of FAK in the dominant mechano-regulation of muscular motor performance via control of gene expression.

Finding Homogeneity in Heterogeneity - A New Approach to Quantifying Landscape Mosaics Developed for the Lao PDR

A key challenge for land change science in general and research on swidden agriculture in particular, is linking land cover information to human–environment interactions over larger spatial areas. In Lao PDR, a country facing rapid and multi-level land change processes, this hinders informed policy- and decision-making. Crucial information on land use types and people involved is still lacking. This article proposes an alternative approach for the description of landscape mosaics. Instead of analyzing local land use combinations, we studied land cover mosaics at a meso-level of spatial scale and interpreted these in terms of human–environmental interactions. These landscape mosaics were then overlaid with population census data. Results showed that swidden agricultural landscapes, involving 17% of the population, dominate 29% of the country, while permanent agricultural landscapes involve 74% of the population in 29% of the territory. Forests still form an important component of these landscape mosaics.

How do subordinate and dominant species in semi-natural mountain grasslands relate to productivity and land-use change?

Changes in agricultural practices of semi-natural mountain grasslands are expected to modify plant community structure and shift dominance patterns. Using vegetation surveys of 11 sites in semi-natural grasslands of the Swiss Jura and Swiss and French Alps, we determined the relative contribution of dominant, subordinate and transient plant species in grazed and abandoned communities and observed their changes along a gradient of productivity and in response to abandonment of pasturing. The results confirm the humpbacked diversity–productivity relationship in semi-natural grassland, which is due to the increase of subordinate species number at intermediate productivity levels. Grazed communities, at the lower or higher end of the species diversity gradient, suffered higher species loss after grazing abandonment. Species loss after abandonment of pasturing was mainly due to a higher reduction in the number of subordinate species, as a consequence of the increasing proportion of dominant species. When plant biodiversity maintenance is the aim, our results have direct implications for the way grasslands should be managed. Indeed, while intensification and abandonment have been accelerated since few decades, our findings in this multi-site analysis confirm the importance of maintaining intermediate levels of pasturing to preserve biodiversity.

Functional regulatory spaces

This article develops the concept of “Functional Regulatory Space” (FRS) in order to analyze the new forms of State action addressing (super) wicked problems. A FRS simultaneously spans several policy sectors, institutional territories and levels of government. It suggests integrating previous policy theories that focused on “boundary-spanning regime,” “territorial institutionalism” or multi-level governance. The FRS concept is envisaged as a Weberian “ideal-type” of State action and is applied to the empirical study of two European cases of potential FRS: the integrated management of water basins and the regulation of the European sky through functional airspace blocks. It will be concluded that the current airspace regulation does match the ideal-type of FRS any better than the water resource regulation does. The next research step consists in analyzing the genesis and institutionalization of potential FRS addressing other (super) wicked problems such as climate change and economic, security, health and immigration issues in different institutional contexts as well as at various levels of governance.

Individual and structural factors of member commitment in sports clubs

This article analyses the conditions influencing the commitment of members of sports clubs. It focuses not only on individual characteristics of members, but also on the corresponding structural conditions of sports clubs related to the individual decision to quit or continue their membership. The influences of both the individual and context levels on the commitment of members are estimated in different multi-level models. Results of these multi-level analyses indicate that commitment of members is not just an outcome of individual characteristics such as strong commitment to the club, positively perceived communication and cooperation, satisfaction with sports clubsʼ offers, or voluntary engagement. It is also influenced by club-specific structural conditions: commitment is more probable in rural sports clubs, and clubs who explicitly support sociability, whereas success-oriented sporting goals in clubs have a destabilizing effect.

Sportvereine als Interessenorganisationen?! – Ursachen und Auswirkungen von Ziel-Interessen-Divergenzen in freiwilligen Sportorganisationen

Für Sportvereine als Interessenorganisationen scheint die Rückbindung der Vereinsziele an die Mitgliederinteressen von zentraler Bedeutung zu sein. In der Vereinsrealität dürfte aber diese Rückbindung nur teilweise gewährleistet sein und folglich Ziel-Interessen-Divergenzen eher die Norm als die Ausnahme darstellen. Vor diesem Hintergrund stellt sich die Frage, welche Ursachen für Ziel-Interessen-Divergenzen verantwortlich zu machen sind und welche Auswirkungen sich daraus für die Vereine ergeben. Dieser Frage geht der vorliegende Beitrag nach, indem auf der Grundlage des Akteurtheoretischen Mehr-Ebenen-Modells zur Analyse der Entwicklung von Sportvereinen die struktur- und handlungsbedingten Ursachen und Auswirkungen von Divergenzen auf der Vereins- und Mitgliederebene beleuchtet werden. Mit Blick auf die Ursachen wurde der Einfluss der korporativen Vereinsstrukturen und der individuellen Handlungsorientierungen der Mitglieder auf Divergenzen untersucht. Die Befunde hierzu zeigen, dass Divergenzen einerseits durch einem zunehmenden Differenzierungs- und Hierarchisierungsgrad (z.B. Vereinsgröße, Umweltvernetzung, Oligarchisierung) begünstigt werden und andererseits vor allem bei einer primären Verfolgung von Eigeninteressen der Mitglieder auftreten. Hinsichtlich der Auswirkungen wurden die individuellen Mitgliederreaktionen und die korporativen Vereinsreaktionen auf Divergenzen analysiert. Diesbezüglich zeigen die Befunde, dass sowohl die Mitglieder als auch die Vereinsführung überwiegend konstruktiv auf Divergenzen reagieren (z.B. durch Problemansprache, Vertrauen, Kompromissfindung), so dass es vielen Vereinen offenbar relativ gut gelingt, Ziel-Interessen-Divergenzen bis zu einem gewissen Grad sowohl aushalten als auch aufarbeiten zu können.

Self-disclosure and privacy calculus on social networking sites: the role of culture

Social Networking Sites (SNSs) have become extremely popular around the world. They rely on user-generated content to offer engaging experience to its members. Cultural differences may influence the motivation of users to create and share content on SNS. This study adopts the privacy calculus perspective to examine the role of culture in individual self-disclosure decisions. The authors use structural equation modeling and multi-group analysis to investigate this dynamics. The findings reveal the importance of cultural dimensions of individualism and uncertainty avoidance in the cognitive processes of SNS users.

K-feldspar hygrochronology

The significance of the multi-isotopic record preserved in K-feldspars is assessed on samples from the Aar metagranite, Central Alps, Switzerland having very tight independent geological constraints. Stepwise leaching reveals that two diachronically grown K-feldspar generations coexist: Kfs-1 (≥ 35 Ma old, Ca-poor, Rb-Cl-rich, with low 87Sr/86Sr and high 206Pb/204Pb) and Kfs-2 (≤ 10 Ma old, antithetic isotopic signatures deriving from external fluids). Microtextures imaged by cathodoluminescence, backscattered electrons, and electron probe microanalysis are patchy and chemically heterogeneous, with pronounced enrichments in Ba in the retrogressed regions. This confirms the simultaneous presence of fluid-dominated retrogression and recrystallization and isotopic inheritance. The staircase-shaped 40Ar/39Ar age spectrum correlates with the Ca/K and Cl/K signatures. This reflects a mixture of heterochemical K-feldspar generations, and not an intracrystalline Ar gradient caused by diffusion. The shape of the age spectrum and the in vacuo release kinetics proceed from entirely different physical and geological phenomena. What K-feldspars can be effectively used for is to constrain the timing of the fluids that interacted with them by multi-isotopic analyses, rather than to model a “cooling history” from 39Ar release alone. The identification of multiple mineral generations by imaging combined with multi-isotopic analysis enables the accurate dating of the events of a multistage evolution after the initial crystallization of the rock in which the minerals occur.

Behind the curtains of privacy calculus on social networking sites: the study of Germany and the USA

As social networking sites (SNSs) become increasingly global, the issues of cultural differences in participation patterns become acute. However, current research offers only limited insights into the role of culture behind SNS usage. Aiming to fill this gap, this study adopts a ‘privacy calculus’ perspective to study the differences between German and American SNS users. Results of structural equation modeling and multi-group analysis reveal distinct variability in the cognitive patterns of American and German subjects. We contribute to the theory by rejecting the universal nature of privacy-calculus processes. From a practical standpoint, our results signal that SNS providers cannot rely on the “proven” means in ensuring user participation when crossing geographic boundaries. When financial means are limited, SNS providers should direct their investments into enhancing platform enjoyment and granting users with more control and, paradoxically, lobbying for more legalistic safeguards of user privacy.