Political process and government growth: a theoretical and empirical investigation

A striking feature of virtually al western industrialized countries sice the middle of the past century has been the persistent growth of their government sector. From the beginning of the century to the late 1970's, the government expenditures' share of gross national product has increased from 7% to 36% in the U.S., 11% to 40% in the U.K., and 3% to 25% in Japan. In Germany, it went from 7% to 42% (1872-1978), while in France it soared from 11% to 59% (1872-1979). The evolution of the number of government employees followed a similar pattern. In the U.S., for instance, the average annual rate of growth of the government labor force over the period 1899-1974 has been 3.17%, compared to a 1.62% average annual growth rate of the working population. Less quantifiable aspects like the number and scope of regulations also refelct a growing public sector.

Chlamydia control activities in Europe: cross-sectional survey

Background: Chlamydia is the most commonly reported bacterial sexually transmitted infection in Europe. The objective of the Screening for Chlamydia in Europe (SCREen) project was to describe current and planned chlamydia control activities in Europe. Methods: The authors sent a questionnaire asking about different aspects of chlamydia epidemiology and control to public health and clinical experts in each country in 2007. The principles of sexually transmitted infection control were used to develop a typology comprising five categories of chlamydia control activities. Each country was assigned to a category, based on responses to the questionnaire. Results: Experts in 29 of 33 (88%) invited countries responded. Thirteen of 29 countries (45%) had no current chlamydia control activities. Six countries in this group stated that there were plans to introduce chlamydia screening programmes. There were five countries (17%) with case management guidelines only. Three countries (10%) also recommended case finding amongst partners of diagnosed chlamydia cases or people with another sexually transmitted infection. Six countries (21%) further specified groups of asymptomatic people eligible for opportunistic chlamydia testing. Two countries (7%) reported a chlamydia screening programme. There was no consistent association between the per capita gross domestic product of a country and the intensity of chlamydia control activities (P = 0.816). Conclusion: A newly developed classification system allowed the breadth of ongoing national chlamydia control activities to be described and categorized. Chlamydia control strategies should ensure that clinical guidelines to optimize chlamydia diagnosis and case management have been implemented before considering the appropriateness of screening programmes.

Cost-effective intervention thresholds against osteoporotic fractures based on FRAX® in Switzerland

FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.

Health care for older persons in Switzerland: a country profile

Switzerland has the second-most-expensive healthcare system worldwide, with 11.5% of gross domestic product spent on health care in 2003. Switzerland has a healthcare system with universal insurance coverage and a social insurance system, ensuring an adequate financial situation for 96% of the 1.1 million older inhabitants. Key concerns related to the care of older persons are topics such as increasing healthcare costs, growing public awareness of patient autonomy, and challenges related to assisted suicide. In 2004, the Swiss Academy of Medical Sciences issued guidelines for the care of disabled older persons. Since 2000, geriatrics has been a board-certified discipline with a 3-year training program in addition to 5 years of training in internal or family medicine. There are approximately 125 certified geriatricians in Switzerland, working primarily in geriatric centers in urban areas. Switzerland has an excellent research environment, ranking second of all countries worldwide in life sciences research-but only 13th in aging research. This is in part due to a lack of specific training programs promoting research on aging and inadequate funding. In addition, there is a shortage of academic geriatricians in Switzerland, in part due to the fact that two of five Swiss universities had no academic geriatric departments in 2005. With more-adequate financial resources for academic geriatrics, Switzerland would have the opportunity to contribute more to aging research internationally and to improved care for older patients.

Tropical cyclone-related socio-economic losses in the western North Pacific region

The western North Pacific (WNP) is the area of the world most frequently affected by tropical cyclones (TCs). However, little is known about the socio-economic impacts of TCs in this region, probably because of the limited relevant loss data. Here, loss data from Munich RE's NatCatSERVICE database is used, a high-quality and widely consulted database of natural disasters. In the country-level loss normalisation technique we apply, the original loss data are normalised to present-day exposure levels by using the respective country's nominal gross domestic product at purchasing power parity as a proxy for wealth. The main focus of our study is on the question of whether the decadal-scale TC variability observed in the Northwest Pacific region in recent decades can be shown to manifest itself economically in an associated variability in losses. It is shown that since 1980 the frequency of TC-related loss events in the WNP exhibited, apart from seasonal and interannual variations, interdecadal variability with a period of about 22 yr – driven primarily by corresponding variations of Northwest Pacific TCs. Compared to the long-term mean, the number of loss events was found to be higher (lower) by 14% (9%) in the positive (negative) phase of the decadal-scale WNP TC frequency variability. This was identified for the period 1980–2008 by applying a wavelet analysis technique. It was also possible to demonstrate the same low-frequency variability in normalised direct economic losses from TCs in the WNP region. The identification of possible physical mechanisms responsible for the observed decadal-scale Northwest Pacific TC variability will be the subject of future research, even if suggestions have already been made in earlier studies.

The global carbon budget 1959–2011

Accurate assessments of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the climate policy process, and project future climate change. Present-day analysis requires the combination of a range of data, algorithms, statistics and model estimates and their interpretation by a broad scientific community. Here we describe datasets and a methodology developed by the global carbon cycle science community to quantify all major components of the global carbon budget, including their uncertainties. We discuss changes compared to previous estimates, consistency within and among components, and methodology and data limitations. CO2 emissions from fossil fuel combustion and cement production (EFF) are based on energy statistics, while emissions from Land-Use Change (ELUC), including deforestation, are based on combined evidence from land cover change data, fire activity in regions undergoing deforestation, and models. The global atmospheric CO2 concentration is measured directly and its rate of growth (GATM) is computed from the concentration. The mean ocean CO2 sink (SOCEAN) is based on observations from the 1990s, while the annual anomalies and trends are estimated with ocean models. Finally, the global residual terrestrial CO2 sink (SLAND) is estimated by the difference of the other terms. For the last decade available (2002–2011), EFF was 8.3 ± 0.4 PgC yr−1, ELUC 1.0 ± 0.5 PgC yr−1, GATM 4.3 ± 0.1 PgC yr−1, SOCEAN 2.5 ± 0.5 PgC yr−1, and SLAND 2.6 ± 0.8 PgC yr−1. For year 2011 alone, EFF was 9.5 ± 0.5 PgC yr−1, 3.0 percent above 2010, reflecting a continued trend in these emissions; ELUC was 0.9 ± 0.5 PgC yr−1, approximately constant throughout the decade; GATM was 3.6 ± 0.2 PgC yr−1, SOCEAN was 2.7 ± 0.5 PgC yr−1, and SLAND was 4.1 ± 0.9 PgC yr−1. GATM was low in 2011 compared to the 2002–2011 average because of a high uptake by the land probably in response to natural climate variability associated to La Niña conditions in the Pacific Ocean. The global atmospheric CO2 concentration reached 391.31 ± 0.13 ppm at the end of year 2011. We estimate that EFF will have increased by 2.6% (1.9–3.5%) in 2012 based on projections of gross world product and recent changes in the carbon intensity of the economy. All uncertainties are reported as ±1 sigma (68% confidence assuming Gaussian error distributions that the real value lies within the given interval), reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. This paper is intended to provide a baseline to keep track of annual carbon budgets in the future.

The global carbon budget 1959–2011

Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the climate policy process, and project future climate change. Present-day analysis requires the combination of a range of data, algorithms, statistics and model estimates and their interpretation by a broad scientific community. Here we describe datasets and a methodology developed by the global carbon cycle science community to quantify all major components of the global carbon budget, including their uncertainties. We discuss changes compared to previous estimates, consistency within and among components, and methodology and data limitations. Based on energy statistics, we estimate that the global emissions of CO2 from fossil fuel combustion and cement production were 9.5 ± 0.5 PgC yr−1 in 2011, 3.0 percent above 2010 levels. We project these emissions will increase by 2.6% (1.9–3.5%) in 2012 based on projections of Gross World Product and recent changes in the carbon intensity of the economy. Global net CO2 emissions from Land-Use Change, including deforestation, are more difficult to update annually because of data availability, but combined evidence from land cover change data, fire activity in regions undergoing deforestation and models suggests those net emissions were 0.9 ± 0.5 PgC yr−1 in 2011. The global atmospheric CO2 concentration is measured directly and reached 391.38 ± 0.13 ppm at the end of year 2011, increasing 1.70 ± 0.09 ppm yr−1 or 3.6 ± 0.2 PgC yr−1 in 2011. Estimates from four ocean models suggest that the ocean CO2 sink was 2.6 ± 0.5 PgC yr−1 in 2011, implying a global residual terrestrial CO2 sink of 4.1 ± 0.9 PgC yr−1. All uncertainties are reported as ±1 sigma (68% confidence assuming Gaussian error distributions that the real value lies within the given interval), reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. This paper is intended to provide a baseline to keep track of annual carbon budgets in the future.

Estimating population and livestock density of mobile pastoralists and sedentary settlements in the southeastern Lake Chad area

Mobile pastoralists provide major contributions to the gross domestic product in Chad, but little information is available regarding their demography. The Lake Chad area population is increasing, resulting in competition for scarce land and water resources. For the first time, the density of people and animals from mobile and sedentary populations was assessed using randomly defined sampling areas. Four sampling rounds were conducted over two years in the same areas to show population density dynamics. We identified 42 villages of sedentary communities in the sampling zones; 11 (in 2010) and 16 (in 2011) mobile pastoralist camps at the beginning of the dry season and 34 (in 2011) and 30 (in 2012) camps at the end of the dry season. A mean of 64.0 people per km2 (95% confidence interval, 20.3-107.8) were estimated to live in sedentary villages. In the mobile communities, we found 5.9 people per km2 at the beginning and 17.5 people per km2 at the end of the dry season. We recorded per km2 on average 21.0 cattle and 31.6 small ruminants in the sedentary villages and 66.1 cattle and 102.5 small ruminants in the mobile communities, which amounts to a mean of 86.6 tropical livestock units during the dry season. These numbers exceed, by up to five times, the published carrying capacities for similar Sahelian zones. Our results underline the need for a new institutional framework. Improved land use management must equally consider the needs of mobile communities and sedentary populations.

Global carbon budget 2013

Accurate assessment of anthropogenic carbon dioxide (CO2) emissions and their redistribution among the atmosphere, ocean, and terrestrial biosphere is important to better understand the global carbon cycle, support the development of climate policies, and project future climate change. Here we describe data sets and a methodology to quantify all major components of the global carbon budget, including their uncertainties, based on the combination of a range of data, algorithms, statistics and model estimates and their interpretation by a broad scientific community. We discuss changes compared to previous estimates, consistency within and among components, alongside methodology and data limitations. CO2 emissions from fossil-fuel combustion and cement production (EFF) are based on energy statistics, while emissions from land-use change (ELUC), mainly deforestation, are based on combined evidence from land-cover change data, fire activity associated with deforestation, and models. The global atmospheric CO2 concentration is measured directly and its rate of growth (GATM) is computed from the annual changes in concentration. The mean ocean CO2 sink (SOCEAN) is based on observations from the 1990s, while the annual anomalies and trends are estimated with ocean models. The variability in SOCEAN is evaluated for the first time in this budget with data products based on surveys of ocean CO2 measurements. The global residual terrestrial CO2 sink (SLAND) is estimated by the difference of the other terms of the global carbon budget and compared to results of independent dynamic global vegetation models forced by observed climate, CO2 and land cover change (some including nitrogen–carbon interactions). All uncertainties are reported as ± 1 σ, reflecting the current capacity to characterise the annual estimates of each component of the global carbon budget. For the last decade available (2003–2012), EFF was 8.6 ± 0.4 GtC yr − 1, ELUC 0.9 ± 0.5 GtC yr − 1, GATM 4.3 ± 0.1 GtC yr − 1, S OCEAN 2.5 ± 0.5 GtC yr − 1, and S LAND 2.8 ± 0.8 GtC yr − 1. For year 2012 alone, EFF grew to 9.7 ± 0.5 GtC yr − 1, 2.2 % above 2011, reflecting a continued growing trend in these emissions, GATM was 5.1 ± 0.2 GtC yr − 1, SOCEANwas 2.9 ± 0.5 GtC yr −1, and assuming an ELU Cof 1.0 ± 0.5 GtC yr − 1 (based on the 2001–2010 average), SLAND was 2.7 ± 0.9 GtC yr − 1. GATM was high in 2012 compared to the 2003–2012 average, almost entirely reflecting the high EFF. The global atmospheric CO2 con- centration reached 392.52 ± 0.10 ppm averaged over 2012. We estimate that EFF will increase by 2.1 % (1.1–3.1 %) to 9.9 ± 0.5 GtC in 2013, 61 % above emissions in 1990, based on projections of world gross domestic product and recent changes in the carbon intensity of the economy. With this projection, cumulative emissions of CO2 will reach about 535 ± 55 GtC for 1870–2013, about 70 % from EFF (390 ± 20 GtC) and 30 % from ELUC (145 ± 50 GtC). This paper also documents any changes in the methods and data sets used in this new carbon budget from previous budgets (Le Quéré et al., 2013). All observations presented here can be downloaded from the Carbon Dioxide Information Analysis Center.

Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008

Background While survival rates of extremely preterm infants have improved over the last decades, the incidence of neurodevelopmental disability (ND) in survivors remains high. Representative current data on the severity of disability and of risk factors associated with poor outcome in this growing population are necessary for clinical guidance and parent counselling. Methods Prospective longitudinal multicentre cohort study of preterm infants born in Switzerland between 240/7 and 276/7 weeks gestational age during 2000–2008. Mortality, adverse outcome (death or severe ND) at two years, and predictors for poor outcome were analysed using multilevel multivariate logistic regression. Neurodevelopment was assessed using Bayley Scales of Infant Development II. Cerebral palsy was graded after the Gross Motor Function Classification System. Results Of 1266 live born infants, 422 (33%) died. Follow-up information was available for 684 (81%) survivors: 440 (64%) showed favourable outcome, 166 (24%) moderate ND, and 78 (11%) severe ND. At birth, lower gestational age, intrauterine growth restriction and absence of antenatal corticosteroids were associated with mortality and adverse outcome (p < 0.001). At 360/7 weeks postmenstrual age, bronchopulmonary dysplasia, major brain injury and retinopathy of prematurity were the main predictors for adverse outcome (p < 0.05). Survival without moderate or severe ND increased from 27% to 39% during the observation period (p = 0.02). Conclusions In this recent Swiss national cohort study of extremely preterm infants, neonatal mortality was determined by gestational age, birth weight, and antenatal corticosteroids while neurodevelopmental outcome was determined by the major neonatal morbidities. We observed an increase of survival without moderate or severe disability.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

“Crye Fredome”? Medievalism and Twenty-First-Century Scottish National Identity

It is a well-documented fact that the Middle Ages have had a long history of instrumentalisation by nationalisms. 19th-century Eu¬rope in particular witnessed an origins craze during the process of nation-building. In the post-Shoah, post-modern West, on the other hand, we might expect this kind of medievalist master nar¬rative to have been consigned to the dustbin of history. And yet, as nationalism surges again in Europe, negotiations of national identi¬ties in medieval dress seem to have become fashionable once more. In order to come to terms with the fragmented and often contradictory presence of the Middle Ages in these discourses of national identity, I propose we consider medievalism a utilitarian product of the cultural memory. Rather than representing any ‘real’ Middle Ages, then, medievalism tailors available knowledge of the medieval past to the diverse social needs and ideologies of the present. This paper looks at a selection of Scottish examples of present-day medievalism in an attempt to investigate, in particular, the place of the medieval Wars of Scottish Independence in contemporary negotiations of ‘Scottishness’. Both the relationships envisioned between self and other and the role played by ‘the land’ in these cultural, social and political instances of national introspection offer starting points for critical inquiry. Moreover, the analysis of a scholarly intervention in the run-up to the 2014 Scottish independence referendum indicates an intriguing dialogue of academic and non-academic voices in the context of Scottish medievalist cultural memory. We thus find a wide array of uses of the Scottish Middle Ages, some of which feed into the burgeoning nationalism of recent years, while others offer more pensive and ambivalent answers to the question of what it means to be Scottish in the 21st century.