Stadt und soziale Bewegungen

Großstädte sind derzeit wieder zu Orten sozialer Bewegungen geworden. Mit Slogans wie „oben bleiben“ (Stuttgart) oder „Recht auf Stadt“ (Hamburg) artikuliert sich heute auf unterschiedliche Weise ein Protest, der auf sich verändernde urbane Realitäten Bezug nimmt und dabei eine breite mediale Resonanz findet. Gleichwohl werden oft nur bestimmte Formen der Organisation und des Protests als legitime soziale Bewegungen anerkannt. Andere werden als NIMBY, Not-in-my-backyard-Intitiativen, definiert und diskreditiert oder als Riots entpolitisiert. Es ist keineswegs ausgemacht, welche Initiativen und Bewegungen sich für ein „Recht auf Stadt“ im Sinne Lefebvres und damit für Aneignung und Umverteilung einsetzen, indem sie gegen die verbreitete stadtpolitische Konzentration auf Wettbewerb und Wachstum agieren, und welche möglicherweise gerade über ihr bürgerschaftliches Engagement ein (partizipativer) Teil einer neoliberalen Governance werden.

Serum Concentrations of Mannan-Binding Lectin (MBL) and MBL-Associated Serine Protease-2 and the Risk of Adverse Events in Pediatric Patients With Cancer and Fever in Neutropenia

Background. It is unknown whether serum concentrations of mannan-binding lectin (MBL) and MBL-associated serine protease-2 (MASP-2) influence the risk of adverse events (AEs) in children with cancer presenting with fever in neutropenia (FN). Methods. Pediatric patients with cancer presenting with FN after non-myeloablative chemotherapy were observed in a prospective multicenter study. Mannan-binding lectin and MASP-2 were measured using commercially available enzyme-linked immunosorbent assay in serum taken at cancer diagnosis. Multiple FN episodes per patient were allowed. Associations of MBL and MASP-2 with AE in general, with bacteremia, and with serious medical complications (SMC) during FN were analyzed using mixed logistic regression. Results. Of 278 FN episodes, AE was reported in 84 (30%), bacteremia was reported in 42 (15%), and SMC was reported in 16 (5.8%). Median MBL was 2152 ng/mL (range, 7–10 060). It was very low (<100) in 11 (9%) patients, low (100–999) in 36 (29%) patients, and normal (�1000) in 79 (63%) patients. Median MASP-2 was 410 ng/mL (range, 68–2771). It was low (<200) in 18 (14%) patients and normal in the remaining 108 (86%) patients. Mannan-binding lectin and MASP-2 were not significantly associated with AE or bacteremia. Normal versus low MBL was independently associated with a significantly higher risk of SMC (multivariate odds ratio, 12.8; 95% confidence interval, 1.01–163; P = .050). Conclusions. Mannan-binding lectin and MASP-2 serum concentrations were not found to predict the risk to develop AEs or bacteremia during FN. Normal MBL was associated with an increased risk of SMC during FN. This finding, in line with earlier studies, does not support the concept of MBL supplementation in MBL-deficient children with cancer presenting with FN.

Holocene flood frequency across the Central Alps – solar forcing and evidence for variations in North Atlantic atmospheric circulation

The frequency of large-scale heavy precipitation events in the European Alps is expected to undergo substantial changes with current climate change. Hence, knowledge about the past natural variability of floods caused by heavy precipitation constitutes important input for climate projections. We present a comprehensive Holocene (10,000 years) reconstruction of the flood frequency in the Central European Alps combining 15 lacustrine sediment records. These records provide an extensive catalog of flood deposits, which were generated by flood-induced underflows delivering terrestrial material to the lake floors. The multi-archive approach allows suppressing local weather patterns, such as thunderstorms, from the obtained climate signal. We reconstructed mainly late spring to fall events since ice cover and precipitation in form of snow in winter at high-altitude study sites do inhibit the generation of flood layers. We found that flood frequency was higher during cool periods, coinciding with lows in solar activity. In addition, flood occurrence shows periodicities that are also observed in reconstructions of solar activity from C-14 and Be-10 records (2500-3000, 900-1200, as well as of about 710, 500, 350, 208 (Suess cycle), 150, 104 and 87 (Gleissberg cycle) years). As atmospheric mechanism, we propose an expansion/shrinking of the Hadley cell with increasing/decreasing air temperature, causing dry/wet conditions in Central Europe during phases of high/low solar activity. Furthermore, differences between the flood patterns from the Northern Alps and the Southern Alps indicate changes in North Atlantic circulation. Enhanced flood occurrence in the South compared to the North suggests a pronounced southward position of the Westerlies and/or blocking over the northern North Atlantic, hence resembling a negative NAO state (most distinct from 4.2 to 2.4 kyr BP and during the Little Ice Age). South-Alpine flood activity therefore provides a qualitative record of variations in a paleo-NAO pattern during the Holocene. Additionally, increased South Alpine flood activity contrasts to low precipitation in tropical Central America (Cariaco Basin) on the Holocene and centennial time scale. This observation is consistent with a Holocene southward migration of the Atlantic circulation system, and hence of the ITCZ, driven by decreasing summer insolation in the Northern hemisphere, as well as with shorter-term fluctuations probably driven by solar activity. (C) 2013 Elsevier Ltd. All rights reserved.

Gonadotrophin stimulation for in vitro fertilization significantly alters the hormone milieu in follicular fluid: a comparative study between natural cycle IVF and conventional IVF.

STUDY QUESTION Is the steroid hormone profile in follicular fluid (FF) at the time of oocyte retrieval different in naturally matured follicles, as in natural cycle IVF (NC-IVF), compared with follicles stimulated with conventional gonadotrophin stimulated IVF (cIVF)? SUMMARY ANSWER Anti-Mullerian hormone (AMH), testosterone (T) and estradiol (E2) concentrations are ∼3-fold higher, androstenedione (A2) is ∼1.5-fold higher and luteinizing hormone (LH) is ∼14-fold higher in NC-IVF than in cIVF follicles, suggesting an alteration of the follicular metabolism in conventional gonadotrophin stimulated IVF. WHAT IS KNOWN ALREADY In conventional IVF, the implantation rate of unselected embryos appears to be lower than in NC-IVF, which is possibly due to negative effects of the stimulation regimen on follicular metabolism. In NC-IVF, the intrafollicular concentration of AMH has been shown to be positively correlated with the oocyte fertilization and implantation rates. Furthermore, androgen treatment seems to improve the ovarian response in low responders. STUDY DESIGN, SIZE, DURATION This cross-sectional study involving 36 NC-IVF and 40 cIVF cycles was performed from 2011 to 2013. Within this population, 13 women each underwent 1 NC-IVF and 1 cIVF cycle. cIVF was performed by controlled ovarian stimulation with HMG and GnRH antagonists. PARTICIPANTS/MATERIALS, SETTING, METHODS Follicular fluid was collected from the leading follicles. AMH, T, A2, dehydroepiandrosterone (DHEA), E2, FSH, LH and progesterone (P) were determined by immunoassays in 76 women. Aromatase activity in follicular fluid cells was analysed by a tritiated water release assay in 33 different women. For statistical analysis, the non-parametric Mann-Whitney U or Wilcoxon tests were used. MAIN RESULTS AND ROLE OF CHANCE In follicular fluid from NC-IVF and from cIVF, median levels were 32.8 and 10.7 pmol/l for AMH (P < 0.0001), 47.2 and 18.8 µmol/l for T (P < 0.0001), 290 and 206 nmol/l for A2 (P = 0.0035), 6.7 and 5.6 pg/ml for DHEA (n.s.), 3292 and 1225 nmol/l for E2 (P < 0.0001), 4.9 and 7.2 mU/ml for FSH (P < 0.05), 14.4 and 0.9 mU/ml for LH (P < 0.0001) and 62 940 and 54 710 nmol/l for P (n.s.), respectively. Significant differences in follicular fluid concentrations for AMH, E2 and LH were also found in the 13 patients who underwent both NC-IVF and cIVF when they were analysed separately in pairs. Hormone analysis in serum excluded any relevant impact of AMH, T, A2, and E2 serum concentration on the follicular fluid hormone concentrations. Median serum concentrations were 29.4 and 0.9 mU/ml for LH (P < 0.0001) and 2.7 and 23.5 nmol/l for P (P < 0.0001) after NC-IVF and c-IVF, respectively. Positive correlations were seen for FF-AMH with FF-T (r = 0.35, P = 0.0002), FF-T with FF-LH (r = 0.48, P < 0.0001) and FF-E2 with FF-T (r = 0.75, P < 0.0001). The analysis of aromatase activity was not different in NC-IVF and cIVF follicular cells. LIMITATION, REASONS FOR CAUTION Any association between the hormone concentrations and the implantation potential of the oocytes could not be investigated as the oocytes in cIVF were not treated individually in the IVF laboratory. Since both c-IVF and NC-IVF follicles were stimulated by hCG before retrieval, the endocrine milieu in the natural cycle does not represent the pure physiological situation. WIDER IMPLICATIONS OF THE FINDINGS The endocrine follicular milieu and the concentration of putative markers of oocyte quality, such as AMH, are significantly different in gonadotrophin-stimulated conventional IVF compared with natural cycle IVF. This could be a cause for the suggested lower oocyte quality in cIVF compared with naturally matured oocytes. The reasons for the reduced AMH concentration might be low serum and follicular fluid LH concentrations due to LH suppression, leading initially to low follicular androgen concentrations and then to low follicular AMH production. STUDY FUNDING/COMPETING INTERESTS Funding for this study was obtained from public universities (for salaries) and private industry (for consumables). Additionally, the study was supported by an unrestricted grant from MSD Merck Sharp & Dohme GmbH and IBSA Institut Biochimique SA. The authors are clinically involved in low-dose monofollicular stimulation and IVF therapies, using gonadotrophins from all gonadotrophin distributors on the Swiss market, including Institut Biochimique SA and MSD Merck Sharp & Dohme GmbH. Otherwise, the authors have no competing interests. TRIAL REGISTRATION NUMBER Not applicable.

Book Review: Entrepreneurship and Regional Development

Zoltan Acs Entrepreneurship and Regional Development. Cheltenham, UK: Edward Elgar, 2010. 640 pp. $299.95 (hardback). ISBN 978-1-84844-978-7

Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial

IMPORTANCE International guidelines advocate a 7- to 14-day course of systemic glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease (COPD). However, the optimal dose and duration are unknown. OBJECTIVE To investigate whether a short-term (5 days) systemic glucocorticoid treatment in patients with COPD exacerbation is noninferior to conventional (14 days) treatment in clinical outcome and whether it decreases the exposure to steroids. DESIGN, SETTING, AND PATIENTS REDUCE: (Reduction in the Use of Corticosteroids in Exacerbated COPD), a randomized, noninferiority multicenter trial in 5 Swiss teaching hospitals, enrolling 314 patients presenting to the emergency department with acute COPD exacerbation, past or present smokers (≥20 pack-years) without a history of asthma, from March 2006 through February 2011. INTERVENTIONS Treatment with 40 mg of prednisone daily for either 5 or 14 days in a placebo-controlled, double-blind fashion. The predefined noninferiority criterion was an absolute increase in exacerbations of at most 15%, translating to a critical hazard ratio of 1.515 for a reference event rate of 50%. MAIN OUTCOME AND MEASURE Time to next exacerbation within 180 days. RESULTS Of 314 randomized patients, 289 (92%) of whom were admitted to the hospital, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis. Hazard ratios for the short-term vs conventional treatment group were 0.95 (90% CI, 0.70 to 1.29; P = .006 for noninferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 to 1.26; P = .005 for noninferiority) in the per-protocol analysis, meeting our noninferiority criterion. In the short-term group, 56 patients (35.9%) reached the primary end point; 57 (36.8%) in the conventional group. Estimates of reexacerbation rates within 180 days were 37.2% (95% CI, 29.5% to 44.9%) in the short-term; 38.4% (95% CI, 30.6% to 46.3%) in the conventional, with a difference of -1.2% (95% CI, -12.2% to 9.8%) between the short-term and the conventional. Among patients with a reexacerbation, the median time to event was 43.5 days (interquartile range [IQR], 13 to 118) in the short-term and 29 days (IQR, 16 to 85) in the conventional. There was no difference between groups in time to death, the combined end point of exacerbation, death, or both and recovery of lung function. In the conventional group, mean cumulative prednisone dose was significantly higher (793 mg [95% CI, 710 to 876 mg] vs 379 mg [95% CI, 311 to 446 mg], P < .001), but treatment-associated adverse reactions, including hyperglycemia and hypertension, did not occur more frequently. CONCLUSIONS AND RELEVANCE In patients presenting to the emergency department with acute exacerbations of COPD, 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN19646069.

Small town sustainability: economic, social, and environmental innovation. 2. überarb. Aufl.

In an age where the globalization process is threatening the uniqueness and vitality of small towns, and where most urban planning discourse is directed at topics such as metropol-regions or mega-regions and world cities, the authors here emphasize the need to critically reflect on the potential of small towns. The second edition is expanded to cover the intensive development of small towns in China and Korea. In addition, the authors examine the impact of the economic crisis on small towns and the recent development of the Slow City movement.

Les experiences de retour des sans-papiers rentrés en Equateur: Ressources et defies, mesures proposes pour un retour viable

Notre compréhension de la migration du retour est encore très limitée. Ce sujet n’a que peu retenu l’attention des spécialistes de la migration et il existe peu d’études qui donnent une vision différenciée sur les divers types de « retourné-e-s », leurs motivations à retourner dans leurs pays, les défis qu’ils/elles affrontent et les ressources dont ils/elles disposent pour parvenir à se réinsérer dans les pays d’origine. Il existe en particulier un manque important d’études qui examinent en détail la situation spécifique du retour des migrant-e-s sans-papiers et l’impact de l’aide de programmes gouvernementaux pour leur réinsertion socio-économique. Cette lacune est particulièrement marquée dans le cas de la Suisse. Confronté à la situation d’absence d’évaluations des programmes d’appui au retour des sans-papiers, et dans le but d’y apporter des améliorations possibles à son propre programme, le Service de la Population du canton de Vaud a chargé Yvonne Riaño de mener une recherche sur la situation de retour des sans-papiers retournés en Équateur entre 2008-2010 avec l’appui du programme. La recherche présentée ici se base sur un travail de terrain réalisé en Équateur en 2010. Nous avons rencontré 25 familles (70% du total des familles rentrées avec l’aide du Canton de Vaud) habitant dans diverses régions du pays et avons recueilli leurs expériences de retour. La méthodologie choisie pour la récolte des données est qualitative et combine entretiens narratifs et semi-directifs. La recherche examine les raisons d'émigration et du retour des personnes interviewées ainsi que la situation actuelle de leurs projets de réinsertion, leurs ressources disponibles et le défis auxquels elles font face pour la réalisation de leurs projets. Six principes clés sont proposés pour repenser l’aide au retour de façon à pouvoir garantir un retour viable.

Beitrag zur Entwicklung eines Ressourcenansatzes der Nachhaltigkeit: eine Diskussion am Beispiel der Regulation der Bodenressource in der Schweiz

Dieser Artikel zeigt die Relevanz eines nachhaltigen Ressourcenansatzes auf, nach dem die Nachhaltigkeit vor allem eine Frage der nachhaltigen Ressourcennutzung ist, sei es im normativen oder im analytischen Blickwinkel. Der Artikel: (1) Zeigt in welchem Masse das nachhaltige Management der Ressourcensysteme eine Bedingung für Nachhaltigkeit sine qua none darstellt, (2) bietet einen auf den Konzepten „Ressource“ und „institutionelles Regime“ begründeten Analyserahmen, (3) illustriert die zwei genannten Konzepte anhand einer Analyse des Bodenregimes und anhand der Entwicklungen des Raumplanungsrechts und (4) schliesst mit einer normativen Anwendung des Ansatzes. Dabei werden die Entscheidungsvorgänge bei der Schaffung eines integrierten Regimes zum Management eines Ressourcensystems modelliert.

Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

OBJECTIVE: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. STUDY DESIGN: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. RESULTS: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710). CONCLUSION: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

Retuschen am Stadtbild: Altstadtsanierung und Identitätspolitik in der Schweiz der 1930er bis 1950er Jahre

In den Altstädten von Bern, Basel und Zürich wurden in den Jahren unmittelbar vor und während des Zweiten Weltkriegs Sanierungskampagnen in Angriff genommen, welche gleichermassen hygienische Zielsetzungen wie auch eine Bewahrung des bestehenden „Stadtbilds“ verfolgten. In der Nachkriegszeit schlugen sich diese in einer eigentlichen Welle von Restaurierungen und Ersatzneubauten nieder, die in ihrer Summe den Bestand weniger bewahrten, als vielmehr in traditionalistischem Sinn überformten. Ziel des Vortrags ist es, die baulichen Eingriffe und die ihnen zugrundeliegenden Sanierungskonzepte in ihrem zeitgenössischen politischen Kontext zu verorten. Beispielhaft lässt sich an den Tätigkeiten der „Eidgenössischen Expertenkommission für Altstadtsanierung“ zeigen, wie in der Schweiz jener Jahre auch das Bauerbe in den Dienst einer traditionalistischen Kulturpolitik gestellt wurde. Dass dies auf mehr indirektem Weg geschah und unter Einbezug verschiedener Institutionen und Akteure, kann dabei als besonderes Kennzeichen der Konsenspolitik im Zeichen der sogenannten „Geistigen Landesverteidigung“ gelten.