Swiss National Research Articles

Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels.

Endovascular treatment (EVT) of stroke with large-vessel occlusion is known to be safe and effective. The effect of EVT for occlusion of medium or distal vessels is unclear. We randomly assigned participants with an isolated occlusion of medium or distal vessels (occlusion of the nondominant or codominant M2 segment of the middle cerebral artery [MCA]; the M3 or M4 segment of the MCA; the A1, A2, or A3 segment of the anterior cerebral artery; or the P1, P2, or P3 segment of the posterior cerebral artery) to receive EVT plus best medical treatment or best medical treatment alone within 24 hours after the participant was last seen to be well. The primary outcome was the level of disability at 90 days, as assessed with the modified Rankin scale score. A total of 543 participants (women, 44%; median age, 77 years) were included in the analysis: 271 were assigned to receive EVT plus best medical treatment and 272 to receive best medical treatment alone. The median score on the National Institutes of Health Stroke Scale (range, 0 to 42, with higher scores indicating more severe symptoms) at admission was 6 (interquartile range, 5 to 9). Intravenous thrombolysis was given to 65.4% of the participants. The predominant occlusion locations were the M2 segment (in 44.0% of the participants), M3 segment (in 26.9%), P2 segment (in 13.4%), and P1 segment (in 5.5%). In the comparison between EVT plus best medical treatment and best medical treatment alone, no significant difference in the distribution of modified Rankin scale scores was observed at 90 days (common odds ratio for improvement in the score, 0.90; 95% confidence interval, 0.67 to 1.22; P = 0.50). All-cause mortality was similar in the two groups (15.5% with EVT plus best medical treatment and 14.0% with best medical treatment alone), as was the incidence of symptomatic intracranial hemorrhage (5.9% and 2.6%, respectively). In persons with stroke with occlusion of medium or distal vessels, EVT did not result in a lower level of disability or a lower incidence of death than best medical treatment alone. (Funded by the Swiss National Science Foundation and others; DISTAL ClinicalTrials.gov number, NCT05029414.).

Diagnoses supported by a computerised diagnostic decision support system versus conventional diagnoses in emergency patients (DDX-BRO): a multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial.

Diagnostic error is a frequent and clinically relevant health-care problem. Whether computerised diagnostic decision support systems (CDDSSs) improve diagnoses is controversial, and prospective randomised trials investigating their effectiveness in routine clinical practice are scarce. We hypothesised that diagnoses made with a CDDSS in the emergency department setting would be superior to unsupported diagnoses. This multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial was done in four emergency departments in Switzerland. Eligible patients were adults (aged ≥18 years) presenting with abdominal pain, fever of unknown origin, syncope, or non-specific symptoms. Emergency departments were randomly assigned (1:1) to one of two predefined sequences of six alternating periods of intervention or control. Patients presenting during an intervention period were diagnosed with the aid of a CDDSS, whereas patients presenting during a control period were diagnosed without a CDDSS (usual care). Patients and personnel assessing outcomes were masked to group allocation; treating physicians were not. The primary binary outcome (false or true) was a composite score indicating a risk of reduced diagnostic quality, which was deemed to be present if any of the following occurred within 14 days: unscheduled medical care, a change in diagnosis, an unexpected intensive care unit admission within 24 h if initially admitted to hospital, or death. We assessed superiority of supported versus unsupported diagnoses in all consenting patients using a generalised linear mixed effects model. All participants who received any study treatment (including control) and completed the study were included in the safety analysis. This trial is registered with ClinicalTrials.gov (NCT05346523) and is closed to accrual. Between June 9, 2022, and June 23, 2023, 15 845 patients were screened and 1204 (591 [49·1%] female and 613 [50·9%] male) were included in the primary efficacy analysis. The median age of participants was 53 years (IQR 34-69). Diagnostic quality risk was observed in 100 (18%) of 559 patients with CDDSS-supported diagnoses and 119 (18%) of 645 with unsupported diagnoses (adjusted odds ratio 0·96 [95% CI 0·71-1·3]). 94 (7·8%) patients suffered a serious adverse event, none related to the study. Use of a CDDSS did not reduce the occurrence of diagnostic quality risk compared with the usual diagnostic process in adults presenting to emergency departments. Future research should aim to identify specific contexts in which CDDSSs are effective and how existing CDDSSs can be adapted to improve patient outcomes. Swiss National Science Foundation and University Hospital Bern.

The Wartburg gittern: new insights

Abstract Since 1860, the collection of the Wartburg Foundation in Eisenach has housed a small lute-like instrument that, based on the glued-in instrument label, is attributed to Hans Ott in Nuremberg, dated around 1450 and described as a gittern. This so-called Wartburg gittern has, to date, been considered to be one of the oldest surviving European plucked string instruments, is regularly mentioned in musicological literature and has often been ‘copied’ in the course of historical performance practice. Surprisingly, however, there has been neither a detailed study nor a comprehensive publication on this instrument. As part of a research project by the Swiss National Science Foundation at the Bern Academy of the Arts, the Wartburg gittern was re-examined in 2021. In addition to the direct analysis of the instrument, a three-dimensional model was created from numerous photographs using photogrammetry, a micro-computed tomography scan was carried out in collaboration with the Fraunhofer Development Center for X-ray Technology in Fürth, Bavaria (Fraunhofer-IIS/EZRT), a dendrochronological dating of the soundboard of the instrument was commissioned and new research into its provenance was undertaken. The most important findings are presented in this article.

Navigating the Ice: Establishing Pre-Concussion Baselines in Ice-Hockey Players for Gait Assessment Utilizing Inertial Measurement Units

Introduction Ice hockey can lead to high-energy collisions and traumas and is a sport with high risk of concussion (Ornon et al., 2020). Concussions represent 2–14% of all hockey injuries (Izraelski, 2014). Sports-related concussions (SRC) sustained in professional ice hockey are a common in-competition injury leading to highly individual return to sport that can be associated with symptoms lasting days to months (Höllerer et al., 2023). Following SRC there is an increased risk of subsequent concussion and musculoskeletal injury upon return to play, however, assessments that can detect subclinical changes in function following a concussion are lacking (Dunne et al., 2023). A COSMIN systematic review suggests gait-based assessments using inertial measurement units to capture pre-concussion baseline scores (Dunne et al., 2023). This study measured pre-season pre-concussion gait data in Swiss National League Ice hockey players. Baseline scores will be compared with measures from players sustaining in-season SRC. Methods Temporal and spatial gait parameters were measured with the Physilog (https://www.physilog.com/ , Lausanne, Switzerland) movement sensors. The sensors were fixed to the shoes for flat overground gait analysis. Over a 20-30 m walkway, participants performed a single-task (ST) walking condition (preferred gait speed) and a dual-task (DT) walking condition, i.e., preferred gait speed whilst counting backwards. Application of the dual-task paradigm aimed at quantifying the automaticity of movement (Soulard et al., 2021). The focus of this study was on gait speed, cadence (+ cv%), and stride length (+ cv%) (Dunne et al., 2023). Results Thirteen male National League players from SC Rapperswil-Jona Lakers, 21.9 ± 3.1 years, 182.5 ± 5.9 cm height, 83.3 ± 7.6 kg body weight performed a pre-season gait analysis. The players sustained 1.5 ± 1.4 [range 0 – 3] concussions in the past. ST/DT walking revealed a walking speed of 1.3 ± 0.14/1.12 ± 0.14 m/s; step length 0.72 ± 0.09/0.67 ± 0.07 m; step length coefficient of variation (cv, %) 5.4 ± 1.9/5.6 ± 1.4 %; cadence 106.7 ± 5.1/100.5 ± 5.7 steps/min; cadence cv 2.8 ± 1/2.9 ± 0.9 %. Discussion/Conclusion Our results will shed light on the reliability and validity of using inertial measurements in the context of concussion management. Practitioners can use this resource at their disposal to help make informed decisions regarding concussion management. References Dunne, L. A. M., et al. (2023). Validity and reliability of methods to assess movement deficiencies following concussion: A COSMIN systematic review. Sports Medicine - Open, 9, 76. https://doi.org/10.1186/s40798-023-00625-0 Höllerer, D., et al. (2023). Injury incidence, outcomes, and return to competition times after sports-related concussions during one professional ice hockey season: A prospective cohort study. Healthcare, 11, 3153. https://doi.org/10.3390/healthcare11243153 Izraelski, J. (2014). Concussions in the NHL: A narrative review of the literature. Journal of the Canadian Chiropractic Association, 58(4), 346–352. Ornon, G., et al. (2020). Epidemiology of injuries in professional ice hockey: A prospective study over seven years. Journal of Experimental Orthopaedics, 7, 87. https://doi.org/10.1186/s40634-020-00300-3 Soulard, J., et al. (2021). Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions. Scientific Reports, 11, 10229. https://doi.org/10.1038/s41598-021-88794-4

Strategies for trading in money markets

Money market trading is a part of Investment Banking and highly business relevant to the Swiss Banking sector. It is astonishing, therefore, that there are very few scientific studies or papers available on this subject. The goal of this article is to clarify and analyse the relevance, chances, and risks of money market trading within the Swiss banking sector and provides comprehensive information not only to professionals such as employees of banks but also for other clients interested in this specific topic. Various aspects of the money market were analysed, taking in a mix of interviews with experienced banking professionals as well as literary analysis. These aspects include products of and participants in the money market and combine it with the politics of the Swiss National Bank over the last few years. Furthermore, the implications of Basel III on cash trading were explored and explained by way of an example. From the interviews with banking experts, some basic requirements for the job profile of money market traders were defined, 5 strategies for money trading designed and related risks identified.

Redirection of Care for Neonates with Hypoxic-Ischemic Encephalopathy Receiving Therapeutic Hypothermia.

Background/Objectives: Hypoxic-ischemic encephalopathy (HIE) in late preterm and term neonates accounts for neonatal mortality and unfavorable neurodevelopmental outcomes in survivors despite therapeutic hypothermia (TH) for neuroprotection. The circumstances of death in neonates with HIE, including involvement of neonatal palliative care (NPC) specialists and neurodevelopmental follow-up at 18-24 months in survivors, warrant further evaluation. Methods: A retrospective multicenter cohort study including neonates ≥ 35 weeks gestational age with moderate to severe HIE receiving TH, registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2021. Neurodevelopmental follow-up at 18-24 months in survivors was assessed. The groups of survivors and deaths were compared regarding perinatal demographic and HIE data. Prognostic factors leading to redirection of care (ROC) were depicted. Results: A total of 137 neonates were included, with 23 (16.8%) deaths and 114 (83.2%) survivors. All but one death (95.7%) occurred after ROC, with death on a median of 3.5 (2-6) days of life. Severe encephalopathy was indicated by a Sarnat score of 3 on admission, seizures were more frequent, and blood lactate values were higher on postnatal days 1 to 4 in neonates who died. Lactate in worst blood gas analysis (unit-adjusted odds ratio 1.25, 95% CI 1.02-1.54, p = 0.0352) was the only variable independently associated with ROC. NPC specialists were involved in one case. Of 114 survivors, 88 (77.2%) had neurodevelopmental assessments, and 21 (23.9%) of those had unfavorable outcomes (moderate to severe disability). Conclusions: Death in neonates with moderate to severe HIE receiving TH almost exclusively occurred after ROC. Parents thus had to make critical decisions and accompany their neonate at end-of-life within the first week of life. Involvement of NPC specialists is encouraged in ROC so that there is continuity of care for the families whether the neonate survives or not.

Cross-sectional analysis of self-promotional language in texts of grant proposals across gender

Abstract To investigate whether the use of positive, self-promotional language in grant proposals is associated with the gender of the applicant, we used a cross-sectional analysis on 8,150 grant proposals submitted to the Swiss National Science Foundation in life sciences disciplines across three different funding schemes, targeting applicants at different career stages. Multivariate, logistic, and negative binomial regressions were used to model the count and binary presence of positive words in grant proposal titles and abstracts. We found no evidence of an association between the use of self-promotional language and gender in grant proposals from life sciences disciplines. In the Projects funding scheme, funding bottom-up research, male applicants have used on average slightly more positive words in their proposals than their female peers, but the estimates (Rate Ratio 1.057; 95% CI 0.982–1.139) show no evidence of an effect. Similarly, no evidence of gender differences was found in proposals from the Careers funding schemes (Rate Ratio 1.087, 95% CI 0.973–1.214) which target early career researchers, and in a pilot scheme (Rate Ratio 1.089, 95% CI 0.911–1.302), a double-blind funding scheme supporting unconventional research. It is encouraging that we found no evidence indicating a difference in the use of positive words between male and female grant applicants. Although many factors influence how peer reviewers perceive the content of grant proposals, language usage undoubtedly plays an important role. We urge other funding agencies to conduct similar studies to identify if language usage contributes to biases in grant evaluation.

In-vitro activity of the novel β-lactam/β-lactamase inhibitor combinations and cefiderocol against carbapenem-resistant Pseudomonas spp. clinical isolates collected in Switzerland in 2022.

To evaluate the in-vitro activity of the novel commercially-available drugs, including meropenem-vaborbactam (MEV), ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (IPR) as well as cefiderocol (FDC), against carbapenem-resistant Pseudomonas spp. (CRP) isolates. All CRP isolates collected at the Swiss National Reference Laboratory (NARA) over the year 2022 (n = 170) have been included. Most of these isolates (n = 121) were non-carbapenemase producers. Among the 49 carbapenemase producers, 47 isolates produced metallo-β-lactamases (MBL) including NDM-1 (n = 11), VIM-like (n = 28), IMP-like (n = 7), and both NDM-1 and VIM-2 (n = 1) and two isolates produced the class A carbapenemase GES-5. Susceptibility testing was determined by broth microdilution method (BMD), or disk diffusion test, and results interpreted following EUCAST guidelines. The susceptibility rates for MEV, CZA, C/T and IPR were found to be 41%, 45%, 59% and 58%, respectively, for the whole set of isolates tested. Among non-carbapenemase producers, susceptibility rates for these β-lactam/β-lactamase inhibitors (BL/BLI) combinations were higher, determined at 55%, 61%, 83%, and 82%, respectively. The overall susceptibility of carbapenemase-producing Pseudomonas spp. to novel BL/BLI was relatively low, while 80% of these isolates demonstrated susceptibility to FDC, with a similar proportion (79%) observed among MBL producers. A total of 10 MBL-producing isolates (6%), mainly NDM-1, were found to exhibit resistance to all drugs tested, with the exception of colistin. FDC exhibited an excellent in-vitro activity against this collection of CRP recovered from Switzerland in 2022, including MBL producers. The new BL/BLI combinations displayed significant activity against non-carbapenemase CRP, with IPR and C/T showing the highest susceptibility rates.

The effect of combining antibiotics on resistance: A systematic review and meta-analysis.

Under which conditions antibiotic combination therapy decelerates rather than accelerates resistance evolution is not well understood. We examined the effect of combining antibiotics on within-patient resistance development across various bacterial pathogens and antibiotics. We searched CENTRAL, EMBASE, and PubMed for (quasi)-randomised controlled trials (RCTs) published from database inception to 24 November 2022. Trials comparing antibiotic treatments with different numbers of antibiotics were included. Patients were considered to have acquired resistance if, at the follow-up culture, a resistant bacterium (as defined by the study authors) was detected that had not been present in the baseline culture. We combined results using a random effects model and performed meta-regression and stratified analyses. The trials' risk of bias was assessed with the Cochrane tool. 42 trials were eligible and 29, including 5054 patients, qualified for statistical analysis. In most trials, resistance development was not the primary outcome and studies lacked power. The combined odds ratio for the acquisition of resistance comparing the group with the higher number of antibiotics with the comparison group was 1.23 (95% CI 0.68-2.25), with substantial between-study heterogeneity (I2=77%). We identified tentative evidence for potential beneficial or detrimental effects of antibiotic combination therapy for specific pathogens or medical conditions. The evidence for combining a higher number of antibiotics compared to fewer from RCTs is scarce and overall compatible with both benefit or harm. Trials powered to detect differences in resistance development or well-designed observational studies are required to clarify the impact of combination therapy on resistance. Support from the Swiss National Science Foundation (grant 310030B_176401 (SB, BS, CW), grant 32FP30-174281 (ME), grant 324730_207957 (RDK)) and from the National Institute of Allergy and Infectious Diseases (NIAID, cooperative agreement AI069924 (ME)) is gratefully acknowledged.

The effect of combining antibiotics on resistance: A systematic review and meta-analysis

Background:Under which conditions antibiotic combination therapy decelerates rather than accelerates resistance evolution is not well understood. We examined the effect of combining antibiotics on within-patient resistance development across various bacterial pathogens and antibiotics.Methods:We searched CENTRAL, EMBASE, and PubMed for (quasi)-randomised controlled trials (RCTs) published from database inception to 24 November 2022. Trials comparing antibiotic treatments with different numbers of antibiotics were included. Patients were considered to have acquired resistance if, at the follow-up culture, a resistant bacterium (as defined by the study authors) was detected that had not been present in the baseline culture. We combined results using a random effects model and performed meta-regression and stratified analyses. The trials’ risk of bias was assessed with the Cochrane tool.Results:42 trials were eligible and 29, including 5054 patients, qualified for statistical analysis. In most trials, resistance development was not the primary outcome and studies lacked power. The combined odds ratio for the acquisition of resistance comparing the group with the higher number of antibiotics with the comparison group was 1.23 (95% CI 0.68–2.25), with substantial between-study heterogeneity (I2=77%). We identified tentative evidence for potential beneficial or detrimental effects of antibiotic combination therapy for specific pathogens or medical conditions.Conclusions:The evidence for combining a higher number of antibiotics compared to fewer from RCTs is scarce and overall compatible with both benefit or harm. Trials powered to detect differences in resistance development or well-designed observational studies are required to clarify the impact of combination therapy on resistance.Funding:Support from the Swiss National Science Foundation (grant 310030B_176401 (SB, BS, CW), grant 32FP30-174281 (ME), grant 324730_207957 (RDK)) and from the National Institute of Allergy and Infectious Diseases (NIAID, cooperative agreement AI069924 (ME)) is gratefully acknowledged.

Remote sensing reveals the role of forage quality and quantity for summer habitat use in red deer

BackgroundThe habitat use of wild ungulates is determined by forage availability, but also the avoidance of predation and human disturbance. They should apply foraging strategies that provide the most energy at the lowest cost. However, due to data limitations at the scale of movement trajectories, it is not clear to what extent even well-studied species such as red deer (Cervus elaphus) trade-off between forage quality and quantity, especially in heterogeneous alpine habitats characterized by short vegetation periods.MethodsWe used remote sensing data to derive spatially continuous forage quality and quantity information. To predict relative nitrogen (i.e. forage quality) and biomass (i.e. forage quantity), we related field data to predictor variables derived from Sentinel-2 satellite data. In particular, our approach employed random forest regression algorithms, integrating various remote sensing variables such as reflectance values, vegetation indices and optical traits derived from a radiative transfer model. We combined these forage characteristics with variables representing human activity, and applied integrated step selection functions to estimate sex-specific summer habitat selection of red deer in open habitats within and around the Swiss National Park, an alpine Strict Nature Reserve.ResultsThe combination of vegetation indices and optical traits greatly improved predictive power in both the biomass (R2 = 0.60, Root mean square error (RMSE) = 88.55 g/m2) and relative nitrogen models (R2 = 0.34, RMSE = 0.28%). Both female and male red deer selected more strongly for biomass (estimate = 0.672 ± 0.059 SE for normalised values for females, and 0.507 ± 0.061 for males) than relative nitrogen (estimate = 0.124 ± 0.062 for females, and 0.161 ± 0.061 for males, respectively). Females showed higher levels of use of the Swiss National Park.ConclusionsRed deer in summer habitats select forage quantity over quality with little difference between sexes. Females respond more strongly to human activities and thus prefer the Swiss National Park. Our results demonstrate the capability of satellite data to estimate forage quality and quantity separately for movement ecology studies, going beyond the exclusive use of conventional vegetation indices.

Radiographic Progression in Patients with Rheumatoid Arthritis in Clinical Remission or Low Disease Activity: Results from a Swiss National Registry (SCQM).

Background/Objectives: The therapeutic aim for rheumatoid arthritis (RA) is to control disease activity and prevent radiographic progression. Various clinical scores are used to assess disease activity in RA patients. The DAS 28 score can define states of low disease activity (LDA) and remission. Despite achieving LDA or remission, radiographic progression may, nevertheless, occur. However, the rates and frequency of this occurrence have not been analyzed in detail. (1) To characterize radiographic progression in patients with persistent DAS 28-defined LDA or remission. (2) Analyze the potential benefits of modifying therapeutic strategies in response to observed radiographic progression in patients with persistent LDA or remission. Methods: An analysis was conducted on RA patients enrolled in the SCQM (Swiss Clinical Quality Management) cohort. Persistent LDA or remission was defined as DAS 28 ≤ 3.2 or <2.6, respectively, recorded at two consecutive follow-up time points. Inclusion criteria involved patients with a minimum of two sets of radiographs taken during these LDA and/or remission periods. Radiographic progression was measured using the Ratingen score, a numerical scale ranging from 0 to 190, which quantifies joint erosions. Repair was defined as a decrease in the Ratingen score > 5 points/year, while progression was characterized by an increase of >1, >2, or >5 points change in the Ratingen score within a one-year timeframe. Results: Among 10'141 RA patients, there were 1'447 episodes of remission and 2'614 episodes of LDA, with two sets of X-rays available for assessment during these episodes. The rates of radiographic progression (>5 points change in the Ratingen score per year) were 11.2% for LDA and 8.8% for remission. Therapeutic adaptations were made in 7.0% of patients in remission and 12.9% of patients in LDA following radiographic progression. After radiographic progression despite LDA, loss of LDA was observed in 19% of patients with treatment intensification versus in 8.5% under continued treatment during follow-up within 36 months. Conclusions: We report a considerable rate of radiographic progression occurring in RA patients with LDA or clinical remission. Notwithstanding minor radiographic progression, maintaining therapeutic continuity seemed more favorable than altering the therapeutic regimen.

Which experimental factors govern successful animal-to-human translation in multiple sclerosis drug development? A systematic review and meta-analysis

Despite successes in multiple sclerosis (MS) drug development, the effectiveness of animal studies in predicting successful bench-to-bedside translation is uncertain. Our goal was to identify predictors of successful animal-to-human translation for MS by systematically comparing animal studies of approved disease-modifying therapies (DMTs) with those that failed in clinical trials due to efficacy or safety concerns. Systematic review of animal studies testing MS DMTs, identified from searches in PubMed and EMBASE. A random effect meta-analysis was fitted to the data to compare outcome effect sizes for approved versus failed DMTs. Effect sizes and testing under diverse experimental conditions were assessed as potential predictors for successful translation. We included 497 animal studies, covering 15 approved and 11 failed DMTs, tested in approximately 30'000 animals. DMTs were tested in a small repertoire of experimental parameters: about 86% of studies used experimental autoimmune encephalomyelitis (EAE), 80% used mice, and 76% used female animals. There was no association between animal study outcomes or testing DMTs under varied conditions (e.g., different laboratories or models) and successful approval. Surprisingly, 91% of animal studies were published after first-in-MS trial and 91% after official regulatory approval. Our findings emphasize the complexity in carrying drugs from animals to clinical practice. Specific challenges include limited experimental methods in animal research and a disconnect between preclinical and clinical research. We advocate for efforts to streamline drug development for MS to improve animal research's relevance for patients. NIH, Swiss National Science Foundation, Universities Federation for Animal Welfare.

Sociodemographic and regional differences in neonatal and infant mortality in Switzerland in 2011-2018: the Swiss National Cohort.

Despite a well-funded healthcare system with universal insurance coverage, Switzerland has one of the highest neonatal and infant mortality rates among high-income countries. Identifying avoidable risk factors targeted by evidence-based policies is a public health priority. We describe neonatal and infant mortality in Switzerland from 2011 to 2018 and explore associations with neonatal- and pregnancy-related variables, parental sociodemographic information, regional factors and socioeconomic position (SEP) using data from a long-term nationwide cohort study. We included 680,077 live births, representing 99.3% of all infants born in Switzerland between January 2011 and December 2018. We deterministically linked the national live birth register with the mortality register and with census and survey data to create a longitudinal dataset of neonatal- and pregnancy-related variables; parental sociodemographic information, such as civil status, age, religion, education, nationality; regional factors, such as urbanity, language region; and the Swiss neighbourhood index of socioeconomic position (Swiss-SEP index). Information on maternal education was available for a random subset of 242,949 infants. We investigated associations with neonatal and infant mortality by fitting multivariable Poisson regression models with robust standard errors. Several sensitivity analyses assessed the robustness of our findings. Overall, neonatal mortality rates between 2011 and 2018 were 3.0 per 1000 live births, with regional variations: 3.2 in German-speaking, 2.4 in French-speaking and 2.1 in Italian-speaking Switzerland. For infant mortality, the rates were 3.7 per 1000 live births overall, and 3.9 in the German-speaking, 3.3 in the French-speaking and 2.9 in the Italian-speaking region. After adjusting for sex, maternal age, multiple birth and birth rank, neonatal mortality remained significantly associated with language region (adjusted rate ratio [aRR] 0.72, 95% confidence interval [CI]: 0.64-0.80 for the French-speaking region and aRR 0.66, 95% CI: 0.51-0.87 for the Italian-speaking region vs German-speaking region), with marital status (aRR 1.55, 95% CI: 1.40-1.71 for unmarried vs married), nationality (aRR 1.40, 95% CI: 1.21-1.62 for non-European Economic Area vs Swiss) and the Swiss-SEP index (aRR 1.17, 95% CI: 1.00-1.36 for lowest vs highest SEP quintile). In the subset, we showed a possible association of neonatal mortality with maternal education (aRR 1.24, 95% CI: 0.95-1.61 for compulsory vs tertiary education). We provide detailed evidence about the social patterning of neonatal and infant mortality in Switzerland and reveal important regional differences with about 30% lower risks in French- and Italian-speaking compared with German-speaking regions. Underlying causes for such regional differences, such as cultural, lifestyle or healthcare-related factors, warrant further exploration to inform and provide an evidence base for public health policies.

The Swiss National Air Pollution Monitoring Network (NABEL) – Bridging Science and Environmental Policy

Awareness of atmospheric air quality in Switzerland became a concern in the 1960s, as a result of which the Swiss National Air Pollution Monitoring Network (Nationales Beobachtungsnetz für Luftfremdstoffe - NABEL) was created in the 1970s. This paper describes the establishment and evolution of NABEL, emphasizing its important role in monitoring air quality in Switzerland, and its contribution to international observation networks and research. The network’s history, legal framework, and measurement program are described, and exemplary time-series of air quality parameters are given. NABEL is an excellent example for reliable, long-term air quality monitoring and demonstrates the importance of such monitoring for air pollution control at both national and international levels.

Profiles of Primary School Children's Sports Participation and Their Motor Competencies.

Children participate in various organized and informal physical activities (PAs) in their leisure time, presenting diverse objectives and environments for motor and social development. However, current research often focuses on specific, mostly organized activities, overlooking the complexity of participation across different settings. This study aimed to (1) identify groups of children with similar characteristics based on their participation in five organized and informal sports activities and (2) examine how the groups differ regarding gender, age, BMI, motor competencies (MCs), and attendance in institutionalized care at school. The study included n = 1717 1st and 2nd graders (M = 7.60 years, SD = 0.59, 50.7% girls) and n = 1319 3rd and 4th graders (M = 9.46 years, SD = 0.57, 49.4% girls) from the "EMOKK" study, funded by the Swiss National Science Foundation. Data were collected via parent questionnaires on leisure sports participation, and MCs were assessed using MOBAK-1-2 and 3-4 tests. Latent profile analyses (LPAs) and univariate ANOVAs were used to identify group differences. A three-profile LPA model best fits the data, revealing differences in participation across individual and team sports, optional school sports, free play on the school playground, and informal activities during leisure time. Children involved more in team sports (profiles: allrounder and very active sportsperson) participate more in informal play and present better MCs than children participating mainly in individual sports (profile: individual sportsperson). Girls were predominantly in the individual sports profile, while boys were more evenly spread across all groups. These findings highlight the importance of designing targeted interventions that promote participation in both organized and informal sports, particularly for children with lower levels of PA. Children show different patterns of engagement in different interrelated organized and informal leisure PA contexts. These specific patterns and the children's MCs should be taken into account for the targeted promotion of PAs during leisure time.

Body ownership alterations in stroke emerge from reduced proprioceptive precision and damage to the frontoparietal network.

Stroke patients often experience alterations in their subjective feeling of ownership for the affected limb, which can hinder motor function and interfere with rehabilitation. In this study, we aimed at disentangling the complex relationship between sensory impairment, body ownership (BO), and motor control in stroke patients. We recruited 20 stroke patients with unilateral upper limb sensory deficits and 35 age-matched controls. Participants performed a virtual reality reaching task with a varying displacement between their real unseen hand and a visible virtual hand. We measured reaching errors and subjective ownership ratings as indicators of hand ownership. Reaching errors were modeled using a probabilistic causal inference model, in which ownership for the virtual hand is inferred from the level of congruency between visual and proprioceptive inputs and used to weigh the amount of visual adjustment to reaching movements. Stroke patients were more likely to experience ownership over an incongruent virtual hand and integrate it into their motor plans. The model explained this tendency in terms of a decreased capability of detecting visuo-proprioceptive incongruences, proportionally to the amount of proprioceptive deficit. Lesion analysis further revealed that BO alterations, not fully explained by the proprioceptive deficit, are linked to frontoparietal network damage, suggesting a disruption in higher-level multisensory integration functions. Collectively, our results show that BO alterations in stroke patients can be quantitatively predicted and explained in a computational framework as the result of sensory loss and higher-level multisensory integration deficits. Swiss National Science Foundation (163951).

Regret Minimization and Separation in Multi-Bidder, Multi-Item Auctions

We study a robust auction design problem with a minimax regret objective, in which a seller seeks a mechanism for selling multiple items to multiple bidders with additive values. The seller knows that the bidders’ values range over a box uncertainty set but has no information on their probability distribution. The robust auction design model we study requires no distributional information except for upper bounds on the bidders’ values for each item. This model is relevant if there is no trustworthy distributional information or if any distributional information is costly or time-consuming to acquire. We propose a mechanism that sells each item separately via a second price auction with a random reserve price and prove that this mechanism is optimal using duality techniques from robust optimization. We then interpret the auction design problem as a zero-sum game between the seller, who chooses a mechanism, and a fictitious adversary or “nature,” who chooses the bidders’ values from within the uncertainty set with the aim to maximize the seller’s regret. We characterize the Nash equilibrium of this game analytically when the bidders are symmetric. The Nash strategy of the seller coincides with the optimal separable second price auction, whereas the Nash strategy of nature is mixed and constitutes a probability distribution on the uncertainty set under which each bidder’s values for the items are comonotonic. We also study a restricted auction design problem over deterministic mechanisms. In this setting, we characterize the suboptimality of a separable second price auction with deterministic reserve prices and show that this auction becomes optimal if the bidders are symmetric. The optimal mechanism is derived in closed form and can easily be implemented by practitioners. History: Accepted by Andrea Lodi, Area Editor for Design &amp; Analysis of Algorithms–Discrete. Funding: This research was funded by the Swiss National Science Foundation [Grant BSCGI0_157733] and by the Ministry of Education, Singapore, under its Academic Research Fund Tier 2 [Grant MOE-T2EP20222-0003]. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2022.0275 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2022.0275 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .

Exploring and Controlling Chemistry Using Quantum Logic.

Over the past years, the development of experimental techniques for the coherent manipulation and control of isolated quantum systems has made impressive progress. Such 'quantum-logic' methods are also highly attractive in a chemical context in view of unravelling and controlling the quantum dynamics of molecular collisions and chemical reactions. Quantum technologies have the potential to transform the way chemical dynamics are investigated - by providing highly sensitive methods for state readout and spectroscopy, by opening up new pathways for the quantum-state preparation of molecules and by enabling an improved control of their microscopic behavior on the single-particle level. However, for complex quantum systems like molecules, these techniques are still in their infancy and their considerable potential remains to be unlocked. The aim of the present research program supported by an Advanced Grant of the Swiss National Science Foundation is to merge the fields of quantum science and chemical dynamics by advancing quantum technologies to polyatomic molecular ions and by applying them to the study of ion-molecule collisions and chemical reactions. In this article, we review the salient experimental methods as well as prospects and challenges in the development of molecular quantum technologies and their applications to chemistry.

Significant pre-post effects on a patient-reported outcome measure in inpatient rehabilitation

Abstract Background We conducted a pilot study for the Swiss National Association for Quality Development in Hospitals and Clinics (ANQ) in the inpatient rehabilitation setting. The aim was to assess the suitability of a generic health-related quality of life patient-reported outcome measure (PROM) as an outcome quality indicator for public reporting across all rehabilitation domains on a national level. Methods In a multi-stage expert-based selection process, the PROMIS Global Health 10 was selected for piloting. We collected data from 29 rehabilitation clinics from April to December 2023. Mean T-scores and effect sizes were analysed across different rehabilitation domains. Patients’ need for assistance in completing the questionnaire was also assessed. Results A dataset of 2261 cases yielded a cleaned sample of 2083, with 1217 complete cases. Mean T-scores for physical health (PHS) and mental health (MHS) significantly differed (p &amp;lt; 0.001) at admission and discharge across all rehabilitation domains. The largest effects were observed in PHS for pulmonary (38.9(7.3); 46.0(7.6); dz = 0.95) and cardiologic rehabilitation (41.7(7.4); 47.9(7.2); dz = 0.85), and in MHS for internal medicine (44.1(6.9); 49.1(5.6); dz = 0.80) and psychosomatic rehabilitation (36.0(7.2); 45.2(8.2); dz = 1.19), while the smallest effects were noted in PHS for paraplegia (36.3(7.2); 39.8(7.2); dz = 0.50) and in MHS for the musculoskeletal rehabilitation domain (46.2(7.9); 48.7(7.4); dz = 0.33). Of all complete cases, 40.5% needed assistance in filling in the PROM and support needs were distributed unequally across rehabilitation domains, ranging from 10.0% in psychosomatic to 70.3% in geriatric rehabilitation. Conclusions The study presents a nuanced understanding of HRQOL across various rehabilitation domains, with notable effects observed across all domains, alongside significant assistance needs. Key messages • PROMIS-GH10 shows significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation, with notable effects observed across all domains. • Observable barriers in implementation are evident due to substantial assistance requirements.