A lo largo de la historia encontramos sistemáticamente procesos de auge y declinación que llevan a determinados estados o imperios relevantes a convertirse en actores secundarios (1). El punto de inflexión es difícil de determinar ya que la declinación no refleja un hecho sino una sucesión de acontecimientos que contribuyen al debilitamiento de la hegemonía en el concierto internacional. En la última década, muchos pensadores se han cuestionado el poder de la principal potencia, particularmente a partir del atentado terrorista del 11 de setiembre del 2001 y las posteriores crisis económicas. De esta forma, hay quienes sostienen que el ícono de la democracia liberal estaría atravesando un proceso de declinación cada vez más sobresaliente. Con esta hipótesis planteada, presentaremos algunos indicadores que podrían reflejar la hipotética situación estadounidense. Para ello, recurriremos a una comparación con China, Brasil, Reino Unido y Japón.La muestra de países ha sido elegida para reflejar cómo EE.UU. podría estar perdiendo poder en un marco donde países emergentes, como China y Brasil, estarían posicionándose, en un mundo crecientemente multipolar. A su vez, la presencia de Reino Unido es relevante debido a que fue la potencia hegemónica que EE.UU. sucedió. Finalmente, Japón ha pasado de segunda a tercera economía mundial. Podría decirse que ha sido una "víctima" del ascenso chino, economía que hoy ocupa el segundo lugar y que determinadas proyecciones ubican en el primero hacia el año 2018 (2). La creatividad siempre ha sido un elemento fundamental para el progreso económico. Es por ello que la propiedad intelectual juega un rol destacado en la escena internacional. La solicitud de patentes por residentes demuestra un fuerte compromiso con los nuevos desafíos globales, donde la competitividad y la innovación son palabras con gran resonancia. Por patentes se entiende aquel derecho exclusivo de los solicitantes por la creación de un producto o proceso innovador por un tiempo determinado.A partir de este relevante indicador, surgen distintas implicancias. Por un lado, EE.UU. continua siendo una economía esencialmente innovadora. Aquí, no puede hablarse de declinación. Mas aún, no puede siquiera pensarse en declinación relativa. Por otro lado, es cierto que determinados países emergentes, como China, están creciendo a pasos más acelerados (3). Mientras EE.UU. pasó de abarcar el 20 al 22% de las patentes solicitadas por residentes a nivel mundial en el período comprendido entre 2000 y 2006, China pasó de representar el 3% al 12%. Así, la brecha entre éstos ha disminuido notablemente. Partiendo de este criterio, podemos sostener que EE.UU. estaría dejando de ser un potencia hegemónica.Es necesario destacar que la creciente solicitud de patentes en los países emergentes ha derivado en una importante caída porcentual japonesa. Hace ya décadas (desde finales de los 70´s) que Japón es considerado un país industrializado con tecnología de punta. Esta caída porcentual no significa que lo haya dejado de ser, sino que hay otros Estados que también están apuntando a los avances innovadores por lo que el peso japonés cae en el total. Aún así, Japón continua reflejando un gran dinamismo innovador en sectores tecnológicos de punta como la telefonía celular. Siguiendo dentro de la misma lógica de ciencia y tecnología, otro indicador relevante es el gasto en Investigación & Desarrollo medido en % del PIB. Por éste nos referimos a aquellos "… gastos corrientes y de capital (público o privado) en trabajo creativo realizado sistemáticamente para incrementar los conocimientos…" (4)Aquí se repite la situación anterior. Si bien los países desarrollados son quienes destinan más de su PBI para Investigación y Desarrollo, el crecimiento a lo largo de los años no ha sido abrupto (a excepción de Japón), sino más bien moderado. Sin embargo, en otros países como China y Brasil se han experimentado importantes variaciones. Esto refleja una decisión económica que posee un respaldo político. Los entes estatales (como las universidades) reciben creciente cantidad de subsidios para desarrollar tecnologías de punta en áreas sensibles como la biotecnología o la tecnología misilística y espacial.Para finalizar, es pertinente analizar la Inversión Extranjera Directa (IED) en % del PIB dentro del marco de las finanzas. Este indicador refleja lo atractivo que puede ser un país para captar capitales extranjeros, donde el inversor estudia el mercado objetivo tomando en cuenta distintos aspectos: económicos, políticos, sociales y tecnológicos.Este indicador manifiesta una realidad distinta a las vistas anteriormente. EE.UU. ha sido el Estado con mayor crecimiento de IED en base al PBI, dentro del grupo de países seleccionados. Esto se debe a que, a pesar (5) que su poder a nivel global se está debilitando en contraposición al ascenso de los países emergentes, los inversores continúan apostando al mercado norteamericano por la seriedad y estabilidad que ha brindado a lo largo de la historia. EE.UU. continúa siendo una economía dinámica con la capacidad intacta para innovar. La calidad de la educación universitaria es un buen ejemplo. Los indicadores utilizados en este trabajo tienen una directa relación con la calidad de los sistemas educativos de cada uno de los países involucrados en la muestra. Según los distintos rankings, las mejores universidades del mundo permanecen en EE.UU. Por su parte, también es cierto que comienzan a aparecer universidades de los países emergentes. Podemos pensar que EE.UU. no está en un proceso de declive como tal. En cambio, asistimos a un período donde los países emergentes están creciendo a pasos más acelerados que el resto del mundo, haciendo que los Estados hegemónicos se vean obligados a convivir con otros centros de poder. Los actores principales del comercio ya no son sólo EE.UU, Japón y la Unión Europea, sino que ahora entraron en juego países como China, India, Corea del Sur, Brasil y Rusia que también tienen poder de decisión en el ámbito internacional. (1) BANCO MUNDIAL. 2011. [online] [citado Octubre 2011] Disponible en Internet: (2) Un trabajo clásico es Kennedy, : "The Rise and Fall of the Great Powers: Economic Change and Military Conflict from 1500 to 2000". Random House. 1987(3) Es posible recurrir a proyecciones en la pagina del Fondo Monetario Internacional: http://www.imf.org/external/ns/cs.aspx?id=29(4) El tema de las patentes es un punto sensible de discusión entre EE.UU. y China. La violación de la propiedad intelectual es un problema central en la economía del país asiático. La cuestión principal para las autoridades americanas (y del resto de los países de la OCDE) pasa por saber hasta que punto este problema esta siendo combatido o, por el contrario, potenciado por el aparato estatal chino.(5) Ver Banco Mundial: http://datos.bancomundial.org. *Estudiante de la Licenciatura en Estudios Internacionales.FACS - Universidad ORT Uruguay
Rahapolitiikan merkitys suhdannepolitiikan työkaluna on erityisesti parin viime vuosikymmenen aikana kasvanut merkittävästi. Varsinkin kahden suurimman keskuspankin, EKP:n ja Yhdysvaltain keskuspankin, päätöksillä on kauaskantoisia vaikutuksia jotka heijastuvat koko maailmantalouteen. Tässä väitöskirjassa tarkastellaan eräitä rahapolitiikan ongelmia, jotka littyvät rahapolitiikan välittymismekanismeihin, keskuspankin tavoitteisiin sekä informaatiojoukkoon, johon perustuen keskuspankin tulisi korkopäätöksensä tehdä. Väitöskirjani koostuu johdantoluvusta ja neljästä esseestä. Ensimmäinen esseistä tarkastelee empiirisesti Yhdysvalloissa ja Saksassa tapahtuvien odottamattomien rahapolitiikan shokkien vaikutuksia ja niiden leviämistä maasta toiseen. Tutkimuksessa kiinnitetään erityistä huomiota niihin erityisongelmiin, joita liittyy rahapolitiikan shokkien identifioimiseen avoimessa taloudessa. Tutkimuksen tulosten perusteella havaittiin mm. että rahapolitiikan kansantuotevaikutukset ovat samansuuntaiset sekä omassa maassa, että ulkomailla. Näin ollen esimerkiksi koronnoston aiheuttamat suorat kansantuotevaikutukset näyttävät dominoivan koronnoston aiheuttaman valuuttakurssimuutoksen epäsuoria kansantuotevaikutuksia. Toisessa esseessä estimoidaan epälineaarinen rahapolitiikan päätössääntö Yhdysvaltain ja Saksan keskuspankeille Bretton Woods- järjestelmän jälkeiselle periodille ja tarkastellaan päätössäännön parametreissa mahdollisesti tapahtuneita muutoksia. Tulosten mukaan kummankin keskuspankin politiikkasäännössä on tapahtunut rakenteellisia muutoksia tarkasteluperiodin aikana. Erityisen selvästi havaittiin Yhdysvaltain keskuspankin rahapolitiikan vaihdelleen kahden vaihtoehtoisen regiimin välillä siten, että toisen regiimin aikana on kiinnitetty enemmän huomiota inflaatiotavoitteen saavuttamiseen, kun taas toisen regiimin aikana suhdannevaihteluiden tasoittaminen on ollut tärkeämpi tavoite. Toisaalta tutkimuksessa löydettiin lisää tukea aikaisemmille havainnoille, joiden mukaan estimoidut keskuspankin politiikkasääntöyhtälöt ovat herkkiä sekä estimoinneissa käytetyn aikasarja-aineiston, että politiikkasäännön täsmällisen spesifikaation suhteen. Kolmas essee tarkastelee yksinkertaisen teoreettisen mallin avulla, kannattaisiko Euroopan keskuspankin ottaa käyttöön suora valuuttakurssitavoite. Kysymys on ollut viime aikoina ajankohtainen, kun muistetaan euron kurssin melko voimakkaat vaihtelut sen käyttöönoton jälkeen. Kysymystä tarkastellaan paitsi koko rahaunionin, myös yhden pienen jäsenmaan näkökulmasta. Tällöin pienen jäsenmaan talouden on oletettu poikkeavan sekä avoimuutensa, että sen kohtaamien rakenteellisten shokkien suhteen muun unionin keskiarvoista. Näin ollen kysymyksenasettelu liittyy myös keskusteluun optimaalisen valuutta-alueen kriteereistä. Tutkimuksen tulokset toisaalta tukevat aikaisempaa näkemystä, jonka mukaan koko euroalueen talouden kannalta saavutettaisiin korkeintaan vähäisiä hyötyjä, jos valuuttakurssitavoite otettaisiin käyttöön. Pienen, taloudensa rakenteen suhteen unionin keskiarvoista poikkeavan jäsenmaan näkökulmasta valuuttakurssitavoitteen potentiaaliset hyödyt olisivat jonkin verran suuremmat. Hyödyt näkyisivät lähinnä pienempinä suhdannevaihteluina kun taas pienen maan hintavakautta ei valuuttakurssitavoitteella pystyttäisi juurikaan parantamaan. Neljännessä esseessä tutkitaan empiirisesti yksinkertaisen ennustemallin avulla, sisältääkö ns. Divisia raha-aggretaatti enemmän informaatiota euroalueen tulevasta inflaatiosta kuin perinteinen M3 raha-aggregaatti, jolle tällä hetkellä on annettu tärkeä muodollinen asema EKP:n päätöksenteossa, mutta jonka käyttöön liittyy eräitä sekä teoreettisia, että empiirisiä ongelmia. Toisin kuin perinteiset raha-aggregaatit, jotka lasketaan yksinkertaisestin komponenttiensa summana, Divisia raha-aggregaattia laskettaessa otetaan huomioon eri maksuvälineiden erilainen likvidisyyden aste. Tutkimuksessa vertaillaan ennustuskykynsä suhteen, paitsi raha-aggregaattien nimellisiä kasvuvauhteja, myös aggregaateille laskettuja kahta rahataloudellista indikaattoria, jotka mittaavat talouden reaalisen rahan määrää verrattuna sen kysyntään. Tulosten mukaan Divisia M3 raha-aggregaattiin ja siitä johdettuihin rahataloudellisiin tunnuslukuihin perustuvat inflaatioennusteet näyttäisivät olevan jonkin verran tarkempia kuin perinteiseen M3 raha-aggregaattiin perustuvat ennusteet. ; The doctoral thesis consists of an introduction and four essays that consider different aspects of conducting monetary policy in the euro area and in the US. The themes covered by the essays include, in particular, the transmission process of the monetary policy, the objectives of the central banks and the information set a central bank should consider when making its monetary policy decisions. The first essay studies the transmission of monetary policy shocks between the US and Germany. The analysis is based on estimating a structural VAR model (SVAR) of eleven variables: the short and long term interest rates, industrial productions, inflation rates and the growth rates of M3 monetary aggregate of both countries, as well as the nominal DEM/USD exchange rate. The identifying restrictions of the model are connected to the traditional open economy ISLM type models. The most important results are as follows: After a negative US monetary policy shock, the outputs of both countries decline, which contradicts the beggar-thy-neighbour result. The nominal USD appreciates against the DEM, and the long-term interest rates decline. The effects of the German monetary policy shock closely resemble the US results above. The outputs of both countries still seem to decline in both countries but surprisingly, the output effect of a monetary policy shock is greater from Germany to the US than the other way round. The DEM appreciates and the long term interest rates react with an initial rise, after which they fall. The purpose of the second essay was to study whether there were sudden changes in the parameter values of the Taylor rule type reaction function of the Federal Reserve and Bundesbank during the period 1970 1998. The reaction functions are estimated as Markov switching models with state dependent coefficients. The robustness of the results on the exact specification of the policy rule and on the measure for inflation and the output gap used in the estimation are examined by considering several alternative data sets and model specifications in the estimations. According to the results it is possible to characterize the behaviour of the Fed as a switching between two regimes with different weights put on resisting inflation and stabilizing fluctuations in output. The regimes of the Bundesbank, in turn, were classified as a regime without any response to either inflation or output gap, and a regime when the Bundesbank responded to both of the gaps. On the other hand, the results supported some previous findings according to which Taylor-type policy rule estimations are sensitive to the specification of the rule and the choice of the data. The third essay uses a a structural, quantitative macro model to investigate, whether the ECB should introduce the stabilization of the real exchange rate of the euro as one of the goals of its monetary policy. The problem is considered from the perspectives of both the whole monetary union and a single member state with a national economy more open than the union economy on average. According to the results, the member state would benefit from exchange rate stabilizing more than the rest of the union. It appears, however, that the asymmetries of the external shocks facing the economies may be a more important factor behind the greater volatility of the inflation and output of the member state than the structural differences. The fourth of the essays investigates, by means of a simulated out-of-sample forecasting exercise, whether the synthetic Divisia M3 monetary aggregate outperforms its simple sum M3 counterpart in forecasting euro area inflation dynamics. In addition to the growth rates of the nominal money stocks, the performance of the real money gap and monetary overhang series calculated for both sort of monies are also discussed. According to the results, some of the Divisia M3 money based monetary indicators seem to contain more information about the change of the future inflation than their counterparts based on the simple sum M3 money, while none of the simple sum M3 based indicator outperformed its Divisia money counterpart. Interestingly, and in contrast to some previous findings obtained with the simple sum M3 data, the growth rate of the Divisia money yielded the best forecasts, also outperforming the real money gap and monetary overhang measures calculated for the Divisia M3 money.
On 2019 August 14, the Advanced LIGO and Virgo interferometers detected the high-significance gravitational wave (GW) signal S190814bv. The GW data indicated that the event resulted from a neutron star-black hole (NSBH) merger, or potentially a low-mass binary BH merger. Due to the low false-alarm rate and the precise localization (23 deg at 90%), S190814bv presented the community with the best opportunity yet to directly observe an optical/near-infrared counterpart to an NSBH merger. To search for potential counterparts, the GROWTH Collaboration performed real-time image subtraction on six nights of public Dark Energy Camera images acquired in the 3 weeks following the merger, covering >98% of the localization probability. Using a worldwide network of follow-up facilities, we systematically undertook spectroscopy and imaging of optical counterpart candidates. Combining these data with a photometric redshift catalog, we ruled out each candidate as the counterpart to S190814bv and placed deep, uniform limits on the optical emission associated with S190814bv. For the nearest consistent GW distance, radiative transfer simulations of NSBH mergers constrain the ejecta mass of S190814bv to be M < 0.04 M at polar viewing angles, or M < 0.03 M if the opacity is κ < 2 cmg. Assuming a tidal deformability for the NS at the high end of the range compatible with GW170817 results, our limits would constrain the BH spin component aligned with the orbital momentum to be χ < 0.7 for mass ratios Q < 6, with weaker constraints for more compact NSs. ; This work was supported by the GROWTH (Global Relay of Observatories Watching Transients Happen) project funded by the National Science Foundation under PIRE grant No. 1545949. GROWTH is a collaborative project among California Institute of Technology (USA), University of Maryland College Park (USA), University of Wisconsin Milwaukee (USA), Texas Tech University (USA), San Diego State University (USA), University of Washington (USA), Los Alamos National Laboratory (USA), Tokyo Institute of Technology (Japan), National Central University (Taiwan), Indian Institute of Astrophysics (India), Indian Institute of Technology Bombay (India), Weizmann Institute of Science (Israel), The Oskar Klein Centre at Stockholm University (Sweden), Humboldt University (Germany), Liverpool John Moores University (UK), and University of Sydney (Australia). D.A.G. acknowledges support from Hubble Fellowship grant HST-HF2-51408.001-A. Support for program No. HST-HF251408.001-A is provided by NASA through a grant from the Space Telescope Science Institute, which is operated by the Association of Universities for Research in Astronomy, Inc., under NASA contract NAS5-26555. We gratefully acknowledge Amazon Web Services, Inc., for a generous grant (PS_IK_ FY2019_Q3_ Caltech_Gravitational_Wave) that funded our use of the Amazon Web Services cloud computing infrastructure to process the DECam data. P.E.N. acknowledges support from the DOE through DE-FOA-0001088, Analytical Modeling for Extreme-Scale Computing Environments. D.A.P. and D.A.G. performed the work associated with this project at the Aspen Center for Physics, which is supported by National Science Foundation grant PHY-1607611. This work was partially supported by a grant from the Simons Foundation. A.J.C.-T. thanks I. Agudo, J. Cepa, V. Dhillon, J. A. Font, A. MartinCarrillo, S. R. Oates, S. B. Pandey, E. Pian, R. Sanchez-Ramirez, A. M. Sintes, V. Sokolov, and B.-B. Zhang for fruitful conversations. F.F. gratefully acknowledges support from NASA through grant 80NSSC18K0565 and from the NSF through grant PHY1806278. M.B., A.G., E.K., S.D., and J.S. acknowledge support from the G.R.E.A.T research environment funded by the Swedish National Science Foundation. J.S. acknowledges support from the Knut and Alice Wallenberg Foundation. J.S.B. and K.Z. are partially supported by a Gordon and Betty Moore Foundation Data-Driven Discovery grant. D.A.H.B. acknowledges research support from the National Research Foundation of South Africa. M.W.C. is supported by the David and Ellen Lee Postdoctoral Fellowship at the California Institute of Technology. S.N. and G.R. are grateful for support from VIDI, Projectruimte, and TOP Grants of the Innovational Research Incentives Scheme (Vernieuwingsimpuls) financed by the Netherlands Organization for Scientific Research (NWO). H.K. and K.Z. thank the LSSTC Data Science Fellowship Program, which is funded by LSSTC, NSF Cybertraining grant No. 1829740, the Brinson Foundation, and the Moore Foundation; his participation in the program has benefited this work. D.D. is supported by an Australian Government Research Training Program Scholarship. P.G. is supported by NASA Earth and Space Science Fellowship (ASTRO18F-0085). D.L.K. was supported by NSF grant AST-1816492. Y.D.H. thanks the support by the program of China Scholarships Council (CSC) under grant No. 201406660015. A.K.H.K. acknowledges support from the Ministry of Science and Technology of the Republic of China (Taiwan) through grants 107-2628-M-007-003 and 1082628-M-007-005-RSP. V.Z.G. acknowledges support from the University of Washington College of Arts and Sciences, Department of Astronomy, and the DIRAC Institute. University of Washington's DIRAC Institute is supported through generous gifts from the Charles and Lisa Simonyi Fund for Arts and Sciences and the Washington Research Foundation. M.J. and A.C. acknowledge the support of the Washington Research Foundation Data Science Term Chair fund and the UW Provost's Initiative in Data-Intensive Discovery. S.M. thanks the LSSTC Data Science Fellowship Program, which is funded by LSSTC, NSF Cybertraining Grant-1829740, the Brinson Foundation, and the Moore Foundation; his participation in the program has benefited this work. M.G. is supported by the Polish NCN MAESTRO grant 2014/14/A/ST9/00121. This research has made use of the VizieR catalog access tool, CDS, Strasbourg, France (doi:10.26093/cds/vizier). The original description of the VizieR service was published in A&AS 143, 23. This project used data obtained with the Dark Energy Camera (DECam), which was constructed by the Dark Energy Survey (DES) collaborating institutions: Argonne National Lab, University of California Santa Cruz, University of Cambridge, Centro de Investigaciones Energeticas, Medioambientales y Tecnologicas-Madrid, University of Chicago, University College London, DES-Brazil consortium, University of Edinburgh, ETH-Zurich, University of Illinois at Urbana-Champaign, Institut de Ciencies de l'Espai, Institut de Fisica d'Altes Energies, Lawrence Berkeley National Lab, Ludwig-Maximilians Universitat, University of Michigan, National Optical Astronomy Observatory, University of Nottingham, Ohio State University, University of Pennsylvania, University of Portsmouth, SLAC National Lab, Stanford University, University of Sussex, and Texas A&M University. Funding for DES, including DECam, has been provided by the U.S. Department of Energy, National Science Foundation, Ministry of Education and Science (Spain), Science and Technology Facilities Council (UK), Higher Education Funding Council (England), National Center for Supercomputing Applications, Kavli Institute for Cosmological Physics, Financiadora de Estudos e Projetos, Fundacao Carlos Chagas Filho de Amparo a Pesquisa, Conselho Nacional de Desenvolvimento Cientifico e Tecnologico and the Ministerio da Ciencia e Tecnologia (Brazil), the German Research Foundation-sponsored cluster of excellence "Origin and Structure of the Universe," and the DES collaborating institutions. The Liverpool Telescope is operated on the island of La Palma by Liverpool John Moores University in the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofisica de Canarias with financial support from the UK Science and Technology Facilities Council. Based on observations made with the Gran Telescopio Canarias (GTC), installed in the Spanish Observatorio del Roque de los Muchachos of the Instituto de Astrofisica de Canarias, in the island of La Palma. This work is partly based on data obtained with the instrument OSIRIS, built by a Consortium led by the Instituto de Astrofisica de Canarias in collaboration with the Instituto de Astronomia of the Universidad Autonoma de Mexico. OSIRIS was funded by GRANTECAN and the National Plan of Astronomy and Astrophysics of the Spanish Government. Some of the observations reported in this paper were obtained with the Southern African Large Telescope (SALT). Polish participation in SALT is funded by grant No. MNiSW DIR/WK/2016/07.
Verlagsinfo: Wenn das ehemals große deutsche Judentum noch heute einen Sinn für unsere Gesellschaft hat. so vielleicht den, daß darüber nachgedacht wird, in welchem Maße auch heutige Deutsche das benötigen, was die besten dieser ermordeten oder vertriebenen Juden einte: kritisches Bewußtsein und der Wille zu Humanität.
AMÉRICA LATINARepública Dominicana elige presidente sin una opción de renovación.Para más información: http://www.nytimes.com/2012/05/20/world/americas/new-hints-at-looser-travel-rules-stir-hope-in-cuba.html?ref=world&gwh=540CD4774545D8E17C7F9064A5EA9D35 http://diario.elmercurio.com/2012/05/22/internacional/_portada/noticias/CB59B748-D065-4F16-884B-A12813557137.htm?id={CB59B748-D065-4F16-884B-A12813557137}http://internacional.elpais.com/internacional/2012/05/18/actualidad/1337333119_548420.html http://www.bbc.co.uk/news/world-latin-america-18139809 http://www.economist.com/blogs/americasview/2012/05/dominican-republics-presidential-election Guatemala: ex dictador enfrenta cargos por genocidio. Para más información: http://oglobo.globo.com/mundo/ex-ditador-da-guatemala-sera-processado-por-massacre-4967912 http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/849e6371-a380-4660-9cee-77b359fe01f2.htm "El País" de Madrid analiza efectos de la política cambiaria argentina: "Lecciones argentinas para esconder billetes".Para más información: http://internacional.elpais.com/internacional/2012/05/19/actualidad/1337443141_571774.html Asesinado otro reportero en México en un mes fatídico para los periodistas. Para más información: http://www.msnbc.msn.com/id/47483396/ns/world_news-americas/#.T7vvRlK1uw4http://internacional.elpais.com/internacional/2012/05/19/actualidad/1337384449_271233.html Reelección en Venezuela: Chávez afirma que inscribirá candidatura. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/D5C4B980-6AD9-4393-9022-FC6AB8A3143D.htm?id={D5C4B980- La detención de tres generales abre una brecha entre el poder civil y militar en México. Para más información: http://www.bbc.co.uk/news/world-latin-america-18133808http://internacional.elpais.com/internacional/2012/05/18/actualidad/1337304528_943912.html México arresta líder de cartel que supuestamente está tras la masacre de Monterrey. http://www.bbc.co.uk/news/world-latin-america-18140844http://www.latimes.com/news/nationworld/world/la-fg-mexico-bodies-20120514,0,2098410.story Repsol no tiene éxito en su primer intento por encontrar petróleo en Cuba. Para más información: http://www.bbc.co.uk/news/world-latin-america-18124320 Repsol cancela las exportaciones de gas desde Argentina. Para más información: http://www.bbc.co.uk/news/world-latin-america-18127122 Corrupción en Bolivia hace que Morales vuelva a cambiar al jefe de la policía. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/internacional /noticias/BA437319-03AB-408A-A19D-0BECB836CC3D.htm?id={ BA437319-03AB-408A-A19D-0BECB836CC3D} Tres mexicanos son condenados a muerte por narcotráfico en Malasia. Para más información: http://www.bbc.co.uk/news/world-asia-18100100 Toma posesión nuevo jefe de Policía en Honduras. Para más información: http://www.eluniversal.com.mx/notas/848737.html El periodista hondureño Alfredo Villatoro fue encontrado muerto. Para más información: http://edition.cnn.com/2012/05/16/world/americas/honduras-journalist-killed/index.html?hpt=wo_bn8http://www.bbc.co.uk/news/world-latin-america-18083550 Haití, entre el cólera y la parálisis política. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/19A02809-E2DD-48F1-A307-8041A9B6E6DA.htm?id={19A02809-E2DD-48F1-A307-8041A9B6E6DA}http://internacional.elpais.com/internacional/2012/05/17/actualidad/1337276825_158084.htmlhttp://www.miamiherald.com/2012/05/19/2807321/remnants-of-haitis-army-march.html#storylink=cpy Argentina dio a conocer nuevo memorial de la Guerra de las Malvinas. Para más información: http://www.bbc.co.uk/news/uk-18135404 Noreste de Colombia: choques con las FARC dejan al menos 12 militares muertos. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/_portada/noticias/7894A443-F4F7-4A70-B44A-C060FA5FA473.htm?id={7894A443-F4F7-4A70-B44A-C060FA5FA473}http://www.eluniversal.com.mx/notas/848734.html Candidato presidencial mexicano, Peña Nieto, presentó un "manifiesto" con los principios de su eventual gobierno. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/8857F115-D995-4E64-907D-78A99A2E98A1.htm?id={8857F115-D995-4E64-907D-78A99A2E98A1} Miles de mexicanos salen a la calle en contra del candidato Peña Nieto. Para más información:http://internacional.elpais.com/internacional/2012/05/20/actualidad/1337480827_289958.html Instalan Comisión de la Verdad en Brasil para investigar crímenes de dictadura. Para más información: http://www.bbc.co.uk/news/world-latin-america-18087390ESTADOS UNIDOS / CANADÁDistintos medios cubren la campaña presidencial en Estados Unidos. Para más información: http://www.bbc.co.uk/news/world-us-canada-15949569 http://elpais.com/tag/elecciones_eeuu_2012/a/http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/DED6F01B-78A2-4AE6-8A73-3E966CDF2A06.htm?id={DED6F01B-78A2-4AE6-8A73-3E966CDF2A06}http://oglobo.globo.com/mundo/romney-encosta-em-obama-em-arrecadacao-de-campanha-4970694#ixzz1vdB1cknL Obama recibe apoyo de sectores que estaban al margen en elecciones. Para más información: http://www.eltiempo.com/mundo/estados-unidos/obama-recibe-apoyo-de-sectores-que-estaban-al-margen-en-elecciones_11836643-4 Violentos choques entre estudiantes y la policía en Quebec. Para más información: http://photoblog.msnbc.msn.com/_news/2012/05/17/11742456-quebec-moves-to-restore-order-as-striking-students-clash-with-police?lite Desvían vuelo en Estados Unidos por mujer que dijo tener artefacto implantado. Para más información: http://oglobo.globo.com/mundo/voo-desviado-nos-eua-por-motivo-de-seguranca-4969522#ixzz1vdB7bRXW http://www.eltiempo.com/mundo/estados-unidos/desvian-vuelo-en-ee-uu-por-mujer-que-dijo-tener-artefacto-implantado_11851821-4 Corrupción fluye libremente en la frontera de Estados Unidos con México. Para más información: http://www.latimes.com/news/nationworld/nation/la-na-border-corruption-20120513,0,5165934.storyDisidente chino recomienza su vida en Estados Unidos, su país guarda silencio. Para más información: http://edition.cnn.com/2012/05/19/world/asia/china-us-chen/index.html?hpt=wo_c2http://www.eltiempo.com/mundo/estados-unidos/disidente-chino-recomienza-su-vida-en-ee-uu-su-pas-guarda-silencio_11839682-http://internacional.elpais.com/internacional/2012/05/20/actualidad/1337473690_210062.html Los recién nacidos blancos ya no son mayoría en Estados Unidos. Para más información: http://internacional.elpais.com/internacional/2012/05/17/actualidad/1337274105_586907.html Obama busca el apoyo de la OTAN a su estrategia para Afganistán. Para más información: http://www.nytimes.com/2012/05/20/us/obamas-journey-to-reshape-afghanistan-war.html?ref=world&gwh=617EC044AFC4D4AE851F916B4AA6F365http://internacional.elpais.com/internacional/2012/05/18/actualidad/1337365516_467431.htmlhttp://www.nytimes.com/2012/05/20/us/us-to-unveil-initiatives-to-bolster-nato.html?ref=world&gwh=B2D94B0606B7E89D5484093F2D5C286C http://www.eltiempo.com/mundo/estados-unidos/barack-obama-dice-que-salida-de-afganistn-no-debe-ser-una-estampida_11843221-4 Para Obama la Eurozona se debe enfocar en el crecimiento económico y el trabajo. Para más información: http://www.bbc.co.uk/news/world-us-canada-18135042 http://www.nytimes.com/2012/05/19/us/19iht-currents19.html?ref=world http://www.bbc.co.uk/news/world-us-canada-18135796 Obama presenta plan de seguridad alimenticia para África. Para más información: http://usa.chinadaily.com.cn/world/2012-05/19/content_15337343.htm EUROPA Distintos portales hacen referencia a la actual crisis económica en la Eurozona. Para más información: http://usa.chinadaily.com.cn/world/2012-05/20/content_15340739.htmhttp://www.bbc.co.uk/news/business-18094883 http://internacional.elpais.com/tag/zona_euro/a/http://internacional.elpais.com/internacional/2012/05/19/actualidad/1337454283_695796.html http://bottomline.msnbc.msn.com/_news/2012/05/22/11805670-vicious-circle-europe-crisis-threatens-world-economy-oecd-says?lite http://www.economist.com/blogs/graphicdetail/2012/05/daily-chart-13 http://www.lemonde.fr/crise-de-l-euro/ Grecia entre el caos político y el derrumbe económico. Para más información: http://www.economist.com/node/21555567 http://diario.elmercurio.com/2012/05/22/internacional/_portada/noticias/877DE393-32C5-4CC5-8A02-A522CFC9D415.htm?id={877DE393-32C5-4CC5-8A02-A522CFC9D415} http://www.latimes.com/news/nationworld/world/la-fg-greece-banks-20120520,0,235777.story Merkel pide a Grecia que subsane a la brevedad la inestabilidad política. Para más información: http://edition.cnn.com/2012/05/18/world/europe/greece-germany-politics/index.html?hpt=hp_t2 Serbia enfrenta la segunda vuelta de las presidenciales. Para más información: http://www.lemonde.fr/europe/article/2012/05/20/le-nationaliste-tomislav-nikolic-donne-en-tete-de-la-presidentielle-en-serbie_1704422_3214.html http://internacional.elpais.com/internacional/2012/05/20/actualidad/1337522464_617545.html http://internacional.elpais.com/internacional/2012/05/20/actualidad/1337510494_056245.html http://www.nytimes.com/2012/05/21/world/europe/serbian-presidential-elections.html?ref=world La denuncia de la limpieza étnica marca la apertura del proceso contra Mladic, el carnicero de Srebrenica. Para más información: http://www.latimes.com/news/nationworld/world/la-fg-mladic-trial-20120517,0,6653722.story http://www.eltiempo.com/mundo/europa/mladic-es-juzgado-por-muerte-de-musulmanes-en-srebrenica_11836645-4 http://internacional.elpais.com/internacional/2012/05/16/actualidad/1337148040_913451.html http://edition.cnn.com/2012/05/16/world/europe/robertson-mladic-justic/index.html?hpt=wo_bn9Terremoto sacude el norte de Italia. Para más información: http://www.lemonde.fr/europe/article/2012/05/20/au-moins-trois-morts-dans-un-seisme-dans-le-nord-est-de-l-italie_1704300_3214.html http://www.nytimes.com/2012/05/21/world/europe/earthquake-in-northern-italy.html?ref=world&gwh=8E237AD33D0F5E8E46AE9B062C9F502Dhttp://edition.cnn.com/2012/05/20/world/europe/italy-earthquake/index.html?hpt=wo_c2http://internacional.elpais.com/internacional/2012/05/20/actualidad/1337489255_970834.htmlhttp://www.bbc.co.uk/news/world-europe-18140543http://www.eltiempo.com/mundo/europa/cinco-mil-evacuados-tras-terremoto-en-italia_11846542-4http://oglobo.globo.com/mundo/cidades-italianas-atingidas-por-tremor-vao-receber-130-milhoes-4970870#ixzz1vdEvkhFR Miles de españoles protestan por recortes en educación. Para más información: http://www.nytimes.com/2012/05/20/opinion/sunday/spains-yearnings-are-now-its-agony.html?ref=world&gwh=5615EC81EBD9E52A32763B7DB59EDFB5 http://www.eltiempo.com/mundo/europa/espanoles-protestan-por-recortes-en-educacion_11850841-4 Sismo de 5,7 sacude la capital de Bulgaria. Para más información: http://www.eltiempo.com/mundo/europa/sismo-de-57-sacude-la-capital-de-bulgaria_11846801-4 http://www.eluniversal.com.mx/notas/848702.html http://www.nytimes.com/2012/05/20/world/europe/frankfurt-germany-protests-austerity-measures.html?ref=world Primera medida del Gobierno socialista francés: un 30% menos de sueldo. Para más información: http://internacional.elpais.com/internacional/2012/05/17/actualidad/1337269966_524573.html http://edition.cnn.com/2012/05/17/world/europe/france-politics/index.html?hpt=wo_bn9 Merkel destituye al ministro Röttgen tras su derrota en el Estado de Renania. Para más información: http://internacional.elpais.com/internacional/2012/05/16/actualidad/1337180794_362929.html Bomba en Italia dejó como saldo una estudiante muerta. Para más información: http://usa.chinadaily.com.cn/world/2012-05/20/content_15339766.htmhttp://www.nytimes.com/2012/05/20/world/europe/fatal-school-bombing-stokes-fears-of-new-italy-violence.html?ref=world&gwh=2EA47097F6019E82A292648550254BEE http://www.eltiempo.com/mundo/europa/bomba-en-brindisi-italia-dej-como-saldo-una-estudiante-muerta_11832821-4 http://edition.cnn.com/2012/05/20/world/europe/italy-blast/index.html?hpt=wo_c2 Rusia aceptaría cambio de régimen sirio sin fuerza. Para más información: http://usa.chinadaily.com.cn/world/2012-05/21/content_15340901.htm "El País" de Madrid analiza: "Italia malvive en el desconcierto". Para más información: http://internacional.elpais.com/internacional/2012/05/19/actualidad/1337455694_588810.html 7 personas enfrentan cargos de terrorismo por supuestamente pertenecer a la IRA. Para más información: http://www.nytimes.com/2012/05/20/world/europe/7-suspected-of-ties-to-ira-faction-are-charged-with-terrorism.html?ref=world&gwh=1227D495BFDA74AC40440613EA7B7F56 Dominique Strauss-Kahn, la caída vertiginosa de un libertino. Para más información: http://www.eltiempo.com/mundo/europa/dominique-strauss-kahn-su-caida-vertiginosa_11846586-4ASIA- PACÍFICO/ MEDIO ORIENTE Atentado de Al Qaeda mata a 112 soldados durante ensayo militar en Yemen. Para más información: http://oglobo.globo.com/mundo/governo-do-iemen-destitui-militares-ligados-saleh-4966159#ixzz1vdGOkL3e http://edition.cnn.com/2012/05/20/world/meast/yemen-clashes/index.html?hpt=wo_c2http://www.eltiempo.com/mundo/medio-oriente/atentado-de-al-qaeda-en-yemen-deja-70-muertos_11846521-4 http://www.eluniversal.com.mx/notas/848691.htmlhttp://www.latimes.com/news/nationworld/world/la-fg-yemen-bombing-20120522,0,2884842.story http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/5F554DE6-CC26-44B2-9DD6-CD028D66C892.htm?id={5F554DE6-CC26-44B2-9DD6-CD028D66C892} La OTAN entregará el mando de sus misiones de combate a los afganos a mediados de 2013. Para más información: http://diario.elmercurio.com/2012/05/22/internacional/_portada/noticias/DB7CA3BD-1E30-4A97-A19B-4D5196B48616.htm?id={DB7CA3BD-1E30-4A97-A19B-4D5196B48616} http://www.lemonde.fr/asie-pacifique/article/2012/05/20/deux-soldats-de-l-otan-tues-en-afghanistan_1704337_3216.html http://www.latimes.com/news/nationworld/world/la-fg-nato-summit-20120521,0,3696577.story Al menos 25 muertos deja el choque de dos trenes en la India. Para más información: http://www.eltiempo.com/mundo/asia/al-menos-15-muertos-deja-el-choque-de-dos-trenes-en-la-india_11848901-4 http://oglobo.globo.com/mundo/batida-de-trens-deixa-aos-menos-25-mortos-na-india-4968644#ixzz1vdEnsqGg Pakistán bloquea Twitter debido a un contenido 'blasfemo'. Para más información: http://edition.cnn.com/2012/05/20/world/asia/pakistan-twitter/index.html?hpt=wo_c2http://www.eltiempo.com/mundo/medio-oriente/pakistn-bloquea-twitter-debido-a-un-contenido-blasfemo_11837901-4http://worldnews.msnbc.msn.com/_news/2012/05/21/11786700-pakistan-blocks-twitter-over-blasphemous-content-but-fails-to-stop-tweets?lite Japón inaugura la segunda torre más alta del mundo. Para más información: http://oglobo.globo.com/mundo/japao-inaugura-torre-mais-alta-do-mundo-4967044 http://worldnews.msnbc.msn.com/_news/2012/05/22/11809861-tokyo-sky-tree-takes-root-as-worlds-second-tallest-structure?lite Continúa la brutal represión gubernamental en Siria. Para más información: http://www.bbc.co.uk/news/world-middle-east-17258397 http://oglobo.globo.com/mundo/rebeldes-acusam-governo-sirio-de-matar-dois-na-frente-de-monitores-4966442#ixzz1vdEs0S7J http://www.lemonde.fr/proche-orient/article/2012/05/20/une-roquette-explose-a-proximite-du-chef-des-observateurs-de-l-onu-pres-de-damas_1704403_3218.html http://www.latimes.com/news/nationworld/world/la-fg-syria-annan-20120509,0,6654876.story http://www.bbc.co.uk/news/world-middle-east-18138269 Corea del Norte libera a pescador chino. Para más información: http://behindthewall.msnbc.msn.com/_news/2012/05/21/11792486-chinese-fishermen-held-by-north-korea-released-but-questions-linger?lite http://www.bbc.co.uk/news/world-asia-china-18141009 La ONU intenta llegar a un acuerdo con Irán sobre desarrollo nuclear. Para más información: http://worldnews.msnbc.msn.com/_news/2012/05/22/11805208-un-nuclear-chief-deal-reached-with-iran-over-suspected-weapons-program?lite http://www.bbc.co.uk/news/world-middle-east-18140539 Hackers iraníes se responsabilizan de ataque cibernético a la NASA. Para más información: http://www.msnbc.msn.com/id/47522497/ns/technology_and_science-security/#.T7vvjFK1uw4 Terremoto de 6.1 grados sacude la región de Honshu en Japón. Para más información: http://usa.chinadaily.com.cn/world/2012-05/20/content_15340479.htm China expande a nuevas ciudades el impuesto a las propiedades. Para más información: http://usa.chinadaily.com.cn/china/2012-05/10/content_15269760.htm "China Daily" analiza: "China y el repunte de sus exportaciones" . Para más información: http://usa.chinadaily.com.cn/business/2012-05/20/content_15339611.htm Presidente de Sri Lanka libera al General Sarath Fonseka. Para más información: http://www.bbc.co.uk/news/world-asia-18127712 Según el ministro de finanzas iraní los precios del petróleo seguirán reflejando las sanciones económicas. Para más información: http://edition.cnn.com/2012/05/20/world/meast/iran-nuclear/index.html?hpt=wo_c2 ÁFRICA Histórica caída en la mortalidad infantil en África. Para más información: http://www.economist.com/node/21555571 Egipto vive unas cruciales elecciones presidenciales. Para más información: http://www.economist.com/node/21555607http://diario.elmercurio.com/2012/05/22/internacional/internacional/noticias/CE137D6C-34FD-439F-B9C7-1A6A78B4767E.htm?id={CE137D6C-34FD-439F-B9C7-1A6A78B4767E}http://worldnews.msnbc.msn.com/_news/2012/05/22/11810404-egypts-elections-a-struggle-between-secularism-and-political-islam-and-how-it-may-transform-the-middle-east?litehttp://www.latimes.com/news/nationworld/world/la-fg-egypt-election-campaign-20120521,0,2977866.story Murió el único libio condenado por atentado en Lockerbie. Para más información: http://www.latimes.com/news/nationworld/world/la-fg-libya-lockerbie-bomber-20120521,0,4044827.story http://www.lemonde.fr/afrique/article/2012/05/20/le-libyen-al-megrahi-condamne-pour-l-attentat-de-lockerbie-est-mort_1704367_3212.htmlhttp://edition.cnn.com/2012/05/20/world/africa/obit-lockerbie-bomber/index.html?hpt=hp_t1 Nigeria entre la inflación y la escasez de alimentos. Para más información: http://usa.chinadaily.com.cn/world/2012-05/16/content_15310965.htm Líder de Malí hospitalizado tras que protestantes atacaran palacio presidencial. Para más información: http://worldnews.msnbc.msn.com/_news/2012/05/21/11796109-mali-leader-in-hospital-after-protesters-attack-presidential-palace?lite Sudan libera a cuatro extranjeros capturados en zona de disputa. Para más información: http://www.bbc.co.uk/news/world-africa-18137033 OTRAS Líderes del G8 se comprometen con crecimiento y una eurozona unida. Para más información: http://edition.cnn.com/2012/05/19/world/obama-g8-nato/index.html?hpt=wo_c2http://usa.chinadaily.com.cn/world/2012-05/20/content_15338533.htmhttp://www.eltiempo.com/mundo/estados-unidos/lderes-del-g8-se-comprometen-con-crecimiento-y-una-eurozona-unida_11835102-4 http://www.latimes.com/news/nationworld/world/la-fg-g8-economy-20120520,0,817522.story"The Economist" presenta su informe semanal: "Business this week".Para más información: http://www.economist.com/node/21555625
Radical prostatectomy is the most commonly performed treatment option for localised prostate cancer. In the last decades the surgical technique has been improved and modified in order to satisfy both oncological safety and postoperative functional results. Urinary incontinence and erectile dysfunction (ED) are the main postoperative functional impairments in patients that undergo radical prostatectomy (RP). [1] According to the EAU Guidelines erectile dysfunction is defined as "the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance". To this moment it is estimated that 25-75% of the patients who underwent RP develop ED with major implications in postoperative quality of life. [2] Various risk factors can be related to post-prostatectomy ED, among which the most important are the patient's age, comorbidities, preoperative erectile function, but also surgical approach (robot-assisted, laparoscopic, open) and nerve-sparing technique (inter/intrafascial). [2, 3] Among physiopathological modifications that concur to ED, the nerve damage (neuropraxia) appears to be the main domino piece that triggers other alterations like structural changes of the smooth muscle, arterial damage and veno-oclusive dysfunction which lead to cavernosal oxygenation impairments. [4–6] The clinical results of physiopathological alterations are shortening of penile size, impairment of orgasm and ejaculation achievement which have tremendous impact on psychological and mental health. [5] Various treatment options include oral medication with phosphodiesterase 5 inhibitors (PDE5i), intracavernosal injections or intraurethral applications of prostaglandin E1 (PGE1), vacuum or vibratory treatments. Though there are many options for ED treatment, to this date there is no definitive protocol for penile rehabilitation (PR) after prostatectomy. [5, 7] In this regard we have made a literature review and meta-analysis of the most important randomised trials published in the last 5 years in order to find the best strategies of penile rehabilitation after radical prostatectomy. MATERIALS AND METHODS We have systematically reviewed and collected data from randomised trials published in the last 5 years involving patients diagnosed with prostate cancer who experienced ED after radical prostatectomy. In order to find the necessary trials we have searched PubMed and ScienceDirect databases and used several key words like: erectile dysfunction, penile rehabilitation, phosphodiesterase 5 inhibitors, erectile functional recovery, prostate cancer, prostatectomy and nerve sparing – in various combinations. The first aspect for our meta-analysis inclusion criteria was to identify randomized (prospective or retrospective) placebo-controlled trials involving patients with localised prostate cancer that benefited of nerve sparing radical prostatectomy and developed postoperative ED. The key aspect of our research was the penile rehabilitation strategy which included the therapeutic means used for erectile 1 Dimitrie Gerota Emergency Hospital, Bucharest, Romania 2 Dr. Carol Davila University Central Emergency Military Hospital, Bucharest, Romania 3 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 10 function recovery and the treatment duration. Other aspects followed by us regarded the means of ED assessment, the surgical means and invasiveness and the rate of treatment success reported to ED severity. In this regard we have conducted our research for each year between January 2014 and December 2018 and reviewed a total of 631 articles published on this theme collected from both search engines. For a time-efficient assessment we have read the title and abstract of each article and included only those articles that matched our criteria. We have excluded the reviews and meta-analyses and also the trials of ED that was not related to prostate cancer surgery. That left us 194 publications from which to select. We have also excluded the trials withdrawn from database for various reasons and articles that didn't followed the therapeutic means of ED recovery. Finally we have selected 15 articles matching our criteria for meta-analysis that were thoroughly full text reviewed. Seven out of the 15 were prospective randomised trials, 2 of them being double-blind, placebo-controlled. Another 2 were nonrandomised prospective trials and the rest of 6 articles were retrospective review. Although some studies included by us followed-up both the ED and postoperative incontinence problem, we have concerned strictly on erectile dysfunction issue and collected the necessary data. For statistical analysis we have used ReviewManager 5.3 and Microsoft Excel software with data of treatment strategies and drug dosages collected from the studies. Although there was less heterogeneity between the study designs of the included articles we found important data about postoperative EF recovery. These data allowed us to include the studies in subgroups in order to analyse them. Table 1. Distribution of included studies Trial author Design Patient no. Mean age Cardiovascular comorbidities Diabetes Vickers et al. [8] Randomised prospective 2162 64.2 NoS NoS Montorsi et al. [9] Randomised double-blind placebo-control 423 58 NoS NoS Seo et al. [10] Retrospective review 92 67.9 40 (43.5%) 14 (15.2%) Nakano et al. [11] Retrospective review 103 63.4 NoS NoS Fode et al. [12] Randomised prospective control 68 62 NoS NoS Stolzenburg et al. [13] Randomised double-blind 422 59 NoS NoS Canat et al. [14] Randomised prospective 112 63 42 (37.5%) 18 (16.07%) Yiou et al. [15] Retrospective review 75 59.4 30 (40%) 6 (8%) Haglind et al. [16] Prospective controlled nonrandomised 2625 63 NoS NoS Kim D. et al. [17] Randomised prospective placebo-control 97 54 NoS NoS Capogrosso et al. [18] Retrospective review 2364 61 NoS NoS Sooriakumaran et al. [19] Prospective non-randomised 2545 63.3 556 (35.2%) 99 (6.2%) RESULTS A total of 11,831 patients were enlisted in the 15 studies we have included for analysis. Mean age of all patients was 61.91 years with a range between 54 and 67.9 years. (Table 1) Although not all the studies specifically mentioned the most encountered comorbidity was the cardiovascular disease (37.5% - 100%) followed by diabetes mellitus (6.2% – 16.07%). For most ED patients the presence of cardiovascular comorbidities creates the premises of disease trigger, followed by diabetes and obesity. [] All patients were Vol. CXXII • No. 3/2019 • December • Romanian Journal of Military Medicine 11 diagnosed (by means of PSA, prostate biopsy and pelvic MRI) with localised prostate cancer mainly T1c - T2c, with Gleason score ranging between 6 and 7 and PSA values below 10 ng/ml. (Table 2) These data were correlated with the postoperative pathology findings which in some cases changed the actual diagnostic stage according to d'Amico criteria. As it can be seen in Table 2 in some cases based on the degree of invasion the cancer stage was changed from localised to locally-advanced (T3b-T4) and based on Gleason score from low or intermediate risk to high risk (Gleason 8). All patients were proposed for radical prostatectomy using various approaches: open surgery (n = 4,460), conventional laparoscopy (n = 1,371) or robot assisted laparoscopic prostatectomy (n = 4,929). (Table 2) Most patients benefited of bilateral nerve sparing (BNS) dissection of the nerve bundles (n = 6,852) by al known technical procedures (interfascial/intrafascial), which represented 63.68% of the operated patients. When case did not impose BNS dissection, unilateral nerve sparing technique was attempted (n = 3,209) which was performed in 29.82% of the operated patients. The rest of 6.5% of the patients either had not benefited of NS dissection either the information about the NS status was not mentioned. [16, 18, 19] The NS status at the end of the surgery was crucial because it ensured the premises for postoperative ED recovery although most of the patients experienced postoperative neuropraxia. Table 2. PCa status and surgical approach for each study Trial author PCa clinical stage Gleason Score Surgical approach Nerve sparing OP CLP RALP BNS UNS Vickers et al. [8] T2a – T3 6 - 8 859 (40%) 546 (25%) 757 (35%) 657 (30%) 1498 (70%) Montorsi et al. [9] T1c – T2c 6 - 7 68 (48.9%) 29 (20.9%) 31 (22.3%) 423 (100%) - Seo et al. [10] T2a – T2c 4 - 8 - - 92 (100%) 57 (62%) 35 (38%) Nakano et al. [11] T2 – T3 6 - 7 NoS NoS NoS 24 (23.3%) 79 (76.7%) Fode et al. [12] T2 – T3 NoS 7 (10.3%) - 61 (89.7%) 37 (54.41%) 31 (45.58%) Stolzenburg et al. [13] T2-T3 ≤ 7 189 (44.78%) 88 (20.85%) 115 (27.25%) 422 (100%) - Canat et al. [14] T2a-T2c 5 - 8 NoS NoS NoS 112 - Yiou et al. [15] T2 - T3 6 - 8 - 75 (100%) - 75 (100%) - Haglind et al. [16] T1 - T3 6 - 8 778 - 1847 1318 750 Kim D. et al. [17] T1c – T3 6 - 8 58 (61.7%) - 36 (38.3%) 96 (98.96%) 1 (1.04%) Capogrosso et al. [18] T2 - T4 NoS 614 (26%) 633 (27%) 1117 (47%) 2253 (95%) 78 (3%) Sooriakumaran et al. [19] T2 – T4 NoS 1792 (70.41%) - 753 (29.58%) 1283 (50.41%) 737 (28.95%) Kim S. et al. [20] T2a – T2c 4 - 8 95 (100%) - - 95 (100%) - Kwon et al. [21] NoS NoS NoS NoS NoS NoS NoS Jo et al. [22] T2a – T2c 5 - 7 - - 120 (100%) NoS NoS NoS – no specification; OS – open surgery; CLP – conventional laparoscopic prostatectomy; RALP – robot assisted laparoscopic prostatectomy; BNS – bilateral nerve-sparing; UNS – unilateral nerve-sparing. 12 Table 3. Preoperative EF assessment and postoperative EF recovery means and results Trial author Type of EF questionnaire Preop. mean EF score Means of penile recovery Subgroups Trial duration Recovery rates Vickers et al. [8] IIEF-6 ³22 - 937 (59%) PDE5i (NoS) PGE1 ICI - 2 years 36% (NoS) Montorsi et al. [9] IIEF-EF ³22 - 423 (100%) PDE5i Tadalafil 5 mg – OaD – 139 (32.86%) Tadalafil 20 mg – PRN – 143 (33.8%) Placebo – 141 (33.3%) 9 months Tadalafil 5 mg – 25.2% Tadalafil 20 mg – 19.7% Placebo – 14.2% Seo et al. [10] IIEF-5 ³22 - 92 (100%) PDE5i Tadalafil 5 mg – OaD Non-Tadalafil 1 year Tadalafil 5 mg – 13.2% Non-Tadalafil – 7.7% Nakano et al. [11] IIEF-5 17.7 PDE5i Vardenafil 10 mg – OD – 30 (29.12%) Vardenafil 20 mg – PRN – 5 (4.85%) No treat – 68 (66.01%) 1 year Vardenafil 10 mg + Vardenafil 20 mg – 21 (60%) No treat – 26 (38.2%) Fode et al. [12] IIEF-5 25 PDE5i PVS PDE5i + PVS - 30 PDE5i - 38 1 year PDE5i + PVS – 16 (53%) PDE5i – 12 (32%) Stolzenburg et al. [13] IIEF-5 ³22 – 422 (100%) PDE5i Tadalafil 5 mg – OaD - 102 Tadalafil 20 mg – PRN - 112 Placebo - 106 9 months Tadalafil 5 mg – OaD – 29 (28.43%) Tadalafil 20 mg – PRN – 24 (21.42%) Placebo – 27 (25.4%) Canat et al. [14] IIEF-6 ³ 22 PDE5i Tadalafil 5 mg – OpW - 38 Tadalafil 20 mg – PRN - 40 Non-Tadalafil - 34 1 year Tadalafil 5 mg – OpW – 19.89 (mean IIEF) Tadalafil 20 mg – PRN – 15.8 (mean IIEF) Non-Tadalafil – 13.47 (mean IIEF) Yiou et al. [15] IIEF-EF EHS ³ 24 ³ 2 PDE5i PGE1 ICI PDE5i + PGE1 ICI – NoS No treatment - NoS 2 years M12 – 19.6 (mean IIEF – treat.) M12 – 18.07 (mean IIEF – no treat.) M24 – 4.63 (mean IIEF – treat.) M24 – 4.92 (mean IIEF – no treat.) Haglind et al. [16] IIEF-5 ³ 21 - RRP RALP 1 year RRP – 124 (15.93%) IIEF-5 ³ 21 RALP – 339 (18.35%) Kim D. et al. [17] IIEF-EF ³ 21 (100%) (Mean 28.1) PDE5i Sildenafil 50 mg - OaD + Sildenafil 100 mg - PRN Placebo + Sildenafil 100 mg - PRN 13 months Sildenafil 50 mg - OaD + Sildenafil 100 mg – PRN – 15 (32.4%) Placebo + Sildenafil 100 mg – PRN – 13 (29%) Capogrosso et al. [18] IIEF-6 ³ 24 (Mean 27) PDE5i PGE1 ICI 12 months - 1779 24 months - 1095 2 years 12 mo – 483 (27%) 24 mo – 377 (34%) Sooriakumaran et al. [19] Penile stiffness Morning erection 1702 (66.9%) PPP. PGE1 ICI PGE1 IUr RARP RRP 2 years RARP – 377 (21%) RRP – 106 (14%) Kim S. et al. [20] IIEF-5 22.4 PDE5i Tadalafil 5 mg – OaD – 2 years Tadalafil 5 mg – OaD – 1 year No Tadalafil 2 years Tadalafil 5 mg OaD – 2 yr. – 16.1 (mean IIEF) Tadalafil 5 mg OaD – 1 yr. – 13.5 (mean IIEF) No Tadalafil – 9.4 (mean IIEF) Vol. CXXII • No. 3/2019 • December • Romanian Journal of Military Medicine 13 Kwon et al. [21] Penile lenght SHIM NoS PDE5i (Sildenafil, Vardenafil, Tadalafil) Complete recovery Incomplete recovery 1 year CR – 318 (60.2%) IR – 210 (39.8%) Jo et al. [22] IIEF - 5 ³ 17 PDE5i (Sildenafil 100 mg) Early treatment - 58 (3 wk. postop.) Delayed treatment - 62 (3 mo. postop.) 1 year ET – 24 (41.4%) DT – 11 (17.7%) PPP – preoperative potent patients; IIEF – International Index of Erectile Function; OaD – oance a day; PRN – pro re nata (on demand); ICI – intracavernosal injections; IUr – intrauretral; For pre and postoperative EF assessment the IIEF questionnaire was preferred in most of the studies in different forms: the classical 15 questions IIEF-EF or the shorter IIEF-5/IIEF-6 questionnaires. Most authors preferred the IIEF-5 questionnaire due to its reliability and rapid way of determining the EF status. (Table 3) In most of the studies that used the IIEF questionnaire a cut-of value of 22 points was established for preoperative potent men [8–10, 13, 14] while others established close cut-of values. [16, 20] Only two studies used other means of EF assessment. Sooriakumaran et al. used two questions about penile stiffness and morning erections, both having single choice answer from 5 possible variants. [19] In a particular case Kim et al. compared the penile length both pre and postoperative and additionally used the SHIM questionnaire for ED appraisal. [20] The most frequently used treatment method for penile recovery was the administration of PDE5i which was tested with various ways of administration and dosages and compared with placebo or no treatment control groups. The most commonly used drug in the included trials was Tadalafil [9, 10, 13, 14, 20], followed by Sildenafil [17, 22] and Vardenafil. [11] Some trials studied the single use treatment of PDE5i compared with combinations of PDE5 with PGE1 ICI [8, 15, 18] or penile vibratory stimulation (PVS) devices. [12] There were also particular studies that did not compare the method of PDE5i administration but rather the rate of EF recovery [8, 21], the moment of treatment initiation [22] or the length of treatment administration. [18] Haglid et al. compared the EF recovery based only on the surgical approach type (open vs. RALP) and not interfering with any medication in this regard while Sooriakumaran et al. compared the same surgical approaches using PGE1 treatment setting. [16] Figure 1: Multivariate comparison of PDE5i OaD and PRN treatment compared to control group Although the articles included in our meta-analysis had dichotomous criteria of study design we could find similarities between some of them, which allowed us to organise subgroups of trials. On multivariate analysis we have included trials in which PDE5i was administered as OaD and PRN treatment compared to a pacebo control group. The variables included in analysis were the mean IIEF scores recorded at the end of the trial for each group (OaD, PRN and control). As it can be observed in fig. 1 the higher rates of recovery are in favour of PDE5i OaD group compared to control group (CI 95%, P < 0.0001). On a lower scale, the same result could be observed when PDE5i OaD treatment was compared to PDE5i PRN although in this analysis only 2 studies had the necessary data to be included (CI 95%, P = 14 0.48). In a univariate analysis we also compared the trials were only the percentage of recovered patients after PDE5i treatment was given. (Fig 2) As in previous assessment the PDE5i OaD group had higher recovery rates compared to control group (CI 95% P = 0.40). Also when we have compared PDE5i OaD with PRN group the better results were slightly higher in favour of OaD group thus resulting that the benefit of PDE5i OaD compared to PRN treatment was minor (CI 95%, P = 0.95). Figure 2: Recovery rates in trials using PDE5i OaD and PRN treatment compared to control group DISCUSSION Erectile dysfunction is a major postoperative complication for men who undergo radical prostatectomy, alongside urinary incontinence. At this moment prostate cancer is the second most diagnosed neoplasia in men due to the systematic determination of PSA. [23] Radical prostatectomy remains the most important therapeutic procedure for localised PCa having a postoperative life-expectancy of 10 years. [2] Although the technical enhancements of prostatectomy reduced the rates of postoperative complication, ED still remains one of the most complex problem for PCa patient's quality of life. Even if the nerve sparing dissection technique of the prostate bundles partially improved the ED rates, there are still problems regarding the postoperative penile rehabilitation. Neuropraxia is the main pathological alteration that leads to major structural changes of the penile tissue. This can also lead to veno-oclusive dysfunctions of blood drainage. Due to the constant state of hypo-oxygenation the penile smooth muscles suffers a process of apoptosis and fibrosis which in time are producing irreversible penile malformations such as penile shortening of 2-3 cm and Peyronie disease. [5, 24] In this regard it is advisable that urologists should discuss with their patients about the possibility of postoperative ED in various rates – from temporary to permanent. [25] Two trials included in our meta-analysis studied the rate of ED occurrence and penile recovery degree after RALP compared to RRP in high volume centres from Sweden. In a 2015 prospective study, Haglid et al. found a slightly higher rate of penile recovery for RALP, but the differences were not significant for these two surgical approaches. [16] In a recently conducted prospective trial, Sooriakumaran et al. (2018) found earlier recovery rates of EF for RALP (21%) compared to RRP (14%) due to a more precise identification and preservation of nerve bundles during RALP. Also the rates of post-surgical positive margins were similar to open surgery which is an important aspect for oncological radicality. [19] Both studies were prospective non-randomised. One key aspect of ED diagnosis is the use of pre and postoperative EF assessment questionnaires. As we have shown above the most frequently used questionnaire was IIEF-5 which is the short version of the IIEF-EF questionnaire. Other questionnaires like Sexual Health Inventory for Men (SHIM) or Expanded Prostate Cancer Index Composite (EHGS) have similar predictive results to IIEF and should be routinely used for postoperative ED diagnosis. [25, 26] It is a known fact that older age, cardiovascular comorbidities and diabetes mellitus are the most important predictive factors for ED onset. [27, 28] On the other hand the younger age and the lower body mass index are Vol. CXXII • No. 3/2019 • December • Romanian Journal of Military Medicine 15 demonstrated protective factors for ED recovery. [2] Even though not all the studies included in our meta-analysis reported the rate of cardiovascular disease and diabetes mellitus we could emphasize that in the post prostatectomy setting these two comorbidities could have significant impact on ED onset and the subsequent penile recovery. [10, 14, 15, 19, 20, 21] Penile rehabilitation is the cumulus of therapeutically means which includes medication, medical devices or actions, simple or in various combination recommended for erectile function recovery. [5] PDE5i are the most frequently used drugs in clinical practice for penile rehabilitation and to this date is the most studied therapeutic method administered to ED patients. The main advantage of PDE5i therapy is that there are quick and easy to administer but it requires the integrity of at least 1 cavernosal nerve bundle. Also the treatment cost and side effects (headache, flushing and palpitations) are not negletable. [24] In their common trial Montorsi et al. (2014) and Stolzenburg et al. (2015) studied the effect of Tadalafil administered once a day (OaD) and on demand (PRN) compared to a placebo-controlled group and found that the OaD administration of Tadalafil 5 mg has the best results for penile recovery after prostatectomy. [9, 13] Similar results for Tadalafil OaD administration were also found by Seo et al. (2014), Canat et al. (2015) and Kim S. et al. (2018) based on the mean IIEF score at the end of the trial. [14, 20] Nakano et al. (2014) and Kim D. et al. (2016) found similar results at the end of their trials although they have studied the effect of Vardenafil respectively Sildenafil. [11, 17] In our multivariate analysis the PDE5i OaD treatment has evident advantages over placebo and on demand PDE5i administration for postoperative penile recovery rate. Regarding the choice of PDE5i treatment there are no specific trials that compare the efficiency of currently available substances in postoperative ED. In a 2005 open-label randomised trial Eardley et al. emphasized that Tadalafil is the preferred PDE5i used for ED treatment because of long-lasting effect in time compared to Sildenafil that allowed patients to have less concerns about spontaneity of erection. [29] Further more Hyndman et al. demonstrated in their randomised trial that Sildenafil could have major impact over urinary continence, thus impairing the overall recovery of PCa operated patients. [30] Prostaglandin E1 intracavernosal injection (PGE1 ICI) was the first type of treatment for postoperative EF recovery, introduced and studied by Prof. Montorsi et al. [31] The most important advantage of PGE1 ICI is that is very effective in any type of surgical approach even if nerve sparing was not indicated, though the cost, the need to refrigerate the product, the invasiveness of the treatment and the side effects are a majos counterbalance for treatment initiation. [24] In our meta-analysis, Vickers et al., Yiou et al. and Capogrosso et al. have used PGE1 ICI in combination with PDE5i treatment for penile recovery. The results achieved by Yiou at 12 respectively 24 months of combined treatment were very similar in both drug-administered and control group. [15] On the other hand Capogrosso et al. found that at 24 months of combined PGE1 ICI and PDE5i treatment the rates of recovery were higher than at 12 months (34% vs. 27%). [18] Vacuum and vibratory devices are non-invasive and very effective in EF recovery especially when combined with PDE5i treatment. Fode et al. demonstrated in their randomised prospective trial that EF recovery could be very effective when penile vibratory stimulation devices are used in conjunction with PDE5i (53% recovery rate) compared to PDE5i only group (32%). [12] Regarding treatment initiation Jo et al. demonstrated that early penile rehabilitation commencement (at 3 weeks after surgery – immediately after urinary catheter removal) has better recovery results than delayed treatment initiation (at 3 months postoperative). [22] CONCLUSIONS The postoperative EF recovery of PCa patients can be achieved using a multitude of penile recovery strategies. For this purpose a preoperative assessment is very important, by using erectile function questionnaires. Patients should be informed about the postoperative ED risk and should be counselled in this area. Nerve-sparing robot assisted laparoscopic prostatectomy is the most protective surgical approach for EF preservation. PDE5i is the main therapeutic approach for postoperative penile recovery. Tadalafil 5 mg once a day was the most effective long term therapy for ED treatment both single use or in combination with PGE1 and other devices (vacuum or vibratory stimulation). Penile prosthesis implants should be regarded as last resort treatment option for cases when no penile recovery strategy has been successful.
Tarttumattomat sairaudet eli kansantaudit kattavat noin 40% tautitaakasta pieni- ja keskituloisissa maissa ja näiden sairauksien taakka kasvaa jatkuvasti. Kohdunkaulan syöpä on koko maailmassa ilmaantuvuudeltaan ja kuolleisuudeltaan naisten neljänneksi yleisin syöpä. Kohdunkaulan syöpä koskettaa erityisesti pieni- ja keskituloisia maita, joista Saharan eteläpuoleinen Afrikka on korkeimman ilmaantuvuuden alueita. Alueella on muitakin haasteita, kuten HIV-infektion leviäminen ja toimivan kohdunkaulasyövän seulontaohjelman puuttuminen. Etelä-Afrikka on ainoa maa Saharan eteläpuoleisessa Afrikassa, jossa naisilla on kansallisesti mahdollisuus hakeutua maksuttomaan kohdunkaulan irtosolutestiin (ns. Papa-testi) syövän esiasteiden ja varhaisen toteamisen mahdollistamiseksi. Tästä huolimatta kohdunkaulasyöpä on toiseksi yleisin syöpä ilmaantuvuudeltaan ja kuolleisuudeltaan ja vaikuttaa merkittävästi myös laatupainotettujen elinvuosien menetykseen. Irtosolutestiin perustuvan seulonnan huono toimivuus on yksi syy kohdunkaulasyövän korkeaan ilmaantuvuuteen. Väitöstutkimuksella haluttiin selvittää, onko väestön irtosolutestiin perustuva seulonta toimiva itäisen provinssin (Eastern Cape Province) alueen maaseutuväestössä. Tutkimuksella selvitettiin myös alueen kohdunkaulasyövän aiheuttama tautitaakka ilmaantuvuuden alueellisten erojen, seulonnan kattavuuden ja potilaiden elossaololukujen valossa. Tavoitteena on voida kehittää toimiva kohdunkaulasyövän ehkäisyohjelma. Itäisen provinssin väestöpohjaisen syöpärekisterin tietojen avulla tutkittiin kohdunkaulasyövän ilmaantuvuutta ja sen muutoksia kahdella maantieteellisellä alueella, eteläisellä ja pohjoisella. Vaikka koko itäisen provinssin alueella nähtiin kohdunkaulasyövän ikävakioidun ilmaantuvuuden selkeä ja jatkuva kasvu vuosista 1998-2002 vuosiin 2008-2012, eteläisellä osa-alueella ilmaantuvuus pysyi lähes ennallaan (arvosta 20/100 000 arvoon 19/100 000) ja pohjoisella osa-alueella se kasvoi merkittävästi (arvosta 24/100 000 arvoon 39/100 000). Kohdunkaulasyövän seulontaa kuvaamaan raportoitiin irtosolutestissä käyneiden 30-vuotiaiden tai sitä vanhempien naisten osuus kalenterivuoden ja alueen mukaisissa ositteissa. Testausta koskevat tiedot saatiin terveyspalveluiden käytön rutiiniseurantajärjestelmästä vuodesta 2007 alkaen. Irtosolutestauksessa käyneiden naisten osuus kaikista alueen 30-vuotta täyttäneistä naisista oli tietojen perusteella vähäinen pohjoisella alueella vuosina 2007-2009 ja saavutti vajaat 15% vuoteen 2012 mennessä. Eteläisen alueen kaksi terveysaluetta, Mbhashe ja Mnquma raportoivat selkeästi korkeamman seulonnan kattavuuden, vajaa 8% vuonna 2007 mutta jo 41% vuonna 2012. Itäisen provinssin väestölähtöinen syöpärekisteri on niitä harvoja Saharan eteläpuoleisen Afrikan rekistereitä, jotka ovat pystyneet raportoimaan syöpäilmaantuvuutta maaseutuväestössä. Väitöstutkimus korostaa syövän rekisteröinnin tärkeyttä naisten syöpätaakan seurannassa. Koska olemassa oleva irtosolutestaus on alueella vähäistä eikä toimi optimaalisesti, ovat kohdunkaulan syövät todettaessa usein levinneitä. Tämä puolestaan johtaa huonoon ennusteeseen. Tutkimuksella pyrittiin tuottamaan tietoa päätöksentekoa varten. On tärkeää tiedottaa kansallisia tahoja kohdunkaulasyövän taakan jatkuvasta kasvusta, jotta sen ehkäisyyn voidaan panostaa. Kohdunkaulasyövän ilmaantuvuus- ja kuolleisuusluvut ovat kasvaneet irtosolutestin tarjonnasta huolimatta. Nykyinen maksuton irtosolutestitoiminta, joka on käynnistetty jo yli 20 vuotta sitten Etelä-Afrikassa, tulee uudistaa. ; Non-communicable diseases (NCDs) currently in low-middle-income countries (LMICs) account for 40% of the total burden of disease. They are recognized as a significant threat to health and the economy. Cancer is among NCDs challenging the LMICs today with projected trends that are continuously increasing. Cervical cancer is estimated as the fourth cause of global incidence and mortality. Women experience high incidence and mortality rates due to this cancer in LMICs, with the highest burden borne by countries in Sub-Saharan Africa (SSA). The problem of cervical cancer was elevated to a severe level of the SSA region by the onset of the Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In addition, many women are unscreened or under-screened because there are no organized screening programs for the early detection of pre-cancerous lesions. South Africa is the only country in the SSA region that offers the national cytology-based screening. Yet, cervical cancer is ranked the second most common cancer and cause of death among women and 8th of the top 10 contributors to Disability Adjusted Life Years (DALYs). Poor screening performance is one of the reasons for the high invasive cervical cancer, which remains a health challenge. Given South Africa's disparate distribution of public healthcare resources, it is essential to know whether the mass population-based cytology screening program is available to the rural population of the Eastern Cape Province of South Africa. This research aims to understand the burden of cervical cancer in this population. The objectives include describing the incidence of cervical cancer, investigating geographical differences, assessing screening coverage, and examining the survival rate using collaborative studies results in the region and internationally to develop an appropriate intervention program. Using a population-based cancer registry, an observational study, Study I, reported cervical cancer as the most common cancer in women, consistently and progressively increasing in the rural population of the Eastern Cape Province. This Study also investigated trends in the age-standardized and age-specific incidence rates of cervical cancer in two distinct geographic areas, the southern and northern covered by the cancer registry. Results identified distinct differences in these two areas. In relation to the overall age-standardised incidence rates (ASRs) per 100,000 women were 22.0 (95% CI:20.0-24.0) in 1998-2002, 24.4 (95% CI:22.4-26.4) in 2003-2007 and 29.2 (95%CI:27.3-31.6) in 2008-2012. While the ASRs in the entire region showed a progressive increase, the southern area slightly decreased over the same period. They were 20.0 (95% CI:18.5-21.4) in 1998-2002, 19.1 (95% CI:16.5-21.7) in 2003-2007 and 18.8 (95%CI:16.2-23.4) in 2008-2012. In contrast, the ASRs in the northern area increased significantly from 24.0 (95% CI: 21.1-27.0) in 1998-2002, to 29.7 (95% CI: 26.6%-32.8%) in 2003-2007 and 39.0 (95% CI: 35.6-42.5) in the period 2008-2012. Study II described cervical cancer screening program trends based on routinely collected health service data for women 30 years and older reported by health sub-district and year. It is important to note that these service health data were only included in the routine information systems from 2007, with deficient coverage in the northern area at 2.2% in 2007 and 4.3% in 2008. A steady increase was observed from 2009 to 2012 to only 14.8% in 2012. The southern area, which spans two health sub-districts, Mbhashe and Mnquma, reported slightly better coverage of the screening program, with an average of 7.7% in 2007. There was an increase to 41.0% in 2012, with an anomalous coverage of 69.0% reported for the Mbhashe sub-district in 2010. Furthermore, this sub-district had almost twice the screening percentage of the Mnquma sub-district (52.3% vs. 29.7%) in 2012. LMICs struggle to generate historical cancer incidence data over a period due to little investment committed to sustaining this critical infrastructure needed for cancer control in these countries. There are also many competing health demands in SSA that cripple the establishment and maintenance of PBCRs, the source of these historical cancer incidence data. Hence, notably in SSA, only a few cancer incidence data are reported. Despite the challenges, SSA faces in cancer registration compared to other LMICs, directed investment towards staff training and infrastructure limitations can improve the current situation. These critical areas need international investment, including the member states, to sustain and support cancer registration. The Eastern Cape Province PBCR is among the few SSA registries that survived those challenges and reports data on cancer incidence of a rural population. This research highlights the importance of cancer registration which tracked the high cervical cancer incidence experienced by women in the rural Eastern Cape Province that progressively increased over time. Important suggesting pointers of the low or non-existence of screening in this population include low survival to this cancer due to an advanced stage at diagnosis that many women present with, showing that clinical signs and symptoms made diagnosis rather than prompt screening. This information significantly impacts decision-making and a statistical infrastructure for health information. It is also essential to inform the national government about a more targeted control program to reduce cervical cancer burden, improve survival, and review the current cytology-based screening program policy rolled out more than 20 years ago in South Africa.
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Ähnlich wie in Polen ist auch in Deutschland der Zweite Weltkrieg fast allgegenwärtig. Keine Stadt ohne Gedenkorte, kaum ein Friedhof ohne Erinnerungen an die entsetzliche Zeit zwischen 1939 und 1945. Dennoch unterscheiden sich die Erinnerungslandschaften beider Länder stark. In Polen, das vom Deutschen Reich überfallen wurde, und Schauplatz bestialischer deutscher Verbrechen an der polnischen Zivilbevölkerung und des industriellen Völkermords an den europäischen Juden wurde, entstanden schon seit den ersten Jahren nach dem Krieg Denkmäler, Gedenkstätten, Gedenktafeln. Dagegen taten sich die beiden deutschen Staaten schwerer mit ihrem Erbe, der Erinnerung und der Auseinandersetzung mit ihrer Täterschaft. Dabei galt es unter anderem auch an die eigenen Opfer zu erinnern, schließlich hatte Deutschland im Krieg etwa 6 Millionen tote Staatsbürger zu beklagen, ähnlich viele wie Polen, und auch das privat empfundene Leid deutscher Familien bis hin zum Heimatverlust von mehr als 10 Millionen Menschen musste zunächst verarbeitet werden. Trauer und Scham, Erinnerung und Vergessen gingen in der deutschen Erinnerungskultur der Nachkriegsjahrzehnte miteinander einher. Aber wie steht es mit Polens Platz in diesem Erinnern? Hat Deutschland, haben die Deutschen in ausreichendem Maße an das Leid Polens im Krieg erinnert?Um die Antwort auf diese Frage besser zu verstehen, ist eine Vorbemerkung notwendig, die banal klingt, aber gerade aus polnischer Sicht manchmal nicht ausreichend berücksichtigt wird: Wer in Polen an den Zweiten Weltkrieg denkt, der denkt automatisch und an erster Stelle an Deutschland. Wer aber in Deutschland an den Zweiten Weltkrieg denkt, der hat die Auswahl – schließlich wurden in deutschem Namen mehr als 30 heutige Staaten besetzt, zahllose Kriegsverbrechen an den Zivilbevölkerungen wie auch an den Kriegsgefangenen, etwa aus der Sowjetunion, verübt. Die Deutschen begingen Völkermord an den europäischen Juden und an Sinti und Roma. Sie verfolgten und ermordeten Menschen mit Behinderungen, Homosexuelle, psychisch Kranke, "Asoziale", Zeugen Jehovas und viele andere. Wenn somit Polen vielfach den Eindruck haben, in Deutschland sei das Leiden Polens zu unbekannt, so haben sie recht und unrecht zugleich: Recht, weil man nie genug über die schrecklichen Ereignisse auf polnischem Boden wissen kann. Und unrecht, weil man als Deutscher, brutal gesagt, die Wahl hat, welchen Opfern man sein Mitgefühl in besonderem Maße zuwendet: Polen oder Griechen, Juden oder Zeugen Jehovas, den verhungerten Einwohnern von Leningrad, den versklaven Zwangsarbeitern, Ukrainern, ermordeten französischen Widerstandskämpfern und so weiter. Ganz abgesehen davon sind Zuschreibungen zu einer dieser Opfergruppe nicht trennscharf, Personen können zu zwei oder mehreren von ihnen gehören. Wissen oder Nichtwissen?Es ist natürlich ein Skandal, dass bei einer Anfang 2020 veröffentlichten Umfrage nur 50,8 Prozent der befragten Deutschen bestätigten, dass der Zweite Weltkrieg am 1. September 1939 begonnen habe (in Polen waren 87,2 Prozent der Befragten dieser Meinung). Allerdings war die Frage suggestiv gestellt und lautete: "Im September 1939 begann der Zweite Weltkrieg – damals griffen Deutschland und die Sowjetunion Polen an. Stimmen Sie dieser Aussage zu?"[1] In der deutschen Erinnerungskultur ist die Tatsache, dass Deutschland maßgeblich für den Kriegsausbruch verantwortlich ist, fest verwurzelt, weshalb es von vielen Deutschen als unzulässige Relativierung angesehen werden dürfte, die Sowjetunion gleichermaßen dafür verantwortlich zu machen, selbst wenn der "Ribbentrop-Molotow-Pakt" weithin bekannt ist. Aus polnischer Sicht nimmt sich dies freilich ganz anders aus, weil Polen während des Kriegs – anders als Deutschland – die sowjetische Besatzung eines Teils des Landes zwischen 1939 und 1941 selbst erlebte. Dieses Beispiel zeigt, wie schwer es ist, die Wahrnehmung des Kriegs aus deutscher und aus polnischer Perspektive zu vergleichen – und wie schwer es auch ist, gemeinsam an den Krieg zu erinnern.In Deutschland war es generell so, dass dort, wo es um Opfergruppen ging, die in einem engen Lebenszusammenhang mit der deutschen Gesellschaft standen, die Aufarbeitung und symbolische Zeichensetzung relativ rasch einsetzte. Dies betraf Gruppen, die von den Nazis aus dem perfide "deutscher Volkskörper" genannten Personenkreis verdrängt wurden, wie etwa die deutschen Juden, aber auch solche, die – wie die Opfer alliierter Luftangriffe oder die Heimatvertriebenen – bis zum Schluss dazugehörten.Vielfach dauerte es aber Jahrzehnte, bis eine umfassendere Aufarbeitung der Geschichte einsetzte. Das zeigt sich etwa am Beispiel der im heutigen Deutschland gelegenen ehemaligen Konzentrationslager. Zwar errichteten mancherorts einstige KZ-Insassen schon kurz nach dem Krieg erste Erinnerungszeichen. So stellten zum Beispiel polnische Häftlinge in Bergen-Belsen ein großes Holzkreuz auf, in Flossenbürg bauten Polen gemeinsam mit Deutschen eine Kapelle. Doch es sollten Jahre und Jahrzehnte vergehen, ehe in Dachau oder Bergen-Belsen, in Buchenwald oder Sachsenhausen umfangreichere Gedenk-Ensembles und später Gedenkstätten entstanden. Manche Kommune war da schneller, wie – ein Beispiel für viele – Frankfurt am Main: Hier wurde 1964, direkt an der Paulskirche, einem Symbol der deutschen Demokratiegeschichte, ein Mahnmal für die Opfer des Nationalsozialismus errichtet, auf dem die Namen vieler deutscher Konzentrations- und Vernichtungslager genannt werden. Zahlreiche davon tragen polnische Namen. Allerdings dachten die Stadtverordneten bei ihrem Beschluss im Jahre 1959 ausdrücklich an "die Mitbürger, die nur ihrem Gewissen folgend und unter Einsatz des eigenen Lebens Widerstand gegen den Nazi-Terror geleistet hatten".[1] Also auch hier richtete sich der Blick vor allem noch in die eigene Gesellschaft, weniger in die Gesellschaften der überfallenen Staaten. Polnische Opfer als Bestandteil deutscher ErinnerungslandschaftDennoch waren polnische Opfer schon seit der unmittelbaren Nachkriegszeit hundertfach Teil der Erinnerungskultur in Deutschland, denn vielerorts wurden verstorbene polnische Zwangsarbeiter nachträglich auf Friedhöfen beigesetzt. Es waren zunächst häufig Polen selbst, die als Displaced Persons in Deutschland lebten und hierfür die Initiative ergriffen. Oft beschränkte sich das auf kleine Grabplatten oder Inschriften mit Namen, Herkunft und Lebensdaten, manchmal aber gibt es hier auch größere Denkmäler. So errichteten polnische Überlebende im Juni 1945 im baden-württembergischen Ellwangen ein "Polendenkmal" für 23 Opfer eines "Todesmarsches" aus einem nahegelegenen Konzentrationslager, mit der Aufschrift: "Den Opfern des Hitlerbarbarismus – Die Polen Jahr 1945". In hessischen Michelstadt bauten Angehörige einer polnischen Wachkompanie 1946 ein Grabmal für eine polnische Bomberbesatzung, die 1944 in der Nähe abgeschossen wurde, und legten einen bis heute erhaltenen Propeller des Flugzeugs davor. In späteren Jahrzehnten waren es vielfach deutsche Initiativen, um an die meist als Zwangsarbeiter gestorbenen Polen – und Vertreter anderer Nationen – zu erinnern, und zwar in Deutschland Ost wie West. So erklärt eine Gedenkmauer auf dem Friedhof des brandenburgischen Eberswalde-Finow seit 1951, ganz im Duktus der stalinistischen Zeit: "Hier ruhen 109 Bürger der Sowjetunion, 39 Töchter und Söhne Volkspolens (…). Die faschistische Willkür entriß sie ihrer Heimat und verurteilte sie zu Zwangsarbeit für die blutigen Ziele des Imperialismus."[2]Die Stiftung Polnisch-Deutsche Aussöhnung hat auf einer Homepage mehr als 1.100 Orte in Deutschland zusammengestellt, wo sich polnische Gräber aus dem Zweiten Weltkrieg befinden (http://www.polskiegroby.pl), manchmal nur einige wenige, manchmal aber auch viele hunderte. Es ist aber von Ort zu Ort unterschiedlich, wie sehr die Existenz dieser Gräber im Bewusstsein der lokalen Öffentlichkeit präsent ist. DDR-Erinnerungen Wenn man aber von den Friedhöfen absieht, so sind markante Erinnerungszeichen an das Schicksal Polens im Zweiten Weltkrieg in Deutschland rar gesät. Einige davon hat die DDR errichtet, und zwar zum Gedenken an die während der letzten Kriegswochen auf deutschem Boden gefallenen Soldaten der polnischen (Berling-) Armee. Diese Denkmäler in Brandenburg und Sachsen-Anhalt sind zeittypisch pathetische Anlagen. In Sandau an der Elbe entstand 1965 ein erstes Denkmal, das aber 1975 durch das bis heute stehende ersetzt wurde. Es zeigt einen polnischen Soldaten, der seinen Karabiner triumphierend in die Höhe hebt, die Aufschrift verkündet auf Deutsch und Polnisch: "Den Soldaten der I. Polnischen Armee die am 3.V.1945 die Elbe bei Sandau erreichten und an der Seite der Sowjetarmee einen Beitrag für die Befreiung des deutschen Volkes vom Joch des Faschismus geleistet haben." Andere große Denkmäler stehen in Orten wie Hohen Neuendorf – drei große polnische Adler auf Sockeln – oder Crostwitz. Am bekanntesten ist aber sicher das ebenfalls ab 1965 geplante "Denkmal des polnischen Soldaten und deutschen Antifaschisten" im Ost-Berliner Volkspark Friedrichshain. Ursprünglich sollte es am Brandenburger Tor stehen und auf einer Relieftafel nur einen polnischen Soldaten zeigen, dann kam auf politisches Geheiß der deutsche Antifaschist dazu, und schließlich, wiederum durch politische Einflussnahme, noch ein Rotarmist, bevor es 1972 eingeweiht werden konnte. Die polnischen Elemente sind aber die deutlichsten – ein polnischer Adler an einer hohen Betonstele und die riesige zweisprachige Aufschrift: "Za naszą i waszą wolność" / "Für eure und unsere Freiheit". Um dieses Denkmal ist nach der politischen Wende von 1989 immer wieder gestritten worden, denn es verkörpert die einstige sozialistische Geschichtskultur beinahe in Reinkultur. Im Jahr 1995 wurden Tafeln mit ergänzenden Informationen angebracht, die auf Deutsch und Polnisch erklären, dass mit dem Denkmal nun auch an Soldaten des polnischen Untergrundstaates, in den alliierten Armeen, an polnische Zwangsarbeiter, Kriegsgefangene und Häftlinge erinnert werden solle.
Der Holocaust als Ansporn zum Erinnern Als der Holocaust in den 1980er Jahren verstärkt ins Zentrum der deutschen Erinnerungsdebatten rückte, geriet auch Polen erneut in den Fokus. Der von Deutschen auf polnischem Boden verübte Mord an den europäischen Juden führte dazu, dass polnische Namen auf einer Fülle deutscher Gedenkstätten, Gedenkorten, Denk- und Mahnmälern, Gedenktafeln, Museen und weiteren Erinnerungszeichen auftauchten. Auch hierzu wieder ein Beispiel aus Frankfurt am Main: 1996 wurde im Rahmen der Gedenkstätte Neuer Börneplatz eine Mauer um den alten jüdischen Friedhof gebaut. An ihr sind auf kleinen Metallblöcken mehr als 11.000 Namen von Holocaust-Opfern aus Frankfurt zu lesen, jeweils mit Lebensdaten und Sterbeort. Sehr oft lauten diese Orte "Auschwitz", "Bełżec" oder "Treblinka". Ähnlich verhält es sich mit den "Stolpersteinen": Diese Initiative des Künstlers Gunter Demnig verlegt in deutschen, aber auch anderen europäischen Städten quadratische Messingtafeln auf den Gehwegen vor den letzten Wohnadressen von NS-Opfern. Auf ihnen sind Name, Lebensdaten das bekannte weitere Schicksal, oft der Sterbeort verzeichnet. Bis Anfang 2020 waren bereits mehr als 75.000 Stolpersteine installiert, und wie auf der Frankfurter Mauer sind auch hier sehr häufig polnische Namen zu lesen. Insofern breitet sich das Gedenken an Leid in Polen und polnisches Leid während des Zweiten Weltkriegs doch immer weiter in Deutschland aus. Selbst wenn die Erinnerung in diesen Fällen meistens Personen betrifft, die Teil der deutschen Vorkriegsgesellschaft gewesen waren, so enthält sie doch polnische Aspekte.
Steinernes Mahnen oder lebendiges Erinnern? Für Polen oder für alle? Doch so zahlreich die vorhandenen Gedenkorte sind, eins können nicht leisten – sie sind kein zentrales Mahnmal, kein Ergebnis einer übergreifenden, gesamtgesellschaftlichen Debatte. Seit Jahren wird deshalb darüber diskutiert, ob nicht das besondere Leid des Nachbarlands im Zweiten Weltkrieg zusätzlich auf eine andere Weise gewürdigt werden sollte, mit einem Denkmal in Berlin. Hierzu gab es verschiedene Vorschläge: Der letzte – demokratische – Außenminister der DDR, Markus Meckel, regte an, das kommunistische Denkmal in Friedrichshain zu aktualisieren. Im Jahr 2017 schlugen Florian Mausbach – ehemaliger Leiter der Bundesamts für Bauwesen und Raumordnung – und Dieter Bingen – zu dieser Zeit Direktor des Deutschen Polen-Instituts – zusammen mit weiteren ein "Polendenkmal" vor der Ruine des Anhalter Bahnhofs vor, als empathische Geste der Versöhnung gegenüber Polen. Dagegen formierte sich aber auch Widerstand: Nicht, weil man von den Opfern Polens nicht wissen wollte, sondern vielmehr wegen Bedenken, andere Opfer durch ein Denkmal "nur für Polen" zurückzusetzen. Die Debatte um ein Polendenkmal führte lange zu keinem Ergebnis, allenfalls zu einem provisorischen Gedenken: Am 1. September 2019 gedachten zum 80. Jahrestag des deutschen Überfalls auf Polen an der Ruine des Anhalter Bahnhofs Bundestagspräsident Wolfgang Schäuble und Sejm-Marschallin Elżbieta Witek in einer feierlichen Versammlung des Überfalls auf Polen und der Kriegsopfer des Landes.
Die Debatte rief auch Gegenvorschläge hervor. So wurden in Reaktion darauf wenige Jahre alte Überlegungen neu aufgegriffen, ein Dokumentationszentrum für deutschen Besatzungsterror und Vernichtungskrieg im östlichen Europa oder in ganz Europa zu errichten. Hiergegen erhob sich wiederum Kritik, unter anderem aus Polen: Ein solches Zentrum würde die polnischen Gewalterfahrungen relativieren und die Sowjetunion bzw. Russland aus ihrer historischen Mitverantwortung an der Zerstörung Polens entlassen. Um diese Polarisierung aufzulösen, legten im Juni 2020 die Stiftung Denkmal für die ermordeten Juden Europas und das Deutsche Polen-Institut einen gemeinsamen Vorschlag vor, der ein "Polendenkmal" als Mahnmal für den deutschen Überfall auf Polen am 1. September 1939 vorsieht, kombiniert mit einem Dokumentationszentrum über deutsche Besatzungsherrschaft in Europa sowie zivilgesellschaftliche Bildungseinrichtungen zu einzelnen Opfergruppen – etwa eine "Fliegende Universität" zu polnischen Kriegserfahrungen. Die Debatte über dieses Konzept dauerte beim Abschluss dieses Beitrags an, es zeichnete sich jedoch ab, dass sie neue Bewegung in eine auch politisch recht festgefahrene Lage brachte, denn im deutschen Bundestag war zwischen den Befürwortern und den Gegnern der einen wie der anderen Lösung lange kein Kompromiss absehbar. Dieser seit Jahren geführten Auseinandersetzung ist aber auch einiges abzugewinnen, denn eine lebendige Diskussion, gegenläufige Ideen und das Aushalten und Einbeziehen von Kritik sind für eine zivilgesellschaftlich verankerte Erinnerung unabdingbar. Die Debatte trägt bereits dazu bei, dass das Schicksal Polens im Zweiten Weltkrieg von der Öffentlichkeit stärker wahrgenommen wird. Alleine das ist schon ein Erfolg. Denn wir Deutschen müssen uns immer und immer wieder vor Augen führen, was Polen durch Deutschland im Krieg widerfahren ist, was Deutsche auf seinem Boden angerichtet haben, mit welcher Last das Land und seine Menschen deshalb nach dem Krieg zu leben hatten und mit welcher Last sie bis heute zu leben haben. Dieser Text ist für die polnische Zeitschrift "Mówia Wieki" entstanden, wo er in der September-Nummer 2020 erschienen ist. http://mowiawieki.pl/index.php?page=biezacy
[1] Zit. nach https://www.frankfurt1933-1945.de/nc/beitraege/show/1/thematik/einzelne-orte-des-gedenkens/artikel/wir-sind-mit-dieser-vergangenheit-noch-nicht-fertig-mahnmal-fuer-die-opfer-des-nationalsozialistischen-terrors-in-frankfurt-am-main/suche/Mahnmal/ [Unterstreichung vom Autor]
[2] Zit. nach Gedenkstätten, Bd. 2, S. 256.
[1] Arkadiusz Grochot: Sondaż: Co czwarty Niemiec uważa, że II wojna światowa nie rozpoczęła się od inwazji III Rzeszy i ZSRR na Polskę. https://www.rmf24.pl/fakty/polska/news-sondaz-co-czwarty-niemiec-uwaza-ze-ii-wojna-swiatowa-nie-roz,nId,4281566
Lievän traumaattisen aivovamman saaneita potilaita kohdataan usein erilaisissa päivystystilanteissa. Lievien aivovammojen ilmaantuvuus on arviolta jopa 600 / 100 000 ja nämä vammat aiheuttavat merkittävän määrän sairaalakäyntejä ja -hoitojaksoja. Keskeisimmät asiat lievien aivovammojen akuutissa hoidossa ovat: (i) vamman tunnistaminen, (ii) vakavimpien, jopa henkeä uhkaavien, kallonsisäisten vammojen pois sulkeminen, ja (iii) pitkittyneelle toipumiselle alttiiden potilaiden varhainen tunnistaminen. Pään tietokonetomografialla (TT) on keskeinen rooli pään vamman saaneiden potilaiden hoitoketjussa. Sillä voidaan todeta kallonsisäiset vammamuutokset, jotka liittyvät vakavimpiin aivovammoihin. Lievien aivovammojen diagnostiikassa TT:sta ei ole suurta hyötyä. Lievä traumaattinen aivovamma diagnosoidaankin kliinisten löydösten ja kognitiivisten oireiden perusteella, jotka usein ovat subjektiivisia ja epäspesifisiä. Myös monet muut sairaustilat ja vammat voivat simuloida vastaavanlaisia löydöksiä ja oireita kuin lievä aivovamma. Lievän aivovamman diagnostiset kriteerit ja varhaiset oireet eivät ole suoraan yhteydessä toipumisennusteeseen. Tämän väitöskirjan keskeisin tavoite oli parantaa akuuttien lievien traumaattisten aivovammojen kliinistä tunnistamista päivystystilanteissa. Myös toipumista ennustavia tekijöitä pyrittiin löytämään. Lisäksi tutkittiin Sport Concussion Assessment Tool 2 (SCAT2) –työkalun validiteettia. Tällaista tutkimusta ei ensiapu-olosuhteissa ole aiemmin tehty. Väitöskirja perustuu prospektiiviseen seurantatutkimukseen, joka toteutettiin yhdessä tutkimuskeskuksessa. Potilasmateriaalin muodostivat TT-kuvatut pään vamman saaneet potilaat (n = 3023). Potilaita hoidettiin Tampereen yliopistollisen sairaalan ensiavussa kahden vuoden ajanjakson aikana (elokuu 2010 – heinäkuu 2012). Tavoitteena oli tutkia työikäisiä lievän aivovamman saaneita potilaita, joilla ei ollut diagnosoituja neurologisia tai psykiatrisia sairauksia. Potilasrekrytoinnissa käytettiin kolmea inkluusiokriteeriä ja yhdeksää ekskluusiokukriteeriä. Lopullinen rekrytoitu potilaskohortti koostui 75 lievän aivovamman saaneesta potilaasta. Näistä potilaista kerättiin perusteelliset tiedot liittyen sosiodemografiaan, vammatapahtumaan, sekä kliinisiin löydöksiin. Kliininen arviointi ensiavussa sisälsi SCAT2- sekä Military Acute Concussion Evaluation – testauksen. Aivot magneettikuvattiin (MK, 3 Teslaa) vamman jälkeisen kahden viikon aikana. Toipumista arvioitiin kahden viikon, yhden kuukauden ja kuuden kuukauden kuluttua vammasta Rivermead Post-concussion Symptoms Questionnaire-kyselyllä. Töihin palaamisajankohtaa käytettiin toipumismittarina. Lievän aivovamman saaneita potilaita verrattiin 40 verrokkipotilaaseen, jotka rekrytoitiin samoja tutkimuskriteereitä käyttäen. Tiukkojen tutkimuskriteerien vuoksi tutkimusaineisto oli erittäin valikoitunut. Seulottujen 3023 potilaan joukosta tutkimukseen otettiin mukaan vain 2.5 % potilaista. Ikä sekä todetut neurologiset ja psykiatriset sairaudet olivat merkittävimpiä syitä tutkimuksesta poissulkuun. Koko aineistossa tasamaalla kaatuminen oli vallitseva (52 %) vammautumismekanismi ja enemmistö kaatuneista oli iäkkäitä. Muihin vammautumismekanismeihin verrattuna tasamaalla kaatumisen seurauksena syntyi yhtä paljon kallonsisäisiä TT:lla todettavia vammamuutoksia. Tasamaalla kaatuneiden joukossa ikääntyminen, pitkäaikainen alkoholin käyttö sekä kaatuneena löytyminen lisäsivät kallonsisäinen vamman riskiä. Retrogradinen amnesia ja perinteiset lievän aivovamman diagnostiset kriteerit eivät olleet yhteydessä vamman toiminnalliseen toipumisennusteeseen tai neuroradiologisiin löydöksiin. SCAT2-osatestien validiteettia tarkasteltiin viidestä eri näkökulmasta. Osatestien validiteetti oli vaihtelevaa. Standardized Assessment of Concussion (SAC) –osatesti (ns. kognitiivinen seulontatutkimus) erotteli aivovammapotilaat verrokeista. SAC-testitulos oli yhteydessä traumaattisiin MK-löydöksiin, parani kuukauden kuluttua vammasta, ja ennusti työhön paluuajankohtaa. SCAT2:n oirekysely erotteli aivovammapotilaat verrokeista, sekä ennusti pitkittynyttä oireilua kuukauden kuluttua vammasta. Valikoiduilla tutkimusaineistoilla saatuja tuloksia ei voida suoraan soveltaa kliiniseen käyttöön lievän aivovamman saaneiden potilaiden hoidossa. Tasamaalla kaatumista ei tulisi väheksyä aivovamman aikaan saavana vammamekanismina. Tasamaalla kaatumiset ovat yleisiä erityisesti iäkkäämmillä henkilöillä, joita usein suljetaan pois lieviä aivovammoja käsittelevistä tutkimuksista. Retrogradisen amnesian ja klassisten aivovammakriteerien kliininen merkitys lienee vähäinen, kun arvioidaan lievän aivovamman saaneen potilaan toiminnallista toipumista sekä aivojen kuvantamisen tarvetta. SCAT2-työkalun osatesteistä oirekysely ja SAC ovat erityisen hyödyllisiä lievään aivovammaan liitettävien oireiden ja kognitiivisten poikkeavuuksien tunnistamisessa, ennusteen määrittämisessä, sekä toipumisen seurannassa. ; Patients with acute mild traumatic brain injury (MTBI) are frequently treated in emergency departments (ED). With an estimated annual incidence of up to 600 / 100,000, MTBI causes a considerable number of hospital visits and admissions. Key points in the acute management of MTBI are (i) injury identification; (ii) exclusion of more severe, even life-threatening, intracranial injuries; and (iii) early identification of individuals at risk for prolonged recovery. Computed tomography (CT) has a crucial role in revealing intracranial lesions related to more severe brain injury, but is not helpful for diagnosing MTBI. Typically, MTBI is diagnosed on the basis of clinical and cognitive symptoms, which are generally based on self-report, and are non-specific because they overlap with other injuries, conditions, and diseases. Furthermore, these diagnostic signs and very early symptoms of MTBI are poorly related long-term outcome. The central objective of this thesis was to improve the clinical identification of acute MTBI among patients with minor head injury (HI) admitted to an ED. Additional emphasis was on discovering clinical factors related to outcome. An additional objective was to test the validity of the Sport Concussion Assessment Tool – Second Edition (SCAT2) in a civilian trauma sample with MTBI. This is a prospective follow-up study performed at a single institution. All consecutive patients who underwent head CT due to an acute HI (n = 3,023) at the Emergency Department of Tampere University Hospital between August 2010 and July 2012 formed the initial patient pool for this study. In order to examine a sample of working aged adults without pre-injury medical or mental health problems who had sustained an acute MTBI, three inclusion criteria and nine exclusion criteria were used during enrolment. The final enrolled sample consisted of 75 patients with MTBI. For the final MTBI sample, a detailed prospective data collection was conducted that included socio-demographics, injury-related data, and clinical information from the ED. The clinical assessment in the ED included the SCAT2 and the Military Acute Concussion Evaluation. Within two weeks from the injury, a magnetic resonance imaging (MRI, 3 Tesla) of the head was performed. Also, 2-week, 1-month, and 6-month follow-up assessments were completed. Post-concussion syndrome symptomatology measured with Rivermead Post-concussion Symptoms Questionnaire and the time to return to work (RTW) were used as outcome variables. Forty community-dwelling, previously orthopedically-injured patients were enrolled as controls using similar study criteria and assessment protocol. Applying strict enrolment criteria resulted in a highly selected sample. Of the initial sample of 3,023 patients with HI, only 2.5% of the patients were recruited. Age and pre-existing psychiatric and neurological problems were the most common causes of exclusion. The strict enrolment process considerably modified the characteristics of the study population of interest. The majority (52%) of the HIs were caused by ground-level falls (GLFs) with an over-representation of older adults. CT-positive traumatic intracranial lesions were as likely to occur in GLFs as in other causes of injury. Age, chronic alcohol abuse, and being found on the ground after a GLF were associated with more frequent lesions on acute CT scanning. Retrograde amnesia and the classic diagnostic criteria for MTBI were unrelated to functional outcome after MTBI. None of these factors were meaningfully associated with traumatic findings on neuroimaging. The scoreable components of the SCAT2 performed variably across five dimensions of validity. The Standardized Assessment of Concussion (SAC; i.e., cognitive screening) component distinguished patients with MTBI from controls, was associated with acute traumatic lesions on MRI, improved over one month post-injury, and predicted RTW. Symptom Scores differentiated patients with MTBI from controls, and elevated initial symptom scores in patients with MTBI were associated with a greater risk of persistent post-concussion symptoms at one month following injury. In conclusion, studying strictly selected MTBI samples has serious limitations in terms of translating research findings into everyday clinical practice. GLFs should not be underestimated as a serious causal mechanism for TBI. They are especially common in the elderly, who are often excluded from MTBI studies. The relevance of retrograde amnesia and traditional diagnostic signs of MTBI seems minor in terms of making estimations of functional long-term outcome or decisions about neuroimaging. The SCAT2 Symptom Score and the SAC appear useful for detecting acute MTBI-related symptoms and cognitive impairment, refining prognosis, and monitoring recovery in civilian trauma patients.
Munuaisten vajaatoiminta on diabeteksen ja sydän- ja verisuonisairauksien yleistymisen takia maailmassa voimakkaasti lisääntymässä oleva sairaus. Munuaisten tehtävä elimistössä on aineenvaihdunnan tuotteiden poisto ja vesitasapainon säätely, jolloin munuaisen glomeruluksissa eli munuaiskeräsissä verenkierrosta suodattuu virtsatiehyeisiin virtsaa. Munuaiset säätelevät myös kalsiumin, fosfaatin ja D-vitamiinin aineenvaihduntaa ja vaikuttavat punasolutuotantoon tuottamalla erytropoietiinia. Munuaisten vajaatoiminnassa glomerulusfiltraatio (GFR) heikentyy. Tällöin kertyviä haitallisia aineenvaihduntatuotteita voidaan poistaa keinomunuais- eli dialyysihoidolla. Munuaisten vajaatoiminnassa immuunipuolustus on heikentynyt, ja riski infektioille lisääntynyt. Infektiot ovat toiseksi yleisin kuolinsyy dialyysipotilailla sydän- ja verisuonisairauksien jälkeen. Immuniteettiä heikentävät puolustuskykyä tukevien tulehdusvälittäjäaineiden puute, toksiset aineenvaihduntatuotteet, ja verikontakti vieraiden materiaalien kanssa hemodialyysihoidossa. Fosfaatin kertymiseen liittyvä sekundaarinen lisäkilpirauhasen liikatoiminta eli hyperparatyreoosi on immuunisoluille toksista. Kalsitriolin eli aktiivisen D-vitamiinin puute voimistaa hyperparatyreoosia. Terveillä kalsitrioli hillitsee immuunivastetta, ja D-vitamiinipuutokseen liittyy lisääntynyt riski mm. autoimmuunitauteihin ja pahanlaatuisiin sairauksiin. Vaurioitunut munuainen ei kykene muuntamaan kalsitriolin esiastetta kalsitrioliksi, josta seuraa D-vitamiinipuutos. Se ei myöskään kykene tuottamaan riittävästi erytropoietiinia (Epoa), joka johtaa anemiaan. Tässä väitöskirjatyössä tutkittiin soluvälitteistä immuniteettiä ja rokotevastetta munuaisten eriasteista vajaatoimintaa sairastavilla potilailla sekä koe-eläimillä. Influenssarokotevastetta verrattiin normaalin munuaistoiminnan omaavien sydänpotilaiden vasteisiin. Lisäksi tutkittiin potilaiden ja kontrollien seeruminäytteistä, sekä influenssan sairastaneiden varusmiesten näytteistä, säilyykö vaste seuraavien vuosien epidemioista eristettyjä virusantigeenejä kohtaan. Selvitettiin fosfaatinsitojana käytetyn ravinnon kalsiumkarbonaattilisän vaikutusta tetanusrokotevasteeseen rotilla, joille oli tehty munuaisten osapoistoleikkaus. Tutkittiin myös kalsitriolin ja Epo-hoidon aloituksen vaikutuksia soluvälitteiseen immuniteettiin. Munuaisten vajaatoimintaa sairastavien potilaiden influenssarokotevaste oli lähes kontrollien luokkaa, eikä hemodialyysipotilaiden vasta-ainevaste epidemiaviruksia kohtaan ollut kontrolleja huonompi. Suonensisäinen kalsitriolihoito kohensi influenssarokotevastetta hemodialyysipotilailla (lähes merkitsevästi, p=0.06). Rotilla, joilla oli munuaisten vajaatoiminta, todettiin selvästi heikentynyt tetanusrokotevaste, joka korreloi glomerulusfiltraatioon sekä fosfaatti- ja lisäkilpirauhashormonitasoon. Ravinnon kalsiumkarbonaattilisä kohensi tetanusrokotevastetta rotilla. Soluviljelmille annosteltu kalsitrioli hemodialyysipotilailla heikensi lymfosyyttistimulaatiovastetta mutta pulssittain annettuna pikemminkin kohensi sitä (tilastollisesti ei-merkitsevästi). Epo heikensi lymfosyyttiproliferaatiota ja vähensi lymfosyyttien ja niiden alaluokkien määrää. Johtopäätökset: Munuaisten vajaatoiminnassa influenssarokotevaste on kontrollien kaltainen. Vain hemodialyysipotilailla se on osittain heikentynyt. Korkea-annoksinen kalsitrioli koeolosuhteissa ja Epo-hoidon aloitus vaimentavat soluvälitteistä immuniteettiä. Kalsitriolilla ja fosfaatinsitojana käytetyllä kalsiumkarbonaatilla on suotuisa vaikutus rokotevasteeseen. ; Background. Chronic kidney disease (CKD) is a globally increasing condition that almost always finally leads to renal replacement therapy (dialysis treatment). CKD is also a state of immunodeficiency with increased susceptibility to infections that are the second most common cause of death after vascular diseases among dialysis patients (Rocco et al. 2002; Collins et al. 2006; Inaguma et al. 2008). In an earlier Finnish doctoral study in 1985, lymphocyte antigen responses of hemodialysis (HD) patients were only 60% of the controls (Huttunen 1985). The vaccination response is also impaired e.g. against influenza (Beyer et al. 1987; Cavdar et al. 2003). Uremic toxins, lack of supportive cytokines, constructive cellular factors, dialysis modality and the membranes used in HD are all involved in the immune suppression. An important cause of dysfunction in the cells of the immune system is intracellular hypercalcemia related to secondary hyperparathyroidism (SHPT) caused by retention of phosphate in CKD. Patients with advanced CKD also by nature develop hypovitaminosis D, because the kidneys have lost their ability to synthesize calcitriol, which is known to have immunoregulatory actions. This contributes to SHPT and the numerous immune abnormalities. Initiation of erythropoietin (Epo) treatment has also been shown to affect the immune functions. By and large, the effects of the treatments of CKD on immune functions remain to be clarified. Aims. In this series of studies we aimed to study the influenza vaccination response against vaccine antigens in CKD of various degrees (I) and HD-patients cross-reacting antibody responses to wild influenza virus antigens (II). We also aimed to study whether phosphate binding with calcium carbonate could increase the reduced tetanus vaccination response in uremic rats (IV). We aimed to study the immune effects of ancillary treatments in CKD, calcitriol (III) and Epo (V), on lymphocyte functions. Subjects and methods. The groups in the clinical studies consisted of patients with all stages of CKD and controls from Tampere University Hospital. Pre-dialysis (Pre-D), HD, peritoneal dialysis (PD) and cardiac control patients were vaccinated against influenza and their antibody response against the influenza vaccine antigens A/H3N2, A/H1N1 and B was measured. HD patients sera were additionally studied for cross-reactivity against subsequent years virus isolates of A/H3N2 subtype. In vitro calcitriol was added in lymphocyte cultures of HD patients in a lymphocyte antigen response study using tuberculin (PPD) and tetanus toxoid (TT) as antigens. In the experimental study rats underwent a 5/6-nephrectomy or a sham operation, and thereafter they were given a high or control calcium carbonate diet, and their tetanus vaccination response was evaluated. Pre-D patients were tested with 1) antibody tests to Ebstein-Barr virus (EBV) and cytomegalovirus (CMV), 2) lymphocyte subclass analyses and 3) lymphocyte proliferation tests using phytohemagglutinin (PHA), pokeweed mitogen (PWM), PPD and TT as stimulants, before and three months after they begun with Epo treatment. Results. Influenza vaccination of CKD patients resulted in post-vaccination titres that were almost comparable to those of the controls. Against A/H3N2 antigen they were 84%, 84% and 96% of the controls titres (pre-D, HD and PD, respectively). Sixty-one percent of controls and 67% of PD patients reached a protective titre against A/H3N2 but no more than 35% of pre-D and 36% of HD patients. However, the proportion of CKD and control patients that reached protective titres was clearly higher for the two other antigens A/H1N1 and B. Among HD patients, those on intravenous (i.v.) calcitriol seemed to have a better protection than those without i.v. calcitriol (p=0.06, borderline significant). The antibodies efficiently cross-reacted against wild influenza virus A/H3N2 antigens, similarly in HD patients and controls and even in healthy military conscripts who had suffered from an influenza A infection previously. In the lymphocyte proliferation studies, the effect of in vitro pulse (mimicking i.v.) calcitriol therapy among HD patients had a statistically non-significant enhancing effect on lymphocyte antigen stimulation cultures, whereas having calcitriol continuously in the culture medium was even immunosuppressive to TT (p=0.001). High calcium diet was beneficial to the tetanus vaccination response of rats with 5/6-nephrectomy: the response of the Ca-NTX rats with high calcium diet was almost as high as (75% of) that of sham-operated (Sham) rats (p=NS), while the NTX rats with control calcium diet had a reduced response (42%) compared to the Sham rats, p The initiation of Epo treatment in pre-D patients caused lymphopenia and a decrease in lymphocyte proliferation, but no changes in the general antibody production against EBV and CMV. The changes in iron status, reticulocytes, hemoglobin or glomerular filtration rate (GFR) did not explain the decline. Conclusions. The influenza vaccination responses of regularly monitored patients with CKD were comparable to controls. Especially HD patients cross-reactivity against several wild viruses was not inferior to that of the controls. In 5/6-NTX animals, the impaired tetanus vaccination response correlated both to GFR and to the control of hyperphosphatemia and PTH level. Calcitriol in vivo borderline significantly (p=0.06) enhanced the influenza vaccine response and calcitriol in vitro pulse treament slightly (non-significantly) enhanced lymphocyte antigen proliferation of HD patients. Incubation with calcitriol in vitro continuously was immunosuppressive to TT response (p=0.001). Epo had initial immune depressing actions to lymphocyte number and function. There seemed to be clinical benefits of calcitriol and phosphate binding therapies in vaccination response in CKD.
Suomalaiset ja espanjalaiset perheet yhtenevässä Euroopassa Tutkimus käsittelee perhettä ja perheessä 1900-luvun aikana tapahtunutta muutosta analysoimalla Suomea ja Espanjaa länsieurooppalaisina esimerkkeinä. Tutkimuksessa pohditaan miten, missä määrin ja miksi eurooppalaiset perheinstituutiot erilaisia tai samanlaisia? Mikä on perheinstituution rooli ja merkitys nykyajan yhteiskunnassa? Miten perhe, sen roolit ja siihen kohdistetut vaatimukset määritellään ja mitkä sosiaaliset ja kulttuuriset tekijät ovat vaikuttaneet eri maissa vallitseviin määritelmiin? Aineistona on käytetty Suomea ja Espanjaa koskevaa siviili- ja sosiaalilainsäädäntöä, demografisia ja sosio-ekonomisia tilastoja, arvo- ja asennetutkimuksia, barometrejä, tutkimuksia ja raportteja. Tutkimuksessa tarkasteltava ajanjakso kattaa koko 1900-luvun, joskin pääpaino on 19601990 lukujen välisessä ajassa. Tämä vertaileva tutkimus tarkastelee perhettä sosiaalisena instituutiona, joka on vuorovaikutuksessa muiden sosiaalisten instituutioiden kuten hyvinvointivaltion, työmarkkinoiden, politiikan, lainsäädännön ja uskonnon kanssa. Tutkimus osoittaa, että suomalaisessa ja espanjalaisessa yhteiskunnassa vallitseva käsitys perheestä (perheidologia) on varsin samanlainen pohjautuen kristilliseen teologiaan. Ideologiat ovat muuttuneet ja kehittyneet samansuuntaisesti patriarkaalisesta ideologiasta sukupuolien ja sukupolvien tasa-arvoa korostavaksi ideologisaksi, joskin muutos on ollut eritahtista. Maiden välillä on myös eroja, joista keskeisin on suomalaisen kulttuurin protestanttisiin arvoihin pohjautuva yksilöllisyys ja espanjalaisen kulttuurin katolisiin arvoihin pohjautuva suurempi kollektiivisuus ja sukukeskeisyys. Tutkimus kuitenkin osoittaa, että perheideologian ja sen historiallisen muutoksen erot ja vaihtelut eivät niinkään johdu perustavanlaatuisista perhekäsityseroista vaan pikemminkin yhteiskuntien historiallisista, sosiaalisista ja poliittisista taustoista ja kehityskuluista. Keskustelu perheen kriisistä länsimaisissa yhteiskunnissa on ollut vilkasta viime aikoina. Demografisiin tilastoihin perustuva analyysi viittaa perheinstituution kriisiin siinä mielessä, että mitään vakioista perhemuotoa ei kummassakaan maassa ole. Toisaalta ihmisten arvot ja asenteet heijastavat sitä tosiasiaa, että ideologisena mallina perhe on edelleen vankka. Ihanteellinen tai ideologinen perhe niin Suomessa kuin Espanjassakin on avioparin ja heidän lastensa muodostama ydinperhe, vaikka yhä suuremman osan perhetodellisuus ei tätä ihannetta vastaakaan. Perheen perustamisen tapojen tarkastelu 1960-1999 välisenä aikana osoittaa, että kummassakin maassa solmittujen avioliittojen määrä on laskenut, perhekoko on pienentynyt ja avioliiton solmimisen ja ensisynnyttäjien keksi-ikä on noussut, joskin espanjalaisnaiset ensisynnyttäjien keksi-ikä on vieläkin korkeampi kuin suomalaisten. Näitä trendejä on selitetty moderneilla ehkäisymenetelmillä sekä avoliittojen ja naisten työssäkäynnin yleistymisellä, mutta tutkimus osoittaa, että edellä mainitut selittävät tekijät eivät ole päteviä Suomen ja Espanjan tapauksissa. Ne eivät selitä, miksi mm. syntyvyys Espanjassa on huomattavasti matalampi kuin Suomessa ja miksi espanjalaiset lykkäävät perheen perustamista vieläkin pidempään kuin suomalaiset. Tarkasteltaessa seikkoja, jotka vaikuttavat perheellistymisen lykkääntymiseen, tutkimus kiinnittää huomiota perheellistymisen rooliin aikuistumisprosessissa. Tutkimus osoittaa, että toisin kuin ennen, vakiintumista ja lastenhankintaa tärkeämmäksi aikuisuuden kriteeriksi on noussut taloudellinen itsenäisyys. Todellisuudessa pidentyneet kouluttautumisajat, työelämän koventunut kilpailu ja työmarkkinoiden epävarmuus ovat niin Suomessa kuin Espanjassakin johtaneet siihen, että nuorten aikuisten taloudellisen itsenäisyyden saavuttaminen vaikeutuu ja pitkittyy ja siten myös perheen perustaminen lykkääntyy. Tutkimuksessa kehitetään selitysmallia niin maiden välisille eroille kuin länsieurooppalaisissa perheinstituutioissa tapahtuneille muutoksille, joka korostaa perheen perustamiseen ja perhe-elämään liittyvien valintojen ja mahdollisuuksien kiinteää liitosta yhteiskunnassa harjoitettuun lainsäädäntöön, perhepolitiikkaan ja erityisesti työmarkkinoihin. Tutkimus oikaisee niin perheestä kuin pohjoisen ja eteläisen Euroopan välisistä eroista vallitsevia stereotypioita ja yksinkertaistuksia ja tuottaa tietoa perheestä, sen roolista ja merkityksestä länsieurooppalaisissa yhteiskunnissa. Tutkimus on ns. artikkeliväitöskirja, joka koostuu laajasta yhteenvetoartikkelista ja neljästä aiemmin julkaistusta artikkelista. ; Finnish and Spanish Families in Converging Europe The study explores the family and its changes during the 20th century and, particularly, between the 1960s and 1990s by comparing Finland and Spain within the West European context. The examination of the family arises from the following questions: (i) How, to what degree and why are family institutions in Europe different or similar? (ii) What are the roles and significance of the family in contemporary societies? (iii) How is the family defined and what social and cultural factors have affected the definitions in different countries? The family is viewed as a social institution, with the interest lying in macro-level social changes and in the interrelationship between the family and other social institutions such as the welfare state, the labour market, politics, legislation and religion. The family as an institution has been examined from the viewpoints of family ideology and family practices. Family ideology has been studied by analysing how public and political institutions such as legislation and family policy define the family and how these definitions changed during the 20th century and, second, by looking at attitudes and values concerning intimate relations, the family and family practices. Family practices have been studied by analysing and comparing socio-demographic statistics between the 1960s and 1990s, the focus being on the formation of the first family. Furthermore, cross-national differences and similarities concerning patterns of family formation and prevailing family ideologies have been examined in association with legislation, social policies, the labour market, housing policies, education, gender relations, and religion. The study questions the stereotypical notions of the modern North and traditional South and their typical families and demonstrates that differences between Finnish (Northern) and Spanish (Southern) families have been greatly exaggerated and oversimplified. Fundamentally, the family ideologies are the same based on Christian tradition and, furthermore, the evolution of ideologies has moved in the same direction along with modernisation processes, albeit at a different pace. The study demonstrates that the variations are not due to fundamentally different conceptions of the family but to the historical, social and political developments of the countries. Analyses of demographic statistics and data on Finns and Spaniards values and attitudes indicate that demographic statistics suggest a crisis of The Family, for in neither of the countries does a fixed or typical family form exist and the growing plurality of family forms is a fact. On the other hand, the study also shows that The Family the conjugal nuclear family - is very much alive and well as an ideological model and ideal. Looking at patterns of family formation and considering a variety of hypotheses usually presented as explaining the differences: contraceptive use, premarital cohabitation and women s labour market participation, the study shows that these reasons do not explain the differences between Finnish and Spanish patterns of first family formation. The study suggests that family-relevant public policies, housing policies and the labour market in particular are factors that better explain why Spaniards have fewer children and form families later than Finns even though the female employment rate is considerably lower and the use of modern contraceptives and premarital cohabitation is clearly more infrequent in Spain than in Finland. Analysis of the role of family formation in the process of attaining adult status shows that financial independence and self-reliance have taken over from marriage and parenthood as the principal markers of adulthood both in Finland and Spain. However, prolonged periods in education and erratic labour markets tend to complicate the attainment of such independence, reflected in the postponement or even rejection of family formation, especially marriage and parenthood. Yet, a de-familialised welfare state like the Finnish one eases gaining independence and family formation even with limited means, whereas a familistic welfare state like the Spanish one makes it more difficult to cut the cord to the parental home and to form new families. The study elaborates a complex and subtle model for explaining both the differences between countries and changes in the West European family institution in general. The model emphasises the role of public policies, housing policies, legislation and the labour market in particular in shaping the framework within which people in different countries make their decisions concerning family and family life. This comparative study is a dissertation comprised of a lengthy summarising article that links four empirical studies that were previously published as articles in international scientific journals and edited volumes.
The unlicensed wireless spectrum offers exciting opportunities for developing innovative wireless applications. This has been true ever since the 2.4 GHz band and parts of the 5 GHz bands were first opened for unlicensed access worldwide. In recent years, the 5 GHz unlicensed bands have been one of the most coveted for launching new wireless services and applications due to their relatively superior propagation characteristics and the abundance of spectrum therein. However, the appetite for unlicensed spectrum seems to remain unsatiated; the demand for additional unlicensed bands has been never-ending. To meet this demand, regulators in the US and Europe have been considering unlicensed operations in the 5.9 GHz bands and in large parts of the 6 GHz bands. In the last two years alone, the Federal Communications Commission in the US has added more than 1.2 GHz of spectrum in the pool of unlicensed bands. Wi-Fi networks are likely to be the biggest beneficiaries of this spectrum. Such abundance of spectrum would allow massive improvements in the peak throughput and potentially allow a considerable reduction of latency, thereby enabling support for emerging wireless applications such as augmented and virtual reality, and mobile gaming using Wi-Fi over unlicensed bands. However, access to these bands comes with its challenges. Across the globe, a wide range of incumbent wireless technologies operate in the 5 GHz and 6 GHz bands. This includes weather and military radars, and vehicular communication systems in the 5 GHz bands, and fixed-service systems, satellite systems, and television pick-up stations in the 6 GHz bands. Furthermore, due to the development of several cellular-based unlicensed technologies (such as Licensed Assisted Access and New Radio Unlicensed, NR-U), the competition for channel access among unlicensed devices has also been increasing. Thus, coexistence across wireless technologies in the 5 GHz and 6 GHz bands has emerged as an extremely challenging and interesting research problem. In this dissertation, we first take a comprehensive look at the various coexistence scenarios that emerge in the 5 GHz and 6 GHz bands as a consequence of new regulatory decisions. These scenarios include coexistence between Wi-Fi and incumbent users (both in the 5 GHz and 6 GHz bands), coexistence of Wi-Fi and vehicular communication systems, coexistence across different vehicular communication technologies, and coexistence across different unlicensed systems. Since a vast majority of these technologies are fundamentally different from each other and serve diverse use-cases each coexistence problem is unique. Insights derived from an in-depth study of one coexistence problem do not help much when the coexisting technologies change. Thus, we study each scenario separately and in detail. In this process, we highlight the need for the design of novel coexistence mechanisms in several cases and outline potential research directions. Next, we shift our attention to coexistence between Wi-Fi and vehicular communication technologies designed to operate in the 5.9 GHz intelligent transportation systems (ITS) bands. Until the development of Cellular V2X (C-V2X), dedicated short range communications (DSRC) was the only major wireless technology that was designed for communication in high-speed and potentially dense vehicular settings. Since DSRC uses the IEEE 802.11p standard for its physical (PHY) and medium access control (MAC) layers, the manner in which DSRC and Wi-Fi devices try to gain access to the channel is fundamentally similar. Consequently, we show that spectrum sharing between these two technologies in the 5.9 GHz bands can be easily achieved by simple modifications to the Wi-Fi MAC layer. Since the design of C-V2X in 2017, however, the vehicular communication landscape has been fast evolving. Because DSRC systems were not widely deployed, automakers and regulators had an opportunity to look at the two technologies, consider their benefits and drawbacks and take a fresh look at the spectrum sharing scenario. Since Wi-Fi can now potentially share the spectrum with C-V2X at least in certain regions, we take an in-depth look at various Wi-Fi and C-V2X configurations and study whether C-V2X and Wi-Fi can harmoniously coexist with each other. We determine that because C-V2X is built atop cellular LTE, Wi-Fi and C-V2X systems are fundamentally incompatible with each other. If C-V2X and Wi-Fi devices are to share the spectrum, considerable modifications to the Wi-Fi MAC protocol would be required. Another equally interesting scenario arises in the 6 GHz bands, where 5G NR-U and Wi-Fi devices are likely to operate on a secondary shared basis. Since the 6 GHz bands were only recently considered for unlicensed access, these bands are free from Wi-Fi and NR-U devices. As a result, the greenfield 6 GHz bands provide a unique and rare opportunity to freshly evaluate the coexistence between Wi-Fi and cellular-based unlicensed wireless technologies. We study this coexistence problem by developing a stochastic geometry-based analytical model. We see that by disabling the listen before talk based legacy contention mechanism---which has been used by Wi-Fi devices ever since their conception---the performance of both Wi-Fi and NR-U systems can improve. This has important implications in the 6 GHz bands, where such legacy transmissions can indeed be disabled because Wi-Fi devices, for the first time since the design of IEEE 802.11a, can operate in the 6 GHz bands without any backward compatibility issues. In the course of studying the aforementioned coexistence problems, we identified several gaps in the literature on the performance analysis of C-V2X and IEEE 802.11ax---the upcoming Wi-Fi standard. We address three such gaps in this dissertation. First, we study the performance of C-V2X sidelink mode 4, which is the communication mode in C-V2X that allows direct vehicular communications (i.e., without assistance from the cellular infrastructure). Using our in-house standards-compliant network simulator-3 (ns-3) simulator, we perform simulations to evaluate the performance of C-V2X sidelink mode 4 in highway environments. In doing so, we identify that packet re-transmissions, which is a feature introduced in C-V2X to provide frequency and time diversity, thereby improving the system performance, can have the opposite effect if the vehicular density increases. In fact, packet re-transmissions are beneficial for C-V2X system performance only at low vehicular densities. Thus, if vehicles are statically configured to always use/disable re-transmissions, the maximum potential of this feature is not realized. Therefore, we propose a simple and effective, distributed re-transmission control mechanism named Channel Congestion Based Re-transmission Control (C2RC), which leverages the locally available channel sensing results to allow vehicles to autonomously decide when to switch on re-transmissions and when to switch them off. Second, we present a detailed analysis of the performance of Multi User Orthogonal Frequency Division Multiple Access (MU OFDMA)---a feature newly introduced in IEEE 802.11ax---in a wide range of deployment scenarios. We consider the performance of 802.11ax networks when the network comprises of only 802.11ax as well as a combination of 802.11ax and legacy stations. The latter is a practical scenario, especially during the initial phases of 802.11ax deployments. Simulation results, obtained from our ns-3 based simulator, give encouraging signs for 802.11ax performance in many real-world scenarios. That being said, there are some scenarios where naive usage of MU OFDMA by an 802.11ax-capable Wi-Fi AP can be detrimental to the overall system performance. Our results indicate that careful consideration of network dynamics is critical in exploiting the best performance, especially in a heterogeneous Wi-Fi network. Finally, we perform a comprehensive simulation study to characterize the performance of Multi Link Aggregation (MLA) in IEEE 802.11be. MLA is a novel feature that is likely to be introduced in next-generation Wi-Fi (i.e., Wi-Fi 7) devices and is aimed at reducing the worst-case latency experienced by Wi-Fi devices in dense traffic environments. We study the impact of different traffic densities on the 90 percentile latency of Wi-Fi packets and identify that the addition of a single link is sufficient to substantially bring down the 90 percentile latency in many practical scenarios. Furthermore, we show that while the addition of subsequent links is beneficial, the largest latency gain in most scenarios is experienced when the second link (i.e., one additional) link is added. Finally, we show that even in extremely dense traffic conditions, if a sufficient number of links are available at the MLA-capable transmitter and receiver, MLA can help Wi-Fi devices to meet the latency requirements of most real-time applications. ; Doctor of Philosophy ; Wireless networks have become ubiquitous in our lives today. Whether it is cellular connectivity on our mobile phones or access to Wi-Fi hotspots on laptops, tablets, and smartphones, never before has wireless communication been as integral to our lives as it is today. In many wireless communication systems, wireless devices operate by sending signals to and receiving signals from a central entity that connects to the wired Internet infrastructure. In the case of cellular networks, this entity is the cell tower deployed by the operators (such as ATandT, Verizon, etc. in the US), while the Wi-Fi router deployed in homes and offices plays this role in Wi-Fi networks. There is also another class of wireless systems, where wireless devices communicate with each other without requiring to communicate with any central entity. An example of such a distributed communication system---which is fast gaining popularity---is vehicular ommunication networks. End-user devices (e.g. cellphone, laptop, tablet, or a vehicle) can communicate with each other or the central entity only if they are both tuned to the same frequency channel. This channel can lie anywhere within the radio frequency spectrum, but some frequency channels (the collection of channels is referred to as frequency bands) are more favorable--in terms of how far the signal sent over these channels can reach--than others. Another dimension to these frequency bands is the licensing mechanism. Not all frequency bands are free to use. In fact, most frequency bands in the US and other parts of the world are licensed by the regional regulatory agencies. The most well-known example of this licensing framework is the cellular network. Cellular operators spend large amounts of money (to the tune of billions of dollars) to gain the privileges of exclusively operating in a given frequency band. No other operator or wireless device is then allowed to operate in this band. Without any external interfering wireless device, cellular operators can guarantee a certain quality of service that is provided to its customers. Thus, the benefits of using licensed frequency bands are obvious but these bands and their associated benefits come at a high price. An alternative to licensed frequency bands are the unlicensed ones. As the name suggests, unlicensed frequency bands are those where any two or more wireless devices can communicate with each other (subject to certain rules) without having to pay any licensing fees. Unsurprisingly, because there is no limit to who or how many devices can communicate over these bands, wireless devices in these bands frequently experience external interference, which manifests to the end-user in terms of interruption of service. The best example of a wireless technology that uses unlicensed bands is Wi-Fi. One of the greatest advantages of Wi-Fi networks is that anyone can purchase a Wi-Fi router and deploy it within their homes or offices--flexibility not afforded by licensed bands. However, this very flexibility and ease-of-use can sometimes contribute negatively to Wi-Fi performance. Arguably, we have all faced scenarios where the performance of Wi-Fi is poor. This is most likely to happen in scenarios where there are hundreds (or even thousands) of neighboring Wi-Fi devices, such as at stadiums, railway stations, concerts, etc. Based on our discussions above, it is clear as to why Wi-Fi performance suffers in such scenarios. Thus, although unlicensed bands are lucrative in terms of low-cost, and ease of use, there is no guarantee on how good a voice/video call or a video streaming session conducted over Wi-Fi will be. The above problem is well-known and well-researched. Regulators, researchers, and service providers actively seek solutions to offer better performance over unlicensed bands. An obvious solution is to make more unlicensed bands available; if all neighboring Wi-Fi users communicate with their respective routers on different channels, everyone could communicate interference-free. The problem, however, is that frequency bands are limited. Even more limited are those bands that support wireless communications over larger distances. Another solution is to improve the wireless technologyif a Wi-Fi device can more efficiently utilize the channel, its performance is likely to improve. This fact has driven the constant evolution of all wireless technologies. However, there are fundamental limits to how much a frequency channel can be exploited. Therefore, in recent years, stakeholders have turned to spectrum sharing. Even though a wireless network may possess an exclusive license to operate on a given frequency band, its users do not use the band everywhere and at all times. Then why not allow unlicensed wireless devices to operate in this band at such places and times? This is precisely the premise of spectrum sharing. In this dissertation, we look at the problem of coexistence between wireless technologies in the 5 GHz and 6 GHz bands. These two bands are extremely lucrative in terms of their relatively favorable propagation characteristics (i.e., their communication range) and the abundance of spectrum therein. Consequently, these bands have garnered considerable attention in recent years with the objective of opening these bands up for unlicensed services. However, the 5 GHz and 6 GHz bands are home to several licensed systems, and the performance of these systems cannot be compromised if unlicensed operations are allowed. Significant activity has taken place since 2013 concerning new technologies being developed, new spectrum sharing scenarios being proposed, and new rules being adopted in these two bands. We begin the dissertation by taking a comprehensive look at these issues, describing the various coexistence scenarios, surveying the existing literature, describing the major challenges, and providing directions for potential research. Next, we look at three coexistence problems in detail: (i) coexistence of dedicated short range communications (DSRC) and Wi-Fi, (ii) coexistence of cellular V2X (C-V2X) and Wi-Fi, and (iii) coexistence of 5G New Radio Unlicensed (5G NR-U) and Wi-Fi. The former two scenarios involve the coexistence of Wi-Fi with a vehicular communication technology (DSRC or C-V2X). These scenarios arose due to considerations in the US and Europe to allow Wi-Fi operations (on an unlicensed secondary basis) in the spectrum that was originally reserved for vehicular communications. Our work shows that because DSRC and Wi-Fi are built on top of fundamentally similar protocols, they are, to an extent, compatible with each other, and coexistence between these two technologies can be achieved by relatively simple modifications to the Wi-Fi protocol. However, C-V2X, owing to its inheritance from the cellular LTE, is not compatible with Wi-Fi. Consequently, significant research is required if the two technologies are to share the spectrum. On the other hand, in the coexistence of 5G NR-U and Wi-Fi, we focus on the operations of these two technologies in the 6 GHz bands. NR-U is a technology that is built atop the 5G cellular system, but is designed to operate in the unlicensed bands (in contrast to traditional cellular systems which only operate in licensed bands). Although these two technologies can coexist in the 5 GHz and 6 GHz bands, we restrict our attention in this dissertation to the 6 GHz bands. This is because the 6 GHz bands are unique in that the entire range of the 6 GHz bands were opened up for unlicensed access all at once recently, and no Wi-Fi or NR-U devices currently operate in these bands. As a result, we can learn from the mistakes made in the 5 GHz bands, where a vast majority of today's Wi-Fi networks operate. Our work shows that, indeed, we can take decisive steps---such as disabling certain Wi-Fi functions---in the 6 GHz bands, which can facilitate better coexistence in the 6 GHz bands. Finally, in the course of identifying and tackling the various coexistence scenarios in the 5 GHz and 6 GHz bands, we identify some open issues in the performance of new wireless technologies designed to operate in these bands. Specifically, we highlight the need to better understand and characterize the performance of Multi User Orthogonal Frequency Division Multiple Access (MU OFDMA), a feature common in cellular networks but newly introduced to Wi-Fi, in the upcoming Wi-Fi 6 generation of devices. We propose and evaluate an analytical model for the same. We also characterize the performance of Multi Link Aggregation---which a novel feature likely to be introduced in future Wi-Fi 7 devices---that is aimed at reducing the worst-case delay experienced by Wi-Fi devices in dense traffic conditions. Additionally, we identify an issue in the performance of the distributed operational mode of C-V2X. We show that packet re-transmissions, which is a feature aimed at improving the performance of C-V2X, can have a counter-productive effect and degrade the C-V2X performance in certain environments. We address this issue by proposing a simple, yet effective, re-transmission control mechanism.
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Wie gehen Deutschlands Hochschulen und Wissenschaftseinrichtungen mit dem Nahostkonflikt um? Wie mit Antisemitismus und einer extrem aufgeheizten politischen Stimmungslage? Eine Analyse.
"AN DEUTSCHEN HOCHSCHULEN ist kein Platz für Antisemitismus", sagte Walter Rosenthal, Präsident der Hochschulrektorenkonferenz (HRK) am Tag nach der HRK-Mitgliederversammlung Mitte November 2023. Die Hochschulen müssten Orte sein, an denen sich Jüdinnen und Juden wohl und sicher fühlen können, "ohne Wenn und Aber". Die Erklärung, die Rosenthal diesmal im Namen aller HRK-Mitgliederhochschulen abgab, war nicht seine erste, und sie kam fünf Wochen nach dem Terrorangriff auf Israel.
Dennoch kam sie genau zum richtigen Zeitpunkt. Denn seit Hamas-Terroristen am 7. Oktober die Grenzanlagen überwunden und wahllos Männer, Frauen und Kinder misshandelt und ermordet und rund 240 Geiseln in den Gaza-Streifen verschleppt hatten, war viel passiert. In Israel, im Gazastreifen, aber auch auf dem deutschen Hochschulcampus. Die HRK zählt auf: "Unverhohlene Drohungen mit körperlicher Gewalt, das Anbringen von Plakaten oder Graffiti sowie Kundgebungen, die den Terror der Hamas gutheißen, die Opfer ausblenden oder aufrechnen, die das Existenzrecht Israels in Frage stellen und Jüdinnen und Juden insgesamt angehen und einschüchtern sollen".
Erste Einigkeit bröckelte schnell
Dabei hatte es direkt nach den Hamas-Verbrechen so ausgesehen, als würde Deutschlands Wissenschaftscommunity in großer Einigkeit reagieren. Vom Deutschen Akademischen Austauschdienst (DAAD) über die Allianz der Wissenschaftsorganisationen bis hin zu Studierendenverbänden und Hochschulen überall im Land: Die Verurteilungen der Untaten waren fast immer ohne Zögern und Relativierungen, unmissverständlich, mitfühlend und zugleich kämpferisch ausgefallen. "Wir stehen solidarisch an der Seite des Staates Israel. Wir gedenken der Israelis und der Menschen aus aller Welt, die dem Terror der Hamas zum Opfer gefallen sind. Unser Mitgefühl gilt ihren Familien und Freunden, insbesondere auch unseren Kolleginnen und Kollegen an den israelischen Universitäten und am Weizmann Institute of Science", schrieben etwa Max-Planck-Gesellschaft und Minerva-Stiftung am 11. Oktober 2023. "Sehr klar" und "außergewöhnlich" nannte denn auch etwa die Vizepräsidentin für Internationales der Universität von Tel Aviv, Milette Shamir, im Research.Table die deutschen Reaktionen.
Während die Hochschulleitung der Hebräischen Universität in Jerusalem den amerikanischen Elite-Unis Stanford und Harvard vorwarf, diese hätten "uns im Stich gelassen". Die ersten Erklärungen der beiden US-Universitäten hätten trotz der extremen Immoralität der Hamas-Terrorakte nicht klar Täter und Opfer benannt. Das Ziel, eine geschlossene Hochschul-Gemeinschaft zu erhalten, sei von Stanford und Harvard über die eindeutige Verurteilung des Bösen gestellt worden, so der Vorwurf aus Jerusalem.
Weitere Aufregung verursachte ein Brief des studentischen "Harvard Undergraduate Palestine Solidarity Committee", demzufolge allein das "israelische Regime" mit seinem "Apartheid"-System die Verantwortung trage für alle kommende Gewalt. 33 weitere Harvard-Studierendengruppen setzten ihre Unterschrift darunter. Woraufhin unter anderem der frühere US-Finanzminister und ehemalige Harvard-Präsident Larry Summers auf der Plattform "X", vormals Twitter, kommentierte, dieses Statement mache ihn krank: Das "Schweigen der Harvard-Leitung" verbunden mit dem Brief der Studierenden sorge dafür, dass Harvard "bestenfalls neutral" dastehe angesichts der "Terrorakte gegen den jüdischen Staat Israel".
Den richtigen Ton treffen
Es sollte nur ein paar Tage länger dauern, bis die Auseinandersetzungen um die Einordnung der Ereignisse in Israel und Gaza dann doch die deutsche Wissenschaft erreichten. So löschte die Hochschule Düsseldorf (HSD) Mitte Oktober 2023 einen Instagram-Beitrag, in dem sie ihre Solidarität mit Israel erklärt hatte, nachdem die antisemitischen Kommentare darunter überhandnahmen. In einer neuen Version, diesmal ohne Kommentarfunktion, sprach die Hochschule dann von einer politischen Diskussion, die zum Teil "in Ton und Inhalt nicht angemessen war". Der Post sei so verstanden worden, "dass nur das Leid der Menschen in Israel gesehen wird. Aber die HSD steht selbstverständlich an der Seite aller Opfer von Krieg und Gewalt." Ein Schritt hin zur nötigen Ausgewogenheit – oder das Einknicken vor dem Mob?
Fest steht: In den Chef*innen-Etagen vieler deutscher Wissenschaftseinrichtungen war in den vergangenen Wochen die Sorge groß, nicht den richtigen Ton zu treffen. Man möchte in der jetzigen politischen Lage alles richtig machen, aber was heißt das? Das Ergebnis waren mitunter gleich klingende, schablonenhaft ähnliche Formulierungen.
Eine blutige Nase wiederum holte sich der Potsdamer Universitätspräsident Oliver Günther, als er – nach einem ersten sehr klaren Solidaritätsstatement zugunsten Israels – einen verunglückten Versuch der vermeintlichen Differenzierung unternahm. Günther kritisierte die durch die israelische "Besetzung verursachten prekären und teilweise menschenunwürdigen Lebensumstände weiter Teile der palästinensischen Bevölkerung" und fügte hinzu: "Offensichtlich ist auch, dass sich diese Probleme nicht durch eine aggressive Siedlungspolitik und Schikanen gegen die Zivilbevölkerung – schlicht: Gewalt jeglicher Art lösen lassen. Ganz im Gegenteil führen solche Maßnahmen, wie wir vor wenigen Tagen gesehen haben, nur zu mehr Gewalt." Brandenburgs Ministerpräsident Dietmar Woidke (SPD) kommentierte flugs im Berliner Tagesspiegel: "Was Israel in diesen schweren Stunden nicht braucht, sind Schuldzuweisungen, Belehrungen, Relativierungen oder gar Versuche einer Täter-Opfer-Umkehr ausgerechnet aus Deutschland."
Trauerfeier eskaliert
Besonders eindrücklich sind die Ereignisse, die sich in den vergangenen Wochen an der Universität Kassel zugetragen haben. Ein autonomes AStA-Referat hatte einen Film zeigen wollen, der ausschließlich Position für Palästina ergreift. Was die Hochschulleitung um Unipräsidentin Ute Clement untersagte. Als wenig später die Jüdische Hochschulunion einen Stand auf dem Campus aufbaute, inklusive Israel-Flagge, kochte die Stimmung hoch. Umso mehr, als bekannt wurde, dass ein früherer Kasseler Student mitsamt seiner Familie im Gazastreifen getötet worden war, laut "Palestinian Lives Matter" bei einem israelischen Angriff.
Clement erlaubte eine Trauerfeier auf dem Campus unter der Auflage, sie nicht zu einer politischen Kundgebung zum Konflikt zwischen Israel und Palästina zu missbrauchen. Clement hielt sogar eine Rede. "Zuerst sah es so aus, als würde es eine würdige Veranstaltung bleiben, dann wurde sie aber doch gekapert." Ihre Palästinensertücher hatten Teilnehmer nach Aufforderung der Unipräsidentin während deren Trauerrede noch abgenommen. Als dann Redner doch gegen Israel zu agitieren begannen, stellte Clement das Mikrofon ab. Später erklärte die Hochschulleitung, sie sehe ihr "Vertrauen missbraucht".
"Morgens, mittags und nachts", denke sie seitdem über sie Situation nach, sagt Clement, ihr sei dabei immer klarer geworden: Es gebe bei dem Thema in Deutschland ein Schisma, auch an den Hochschulen. "Da sind Menschen meiner Generation, etwas jünger und älter, die alle ihr Leben lang gesagt haben: Nie wieder. Und die jetzt fassungslos vor dem stehen, was Juden in Israel und anderswo geschieht. Und da sind viele Studierende und Angehörige der jungen Generation, viele mit arabischen Wurzeln, aber nicht nur, die das für einseitige Parteinahme halten und das Gefühl haben, ihre Stimme werde in dem Konflikt nicht gehört. Die uns Älteren, die wir an das Existenzrechts Israels als deutsche Staatsräson glauben, vorwerfen, wir würden in unserem Rassismus nicht das Leid der getöteten Kinder in Gaza und anderswo sehen.“
Sie sei erschrocken über solche Wahrnehmungen, sagt Clement, aber es sei wichtig, ihnen einen Rahmen zu geben, um Radikalisierungen zu verhindern. "Genau das sehen wir als Hochschulleitung jetzt als unsere Aufgabe: eine gewaltfreie Debatte ermöglichen, die auf der Grundlage von Argumenten und Fakten stattfindet." Weshalb sie auf dem Zentralcampus jetzt zwei Banner aufgehängt haben, auf Deutsch und auf Englisch, mit den Grundsätzen, die für alle gelten sollen. Unter anderem steht da: "Klar muss sein: Wir schauen nicht weg, wenn Menschen leiden. Das Existenzrecht Israels wird nicht in Frage gestellt. Das Recht der Palästinenser auf einen eigenen Staat wird nicht in Frage gestellt." Jede Form des Terrors sei abzulehnen, jegliche NS-Vergleiche verböten sich. "Genau wie jede Form von Antisemitismus und Islamfeindlichkeit." Der gesamte Uni-Senat stehe dahinter, sagt Clement. Was sie sich wünscht: dass sich alle Hochschulen in Deutschland gemeinsam einen solchen Diskursrahmen geben.
Hitzige Töne und gegenseitig Vorwürfe
Und tatsächlich lud HRK-Präsident Walter Rosenthal direkt nach der HRK-Mitgliederversammlung zu einer weiteren virtuellen Austauschrunde ein "mit einem besonderen Fokus auf Maßnahmen zum Schutz von jüdischen Studierenden sowie auf die Moderation von Konflikten auf dem Campus". Wie hatte er in seiner Erklärung gesagt: "Wir dulden keine Gewalt, weder verbal noch physisch, keinen Antisemitismus, keinerlei Ausgrenzung – auch nicht gegen Studierende und Mitarbeitende palästinensischer Herkunft, die sich aktuell ebenfalls Sorgen machen." Und er fügte hinzu: Das Miteinander an einer Hochschule und die produktive Diskussion auf und neben dem Campus beruhten auf wechselseitigem Respekt, der Wahrung wissenschaftlicher Grundsätze, auf der freiheitlich-demokratischen Grundordnung und der Einhaltung der Gesetze.
Doch statt produktiven Diskussionen und wechselseitigem Respekt gibt es seit Wochen hitzige Töne und gegenseitige Vorwürfe. Etwa als die Staatsekretärin im Bundesministerium für Bildung und Forschung (BMBF) Sabine Döring auf "X" kritisierte, die international bekannte US-Philosophin Judith Butler kontextualisiere in einem Meinungsbeitrag das "Opfer" Hamas, aber nicht den "Täter" Israel. "So kommt – trotz ‚Ich verdamme den Terror der Hamas‘ — am Ende eben doch eine Relativierung desselben heraus". Und Döring, zugleich Philosophieprofessorin an der Universität Tübingen, fügte hinzu: Wenn man Butlers "hehre Vision" umsetze, würde der Staat Israel empirisch aufhören zu existieren und jüdisches Leben würde aus der Region rückstandsfrei getilgt.
Dörings Post löste Zustimmung, aber auch empörte Reaktionen in der Wissenschaftsszene aus. Der Historiker Ben Miller bezeichnete es ebenfalls auf "X" als "intellektuell grotesk, wenn jemand, insbesondere eine Deutsche, auf die Arbeit einer jüdischen Philosophin, die in der jüdischen intellektuellen Tradition arbeitet, mit dem Vorwurf reagiert, sie würde das jüdische Leben nicht genug wertschätzen". Was Döring pessimistisch resümieren ließ: "Sehen Sie, das ist genau der Grund, warum wir keine Chance mehr haben, miteinander einen fruchtbaren Diskurs zu führen."
Ein praktisches Ausrufezeichen der Verbundenheit mit Israel setzte derweil die Deutsche Forschungsgemeinschaft (DFG) und vereinbarte mit ihrer israelischen Partnerorganisation Israel Science Foundation (ISF) eine weitere Stärkung ihrer Zusammenarbeit. Zu den Zielen gehört, die gemeinsame Förderung deutsch-israelischer Forschungsprojekte zu ermöglichen und die Ausarbeitung eines bilateralen Begutachtungsverfahrens. DFG-Präsidentin Katja Becker betonte, das sogenannte Memorandum of Understanding sei bereits vor dem Terrorangriff der Hamas ausgearbeitet worden. "Vor dem Hintergrund der aktuellen Situation in Israel und in der Region bekommt die Stärkung der wissenschaftlichen Zusammenarbeit nun zusätzliche Bedeutung, auch als Zeichen der Solidarität."
Dieser Artikel erschien zuerst im DSW Journal 4/2023.
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BACKGROUND: The Critical Assessment of Functional Annotation (CAFA) is an ongoing, global, community-driven effort to evaluate and improve the computational annotation of protein function. RESULTS: Here, we report on the results of the third CAFA challenge, CAFA3, that featured an expanded analysis over the previous CAFA rounds, both in terms of volume of data analyzed and the types of analysis performed. In a novel and major new development, computational predictions and assessment goals drove some of the experimental assays, resulting in new functional annotations for more than 1000 genes. Specifically, we performed experimental whole-genome mutation screening in Candida albicans and Pseudomonas aureginosa genomes, which provided us with genome-wide experimental data for genes associated with biofilm formation and motility. We further performed targeted assays on selected genes in Drosophila melanogaster, which we suspected of being involved in long-term memory. CONCLUSION: We conclude that while predictions of the molecular function and biological process annotations have slightly improved over time, those of the cellular component have not. Term-centric prediction of experimental annotations remains equally challenging; although the performance of the top methods is significantly better than the expectations set by baseline methods in C. albicans and D. melanogaster, it leaves considerable room and need for improvement. Finally, we report that the CAFA community now involves a broad range of participants with expertise in bioinformatics, biological experimentation, biocuration, and bio-ontologies, working together to improve functional annotation, computational function prediction, and our ability to manage big data in the era of large experimental screens. ; The work of IF was funded, in part, by the National Science Foundation award DBI-1458359. The work of CSG and AJL was funded, in part, by the National Science Foundation award DBI-1458390 and GBMF 4552 from the Gordon and Betty Moore Foundation. The work of DAH and KAL was funded, in part, by the National Science Foundation award DBI-1458390, National Institutes of Health NIGMS P20 GM113132, and the Cystic Fibrosis Foundation CFRDP STANTO19R0. The work of AP, HY, AR, and MT was funded by BBSRC grants BB/K004131/1, BB/F00964X/1 and BB/M025047/1, Consejo Nacional de Ciencia y Tecnología Paraguay (CONACyT) grants 14-INV-088 and PINV15-315, and NSF Advances in BioInformatics grant 1660648. The work of JC was partially supported by an NIH grant (R01GM093123) and two NSF grants (DBI 1759934 and IIS1763246). ACM acknowledges the support by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy - EXC 2155 "RESIST" - Project ID 39087428. DK acknowledges the support from the National Institutes of Health (R01GM123055) and the National Science Foundation (DMS1614777, CMMI1825941). PB acknowledges the support from the National Institutes of Health (R01GM60595). GB and BZK acknowledge the support from the National Science Foundation (NSF 1458390) and NIH DP1MH110234. FS was funded by the ERC StG 757700 "HYPER-INSIGHT" and by the Spanish Ministry of Science, Innovation and Universities grant BFU2017-89833-P. FS further acknowledges the funding from the Severo Ochoa award to the IRB Barcelona. TS was funded by the Centre of Excellence project "BioProspecting of Adriatic Sea", co-financed by the Croatian Government and the European Regional Development Fund (KK.01.1.1.01.0002). The work of SK was funded by ATT Tieto käyttöön grant and Academy of Finland. JB and HM acknowledge the support of the University of Turku, the Academy of Finland and CSC – IT Center for Science Ltd. TB and SM were funded by the NIH awards UL1 TR002319 and U24 TR002306. The work of CZ and ZW was funded by the National Institutes of Health R15GM120650 to ZW and start-up funding from the University of Miami to ZW. The work of PWR was supported by the National Cancer Institute of the National Institutes of Health under Award Number U01CA198942. PR acknowledges NSF grant DBI-1458477. PT acknowledges the support from Helsinki Institute for Life Sciences. The work of AJM was funded by the Academy of Finland (No. 292589). The work of FZ and WT was funded by the National Natural Science Foundation of China (31671367, 31471245, 91631301) and the National Key Research and Development Program of China (2016YFC1000505, 2017YFC0908402]. CS acknowledges the support by the Italian Ministry of Education, University and Research (MIUR) PRIN 2017 project 2017483NH8. SZ is supported by the National Natural Science Foundation of China (No. 61872094 and No. 61572139) and Shanghai Municipal Science and Technology Major Project (No. 2017SHZDZX01). PLF and RLH were supported by the National Institutes of Health NIH R35-GM128637 and R00-GM097033. JG, DTJ, CW, DC, and RF were supported by the UK Biotechnology and Biological Sciences Research Council (BB/N019431/1, BB/L020505/1, and BB/L002817/1) and Elsevier. The work of YZ and CZ was funded in part by the National Institutes of Health award GM083107, GM116960, and AI134678; the National Science Foundation award DBI1564756; and the Extreme Science and Engineering Discovery Environment (XSEDE) award MCB160101 and MCB160124. The work of BG, VP, RD, NS, and NV was funded by the Ministry of Education, Science and Technological Development of the Republic of Serbia, Project No. 173001. The work of YWL, WHL, and JMC was funded by the Taiwan Ministry of Science and Technology (106-2221-E-004-011-MY2). YWL, WHL, and JMC further acknowledge the support from "the Human Project from Mind, Brain and Learning" of the NCCU Higher Education Sprout Project by the Taiwan Ministry of Education and the National Center for High-performance Computing for computer time and facilities. The work of IK and AB was funded by Montana State University and NSF Advances in Biological Informatics program through grant number 0965768. BR, TG, and JR are supported by the Bavarian Ministry for Education through funding to the TUM. The work of RB, VG, MB, and DCEK was supported by the Simons Foundation, NIH NINDS grant number 1R21NS103831-01 and NSF award number DMR-1420073. CJJ acknowledges the funding from a University of Illinois at Chicago (UIC) Cancer Center award, a UIC College of Liberal Arts and Sciences Faculty Award, and a UIC International Development Award. The work of ML was funded by Yad Hanadiv (grant number 9660 /2019). The work of OL and IN was funded by the National Institute of General Medical Science of the National Institute of Health through GM066099 and GM079656. Research Supporting Plan (PSR) of University of Milan number PSR2018-DIP-010-MFRAS. AWV acknowledges the funding from the BBSRC (CASE studentship BB/M015009/1). CD acknowledges the support from the Swiss National Science Foundation (150654). CO and MJM are supported by the EMBL-European Bioinformatics Institute core funds and the CAFA BBSRC BB/N004876/1. GG is supported by CAFA BBSRC BB/N004876/1. SCET acknowledges funding from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 778247 (IDPfun) and from COST Action BM1405 (NGP-net). SEB was supported by NIH/NIGMS grant R01 GM071749. The work of MLT, JMR, and JMF was supported by the National Human Genome Research Institute of the National of Health, grant numbers U41 HG007234. The work of JMF and JMR was also supported by INB Grant (PT17/0009/0001 - ISCIII-SGEFI / ERDF). VA acknowledges the funding from TUBITAK EEEAG-116E930. RCA acknowledges the funding from KanSil 2016K121540. GV acknowledges the funding from Università degli Studi di Milano - Project "Discovering Patterns in Multi-Dimensional Data" and Project "Machine Learning and Big Data Analysis for Bioinformatics". SZ is supported by the National Natural Science Foundation of China (No. 61872094 and No. 61572139) and Shanghai Municipal Science and Technology Major Project (No. 2017SHZDZX01). RY and SY are supported by the 111 Project (NO. B18015), the key project of Shanghai Science & Technology (No. 16JC1420402), Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01), and ZJLab. ST was supported by project Ribes Network POR-FESR 3S4H (No. TOPP-ALFREVE18-01) and PRID/SID of University of Padova (No. TOPP-SID19-01). CZ and ZW were supported by the NIGMS grant R15GM120650 to ZW and start-up funding from the University of Miami to ZW. The work of MK and RH was supported by the funding from King Abdullah University of Science and Technology (KAUST) Office of Sponsored Research (OSR) under Award No. URF/1/3454-01-01 and URF/1/3790-01-01. The work of SDM is funded, in part, by NSF award DBI-1458443 ; Sí
BACKGROUND: The Critical Assessment of Functional Annotation (CAFA) is an ongoing, global, community-driven effort to evaluate and improve the computational annotation of protein function. RESULTS: Here, we report on the results of the third CAFA challenge, CAFA3, that featured an expanded analysis over the previous CAFA rounds, both in terms of volume of data analyzed and the types of analysis performed. In a novel and major new development, computational predictions and assessment goals drove some of the experimental assays, resulting in new functional annotations for more than 1000 genes. Specifically, we performed experimental whole-genome mutation screening in Candida albicans and Pseudomonas aureginosa genomes, which provided us with genome-wide experimental data for genes associated with biofilm formation and motility. We further performed targeted assays on selected genes in Drosophila melanogaster, which we suspected of being involved in long-term memory. CONCLUSION: We conclude that while predictions of the molecular function and biological process annotations have slightly improved over time, those of the cellular component have not. Term-centric prediction of experimental annotations remains equally challenging; although the performance of the top methods is significantly better than the expectations set by baseline methods in C. albicans and D. melanogaster, it leaves considerable room and need for improvement. Finally, we report that the CAFA community now involves a broad range of participants with expertise in bioinformatics, biological experimentation, biocuration, and bio-ontologies, working together to improve functional annotation, computational function prediction, and our ability to manage big data in the era of large experimental screens. ; The work of IF was funded, in part, by the National Science Foundation award DBI-1458359. The work of CSG and AJL was funded, in part, by the National Science Foundation award DBI-1458390 and GBMF 4552 from the Gordon and Betty Moore Foundation. The work of DAH and KAL was funded, in part, by the National Science Foundation award DBI-1458390, National Institutes of Health NIGMS P20 GM113132, and the Cystic Fibrosis Foundation CFRDP STANTO19R0. The work of AP, HY, AR, and MT was funded by BBSRC grants BB/K004131/1, BB/F00964X/1 and BB/M025047/1, Consejo Nacional de Ciencia y Tecnologia Paraguay (CONACyT) grants 14-INV-088 and PINV15-315, and NSF Advances in BioInformatics grant 1660648. The work of JC was partially supported by an NIH grant (R01GM093123) and two NSF grants (DBI 1759934 and IIS1763246). ACM acknowledges the support by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy -EXC 2155 "RESIST" - Project ID 39087428. DK acknowledges the support from the National Institutes of Health (R01GM123055) and the National Science Foundation (DMS1614777, CMMI1825941). PB acknowledges the support from the National Institutes of Health (R01GM60595). GB and BZK acknowledge the support from the National Science Foundation (NSF 1458390) and NIH DP1MH110234. FS was funded by the ERC StG 757700 "HYPER-INSIGHT" and by the Spanish Ministry of Science, Innovation and Universities grant BFU2017-89833-P. FS further acknowledges the funding from the Severo Ochoa award to the IRB Barcelona. TS was funded by the Centre of Excellence project "BioProspecting of Adriatic Sea", co-financed by the Croatian Government and the European Regional Development Fund (KK.01.1.1.01.0002). The work of SK was funded by ATT Tieto kayttoon grant and Academy of Finland. JB and HM acknowledge the support of the University of Turku, the Academy of Finland and CSC -IT Center for Science Ltd. TB and SM were funded by the NIH awards UL1 TR002319 and U24 TR002306. The work of CZ and ZW was funded by the National Institutes of Health R15GM120650 to ZW and start-up funding from the University of Miami to ZW. The work of PWR was supported by the National Cancer Institute of the National Institutes of Health under Award Number U01CA198942. PR acknowledges NSF grant DBI-1458477. PT acknowledges the support from Helsinki Institute for Life Sciences. The work of AJM was funded by the Academy of Finland (No. 292589). The work of FZ and WT was funded by the National Natural Science Foundation of China (31671367, 31471245, 91631301) and the National Key Research and Development Program of China (2016YFC1000505, 2017YFC0908402]. CS acknowledges the support by the Italian Ministry of Education, University and Research (MIUR) PRIN 2017 project 2017483NH8. SZ is supported by the National Natural Science Foundation of China (No. 61872094 and No. 61572139) and Shanghai Municipal Science and Technology Major Project (No. 2017SHZDZX01). PLF and RLH were supported by the National Institutes of Health NIH R35-GM128637 and R00-GM097033. JG, DTJ, CW, DC, and RF were supported by the UK Biotechnology and Biological Sciences Research Council (BB/N019431/1, BB/L020505/1, and BB/L002817/1) and Elsevier. The work of YZ and CZ was funded in part by the National Institutes of Health award GM083107, GM116960, and AI134678; the National Science Foundation award DBI1564756; and the Extreme Science and Engineering Discovery Environment (XSEDE) award MCB160101 and MCB160124. The work of BG, VP, RD, NS, and NV was funded by the Ministry of Education, Science and Technological Development of the Republic of Serbia, Project No. 173001. The work of YWL, WHL, and JMC was funded by the Taiwan Ministry of Science and Technology (106-2221-E-004-011-MY2). YWL, WHL, and JMC further acknowledge the support from "the Human Project from Mind, Brain and Learning" of the NCCU Higher Education Sprout Project by the Taiwan Ministry of Education and the National Center for High-performance Computing for computer time and facilities. The work of IK and AB was funded by Montana State University and NSF Advances in Biological Informatics program through grant number 0965768. BR, TG, and JR are supported by the Bavarian Ministry for Education through funding to the TUM. The work of RB, VG, MB, and DCEK was supported by the Simons Foundation, NIH NINDS grant number 1R21NS103831-01 and NSF award number DMR-1420073. CJJ acknowledges the funding from a University of Illinois at Chicago (UIC) Cancer Center award, a UIC College of Liberal Arts and Sciences Faculty Award, and a UIC International Development Award. The work of ML was funded by Yad Hanadiv (grant number 9660/2019). The work of OL and IN was funded by the National Institute of General Medical Science of the National Institute of Health through GM066099 and GM079656. Research Supporting Plan (PSR) of University of Milan number PSR2018-DIP-010-MFRAS. AWV acknowledges the funding from the BBSRC (CASE studentship BB/M015009/1). CD acknowledges the support from the Swiss National Science Foundation (150654). CO and MJM are supported by the EMBL-European Bioinformatics Institute core funds and the CAFA BBSRC BB/N004876/1. GG is supported by CAFA BBSRC BB/N004876/1. SCET acknowledges funding from the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 778247 (IDPfun) and from COST Action BM1405 (NGP-net). SEB was supported by NIH/NIGMS grant R01 GM071749. The work of MLT, JMR, and JMF was supported by the National Human Genome Research Institute of the National of Health, grant numbers U41 HG007234. The work of JMF and JMR was also supported by INB Grant (PT17/0009/0001 - ISCIII-SGEFI/ERDF). VA acknowledges the funding from TUBITAK EEEAG-116E930. RCA acknowledges the funding from KanSil 2016K121540. GV acknowledges the funding from Universita degli Studi di Milano - Project "Discovering Patterns in Multi-Dimensional Data" and Project "Machine Learning and Big Data Analysis for Bioinformatics". SZ is supported by the National Natural Science Foundation of China (No. 61872094 and No. 61572139) and Shanghai Municipal Science and Technology Major Project (No. 2017SHZDZX01). RY and SY are supported by the 111 Project (NO. B18015), the key project of Shanghai Science & Technology (No. 16JC1420402), Shanghai Municipal Science and Technology Major Project (No. 2018SHZDZX01), and ZJLab. ST was supported by project Ribes Network POR-FESR 3S4H (No. TOPP-ALFREVE18-01) and PRID/SID of University of Padova (No. TOPP-SID19-01). CZ and ZW were supported by the NIGMS grant R15GM120650 to ZW and start-up funding from the University of Miami to ZW. The work of MK and RH was supported by the funding from King Abdullah University of Science and Technology (KAUST) Office of Sponsored Research (OSR) under Award No. URF/1/3454-01-01 and URF/1/3790-01-01. The work of SDM is funded, in part, by NSF award DBI-1458443. ; Sí