Swiss School of Public Health

Background: Evidence of the diverse genetic architecture of dilated cardiomyopathy (DCM) continues to emerge and requires reassessment of the clinical relevance of implicated disease genes. Building on the 2019-2020 Clinical Genome Resource (ClinGen) evaluation, the DCM Gene Curation Expert Panel (GCEP) reconvened in 2024-2025 to conduct a reassessment of genes in DCM. Methods: The ClinGen semi-quantitative clinical validity classification framework was applied with specifications to DCM to classify genes into categories based upon strength of published evidence for a DCM phenotype. Previously curated genes were reassessed and newly reported gene-disease-mode of inheritance (MOI) relationships, termed ?curations,? were evaluated. Results: Sixty-eight genes were evaluated, inclusive of 72 unique gene-disease-MOI relationships across 51 previously evaluated and 17 newly assessed genes. Thirty-five curations were classified as high evidence (16 Definitive, 10 Strong, 9 Moderate), increasing by 16 from the prior assessment. Nine newly assessed genes were classified as high evidence, including BAG5, FLII, LMOD2, MYLK3, MYZAP, NRAP, PPA2, PPP1R13L, and RPL3L. Twelve genes (11 newly appraised) were rated as high evidence with an autosomal recessive (AR) MOI. Five re-evaluated genes from 2019-2020 had clinically significant changes in classification. Except for JPH2, for which curation was modified to separate autosomal dominant (-AD) and -AR MOI curations, clinically significant changes involved upgrades from low to high evidence categories (PLEKHM2, PRDM16, TBX20, TNNI3K), demonstrating the robustness of the ClinGen gene curation process over time. An additional 29 gene-disease-MOI curations were classified as Limited, including six newly evaluated genes and one new MOI for a previously evaluated gene, MYBPC3-AR; four were classified as No Known Disease Relationship, and four remained Disputed. Four previously evaluated genes were curated for both AD and AR MOIs, including JPH2 (AD-Strong, AR-Limited), LDB3 (AD-Limited, AR-Strong), MYBPC3 (AD-Limited, AR-Limited), and TNNI3 (AD- and AR- Strong). Conclusions: With substantial new evidence, the genetic architecture of DCM has rapidly expanded. This updated assessment of genes reported in DCM yielded 35 high evidence curations, an increase from 19 only five years ago. The results of this evidence-based evaluation process informs clinical interpretation of genetic information in the care of DCM patients and families.

Healthcare systems contribute to about 5% of the emissions of the greenhouse gases globally when taken together. With 6.7% of its national emissions of greenhouse gases, the Swiss healthcare system is among the biggest contributors worldwide when taken per capita. Although isolated initiatives to reduce environmental impacts have emerged these last years, there is a strong need for better understanding the barriers and the possibilities for a heuristic framework like One Health to facilitate transformation, in particular in the Swiss context. The main objective is to explore to what extent One Health can facilitate transformation of the Swiss healthcare system and a secondary objective is to examine the role of bioethics in reducing healthcare's environmental impact. A focus group was conducted with nine experts from different disciplines (medicine, environment, veterinary medicine, public health) at the premises of the Swiss Medical Association in Bern on January 27th, 2025. The discussion lasted 180 min and was audio-recorded. Verbatim was transcribed and analyzed using thematic analysis following COREQ guidelines. Three additional individual interviews were conducted with participants who were not able to attend the focus group. Six key themes emerged: the need to reorganize healthcare delivery, the specificity of the Swiss governance system, the need to adopt solutions that are “good enough”, One Health as a heuristic framework for systemic change, the required expansion of the borders of bioethics to include environmental and animal welfare considerations and the possible tensions between different dimensions within the One Health framework. Integrating environmental perspectives through a One Health approach is a possible solution to reduce the environmental impacts of the Swiss healthcare system. The study identifies both barriers (complexity of the Swiss healthcare system, siloed departments) and opportunities (professional willingness to collaborate, the development of post-Covid initiatives) for implementing sustainable healthcare transformation in Switzerland.

As organizations accelerate the adoption and use of artificial intelligence, a common misconception arises that equates automation with progress and strategic necessity. This paper argues that not all that can be automated should be automated. It introduces Strategic Minimalism, a disciplined and ethically grounded approach to AI adoption that values purpose, proportionality, and prudence over speed and scale. Drawing on bounded rationality, virtue ethics, and frugal innovation, the study reframes technological restraint as a form of higher intelligence and responsible governance. Methodologically, the framework emerges from a structured conceptual synthesis and abductive reasoning process: the three traditions are integrated into two core dimensions (automation intensity and retained human judgment), whose intersection yields four strategic quadrants (Virtuous Minimalism, Balanced Synergy, Automation Excess, and Performative Minimalism). The framework is then conceptually stress-tested against rival explanations and boundary conditions to ensure internal coherence and analytic validity. By classifying automation into necessary, excessive, and performative types, the paper advances Responsible AI scholarship by identifying restraint as a strategic virtue that strengthens accountability, human oversight, and organizational resilience. Ultimately, it contends that in the age of intelligent machines, leadership wisdom lies not in automating more, but in knowing precisely when and why to stop.

Abstract Unintended policy consequences in higher education may arise when reforms targeting specific student groups interact with stratified institutional landscapes, with potential spillover effects on structurally disadvantaged domestic populations. This article examines a policy reform aimed at international students—specifically, the 2014 tightening of admission criteria at a Swiss elite STEM higher education institution (HEI)—and its broader, unforeseen impact on first-generation domestic students. Using administrative data and a quasi-experimental design, we find lower attrition among international students after the policy change and no observable change in Swiss students’ graduation rates. At the same time, enrolment of Swiss students declines—most notably among first-generation students—with a compensating increase in enrolment at less selective institutions, concentrated in fields that overlap with the elite programmes affected by the policy. These patterns suggest that the reform altered both formal access and perceptions of attainability, risk and institutional fit, aligning with arguments of constrained educational choice. The findings highlight redistributive costs of regulating international student inflow—shifting opportunities away from first-generation domestic students—and call for system-level governance that anticipates indirect effects on equity.

International trade agreements are major avenues for facilitating global economic growth, ensuring smooth supply chain management across the globe, and coordination of international relations among other social and economic activities among nations. However, such agreements and activities thereof are inevitably prone to disagreements and violations of the guiding principles. Multilateral trade agreements, Bilateral Investment Treaties, and even Regional Trade Agreements often involve countries with economic, political, and legal backgrounds or trends that predisposes them to occasional disharmony with the provisions. It is the inevitability of the disharmony and disputes in the international trade agreements that moved commercial regulators like the World Trade Organization to come up with legal and alternative mechanisms for resolving the disputes. Nevertheless, the trade agreements are equally unique in terms of their provisions with potential impacts on arbitration as an established alternative mechanism for solving international investment disputes. This study sought to examine the possible economic and legal implications of international trade agreements, including bilateral investment treaties and regional trade agreements on arbitration of international investment disputes. It was informed by three specific objectives namely, analysis of the provisions and mechanisms of international trade agreements, assessing the effects of the international trade agreements on the legal framework governing investment dispute resolution, and examination of the economic consequences of investment dispute resolution under international trade agreements. Systematic review of relevant literature alongside case analysis were used as the research methods for the realization of the aforementioned objectives. Both bilateral investment treaties and regional trade agreements were establish to contain substantial and binding provisions most of which recognize and support arbitration in the resolution of their investment disputes. Multiple cases emanating from various trade agreements were established to have been settled through arbitral tribunals. Therefore, the study concludes by noting that different provisions of the international trade agreements have worked towards strengthening the position of arbitration as a mechanism of solving international investment disputes.

The utilisation of theory, the conceptual framework, the theoretical framework, and the research framework is frequently required to be clearly articulated in academic studies. However, these terms are often used interchangeably without a clear understanding of their distinctions. This scenario is complicated because the terms theoretical, conceptual, and research frameworks are employed differently in different research approaches. This article aims to define these concepts and explain their usage with two research approaches: the objectivist deductive approach, which goes from theory to data, and the subjectivist inductive approach, which goes from data to theory, together with a research framework. The theoretical framework provides the foundation of established theories and principles underpinning the study, offering a broad lens through which the research phenomenon is understood. The conceptual framework, derived from the theoretical framework, refines the understanding by delineating specific constructs and their interrelationships, serving as a guide to address the research objectives. Meanwhile, the research framework translates these constructs into operationalised variables and methodologies, facilitating the systematic collection and analysis of data. Together, these frameworks ensure the study's alignment with established knowledge while enabling methodological rigour and clarity in addressing the research problem. Furthermore, the integration of research, conceptual, and theoretical frameworks not only guides the logical flow of a study and strengthens its academic foundation but also enhances its potential to generate meaningful insights across diverse domains, including business innovation and strategy, international business and marketing, technology and operations management, corporate governance and ethics, human resource and project management, and entrepreneurship.

This paper addresses a key challenge in remote care: Designing contexts that foster trust across spatial, technological, and human dimensions. Based on an exploratory workshop with four simulated remote care scenarios, we used qualitative methods and the Kano model of quality to identify design elements that promote or undermine trust. The results highlight the role of caregivers, fragile communication in digital settings, and the importance of spatial and emotional alignment. We distinguish between basic expectations (e.g., privacy), performance factors (e.g., eye contact), and delight features (e.g., human facilitation), and provide a set of hypotheses for recommendations for more human-centred care. The study contributes to innovation management by conceptualising technology and space as relational infrastructures and advocating participatory design through full-scale simulations.

This study aims at the contribution of education to ASEAN low-and-lower-middle-income countries (LLMICs) economic development and particularly the role of higher education in avoiding the low-and-lower-middle-income trap (LLMIT). Panel data analysis indicates a positive relationship between GDP per capita and higher education enrollment, though with its full effect constrained by persistent skill mismatches and poor digital infrastructure. Besides the quantitative findings, qualitative findings derived from the grounded theory approach (GTA) uncover severe impediments and propose measures such as e-learning, spin-offs from universities, and stabilizing community networks. The result underlines the need for continuous investment in higher education combined with primary and secondary education development as the foundation for human capital formation. In nations such as Cambodia, Laos, Myanmar, the Philippines, and Vietnam, issues like low tertiary participation, increasing privatization, and digital divides continue to be high hurdles. To overcome them, governments need to introduce inclusive education policies and increase access to the internet. At the same time, institutions of higher learning are urged to promote more inclusiveness, implement global academic standards, and spur innovation through entrepreneurship led by universities.