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Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter. Compr Psychiatry 2024; 130:152457. [PMID: 38325041 DOI: 10.1016/j.comppsych.2024.152457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.
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Dissemination of ESBL-producing E. coli ST131 through wastewater and environmental water in Switzerland. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 337:122476. [PMID: 37659628 DOI: 10.1016/j.envpol.2023.122476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/06/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
The E. coli lineage ST131 is a major cause of multidrug-resistant urinary tract and bloodstream infections worldwide. Recently emerged ST131 sublineages spread globally within few years, but their dissemination routes are incompletely understood. In this study, we investigate the potential role of wastewater and surface water in the spread of extended-spectrum β-lactamase (ESBL)-producing ST131. Streams, lakes, and two wastewater treatment plants (WWTPs) in the canton of Zug, Switzerland, were consecutively sampled over 1.5 years. ST131 was detected in 38% of the samples taken downstream (1-5 km) of WWTP discharge sites, but usually absent in water bodies distant from urban areas or WWTP discharge. Specific strains were repeatedly isolated (≤5 pairwise cgSNP distance) from wastewater or river sites downstream of effluent discharge, indicating their repeated entry or persistence in WWTPs in large concentrations. Genetic characterization of the ESBL-producing water isolates revealed a predominance of clades A and C1 and an emerging ciprofloxacin-resistant sublineage with mutations in quinolone resistance determining regions (QRDR) within clade A. Multiple isolates belonged to internationally circulating sublineages, including C1-M27 and papGII + sublineages with chromosomally encoded ESBLs. This study demonstrates that the clinically relevant E. coli lineage ST131 pollutes river ecosystems, representing a significant challenge to public health and to technologies to minimize their entry into the water environment.
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Differential Response to Radiation Fractionation in Head and Neck Cancer Patient-Derived Xenografts. Int J Radiat Oncol Biol Phys 2023; 117:e253. [PMID: 37784980 DOI: 10.1016/j.ijrobp.2023.06.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite optimal management with conventionally fractionated radiotherapy, head and neck cancer (HNC) mortality is driven by locoregional failure. With the increasing development of hypofractionated regimens in other malignancies, we sought to investigate the sensitivity of patient HNC to radiation fractionation using murine patient-derived xenografts (PDXs). MATERIALS/METHODS We developed PDXs from three HNC patients who underwent primary surgical resection and enrolled on our IRB-approved (PRO00040992) prospective HNC tumor bank by implanting freshly resected tumors subcutaneously in the flank of NSG-SGM3 mice. PDXs from each patient were randomized to receive no radiation, 2 Gy x 5 fractions delivered daily (conventional arm) or 10 Gy in a single fraction (hypofractionation arm). Tumor volume was measured until 15 days post-RT, when mice were sacrificed. Bulk RNA sequencing analysis was performed on PDX tumors after intervention. RESULTS Three PDX tumors from three unique patients (P006, P010 and P016) were successfully developed and irradiated per protocol. Unique responses to radiation were seen with each tumor: P010 showed equal sensitivity to both the conventional and hypofractionated regimens; P006 showed intermediate sensitivity to the conventional regimen with high sensitivity to hypofractionation, and P016 was resistant to conventional fractionation but showed sensitivity to hypofractionation. Concurrent with the patient-specific PDX response to fractionation, principal component analysis demonstrated that each patient PDX had a unique signature of differentially expressed genes in response to the conventional and hypofractionated regimens. CONCLUSION HNC PDXs show differential tumor and genomic response to radiation fractionation regimens. A precision approach to radiation fractionation for HNC may improve tumor control outcomes in HNCs.
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Differential Response in Quantitative MRI Parameters Detected in Head and Neck Cancer Patients Treated with Concurrent Immunotherapy during Hypo-Fractionated MR-gRT. Int J Radiat Oncol Biol Phys 2023; 117:S65. [PMID: 37784546 DOI: 10.1016/j.ijrobp.2023.06.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Recently, multiple clinical trials have demonstrated success of PD-1/PD-L1-targeted immune checkpoint inhibition (ICI) in recurrent and metastatic head and neck cancer (HNC). However, three large clinical trials combining PD-1/PD-L1-targeted ICI with RT or chemo-RT (CRT) in the definitive management of HNC have shown no benefit of combination therapy with ICI over RT or CRT alone. Our overarching hypotheses are: i) hypo-fractionation may ultimately better synergize with ICI compared to conventional RT regimens, and ii) immunologic changes in the tumor microenvironment may be detectable using quantitative MRI (qMRI) parameters collected during RT. MATERIALS/METHODS Seven patients treated with hypo-fractionated MR-guided RT of 50 Gy in 15 fractions (DEHART, NCT04477759) were included in the study. Four patients (Group 1) were treated with concurrent atezolizumab (a monoclonal antibody) and three patients (Group 2) were treated with RT alone. Daily DWI, T1 mapping, and T2 mapping sequences were acquired on a 1.5T MR-Linac in the idle time during adaptive plan generation. Median ADC, T1, T2, and Dslow (derived from b-values 150 and 550 s/mm2) values were extracted from physician-defined GTV and manually constructed posterior paraspinal muscle contours, the latter serving as a control. Wilcoxon signed rank tests were conducted using pre/post treatment data for each qMRI parameter. RESULTS GTV ADC, Dslow, T2, and T1 increased for both patient groups over the course of treatment with significant differences in ADC, Dslow, and T2 detected between fractions 1 and 15 for all patients studied (p = 0.0156, p = 0.0156, and p = 0.0469, respectively). No significant differences were detected in control qMRI parameters pre/post treatment. No significant differences in ADC, Dslow, and T2 were detected between groups' fractions 1 and 15 in these small cohorts. However, interestingly, we observed a differential change in the increase of median GTV T2 and Dslow values during fractions 10-12 in Group 1 compared to Group 2, suggesting this time interval may prime the anti-tumor immune response. CONCLUSION Combining hypo-fractionated RT with ICI leads to a differential response in quantitative MRI (qMRI) parameters in HNC patients. These results suggest that qMRI parameter changes ten days following the start of RT may reflect a critical juncture in the anti-tumoral immune response when ICI is combined with hypo-fractionated RT.
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Longitudinal Humoral and Cell-Mediated Immune Responses in a Population-Based Cohort in Zurich, Switzerland from March to June 2022 - Evidence for Protection against Omicron SARS-CoV-2 Infection by Neutralizing Antibodies and Spike-specific T cells. Int J Infect Dis 2023; 133:18-26. [PMID: 37149211 PMCID: PMC10159929 DOI: 10.1016/j.ijid.2023.04.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The correlate(s) of protection against SARS-CoV-2 remain incompletely defined. Additional information regarding the combinations of antibody and T cell-mediated immunity which can protect against (re)infection are needed. METHODS We conducted a population-based, longitudinal cohort study including 1044 individuals of varying SARS-CoV-2 vaccination and infection statuses. We assessed Spike (S)- and Nucleocapsid (N)-IgG and wildtype, delta, and omicron neutralizing antibody (N-Ab) activity. In a subset of 328 individuals, we evaluated S, Membrane (M) and N-specific T cells. 3 months later, we reassessed antibody (n=964) and T cell (n=141) responses and evaluated factors associated with protection from (re)infection. RESULTS At study start, >98% of participants were S-IgG seropositive. N-IgG and M/N-T cell responses increased over time, indicating viral (re)exposure, despite existing S-IgG. Compared to N-IgG, M/N-T cells were a more sensitive measure of viral exposure. High N-IgG titers, omicron-N-Ab activity, and S-specific-T cell responses were all associated with reduced likelihood of (re)infection over time. CONCLUSIONS Population-level SARS-CoV-2 immunity is S-IgG-dominated, but heterogenous. M/N T cell responses can distinguish previous infection from vaccination, and monitoring a combination of N-IgG, omicron-N-Ab and S-T cell responses may help estimate protection against SARS-CoV-2 (re)infection.
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Associations between cow-level parameters and heart rate variability as a marker of the physiological stress response in dairy cows. J DAIRY RES 2022; 89:1-6. [PMID: 36039959 DOI: 10.1017/s0022029922000565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To maintain and enhance cow productivity and welfare, it is important that we can accurately assess and understand how cows respond to the physiological demands of gestation and lactation. Several methods have been developed for assessing the physiological responses to stressors and for detecting distress in cattle. Heart rate (HR) variability (HRV) is a non-invasive measure of autonomic nervous system activity and consequently a component of the physiological response to stress. In cattle, HRV has been successfully used to measure autonomic responses to a variety of health conditions and management procedures. The objectives of this study were to determine whether, among commercial Holstein Friesian cows and across farms, relationships exist between cow-level factors, HR and HRV. HRV parameters were compared with production records for 170 randomly selected, Holstein-Friesian-cows on 3 commercial dairy farms. Production data included parity, days in milk (DIM), milk yield, somatic cell count (SCC), % butterfat and protein, body condition score (BCS) and genetic indices. Fixed-effect, multivariable linear regression models were constructed to examine the association between cow-level variables and HRV parameters. Statistically significant relationships were found between HR and farm, temperature and BCS, and between HRV parameters and farm, rectal temperature, BCS, DIM, and percentage butterfat. Given the significant association between farms and several of the indices measured, it is recommended that care must be taken in the interpretation of HRV studies that are conducted on animals from a single farm. The current study indicated that within clinically normal dairy cattle HRV differed with the percentage of butterfat and BCS. Based on the relationships reported previously between HRV and stress in dairy cattle these results suggest that stress may be increased early in lactation, in cows with BCS <2.75 that are producing a high percentage of butterfat milk. Future work could focus on the physiological mechanisms through which these factors and their interactions alter HRV and how such physiological stress may be managed within a commercial farm setting.
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PO-1464 Impact of COVID-19 on Radiation Oncology, an Austrian Experience. Radiother Oncol 2021. [PMCID: PMC8629158 DOI: 10.1016/s0167-8140(21)07915-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Über eine neue Bestimmung der Aktivität von Waschmittelenzymen direkt an textilem Material. TENSIDE SURFACT DET 2021. [DOI: 10.1515/tsd-1970-070203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Assessment of Functional Enrichment of Genes Associated with Radiation Cardiosensitivity in Rat Pre-Clinical Models in Human Genome-wide Association Study (GWAS) of Heart Failure. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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EVALUATION OF THE IMPLEMENTATION OF THE “LIVING WELL WITH COPD” SELF-MANAGEMENT PROGRAM IN SWITZERLAND. Chest 2020. [DOI: 10.1016/j.chest.2020.05.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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P3630Coronary angiography and percutaneous coronary intervention post implantation of a transcatheter aortic valve. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
When treating younger patients with longer life expectancy, the likelihood of having to perform a subsequent coronary angiogram and PCI during follow-up post transcatheter aortic valve implantation (TAVI) is increased. The aim of our study was to assess the feasibility and characteristics of the post TAVI coronary angiogram.
We interrogated our prospective single center TAVI database to analyze data from patients who underwent a coronary angiogram or PCI post TAVI. Between August 2008 and January 2019, 405 consecutive TAVI were performed in our institution with a 30-day, 6-month and yearly follow-up.
Among 405 procedures, 18 coronary angiograms with 9 PCI (RCA 2; LM 3; LAD 3, LCX 1) were performed in 17 patients post TAVI. The mean age of patients was 78.1±7.5 years (3 women), with a mean STS score of 5.6±3.4%. Five patients had a history of prior CABG. The transcatheter heart valves implanted were 6 CoreValve, 8 Evolut R, 1 Evolut Pro and 2 Edwards Sapien. The valve sizes were 31mm (n=3), 29mm (n=6), 26mm (n=3) and 23mm (n=5). The indication for the coronary angiogram was acute coronary syndrome for 8 procedures (1 STEMI, 7 NSTEMI) and stable angina for the remaining 10 procedures. The mean time between TAVI and coronary angiogram was 519±332 days (189–1093 days). Femoral and radial approach was used in, respectively, 11 and 7 (right: 5, left: 2) procedures with one cross-over needed from right transradial to transfemoral. Out of 33 attempted ostia cannulations, there were 2 failures (both involving the RCA), and 31 successes classified as selective (RCA: 7, LM: 9), borderline selective (RCA: 3, LM: 2) and non-selective but sufficient for diagnosis (RCA: 3, LM: 7), using standard catheters (average number of catheter used to cannulate RCA: 1.2±0.8 and LM: 1.7±1.1 [min. 1 and max. 4]). All planned PCI were successful with the treatment of 11 stenosis including 2 multivessel lesions. In 44% of the treated arteries, the use of a GuideLiner catheter (Vascular Solutions Inc) was required to cannulate the ostium.
In conclusion, coronary angiogram post TAVI was needed in 4.2% of our cohort during follow-up. Overall, LM ostia cannulation was successful in 100% of the cases and we failed to cannulate 13.3% of RCA ostia. All PCI were successful with the need of a guiding cathteter extension in 44% of the procedures.
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Identification of Pathways and Genetic Variants Important for Radiation-Induced Cardiotoxicity Using Genetic Mapping. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract P2-11-18: The use of consomic animal models to identify genetic factors that modulate radiation-induced cardiac toxicity. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose/Objectives: Radiation therapy is used by more than 50% of breast cancer patients, but radiation doses can be limited by normal tissue side effects. For example, breast cancer radiation therapy can improve breast cancer-specific survival, but increase cardiac deaths in those with left-sided cancers. Identifying genetic factors that can enhance tumor radiation sensitivity while decreasing normal tissue toxicities has the potential to improve the therapeutic ratio of radiation therapy – leading to more cures and less long-term toxicities. The use of animal models with differing genetic backgrounds to assess radiation toxicity, followed by genetic mapping of radiosensitivity phenotypes, has the potential to identify new targets that can predict cardiac toxicity from radiation therapy. This project examines how genetic host factors alter normal tissue toxicity risks from breast cancer radiation.
Materials/Methods: Inbred female SS rats and SS.BN3 consomic rats, that are genetically identical to SS rats except that chromosome 3 is inherited from the BN strain, have previously been shown to exhibit different vascular dynamics and breast tumor growth. For this study, adult female SS and SS.BN3 rats received image-guided whole heart radiation to a dose of 21 Gy (3 fields, AP and 2 laterals). Cardiac troponin was serially measured at 2, 6, and 12 weeks, and echocardiograms with strain analysis were performed at baseline and 3 months. The Student's t-test was used to compare values.
Results: The SS female rats exhibited enhanced cardiac toxicity compared to SS.BN3 rats, with cardiac troponin levels elevated at 12 weeks (0.32 ng/ml vs.0.08 ng/ml for SS vs. SS.BN3, p=0.01), and moderate to severe pericardial effusions seen in 6 of 9 SS rats vs. 2 of 7 SS.BN3 rats. At 3 months post-radiation, echocardiograms revealed increased left ventricular posterior wall thickness at end diastole (LVPWd) in SS vs. SS.BN3 rats (0.25 vs. 0.20 cm, p=0.002) and increased left ventricular mass (LVM) in SS vs. SS.BN3 rats (1.54 vs. 1.28 g, p<0.001). Taken together, the SS female rats are more sensitive to cardiac irradiation than SS.BN3.
Conclusions: These results demonstrate that genetic variant on rat chromosome 3 alter the radiosensitivity to single fraction cardiac radiation therapy. Gene expression analysis and genetic mapping will be performed to identify the causative target(s). These models will also be expanded to test whether similar results are seen with fractionated cardiac radiation therapy. This project has the potential to enhance the effectiveness and toxicity profile of radiation therapy in breast cancer.
Citation Format: Bergom C, Schlaak R, Frei A, Fish BL, Harmann L, Gasperetti T, Schottstaedt AM, Flister MJ, Medhora M, Strande JL. The use of consomic animal models to identify genetic factors that modulate radiation-induced cardiac toxicity [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-18.
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Identifying Genetic Variants that Enhance the Therapeutic Ratio of Radiation. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ru(II) polypyridyl complexes as photosensitizers in (two-photon excitation) photodynamic therapy. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial. Thorax 2017; 72:415-423. [PMID: 28137918 PMCID: PMC5520265 DOI: 10.1136/thoraxjnl-2016-209026] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/14/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022]
Abstract
Rationale Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. Methods 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. Main results Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit – upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ. Conclusions The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone. Trial registration number: NCT02158065.
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Poster Session 5The imaging examination and quality assessmentP1064The natural course of heart failure with preserved ejection fraction (HFpEF) - insights from an exploratory echocardiographic registryP1065Epicardial fat and effectiveness of catheter radiofrequency ablation in patients with atrial fibrillation and metabolic syndromeP1066Systematic disinfection of echocardiographic probe after each examination to reduce the persistence of pathogens as a potential source of nosocomial infectionsP1067Left atrial mechanical function assessed by two-dimensional echocardiography in hypertensive patientsP1068Real live applications of three-dimensional echocardiographic quantification of the left ventricular volumes and function using an automated adaptive analytics algorithmP10693D echocardiographic left ventricular dyssynchrony indices in end stage kidney disease: associations and outcomesP1070Relative contribution of right ventricular longitudinal shortening and radial displacement to global pump function in healthy volunteersP1071ECHO-parameters, associated with short-term mortality and long-term complications in patients with pulmonary embolism of high and intermediate riskP1072Increased epicardial fat is an independent marker of heart failure with preserved ejection fraction.P1073Influence of optimized beta-blocker therapy on diastolic dysfunction determined echocardiographically in heart failure patientsP1074Early diastolic mitral flow velocity/ annular velocity ratio is a sensitive marker of elevated filling pressure in left ventricular dyssynchronyP1075Left ventricular diastolic function in STEMI patients receiving early and late reperfusion by percutaneous coronary intervention P1076Could anatomical and functional features predict cerebrovascular events in patients with patent foramen ovale?P1077Efficacy of endarterectomy of the left anterior descending artery: evaluation by adenosine echocardiography?P1078Left ventricular diastolic dysfunction after acute myocardial infarction with preserved ejection fraction is related to lower exercise capacityP1079Potentially predictors of ventricular arrhythmia during six months follow up in STEMI patientsP1080Association between left atrial dilatation and invasive haemodynamics at rest and during exercise in asymptimatic aortic stenosisP1081Cardiac amyloidosis and aortic stenosis - the convergence of two aging processes and its association with outcomesP1082Prognostic impact of initial left ventricular dysfunction and mean gradient after transcatheter aortic valve implantationP1083Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysisP1084Discrepancies between echocardiographic and invasive assessment of aortic stenosis in multimorbid elderly patientsP1085Echocardiographic determinants and outcome of patients with low-gradient moderate and severe aortic valve stenosis: implications for aortic valve replacementP1086Atrial deformation correlated with functional capacity in mitral stenosisP1087Net atrioventricular compliance can predict reduction of pulmonary artery pressure after percutaneous mitral balloon commissurotomy. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Changes of eicosanoid metabolism in CAPD-associated peritonitis. CONTRIBUTIONS TO NEPHROLOGY 2015; 57:45-54. [PMID: 3677702 DOI: 10.1159/000414263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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A magnetically shielded room with ultra low residual field and gradient. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2014; 85:075106. [PMID: 25085172 DOI: 10.1063/1.4886146] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A versatile and portable magnetically shielded room with a field of (700 ± 200) pT within a central volume of 1 m × 1 m × 1 m and a field gradient less than 300 pT/m, achieved without any external field stabilization or compensation, is described. This performance represents more than a hundredfold improvement of the state of the art for a two-layer magnetic shield and provides an environment suitable for a next generation of precision experiments in fundamental physics at low energies; in particular, searches for electric dipole moments of fundamental systems and tests of Lorentz-invariance based on spin-precession experiments. Studies of the residual fields and their sources enable improved design of future ultra-low gradient environments and experimental apparatus. This has implications for developments of magnetometry beyond the femto-Tesla scale in, for example, biomagnetism, geosciences, and security applications and in general low-field nuclear magnetic resonance (NMR) measurements.
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Swiss quality and outcomes framework: quality indicators for diabetes management in Swiss primary care based on electronic medical records. Gerontology 2014; 60:263-73. [PMID: 24603324 DOI: 10.1159/000357370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. OBJECTIVE We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). METHODS We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. RESULTS A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. CONCLUSIONS Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.
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Combined complex PCI and TAVI procedure in a 94-year-old man: Two more 4000-meter summits to go. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[The diabetes traffic light scheme - development of an instrument for the case management in patients with diabetes mellitus in primary care]. PRAXIS 2011; 100:1457-1473. [PMID: 22124957 DOI: 10.1024/1661-8157/a000751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In order to sustain the continuity and quality of treatment in diabetic primary care patients, it is necessary to introduce structured and regularly performed monitoring system into the practice team. The monitoring aims at early and valid recognition of potential complications resulting from a chronic disease. Ideally the practice nurse is in charge of the case management. The central element of the case management is a colour coded instrument, the diabetes traffic light scheme, by which means the most important clinical parameters and patient adherence can be screened in regular intervals. Additionally, the instrument regulates in-practice communication by means of stratified action plans and enables ideal treatment continuity also in larger teams. The experiences resulting from the development of this diabetes-specific traffic light scheme can be beneficial for the future development of similar instruments in other chronic diseases.
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Abstract
OBJECTIVE Research in the USA has demonstrated numerous associations between adult attention-deficit/hyperactivity disorder (ADHD) and smoking behaviour; however, no specific work on this topic has been done in Switzerland. The aim of the study was to gain knowledge about the association between ADHD and tobacco consumption in a Swiss sample of adult ADHD patients. METHODS The study subjects were recruited from patients with a DSM-IV diagnosis of ADHD consecutively presenting to the ADHD consultation service at the Centre for Addiction Disorders, an outpatient facility of the Zurich University Hospital, between September 2000 and January 2006. Complete data could be obtained from 100 of 134 patients presenting to the service. RESULTS The number of current smokers in the ADHD sample was significantly elevated compared to the Swiss general population (55 vs 31%). Additionally, daily smokers in the ADHD sample smoked significantly more cigarettes per day, reported higher levels of nicotine dependence and started to smoke regularly at a significantly younger age. The motivation to quit smoking was high. CONCLUSIONS The results of this Swiss study are consistent with previous research in the USA. The fact that many adults with ADHD are motivated to quit smoking and that they actually make use of support in quitting is crucial for secondary tobacco prevention.
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PW01-117 - Recidivism of internet sex offenders - an epidemiologic study on more than 4600 offenders in Switzerland. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71516-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Production of AlN by Carbothermal and Methanothermal Reduction of Al2O3 in a N2 Flow Using Concentrated Thermal Radiation. Ind Eng Chem Res 2008. [DOI: 10.1021/ie8011193] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magnesium Production by the Pidgeon Process Involving Dolomite Calcination and MgO Silicothermic Reduction: Thermodynamic and Environmental Analyses. Ind Eng Chem Res 2008. [DOI: 10.1021/ie071234v] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ammonia Production via a Two-Step Al2O3/AlN Thermochemical Cycle. 3. Influence of the Carbon Reducing Agent and Cyclability. Ind Eng Chem Res 2008. [DOI: 10.1021/ie071244w] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Direct experimental verification of neutron acceleration by the material optical potential of solid 2H2. PHYSICAL REVIEW LETTERS 2008; 100:014801. [PMID: 18232776 DOI: 10.1103/physrevlett.100.014801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Indexed: 05/25/2023]
Abstract
We have measured the acceleration of neutrons by the material optical potential of solid 2H2. Using a gravitational spectrometer, we find a minimal kinetic energy Ec = (99+/-7) neV of neutrons from a superthermal ultracold neutron (UCN) source with solid 2H2 as an UCN converter. The result is in excellent agreement with theoretical predictions, Ec = 106 neV.
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Cold neutron energy dependent production of ultracold neutrons in solid deuterium. PHYSICAL REVIEW LETTERS 2007; 99:262502. [PMID: 18233572 DOI: 10.1103/physrevlett.99.262502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Indexed: 05/25/2023]
Abstract
A measurement of the production of ultracold neutrons from velocity-selected cold neutrons on gaseous and solid deuterium targets is reported. The expected energy dependence for two-particle collisions with well defined neutron and Maxwell-Boltzmann distributed molecular velocities is found for the gas target. The solid target data agree in shape with the phonon density-of-states curve and provide strong evidence for the phonon model including multiphonon excitations.
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Ammonia Production via a Two-Step Al2O3/AlN Thermochemical Cycle. 2. Kinetic Analysis. Ind Eng Chem Res 2007. [DOI: 10.1021/ie061551m] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Use of army weapons and private firearms for suicide and homicide in the region of Basel, Switzerland. CRISIS 2006; 27:140-6. [PMID: 17091825 DOI: 10.1027/0227-5910.27.3.140] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Switzerland has one of the highest rates of firearm suicides in the world. International studies show a positive correlation between the rate of households with guns and femicides with guns. Because its defense system requires a militia to keep personal firearms at home, Switzerland has a high rate of households with a gun. METHODS Records of suicides in the region of Basel between 1992 and 1996 were reviewed. Suicides with either army weapons or private firearms and suicides by other means were compared. Methods and types of homicides that occurred in the region at the same time were also analyzed. FINDINGS Firearm suicides were clearly the most frequent means of suicide. They were also used in 30.0% of domestic homicides, although other means were used at similar rates. Firearms for suicide were mainly used by men, especially army weapons. These men were younger, professionally better qualified, and fewer had ever been treated in one of the local state psychiatric services. DISCUSSION The use of firearms for suicide, rather than homicide, and particularly of army weapons by young, well-educated men, requires more attention in debates and informed policy regarding access to firearms and suicide prevention in Switzerland.
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[Health economic consequences of the use of irbesartan in patients with type 2 diabetes, hypertension and nephropathy in Switzerland]. PRAXIS 2006; 95:401-8. [PMID: 16570646 DOI: 10.1024/0369-8394.95.11.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The irbesartan in Diabetic Nephropathy Trial (IDNT) demonstrated that treatment of patients with type 2 diabetes, hypertension and nephropathy with irbesartan resulted in a 20% relative reduction of the composite endpoint of doubling serum creatinine, end-stage renal disease or death as compared with amlodipine and placebo (antihypertensive standard therapy). The objective of this study was to investigate the long-term health economic consequences of this treatment strategy in a Swiss health care setting. This analysis used a Markov model to simulate the progression of nephropathy, life-years and treatment costs over ten years for each of the three treatment options. In additon, sensitivity analyses were performed. Treatment with irbesartan will save CHF 22681/patient as compared with amlodipine and CHF 13847 as compared with standard therapy.
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[Osteoporosis and digestive disease]. REVUE MEDICALE SUISSE 2006; 2:205-9. [PMID: 16493963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
All patients receiving cortisone for more than 3 months should be offered not only calcium and vitamin D supplementation but also bisphosphonates in order to decrease the fractural risk. A screening for celiac disease should be performed in all patients with idiopathic osteoporosis. Following hepatic transplantation, the administration of bisphosphonates should be the rule.
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Antixenosis and antibiosis of common beans to Thrips palmi Karny (Thysanoptera: Thripidae). JOURNAL OF ECONOMIC ENTOMOLOGY 2003; 96:1577-1584. [PMID: 14650534 DOI: 10.1093/jee/96.5.1577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Antixenosis and antibiosis in the resistance of common beans (Phaseolus vulgaris L.) to the melon thrips, Thrips palmi Karny, were investigated under laboratory and field conditions. Experiments were conducted for four moderately resistant genotypes ('Brunca', BH-130, EMP 486, and FEB 115) in comparison with one susceptible genotype (APN 18). Multiple-choice tests recorded most thrips on EMP 486 and least on FEB 115. Dual-choice tests conducted in both laboratory and field confirmed the antixenotic effect of FEB 115 and the attractant effect of EMP 486 on thrips. These results demonstrate the significance of antixenosis in the resistance of common beans to T. palmi. Life-table studies showed significant differences in egg duration, immature and adult survivorship, female body length and longevity, daily oviposition rate, and total fecundity among the bean genotypes. The intrinsic rate of natural increase (r(m)) and its associated population parameters varied significantly with the bean genotype on which T. palmi cohorts were reared. Based on mean r(m) values, the five bean genotypes can be divided into two groups, with BH-130 and 'Brunca' being less favorable for the population growth of thrips than EMP 486 and FEB 115; the latter were comparable to the susceptible genotype APN 18. These life-table results indicate the role of antibiosis in enhancing the resistance of common beans to T. palmi.
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Resistance to Thrips palmi (Thysanoptera: Thripidae) in beans. JOURNAL OF ECONOMIC ENTOMOLOGY 2002; 95:1066-1073. [PMID: 12403436 DOI: 10.1093/jee/95.5.1066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Resistance in beans, Phaseolus vulgaris L., to the melon thrips Thrips palmi Karny was studied under field conditions at two sites in Colombia. Genotypes were rated for resistance on the basis of visual damage scores, bean production ratings (a visual estimate of pod and seed set), and grain yields. Of 1,138 genotypes tested, only 60 (5.3%) were rated as resistant. Repeated testing allowed us to identify potential sources of resistance in five germplasm accessions (G 02402, G 02852, G 03177, G 03569, and G 04055), one commercial variety ('Brunca'), six elite breeding lines (A 216, DOR 714, EMP 486, FEB 115, FEB 161, and FEB 162), 41 recombinant inbred lines derived from the BAT 881 x G 21212 cross, and seven recombinant inbred lines derived from a cross between DOR 364 and BAT 477. Resistance was not associated with maturity, growth habit, pubescence, and seed color or seed size. In general, correlations between visual damage scores and bean production ratings and between damage scores and yield were high and significant meaning that selection on damage rating is useful to identify genotypes that may have tolerance as a mechanism of resistance. The continuous distribution of damage scores of 139 recombinant inbred lines suggested that the inheritance of resistance to the melon thrips might be quantitative. Overall, resistance levels in beans can be considered as moderate, because none of the genotypes tested received damage scores of <3 on a 1-9 scale and none was ever rated as highly resistant in terms of bean production ratings.
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Abstract
Resistance in beans, Phaseolus vulgaris L., to the melon thrips Thrips palmi Karny was studied under field conditions at two sites in Colombia. Genotypes were rated for resistance on the basis of visual damage scores, bean production ratings (a visual estimate of pod and seed set), and grain yields. Of 1,138 genotypes tested, only 60 (5.3%) were rated as resistant. Repeated testing allowed us to identify potential sources of resistance in five germplasm accessions (G 02402, G 02852, G 03177, G 03569, and G 04055), one commercial variety ('Brunca'), six elite breeding lines (A 216, DOR 714, EMP 486, FEB 115, FEB 161, and FEB 162), 41 recombinant inbred lines derived from the BAT 881 x G 21212 cross, and seven recombinant inbred lines derived from a cross between DOR 364 and BAT 477. Resistance was not associated with maturity, growth habit, pubescence, and seed color or seed size. In general, correlations between visual damage scores and bean production ratings and between damage scores and yield were high and significant meaning that selection on damage rating is useful to identify genotypes that may have tolerance as a mechanism of resistance. The continuous distribution of damage scores of 139 recombinant inbred lines suggested that the inheritance of resistance to the melon thrips might be quantitative. Overall, resistance levels in beans can be considered as moderate, because none of the genotypes tested received damage scores of <3 on a 1-9 scale and none was ever rated as highly resistant in terms of bean production ratings.
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Abstract
Empty capsids from adenovirus, that is, virus particles lacking DNA, are well documented in the published literature. They can be separated from complete virus by CsCl density gradient centrifugation. Here we characterize the presence of empty capsids in recombinant adenovirus preparations purified by column chromatography. The initial purified recombinant adenovirus containing the p53 tumor suppressor gene was produced from 293 cells grown on microcarriers and purified by passage through DEAE-Fractogel and gel-filtration chromatography. Further sequential purification of the column-purified virus by CsCl and glycerol density gradient centrifugations yielded isolated complete virus and empty capsids. The empty capsids were essentially noninfectious and free of DNA. Analysis of empty capsids by SDS-PAGE or RP-HPLC showed the presence of only three major components: hexon, IIIa, and a 31K band. This last protein was identified as the precursor to protein VIII (pVIII) by mass spectrometric analysis. No pVIII was detected from the purified complete virus. Analysis by electron microscopy of the empty capsids showed particles with small defects. The amount of pVIII was used to determine the level of empty capsid contamination. First, the purified empty capsids were used to quantify the relation of pVIII to empty capsid particle concentration (as estimated by either light scattering or hexon content). They were then used as a standard to establish the empty capsid concentration of various recombinant adenovirus preparations. Preliminary research showed changes in empty capsid concentration with variations in the infection conditions. While virus purification on anion-exchange or gel-filtration chromatography has little effect on empty capsid contamination, other chromatographic steps can substantially reduce the final concentration of empty capsids in column-purified adenovirus preparations.
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[Economic evaluation of the Swiss project on medically prescribed heroin substitution treatment]. PSYCHIATRISCHE PRAXIS 2001; 28 Suppl 1:S41-4. [PMID: 11533906 DOI: 10.1055/s-2001-15386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Assisted suicide as conducted by a "Right-to-Die"-society in Switzerland: a descriptive analysis of 43 consecutive cases. Swiss Med Wkly 2001; 131:375-80. [PMID: 11524903 DOI: 10.4414/smw.2001.09725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND METHODS The Swiss "Right-to-Die"-society EXIT enables assisted suicide by providing terminally ill members with a lethal dosage of barbiturates on request. This practice is tolerated by Swiss legislation. EXIT insists on its assumption that people with serious illness and suffering have the competency to take such a decision. The case of two patients who committed suicide a short time after their release from a psychiatric clinic raised some doubts about the practice of EXIT. The files of all 43 cases of suicide assisted by EXIT between 1992 and 1997 in the region of Basle kept in the Institute of Forensic Medicine were examined for accuracy of the medical data. This sample was compared for age, gender-ratio and prior psychiatric treatment with 425 ordinary suicides in the same region. An attempt was made to assess whether only terminally ill and people with intolerable suffering had been assisted with suicide and what efforts EXIT had made to rule out psychiatric illnesses or poor social conditions as the reason for the wish to die. RESULTS A medical report of the treating doctor(s) was in the files in only five cases. The "EXIT" cases where older than the "ordinary"-sample. Among those over 65 years old there were almost twice as many women as men. 16 of the 24 women older than 65 years were widowed. There were 20 cases of cancer; but in eleven cases medical files revealed no apparent medical condition to explain a death-wish. Five of the patients declared a social loss or fear of such loss as the reason for their wish to die. Six persons had formerly been in psychiatric care, though this was not mentioned in the files. CONCLUSIONS Due to the scarcity of information in the files as regards previous palliative care, the high proportion of old women and the high percentage of people not suffering from a terminal illness compared to the literature we conclude that psychiatric or social factors are not an obstacle for EXIT to assist with suicide.
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Assisted suicide as conducted by a "Right-to-Die"-society in Switzerland: a descriptive analysis of 43 consecutive cases. Swiss Med Wkly 2001; 131:375-80. [PMID: 11524903 DOI: 2001/25/smw-09725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND METHODS The Swiss "Right-to-Die"-society EXIT enables assisted suicide by providing terminally ill members with a lethal dosage of barbiturates on request. This practice is tolerated by Swiss legislation. EXIT insists on its assumption that people with serious illness and suffering have the competency to take such a decision. The case of two patients who committed suicide a short time after their release from a psychiatric clinic raised some doubts about the practice of EXIT. The files of all 43 cases of suicide assisted by EXIT between 1992 and 1997 in the region of Basle kept in the Institute of Forensic Medicine were examined for accuracy of the medical data. This sample was compared for age, gender-ratio and prior psychiatric treatment with 425 ordinary suicides in the same region. An attempt was made to assess whether only terminally ill and people with intolerable suffering had been assisted with suicide and what efforts EXIT had made to rule out psychiatric illnesses or poor social conditions as the reason for the wish to die. RESULTS A medical report of the treating doctor(s) was in the files in only five cases. The "EXIT" cases where older than the "ordinary"-sample. Among those over 65 years old there were almost twice as many women as men. 16 of the 24 women older than 65 years were widowed. There were 20 cases of cancer; but in eleven cases medical files revealed no apparent medical condition to explain a death-wish. Five of the patients declared a social loss or fear of such loss as the reason for their wish to die. Six persons had formerly been in psychiatric care, though this was not mentioned in the files. CONCLUSIONS Due to the scarcity of information in the files as regards previous palliative care, the high proportion of old women and the high percentage of people not suffering from a terminal illness compared to the literature we conclude that psychiatric or social factors are not an obstacle for EXIT to assist with suicide.
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Antimicrobial susceptibility of intestinal bacteria from Swiss poultry flocks before the ban of antimicrobial growth promoters. Syst Appl Microbiol 2001; 24:116-21. [PMID: 11403390 DOI: 10.1078/0723-2020-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
From the crop and the caecum of Swiss broilers slaughtered between November 1997 and January 1998, Escherichia coli, enterococci, staphylococci, lactobacilli and Campylobacter species were isolated. After identification to the genus or species level, their minimal inhibitory concentrations (MIC's) for several clinically used antimicrobial agents were determined with the E-Test stripes and compared to those from studies in other European countries. All strains of Enterococcus faecalis (n = 38), E. faecium (27), staphylococci (n = 39) and lactobacilli (n = 14) showed a hundred percent resistance against bacitracin which was included in the feed of the mother animals, but not in the feed of the investigated animals. E.coli strains (n = 60) showed higher resistance incidences than in comparable studies from Finland and Denmark, but lower than those in studies from Italy and Germany. In staphylococci, low resistance rates were observed. A high susceptibility of the 13 Campylobacter jejuni strains was found against therapeutically used antimicrobials. These data can be used as a baseline to determine antibiotic resistance rates after implementation of the growth promotor ban in 1999 in Switzerland.
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Abstract
The objectives of the study were to calculate the costs of postoperative complications and to evaluate whether the use of perioperative enteral immunonutrition, may lead to a saving in health care resources consumed. The economic analysis was based on data from a randomized double-blind trial that include 206 cancer patients who received perioperatively either enteral immunonutrition (treatment group, n = 102) or a standard enteral diet (control group, n = 104). Estimates of costs were based on resource use for treatment of complications, which were valued according to the National List of Sanitary Costs of the Italian Ministry of Health and on the medical Diagnosis-Related-Group (DRG) reimbursement rates. Costs of nutrition were also calculated. Cost comparison and cost effectiveness analyses were then carried out. Intent-to-treat analysis showed that the total costs of 52 postoperative complications were 322,218 euros, with a consumption of the DRG reimbursement rate of 15.4%. The costs of nutrition were 35,437 euros in the treatment group versus 10,768 euros in the control group. The total costs (nutrition plus treating complications) amounted to 113,778 euros in the treatment group versus 254,450 euros in the control group. The mean total costs per patient were 1,115 euros in the treatment group versus 2,447 euros in the control group (P = 0.04). Effectiveness was 83.3% in the treatment group versus 68.3% in the control group (P = 0.009). Cost effectiveness analysis showed a net saving of 2,386 euros per complication-free patient in favor of the treatment group. In conclusion, the perioperative use of immunonutrition appears cost effective due to a substantial saving of resources used to treat postoperative complications.
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Economic investigation of the use of three-compartment total parenteral nutrition bag: prospective randomized unblinded controlled study. Clin Nutr 2000; 19:245-51. [PMID: 10952795 DOI: 10.1054/clnu.2000.0106] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Optimal strategy for total parenteral nutrition (TPN) administration is essential both in terms of clinical effectiveness and economic efficiency. The aim of the present economic analysis was to provide a systematic and comprehensive cost comparison of the application of three currently available TPN systems: Separate Bottles (SB), Hospital-Compounded Bags (HCB) and Three-Compartment Bags (TCB). Sixty patients, admitted to the Geneva University Hospital and requiring TPN, were randomly assigned to one of the three systems. Three standard TPN formulas were prescribed to meet the patients' protein energy needs. TPN-related activities of medical, nursing and pharmacy staff were timed for the 24 hours of TPN administration. Manpower, nutrient solutions and medical supplies costs were calculated on the basis of mean Swiss salaries and hospital prices. TCB was the least expensive TPN system. SB and HCB systems' application costs were 120 and 150% of TCB cost, respectively. All intersystems cost comparisons were statistically significant (ANOVA p < or = 0.01). SB system required more items and manipulations, resulting in higher nurses manpower cost. Pharmacy overhead cost due to compounding was responsible for the higher cost of HCB system. Detailed manpower data presented in this study allow for an estimation of TPN application costs in other hospitals, using local salaries, specific product prices and compounding costs.
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Outcome and cost-effectiveness of perioperative enteral immunonutrition in patients undergoing elective upper gastrointestinal tract surgery: a prospective randomized study. ARCHIVES OF SURGERY (CHICAGO, ILL. : 1960) 1999; 134:1309-16. [PMID: 10593328 DOI: 10.1001/archsurg.134.12.1309] [Citation(s) in RCA: 202] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
HYPOTHESIS Perioperatively administered enteral immunonutrition will improve early postoperative morbidity and cost-effectiveness after gastrointestinal tract surgery. DESIGN A prospective, randomized, double-blind, multicenter clinical trial. SETTING Surgical departments in German university and teaching hospitals. PATIENTS One hundred fifty-four patients with upper gastrointestinal tract malignant neoplasms who were eligible for analysis. INTERVENTION Preoperatively, patients received 5 days of oral immunonutrition (an arginine-, RNA-, and omega3 fatty acid-supplemented diet) or an isoenergetic control diet (1 L/d). Early postoperative enteral feeding with immunonutrition or an isoenergetic, isonitrogenous control diet using a catheter jejunostomy was performed for 10 days. MAIN OUTCOME MEASURES Postoperative infectious complications, their treatment costs, and cost-effectiveness of immunonutrition were analyzed. Plasma levels of the fatty acids eicosapentaenoic acid and docosahexaenoic acid were measured. RESULTS In the immunonutrition group, significantly fewer infectious complication events occurred (14 vs 27; P = .05). The number of patients with complications was significantly lower in the supplemented diet group after postoperative day 3 (7 vs 16; P = .04). The treatment costs of complications in the supplemented diet group were suggestively lower than in the control diet group (DM 75172 vs DM 204273). Cost-effectiveness was DM 1503 in the experimental group vs DM 3587 in the control group, where DM denotes deutsche mark (German currency). CONCLUSION The perioperative administration of an enteral immunonutrition significantly (P = .05) decreased the early occurrence of postoperative infections and reduced substantially the treatment costs of the complications after major upper gastrointestinal tract surgery.
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Abstract
In the region of Basel in Switzerland 43 assisted suicides were registered between 1992 and 1997, eight percent of all suicides in the region. Assisted suicide was administered by the help-to-die society Exit. There was a psychiatric history in six of the suicides. Four of them suffered of serious physical illness as well. The analyses of these six suicides focuses on the conditions of assisted suicide in people with mental illness and the ethical problems arising.
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[Dealing creatively with laws regarding protective custody]. PSYCHIATRISCHE PRAXIS 1999; 26:207. [PMID: 10457976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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[Paranoid schizophrenia as Munchausen syndrome in a forensic psychiatry setting]. PSYCHIATRISCHE PRAXIS 1999; 26:149. [PMID: 10412715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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