Variation in treatment strategies of Swiss general practitioners for subclinical hypothyroidism in older adults.

QUESTIONS UNDER STUDY: As the best management of subclinical hypothyroidism is controversial, we aimed to assess variations in treatment strategies depending on different Swiss regions, physician and patient characteristics. METHODS: We performed a case-based survey among general practitioners (GPs) in different Swiss regions, which consisted of eight hypothetical cases presenting a female patient with subclinical hypothyroidism and nonspecific complaints differing by age, vitality status and thyroid-stimulating hormone (TSH) concentration. RESULTS: A total of 262 GPs participated in the survey. There was considerable variation in the levothyroxine starting dose chosen by GPs, ranging from 25 µg to 100 µg. Across the Swiss regions, GPs in the Bern region were significantly more inclined to treat, with a higher probability of initiating treatment (60%, p = 0.01) and higher mean starting doses (45 µg, p <0.01) compared with the French-speaking region (44%, 36 µg); the Zurich region had intermediate values (52%, 39 µg). We found no association between treatment rate and other physician characteristics. GPs were more reluctant to initiate treatment in 85-year-old than in 70-year-old women (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.63-0.94), and more likely to treat women with a TSH of 15 mU/l than those with a TSH of 6mU/l (OR 8.71, 95% CI 6.21-12.20). CONCLUSIONS: There are strong variations in treatment strategies for elderly patients with subclinical hypothyroidism across different Swiss regions, including use of higher starting doses than the recommended 25 µg in the Swiss guidelines, which recommend a starting dose of 25 µg. These variations likely reflect the current uncertainty about the benefits of treatment, which arise from the current lack of evidence from adequately powered clinical trials.

Sociodemographic, behavioral and genetic determinants of allostatic load in a Swiss population-based study.

Allostatic load (AL) is a marker of physiological dysregulation which reflects exposure to chronic stress. High AL has been related to poorer health outcomes including mortality. We examine here the association of socioeconomic and lifestyle factors with AL. Additionally, we investigate the extent to which AL is genetically determined. We included 803 participants (52% women, mean age 48±16years) from a population and family-based Swiss study. We computed an AL index aggregating 14 markers from cardiovascular, metabolic, lipidic, oxidative, hypothalamus-pituitary-adrenal and inflammatory homeostatic axes. Education and occupational position were used as indicators of socioeconomic status. Marital status, stress, alcohol intake, smoking, dietary patterns and physical activity were considered as lifestyle factors. Heritability of AL was estimated by maximum likelihood. Women with a low occupational position had higher AL (low vs. high OR=3.99, 95%CI [1.22;13.05]), while the opposite was observed for men (middle vs. high OR=0.48, 95%CI [0.23;0.99]). Education tended to be inversely associated with AL in both sexes(low vs. high OR=3.54, 95%CI [1.69;7.4]/OR=1.59, 95%CI [0.88;2.90] in women/men). Heavy drinking men as well as women abstaining from alcohol had higher AL than moderate drinkers. Physical activity was protective against AL while high salt intake was related to increased AL risk. The heritability of AL was estimated to be 29.5% ±7.9%. Our results suggest that generalized physiological dysregulation, as measured by AL, is determined by both environmental and genetic factors. The genetic contribution to AL remains modest when compared to the environmental component, which explains approximately 70% of the phenotypic variance.

The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma.

Cutaneous melanoma is the most deadly cutaneous neoplasm. In order to guide treatment decisions and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006 and 2016. Recent data on surgical and medical treatments from randomised trials necessitated modification of the treatment and follow-up recommendations.

Berlin, colonel Reinhard au centre, auteur de la phrase Jewish flag for the new German colours [il a comparé le nouveau drapeau allemand à un torchon juif] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 58631

Pleasant Hours: A Paper for Young Folk, Vol. III No. 20- October 6, 1863

This issue of Pleasant Hours: a paper for young folk contains an article titled "The Story of Queenston Heights".

Morphonotactic and phonotactic processing in German-speaking adults

Based on the theoretical framework of Dressler and Dziubalska-Kołaczyk (2006a,b), the Strong Morphonotactic Hypothesis will be tested. It assumes that phonotactics helps in decomposition of words into morphemes: if a certain sequence occurs only or only by default over a morpheme boundary and is thus a prototypical morphonotactic sequence, it should be processed faster and more accurately than a purely phonotactic sequence. Studies on typical and atypical first language acquisition in English, Lithuanian and Polish have shown significant differences between the acquisition of morphonotactic and phonotactic consonant clusters: Morphonotactic clusters are acquired earlier and faster by typically developing children, but are more problematic for children with Specific Language Impairment. However, results on acquisition are less clear for German. The focus of this contribution is whether and how German-speaking adults differentiate between morphonotactic and phonotactic consonant clusters and vowel-consonant sequences in visual word recognition. It investigates whether sub-lexical letter sequences are found faster when the target sequence is separated from the word stem by a morphological boundary than when it is a part of a morphological root. An additional factor that is addressed concerns the position of the target cluster in the word. Due to the bathtub effect, sequences in peripheral positions in a word are more salient and thus facilitate processing more than word-internal positions. Moreover, for adults the primacy effect most favors word-initial position (whereas for young children the recency effect most favors word- final position). Our study discusses effects of phonotactic vs. morphonotactic cluster status and of position within the word.

Internationalization in German Academic Libraries: Moving beyond North American Perspectives

This paper explores how internationalization is understood and experienced in German academic libraries. Its main purpose is to move the discussion of internationalization in academic libraries beyond the boundaries of English-speaking North America by investigating a European perspective. Its secondary purpose is to investigate the role of English in German academic libraries. An online survey and a series of in-person interviews conducted in Germany in April 2015 provided the data for this study. What emerged are a series of stated differences and similarities between North America and Germany informed by the two overarching themes of implicit internationalization and plurilingualism, the ability to switch from one language to another as required.

Letter to P.I. Price asking him to make out a cheque in favour of German and Pettit for looking after certain petitions in Willoughby and Bertie Townships and in Welland

Letter to P.I. Price asking him to make out a cheque in favour of German and Pettit for looking after certain petitions in Willoughby and Bertie Townships and in Welland. This is signed by H.H. Collier, March 5, 1906.

Readings in european history ; a collection of extracts from the progress of culture in western Europe since the German invasions

UANL

The Rise and Decline of the East German Economy, 1949-1989.

Why do some organizations decline while other do not? to study this issue , we introduce technological change into a theory of agency proposed by Laffont and Tirole. We show that the optimal organizational form for production depends on the estent of scale ecoomies and on the cost of monitoring workers. When the discrepancy between ideal and actual forms becomes too great, an organization's viability is threatened. We test this structuralist hypothesis for East and west Gemany over the 1949-1989 period. east Germany's relative decline is explained by an institutional structure the proved incompatible with technological change favoring smaller, flatter organizations.

Polyglot reader, and guide for traslation: consisting of a series of english extracts, with their traslation into French, German, Spanish, and Italian : the severeal parts designed to serve as mu tual keys

UANL

Jus ecclesiasticum universum hodiernae disciplinae, praesertim Belgii, Galliae German, et vicinarum provinciarum accommodatum...

UANL