TRENDS IN HOSPITAL MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN SWITZERLAND, 1998 TO 2008 THE REGION MAKES THE DIFFERENCE: DISPARITIES IN MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION WITHIN SWITZERLAND

The aim of this master's thesis was to assess the ten- year trends and regional differences in management and outcome of acute myocardial infarction (AMI) within Switzerland. The thesis is composed of two articles. First, in the article "Trends in hospital management of acute myocardial infarction in Switzerland, 1998 to 2008" over 102,700 cases of AMI with corresponding management and revascularization procedures were assessed. The results showed a considerable increase in the numbers of hospital discharges for AMI, namely due to the increase of between- hospital transfers. Rates of intensive care unit admissions remained stable. All types of revascularization procedures showed an increase. In particular, overall stenting rates increased with drug-eluting stents partly replacing bare stents. Second, in the article "The region makes the difference: disparities in management of acute myocardial infarction within Switzerland" around 25,600 cases of AMI with corresponding management were assessed for the period of 2007-2008 and according to seven Swiss regions. As reported by our results, considerable regional differences in AMI management were stated within Switzerland. Although each region showed different trends regarding revascularization interventions, Leman and Ticino contrast significantly by presenting the minimum and maximum rates in almost all assessed parameters. As a consequence these two regions differ the most from the Swiss average. The impact of the changes in trends and the regional differences in AMI management on Swiss patient's outcome and economics remains to be assessed. Purpose: To assess ten-year trends in management and outcome of acute myocardial infarction (AMI) in Switzerland. Methods: Swiss hospital discharge database for the 1998 to 2008 period. AMI was defined as a primary discharge diagnosis code I21 according to the CIM-10 classification of the World Health Organization. Management and revascularization procedures were assessed. Results: Overall, 102,729 hospital discharges with a diagnosis of AMI were analyzed. The number of hospital discharges increased almost three-fold from 5530 in 1998 to 13,834 in 2008, namely due to a considerable increase in between-hospital transfers (1352 in 1998, 6494 in 2008). Relative to all hospital discharges, Intensive Care Unit admission rate was 38.0% in 1998 and remained stable (36.2%) in 2008 (p for trend=0.25). Percutaneous revascularization rates increased from 6.0% to 39.9% (p for trend<0.001). Non-drug-eluting stent use increased from 1.3% to 16.6% (p for trend<0.05). Drug eluting stents appeared in 2004 and increased to 23.5% of hospital discharges in 2008 (p for trend=0.07). Coronary artery bypass graft increased from 1.0% to 3.0% (p for trend<0.001). Circulatory assistance increased from 0.2% to 1.7% (p for trend<0.001). Thrombolysis showed no significant changes, from 0.5% to 1.9% (p for trend=0.64). Most of these trends were confirmed after multivariate adjustment. Conclusion: Between 1998 and 2008 the number of hospital discharges for AMI increased considerably in Switzerland, namely due to between-hospital transfers. Overall stenting rates increased, drug-eluting stents partly replacing bare stents. The impact of these changes on outcome and economics remains to be assessed.

Simultaneous identification of multiple mammalian species from mixed forensic samples based on mtDNA control region length polymorphism

Molecular species identification in mixed or contaminated biological material has always been problematic. We developed a simple and accurate method for mammal DNA identification in mixtures, based on interspecific mitochondrial DNA control region length polymorphism. Contrary to other published methods dealing with species mixtures, our protocol requires a single universal primer pair and amplification step, and is not based on a pre-defined panel of species. This protocol has been routinely employed by our laboratory for species identification in dozens of human and animal forensic caseworks. Six representative forensic caseworks involving the specific identification of mixed animal samples are reported in this paper, in order to demonstrate the applicability and usefulness of the method.

UVBY-Beta Photometry for 67 Stars in the Region of Alpha-Persei

UVBY-Beta photometric data are presented for 67 stars in the region of alpha-Persei and their relationship to the cluster is analyzed. These data allowed us to confirm at least 16 new members of the alpha-Persei open cluster.

A photometric analysis of the Cepheus OB3 region

Results are presented on Stromgren-Crawford uvby-beta photometry carried out at Calar Alto (Spain) for 45 stars in the Cepheus OB3 region covering an apparent area of 6 deg x 6 deg. The relationship of these stars with the association is examined. Three of these stars (BD +62 deg 2114, BD +62 deg 2152, and BD +62 deg 2156) are identified as members of this association, while two more (BD +64 deg 1714 and BD +64 deg 1717) are classified as possible members. It is noted that intrinsic colors and absolute magnitudes of member stars are consistent with the hypothesis of Blaauw (1964) and Garmany (1973) of the existence of two subgroups with different evolutionary phases.

Anomalous Proper-Motions in the Cygnus Super Bubble Region

In an analysis of proper motions of O and B stars contained the Input Catalogue for Hipparcos, we have found a clear deviation from the expected pattern of systematic motions which can be readily identified with the associations Cygnus OB1 and Cygnus OB9, located near de the edge of the Cygnus Superbubble. Teha anomalous motions are directed outwards from the center of the Superbubble, which is coincident with tha association Cygnus OB2. This seems to support the hypothesis of a strong stellar and supernova activity in Cygnus 0B2 giving rise to the Superbubble and, by means of gravitational instabilities in its boundaries, to Cygnus 0B1 and Cygnus OB9. New uvby-beta aperture photometry of selected O and B stars in the area of Cygnus OB1 and Cygnus OB9 is also presented and analyzed in this paper.

Analysis of IRAS stellar sources in Alpha Persei region

The present study is an analysis of IR sources in the Alpha Persei open cluster region from the IRAS Point Source Catalog and from ground-based photometric observations. Cross-identification between stars in the region and IRAS Point Source Catalog was performed and nine new associations were found. BVRI Johnson photometry for 24 of the matched objects have been carried out. Physical identity of visual and IRAS sources and relationship to the Alpha Persei open cluster are discussed.

Estudio del mecanismo focal de los terremotos a partir de ondas sísmicas. Aplicación a terremotos de las dorsales del Atlántico y Oriental del Pacífico

En este trabajo se presenta un estudio de los parámetros dinámicos de terremotos ocurridos bajo las dorsales del Atlántico y Oriental del Pacífico, así como de la variación regional del coeficiente de atenuación de las ondas Rayleigh para la región oriental del Pacífico. Se ha obtenido un coeficiente de atenuación anormalmente alto bajo la dorsal del Pacífico e importantes diferencias en las condiciones de similaridad para las dos dorsales. Comparando los parámetros dinámicos obtenidos para las dorsales (zonas de tensión) con parámetros obtenidos para zonas de subducción (zonas de compresión), resultan ser similares excepto para la caída de esfuerzos. Los resultados obtenidos se interpretan en función de la actividad tectónica de las dorsales.

Respiratory effects of an exposure to grain dust among grain workers in the Vaud region (Switzerland)

Introduction: Bioaerosols such as grain dust, via biologically active agents, elicit local inflammation and direct immunological reactions within the human respiratory system. Workplace-dependent exposure to grain dust (GD) may thus induce asthma, chronic bronchitis, and hypersensitivity pneumonitis. The aim of this study is to assess the clinical impact of occupational exposure to GD and to determine quantitative biological markers of bioaerosol exposure in grain workers. Methods: This longitudinal study has been conducted from summer 2012, to summer 2013, comprising 6 groups of 30 active workers with different GD exposure patterns (4 groups of grain workers, 2 control groups). After obtaining informed consent, two evaluations at high- and low-exposing seasons take place, during which an occupational history and a detailed medical history are questionnaire-assessed, lung function is evaluated by spirometry, airway inflammation is measured by exhaled nitric oxide (eNO), and specific blood IgG and IgE are titrated. The preliminary results presented hereafter are those of two of the four exposed groups, namely harvesters and mill workers, compared to the control groups, at first assessment (n=100). Results: Mean age is 38.4 [years]; 98% are male. Exposed groups differ from controls (p<0.05) in daily contact with animals (57% vs. 40%) and active smoking (39% vs. 11%). Grain workers have more respiratory (50%), nasal (57%), ocular (45%), dermatologic (36%) and systemic (20%) occupational symptoms than controls (6.4%, 19%, 16%, 6.4%, 1.6% respectively, p<0.05). Lower mean peak-expiratory-flow (PEF) values (96.1 ± 18.9 vs. 108.2 ± 17.4 [% of predicted], p<0.05) and eNO values (13.9 ± 9.6 vs. 20.5 ± 14.7 [ppm], p<0.05) are observed in the exposed groups. Conclusion: Preliminary results show a higher prevalence of clinical symptoms and a lower mean PEF value in the exposed groups. Detailed supplementary analyses are pending.

Glomerular hyperfiltration and increased proximal sodium reabsorption in subjects with type 2 diabetes or impaired fasting glucose in a population of the African region.

BACKGROUND. Glomerular hyperfiltration (GHF) is a well-recognized early renal alteration in diabetic patients. As the prevalence of GHF is largely unknown in populations in the African region with respect to normal fasting glucose (NFG), impaired fasting glucose (IFG) and type 2 diabetes [diabetes mellitus (DM)], we conducted a cross-sectional study in the Seychelles islands among families including at least one member with hypertension. METHODS. The glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and proximal tubular sodium reabsorption were measured using inulin, p-aminohippurate (PAH) and endogenous lithium clearance, respectively. Twenty-four-hour urine was collected on the preceding day. RESULTS. Of the 363 participants (mean age 44.7 years), 6.6% had IFG, 9.9% had DM and 63.3% had hypertension. The prevalence of GHF, defined as a GFR >140 ml/min, was 17.2%, 29.2% and 52.8% in NFG, IFG and DM, respectively (P trend <0.001). Compared to NFG, the adjusted odds ratio for GHF was 1.99 [95% confidence interval (CI) 0.73-5.44] for IFG and 5.88 (2.39-14.45) for DM. Lithium clearance and fractional excretion of lithium were lower in DM and IFG than NFG (P < 0.001). CONCLUSION. In this population of African descent, subjects with impaired fasting glucose or type 2 diabetes had a high prevalence of GHF and enhanced proximal sodium reabsorption. These findings provide further insight on the elevated incidence of nephropathy reported among African diabetic individuals.

Moesin interacts with the cytoplasmic region of intercellular adhesion molecule-3 and is redistributed to the uropod of T Lymphocytes during cell polarization

During activation, T lymphocytes become motile cells, switching from a spherical to a polarized shape. Chemokines and other chemotactic cytokines induce lymphocyte polarization with the formation of a uropod in the rear pole, where the adhesion receptors intercellular adhesion molecule-1 (ICAM-1), ICAM-3, and CD44 redistribute. We have investigated membrane-cytoskeleton interactions that play a key role in the redistribution of adhesion receptors to the uropod. Immunofluorescence analysis showed that the ERM proteins radixin and moesin localized to the uropod of human T lymphoblasts treated with the chemokine RANTES (regulated on activation, normal T cell expressed, and secreted), a polarization-inducing agent; radixin colocalized with arrays of myosin II at the neck of the uropods, whereas moesin decorated the most distal part of the uropod and colocalized with ICAM-1, ICAM-3, and CD44 molecules. Two other cytoskeletal proteins, ß-actin and ¿-tubulin, clustered at the cell leading edge and uropod, respectively, of polarized lymphocytes. Biochemical analysis showed that moesin coimmunoprecipitates with ICAM-3 in T lymphoblasts stimulated with either RANTES or the polarization- inducing anti-ICAM-3 HP2/19 mAb, as well as in the constitutively polarized T cell line HSB-2. In addition, moesin is associated with CD44, but not with ICAM-1, in polarized T lymphocytes. A correlation between the degree of moesin-ICAM-3 interaction and cell polarization was found as determined by immunofluorescence and immunoprecipitation analysis done in parallel. The moesin-ICAM-3 interaction was specifically mediated by the cytoplasmic domain of ICAM-3 as revealed by precipitation of moesin with a GST fusion protein containing the ICAM-3 cytoplasmic tail from metabolically labeled Jurkat T cell lysates. The interaction of moesin with ICAM-3 was greatly diminished when RANTES-stimulated T lymphoblasts were pretreated with the myosin-disrupting drug butanedione monoxime, which prevents lymphocyte polarization. Altogether, these data indicate that moesin interacts with ICAM-3 and CD44 adhesion molecules in uropods of polarized T cells; these data also suggest that these interactions participate in the formation of links between membrane receptors and the cytoskeleton, thereby regulating morphological changes during cell locomotion.

Report on a special investigation of the Region 4 Fusion Office in Atlantic, Iowa for the period March 1, 2006 through August 31, 2009

Report on a special investigation of the Region 4 Fusion Office in Atlantic, Iowa for the period March 1, 2006 through August 31, 2009

La mineralització kàrstica (Ba,Cu,Pb,Zn,Sb) de Rocabruna i de Can Pubill, Pirineo Oriental: geologia, morfologia i gènesi

La mineralització consisteix en el rebliment de cavitats mètriques de morfologia kàrstica, encaixades en dolomies Cambro-Ordovicianes. Les cavitats són plenes de baritina amb una aurèola centi a mil·limètrica de quars i sulfurs (tetraedrita-tennantita, calcopirita, galena, esfalerita). La mineralització és situada a prop i per sota d'una paleosuperficie sobre la qual es depositaren els red-beds, amb disseminacions de baritina, de fàcies garumniana (Cretaci superior-Paleocè). Les condicions de deposició son coherents amb una precipitació a partir de solucions, inicialment àcides, que omplien cavitats preexistents.

El depósito volcanogénico de Cu-Zn-Pb-Au El Cobre, Cuba Oriental: estructura y mineralogía

El depósito "El Cobre" encaja en series volcanosedimentarias del arco de islas Paleógeno de Cuba Oriental. Los tipos de mineralización presentes son estratiforme, estratoligada y filoniana. Los depósitos estratiformes (anhidrita, barita o criptomelana) se formaron por precipitación de fluidos hidrotermales en un fondo submarino. La mineralización filoniana constituye la zona de raíz de los depósitos estratiformes, presentando morfología de stockwork en sectores superficiales, pero hacia los sectores profundos disminuye la anchura de la zona mineralizada. En ella predominan pirita y calcopirita en asociación con cuarzo, excepto en algunos filones más superficiales en donde predomina esfalerita asociada a anhidrita. Las alteraciones asociadas son cloritización y silicificación en los sectoresmás profundos; en los más superficiales se dan sericitización y caolinitización. La mineralización estratoligada es contemporánea con la mineralización filoniana y se produce por reemplazamiento de diversos niveles favo r a bles de la serie: calizas en la parte inferior y el nivel exhalativo de sulfato en la parte superior (donde se producen las concentraciones de oro más elevadas del depósito). En base a los tipos de mineralización presentes y de acuerdo al carácter singenético de los depósitos con las rocas vulcanosedimentarias de la secuencia media del Grupo El Cobre, se propone un modelo de formación exhalativo vulcanogénico en un contexto geodinámico de arco de islas, similar al modelo Kuroko.

El placer lateral de playa Mejías (noreste de Cuba Oriental): un ejemplo de interacción de procesos aluviales y marinos en la concentración de minerales de elementos preciosos

El placer lateral de playa Mejías es el más importante de Cuba, y su composición mineral principal (magnetita, cromita, rutilo, ilmenita, ortopiroxeno) revela que la principal área fuente son las rocas ofiolíticas de la Faja de Mayarí-Baracoa. No obstante, hay aportes de diversa procedencia, como lo prueban la presencia de hasta 4 tipos de cristales de zircón, así como de minerales típicos de asociaciones listveníticas (calcosilicatos, carbonatos). Se reconocen además partículas de metales preciosos. Los granos de oro fueron afectados en las áreas fuente por procesos de alteración laterítica, que produjeron un lavado selectivo de oro en relación a la plata. Las partículas de minerales de oro se transportaron en medio fluvial como partículas finas de electrum de diversas composiciones y de amalgama, que se aglutinaron por coalescencia formando granos cada vez mayores. En los granos de electrum se produce,en el medio fluvial, una precipitación de oro en las juntas entre subgranos. Estas partículas se redepositaron en un placer lateral de p l aya, interaccionando con agua marina y produciéndose una disolución selectiva de Ag y Au del electrum o de Hg de la amalgama. Las partículas de minerales de elementos del grupo del platino (EGP) consisten en una primera generación de laurita rica en osmio, reemplazada por vetas de laurita muy pura, con crecimientos simplectíticos de otra generación de laurita (de composición intermedia entre las dos anteriores) e iridoarsenita. Estos reemplazamientos tuvieron lugar durante los procesos de serpentinización en las ofiolitas del área fuente. Durante los procesos de interacción con agua marina se produce una lixiviación selectiva de osmio en relación al restode los EGP.