Patients' understanding of blood tests and attitudes to HIV screening in the emergency department of a Swiss teaching hospital: a cross-sectional observational study.

BACKGROUND: In Switzerland, patients may undergo "blood tests" without being informed what these are screening for. Inadequate doctor-patient communication may result in patient misunderstanding. We examined what patients in the emergency department (ED) believed they had been screened for and explored their attitudes to routine (non-targeted) human immunodeficiency virus (HIV) screening. METHODS: Between 1st October 2012 and 28th February 2013, a questionnaire-based survey was conducted among patients aged 16-70 years old presenting to the ED of Lausanne University Hospital. Patients were asked: (1) if they believed they had been screened for HIV; (2) if they agreed in principle to routine HIV screening and (3) if they agreed to be HIV tested during their current ED visit. RESULTS: Of 466 eligible patients, 411 (88%) agreed to participate. Mean age was 46 ± 16 years; 192 patients (47%) were women; 366 (89%) were Swiss or European; 113 (27%) believed they had been screened for HIV, the proportion increasing with age (p ≤0.01), 297 (72%) agreed in principle with routine HIV testing in the ED, and 138 patients (34%) agreed to be HIV tested during their current ED visit. CONCLUSION: In this ED population, 27% believed incorrectly they had been screened for HIV. Over 70% agreed in principle with routine HIV testing and 34% agreed to be tested during their current visit. These results demonstrate willingness among patients concerning routine HIV testing in the ED and highlight a need for improved doctor-patient communication about what a blood test specifically screens for.

Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).

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.

Assessing the Precision of Compositional Data in a Stratified Double Stage Cluster Sample: Application to the Swiss Earnings Structure Survey

Precision of released figures is not only an important quality feature of official statistics, it is also essential for a good understanding of the data. In this paper we show a case study of how precision could be conveyed if the multivariate nature of data has to be taken into account. In the official release of the Swiss earnings structure survey, the total salary is broken down into several wage components. We follow Aitchison's approach for the analysis of compositional data, which is based on logratios of components. We first present diferent multivariate analyses of the compositional data whereby the wage components are broken down by economic activity classes. Then we propose a number of ways to assess precision

GeoNetwork: metadata and cataloging. French (GeoSource) and Swiss (geocat.ch) experiences

GeoNetwork opensource is a standards based, Free and Open Source catalog application to manage spatially referenced resources through the web. It is an OSGEO Project initiated by the Food and Agricultural Organization (FAO). The purpose of this presentation is to illustrate the implementation of such a catalog in national projects in France and in Switzerland. Firstly, we will present you the Geosource project undertaken by BRGM (http://www.brgm.fr/), gathering national and local authorities, national geographic survey, public organisations, associations in order to provide a metadata catalog for french users : definition of french iso profile, support for INSPIRE metadata requirements. Finally, we will present the SwissTopo geocat II project. The purpose of the project is to develop the next generation geospatial catalog for SwissTopo on the basis of GeoNetwork opensource. This both projects underline the closely collaboration between national authorities and the Geonetwork opensource community

Yasmin Levy's Ladino ballads and flamenco songs : background for students of Spanish. 'Yasmin Levy canta romances ladinos y canciones flamencas : orientación para los estudiantes de hispánicas'.

Resumen en español

Wordsworth and Coleridge : lyrical ballads.

El libro contiene algunos de los trabajos más conocidos de los poetas románticos ingleses William Wordsworth y Samuel Taylor Coleridge, dirigidos a estudiantes de literatura inglesa de nivel avanzado. Incluye un apartado con el contexto histórico de cada poema, notas explicativas de las alusiones literarias o históricas y los temas que aparecen en los textos, una sección con ideas relacionadas para debatir, ejercicios y preguntas de desarrollo para ayudar a los estudiantes a preparar los exámenes.

El "Swiss Challenge" y la contratación administrativa en el Ecuador

En el foro se ha discutido ampliamente respecto de la naturaleza jurídica del “Swiss Challenge”, que constituye una figura poco conocida y que muchas veces, incluyendo los organismos de control han considerado que se asimila a una contratación directa, incluso llegando a manifestarse que es una figura no prevista en el Derecho Público Ecuatoriano, y atentatoria de los principios de la contratación administrativa. Con este antecedente, amable lector, surge la necesidad de proceder al análisis del procedimiento “Swiss Challenge”, a fin de determinar si es un procedimiento que cumple con los principios de la contratación administrativa, si se encuentra previsto en la legislación ecuatoriana; así como, evidenciar el tratamiento que se ha dado de este procedimiento en los casos emblemáticos en que se ha desarrollado en el Ecuador. Por esta razón, abordaremos en el primer capítulo del presente trabajo de investigación, los conceptos fundamentales y las diferentes etapas del procedimiento “Swiss Challenge”; así como, su relación con los principios de la contratación administrativa; llegando al análisis del cumplimiento de cada uno; y, de manera especial, respecto de los principios de igualdad, oposición o libre concurrencia y transparencia. Avanzando en el análisis es importante verificar cual ha sido la aplicación que se ha dado en la administración pública ecuatoriana de este procedimiento, para lo cual, nos adentraremos en el análisis de los dos casos emblemáticos de “Swiss Challenge” en la república del Ecuador; esto es, revisaremos los concernientes a la concesión para la construcción, administración y mantenimiento del Nuevo Aeropuerto Internacional de Quito –NAIQ-; así como, el financiamiento y la construcción del proyecto hidroeléctrico Toachi- Pilatón. Asimismo, evidenciaremos si es que el desarrollo del procedimiento “Swiss Challenge” en estos dos proyectos, atendieron a los principios de la contratación administrativa, identificando las dificultades que se hubieren producido en los mismos; aspectos que, determinarán el cumplimiento formal y material de dichos axiomas y su correcta aplicación. Finalmente, realizaremos un análisis de las normas del ordenamiento jurídico ecuatoriano, con especial atención en el cambio de modelo en la gestión de los sectores estratégicos por parte de la Constitución del 2008; lo que nos permitirá desentrañar si el “Swiss Challenge” es un figura prevista en el Ordenamiento Jurídico Ecuatoriano.

Both tumour-promoting and non-promoting phorbol esters inhibit 125I-EGF binding and stimulate the phosphorylation of a 80kd protein kinase C substrate protein in intact Swiss 3T3 cells

Sapintoxin A (SAP A) and 12-deoxyphorbol 13-phenylacetate (DOPP), are two biologically active but non-turnour-promoting phorbol esters that potently bind to and activate the phorbol ester receptor, protein kinase C (PKC). SAP A and DOPP cause a dose-dependent increase in the phosphorylation of an 80 kd (80K) substrate protein for PKC in Swiss 3T3 cells. A similar dose—response effect was seen with sapintoxin D (SAP D), the stage 2 promoting analogue of 12-O-tetradecanoylphorbol-13-acetate and the complete promoter phorbol 12,13-dibutyrate (PDB). The doses resulting in a half maximal phosphorylation of this protein (Ka were 20 nM (SAP A), 45 nM (DOPP), 23 nM (SAP D) and 37 nM (PDB). Both non-promoting and phorbol esters induced a dose-dependent inhibition of [125I]epidermal growth factor (EGF) binding to its receptor in Swiss 3T3 cells. The doses required for 50% inhibition of binding (Ki) were: 8 nM (SAP A), 16 nM (DOPP), 14 nM (SAP D) and 17 nM (PDB). The results clearly demonstrate that induction of phosphorylation of the Pu 80K phosphoprotein and inhibition of [125I]EGF binding in Swiss 3T3 cells following exposure to phorbol esters is independent of the tumour-promoting activity of these compounds. The fact that SAP A, DOPP, SAP D and PDB are mitogenic for a variety of cell types and that exposure to these compounds leads to 80K phosphorylation and inhibition of [125I]EGF binding, suggests that these early biological events may play a role in the mitogenic response induced by these compounds.

Impact of US Brown Swiss genetics on milk quality from low-input herds in Switzerland: interactions with grazing intake and pasture type

This study investigated the effect of, and interactions between, contrasting crossbreed genetics (US Brown Swiss [BS] × Improved Braunvieh [BV] × Original Braunvieh [OB]) and feeding regimes (especially grazing intake and pasture type) on milk fatty acid (FA) profiles. Concentrations of total polyunsaturated FAs, total omega-3 FAs and trans palmitoleic, vaccenic, α-linolenic, eicosapentaenoic and docosapentaenoic acids were higher in cows with a low proportion of BS genetics. Highest concentrations of the nutritionally desirable FAs, trans palmitoleic, vaccenic and eicosapentaenoic acids were found for cows with a low proportion of BS genetics (0-24% and/or 25-49%) on high grazing intake (75-100% of dry matter intake) diets. Multivariate analysis indicated that the proportion of OB genetics is a positive driver for nutritionally desirable monounsaturated and polyunsaturated FAs while BS genetics proportion was positive driver for total and undesirable individual saturated FAs. Significant genetics × feeding regime interactions were also detected for a range of FAs.