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

The stinky cheese man and other fairly stupid tales.

Hace mucho tiempo la gente estaba acostumbrada a que le contarán mágicas historias sobre maravillas y encantamientos, pero de ellas no trata este libro. Más bien, casi podían ser cuentos de hadas, pero tampoco. Las historias que aquí se cuentan son más bien cuentos estúpidos.

Moon cheese.

Cumple las necesidades de la Estrategia Nacional de Lectura, Programa Nacional de Estudios en Inglaterra y Gales, Idioma Inglés en Escocia para cinco a catorce años, y el plan de estudios común en Irlanda del Norte. Diseñado para alumnos de primaria, combina las habilidades básicas relacionadas con el aprendizaje de la lectura y la escritura con una amplia gama de estilos literarios. Esta historia introduce vocabulario básico en el contexto de una historia de ficción. Joh y Buzz van a menudo a la tienda de antigüedades después del colegio. Un día encuentran lo que creen es una quesera, pero la abuela les cuenta una historia sobre el origen de aquello que es en realidad un sombrero muy especial.

A cheese and tomato spider.

Presenta las páginas divididas por la mitad en horizontal, con lo que las múltiples ilustraciones de animales, objetos y personas, se pueden combinar para dar origen a objetos y personas absurdos e inverosímiles.

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.

Selenium supplementation of lactating dairy cows: effects on milk production and total selenium content and speciation in blood, milk and cheese

Forty-multiparous Holstein cows were used in a 16-wk continuous design study to determine the effects of either selenium (Se) source, selenized yeast (SY) (derived from a specific strain of Saccharomyces cerevisiae CNCM I-3060 Sel-Plex®) or sodium selenite (SS), or inclusion rate of SY on Se concentration and speciation in blood, milk and cheese. Cows received ad libitum a TMR with 1:1 forage:concentrate ratio on a dry matter (DM) basis. There were four diets (T1-T4) which differed only in either source or dose of Se additive. Estimated total dietary Se for T1 (no supplement), T2 (SS), T3 (SY) and T4 (SY) was 0.16, 0.30, 0.30 and 0.45 mg/kg DM, respectively. Blood and milk samples were taken at 28 day intervals and at each time point there were positive linear effects of SY on Se concentration in blood and milk. At day 112 blood and milk Se values for T1-T4 were 177, 208, 248, 279 ± 6.6 and 24, 38, 57, 72 ± 3.7 ng/g fresh material, respectively and indicate improved uptake and incorporation of Se from SY. While selenocysteine (SeCys) was the main selenised amino acid in blood its concentration was not markedly affected by treatment, but the proportion of total Se as selenomethionine (SeMet) increased with increasing inclusion rate of SY. In milk, there were no marked treatment effects on SeCys content, but Se source had a marked effect on the proportion of total Se as SeMet. At day 112 replacing SS (T2) with SY (T3) increased the SeMet concentration of milk from 36 to 111 ng Se/g and its concentration increased further to 157 ng Se/g as the inclusion rate of SY increased further (T4) to provide 0.45 mg Se/kg TMR. Neither Se source nor inclusion rate effected the keeping quality of milk. At day 112, milk from T1, T2, and T3 was made into a hard cheese and Se source had a marked effect on total Se and the proportion of total Se comprised as either SeMet or SeCys. Replacing SS (T2) with SY (T3) increased total Se, SeMet and SeCys content from 180 to 340 ng Se/g, 57 to 153 ng Se/g and 52 to 92 ng Se/g, respectively. Key words: dairy cow, milk and cheese, selenomethionine, selenocysteine, milk keeping quality

Cutting, by 'pressing and slicing,' of thin floppy slices of materials illustrated by experiments on cheddar cheese and salami

Why it is easier to cut with even the sharpest knife when 'pressing down and sliding' than when merely 'pressing down alone' is explained. A variety of cases of cutting where the blade and workpiece have different relative motions is analysed and it is shown that the greater the 'slice/push ratio' xi given by ( blade speed parallel to the cutting edge/blade speed perpendicular to the cutting edge), the lower the cutting forces. However, friction limits the reductions attainable at the highest.. The analysis is applied to the geometry of a wheel cutting device (delicatessan slicer) and experiments with a cheddar cheese and a salami using such an instrumented device confirm the general predictions. (C) 2004 Kluwer Academic Publishers.

Effects of fat on the properties of halloumi cheese

Halloumi cheese was produced from 11 bovine milks with fat contents of 1.61-4.04%, giving a range of 32-53% fat in dry matter (FDM) in the cheeses. Starter culture and/or microparticulated whey protein (Simplesse((R)) 100(E)) was also added to selected batches of milk. Hardness decreased with increasing FDM, with increase in moisture and with lower pH. On sensory evaluation, there was an increase in preference score with FDM (R-2 = 0.8). Inclusion of microparticulated whey protein may have had a fat mimetic effect, as preference scores otherwise decreased with increasing protein levels (R-2 = 0.75).