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BackgroundThe mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health (“Réseau santé et migration” RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the “community health phase”. This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors.MethodsWe detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model.ResultsWe identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20–24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge.ConclusionsAsylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.

A Pseudomonas aeruginosa (isolate 416) from a patient with pneumonia, was initially susceptible to imipenem (MIC: 2 mg/l) but became resistant to this antibiotic (isolate 470, MIC: 32 mg/l) during imipenem therapy. Treatment failed. No parallel increases in MIC were observed for other antimicrobials tested. Isolates 416 and 470 shared the same pyocin type and serotype, produced small amounts of an inducible β-lactamase, and had similar lipopolysaccharide compositions. On electrophoresis of outer membrane proteins, the porin F, identified by the monoclonal antibody MA4-4, was expressed similarly by the two isolates but the production of one band (apparent molecular weight 47,000) was diminished in isolate 470. [14C]-Imipenem labelling of intact cells proceeded more slowly in 470 than in 416, especially when bacterial cells were treated by antibody MA4-4 to block the porin F channel. [14C]-Imipenem labelling of penicillin binding proteins (PBP) showed that the band identified as PBP-4 bound markedly less radioactivity in isolate 470 than in 416. After isolate 470 was passaged several times in antibiotic-free broth, the imipenem MIC was decreased from 32 to 8 mg/l, and the [14C]-imipenem PBP pattern recovered the initial profile as exhibited by isolate 416. Two resistance mechanisms, affecting imipenem electively, could have combined their effect in the post-therapy isolate, altered target protein and reduced permeability

Little is known about how many bacteria are present at an infectious focus at the onset of antibiotic therapy. The number of cfu was determined in pus and infected peritoneal fluids obtained from 41 patients. Pathogens were detected in 71% of specimens. There were high concentrations of bacteria in culture-positive samples, in both soft-tissue and peritoneal infections, averaging 2 x 10(8) cfu/mL. These concentrations were much higher than the standard inoculum size used in in-vitro susceptibility tests, 5 x 10(5) cfu/mL. The impact of this discrepancy on antibacterial efficacy was studied with amikacin, ciprofloxacin, imipenem and piperacillin against Escherichia coli and Staphylococcus aureus. The inhibitory and bactericidal activities of amikacin and ciprofloxacin determined with high inocula were two to four times lower than with standard inocula, whereas the activity of piperacillin was diminished at least 128-fold. Similar activity was observed with these drugs in Mueller-Hinton broth and peritoneal fluid. The bactericidal activity of imipenem was reduced in peritoneal fluid. Thus, conditions prevailing at the infection site may compromise antibiotic activity determined in vitro

Einleitung: In Deutschland werden Kinder mit akuter Appendizitis sowohl durch Allgemeinchirurgen (ACH) und Kinderchirurgen (KCH) in offen chirurgischer als auch laparoskopischer Technik operiert. Als Ursache für chirurgische Komplikationen werden verschiedene Faktoren diskutiert. Ziel dieser Studie[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Deux logiciels de dictée en langue allemande ont été étudiés dans une division de médecine interne. L'acuité de reconnaissance a pu être améliorée de 92–94% par des optimalisations successives durant un mois, de 97% pour des lettres courtes standardisées et des textes qui se répètent. Le temps de production pour les médecins pour les lettres de sortie complètes est resté inchangé par opposition aux lettres courtes. Cependant, toutes les lettres étaient plus rapidement disponibles. Les expériences de cet essai-pilote ont permis de documenter des difficultés d'ordre pratique qui limitent à l'heure actuelle l'utilisation à grande échelle de cette technologie à l'hôpital. Les conditions principales sont, en plus d'un logiciel adéquat, un choix judicieux des domaines d'application, un environnement calme et un utilisateur motivé.

Steffen M. Zeisbergera,b, Max Durstelerc, Rainer Warthd, Peter Schramle, Daniel Simeon-Dubachd, Simon P. Hoerstrupa,b, Jurg Blaserf a Zentrum Regenerative Medizin (ZRM), UniversitatsSpital Zurich (USZ) und Universitat Zurich (UZH), b Forschung Chirurgie, Herzchirurgie, Univer sitatsSpital Zurich (USZ) c Direktion ICT, UniversitatsSpital Zurich (USZ) d biobank-suisse (BBS), Bern e Institut Klinische Pathologie, UniversitatsSpital Zurich (USZ) f Forschungszentrum Medizininformatik Direktion F&L, UniversitatsSpital Zurich (USZ)

Objective, To study tissue inhibitor of metalloproteinase 1 (TIMP-1) in relation to collagenolytic and gelatinolytic potential, namely dinitrophenyl-Pro-Gln-Gly-Ile-Ala-Gly-Gln-D-Arg (DNP-S) sensitive proteolytic activity, in loose total hip arthroplasty (THA) endoprostheses. Methods. Tissue localization of TIMP-1 was investigated immunohistochemically. TIMP-1 level of the periprosthetic tissues and fluid samples from 9 loose THA endoprostheses was measured by competitive ELISA, and DNP-S sensitive collagenolytic and gelatinolytic potential was evaluated by the degradation of synthetic DNP-S and reverse phase high performance liquid chromatography. Results. Immunohistochemical analysis revealed moderate to marked immunoreactivity of TIMP-1 in pseudosynovial lining cells, and weak to moderate immunoreactivity often in monocyte/macrophages, endothelial cells, and fibroblasts in both interface tissues between bone and implant and pseudocapsular tissues around the artificial joints. TIMP-1 level was low in interface tissue samples (795 +/- 203 ng/ml) compared to pseudosynovial fluid samples (2026 +/- 584 ng/ml). Degradation rate of the substrate was higher in interface tissue samples (56 +/- 6%) than in pseudocapsular tissue samples (32 +/- 4%) and pseudosynovial fluid samples (6 +/- 2%). Conclusion. Low TIMP-1 level combined with high percentage of degradation of synthetic substrate DNP-S leads to high collagenolytic and gelatinolytic activity in interface tissue samples. This may in part explain the weakening of periprosthetic connective tissue. Weakening Combined with cyclic mechanical loading may lead to loosening of THA endoprostheses.

Objective: Impaired trophoblast invasion plays a major role in the development of preeclampsia. Therefore various factors that are involved in invasion were investigated in gestational disease. Methods: In pregnant women with HELLP-syndrome (n = 18), pre-/eclampsia (n = 21) and highly pathological Doppler flow measurements (hpD) (n = 13), plasma and placental tissue extract concentrations of uPA, uPA-receptor, tPA, PAI-1, MMP-8, MMP-9, TIMP-1, thrombomodulin, and angiogenin were measured using ELISA. Results: In all three collectives, PAI-1 plasma concentrations were significantly higher (p < 0,05) than in normal pregnancies, in patients with HELLP-syndrome, tPA and TIMP-1 plasma levels were also elevated. MMP-9 concentrations in placental tissue extracts were lower in pre-/eclampsia than in normal pregnancies. Conclusions: Impaired placental implantation and remodelling in gestational disease is reflected by changes in plasma and placental tissue extract concentrations of various factors that are involved in these processes.

Ilus. 15 tab. Bib. p. 58-63. Sum. (En, Es) El objetivo del presente trabajo fue la obtención de conocimientos iniciales sobre la composición, estructura y dinámica de los robledales de altura. En Costa Rica esta comunidad se extiende aproximadamente desde los 1800 hasta los 3200 msnm, principalmente en la cordillera de Talamanca. El sitio de estudio está ubicado en la parte noroccidental de dicha cordillera. El rodal estudiado tiene una superficie total de 12,35 ha, que fue subdividido en 247 parcelas de 500 m2, en las cuales se caracterizó los diferentes tipos de suelo presentes; muestreo de la vegetación de bambú (Chusques); inventario de todos los árboles, arbustos y helechos arbóreos, con un diámetro mínimo de 5 cm; levantamiento estructural, por compartimentos para la vegetación total a partir de 50 cm de altura; levantamiento de todos los árboles muertos con diámetro mayor o igual a 50 cm. Mediante el análisis de los suelos se logró reconocer dos unidades edáficas principales: Dystradept y Placandept; mientras que el examen de la ocurrencia del bambú arrojó estrecha relación entre el tipo de bambú y dichas unidades. Se definieron dos tipos de bosque: bosque mixto de encino (BME) y bosque de roble blanco (BRB). El número de especies con un diámetro mínimo de 5 cm totaliza 35 en el BME y 37 en el BRB. Con diámetro mínimo de 25 cm y 40 cm, el número en ambos tipos de bosque llega a 16 y 12, respectivamente. En ambos bosques se recomienda una corta de refinamiento como medida silvicultural preparatoria, la cual comprende árboles con copas mal desarrolladas y/o fustes de mala calidad, Los rodales así mejorados serán considerados como rodales de partida.

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The positron spectrum of Cu61 has been examined recently by Cook and Langer with a large magnetic spectrometer. The experimental curves of these authors show a deviation from the Fermi distribution which is much larger than for Cu64 and it seems possible that not all of this deviation arises from the instrumental factors. It is pointed out by different authors that Cu61 does not emit nuclear gamma-rays which means that the spectrum of Cu61 must be simple. On the other hand the measurements of Cook and Langer can hardly be understood without the assumption of a complex spectrum. To examine this discrepancy, we started a search for gamma-radiation in Cu61.

Human polymorphonuclear-leucocyte collagenase (M(r) 64,000) shows autoproteolytic degradation to two major fragments of M(r) 40,000 and M(r) 27,000. N-terminal sequence data and investigation of the substrate specificity of the fragments demonstrate that the M(r)-40,000 fragment corresponds to the catalytic domain, whereas the M(r0-27,000 fragment shows no enzymic activity. The activity profile of the M(r)-40,000 fragment is comparable with the specificity of the intact active collagenase (M(r) 64,000), but the ability to cleave collagen was lost. The enzymic activity of this fragment can be inhibited by either tissue inhibitor of metalloproteinase (TIMP)-1 or recombinant TIMP-2 in a 1:1 molar ratio. The C-terminal part of the enzyme (M(r) 27,000), important for the binding reaction with collagen substrates, is involved in collagenolysis.

SummaryAdvanced electronic alerts (eAlerts) and computerised physician order entry (CPOE) increase adequate thromboprophylaxis orders among hospitalised medical patients. It remains unclear whether eAlerts maintain their efficacy over time, after withdrawal of continuing medical education (CME) on eAlerts and on thromboprophylaxis indications from the study staff. We analysed 5,317 hospital cases from the University Hospital Zurich during 2006–2009: 1,854 cases from a medical ward with eAlerts (intervention group) and 3,463 cases from a surgical ward without eAlerts (control group). In the intervention group, an eAlert with hospital-specific venous thromboembolism (VTE) prevention guidelines was issued in the electronic patient chart 6 hours after admission if no pharmacological or mechanical thromboprophylaxis had been ordered. Data were analysed for three phases: pre-implementation (phase 1), eAlert implementation with CME (phase 2), and post-implementation without CME (phase 3). The rates of thromboprophylaxis in the intervention group were 43.4% in phase 1 and 66.7% in phase 2 (p

Bacterial inocula were exposed as suspended cultures or as adherent biofilms on glass beads in a novel in vitro model of infection to oscillating drug concentrations mimicking human serum kinetics during clinical treatment. Amikacin was given once or thrice daily alone or in combination with ceftazidime or flucloxacillin against Pseudomonas aeruginosa or Staphylococcus epidermidis. Killing of adherent bacteria was significantly reduced during single-drug treatment compared with suspended bacteria (P less than .001), and beta-lactams were more active than amikacin against both suspended and adherent bacteria (P less than .01). Amikacin-beta-lactam combinations killed the inocula more rapidly and were consistently bactericidal against both suspended and adherent pathogens (P less than .05). Once-daily dosing of amikacin produced greater initial killing than thrice daily dosing (P less than .05), but both regimens were similarly effective after 48 h. The differences in antibiotic activity against suspended and adherent bacteria may relate to clinical failures in the treatment of foreign-body infections by bacteria sensitive to the administered antibiotics, as determined by standard susceptibility tests.

The effect of dosing regimen on nephrotoxicity, high frequency ototoxicity, efficacy and serum kinetics was studied in a prospective, randomised clinical study. Therapy was started with total daily doses of 6 mg/kg given once (od) or thrice (tid) daily to 56 and 57 patients, respectively. Subsequent doses were adjusted according to serum levels. No major differences in toxicity or efficacy were noticed between od and tid regimens: clinical failures occurred in two and two patients, four and five patients suffered from a decrease of > or = 20 dB at least unilaterally at one frequency between 8 and 18 kHz, six and seven patients had a > 25 mumol/L or > 25% increase in serum creatinine, respectively. Serum creatinine or creatinine clearance did not change significantly during either therapy. Major differences between the two study groups were limited to pharmacokinetic parameters. Od dosing resulted in higher peak (mean of 21.6 vs 7.2 mg/L) and lower trough levels (0.5 vs 1.4 mg/L). Half-lives of netilmicin determined between 1 and 8 h increased significantly during therapy with tid (from a mean of 2.75 to a mean of 3.33 h, P < 0.01) but not significantly with od (rise from 2.8 to 3.03 h). Much longer half-lives were determined between 8 and 24 h in the od group (mean of 5.7 h, P < 0.01). In conclusion, only minimal differences in toxicity and efficacy were observed. Their clinical relevance appears to be minimal.

The bactericidal efficacy of amikacin, isepamicin and netilmicin was studied against Pseudomonas aeruginosa and Serratia marcescens over a treatment period of 30 h using two one-compartment in-vitro models with differently designed culture compartments. High bacterial inocula were exposed to fluctuating drug concentrations, simulating human serum concentrations (t1/2 = 2 h) during clinical treatment. The same daily dose was administered as 1 h infusions given every 8 h or every 24 h, resulting in peak concentrations of 8 and 24 mg/l for netilmicin, and 24 and 72 mg/l for amikacin and isepamicin, respectively. Once-daily dosing was more bactericidal during initial treatment in the in-vitro models (P less than 0.01) and at least as effective as thrice-daily dosing in preventing bacterial regrowth, despite a prolonged period of subinhibitory drug concentration before administration of the second dose. Lower ratios of peak concentration to MIC were needed to achieve bactericidal activity (greater than 99.9% reduction of cfu) after 24 h treatment against S. marcescens compared with P. aeruginosa (P less than 0.01). All nine regimens providing peaks of at least four times the MIC were bactericidal against S. marcescens after 24 h exposure. In contrast, a bactericidal effect against P. aeruginosa occurred only during two of six experiments with peaks of four to nine times the MIC. Similar results were obtained in both in-vitro models of infection. These data suggest insufficient intrinsic activity of the aminoglycosides studied for single drug treatment of P. aeruginosa in the absence of host-defence mechanisms.