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Degradation of forest roads in Canada has strong negative effects on access to forestlands, together with economic (e.g., increased maintenance costs), environmental (e.g., erosion of materials and subsequent habitat contamination), and social (e.g., use risks) impacts. Maintaining sustainable and safe access to forestland requires a better understanding and knowledge of forest road degradation over time and space. Our study aimed to identify relevant spatiotemporal variables regarding the state of eastern Canadian forest road networks by (1) building predictive models of gravel forest road degradation and assessing effects of the slope, time, loss of the road surface, and road width (field approach), and (2) evaluating the potential of topography, roughness and vegetation indices obtained from Airborne Laser Scanning (ALS) data and Sentinel-2 optical images to estimate degradation rates (remote sensing approach). The field approach (n = 207 sample plots) confirmed that only four variables were efficient to estimate degradation rates (pseudo-R2 = 0.43 with ±8% error). Simulations that were conducted showed that after about five years without maintenance, the rate of degradation on a road, regardless of its width, increased exponentially, exacerbated by a high slope gradient and loss of road surface. The narrowest roads tended to degrade more rapidly over time. The remote sensing approach performed quite well (pseudo-R2 = 0.34 with ±9% error) in terms of predicting road degradation, giving us the valuable tools to spatialise the state of gravel forest road degradation in eastern Canadian forest. This study provided new knowledge and tools that are critical for maintaining and sustaining access to Canada’s boreal forest territory in both the short- and the long-term.

Melt processing is one of the essential technologies for the mass production of polymer electrolyte membranes (PEM) at low cost. Azoles have been widely used in PEM to improve their conductivity at a relatively low humidity and recently as bifunctional additives in a melt blowing processing for PEM mass production. In this work, we attempted to assess the effect of 1, 2, 4-triazole additive in membranes and in catalyst layers on PEM fuel cell conditioning. Various characterization tools including electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV) and conditioning with constant current were applied to diagnose the temporary electrochemical reaction effect and the permanent performance loss caused by the triazole additives. It was found that triazole additives in membranes could migrate into the catalyst layers and significantly affect the open circuit voltage (OCV) and the conditioning. The effect could be partially or completely removed/cleaned either through longer conditioning time or via CV cycling, which depends on the amount of additives remaining in the membrane. The findings provide valuable scientific insights on the relevance of post treatment steps during membrane production and overcoming fuel cell contamination issues due to residual additive in the membranes and understanding the quality control needed for fuel cell membranes by melt blowing processing.

Field observations using chronosequences are helpful to study vegetation succession. This method allows to establish comparisons based on soil composition, stand structure, micro- and macrofossil remains from sites of different ages but on similar edaphic and topographic conditions. In the boreal forest, post-fire succession through time is triggered by climate, disturbance history (insect epidemics, fire and logging), latitude and altitude. The main objective of this research is to identify the main patterns of early post-fire succession, including similarities and differences in vegetation composition and attributes, of three contrasted ecosystems distributed along an altitudinal gradient. To do so, we have monitored the successional development of the alpine, subalpine and boreal lichen-woodland sites during the first 21 years (1991 to 2011) of post-fire sequence in eastern Canada 1991 to 2011. Each site was characterized by a different functional group that became established following fire. A rapid resurgence of ericaceous shrubs and lichens was observed in the lichen woodland and subalpine sites. Bryophyte and lichen species were not an important component of vegetation communities during the earlier stages of post-fire succession. For all three sites monitored, lichens were the last functional group to establish in the chronosequences. Herbs and mosses characterized the post-fire succession in alpine areas, the latter functional group established late in the chronosequence to cover >25% of the site after 15 years. Post-fire chronosequences in the three contrasted environments indicate that plant succession is a repetitive process often involving similar resilient plant assemblages.

Abstract Drug type and dosing recommendation have been designed and optimized based on average response in the general population. Yet, there is significant inter‐individual variability in drug response, which results in treatment inefficacy or adverse drug reactions in a subset of patients. This is partly due to genetic factors that typically affect drug metabolism or clearance. To verify the relevance and applicability of international pharmacogenetic guidelines in the Swiss population, we genotyped 1533 patients from a hospital‐based biobank who received at least 30 different drugs, as documented in their electronic health record. We then assessed the prevalence of clinically actionable variants in 13 high‐risk pharmacogenes. We compared the allele frequencies obtained in the hospital‐based cohort with those of a Swiss population‐based cohort of 4791 individuals. The prevalence of clinically actionable variants was comparable between the two cohorts, with most study participants (97.3%) carrying at least one actionable pharmacogenetic variant. We then assessed the frequency of high‐risk prescriptions due to actionable gene–drug interactions and observed that 31% of patients in the hospital‐based cohort were prescribed at least one drug for which they carried a high‐risk variant, and for which international guidelines recommend a change of drug or dosage. Our analysis confirms the high prevalence of actionable pharmacogenetic variants in the Swiss population. It also shows that a substantial minority of patients are exposed to drugs for which they carry potentially problematic variants. Implementing a genetically informed approach to drug prescribing could have a positive impact on the quality of healthcare delivery.

AIMS OF THE STUDY: Limited knowledge exists regarding exposures to non-therapeutic chemicals by women planning to conceive, or during pregnancy or breastfeeding. The Swiss Teratogen Information Service (STIS) provides information to healthcare professionals about medications and other exposures during pregnancy or breastfeeding. This study aimed to describe the queries on non-therapeutic chemicals addressed to the STIS over the past two decades. METHODS: Using data from the STIS for the years 2000 to 2019, we conducted a descriptive analysis of all queries related to women’s exposures to non-therapeutic chemicals during pregnancy planning, pregnancy or breastfeeding. RESULTS: Over two decades, the STIS database recorded 320 exposures to chemicals. Workplace settings accounted for over 60% of queries, followed by exposures at home (20%). In almost half (48%) of the queries, more than one chemical was mentioned, totalling 885 chemicals across these 320 queries. Commonly mentioned chemicals included isopropanol, acetone and lead. Solvents were the leading category of products (16%), followed by cleaning products (10%), paints (8%) and insecticides (5%). The follow-up data showed five diverse cases of congenital malformations, accounting for 4.0% (5 out of 125) of the sample, a figure in line with the background risk of malformations in the general population. CONCLUSIONS: This study emphasises the importance of conducting research that comprehensively captures the highly heterogeneous exposures to non-therapeutic chemicals during pregnancy and suggests that attention should be given not only to professional settings, but also to domestic contexts.

Understanding seed characteristics, germination, and seedling establishment patterns is essential for formulating effective management strategies to control invasive species. Glossy buckthorn (Frangula alnus) is a shrub or small tree from Eurasia that has become invasive in North America, and which has negative impacts on plant communities and ecosystems. In this study, we analyzed the germination response of glossy buckthorn seeds to different temperatures (12, 14, 16, 18, 20, 24, and 28 °C), various stratification lengths (4 to 20 weeks), and scarification conditions to measure the impact on breaking seed dormancy, and the effect of light in triggering germination. Analysis using distinct time-to-event approaches, including the Kaplan–Meier estimator and Cox proportional hazard model, was employed to interpret germination data. Glossy buckthorn seeds exhibited physiological dormancy and required cold stratification to germinate. At 12 °C, only 14% of the seeds could germinate. At warmer temperatures, germination rates increased, reaching a peak of 70% at 20 °C. At 24 °C and 28 °C, germination declined, and seeds were probably induced into secondary dormancy. Scarified seeds had a higher probability of germination than non-scarified ones, even at the lowest temperatures. Darkness had a negative impact on germination at all tested temperatures. This study significantly advances our understanding of how temperature, light, stratification, and scarification impact glossy buckthorn seeds, elucidating the species’ seasonal germination patterns in North America. The results emphasize that glossy buckthorn utilizes seed banks as a primary strategy for invading and establishing in new habitats. The ungerminated seeds form persistent seed banks, ensuring F. alnus’ survival and bolstering its chances of successful establishment and invasion. As climate change drives temperature increases, it may affect seeds in the soil, altering stratification periods and consequently shifting the timing of germination.

Abstract Objective This study aimed to assess the performance improvement for machine learning-based hospital length of stay (LOS) predictions when clinical signs written in text are accounted for and compared to the traditional approach of solely considering structured information such as age, gender and major ICD diagnosis. Methods This study was an observational retrospective cohort study and analyzed patient stays admitted between 1 January to 24 September 2019. For each stay, a patient was admitted through the Emergency Department (ED) and stayed for more than two days in the subsequent service. LOS was predicted using two random forest models. The first included unstructured text extracted from electronic health records (EHRs). A word-embedding algorithm based on UMLS terminology with exact matching restricted to patient-centric affirmation sentences was used to assess the EHR data. The second model was primarily based on structured data in the form of diagnoses coded from the International Classification of Disease 10th Edition (ICD-10) and triage codes (CCMU/GEMSA classifications). Variables common to both models were: age, gender, zip/postal code, LOS in the ED, recent visit flag, assigned patient ward after the ED stay and short-term ED activity. Models were trained on 80% of data and performance was evaluated by accuracy on the remaining 20% test data. Results The model using unstructured data had a 75.0% accuracy compared to 74.1% for the model containing structured data. The two models produced a similar prediction in 86.6% of cases. In a secondary analysis restricted to intensive care patients, the accuracy of both models was also similar (76.3% vs 75.0%). Conclusions LOS prediction using unstructured data had similar accuracy to using structured data and can be considered of use to accurately model LOS.

AIM OF THE STUDY: Patients surviving COVID-19 have been described as being at risk of developing sequelae. We aimed to investigate and elicit persistent symptoms, emotional status and quality-of-life in patients discharged after an acute COVID-19 episode. METHODS: Patient-reported outcome measures were collected during a telephone interview 30 days and 1 year after discharge. Patients' general health status was evaluated using questions based on their symptoms, emotional status was assessed using the items 9 to 12 of the HeartQoL questionnaire and quality of life was assessed at 1 year through the EQ-5D-5L. In patients with a history of cardiovascular disease, all 14 items of the HeartQoL questionnaire were completed to derive the HeartQoL global score. RESULTS: Among 687 patients who survived after being hospitalised for COVID-19 at the University Hospitals of Geneva between 26 February and 26 April 2020, 184 (27%) and 165 (24%), respectively, participated in the follow-up at 30 days and 1 year. Of these 184 participants, 62% were male, median age was 58 years and 21% had a past medical history of cardiovascular disease. At one month after discharge, 61% (113/184) of patients presented fatigue and 28% (52/184) dyspnoea. One year after discharge, the main complaints were persistent fatigue in 27% (45/165) of patients, neurological problems in 17% (28/165) and dyspnoea in 14% (23/165). Eight percent (14/184) of patients declared being significantly worried 1 month after discharge and 5% (9/184) feeling depressed. The number of patients reporting being significantly worried or depressed at 1 year was lower. Regarding the quality of life at 1 year, the median EQ-5D-5L visual analogue scale score was 80 (interquartile range 70–90). CONCLUSIONS: Approximately half of patients reported some symptoms 1 year after discharge following an acute episode of COVID-19. The predominant symptom was persistent fatigue both at 1-month and at 1-year follow-up. Emotional status and quality of life appeared satisfactory. ClinicalTrials.gov number: NCT04384029

Background & Aims: Patients hospitalised because of mental illness often have risk factors for contracting HCV. Scaling-up HCV screening for all psychiatric inpatients as a case-detection strategy for viral elimination is underexplored. This study aimed to evaluate the cost-effectiveness of scaling-up HCV screening and treatment for psychiatry hospital admissions in Switzerland vs. the current standard-of-care risk-based approach, where only those with a history of substance misuse disorder are offered testing. Methods: HCV prevalence by history of substance misuse disorder was analysed in medical records from inpatient admissions to a Swiss psychiatry department. Cost-effectiveness was analysed from a healthcare provider perspective through a decision-tree screening model, using these HCV prevalence data. Model and parameter uncertainty were assessed using deterministic and probabilistic sensitivity analyses. Results: Prevalence of HCV in psychiatry inpatients with a history of substance misuse disorder (n = 1,013) was 25.7%, compared with 3.5% among the remaining inpatients (n = 3,535). Scaling up HCV screening and treatment for all psychiatry admissions was cost-effective vs. the risk-based approach, with an incremental cost-effectiveness ratio of US$9,188 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio remained cost-effective considering a HCV prevalence as low as 0.07%. The population-level net monetary benefit of the generalised screening approach was US$435,156,348, with 917 additional patients per year detected and treated at a cost of US$3,294 per person (vs. US$2,122 under risk-based screening). Conclusions: Scaling up HCV screening and treatment at diagnosis with all-oral, interferon-free regimens as a generalised approach for psychiatric admissions was cost-effective and could support reaching World Health Organization targets for HCV elimination by 2030. Lay summary: Patients hospitalised because of mental illness often have risk factors for HCV. We found that testing all psychiatry patients in hospital for HCV was cost-effective compared with testing only patients who have a history of substance misuse. Scaling up HCV testing and treatment could help to wipe out HCV.

Objective History of cardiovascular diseases (CVDs) may influence the prognosis of patients hospitalised for COVID-19. We investigated whether patients with previous CVD have increased risk of death and major adverse cardiovascular event (MACE) when hospitalised for COVID-19.Methods We included 839 patients with COVID-19 hospitalised at the University Hospitals of Geneva. Demographic characteristics, medical history, laboratory values, ECG at admission and medications at admission were collected based on electronic medical records. The primary outcome was a composite of in-hospital mortality or MACE.Results Median age was 67 years, 453 (54%) were males and 277 (33%) had history of CVD. In total, 152 (18%) died and 687 (82%) were discharged, including 72 (9%) who survived a MACE. Patients with previous CVD were more at risk of composite outcomes 141/277 (51%) compared with those without CVD 83/562 (15%) (OR=6.0 (95% CI 4.3 to 8.4), p

Climate change is likely to affect the growth, development and regeneration of the black spruce stands across the boreal forest. Regeneration failures cause gaps in the dense black spruce-feathermoss (SM) mosaic increasing the landscape proportion of open lichen woodland (LW). The aims of the study are to determine whether the contrasting characteristics of SM and LW induce different maximum carboxylation rate (Vcmax), maximum electron transport rate (Jmax) and light-saturated maximum photosynthesis (Amax) in black spruce trees across a latitudinal or seasonal gradient. Results show that the Vcmax and Jmax were higher in SM than in LW in western Quebec, at the ecotone of the closed-crown and open forest. Vcmax and Jmax were different between SM and LW mainly because nutrient acquisition seems different between stand types. Latitude affects values of Vcmax and Jmax, but the effect could be explained by soil and vegetation composition between experimental plots rather than by latitude. Physiological capacities do not match Amax values for stand types and latitude. Indeed, Amax rates suggest that black spruce in LWs perform as well as those in SMs at the needle scale because Amax would be limited by CO2 concentration which prevents saturation of Rubisco. Despite the lack of difference between the Amax of SM and LW stands, future increases in CO2 concentration and temperature could induce a gap between their respective photosynthesis rates because of their different physiological capacities.

Abstract Background Incarcerated people carry a high burden of infection, including blood-borne diseases (BBDs). It is also known that one million people contract a sexually transmitted infection (STI) every day worldwide, which represents a global public health challenge. However, data regarding the prevalence of STIs and the risk factors among incarcerated populations are lacking. The objective of this study was to determine the prevalence and associated factors of BBDs and STIs among detainees in the largest pre-trial prison in Switzerland. Methods In a cross-sectional study conducted at the Champ-Dollon pre-trial prison, 273 male detainees answered a standardized questionnaire and were screened for syphilis, herpes simplex virus 2 (HSV-2), HIV, and hepatitis C (HCV). Prevalence rates and associations of BBDs and STIs with risk factors were computed. Results Most participants (90.9%) were migrants from outside Western Europe, and 5.9% were injecting drug users. HCV was diagnosed among 6.2% of participants (antibody prevalence). The prevalence of HCV was higher among injecting drug users (81.2%) than non-injectors (1.6%). The prevalence of HIV, syphilis, and HSV-2 was 0.4%, 1.1%, and 22.4%, respectively. HCV was associated with a history of injecting drug use and HSV-2 with a lower education level and being older than 26 years. Conclusions This study showed the infection prevalence of 2–9 times higher among detainees than in the Swiss community. It also illustrated that these infections are associated with sociodemographic and risk factors. Therefore, the prison environment offers an opportunity to strengthen infectious disease control programs targeting specific subgroups of at-risk people. Such programs would benefit both the prison population and broader society.

Optimization of the ionomer materials in catalyst layers (CLs) which sometimes is overlooked has been equally crucial as selection of the membranes in membrane electrode assembly (MEA) for achieving a superior performance in proton exchange membrane fuel cells (PEMFCs). Four combinations of the MEAs composed of short-side-chain (SSC) and long-side-chain (LSC) perfluorosulfonic acid (PFSA) polymers as membrane and ionomer materials have been prepared and tested under various temperatures and humidity conditions, aiming to investigate the effects of different side chain polymer in membranes and CLs on fuel cell performance. It is discovered that SSC PFSA polymer used as membrane and ionomer in CL yields better fuel cell performance than LSC PFSA polymer, especially at high temperature and low RH conditions. The MEA with the SSC PFSA employed both as a membrane and as an ionomer in cathode CL demonstrates the best cell performance amongst the investigated MEAs. Furthermore, various electrochemical diagnoses have been applied to fundamentally understand the contributions of the different resistances to the overall cell performance. It is illustrated that the charge transfer resistance (Rct) made the greatest contribution to the overall cell resistance and then membrane resistance (Rm), implying that the use of the advanced ionomer in CL could lead to more noticeable improvement in cell performance than only the substitution as the membrane.

Current optimization strategies are based on the increase the productivity and the quality with lower cost in short time. Grey relational analysis “GRA” based on Taguchi design was proposed in this paper for simultaneous improvement of surface quality and productivity. The turning trials based on mixed Taguchi L18 factorial plan were conducted under dry cutting conditions for the machining couple: AISI D3 steel/mixed ceramic inserts (CC650). The machining parameters taken into account during this study are as follow: major cutting edge angle (χr), cutting insert nose radius (r), cutting speed (Vc), feed rate (f), and depth of cut (ap). Significant effects of machining parameters and their interactions were evaluated by the analysis of variance. Through this analysis, it have been found clearly that feed rate and cutting insert nose radius had a big significant effects on surface quality while depth of cut, feed rate followed by cutting speed had a major effect on productivity. The mathematical relationship between the machining parameters and the performance characteristics was formulated by using a linear regression model with interactions. Optimal levels of parametric combination for achieving the higher surface quality with maximum productivity were selected by grey relational analysis which is based on the high value of grey relational grade. Confirmation experiments were carried out to prove the powerful improvement of experimental results and to validate the effectiveness of the multi-optimization technique applied in this paper.

Inconel 718 is among difficult to machine materials because of its abrasiveness and high strength even at high temperature. This alloy is mainly used in aircraft and aerospace industries. Therefore, it is very important to reveal and evaluate cutting tools behavior during machining of this kind of alloy. The experimental study presented in this research work has been carried out in order to elucidate surface roughness and productivity mathematical models during turning of Inconel 718 superalloy (35 HRC) with SiC Whisker ceramic tool at various cutting parameters (depth of cut, feed rate, cutting speed and radius nose). A small central composite design (SCCD) including 16 basics runs replicated three times (48 runs), was adopted and graphically evaluated using Fraction of design space (FDS) graph, completed by a statistical analysis of variance (ANOVA). Mathematical models for surface roughness and productivity were developed and normality was improved using the Box-Cox transformation. Results show that surface roughness criterion Ra was mainly influenced by cutting speed, radius nose and feed rate, and that the depth of cut had major effect on productivity. Finally, ranges of optimized cutting conditions were proposed for serial industrial production. Industrial benefit was illustrated in terms of high surface quality accompanied with high productivity. Indeed, results show that the use of optimal cutting condition had an industrial benefit to 46.9 % as an improvement in surface quality Ra and 160.54 % in productivity MRR.

The aim of this study is to evaluate the impact of factors such as cutting speed, feed rate, and depth of cut on surface roughness and Material Removed Rate (MRR) when machining in dry face milling AISI 1040 steel with coated carbide inserts GC1030 using the response surface methodology (RSM). For this purpose, a number of machining experiments based on statistical three-factor and three-level factorial experiment designs, completed (L27) with a statistical analysis of variance (ANOVA), were performed in order to develop mathematical models and to identify the significant factors of these technological parameters. Multi-objective optimization procedure for minimizing Ra, Ry and Rz and maximizing MRR using desirability approach has been also implementented. The current study was also carried out to investigate the tool life of the inserts. The models found the relationship between the cutting parameters (Vc, fz and ap) and the studied technological parameters. It has been found that the cutting speed was the most affecting surface roughness which is due to the geometry of the insert which has a scraping edge and enables to obtain low roughness even at important feed rate, followed by the feed rate and the depth of cut at the end. The optimal combination of cutting parameters were cutting speed of 314 m/min, feed rate of 0.16 mm/tooth and depth of cut of 0.6 mm with a composite desirability of 0.924.

Nickel based super alloys are excellent for several applications and mainly in structural components submitted to high temperatures owing to their high strength to weight ratio, good corrosion resistance and metallurgical stability such as in cases of jet engine and gas turbine components. The current work presents the experimental investigations of the cutting parameters effects (cutting speed, depth of cut and feed rate) on the surface roughness, cutting force components, productivity and power consumption during dry conditions in straight turning using coated carbide tool. The mathematical models for output parameters have been developed using Box-Behnken design with 15 runs and Box-Cox transformation was used for improving normality. The results of the analysis have shown that the surface finish was statistically sensitive to the feed rate and cutting speed with the contribution of 43.58% and 23.85% respectively, while depth of cut had the greatest effect on the evolution of cutting force components with the contribution of 79.87% for feed force, 66.92% for radial force and 66.26% for tangential force. Multi-objective optimization procedure allowed minimizing roughness Ra, cutting forces and power consumption and maximizing material removal rate using desirability approach.

Glossy buckthorn (Frangula alnus Mill.) is an alien species in Canada that is invading many forested areas. Glossy buckthorn has impacts on the biodiversity and productivity of invaded forests. Currently, we do not know much about the species’ ecology and no thorough study of its distribution in temperate forests has been performed yet. As is often the case with invasive plant species, the phenology of glossy buckthorn differs from that of other indigenous plant species found in invaded communities. In the forests of eastern Canada, the main phenological difference is a delay in the shedding of glossy buckthorn leaves, which occurs later in the fall than for other indigenous tree species found in that region. Therefore, our objective was to use that phenological characteristic to map the spatial distribution of glossy buckthorn over a portion of southern Québec, Canada, using remote sensing-based approaches. We achieved this by applying a linear temporal unmixing model to a time series of the normalized difference vegetation index (NDVI) derived from Landsat 8 Operational Land Imager (OLI) images to create a map of the probability of the occurrence of glossy buckthorn for the study area. The map resulting from the temporal unmixing model shows an agreement of 69% with field estimates of glossy buckthorn occurrence measured in 121 plots distributed over the study area. Glossy buckthorn mapping accuracy was limited by evergreen species and by the spectral and spatial resolution of the Landsat 8 OLI.

In Swiss prisons, more than 70% of detained people are foreigners and over one-third originate from sub-Saharan Africa or Latin America. These two regions are endemic for various tropical diseases and viral infections, which persist after migration to nonendemic countries. Parasitic infections (schistosomiasis; strongyloidiasis) and cooccurrent viral infections (HIV, hepatitis B (HBV), and hepatitis C (HCV)) are especially of concern for clinical care but have been neglected in empirical research. These diseases often remain silent for years before causing complications, especially if they occur concomitantly. Our research aimed to study the prevalence rates and coinfections of two neglected tropical diseases, namely, Strongyloides stercoralis and Schistosoma sp. and viral infections among sub-Saharan Africans (SSA) and Latin Americans (LA) in Switzerland’s largest pretrial prison. We carried out a cross-sectional prevalence study using a standardized questionnaire and serological testing. Among the 201 participants, 85.6% were SSA and 14.4% LA. We found the following prevalence ratios: 3.5% of HIV (4.1% in SSA, 0% in LA), 12.4% of chronic HBV (14.5% in SSA, 0% in LA), 2.0% of viraemic HCV (1.7% in SSA, 3.4% in LA), and 8.0% of strongyloidiasis (8.1% in SSA, 6.9% in LA). The serological prevalence of schistosomiasis among SSA was 20.3% (not endemic in Latin America). Two infections were simultaneously detected in SSA: 4.7% were coinfected with schistosomiasis and chronic HBV. Four other coinfections were detected among SSA: schistosomiasis-HIV, HIV-chronic HBV, HIV-HCV, and schistosomiasis-strongyloidiasis. To conclude, the high prevalence rates of persistent viral and parasitic infections and their potential coinfections among SSA and LA detained migrants highlight the need to implement control strategies and programs that reach people in detention centers in nonendemic countries.

Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported.We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire.Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care.Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

OBJECTIVE:We aimed to determine the association between the stepwise increase in the sustained viral response (SVR) and Swiss and United States (US) market prices of drug regimens for treatment-naive, genotype 1 chronic hepatitis C virus (HCV) infection in the last 25 years. We identified the following five steps in the development of HCV treatment regimens: 1) interferon (IFN)-α monotherapy in the early '90s, 2) IFN-α in combination with ribavirin (RBV), 3) pegylated (peg) IFN-α in combination with RBV, 4) the first direct acting antivirals (DAAs) (telaprevir and boceprevir) in combination with pegIFN-α and RBV, and 5) newer DAA-based regimens, such as sofosbuvir (which is or is not combined with ledipasvir) and fixed-dose combination of ritonavir-boosted paritaprevir and ombitasvir in combination with dasabuvir. DESIGN:We performed a linear regression and mean cost analysis to test for an association between SVRs and HCV regimen prices. We conducted a sensitivity analysis using US prices at the time of US drug licensing. We selected randomized clinical trials of drugs approved for use in Switzerland from 1997 to July 2015 including treatment-naïve patients with HCV genotype 1 infection. RESULTS:We identified a statistically significant positive relationship between the proportion of patients achieving SVRs and the costs of HCV regimens in Switzerland (with a bivariate ordinary least square regression yielding an R2 measure of 0.96) and the US (R2 = 0.95). The incremental cost per additional percentage of SVR was 597.14 USD in Switzerland and 1,063.81 USD in the US. CONCLUSION:The pricing of drugs for HCV regimens follows a value-based model, which has a stable ratio of costs per achieved SVR over 25 years. Health care systems are struggling with the high resource use of these new agents despite their obvious long-term advantages for the overall health of the population. Therefore, the pharmaceutical industry, health care payers and other stakeholders are challenged with finding new drug pricing schemes to treat the entire population infected with HCV.

BACKGROUND: Drug manufacturers have developed "evergreening" strategies to compete with generic medication after patent termination. These include marketing of slightly modified follow-on drugs. We aimed to estimate the financial impact of these drugs on overall healthcare costs and also to examine the impact of listing these drugs in hospital restrictive drug formularies (RDFs) on the healthcare system as a whole ("spillover effect"). METHODS AND FINDINGS: We used hospital and community pharmacy invoice office data in the Swiss canton of Geneva to calculate utilisation of eight follow-on drugs in defined daily doses between 2000 and 2008. "Extra costs" were calculated for three different scenarios assuming replacement with the corresponding generic equivalent for prescriptions of (1) all brand (i.e., initially patented) drugs, (2) all follow-on drugs, or (3) brand and follow-on drugs. To examine the financial spillover effect we calculated a monthly follow-on drug market share in defined daily doses for medications prescribed by hospital physicians but dispensed in community pharmacies, in comparison to drugs prescribed by non-hospital physicians in the community. Estimated "extra costs" over the study period were €15.9 (95% CI 15.5; 16.2) million for scenario 1, €14.4 (95% CI 14.1; 14.7) million for scenario 2, and €30.3 (95% CI 29.8; 30.8) million for scenario 3. The impact of strictly switching all patients using proton-pump inhibitors to esomeprazole at admission resulted in a spillover "extra cost" of €330,300 (95% CI 276,100; 383,800), whereas strictly switching to generic cetirizine resulted in savings of €7,700 (95% CI 4,100; 11,100). Overall we estimated that the RDF resulted in "extra costs" of €503,600 (95% CI 444,500; 563,100). CONCLUSIONS: Evergreening strategies have been successful in maintaining market share in Geneva, offsetting competition by generics and cost containment policies. Hospitals may be contributing to increased overall healthcare costs by listing follow-on drugs in their RDF. Therefore, healthcare providers and policy makers should be aware of the impact of evergreening strategies.

Based on research carried out in a variety of contexts (UPE2A / DASPA; European / bi-national sections / CLIL; AEFE network; internationalized universities), this article looks at how conceptions of the public and of languages feed into the ways of thinking about these institutional arrangements, and into the practices and representations of teachers and learners. More concretely, it examines the ways in which linguistic and cultural plurality is recognized, notably through the teaching content used, and the attention paid (or not paid) to linguistic repertoires and epistemic, scholastic and educational traditions. From a cross-cutting and historical perspective, the aim is to find keys to understanding the constitution of the various networks involved (DASPA-UPE2A, bilingual sections, AEFE, internationalized universities) and the socio-political issues at stake against a backdrop of globalization. The article takes a fresh look at the usual conceptions that assign students to distinct roles according to the underlying representations of the plurilingualism.

Magnetic Resonance Sounding (MRS) measurements are acquired at 16 stations in the Strengbach headwater catchment (Vosges Mountains – France). These data, rendering the vertical distribution of water contents in the subsurface, are used to show their potential in conditioning a hydrological model of the catchment, as described in the article “Magnetic resonance sounding measurements as posterior information to condition hydrological model parameters: Application to a hard-rock headwater catchment” – Journal of Hydrology (2020). Acquisition protocols follow a free induction decay scheme. Data are filtered by applying a band-pass filter at the Larmor frequency. A filter removing the 50 Hz noise is also applied with the exception of data at a Larmor frequency close to the 50 Hz harmonic. The signal envelopes are then fitted by a decaying exponential function over time to estimate the median characteristic relaxation time of each MRS sounding.

The investigation of permeable hydrothermally altered and fractured zones and their distribution is a key issue for the understanding of fluid circulation in granitic rocks, on which the success of geothermal projects relies. Based on the use of short-wave infrared (SWIR) spectroscopy applied to rock cuttings coupled with interpretation of geophysical logs, we propose an investigation of the clay signature of fault and fracture zones (FZ) inside the granitic basement. This methodology was applied to two geothermal wells: GRT-2 from the Rittershoffen and GPK-1 from the Soultz-sous-Forêts (Soultz) geothermal sites, both located in the Upper Rhine Graben (URG). A total of 1430 SWIR spectra were acquired and analysed. Variations in the 2200 nm absorption band area are correlated with hydrothermal alteration grades. The 2200 nm absorption band area is found to reflect the illite quantity and its variations in the granitic basement. Low, stable values are observed in the unaltered granite facies, showing good reproducibility of the method, whereas scattered high values are associated with high hydrothermal alteration and FZs. Variations in the 2200 nm absorption band area were correlated with the gamma ray and electrical resistivity logs. This procedure allowed us to confirm that illite mainly controls the resistivity response except inside the permeable FZs, where the resistivity response is controlled by the geothermal brine. Thus, the architecture of these permeable FZs was described precisely by using a combination of the 2200 nm absorption band area data and the electrical resistivity log. Moreover, by correlation with other geophysical logs (temperature (T), porosity, and density), paleo-permeable and currently permeable FZs inside the reservoir were distinguished. The correlation of SWIR spectroscopy with electrical resistivity logs appears to be a robust tool for geothermal exploration in granitic reservoirs in the URG.

Research activity associated with various observations at the Strengbach catchment in the Vosges Massif (880–1150 m) addresses many questions in the domains of hydrology and geochemistry. The catchment is the observation and experimental site of the Observatoire Hydro-Géochimique de l’Environnement appointed by the Centre National de la Recherche Scientifique. It also belongs to the research facilities that form the French Network of Critical Zone Observatories (OZCAR), which supports a network of critical zone observatories. The catchment is small (0.8 km) with steep slopes (20–30%) on granitic bedrock that mainly allow for forestry (spruce and beech stands) as the main land cover. Meteorological, hydrological, and geochemical data have been monitored since 1986. The first studies conducted were dedicated to the elucidation of acid rain effects on forest ecosystems and particularly on forest decline. Multidisciplinary research studies conducted on the Strengbach catchment enable exploration of the following issues: (i) hydrological functioning at the scale of a small catchment and questions regarding the evolution and preservation of the water resources in mountainous environments (stock, recharge, infiltration, and water pathways), (ii) exchange processes observed at the soil–plant–atmosphere continuum and in particular weathering processes and the evolution of soil mineral fertility (Ca, Mg, K, P), (iii) processes responsible for the export of water and for associated fluxes (dissolved chemicals, suspended materials, bed loads) and their dynamic at the outlet, and (iv) responses of the ecosystems to environmental disturbances (acid rain, forest management, and climate change) and their current and future modeling.