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ObjectivesOpposed to other spectral CT techniques, fat quantification in dual-layer detector CT (dlCT) has only recently been developed. The impact of concomitant iron overload and dlCT-specific protocol settings such as the dose right index (DRI), a measure of image noise and tube current, on dlCT fat quantification was unclear. Further, spectral information became newly available Material and methodsPhantoms with 0 and 8mg/cm3 iron; 0 and 5mg/cm3 iodine; 0, 10, 20, 35, 50, and 100% fat and liver equivalent, respectively, were scanned with a dlCT (CT7500, Philips, the Netherlands) at 100kV/20DRI, 120kV/20DRI, 140kV/20DRI, and at 120kV/16DRI, 120kV/24DRI. Material decomposition was done for fat, liver, and iodine (A1); for fat, liver, and iron (A2); and for fat, liver, and combined reference values of iodine and iron (A3). All scans were analyzed with reference values from 120kV/20DRI. For statistics, the intraclass correlation coefficient (ICC) and Bland-Altman analyses were used.ResultsIn phantoms with iron and iodine, results were best for A3 with a mean deviation to phantom fat of 1.3±2.6% (ICC 0.999 [95%-confidence interval 0.996-1]). The standard approach A1 yielded a deviation of -2.5±3.0% (0.998[0.994-0.999]), A2 of 6.1±4.8% (0.991[0.974-0.997]). With A3 and changing tube voltage, the maximal difference between quantified fat and the phantom ground truth occurred at 100kV with 4.6±2.1%. Differences between scans were largest between 100kV and 140kV (2.0%[-7.1-11.2]). The maximal difference of changing DRI occurred between 16 and 24 DRI with 0.4%[-2.2-3.0].ConclusionFor dlCT fat quantification in the presence of iron, material decomposition with combined reference values for iodine and iron delivers the most accurate results. Tube voltage-specific calibration of reference values is advisable while the impact of the DRI on dlCT fat quantification is neglectable.

Abstract Background This cardiovascular magnetic resonance (CMR) study investigates the impact of trabeculae and papillary muscles (TPM) on diastolic function parameters by differentiation of the time-volume curve. Differentiation causes additional problems, which is overcome by standardization. Methods Cine steady-state free-precession imaging at 1.5 T was performed in 40 healthy volunteers stratified for age (age range 7–78y). LV time-volume curves were assessed by software-assisted delineation of endocardial contours from short axis slices applying two different methods: (1) inclusion of TPM into the myocardium and (2) inclusion of TPM into the LV cavity blood volume. Diastolic function was assessed from the differentiated time-volume curves defining the early and atrial peaks, their filling rates, filling volumes, and further dedicated diastolic measures, respectively. Results Only inclusion of TPM into the myocardium allowed precise assessment of early and atrial peak filling rates (EPFR, APFR) with clear distinction of EPFR and APFR expressed by the minimum between the early and atrial peak (EAmin) (100% vs. 36% for EAmin

Abstract Background In addition to the threat of the COVID-19 pandemic to physical health, mental health is challenged by the emotional response to the situation and the official measures taken to stop the pandemic. This study aimed to assess the prevalence of impaired mental well-being due to COVID-19 and explore associated factors. Methods The study was an observational, population-based, nationwide, cross-sectional online survey of a representative sample of the general Swiss population performed between March and April 2020. Participants reported on mental well-being, self-isolation/quarantine, their risk for developing severe COVID-19, and their work situation. Multivariable logistic regression analyses assessed risk factors for impaired mental well-being due to the pandemic. Results Data from 1022 individuals were analysed. The median age was 44 years (range 18 to 78) and 49% were women. A third of respondents reported that the COVID-19 pandemic impaired their mental well-being and almost half reported specific mental health concerns. Impaired mental well-being was associated with having health problems (OR = 1.88, 95% CI: 1.29–2.74, vs no problems), being or living with someone at risk for severe COVID-19 (OR = 1.38, 95% CI: 1–1.9,), smoking (OR = 1.8, 95% CI: 1.24–2.61), living in urban residential environments (OR = 1.62, 95% CI: 1.13–2.32, vs rural), not being able to work due to closed workplace (OR = 1.66, 95% CI: 1.04–2.67), aged between 18 and 29 years old (OR = 1.99, 95% CI: 1.32–3.01, vs 45 to 59 years old), and living in a single household (living with someone, OR = 0.65, 95% CI: 0.44–0.97,vs single household). Overall, the most significant covariates of impaired mental well-being were specific mental health concerns: feeling depressed (OR = 7.21, 95% CI: 4.5–11.55), feeling less pleasure in doing things than before (OR = 6.28, 95% CI: 4.1–9.62), feeling anxious (OR = 6.13, 95% CI: 3.91–9.59) and feeling lonely (OR = 4.08, 95% CI: 2.53–6.58). Conclusion Impaired mental well-being can carry long-term consequences. We encourage policymakers to implement strategies to promote mental health during this pandemic situation. Special attention should be addressed to the youngest, those at risk for severe COVID-19 and those with government-imposed work restrictions.

Abstract Background The distribution of health care resources during a pandemic is challenging. The aim of the study was to describe the use of health care in a representative sample of the Swiss population during the SARS-CoV-2 pandemic in 2020, and to compare it to data from a survey conducted in 2018. Methods We conducted an observational, population-based, nationwide, repeated cross-sectional survey of the adult Swiss general population in 2018 and in March and April 2020 during the first wave of the SARS-CoV-2 pandemic. Recruitment and data acquisition was conducted by the Link Institute in Lucerne in representative samples of Swiss citizens in 2020 and in 2018. Variables of interest were estimates of health problems, health seeking behaviour, medication and health care use in the population. Results In total, we included data of 1980 individuals (in 2018 N = 958 and in 2020 N = 1022). Across both rounds of data collection the median age was 46 years (range = 18–79 years) and 50% were women. Per 1000 adults, half had at least one symptom and a quarter sought medical advice across both surveys. The most frequently consulted health providers in 2020 were general practitioners (GP) (180/1000), specialist physicians (41/1000), pharmacies (38/1000), the internet (26/1000) and accident and emergency units (25/1000). Compared to 2018, we noted a significant increase in the use of health providers during the pandemic, which was independent of demographic variables for the following health care providers: use of internet (OR = 9.8), pharmacy (OR = 2.64), accident and emergency units (OR = 2.54), and a significant decrease in the number of people who consulted specialist physicians (OR = 0.46). Overall, 76/1000 contacted their GP in relation to COVID-19. Conclusions Compared to 2018, GPs remained the most important source of medical advice for the population during the first wave of the COVID-19 pandemic in Switzerland. While the self-appraisal of health problems and of the need for medical advice remained constant, individuals seemed to change their provider choice during the pandemic, with an increased utilisation of accident and emergency units and pharmacies, which represent easily accessible and low-threshold medical services.

Abstract Introduction The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited. Objectives This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies’ structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care. Design and methods This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees’ working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses. Discussion The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.

AIMS The Centor criteria and the FeverPAIN score are recommended for guiding antibiotic prescription for tonsillitis, but they are not validated for this purpose. We aimed to identify risk factors for peritonsillar abscess in group A haemolytic streptococcus-negative tonsillitis and to test the performance of clinical scores and laboratory tests. METHODS In a retrospective case-control study at two regional hospitals from January 2015 to June 2018, we identified all cases of peritonsillar abscess and used propensity score matching utilising age and gender to select two controls per case from all patients who had a rapid group A haemolytic streptococcus antigen test in the emergency department. Exclusion criteria were age

IntroductionGeneral health check-up examinations in asymptomatic adults have not been shown to be beneficial. Instead, opportunistic prevention during regular primary care consultations is most cost-effective and recommended. The study aimed to elucidate the expectations about check-ups of the general Swiss population.MethodsA nationwide cross-sectional telephone survey was conducted in a representative sample of the population, stratified by sex, age, and language in November 2019.ResultsData of 1077 respondents were analysed. Mean age was 45 years (range 18 to 89), and 51% were female. Overall, 40% of respondents expected to have check-up examinations (yearly: 41.6%), and 42% expected opportunistic prevention. Most expected check-up interventions were sex-specific such as mammography (89% of women), Pap smear test (89% of women), and blood test of prostate-specific antigen (81% of men). The least favoured ones related to counselling (tobacco: 27%; alcohol abuse: 29%). Most significant predictors of positive check-up expectations were being male (OR = 1.45, CI: 1.02-2.05 P = 0.04)), age between 45 and 59 years old (OR = 2.03, CI: 1.27-3.23, P = 0.003 vs. 18 to 29 years), having a degree from professional (OR = 1.73, 95% CIs: 1.11-2.69, P 0.015) or, middle school (OR = 1.99, 95% CIs:1.04-3.78, P = 0.037) or university (OR = 1.66, 95% CIs: 1.06-2.61, P< 0.001, vs. secondary school) and the more importance attributed to regularly checking one's health (OR = 2.12, 95% CIs: 1.70-2.36, P < 0.001).ConclusionsAlmost half of the population expected to have mostly yearly check-up examinations in addition to regular care, which is in contradiction to recommendations. This behaviour impacts the rational use of health care resources and must be considered by physicians and given the active role of patients in the health care system.

INTRODUCTION The allocation and equal distribution of healthcare resources is one of the major challenges of today. Therefore, a framework to analyse the prevalence of illness in the community and the use of various sources of healthcare is crucial. The aim of the study was to evaluate the health-seeking behaviour of 1025 individuals in Switzerland in a 2-month period in 2018. METHODS Population-based, cross-sectional health survey with a multistage, stratified cluster design. The LINK Institute interviewed a representative sample of the adult Swiss population (age ≥18 years, stratified by language region: German-, French- and Italian-speaking, 70, 25 and 5%, respectively) by telephone. There were two interview rounds to account for potential seasonal variations, in May (n = 506) and November 2018 (n = 516). The health-seeking behaviour of these individuals during the previous 2 months was analysed. RESULTS In total, data of 1025 individuals were analysed: 51% females, median age 52 years (range 18−85). During the preceding 2 months, per 1000 adults, 546 had at least one symptom, 184 reported several symptoms, 243 sought medical advice, 164 first contacted their general practitioner, 81 directly contacted a specialist in a private practice, 16 were self-admitted to an accident and emergency department, 17 firstly contacted a pharmacy and 6 contacted an alternative medicine healthcare provider. In total, 21 persons were admitted to a hospital, of whom 8 underwent surgical procedures, 18 were at first transferred to a regular ward and 3 required intensive care unit services. Because of their current health problem, 387 individuals took medication and 259 bought their medication themselves. The vast majority (95%) of subjects was registered with a general practitioner. CONCLUSIONS This study represented an attempt to map the healthcare utilisation of the Swiss population. These results may be useful for further delineation of healthcare policies and medical education to meet the demand and needs of people in Switzerland. They indicate that general practitioners are the most important healthcare resource in Switzerland. Compared with specialists, they provide twice as much health advice at less costs. To optimise the health care system in Switzerland, we suggest to allocate resources where they are most needed.

The origin of unknown polymorphic phases within thin films is still not well understood. This work reports on crystals of the molecule terthiophene which were grown by thermal gradient crystallization using glass-plate substrates. The crystalline domains displayed a plate-like morphology with an extended lateral size of about 100 µm, but a thickness of only a few µm. Specular X-ray diffraction patterns confirmed the presence of a new polymorph of terthiophene. Crystal structure solution from a single crystal peeled from the film revealed a structure with an extremely large unit-cell volume containing 42 independent molecules. In contrast to the previously determined crystal structure of terthiophene, a herringbone packing motif was observed where the terminal ends of the molecules are arranged within one plane (i.e. the molecular packing conforms to the flat substrate surface). This type of molecular packing is obtained by 180° flipped molecules combined with partially random (disordered) occupation. A densely packed interface between terthiophene crystallites and the substrate surface is obtained, this confirms that the new packing motif has adapted to the flat substrate surface.

The scope of a series of N-alkylated iminosugar based inhibitors in the d-gluco as well as d-xylo configuration towards their interaction with human lysosomal β-glucocerebrosidase has been evaluated. A versatile synthetic toolbox has been developed for the synthesis of N-alkylated iminosugar scaffolds conjugated to a variety of terminal groups via a benzoic acid ester linker. The terminal groups such as nitrile, azide, alkyne, nonafluoro-tert-butyl and amino substituents enable follow-up chemistry as well as visualisation experiments. All compounds showed promising inhibitory properties as well as selectivities for β-glucosidases, some exhibiting activities in the low nanomolar range for β-glucocerebrosidase.

Based on the previous identification of metastable polymorphs in crystalline triphenylbismuth by nuclear quadrupole resonance spectroscopy (NQRS), the potential formation of similar phases was studied in Tris(2-Methoxyphenyl)Bismuthine. To this end, commercial samples with known NQRS properties were molten and re-crystallized at different speeds (shock freezing in different coolants versus slow cooling inside of a heater). In all recrystallization products we have identified a new crystal phase which has not been observed after synthesis from a solution. The new crystallographic structure has been confirmed by X-ray diffraction (XRD). The newly isolated polymorph crystallizes in the monoclinic space group P2(1)/c with only one molecule in the asymmetric unit and consequently only one 5/2-7/2 transition is observed at 88.75 MHz at 310 K. In contrast, the two transitions at 89.38 and 89.29 MHz for the well-known trigonal polymorph originate from two crystallographically distinct molecules of Tris(2-methoxy-Phenyl)Bismuthine in the asymmetric unit. Additional relaxometric NQRS shows distinctly different T2 relaxation times for the new polymorph when compared to the original samples. Additional phase transitions could not be observed during temperature sweeps between 153 K and 323 K.

The interaction between water protons and suitable quadrupolar nuclei (QN) can lead to quadrupole relaxation enhancement (QRE) of proton spins, provided the resonance condition between both spin transitions is fulfilled. This effect could be utilized as a frequency selective mechanism in novel, responsive T_{1} shortening contrast agents (CAs) for magnetic resonance imaging (MRI). In particular, the proposed contrast mechanism depends on the applied external flux density—a property that can be exploited by special field-cycling MRI scanners. For the design of efficient CA molecules, exhibiting narrow and pronounced peaks in the proton T_{1} relaxation dispersion, the nuclear quadrupole resonance (NQR) properties, as well as the spin dynamics of the system QN-^{1}H, have to be well understood and characterized for the compounds in question. In particular, the energy-level structure of the QN is a central determinant for the static flux densities at which the contrast enhancement appears. The energy levels depend both on the QN and the electronic environment, i.e., the chemical bonding structure in the CA molecule. In this work, the NQR properties of a family of promising organometallic compounds containing ^{209}Bi as QN have been characterized. Important factors like temperature, chemical structure, and chemical environment have been considered by NQR spectroscopy and ab initio quantum chemistry calculations. The investigated Bi-aryl compounds turned out to fulfill several crucial requirements: NQR transition frequency range applicable to clinical 1.5- and 3 T MRI systems, low temperature dependency, low toxicity, and tunability in frequency by chemical modification.

To identify calmodulin-binding proteins in cellular extracts and tissue homogenates and to analyze purified calmodulin target proteins, overlay procedures using 125I-calmodulin or, more recently, nonradioactive biotinylated calmodulin have been widely used. Here we describe a rapid, alternative method for detecting calmodulin-binding proteins with a 32P-labeled calmodulin probe generated as a glutathione-S-transferase (GST)-fusion protein. We used a modified pGEX-2TK vector, which contains the flag epitope and the consensus sequence RR- A-S, that can be phosphorylated by the cAMP-dependent protein kinase A. The fusion protein is easily purified from bacterial lysates by affinity chromatography using glutathione-Sepharose® 4B beads. Phosphorylation of GST-calmodulin is performed directly on the beads and, after elution with reduced glutathione, the labeled calmodulin probe can be used for overlay experiments. We also describe a rapid renaturation protocol that enhances the signal for some but not all calmodulin-binding proteins and is used after the proteins have been transferred to nitrocellulose filters. Furthermore, we have compared the specificity and sensitivity of the 32P-labeled GST-calmodulin overlay with those of 125I-calmodulin and biotinylated calmodulin, clearly indicating that our newly developed protocol is a suitable alternative to conventionally used calmodulin overlay procedures.

Antiviral treatment of hepatitis C virus in thalassemia has raised concerns of ribavirin-induced hemolysis and increased iron loading. This study examined the change in liver iron concentration, transfusion requirement, virological response, and iron-related toxicities after pegylated interferon α-2a/ribavirin treatment in patients with thalassemia. Median transfusions increased by 44%. However, only 29% (4/14) of patients showed an increase of liver iron concentration > 5mg/g dry wt. and overall liver iron remained stable. One of 4 patients with genotype 2 or 3 demonstrated sustained viral response, compared with 50% with genotype 1 (6/12). No patient developed cardiac, liver or endocrine toxicities, although neutropenia occurred in 52%. The molar efficacy of deferoxamine improved with reduction in liver inflammation on biopsy (p=0.001). In conclusion, antiviral treatment is safe if transfusion requirement, iron toxicities and neutropenia are monitored.