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Abstract Brucellosis, a zoonotic disease impacting public health and economies, is prevalent in several countries, particularly low- and middle-income regions. This study centers on Armenia, where the Veterinary Department of the Food Safety Inspection Body employs a test-and-slaughter strategy to control the disease. A dynamic deterministic compartmental model was constructed using seropositive reported data from humans and livestock (cattle and sheep) from 2019 to 2021. The model simulates the effects of enhanced test-and-slaughter strategies from 2022 to 2031 on brucellosis transmission among sheep, cattle, and humans. The results suggest that an increase in testing and slaughter rates leads to a decrease in infected populations among both humans and livestock. Approximately 65% of the human brucellosis cases are a result of sheep-to-human transmissions. This reduction in infected populations is expected to subsequently lower the overall transmission rates in livestock and humans. However, even with the highest coverage levels (75% for sheep and 90% for cattle), infections in humans and livestock are projected to persist. The study highlights the need for a One Health approach that integrates mathematical modeling with public health intervention strategies. While the upgraded test-and-slaughter strategy could prove effective, an economic analysis of the predicted cumulative incidence in humans and livestock prevalence could guide decision making processes. Compensation for culled animals is a critical factor. The success of the intervention relies on collaboration between veterinary and public health sectors, community engagement, and awareness campaigns. One Health impact statement This study applied a mathematical model to investigate brucellosis transmission within the livestock population and from animals to humans. It assessed the impact of different test-and-slaughter coverage levels from 2022 to 2031 on disease burden and livestock populations. Although the research did not encompass the entire One Health spectrum, it shed light on the potential benefits of integrating human and animal health interventions. Local institutions (such as the Food Safety and Inspectorate Body and the National Centre for Disease Control in Armenia) and international collaboration among scientists contributed to a better understanding and controlling zoonotic diseases. The findings offer valuable insights for decision making, aiding Armenian policy makers in effectively managing brucellosis and enhancing public health, food safety, and monetary savings. Furthermore, the research provides a basis for further exploration in this field.

ABSTRACT The aim of the present study was to carry out a hydrological simulation of the Formoso River basin using WEAP and to model scenarios based on the rotating rules of the water pump in regions of conflict for the use of water. During July 2020, the influence of such rules on the remaining flow in these regions was assessed considering a collective grant context in which minimum environmental flows, determined from the seasonal Q90 (flexible) and monthly Q95 (conservative), should be preserved downstream from the critical sections. The results showed that the remaining flow exceeded the limit of the flexible environmental flow in 61% of the days in the middle stretch of the Formoso River and at the mouth of the Urubu River. In the lower section and mouth of the Formoso River, these values were above the conservative limit in 93% and 100% of the days, respectively. It was concluded that the application of the rules, coupled with the collective grant, could produce satisfactory results for water availability in the basin.

Background and purpose: Dynamic trajectory radiotherapy (DTRT) has been shown to improve healthy tissue sparing compared to volumetric arc therapy (VMAT). This study aimed to assess and compare the robustness of DTRT and VMAT treatment-plans for head and neck (H&N) cancer to patient-setup (PS) and machine-positioning uncertainties. Materials and methods: The robustness of DTRT and VMAT plans previously created for 46 H&N cases, prescribed 50–70 Gy to 95 % of the planning-target-volume, was assessed. For this purpose, dose distributions were recalculated using Monte Carlo, including uncertainties in PS (translation and rotation) and machine-positioning (gantry-, table-, collimator-rotation and multi-leaf collimator (MLC)). Plan robustness was evaluated by the uncertainties’ impact on normal tissue complication probabilities (NTCP) for xerostomia and dysphagia and on dose-volume endpoints. Differences between DTRT and VMAT plan robustness were compared using Wilcoxon matched-pair signed-rank test (α = 5 %). Results: Average NTCP for moderate-to-severe xerostomia and grade ≥ II dysphagia was lower for DTRT than VMAT in the nominal scenario (0.5 %, p = 0.01; 2.1 %, p

Background The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. Participants and procedure This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. Results Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. Conclusions Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students’ loneliness and well-being.

Abstract Background Musculoskeletal pain, especially back pain, is common among health care professionals (HP). For prevention purposes, it is important to know whether HP develop their symptoms before or after entering the health care workforce. Cross-sectional studies among HP cannot answer this question. This follow-up study measures the prevalence and individual course of musculoskeletal pain among full-time HP students at the end of their studies and one year after entering the health care workforce. Method Self-reported one-year prevalence for low back pain, neck/shoulder pain, pain in arms/hands, and pain in legs/feet was collected at two timepoints from 1046 participating HP using an online questionnaire. Participants were asked whether their musculoskeletal pain was related to study or work conditions. Generalized estimating equation (GEE) models of the binomial family with log link were used to estimate adjusted prevalence and corresponding normal based 95% confidence intervals were derived using the bootstrap method with 1000 replications. Results The prevalence of low back pain as well as neck and shoulder pain was very high at baseline and follow-up in all full-time students and later HP. Prevalence for pain in arms/hands, legs/feet was low and there were significant differences between the professions. HP clearly associated their low back pain and neck/shoulder pain with study and work conditions; HP strongly associated pain in arms/hands, legs/feet only with work conditions. Conclusion Many HP suffer from back/neck/shoulder pain already as students before starting their professional career. The prevention of back/neck/shoulder pain must be part of the education of all health professions at universities. As an example of best practice, universities should incorporate ergonomic measures and exercises into the daily routine of training health professionals. The effects of physically demanding professional tasks on the upper and lower extremities need to be investigated in further studies to take preventive measures.

ABSTRACTObjectives The aim of this study is to investigate the effect of treatment choice on survival, transfusion needs and hospitalizations in patients > 64 years old with newly diagnosed acute myeloid leukaemia (AML).Material and methods This study retrospectively analysed patients over 64 years with AML diagnosed at a regional healthcare network in Switzerland between 2017 and 2020. Patients underwent four therapy groups: intensive chemotherapy (IC), hypomethylating agent in combination with the BCL2-Inhibitor venetoclax (HMA + VEN), hypomethylating agents alone (HMA) or best supportive care (BSC).Results Of 54 patients 12 (22%) were selected for IC, 13 (24%) for HMA + VEN, 17 (32%) for HMA and 12 (22%) for BSC. The median overall survival of the patients was 76 days, with a significant difference in the four therapy groups (IC 119 days, HMA + VEN 732 days, HMA monotherapy 73 days and BSC 12 days Log-Rank Test Chi2(2): p

Abstract Background During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. Methods One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020–Mar2021, May–Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. Results We observed scores above thresholds for normal levels for 16% (95%CI = 15–18) of participants for depression, 8% (95%CI = 7–10) for anxiety, and 10% (95%CI = 9–12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. Conclusion This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

AIMS OF THE STUDY: Health-related quality of life (HRQoL) indicators are patient-reported outcomes (PROs). PROs are defined as any report of the status of a patient’s health condition or health behaviour that comes directly from the patient, without interpretation of the patient’s response by a clinician or anyone else. Despite Swiss national bodies (FOPH, FMH) recognising the potential of PRO measures (PROMs) for improving the health system, no consensus has yet emerged regarding a generic PROM framework or specific domains for practical uptake. The aim of the present digital Delphi study was to generate a consensual Swiss expert opinion on a generic PROM framework, measurement domains and items from a validated instrument (PROMIS [Patient-Reported Outcome Measurement Information System]) as well as on the role and implementation of PROs in the Swiss healthcare system via PRO consensus statements. METHODS: A 4-round digital Delphi study was conducted among Swiss PRO stakeholders. A total of n = 21 Swiss PROM stakeholders completed round 1 surveys on the PROM framework. During the stakeholder meeting, n = 11 stakeholders completed round 2 and round 3 surveys pertaining to measurement domains and items, respectively. In-meeting key questions and discussion items were extracted, consolidated into statements and subjected to consensus voting in a round 4, post-meeting survey. Consensus was defined as ≥70% agreement. RESULTS: Pre-meeting, agreement was reached for the tripartite framework of physical, mental and social health (95–100%). During the meeting, agreement was reached on all seven measurement domains of a generic PROM (PROMIS-29), ranging from 80% (Anxiety, Sleep Disturbance) to 100% (Pain Interference, Depression, Ability to Participate in Social Roles). Consensus was also reached for all PROMIS-29 items, with average domain consensus ranging from 83% (Sleep Disturbance, Ability to Participate in Social Roles) to 100% (Depression). Finally, four post-meeting consensus statements regarding PROs in Switzerland reached agreement. CONCLUSIONS: A Delphi method can help identify areas of need regarding PROMs in Switzerland. The current study identified a generic PROM as a missing quality indicator for the Swiss national health system’s value. A pre-meeting informational briefing, expert presentations and moderation supported three voting rounds to help identify PROMIS-29 as a PROM framework (round 1), measurement domains (round 2) and items (round 3) as a basis for further validation research. The empirical agreement among diverse stakeholders supports broad consensus towards preliminary feasibility of integrating generic PROMs into the Swiss health system based on content relevance.

Abstract The purpose of this review was to describe how adaptive laboratory evolution (ALE) can provide improvement to lactic acid bacteria (LAB) strains for their application in industrial biotechnological processes. This review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) approach, incorporating the ScienceDirect and Scopus databases. The literature search yielded 4,167 (ScienceDirect) and 27 (Scopus) articles, which were reduced to 12 after applying the inclusion /exclusion criteria. The studies revolved around LAB of the genera Lactobacillus, Lactococcus, Leuconostoc and Enterococcus and the application of ALE experiments in batch mode, fed-batch mode, or both, and aimed to produce strains with increased lactic acid production capabilities, higher cell viability, and multiple-stress tolerance. The studies demonstrated that ALE is an efficient approach for strain modification towards desired phenotypic functions and does not require genetic engineering. Knowledge of the cellular and molecular responses of microorganisms to stress enables an understanding of the adaptation mechanisms of LAB strains for survival and increased production of metabolites throughout ALE experiments.

Abstract Background Due to the complexity of the provision of care for people with dementia, pain assessment and management is still considered to be lacking. An optimal way to support frontline staff in providing pain assessment and management for people with dementia living in nursing homes has not yet been identified. The success of supporting interventions seems dependent on contextual factors in the nursing homes. This study, therefore, analyzes the feasibility of a nurse-led training intervention, using repeated on-site case studies, in modifying pain intensity and frequency in people with dementia. Methods Using a quasi-experimental design, we undertook a multi-center study of nurse-led training in pain management, with subsequent on-site case studies. Healthcare workers from 3 nursing homes assessed pain in 164 residents with dementia over 147 days. We used mixed-effect growth curve models with spline regression to analyze the data. Results We found that on-site case studies support frontline staff with pain management and assessment. Repeated reflection in case studies led to significantly longer pain free intervals (from 4.7 at baseline to 37.1 days at second follow-up) and decreased frequency of pain events (OR 0.54 at first follow-up and 0.43 at second follow-up). However no trends regarding pain intensity could be found. Therefore, on-site case studies may be valuable for improving pain frequency and pain-free intervals over time. Conclusion This feasibility study shows the potential of on-site support for frontline nursing home staff. On-site case studies may also affect health outcomes in people with dementia. However, the complexity of dementia care necessitates the management of a broader range of needs. Trial registration The study was retrospectively registered on the tenth of January 2017 with the German registry of clinical trials (DRKS00009726).

Abstract Background Dynamic trajectory radiotherapy (DTRT) extends volumetric modulated arc therapy (VMAT) with dynamic table and collimator rotation during beam-on. The aim of the study is to establish DTRT path-finding strategies, demonstrate deliverability and dosimetric accuracy and compare DTRT to state-of-the-art VMAT for common head and neck (HN) cancer cases. Methods A publicly available library of seven HN cases was created on an anthropomorphic phantom with all relevant organs-at-risk (OARs) delineated. DTRT plans were generated with beam incidences minimizing fractional target/OAR volume overlap and compared to VMAT. Deliverability and dosimetric validation was carried out on the phantom. Results DTRT and VMAT had similar target coverage. For three locoregionally advanced oropharyngeal carcinomas and one adenoid cystic carcinoma, mean dose to the contralateral salivary glands, pharynx and oral cavity was reduced by 2.5, 1.7 and 3.1 Gy respectively on average with DTRT compared to VMAT. For a locally recurrent nasopharyngeal carcinoma, D0.03 cc to the ipsilateral optic nerve was above tolerance (54.0 Gy) for VMAT (54.8 Gy) but within tolerance for DTRT (53.3 Gy). For a laryngeal carcinoma, DTRT resulted in higher dose than VMAT to the pharynx and brachial plexus but lower dose to the upper oesophagus, thyroid gland and contralateral carotid artery. For a single vocal cord irradiation case, DTRT spared most OARs better than VMAT. All plans were delivered successfully on the phantom and dosimetric validation resulted in gamma passing rates of 93.9% and 95.8% (2%/2 mm criteria, 10% dose threshold). Conclusions This study provides a proof of principle of DTRT for common HN cases with plans that were deliverable on a C-arm linac with high accuracy. The comparison with VMAT indicates substantial OAR sparing could be achieved.

The Urubu River is part of the Formoso River Basin located in Tocantins State in northern Brazil. It is an important agricultural region where irrigation has an important role in rice and soybean crops, cultivated during the rainy and the dry seasons, respectively. The high levels of irrigation associated with below-average precipitation in 2016 and in the following years resulted in a water crisis in the Urubu Basin, with serious consequences to the environment and the economy of the region. This work evaluated the impact of reducing irrigation on environmental flows in the Urubu River Basin using hydrological modeling in WEAP. Irrigation water demand scenarios were simulated and analyzed from July 2018 through June 2019. Results indicated the need to reduce 35% of all water withdrawls in order to avoid the interruption of flow in the Urubu River Basin. This percentage was even greater when only some of the farmers cooperated. The paper emphasized that it is important that all farmers be involved and cooperate to reduce their water withdrawal by any means, including improving their irrigation system efficiency. The water regulator may also motivate water withdrawal reduction by modifying water permits and applying water withdrawal restrictions during the dry season.

Abstract Background In Switzerland, there is a lack of adequate rehabilitation services, and effective coordination, that take into account the multifactorial health risks of older people. The literature shows that the hospitalisation rate in rehabilitation facilities has increased in recent years and that a gender bias exists. Additionally, there is little or no evidence available on the effect that a post-acute care programme might have over an extended period on functioning, quality of life and the informal network of older people. Therefore, the aim of this trial is to evaluate the sustainability of post-acute care within three nursing homes in Zurich, Canton of Zurich, Switzerland. Methods The Prevention Admission into Nursing homes (PAN) study is a explorative, prospective, longitudinal pilot trial based on a convenience sample of three long-term care facilities in the Swiss Canton of Zurich. The proposed pilot study will examine the effects of a post-acute care programme on people aged ≥65 years with a post-acute care potential ≥ three admitted to any of the three post-acute care units (n = 260). Older people of all sexes admitted to one of the post-acute care units and likely to be discharged to home within 8 weeks will be eligible for participation in the study. The primary endpoint is functionality based on the Barthel Index. The secondary endpoints are independency based on delirium, cognition, mobility, falling concerns, frailty, weight/height/body mass index, post-acute care capability, quality of life, and lastly, the informal network. As part of process evaluation, a qualitative evaluation will be conducted based on constructive grounded theory to specifically analyse how the experience of informal caregivers (n = 30) can contribute to a successful daily life 6 months after discharge. Discussion We expect to observe improved functional status and independence after the post-acute care programme. The qualitative evaluation conducted with caregivers will complement our description of the transition of older people towards living at home. Trial registration This study is registered in the German Clinical Trials Register under DRKS00016647 (registered on 23.05.2019).

Abstract Traditional simulation techniques such as wave optics methods and Monte Carlo (MC) particle transport cannot model both interference and inelastic scattering phenomena within one framework. Based on the rules of quantum mechanics to calculate probabilities, we propose a new semi-classical MC algorithm for efficient and simultaneous modeling of scattering and interference processes. The similarities to MC particle transport allow the implementation as a flexible c++ object oriented extension of EGSnrc—a well-established MC toolkit. In addition to previously proposed Huygens principle based transport through optics components, new variance reduction techniques for the transport through gratings are presented as transport options to achieve the required improvement in speed and memory costs necessary for an efficient exploration (system design—dose estimations) of the medical implementation of X-ray grating interferometry (GI), an emerging imaging technique currently subject of tremendous efforts towards clinical translation. The feasibility of simulation of interference effects is confirmed in four academic cases and an experimental table-top GI setup. Comparison with conventional MC transport show that deposited energy features of EGSnrc are conserved.

Abstract Background In this article, we report the cultural adaption and translation of the Integrated Palliative Care Outcome Scale for People with Dementia (IPOS-Dem) into a Swiss-German easy language version for proxy assessment of people with dementia living in Swiss nursing homes. The Swiss-German easy language version of the IPOS-Dem was developed and culturally adapted in a six-phase process from the German IPOS-Dem using recommended guidelines. With nursing home staff and laypeople, the conceptual definition and relevance of IPOS-Dem items were established during phase I. Phase II encompassed the completion of forward translations. Independent native speakers blind to the original scale translated and back-translated the Swiss-German easy language version. The resulting IPOS-Dem version was then blindly back-translated in phase III. Experts reviewed all resulting translations in phase IV to produce a pre-final IPOS-Dem version. Finally, the phase V cognitive debriefing involved two focus groups assessing the pre-final IPOS-Dem version. Phase V included cognitive interviews with laypeople (n = 2), family members of those with dementia (n = 4) and staff from different care contexts (n = 12). Results Using easy language specialists yielded a clinically relevant, comprehensive and understandable translation. In addition, face and content validity for the easy language version were established in the cognitive interviews. Conclusions With an easy language IPOS-Dem, all frontline staff and family members can be empowered to communicate their observations after caring interactions. Enhanced clinical communication with easy language tools shows the potential for research and clinical applications. In addition, attentive use in scales of easy language communication may foster increased engagement with untrained laypeople in clinical and care research.

Research background. Cheese whey and whey permeate are dairy industry by-products usually sent to effluent treatment or incorrectly disposed in the environment, generating costs for the production of dairy products and environmental problems due to the high organic load. Cheese whey and whey permeate can be reused as wall materials to form chia oil microcapsules, which act as a barrier to prooxidants. This study aims to develop an encapsulation method by spray-drying to protect chia oil using dairy by-products as wall materials. Experimental approach. We evaluated cheese whey, whey permeate and mixtures of m(cheese whey):m(whey permeate)=50, 70 and 80% as encapsulating agents with the spray-drying process. Initially, we characterized the chia oil and encapsulating materials. Chia oil emulsions were prepared using the encapsulating materials and an emulsifier. The stability of the emulsions was evaluated by creaming index, and they were characterized according to size distribution and polydispersity index. Emulsions were encapsulated in a spray dryer with inlet and outlet air temperature at 125 and 105 °C, respectively. After encapsulation, we assessed the oxidative degradation of chia oil over 30 days of storage by determining the peroxide index. Results and conclusions. Emulsions presented creaming index between 51 and 83% in all formulations, and the oxidative stability of microencapsulated chia oil was significantly higher than that of free chia oil after 30 days. Wall material combination affected both encapsulation efficiency and oxidation protection. The cheese whey and whey permeate (8:2) mixture exhibited the highest encapsulation efficiency (70.07%) and ability to protect the chia seed oil. After 30 days, the peroxide value was below the maximum limit considered safe for human consumption. Novelty and scientific contribution. According to these results, dairy by-products can be used for encapsulation of oxidation-sensitive oils. This represents an alternative use for dairy by-products, which otherwise are discarded and can impact the environment due to their high organic load. Our findings suggest that dairy by-products can be effectively used as wall materials to generate value-added products.

Non-physical barriers for migrating fish, such as effluent plumes discharged by sewage treatment plants (WWTPs), are hardly considered, and field studies on this topic are very scarce. The encounter with these plumes however may evoke behavioural responses in fish and could delay or (partially) block the migration. In this study, the behavioural responses of 40 acoustically-tagged silver eel (Anguilla anguilla) were monitored in situ, when confronting a WWTP effluent plume during their downstream migration in the canal Eems, the Netherlands. Their behavioural responses and the potential blocking effect of the plume were assessed using a 2D and 3D telemetry design displayed in the waterway, and matched to a modelled and calibrated WWTP effluent plume. When confronted with the WWTP effluent plume during their downstream migration, 22 of the silver eels (59%) showed an avoidance response, varying from lateral diverting to multiple turning in the vicinity of the effluent plume. Nineteen out of these 22 (86%) eventually passed the study site. No silver eel showed attraction to the plume. Delays in migration were from several hours up to several days. Due to the strong variation in discharged volumes and flow velocity of the receiving canal, the WWTP plume did not always flow over the full width of the canal. As a result, numerous migratory windows, where silver eels could pass the WWTP while avoiding direct contact with the plume, remained available in time. When discharge points cannot be avoided, reduced or restricted to areas that are not preferred as fish migration routes, discharge points should be designed such, that the chance is limited that a waterway is (temporarily) impacted over its full width.

Abstract Background The innate and adaptive immune system is involved in the airway inflammation associated with acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). We evaluated the association of mannose-binding lectin (MBL), immunoglobulin (Ig) and ficolin-2 concentrations with COPD exacerbations and according to the glucocorticoid treatment duration for an index exacerbation. Methods Post-hoc analysis of the randomized, double-blind, placebo-controlled REDUCE trial of 5 vs. 14 days of glucocorticoid treatment for an index exacerbation. MBL, ficolin-2 and total IgG/IgA and subclass concentrations were determined in stored samples drawn (n = 178) 30 days after the index exacerbation and associated with the risk of re-exacerbation during a 180-day follow-up period. Results IgG and subclass concentrations were significantly lower after 14 days vs. 5 days of glucocorticoid treatment. Patients with higher MBL concentrations were more likely to suffer from a future exacerbation (multivariable hazard ratio 1.03 per 200 ng/ml increase (95% confidence interval (CI) 1.00–1.06), p = 0.048), whereas ficolin-2 and IgG deficiency were not associated. The risk was most pronounced in patients with high MBL concentrations, IgG deficiency and 14 days of glucocorticoid treatment pointing towards an interactive effect of MBL and IgG deficiency in the presence of prolonged glucocorticoid treatment duration [Relative excess risk due to interaction 2.13 (95% CI − 0.41–4.66, p = 0.10)]. IgG concentrations were significantly lower in patients with frequent re-exacerbations (IgG, 7.81 g/L vs. 9.53 g/L, p = 0.03). Conclusions MBL modified the short-term exacerbation risk after a recent acute exacerbation of COPD, particularly in the setting of concurrent IgG deficiency and recent prolonged systemic glucocorticoid treatment. Ficolin-2 did not emerge as a predictor of a future exacerbation risk.

Abstract Non-conventional food plants have a variety of bioactive compounds with nutritional value. Vasconcellea quercifolia A. St.-Hil., belonging to the Caricaceae family, is a dietary alternative with excellent nutritional composition. This study aimed at characterizing the nutritional composition of mountain papaya (V. quercifolia) green fruit flour, in order to incorporate it in a functional food. For that purpose, the flour was characterized regarding its macro and micronutrients, anti-nutritional factors, pH, water activity, and color. This flour showed contents of carbohydrate of 22.31%; protein of 9.65%; dietary fiber of 32.80%; lipids of 14.95%, 63.56% of which are unsaturated fatty acids, especially oleic acid; and ash of 9.10%, with higher concentrations for potassium, calcium and magnesium. Therefore, V. quercifolia flour had good nutritional characteristics and might be used as supplementary food.

Abstract Cheese whey is the main by-product obtained in the production of cheese. Despite its high nutritional value, approximately half of the whey volume generated is still disposed incorrectly, which causes damage to the ecosystem due to the high cheese whey pollutant load. Therefore, it is important to use this by-product and its components in an increasing number of applications, especially as food ingredient. This review aimed to show the technology of production of butter from whey cream, as well as showing the physico-chemical, sensory, and nutritional characteristics of the product. There were no significant variations in the physico-chemical composition of milk cream butter and whey cream butter in the literature available. As the technology to produce whey butter is quite simple, this by-product has potential to be exploited by the dairy industry. Additionally, further studies on production process, characterization, and sensory analysis are required to enable its large-scale production.

Introduction: Home-dwelling older people with chronic diseases often need the support of informal and formal caregivers in order to continue living at home. Family members, however, need to be willing and prepared for caregiving together with home care nurses. Objectives: The purpose of this study was to explore factors associated with family caregivers’ preparedness to care for older home-dwelling adults who also receive home care nursing services. Methods: For this cross-sectional correlational study, a structured questionnaire was sent to family caregivers of adults aged 65 years or older receiving services from a community care agency. A total of 243 participants returned the questionnaire, of which 199 could be analyzed. Results: The stepwise backward regression model explained 29.1% of the variance of family caregivers’ preparedness. Mutuality was the most strongly associated factor with family caregivers’ preparedness whereas professional involvement of family caregiver in care process was important as well. Care intensity showed no significant impact. Conclusion: Nurses should support the whole family emotionally, and appreciate, admire, reinforce, and respect the caregivers’ situation. Home care nurses need to invest in helping families to find solutions, to strengthen their relationships between family members and the older person dwelling at home.

Abstract This study aimed to make and characterize a fresh cheese using the surplus of bovine colostrum from dairy farms. The bovine colostrum was characterized in terms of fat (4.00%), protein (16.30%), moisture (79.68%), ash (0.95%), minerals, pH (6.32), titratable acidity (0.27 g/100 mL), immunoglobulin G (>50 g/L), lactose (1.60%), color, and the presence of pathogenic bacteria. The fresh cheese made with colostrum was characterized in the same terms as the bovine colostrum (fat (7.00%), protein (22.95%), moisture (67.98%), ash (1.85%), minerals, pH (6.15), titratable acidity (0.04 g/100 mL), immunoglobulin G (30.95 g/L), lactose (not detectable), color, and the presence of pathogenic bacteria), with the addition of the texture and sensory analysis. The colostrum cheese had high moisture content (67.98%) and low-fat content (7.00%). The protein content was also high (22.95%), whose major percentage was composed by immunoglobulins. An important finding in this work was associated with the possible absence of lactose in the colostrum cheese, thus opening opportunities for future research regarding the development of dairy products for lactose intolerant consumers. In addition, the high concentration of immunoglobulin G might give this product an immune boost feature. The sensorial analysis showed that the recipe of the fresh cheese requires improvement to achieve higher acceptance from the public, especially regarding texture.

ObjectivesYoung adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods.MethodsA prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change).ResultsOverall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking.ConclusionsA substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

BACKGROUND: Hospitals are using nursing-sensitive outcomes (NSOs) based on administrative data to measure and benchmark quality of nursing care in acute care wards. In order to facilitate comparisons between different hospitals and wards with heterogeneous patient populations, proper adjustment procedures are required. In this article, we first identify predictors for common NSOs in acute medical care of adult patients based on administrative data. We then develop and cross-validate an NSO-oriented prediction model. METHODS: We used administrative data from seven hospitals in Switzerland to derive prediction models for each of the following NSO: hospital-acquired pressure ulcer (≥ stage II), hospital-acquired urinary tract infection, non-ventilator hospital-acquired pneumonia and in-hospital mortality. We used a split dataset approach by performing a random 80:20 split of the data into a training set and a test set. We assessed discrimination of the models by area under the receiver operating characteristic curves. Finally, we used the validated models to establish a benchmark between the participating hospitals. RESULTS: We considered 36,149 hospitalisations, of which 51.9% were male patients with a median age of 73 years (with an interquartile range of 59–82). Age and length of hospital stay were independently associated with all four NSOs. The derivation and validation models showed a good discrimination in the training (AUC range: 0.75–0.84) and in the test dataset (AUC range: 0.77–0.81), respectively. Variation among different hospitals was relevant considering the risk for hospital-acquired pressure ulcer (≥ stage II) (adjusted Odds ratio [aOR] range: 0.51 [95% CI: 0.38–0.69] – 1.65 [95% CI: 1.33–2.04]), the risk for hospital-acquired urinary tract infection (aOR range: 0.46 [95% CI: 0.36–0.58] – 1.45 [95% CI: 1.31–1.62]), the risk for non-ventilator hospital-acquired pneumonia (aOR range: 0.28 [95% CI: 0.09–0.89] – 2.87 [95% CI: 2.27–3.64]), and the risk for in-hospital mortality (aOR range: 0.45 [95% CI: 0.36–0.56] – 1.39 [95% CI: 1.23–1.60]). CONCLUSION: The application of risk adjustment when comparing nursing care quality is crucial and enables a more objective assessment across hospitals or wards with heterogeneous patient populations. This approach has potential to establish a set of benchmarks that could allow comparison of outcomes and quality of nursing care between different hospitals and wards.

Abstract Background Non-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers. Methods/design This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models. Discussion To the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers. Trial registration ClinicalTrials.gov, NCT04169646 . Registered 15 November 2019 - Retrospectively registered.

Abstract Background In order to locate an arteriovenous malformation, typically, a digital subtraction angiography (DSA) is carried out. To use the DSA for target definition an accurate image registration between CT and DSA is required. Carrying out a non-invasive, frameless procedure, registration of the 2D-DSA images with the CT is critical. A new software prototype is enabling this frameless procedure. The aim of this work was to evaluate the prototype in terms of targeting accuracy and reliability based on phantom measurements as well as with the aid of patient data. In addition, the user’s ability to recognize registration mismatches and quality was assessed. Methods Targeting accuracy was measured with a simple cubic, as well as with an anthropomorphic head phantom. Clearly defined academic targets within the phantoms were contoured on the CT. These reference structures were compared with the structures generated within the prototype. A similar approach was used with patient data, where the clinically contoured target served as the reference structure. An important error source decreasing the target accuracy comes from registration errors between CT and 2D-DSA. For that reason, the tools in BC provided to the user to check these registrations are very important. In order to check if the user is able to recognize registration errors, a set of different registration errors was introduced to the correctly registered CT and 2D-DSA image data sets of three different patients. Each of six different users rated the whole set of registrations within the prototype. Results The target accuracy of the prototype was found to be below 0.04 cm for the cubic phantom and below 0.05 cm for the anthropomorphic head phantom. The mean target accuracy for the 15 patient cases was found to be below 0.3 cm. In the registration verification part, almost all introduced registration errors above 1° or 0.1 cm were detected by the six users. Nevertheless, in order to quantify and categorize the possibility to detect mismatches in the registration process more data needs to be evaluated. Conclusion Our study shows, that the prototype is a useful tool that has the potential to fill the gap towards a frameless procedure when treating AVMs with the aid of 2D-DSA images in radiosurgery. The target accuracy of the prototype is similar to other systems already established in clinical routine.