The out-of-hours care system in Switzerland and in nine European countries, a comparative analysis

Background: the OOHC organization is in evolution in most of the western countries. The traditional model (the GP taking care of his own patients 24/7) tends to evolve towards bigger-scale organizations. Switzerland undergoes the same evolution. The OOHC system is different in each of the twenty-six Swiss cantons, and no comprehensive comparative review was ever published. In this context of change, it could be useful for decision makers to have this information, and in addition, to know which innovating OOHC models have been implemented in Europe so far. Aims: 1) To describe in detail the Swiss out-of-hours care (OOHC) system based on internet information and a survey sent to key informants. 2) To compare the organization of the OOHC system of nine Europeans countries. Methodology: 1) information was gathered on the internet using OOHC related key-words. We designed a survey and filled it according to this information, and then sent it to the key informants of each twenty-six cantons. 2) An extensive literature review was made about nine European countries that we chose based on their geographical proximity to Switzerland, and to which countries we thought could have been implementing innovating models in the field of OOHC. Results: 1) Finding information about OOHC on the internet was easily feasible in 100% of the cantons. The answer rate to the survey was 50%. In 25/26 cantons, the medical cantonal society was responsible for organizing the OOHC, in 1/26 it was shared with the State. Inter-cantonal collaboration was active in 10/26 cantons. To take part in the OOHC was mandatory in 100% of the cantons. Duties were remunerated in 46% of the cantons that answered. Innovating models implemented in Switzerland were: a unique cantonal number (20/26 cantons, 17/20 using a non-surtaxed number), a telephonic regulation (17/26 cantons), the use of nurses for the latter (15/17 cantons), GP-cooperatives (16/26 cantons, 15/16 integrated to the hospitals), Baden’s model (hospital-integrated GP-cooperatives (H-GPs) managed alternatively by general practioners (GPs) and hospital’s doctors, 10/16 of the H-GPs), Lyss Model (at night, the hospital answer the calls, the on-call GP being called only if needed; 5/26 cantons), the use of private societies to do part of the home visits (12/26 cantons). 2) The main innovating models across Europe were the implementation of GP-cooperatives (Netherlands, Denmark, Sweden, UK), the increasing role of telenurses (nurses used for telephonic triage), the creation of new specific OOHC professions (UK). The UK has a special system of integrated care. During the literature review, several interesting points stood out: emergency department’s overcrowding is a global OOHC critical issue (that GP-Cs seem to have an efficacy in reducing); too much innovation and creation of new professions leads to explosion of the costs (UK); specific populations tend to be left out of the new OOHC model (older people, disabled); patient’s education about the new OOHC system is crucial for an efficient use and patients’ satisfaction. Limitations: 1) the 50% answer rate to the survey obligated us to rely a lot on the information found on the internet; 1) and 2) the accuracy and correctness of the latter is not guaranteed. Conclusion: the Swiss OOHC system varies amongst the cantons. The same main innovating models were implemented as in some European countries: telephone triage (done by nurses) and GP-cooperatives. The latter have produced numerous studies that can be taken into account while redesigning the OOHC system

The eye and the heart

The vasculature of the eye and the heart share several common characteristics. The easily accessible vessels of the eye are therefore—to some extent—a window to the heart. There is interplay between cardiovascular functions and risk factors and the occurrence and progression of many eye diseases. In particular, arteriovenous nipping, narrowing of retinal arteries, and the dilatation of retinal veins are important signs of increased cardiovascular risk. The pressure in the dilated veins is often markedly increased due to a dysregulation of venous outflow from the eye. Besides such morphological criteria, functional alterations might be even more relevant and may play an important role in future diagnostics. Via neurovascular coupling, flickering light dilates capillaries and small arterioles, thus inducing endothelium-dependent, flow-mediated dilation of larger retinal vessels. Risk factors for arteriosclerosis, such as dyslipidaemia, diabetes, or systemic hypertension, are also risk factors for eye diseases such as retinal arterial or retinal vein occlusions, cataracts, age-related macular degeneration, and increases in intraocular pressure (IOP). Functional alterations of blood flow are particularly relevant to the eye. The primary vascular dysregulation syndrome (PVD), which often includes systemic hypotension, is associated with disturbed autoregulation of ocular blood flow (OBF). Fluctuation of IOP on a high level or blood pressure on a low level leads to instable OBF and oxygen supply and therefore to oxidative stress, which is particularly involved in the pathogenesis of glaucomatous neuropathy. Vascular dysregulation also leads to a barrier dysfunction and thereby to small retinal haemorrhage

Weak Cosmic Censorship: As Strong as Ever

Spacetime singularities that arise in gravitational collapse are always hidden inside of black holes. This is the essence of the weak cosmic censorship conjecture. The hypothesis, put forward by Penrose 40 years ago, is still one of the most important open questions in general relativity. In this Letter, we reanalyze extreme situations which have been considered as counterexamples to the weak cosmic censorship conjecture. In particular, we consider the absorption of scalar particles with large angular momentum by a black hole. Ignoring back reaction effects may lead one to conclude that the incident wave may overspin the black hole, thereby exposing its inner singularity to distant observers. However, we show that when back reaction effects are properly taken into account, the stability of the black-hole event horizon is irrefutable. We therefore conclude that cosmic censorship is actually respected in this type of gedanken experiments.Comment: 4 page

The effect of ranibizumab versus photodynamic therapy on DNA damage in patients with exudative macular degeneration

PURPOSE: To compare the effect of ranibizumab treatment versus photodynamic therapy (PDT) on single-stranded DNA damage in circulating leukocytes in patients with exudative age-related macular degeneration (AMD). METHODS: A comparative quantification of single-stranded DNA breaks was performed in circulating leukocytes of AMD patients before and 30 min, 45 min, 60 min, and 24 h after two different modes of therapy: a) PDT; and b) intravitreal ranibizumab injection. DNA breaks lead to smaller pieces of DNA, which in an electrical field, migrate out of the nucleus forming a tail. Damage of an individual cell was quantified as a comet tail moment. The proportion of non-zero values compared to the total number of observations was referred to as "amount of DNA damage" expressed in arbitrary units (AU). Comparisons between time points and study groups were assessed using a linear mixed-effect model. RESULTS: PDT induced an increase in the amount of single-stranded DNA damage in the circulating leukocytes from 0.2 AU (before treatment) to 0.53 AU (30 min after treatment). This increase was significant (p=0.004). In contrast, after ranibizumab treatment, the DNA damage in the circulating leukocytes remained unchanged. CONCLUSIONS: PDT purposely induces a local oxidative stress to damage the newly formed vessels. Our results indicate an additional systemic oxidative stress, apparent as amount of single-stranded DNA damage in the circulating leukocytes, for at least 30 min after treatment

Microscopic dynamics of thin hard rods

Based on the collision rules for hard needles we derive a hydrodynamic equation that determines the coupled translational and rotational dynamics of a tagged thin rod in an ensemble of identical rods. Specifically, based on a Pseudo-Liouville operator for binary collisions between rods, the Mori-Zwanzig projection formalism is used to derive a continued fraction representation for the correlation function of the tagged particle's density, specifying its position and orientation. Truncation of the continued fraction gives rise to a generalised Enskog equation, which can be compared to the phenomenological Perrin equation for anisotropic diffusion. Only for sufficiently large density do we observe anisotropic diffusion, as indicated by an anisotropic mean square displacement, growing linearly with time. For lower densities, the Perrin equation is shown to be an insufficient hydrodynamic description for hard needles interacting via binary collisions. We compare our results to simulations and find excellent quantitative agreement for low densities and qualtitative agreement for higher densities.Comment: 21 pages, 6 figures, v2: clarifications and improved readabilit

Quasinormal resonances of a massive scalar field in a near-extremal Kerr black hole spacetime

The fundamental resonances of near-extremal Kerr black holes due to massive scalar perturbations are derived {\it analytically}. We show that there exists a critical mass parameter, $\mu_c$, below which increasing the mass $\mu$ of the field increases the oscillation frequency $\Re(\omega)$ of the resonance. On the other hand, above the critical field mass increasing the mass $\mu$ increases the damping rate $\Im(\omega)$ of the mode. We confirm our analytical results by numerical computations.Comment: 6 page

Breakup of the aligned H2_2 molecule by xuv laser pulses: A time-dependent treatment in prolate spheroidal coordinates

We have carried out calculations of the triple-differential cross section for one-photon double ionization of molecular hydrogen for a central photon energy of $75$~eV, using a fully {\it ab initio}, nonperturbative approach to solve the time-dependent \Schro equation in prolate spheroidal coordinates. The spatial coordinates $\xi$ and $\eta$ are discretized in a finite-element discrete-variable representation. The wave packet of the laser-driven two-electron system is propagated in time through an effective short iterative Lanczos method to simulate the double ionization of the hydrogen molecule. For both symmetric and asymmetric energy sharing, the present results agree to a satisfactory level with most earlier predictions for the absolute magnitude and the shape of the angular distributions. A notable exception, however, concerns the predictions of the recent time-independent calculations based on the exterior complex scaling method in prolate spheroidal coordinates [Phys.~Rev.~A~{\bf 82}, 023423 (2010)]. Extensive tests of the numerical implementation were performed, including the effect of truncating the Neumann expansion for the dielectronic interaction on the description of the initial bound state and the predicted cross sections. We observe that the dominant escape mode of the two photoelectrons dramatically depends upon the energy sharing. In the parallel geometry, when the ejected electrons are collected along the direction of the laser polarization axis, back-to-back escape is the dominant channel for strongly asymmetric energy sharing, while it is completely forbidden if the two electrons share the excess energy equally.Comment: 17 pages, 9 figure

Comet assay analysis of single–stranded DNA breaks in circulating leukocytes of glaucoma patients

PURPOSE: To investigate the amount of single-stranded DNA breaks in circulating leukocytes of primary open-angle glaucoma (POAG) patients. METHODS: A comparative quantification of DNA breaks was performed in circulating leukocytes of POAG patients and healthy controls. The following groups of subjects were compared: (1) POAG patients having primary vascular dysregulation (PVD), (2) POAG patients without PVD, (3) healthy controls with PVD, and (4) healthy controls without PVD. The damage to DNA resulting in single-stranded breaks was assessed by means of the alkaline comet assay in which the damaged DNA migrates out of the nucleus forming a tail, which can be quantified using image analysis. Damage was quantified as the comet tail moment, which represents the extent of DNA damage in individual cells. RESULTS: Leukocytes of POAG patients exerted a significantly higher amount of comet tails, which are indicative of DNA damage, in comparison to control leukocytes (p>0.001). DNA breaks occurred particularly in the subgroup of POAG patients with PVD in comparison to glaucoma patients without PVD (p=0.002). In the control group, there was no significant difference between controls with PVD and controls without PVD (p=0.86). CONCLUSIONS: POAG patients with PVD have a significantly higher rate of DNA breaks than both POAG patients without PVD and healthy controls with and without PVD