Swiss School of Archaeology in Greece
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Multi-Wearable Approach for Monitoring Diurnal Light Exposure and Body Rhythms in Nightshift Workers.
No full textAs our understanding of light's impact on human health grows, studies examining light exposure and related health outcomes in everyday settings are increasingly important, particularly in high-risk groups like nightshift workers.
In this observational study, we monitored personal light exposure and physiological functions in a large cohort of healthcare nightshift workers using a spectrally resolved light dosimeter and wearable body temperature, actigraphy, and electrocardiography sensors.
Our findings revealed a common occurrence of unfavorable light conditions during both shift types. During nightshift work, participants frequently experienced exposure to biologically potent cool-white LED lighting. On dayshifts, melanopic light levels often failed to meet recommended guidelines, with daylight as the primary source of bright light levels. Sleep duration, but not quality, significantly varied between shifts, with longer sleep before the first nightshift but shorter sleep on subsequent nights. Daytime and nighttime napping helped compensate for reduced sleep on nightshifts. Limited associations between light exposure and sleep were found, partially contradicting existing knowledge. Diurnal physiological and activity rhythms followed the change from day-active to night-active schedules; however, the change in physiological rhythms appeared partly dissociated from that of activity, suggesting a circadian modulation. Moreover, physiological functions exhibited bi-directional phase-shifts across consecutive nightshifts, which may have been mediated by differences in daytime light exposure before the first nightshift.
By employing a multi-wearable approach including recent sensors, we provide new insights into the lighting environments experienced by nightshift workers and the potential impact of nightshift work and light exposure on endogenous circadian rhythms
Adapting Mountain Huts in the Western Alps to Climate Change: Strategies, Challenges, Governance, and Recommendations
No full textClimate change significantly affects alpine huts and surrounding recreational activity infrastructure, making these structures highly vulnerable. In response, stakeholders have implemented various adaptation strategies to enhance the resilience of these huts and support local recreational and professional practices. This article examines the diverse adaptation strategies employed by key actors. Moving beyond binary typologies (eg adaptation versus maladaptation or incremental versus transformative adaptation), we explore the barriers and limitations affecting these efforts by focusing on adaptive governance. Our goal is to identify effective practices and provide recommendations for adapting alpine huts to the challenges posed by climate change. This study is based on an action research program conducted in the Franco-Swiss Alps in collaboration with mountain hut stakeholders to better understand and address the ongoing tourism transition in the European Alps. To investigate adaptation strategies, we employed a qualitative and participatory approach, integrating field observations, semistructured interviews, stakeholder workshops, and a survey of 45 huts. This multimethod framework allowed us to capture diverse perspectives, assess implemented strategies, and identify both constraints and opportunities for adaptation
First-line immunotherapy ± chemotherapy with or without upfront stereotactic radiotherapy (SRT) in patients with Non-Small cell lung cancer (NSCLC) with asymptomatic brain metastases
No full textThe role and optimal timing of SRT for patients with advanced NSCLC and asymptomatic brain metastases treated with immune checkpoint inhibitors (ICI) are controversial.
Efficacy and safety outcomes of patients with newly diagnosed non oncogene- addicted NSCLC with asymptomatic brain metastases (1-10 lesions, max. diameter of lesions 3 cm) treated with a first-line ICI-containing regimen at 11 Swiss cancer centers were retrospectively analyzed.
A total of 128 patients in two cohorts (58 patients with upfront SRT and 69 patients without upfront SRT) were included in this analysis. The median intracranial progression-free survival (PFS) was significantly longer in patients with upfront SRT (12.6 vs. 8.2 months, Hazard ratio (HR) 0.62 [95 % CI 0.41 vs. 0.95], p = 0.026). This benefit remained significant after correcting for number and size of lesions and programmed cell death 1 ligand (PD-L1) status. The proportion of patients with symptomatic progression of brain metastases and of patients receiving further local treatment to the brain was similar between cohorts (3 % vs. 12 %, p = 0.11 and 33 % vs. 42 %, p = 0.3). No significant difference in median overall survival (OS) was observed between the cohorts (22.8 vs. 21.7 months, p = 0.4). Only two patients with upfront SRT experienced a clinically significant Central Nervous System (CNS) adverse event (AE).
In this multicentric retrospective analysis of patients with asymptomatic brain metastases upfront SRT was associated with an improved intracranial PFS and was well tolerated but median OS and the rate of patients developing symptomatic brain progression were similar to patients without upfront SRT.
Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved
When simulation becomes physical: vicarious symptoms in standardized patients during osces
No full textObjective structured clinical examinations (OSCEs) are a cornerstone of undergraduate medical student assessment evaluating encounters between students and simulated patients (SPs). SPs are at risk of developing non-specific symptoms such as stress and anxiety. However, data on physical sensations related to their role, vicarious symptoms (VSs), are limited. We sought to measure the prevalence of VSs among SPs and identify factors among socio-demographic characteristics and psychometric scales associated with their presence.
This was a prospective single-center cohort study in a large French medical University during three OSCE exams. New VSs and their intensity using 0-100 numerical rate scale were assessed in SPs at the end of the examination day and seven days later using electronical survey. Health anxiety (excessive concern about illness) was measured before the examination using IAS scale. Interoceptive sensitivity (awareness of bodily signals) was also measured before the examination using MAIA-2 and THISQ scales. We performed a multinomial logistic regression to identify characteristics associated with the appearance of VSs.
Among the 428 SPs participating to the OSCEs examens, data from 244 SPs were analyzed. On the day of the OSCE, 12% of participants reported VSs (median intensity of 30, interquartile range 20–50). During the following week, 11% experienced similar symptoms (intensity 50, 30–60). Overall, 20% of SPs reported VSs either during the day of OSCEs or during the following week. Personal experience of a similar condition as the one played (adjusted odds ratio [aOR] 3.07, 95% confidence interval 1.33–7.07, p = 0.008) and higher IAS scores (aOR 1.03 per point, 1.01–1.05, p = 0.03) were associated with VSs occurrence. MAIA-2 and THISQ scores were not associated with the presence of these symptoms using multivariate analysis.
VSs are frequent among SPs particularly when the role is similar to a personal experience and in SP with higher IAS scores. The findings may inform on the selection and the preparation of SPs for OSCEs while shedding light on the influence of symptom portrayal on bodily experiences and its potential influence on the quality of the SPs acting across students.
Not applicable.
The online version contains supplementary material available at 10.1186/s12909-025-07950-w
Subchronic amphetamine decreases hyperactivity, anti-social behaviour and anhedonia in dopamine transporter knockout rats: role of prefrontal glutamate
No full textHyperdopaminergia is a key feature of neuropsychiatric disorders including schizophrenia, attention deficit hyperactivity disorder, and bipolar disorder and can be modeled using dopamine transporter knockout (DAT KO) rats. Previous studies have shown that acute amphetamine has a paradoxical calming effect in DAT KO rats, but the effects of repeated amphetamine treatment are unknown.
We studied the effect of subchronic amphetamine on hyperdopaminergia-related disease symptoms and underlying mechanisms using male and female DAT KO rats. We measured locomotor activity, anxiety-like behaviour, social behaviour, anhedonia and problem-solving behaviour at baseline and after 10 days of amphetamine treatment and assessed protein expression changes in the glutamate system in the prefrontal cortex.
Both female and male DAT KO rats exhibited hyperlocomotion compared to control rats. Subchronic amphetamine treatment significantly dampened this effect in female, but not in male DAT KO rats. Additionally, amphetamine increased sociability in female, but not in male DAT KO rats. From a molecular point of view, we observed differences in the modulation of glutamatergic transmission between males and females mainly at the level of the infralimbic, but not prelimbic, prefrontal cortex, suggesting that the glutamatergic synapse may contribute to the behavioral response to amphetamine between the two sexes.
Subchronic amphetamine treatment decreased the hyperactivity, anxiety-like, anti-social and anhedonic phenotypes of female DAT KO rats, potentially by modulating glutamate transmission in the prefrontal cortex. These findings foster further research into the treatment of hyperdopaminergia-related disorders.
Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved
Implications of Primary Care Scenarios for the ‘Performance' of Chronic Care Delivery in Switzerland: A Systems Modelling View
No full textSex-specific efficacy and safety outcomes in patients with resectable stage III non-small-cell lung cancer (NSCLC) undergoing neoadjuvant therapies: a pooled analysis of the SAKK trials 16/96, 16/00, 16/01, 16/08 and 16/14
No full textCurrent data suggest better survival in various cancer types but increased treatment toxicity in female compared with male patients. In this article, we report a pooled analysis of sex-related differences in survival outcomes and safety in patients with resectable stage III non-small-cell lung cancer (NSCLC) treated in five prospective clinical trials.
Data from 499 patients included in five Swiss Group for Clinical Cancer Research (SAKK) trials for resectable stage III NSCLC were pooled. All patients were treated with three cycles of chemotherapy (cisplatin/docetaxel), either alone (n = 207, 41%), with sequential radiotherapy (n = 229, 46%) or with sequential perioperative programmed death-ligand 1 blockade (n = 62, 12%).
Of 499 patients included, 341 (68.3%) were male. Median event-free survival (EFS) [24.4 versus 11.8 months, hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.06-1.64, P = 0.014] and median overall survival (OS) (59.3 versus 26.1 months, HR 1.45, 95% CI 1.15-1.83, P = 0.0018) were significantly longer in female patients compared with male patients. OS/EFS remained significant in a multivariable Cox regression model. While the cause-specific hazard of non-cancer-related death was increased in males (HR 2.14, 95% CI 1.32-3.46, P = 0.0019), the risk of tumor-related death was not significantly different between sexes (HR 1.26, 95% CI 0.96-1.65, P = 0.09). No significant differences in treatment-related grade ≥3 adverse events (62.5% versus 69.7%) or treatment discontinuation (3.2% versus 3.2%) were observed.
In this pooled analysis, female patients with resectable stage III NSCLC had longer EFS and OS than males, mainly due to lower non-cancer-related mortality. Given the retrospective design and limited sample size, these results should be interpreted with caution. Prospective studies are needed to confirm these findings and explore underlying causes of sex-based differences.
Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved
Empirical and targeted antimicrobial therapy in patients with febrile neutropenia and haematological malignancy or after haematopoietic cell transplantation: recommendations from the 10th European Conference on Infections in Leukaemia
No full textFebrile neutropenia can lead to life-threatening infections in patients with haematological malignancies or after hematopoietic cell transplantation. Infection management is challenged by rising antibiotic resistance and regional differences in bacterial epidemiology. The 10th European Conference on Infections in Leukaemia panel recommends a personalised approach guided by local resistance patterns and individual risk factors. For patients who are haemodynamically stable without colonisation or infection by resistant Gram-negative bacteria in low-resistance prevalence settings, empirical monotherapy sparing carbapenems or novel β-lactams with or without β-lactamase inhibitors (BLI) is recommended. For patients who are critically ill or haemodynamically unstable, those with previous resistant Gram-negative bacteria colonisation or infection, or in high-resistance prevalence settings, broader-spectrum therapy is indicated. Treatment options include β-lactam plus aminoglycoside combinations, carbapenem with or without BLI, anti-pseudomonal cephalosporin and BLI combinations, or cefiderocol, individualised by local epidemiology and patient factors. Antimicrobial stewardship is recommended, including antimicrobial de-escalation once resistant Gram-negative bacteria infection is excluded; and antibiotic discontinuation regardless of neutrophil count, in patients who are afebrile and stable after completing the intended course. We provide treatment strategies for resistant Gram-negative bacteria infections.
Copyright © 2025 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies
Postoperative complications in breast reconstruction with deep inferior epigastric perforator flap: Looking for evidence.
No full textThis study investigated patient- and surgery-related risk factors of postoperative complications in microvascular breast reconstruction with deep inferior epigastric perforator (DIEP) flaps.
We reviewed the retrospective charts of 212 patients who underwent 250 DIEP flap breast reconstructions between 2018 and 2023. Patient-related factors included demographic characteristics, comorbidities, radiation therapy, and chemotherapy. Surgery-related factors included reconstructive timing and laterality, perforator choice, venous anastomosis technique, and postoperative acetylsalicylic acid (ASA). Early flap complications (first postoperative week) included flap loss, venous congestion, and hematoma. Late flap complications (after the first postoperative week) included wound dehiscence, skin necrosis, fat necrosis, and infection. Donor-site complications (all late) included wound dehiscence, skin necrosis, infection, seroma, and bulging.
The overall complication rate was 31.1%, and flap loss was 1.9%. Obesity and diabetes were significantly associated with late flap complications and donor-site complications (dehiscence, infection, fat necrosis, and seroma). Radiation therapy showed trends toward greater total flap loss, take back, and flap skin necrosis. Age, hypertension, smoking, and chemotherapy were not associated with higher complications. Harvesting multiple versus a single perforator was associated with significantly more donor-site complications. There were significantly more early flap complications and a trend toward more bulging with lateral versus medial row perforators. Venous anastomosis with a coupler versus a suture showed significantly lower flap complications. Reconstruction timing, laterality, vein number, and ASA use did not impact outcomes.
Complications increased by obesity, diabetes, radiation therapy, and the use of multiple and lateral row perforators, as well as sutured venous anastomoses. Conversely, outcomes were not affected by age, hypertension, chemotherapy, reconstructive laterality and timing, vein number, coupler size, or postoperative ASA use