Donors/recipients representations about living-kidney donation : P-527

Living-kidney donation offers an option to patients awaiting renal transplantation. Representations about giving-receiving are explored retrospectively in a qualitative study. Questionnaires with open questions were sent to thirty donor-recipient dyads. Interviews were also conducted, during which participants were invited to propose an image representing donation. Thematic analysis was performed on the questionnaires (twenty-nine donors; twenty-five recipients), and on the comments of ten images selected by five donors and five recipients. Percentages are given regarding each part (donors; recipients). In the questionnaires, life (34.5%; 12%), love (27.6%; 40%), quality of life (27.6%; 8%) and generosity (6.9%; 24%) are common grounds regarding giving-a-kidney. Obviousness, hope, personal benefits or duty are expressed by donors. Recipients explain donation through emphatic sentences, qualify it as a gift or refer to the donor's courage or risk-taking. Regarding receiving-a-kidney, life (31%; 60%), gift (10.3%; 28%) and debt (3.4%; 4%) are common grounds. Donors refer to generosity or love. Quality of life, donor's risk-taking or emphatic sentences are characteristic of recipients, who highlight that nobody had to die. Preliminary data on the comments of the images underline that live-donation represents life and love. Mutual help, sharing-act, obviousness and personal benefits are expressed by donors. Recipients use emphatic sentences or refer to quality of life, gift or the difficulty to accept donation. Life and love are common grounds in live-donation. Improvement in quality of life is underlined by recipients, who stress the donor's courage or risk-taking. Donors describe donation as obvious, sometimes accompanied by personal benefits. Feelings of duty (donors) and of debt (recipients) are less discussed. Representations about giving and receiving differ between donors and recipients. These data show the specificity of each perspective. This analysis provides valuable information in order to adapt individual or dyad psychological support in live-donation.

Inference about the number of contributors to a DNA mixture: Comparative analyses of a Bayesian network approach and the maximum allele count method.

In the forensic examination of DNA mixtures, the question of how to set the total number of contributors (N) presents a topic of ongoing interest. Part of the discussion gravitates around issues of bias, in particular when assessments of the number of contributors are not made prior to considering the genotypic configuration of potential donors. Further complication may stem from the observation that, in some cases, there may be numbers of contributors that are incompatible with the set of alleles seen in the profile of a mixed crime stain, given the genotype of a potential contributor. In such situations, procedures that take a single and fixed number contributors as their output can lead to inferential impasses. Assessing the number of contributors within a probabilistic framework can help avoiding such complication. Using elements of decision theory, this paper analyses two strategies for inference on the number of contributors. One procedure is deterministic and focuses on the minimum number of contributors required to 'explain' an observed set of alleles. The other procedure is probabilistic using Bayes' theorem and provides a probability distribution for a set of numbers of contributors, based on the set of observed alleles as well as their respective rates of occurrence. The discussion concentrates on mixed stains of varying quality (i.e., different numbers of loci for which genotyping information is available). A so-called qualitative interpretation is pursued since quantitative information such as peak area and height data are not taken into account. The competing procedures are compared using a standard scoring rule that penalizes the degree of divergence between a given agreed value for N, that is the number of contributors, and the actual value taken by N. Using only modest assumptions and a discussion with reference to a casework example, this paper reports on analyses using simulation techniques and graphical models (i.e., Bayesian networks) to point out that setting the number of contributors to a mixed crime stain in probabilistic terms is, for the conditions assumed in this study, preferable to a decision policy that uses categoric assumptions about N.

Controversies about the enhanced vulnerability of the adolescent brain to develop addiction.

Adolescence, defined as a transition phase toward autonomy and independence, is a natural time of learning and adjustment, particularly in the setting of long-term goals and personal aspirations. It also is a period of heightened sensation seeking, including risk taking and reckless behaviors, which is a major cause of morbidity and mortality among teenagers. Recent observations suggest that a relative immaturity in frontal cortical neural systems may underlie the adolescent propensity for uninhibited risk taking and hazardous behaviors. However, converging preclinical and clinical studies do not support a simple model of frontal cortical immaturity, and there is substantial evidence that adolescents engage in dangerous activities, including drug abuse, despite knowing and understanding the risks involved. Therefore, a current consensus considers that much brain development during adolescence occurs in brain regions and systems that are critically involved in the perception and evaluation of risk and reward, leading to important changes in social and affective processing. Hence, rather than naive, immature and vulnerable, the adolescent brain, particularly the prefrontal cortex, should be considered as prewired for expecting novel experiences. In this perspective, thrill seeking may not represent a danger but rather a window of opportunities permitting the development of cognitive control through multiple experiences. However, if the maturation of brain systems implicated in self-regulation is contextually dependent, it is important to understand which experiences matter most. In particular, it is essential to unveil the underpinning mechanisms by which recurrent adverse episodes of stress or unrestricted access to drugs can shape the adolescent brain and potentially trigger life-long maladaptive responses.

Ex-post survey on the consequences and perceptions about amalgamation : The case of two Swiss municipalities

In 2006, two municipalities located in the canton of Fribourg (Switzerland), La Tour-de-Trême and Bulle, amalgamated. In this study, we report on the evolution of citizen perceptions as well as try to better understand the reasons behind the respondents various positions concerning this new political and territorial entity. Five-hundred individuals were surveyed almost four years after the amalgamation came into effect. Our results show that if the amalgamation was voted again, it would be necessary to be particularly attentive to citizen access to municipal offices and to local service provisions, to citizen identification to their municipality as well as to the life of the local associations. Indeed, these are clearly important issues for small localities. Furthermore, citizens of the newly amalgamated municipality are mostly sensitive to access to municipal offices and to contact with local representatives. Improving the population's perceptions of these particular issues could lead to a 12 percentage point increase in support for the amalgamation.

Inferring about individual drug and schizotypy effects on cognitive functioning in polydrug using mephedrone users before and after clubbing

Objective: Mephedrone has been recently made illegal in Europe, but little empirical evidence is available on its impact on human cognitive functions. We investigated acute and chronic effects of mephedrone consumption on drug-sensitive cognitive measures, while also accounting for the influence of associated additional drug use and personality features. Method: Twenty-six volunteers from the general population performed tasks measuring verbal learning, verbal fluency and cognitive flexibility before and after a potential drug-taking situation (pre- and post-clubbing at dance clubs, respectively). Participants also provided information on chronic and recent drug use, schizotypal (O-LIFE) and depressive symptoms (Beck depression inventory), sleep pattern and premorbid IQ. Results: We found that i) mephedrone users performed worse than non-users pre-clubbing, and deteriorated from the pre-clubbing to the post-clubbing assessment, ii) pre-clubbing cannabis and amphetamine (not mephedrone) use predicted relative cognitive attenuations, iii) post-clubbing, depression scores predicted relative cognitive attenuations, and iv) schizotypy was largely unrelated to cognitive functioning, apart from a negative relationship between cognitive disorganisation and verbal fluency. Conclusion: Results suggest that polydrug use and depressive symptoms in the general population negatively affect cognition. For schizotypy, only elevated cognitive disorganisation showed potential links to a pathological cognitive profile previously reported along the psychosis dimension.

Faiblesse et douleurs musculaires generalisees chez une patiente de 88 ans: avez-vous pense aux medicaments [88 years old woman with acute muscular weakness and diffuse muscular pain: have you thought about the drugs?].

An 88 years old woman was admitted for muscular pain and weakness. She was under a treatment of simvastatin and was recently prescribed clarithromycin for a lung infection. The diagnosis of statin induced rhabdomyolysis by drug interaction was made. The evolution is good with eviction of the statin and aggressive hydratation. This case shows how important it is to know the risks factors and drug interactions predisposing to statin-induced myopathy.

La crampe du musicien. A propos de la maladie de Robert Schumann [The mucisian's cramp. About the illness of Robert Schumann].

The musicians are seen in daily neurological practice facing various problems sometimes simple such as skeletal or tendon pain or even compression of a nerve trunk and sometimes more complicated such as focal dystonia. Dystonia often has a dramatic impact on the career of a musician given the complexity of the clinical and therapeutic approach and the results are often disappointing. The history of the German Romantic composer Robert Schumann illustrates this reality; through his story a discussion of both the different pathophysiological hypotheses responsible for focal dystonia, a disorder of brain plasticity, and of the multimodal therapeutic approaches, revisited in the light of neurophysiological findings will be described.

Teachers' remarks about their salaries in 1800 in the Helvetic Republic

For centuries, teachers have complained about their salaries. In the Stapfer inquiry of 1799, some teachers made remarks about financial issues, particularly their low incomes. This inquiry is the main source for the arguments presented here regarding teachers' low salary during this period of the Helvetic Republic. The disparity between the lowest and the highest income was huge in 1799. This fact invites investigations about the people who complained. The evidence indicates incoherence between the complaints regarding low salary and the real income that was earned by these teachers. However, in order for this thesis to be wholly understood, the salaries must be explained; at the time of the Stapfer inquiry, salaries were paid in different currencies, as wages in kind and using divergent measurements. The present article aims to determine who these teachers were and why they complained. The arguments presented by the teachers shed light on the topics of political appeals, the social status of teachers in 1800 and the professionalisation of teachers.

Stranger than Fiction: Métalepse de Genette et quelques univers filmiques contemporains

Dans le présent article, l'auteur examine certains commentaires développés par Gérard Genette à propos d'exemples filmiques dans l'ouvrage Métalepse, et tente de prolonger l'étude de cette « figure » dans le cadre des théories de la fiction en se penchant sur des films réalisés dans la dernière décennie. Il montre ainsi la pertinence de l'étude des phénomènes relevant de la métalepse pour aborder certaines productions cinématographiques contemporaines qui engagent des pratiques réflexives complexes. Par ailleurs, il aborde la façon dont Genette se positionne par rapport à l'objet cinéma - qu'il tient distance -, et propose d'autres ouvertures théoriques, notamment en tenant plus spécifiquement compte des théories de l'énonciation filmique. Enfin, il discute certains problèmes soulevés par la conception genettienne de la « diégèse » appliquée au cinéma, notamment dans le cas de l'analyse des implications du procédé du pont sonore et des sons dits « extradiégétiques ». L'étude s'achève par l'analyse de la transgression des niveaux narratifs dans un film à voix-over, Stranger than fiction (Marc Forster, 2006), qui constitue un lieu privilégié pour éprouver certaines remarques de Genette. This article discusses some reflections developed by Gérard Genette with respect to the filmic examples in Métalepse and tries to pursue the study of this figure within the framework of fiction theories, by focusing on certain films released in the last decade. The article also shows how the study of metalepsis can be important in order to address contemporary movies presenting complex self-reflexive strategies. Furthermore, it gives account of the particular way in which Genette deals with cinema and suggests some other possible theoretical developments, considering in particular the theories about filmic enunciation. Finally, the paper discusses some problems concerning Genette's idea of "diegesis" when it is applied to cinema and analyses the transgression of narrative levels in a voice-over film - in this case Stranger than Fiction (Marc Forster, 2006), which provides a particularly interesting example in order to test some of Genette's remarks.

Response-to-comments about: "Is it really the method for carbon dioxide determination in human postmortem cardiac gas samples using Headspace-Gas Chromatography-Mass Spectrometry valid?" from T. Saffaj and B. Ihssane

Saffaj et al. recently criticized our method of monitoring carbon dioxide in human postmortem cardiac gas samples using Headspace-Gas Chromatography-Mass Spectrometry. According to the authors, their demonstration, based on the latest SFSTP guidelines (established after 2007 [1,2]) fitted for the validation of drug monitoring bioanalytical methods, has put in evidence potential errors. However, our validation approach was built using SFSTP guidelines established before 2007 [3-6]. We justify the use of these guidelines because of the post-mortem context of the study (and not clinical) and the gaseous state of the sample (and not solid or liquid). Using these guidelines, our validation remains correct.

Talking about sexuality with the physician: are patients receiving what they wish?

QUESTIONS UNDER STUDY/PRINCIPLES: Little is known concerning patients' expectations regarding sexual history taking by doctors: to ascertain expectations and actual experience of talking about sexuality among male patients attending outpatient clinics, and their sexual behaviour. METHODS: Patients consecutively recruited from two outpatient clinics in Lausanne, Switzerland were provided with an anonymous self-administered questionnaire. Survey topics were: patients' expectations concerning sexual history taking, patients' lifetime experience of sexual history taking, and patients' sexual behaviour. RESULTS: The response rate was 53.0% (N = 1452). Among respondents, 90.9% would like their physician to ask them questions regarding their sexual history in order to receive advice on prevention (60.0% yes, 30.9% rather yes). Fifteen percent would be embarrassed or rather embarrassed if asked such questions. Nevertheless, 76.2% of these individuals would like their physician to do so. Despite these wishes, only 40.5% reported ever having a discussion "on their sexual life in general" with a doctor. Only one patient out of four to five was asked about previous sexually transmitted infections (STIs), the number of sexual partners and their sexual orientation. No feature of their sexual life distinguishes those who had discussed sexual issues with a doctor from those who had not, except a history of previous consultation for health problems related to sexuality. Conversely, being embarrassed about conducting this discussion was significantly associated with lack of discussion regarding sexuality. CONCLUSIONS: This study highlights the gap existing in the field of STI prevention in terms of doctors' advice and patients' wishes.

What process research tells us about brief intervention efficacy.

ISSUE: This article explores mechanisms of the efficacy of brief intervention (BI). APPROACH: We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups. The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome. KEY FINDINGS: Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention. Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later. Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change. Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention. IMPLICATION: These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients. [Daeppen J-B, Bertholet N, Gaume J. What process research tells us about brief intervention efficacy.

Beliefs about and attitudes toward gambling in French-speaking Switzerland.

The present study aims to analyze attitudes and beliefs of the French-speaking general Swiss population (n = 2500; female n = 1280; mean age = 43 years) as regards gambling, which are to date almost exclusively studied in the North American and Australian contexts. Beliefs related to gambling include the perception of the effectiveness of preventive measures toward gambling, the comparative risk assessment of different addictive behaviors, the perceived risks of different types of gambling and attitudes are related to the gambler's personality. The general population perceived gambling rather negatively and was conscious of the potential risks of gambling; indeed, 59.0% of the sample identified gambling as an addictive practice. Slot machines were estimated to bear the highest risk. Compared with women and older people, men and young people indicated more positive beliefs about gambling; they perceived gambling as less addictive, supported structural preventive measures less often, and perceived gambling as a less serious problem for society. Gamblers were more likely to put their practices into perspective, perceiving gambling more positively than non-gamblers. General population surveys on such beliefs can deliver insights into preventive actions that should be targeted to young men who showed more favorable views of gambling, which have been shown to be associated with increased risk for problematic gambling.