Sondage pilote concernant la fréquentation d'une unité mobile de mammographie

En matière de dépistage du cancer du sein, il a été proposé de compléter les moyens techniques actuellement disponibles des praticiens du canton de Vaud par ceux d'une unité mobile de mammographie. Avant de se lancer dans cette aventure, il paraît raisonnable d'estimer le volume et la nature de la demande pour ce nouveau service. La participation des femmes vaudoises peut être évaluée par une enquête de population. Pour préparer cette enquête, un sondage téléphonique pilote a été effectué, permettant d'en estimer la faisabilité, le coût et le rendement.

Continuous electroencephalography in the medical intensive care unit.

OBJECTIVES: To examine predictors and the prognostic value of electrographic seizures (ESZs) and periodic epileptiform discharges (PEDs) in medical intensive care unit (MICU) patients without a primary acute neurologic condition. DESIGN: Retrospective study. SETTING: MICU in a university hospital. PATIENTS: A total of 201 consecutive patients admitted to the MICU between July 2004 and January 2007 without known acute neurologic injury and who underwent continuous electroencephalography monitoring (cEEG) for investigation of possible seizures or changes in mental status. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Median time from intensive care unit (ICU) admission to cEEG was 1 day (interquartile range 1-4). The majority of patients (60%) had sepsis as the primary admission diagnosis and 48% were comatose at the time of cEEG. Ten percent (n = 21) of patients had ESZs, 17% (n = 34) had PEDs, 5% (n = 10) had both, and 22% (n = 45) had either ESZs or PEDs. Seizures during cEEG were purely electrographic (no detectable clinical correlate) in the majority (67%) of patients. Patients with sepsis had a higher rate of ESZs or PEDs than those without sepsis (32% vs. 9%, p < 0.001). On multivariable analysis, sepsis at ICU admission was the only significant predictor of ESZs or PEDs (odds ratio 4.6, 95% confidence interval 1.9-12.7, p = 0.002). After controlling for age, coma, and organ dysfunction, the presence of ESZs or PEDs was associated with death or severe disability at hospital discharge (89% with ESZs or PEDs, vs. 39% if not; odds ratio 19.1, 95% confidence interval 6.3-74.6, p < 0.001). CONCLUSION: In this retrospective study of MICU patients monitored with cEEG, ESZs and PEDs were frequent, predominantly in patients with sepsis. Seizures were mainly nonconvulsive. Both seizures and periodic discharges were associated with poor outcome. Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients.

Modeling the forensic two-trace problem with Bayesian networks

The forensic two-trace problem is a perplexing inference problem introduced by Evett (J Forensic Sci Soc 27:375-381, 1987). Different possible ways of wording the competing pair of propositions (i.e., one proposition advanced by the prosecution and one proposition advanced by the defence) led to different quantifications of the value of the evidence (Meester and Sjerps in Biometrics 59:727-732, 2003). Here, we re-examine this scenario with the aim of clarifying the interrelationships that exist between the different solutions, and in this way, produce a global vision of the problem. We propose to investigate the different expressions for evaluating the value of the evidence by using a graphical approach, i.e. Bayesian networks, to model the rationale behind each of the proposed solutions and the assumptions made on the unknown parameters in this problem.

Recent misconceptions about the "database search problem": a probabilistic analysis using Bayesian networks

This paper analyses and discusses arguments that emerge from a recent discussion about the proper assessment of the evidential value of correspondences observed between the characteristics of a crime stain and those of a sample from a suspect when (i) this latter individual is found as a result of a database search and (ii) remaining database members are excluded as potential sources (because of different analytical characteristics). Using a graphical probability approach (i.e., Bayesian networks), the paper here intends to clarify that there is no need to (i) introduce a correction factor equal to the size of the searched database (i.e., to reduce a likelihood ratio), nor to (ii) adopt a propositional level not directly related to the suspect matching the crime stain (i.e., a proposition of the kind 'some person in (outside) the database is the source of the crime stain' rather than 'the suspect (some other person) is the source of the crime stain'). The present research thus confirms existing literature on the topic that has repeatedly demonstrated that the latter two requirements (i) and (ii) should not be a cause of concern.

Taking "Galton's problem" Seriously : Towards a Theory of Policy Diffusion

This article builds on the recent policy diffusion literature and attempts to overcome one of its major problems, namely the lack of a coherent theoretical framework. The literature defines policy diffusion as a process where policy choices are interdependent, and identifies several diffusion mechanisms that specify the link between the policy choices of the various actors. As these mechanisms are grounded in different theories, theoretical accounts of diffusion currently have little internal coherence. In this article we put forward an expected-utility model of policy change that is able to subsume all the diffusion mechanisms. We argue that the expected utility of a policy depends on both its effectiveness and the payoffs it yields, and we show that the various diffusion mechanisms operate by altering these two parameters. Each mechanism affects one of the two parameters, and does so in distinct ways. To account for aggregate patterns of diffusion, we embed our model in a simple threshold model of diffusion. Given the high complexity of the process that results, strong analytical conclusions on aggregate patterns cannot be drawn without more extensive analysis which is beyond the scope of this article. However, preliminary considerations indicate that a wide range of diffusion processes may exist and that convergence is only one possible outcome.

Parenteral nutrition in the intensive care unit: cautious use improves outcome.

Critical illness is characterised by nutritional and metabolic disorders, resulting in increased muscle catabolism, fat-free mass loss, and hyperglycaemia. The objective of the nutritional support is to limit fat-free mass loss, which has negative consequences on clinical outcome and recovery. Early enteral nutrition is recommended by current guidelines as the first choice feeding route in ICU patients. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequently energy deficit is correlated to worsened clinical outcome. Controlled trials have demonstrated that, in case of failure or contraindications to full enteral nutrition, parenteral nutrition administration on top of insufficient enteral nutrition within the first four days after admission could improve the clinical outcome, and may attenuate fat-free mass loss. Parenteral nutrition is cautious if all-in-one solutions are used, glycaemia controlled, and overnutrition avoided. Conversely, the systematic use of parenteral nutrition in the ICU patients without clear indication is not recommended during the first 48 hours. Specific methods, such as thigh ultra-sound imaging, 3rd lumbar vertebra-targeted computerised tomography and bioimpedance electrical analysis, may be helpful in the future to monitor fat-free mass during the ICU stay. Clinical studies are warranted to demonstrate whether an optimal nutritional management during the ICU stay promotes muscle mass and function, the recovery after critical illness and reduces the overall costs.

Intégrer les proches dans l'abord des addictions aux jeux d'argent : l'expérience d'une unité spécialisée en Suisse romande

Cet article décrit les procédures de soins mises en place depuis 10 ans au Centre de jeu excessif à Lausanne pour intégrer les proches dans le traitement des addictions aux jeux d'argent. Ce bilan permet de dégager également des pistes pour améliorer cette prise en compte des proches, que ce soit au niveau de la formation ou au niveau politique. (réd.).

Grundriss innovativer Polizeiansätze. Eine kritische Begutachtung verschiedener Strategien und Tätigkeiten und deren Implementierung in der Schweiz in Theorie und Praxis.

This thesis contains three parts. The first one offers the theoretical basement, where the history of the police from their beginning in the early 19th century to this day is shown. The emphasis however is laid on the last 40 years, which gave birth to a multitude of innovations, such as community, problem-oriented, hot-spots or zero-tolerance policing. Those innovations are described in detail and are critically commented. At the end of this section, I present a scheme, where all the approaches are classified as strategic or methodic innovations, but united under a model called "modern policing". The fact that the innovations are not competitive but rather complementary is the most important finding of this examination. The second part of this work deals with a unique survey about the implementation of four innovations and eight problem- and community-oriented activities in 85 Swiss police forces. This explorative study shows that in the last 15 years the Swiss police forces have increasingly adopted innovative approaches. The most frequent innovation is community policing, which has been implemented all over the country. Due to the results, we can also assume that the implementation of the innovations is mostly substantial and profound. However, particularly in the area of problem-solving there is still a need for improvements. The third section consists of a scientific evaluation of a temporary special unit of the municipal police Zurich, which, during nine months, fought against public drug dealing and illegal prostitution in a particular neighborhood called Langstrasse. The effects of this hot-spot project were measured with police data, observations and several population surveys. In general, the special unit achieved a positive outcome and helped to defuse the hot-spot. Additionally, a survey conducted within the police department showed that the personal attitude towards the special unit differed widely between the policemen. We found significant differences between both police regions East and West, rank-and-file and higher ranking officers, different ages and the personal connection to the special unit. In fact, the higher the rank, the lower the age, and the closer the relationship, the more positive the officers were towards the unit.