Intoxications alcooliques massives aux urgences: combien, qui, quoi et comment [Massive alcoholic poisoning in the emergency department: how many, who, what and how?].

Alcohol abuse causes numerous medical and social problems. In spite of the decrease of the global consumption of alcohol per capita in Switzerland during the last years, the cases of massive alcoholic poisoning seem increasing in emergency departments. Very few data is available at the moment on this phenomenon. The present article focuses on this problem within the framework of the emergency department of the CHUV. It aims at bringing to light on the sociodemographic and medical characteristics, as well as on the characteristics of the stay of these patients who are admitted with such a problem, to have a global vision of this phenomenon.

La médecine interne generate: un terrain propice à l'exercice de l'éthique au quotidien [Everyday bioethics in general internal medicine]

The knowledge of the national legislation and the key concepts of bioethics are necessary for medical practice. The four principles of bioethics are autonomy, beneficence, non-maleficence, and justice. General internal medicine is the speciality of comprehensive care for often elderly patients with multiple chronic illnesses. This care is related to many ethically difficult decisions. In our article, we discuss common ethical problems in general internal medicine, including ethical aspects of the patient-physician relationship and medical decision making, the ethical significance of time management, research in bioethics and medical education.

Galois representations, embedding problems and modular forms

To an odd irreducible 2-dimensional complex linear representation of the absolute Galois group of the field Q of rational numbers, a modular form of weight 1 is associated (modulo Artin's conjecture on the L-series of the representation in the icosahedral case). In addition, linear liftings of 2-dimensional projective Galois representations are related to solutions of certain Galois embedding problems. In this paper we present some recent results on the existence of liftings of projective representations and on the explicit resolution of embedding problems associated to orthogonal Galois representations, and explain how these results can be used to construct modular forms.

Why Objective Monitoring of Compliance is Important in the Management of Hypertension.

Hypertensive patients often experience poor adherence to treatment, a frequent cause of uncontrolled blood pressure. In this study, we have evaluated whether or not the use of electronic monitoring for drug adherence is a useful approach to identify and correct compliance problems in hypertensive patients, which may ultimately enhance the effect of antihypertensive therapy. Sixty-nine treated patients with an office blood pressure greater than 140/90 mm Hg were enrolled in this study. With patient consent, current antihypertensive therapy was dispensed in electronic pillboxes that record the time and date of each opening without changing the drug regimen. The intention was to provide physicians with objective measurements of drug compliance. The monitoring of compliance per se without any other intervention induced a marked decrease of blood pressure in the whole group (from 159/104Â+/-23/12 mm Hg to 143/92Â+/-20/15, meansÂ+/-standard deviation, p less than 0.001). A complete normalization of blood pressure (less than 140/90 mm Hg) was obtained in one third of the patients (group 1, n=23) during the monitoring period. A significant improvement of blood pressure control was found in another third (group 2, n=23), whereas in the remaining patients (group 3, n=23) no change in blood pressure was observed. The distribution of individual compliance values, as well as the mean compliances was comparable in the three subgroups. Conversely, the compliance reports have identified several potentially overtreated patients in group 1, a large number of patients with a poor adherence to the prescribed therapy in all groups, and patients who clearly needed a change in pharmacotherapy mainly in group 3. Thus, our results suggest that electronic monitoring of compliance can considerably enhance the efficacy of antihypertensive therapy in patients with uncontrolled hypertension. This procedure should be used more extensively in clinical practice whenever the blood pressure response to therapy appears insufficient. (c)2000 by Le Jacq Communications, Inc.

Molecular analysis of the bacterial diversity in a specialized consortium for diesel oil degradation

Diesel oil is a compound derived from petroleum, consisting primarily of hydrocarbons. Poor conditions in transportation and storage of this product can contribute significantly to accidental spills causing serious ecological problems in soil and water and affecting the diversity of the microbial environment. The cloning and sequencing of the 16S rRNA gene is one of the molecular techniques that allows estimation and comparison of the microbial diversity in different environmental samples. The aim of this work was to estimate the diversity of microorganisms from the Bacteria domain in a consortium specialized in diesel oil degradation through partial sequencing of the 16S rRNA gene. After the extraction of DNA metagenomics, the material was amplified by PCR reaction using specific oligonucleotide primers for the 16S rRNA gene. The PCR products were cloned into a pGEM-T-Easy vector (Promega), and Escherichia coli was used as the host cell for recombinant DNAs. The partial clone sequencing was obtained using universal oligonucleotide primers from the vector. The genetic library obtained generated 431 clones. All the sequenced clones presented similarity to phylum Proteobacteria, with Gammaproteobacteria the most present group (49.8 % of the clones), followed by Alphaproteobacteira (44.8 %) and Betaproteobacteria (5.4 %). The Pseudomonas genus was the most abundant in the metagenomic library, followed by the Parvibaculum and the Sphingobium genus, respectively. After partial sequencing of the 16S rRNA, the diversity of the bacterial consortium was estimated using DOTUR software. When comparing these sequences to the database from the National Center for Biotechnology Information (NCBI), a strong correlation was found between the data generated by the software used and the data deposited in NCBI.

Soil and nutrient losses in erosion gullies at different degrees of restoration

The most advanced stage of water erosion, the gully, represents severe problems in different contexts, both in rural and urban environments. In the search for a stabilization of the process in a viable manner it is of utmost importance to assess the efficiency of evaluation methodologies. For this purpose, the efficiency of low-cost conservation practices were tested for the reduction of soil and nutrient losses caused by erosion from gullies in Pinheiral, state of Rio de Janeiro. The following areas were studied: gully recovered by means of physical and biological strategies; gullies in recovering stage, by means of physical strategies only, and gullies under no restoration treatment. During the summer of 2005/2006, the following data sets were collected for this study: soil classification of each of the eroded gully areas; planimetric and altimetric survey; determination of rain erosivity indexes; determination of amount of soil sediment; sediment grain size characteristics; natural amounts of nutrients Ca, Mg, K and P, as well as total C and N concentrations. The results for the three first measurements were 52.5, 20.5, and 29.0 Mg in the sediments from the gully without intervention, and of 1.0, 1.7 and 1.8 Mg from the gully with physical interventions, indicating an average reduction of 95 %. The fully recovered gully produced no sediment during the period. The data of total nutrient loss from the three gullies under investigation showed reductions of 98 % for the recovering gully, and 99 % for the fully recovered one. As for the loss of nutrients, the data indicate a nutrient loss of 1,811 kg from for the non-treated gully. The use of physical and biological interventions made it possible to reduce overall nutrient loss by more than 96 %, over the entire rainy season, as compared to the non-treated gully. Results show that the methods used were effective in reducing soil and nutrient losses from gullies.

Pharmaceutical care in an inpatient pediatric intensive care unit: an international multicentric study

Introduction Pediatric intensive care patient represent a population athigh risk for drug-related problems. Our objective is to describe drugrelated problems and intervention of four decentralized pharmacists inpediatric and cardiac intensive care unit.Materials & Methods Multicentric, descriptive and prospectivestudy over a six-month period (August 1st 2009-January 31st 2010).Drug-related problems and clinical interventions were compiled infour pediatric centers using a tool developed by the Socie´te´ Franc¸aisede Pharmacie Clinique. Data concerning patients, drugs, intervention,documentation, approval (if needed), and estimated impact werecompiled. The four pharmacists participating were from Belgium (B),France (F), Quebec (Q) and Switzerland (S).Results A total of 996 interventions were collected: 129 (13%) in B,238 (24%) in F, 278 (28%) in Q and 351 (35%) in S. These interventionstargeted 269 patients (median 22 month-old, 52% male): 69(26%) in B, 88 (33%) in F, 56 (21%) in Q and in S. These data werecollected during 28 non consecutive days in the clinical unit in B, 59days in F, 42 days in Q and 63 days in S. The main drug-relatedproblems were inappropriate administration technique (293, 29%),untreated indication (254, 25%) and supra therapeutic dosage (106,11%). The pharmacist's interventions concerned mainly administrationmode optimization (223, 22%), dose adjustment (200, 20%) andtherapeutic monitoring (164, 16%). The three major drug classesleading to interventions were anti-infectives for systemic use (233,23%) and alimentary tract and metabolism drugs (218, 22%). Interventionsconcerned mainly residents and all clinical staff (209, 21%).Among the 879 (88%) interventions requiring a physician's approval,731 (83%) were accepted. Interventions were considered as having amoderate (51%) or major (17%) clinical impact. Among the interventionsprovided, 10% were considered to have an economicalpositive impact. Differences and similarities between countries willbe presented at the poster session.Discussion & Conclusion Decentralized pharmacist at patient bedsideis a pre-requisite for pharmaceutical care. There are limitedstudies comparing the activity of clinical pharmacists betweencountries. This descriptive study illustrates the ability of clinicalpharmacist to identify and solve drug-related problems in pediatricintensive care unit in four different francophone countries.

Decay of an unstable state in the presence of multiplicative noise

The phenomenon of anomalous fluctuations associated with the decay of an unstable state is analyzed in the presence of multiplicative noise. A theory is presented and compared with a numerical simulation. Our results allow us to distinguish the roles of additive and multiplicative noise in the nonlinear relaxation process. We suggest the use of experiments on transient dynamics to understand the effect of these two sources of noise in problems in which parametric noise is thought to be important, such as dye lasers.

Application of fuzzy-rule-based postprocessing to correlation methods in pattern recognition

One of the most important problems in optical pattern recognition by correlation is the appearance of sidelobes in the correlation plane, which causes false alarms. We present a method that eliminate sidelobes of up to a given height if certain conditions are satisfied. The method can be applied to any generalized synthetic discriminant function filter and is capable of rejecting lateral peaks that are even higher than the central correlation. Satisfactory results were obtained in both computer simulations and optical implementation.

Solutions of the telegrapher's equation in the presence of traps

Several problems in the theory of photon migration in a turbid medium suggest the utility of calculating solutions of the telegrapher¿s equation in the presence of traps. This paper contains two such solutions for the one-dimensional problem, the first being for a semi-infinite line terminated by a trap, and the second being for a finite line terminated by two traps. Because solutions to the telegrapher¿s equation represent an interpolation between wavelike and diffusive phenomena, they will exhibit discontinuities even in the presence of traps.

Altered brain mechanisms of emotion processing in pre-manifest Huntington's disease.

Huntington's disease is an inherited neurodegenerative disease that causes motor, cognitive and psychiatric impairment, including an early decline in ability to recognize emotional states in others. The pathophysiology underlying the earliest manifestations of the disease is not fully understood; the objective of our study was to clarify this. We used functional magnetic resonance imaging to investigate changes in brain mechanisms of emotion recognition in pre-manifest carriers of the abnormal Huntington's disease gene (subjects with pre-manifest Huntington's disease): 16 subjects with pre-manifest Huntington's disease and 14 control subjects underwent 1.5 tesla magnetic resonance scanning while viewing pictures of facial expressions from the Ekman and Friesen series. Disgust, anger and happiness were chosen as emotions of interest. Disgust is the emotion in which recognition deficits have most commonly been detected in Huntington's disease; anger is the emotion in which impaired recognition was detected in the largest behavioural study of emotion recognition in pre-manifest Huntington's disease to date; and happiness is a positive emotion to contrast with disgust and anger. Ekman facial expressions were also used to quantify emotion recognition accuracy outside the scanner and structural magnetic resonance imaging with voxel-based morphometry was used to assess the relationship between emotion recognition accuracy and regional grey matter volume. Emotion processing in pre-manifest Huntington's disease was associated with reduced neural activity for all three emotions in partially separable functional networks. Furthermore, the Huntington's disease-associated modulation of disgust and happiness processing was negatively correlated with genetic markers of pre-manifest disease progression in distributed, largely extrastriatal networks. The modulated disgust network included insulae, cingulate cortices, pre- and postcentral gyri, precunei, cunei, bilateral putamena, right pallidum, right thalamus, cerebellum, middle frontal, middle occipital, right superior and left inferior temporal gyri, and left superior parietal lobule. The modulated happiness network included postcentral gyri, left caudate, right cingulate cortex, right superior and inferior parietal lobules, and right superior frontal, middle temporal, middle occipital and precentral gyri. These effects were not driven merely by striatal dysfunction. We did not find equivalent associations between brain structure and emotion recognition, and the pre-manifest Huntington's disease cohort did not have a behavioural deficit in out-of-scanner emotion recognition relative to controls. In addition, we found increased neural activity in the pre-manifest subjects in response to all three emotions in frontal regions, predominantly in the middle frontal gyri. Overall, these findings suggest that pathophysiological effects of Huntington's disease may precede the development of overt clinical symptoms and detectable cerebral atrophy.

Cannabis Dependence in Swiss Adolescents Exploration of the Role of Anxiety, Coping Styles, and Psychosocial Difficulties

This naturalistic cross-sectional study explores how and to what extent cannabis dependence was associated with intrapersonal aspects (anxiety, coping styles) and interpersonal aspects of adolescent functioning (school status, family relationships, peer relationships, social life). A convenience sample of 110 adolescents (aged 12 to 19) was recruited and subdivided into two groups (38 with a cannabis dependence and 72 nondependent) according to DSM-IV-TR criteria for cannabis dependence. Participants completed the State-Trait Anxiety Inventory (STAI-Y), the Coping Across Situations Questionnaire (CASQ), and the Adolescent Drug Abuse Diagnosis (ADAD) interview investigating psychosocial and interpersonal problems in an adolescent's life. Factors associated with cannabis dependence were explored with logistic regression analyses. The results indicated that severity of problems in social life and peer relationships (OR = 1.68, 95% CI = 1.21 - 2.33) and avoidant coping (OR = 4.22, 95% CI = 1.01 - 17.73) were the only discriminatory factors for cannabis dependence. This model correctly classified 84.5% of the adolescents. These findings are partially consistent with the "self-medication hypothesis" and underlined the importance of peer relationships and dysfunctional coping strategies in cannabis dependence in adolescence. Limitations of the study and implications for clinical work with adolescents are discussed.

High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations.

Because of the development of modern transportation facilities, an ever rising number of individuals including many patients with preexisting diseases visit high-altitude locations (>2500 m). High-altitude exposure triggers a series of physiologic responses intended to maintain an adequate tissue oxygenation. Even in normal subjects, there is enormous interindividual variability in these responses that may be further amplified by environmental factors such as cold temperature, low humidity, exercise, and stress. These adaptive mechanisms, although generally tolerated by most healthy subjects, may induce major problems in patients with preexisting cardiovascular diseases in which the functional reserves are already limited. Preexposure assessment of patients helps to minimize risk and detect contraindications to high-altitude exposure. Moreover, the great variability and nonpredictability of the adaptive response should encourage physicians counseling such patients to adapt a cautionary approach. Here, we will briefly review how high-altitude adjustments may interfere with and aggravate/decompensate preexisting cardiovascular diseases. Moreover, we will provide practical recommendations on how to investigate and counsel patients with cardiovascular disease desiring to travel to high-altitude locations.

Stage of change of cigarette smoking in alcohol-dependent patients.

Despite the heavy burden of tobacco-related problems in alcohol-dependent patients, little effort has been directed toward reducing the prevalence of smoking in these patients. It seems reasonable to develop nicotine addiction treatments for alcohol-dependent patients based on the smoker's stage of change. To assess the stage of change for tobacco consumption and possible quitting barriers in alcohol-dependent patients, 88 consecutively admitted inpatients of a Swiss university-affiliated alcohol withdrawal clinic were interviewed with a semistructured schedule. More than half of the alcohol-dependent smokers (50.7%) considered the possibility of smoking cessation or had already decided to stop, although the majority (83.1%) were highly dependent smokers. Positive reinforcers were factors influencing motivation both to stop smoking as well as to continue smoking, whereas negative reinforcers had no influence. As recovering alcoholic patients are often interested in smoking cessation and the introduction of nicotine treatment interventions has been shown not to jeopardize the outcome of alcohol treatment, alcohol treatment programs should include counseling for smoking cessation. Education and training for staff is essential, as their beliefs and habits remain an important barrier.

Contribution to the conservation biology of the wood ant Formica lugubris (Hymenoptera, Formicidae) in Switzerland

Summary Among ants, wood ants are probably the most fascinating and studied species in temperate European forests. Unfortunately, due to several threats they are nowadays registered in red lists. Recent studies made in the Swiss Jura Mountains ended up in the description of a new sympatric sibling species of Formica lugubris (i.e. Formica paralugubris Seifert 1996). Because of this confusion the biology of F. lugubris is incomplete. Due to the extreme difficulties to distinguish morphologically F. lugubris from F. paralugubris we studied their cuticular hydrocarbons profiles. Irrespective of their geographic origin, we observed quantitative discrimination between species within each caste (workers, males and gynes =young alate female). Moreover, using a behavioural taxonomic approach (i.e. the pupa-carrying test) we showed that ants preferred conspecific worker pupae to those of the sibling species. These first results allowed us to consider the two species as two separate taxonomic units. To understand their coexistence, habitat distribution models were fitted with GIS predictors and factors known to influence wood ant distribution. In the Jura Mountains, although the two species share very similar habitats, they are spatially segregated. F. lugubris occurs more frequently at woodland borders than in forest interiors. We demonstrated with genetic and field data that Formica lugubris displays two different social forms in close proximity in alpine zone (e.g. unmanaged forests of the Swiss National Park). We discovered populations mostly monogynous to weakly polygynous (i.e. one to a few egg laying queens per colony) and monodomous (i.e. one nest per colony), and polygynous/polydomous populations (new nests being founded by colony budding). It is generally admitted that monogyne species disperse well in order to find suitable habitat to found new colonies whereas polygyne species have restricted dispersal and local mating within the nest. In order to compare reproductive strategies of F. lugubris and F. paralugubris (i.e. matings and dealation process) we conducted experiments with sexuals. F, lugubris gynes from monogynous/monodomous populations do not show a local strategy like the obligately polygynous F. paralugubris (i.e. early dealation even without mating, insemination without flight activity and low fat reserve). They always keep their wings, do not mate when not able to fly and have high amount of fat content revealing high survival capacities. On the other side, F, lugubris gynes from polygynous/polydomous populations have lower lipid reserves and displayed a reproductive behaviour close to the F. para lugubris one. After dispersal, wood ant gynes can either start new societies by temporary social parasitism of another species (i.e. subgenus Serviformica) or be adopted intraspecifically in an existing nest. In F. lugubris, we demonstrated that gynes from monogynous/monodomous colonies showed a high success for temporary social parasitism compare to the lower success of gynes from polygynous/polydomous colonies. However, physiological analyses suggested that only gynes from monogynous/ monodomous populations can efficiently disperse and found new nest by temporary social parasitism. Intraspecifically, gynes were accepted to a high degree in polygynous nest and in monogynous nests as long as these nests contained sexuals. In conclusion, Formica lugubris displays a social and dispersal polymorphism (mixed mating and founding system) representing a behavioural plasticity in relation to environmental and ecological conditions. Therefore, conservation measures directed toward this species should try to maintain a maximum of diversity at the habitat level. Résumé Les fourmis des bois sont probablement parmi les espèces de fourmis les plus fascinantes et les plus étudiées des forêts tempérées Européennes. Actuellement, du fait de différentes menaces, elles figurent malheureusement sur listes rouges. Plusieurs études menées au sein du Jura Suisse ont abouti à la description d'une nouvelle espèce jumelle et sympatrique de Formica lugubris (F. para- lugubris Seifert 1996). A cause de cette confusion la biologie de F lugubris est lacunaire. La distinction morphologique de F. lugubris et de F. para lugubris est si difficile que nous avons étudié leurs hydrocarbures cuticulaires. Indépendamment de l'origine géographique, nous avons observé une discrimination quantitative entre les espèces au sein de chaque caste (ouvrières, mâles et jeunes femelles ailées). De plus, à l'aide d'une approche taxonomique comportementale (le test de transport de cocons) nous avons montré que les fourmis préfèrent des cocons d'ouvrières conspécifiques à ceux de l'espèce jumelle. Ces premiers résultats nous permettent de considérer ces deux espèces comme deux unités taxonomiques distinctes et valables. Afin de comprendre leur coexistence, des modèles mathématiques ont été développés avec des données SIG et des facteurs écologiques influençant la répartition des fournis des bois. Dans le Jura, même si elles partagent des habitats fortement similaires, les deux espèces n'occupent pas les mêmes secteurs. F. lugubris est plus fréquente en lisière forestière plutôt qu'en pleine forêt. Nous avons démontré grâce à des données génétiques et de terrain que F. lugubris présente deux formes sociales au sein de la zone alpine (forêts protégées du Parc National Suisse). D'autre part, nous avons découvert des populations monogynes à faiblement polygynes (une à quelques reines pondeuses par colonie) et monodomes (colonies composées d'une seule fourmilière), et des populations polygynes/polydomes (les nouveaux nids étant produit par bourgeonnement). Généralement, les espèces monogynes dispersent sur de grandes distances et peuvent coloniser des habitats favorables à la fondation de nouvelles colonies alors que les espèces polygynes possèdent une dispersion limitée avec des accouplements à l'intérieur des nids. Afin de comparer les stratégies de reproduction de F. lugubris et de F. paralugubris (accouplements et perte des ailes) nous avons mené des expériences avec les sexués. Les jeunes femelles ailées de F. lugubris issues de populations monogynes/monodomes ne présentent pas de stratégie locale comparée à l'espèce obligatoirement polygyne F paralugubris (perte des ailes précoce même si il n'y a pas eu accouplement, insémination possible sans avoir volé activement et faibles réserves de graisse). Elles conservent toujours leurs ailes, ne s'accouplent pas lorsqu'elles sont empêchées de voler et possèdent de grandes quantités de graisse révélant de fortes capacités de survie. D'autre part, les jeunes femelles ailées de F. lugubris provenant de populations polygynes/polydomes ont peu de réserves lipidiques et ont un comportement de reproduction proche de celles de F. paralugubris. Après leur dispersion, les jeunes sexués femelles de fourmis des bois peuvent soit fonder une nouvelle société par parasitisme social temporaire d'un nid d'une autre espèce (sous-genre Serviformica) soit être adoptées dans un nid déjà existant de leur propre espèce. Chez F. lugubris, nous avons pu démontrer que les jeunes sexués femelles de colonies monogynes/monodomes présentent un succès élevé au parasitisme sociale temporaire en comparaison au plus faible succès obtenu avec des sexués provenant de colonies polygynes/polydomes. Cependant, les données physiologiques suggèrent que seules les jeunes sexués femelles de populations mono-gynes/monodomes peuvent disperser efficacement et fonder un nouveau nid par parasitisme social temporaire. Au niveau intraspécifique, les jeunes femelles sont acceptées à un taux élevé dans les nids polygynes mais aussi dans les nids monogynes tant que ces nids possèdent encore de jeunes sexués. En conclusion, F. lugubris est caractérisée par un polymorphisme dans ses structures sociales et ses stratégies de dispersion (système mixte d'accouplement et de fondation) ce qui représente une forte plasticité comportementale en relation avec les conditions environnementales et écologiques. Par conséquent, les mesures de conservation de cette espèce devraient s'attacher à maintenir un maximum de diversité au niveau des habitats.