Clinical microbiologists facing an anthrax alert.

Microbiological war and terrorist attacks are made to weaken populations by transmitting pathogenic and epidemic microorganisms. These bacteria or viruses are often difficult to diagnose. Anthrax alerts following September 2001 showed that most clinical microbiology laboratories were not adequately prepared, using obsolete diagnostic methods or being too slow to use accurate tools when facing a major threat. Following this period, most microbiology laboratories were prepared for bioterrorism alerts, in order to provide accurate and rapid results, although such events are rare and unexpected. In this review, we describe the organization and preparedness of our clinical microbiology laboratory regarding bioterrorism risk, although its main task is to perform routine diagnostic microbiology tests. To illustrate the difficulties, we briefly describe an anthrax alert.

Neurobiologia, coscienza e neuroetica. Ricerche filosofiche in margine al dialogo tra G.P. CHANGEUX e P. RICOEUR

Le neuroscienze occupano oggi un ruolo essenziale nel dibattito scientifico e filosofico, nonché in quello delle scienze umane. Esse costituiscono la sfida più seria al sapere fin qui elaborato intorno ai fondamenti dell'esperienza di coscienza, poiché si propongono come capaci di rispondere alla domanda di origine e funzionamento della coscienza. Le neuroscienze cognitive stanno, oggi, rivoluzionando la nostra concezione della mente e delle sue funzioni. Ci forniscono nuovi dati sulla natura delle sensazioni, della memoria, della percezione e dei processi di astrazione. L'epistemologia è rientrata così pienamente nell'ambito di una disciplina sperimentale, come diversi filosofi (da Hume a Quine) hanno auspicato. È, alla fine, evoluta nell'esperienza odierna della cosiddetta "epistemologia sperimentale", luogo che coniuga il rigore sperimentale della scienza con la profondità e la sofisticazione argomentativa della tradizione filosofica. Come arriviamo a conoscere? Quali vincoli poniamo a quello che deve essere conosciuto? Perché seguiamo certe vie invece di altre? Come arriviamo a formulare giudizi e a prendere decisioni? Che valore ha la conoscenza già acquisita nell'elaborazione di nuove esperienze? In particolare, che peso hanno le aspettative e i ricordi in questo processo? Qual è il rapporto fra esperienza, conoscenza e memoria? Come si fissano e come si richiamano i ricordi? Qual è il rapporto fra coscienza e memoria? Sono alcune delle domande che l'autore si pone in questa ottica e alle quali cerca di rispondere, a partire dall'analisi e valutazione del dialogo-dibattito fra J.-P. Changeux e P. Ricoeur, per apprenderne il linguaggio, capire i problemi sollevati, adattarsi alla complessità della materia. Nel contesto della filosofia della mente, la "lettura" della discussione ripercorre i relativi percorsi attraverso l'analisi delle loro opere, da un lato quelle dello scienziato (sulla struttura e dinamica del cervello, la teoria dell'epigenesi e stabilizzazione selettiva, le speculazioni sull'uomo neuronale e i rilievi antropologici, le teorie della conoscenza e della coscienza, oltre che sulla conoscenza matematica, gli argomenti di estetica ed etica); dall'altro lato quelle del filosofo (dal Cogito riflessivo alla scoperta dell'ermeneutica, dalle eterogenee riflessioni sul Conflitto delle interpretazioni alla grande teoria sulla creatività del linguaggio, le conclusioni teoriche sull'ermeneutica del sé e l'ontologia dell'agire). Il punto di arrivo è la determinazione delle relative posizioni: quella di Changeux tra i neuroscienziati che si occupano di questioni filosofiche, epistemologiche ed etiche, e quella di Ricoeur tra i filosofi che si occupano di neuroscienze. La conclusione della tesi si svolge in un approfondimento teoretico che dalla nozione di "traccia" porta all'esperienza della "memoria", al fine di intrecciare i fili della discussione ripercorsa ed offrire una sponda non forzata al dibattito più ampio. Il tema della memoria è privilegiato per ragioni intrinseche, poiché si tratta di uno dei temi precipui delle neuroscienze, della filosofia della mente e della fenomenologia. A un primo livello viene instaurato su questo punto un confronto epistemologico tra la proposta della neurofenomenologia (Varala, ad esempio) e la posizione tenuta in particolare da Ricoeur rispetto ad essa e al suo "progetto unificante", posizione defilata e, per certi aspetti, criticamente dubbiosa sul fatto che si possa davvero giungere a un "terzo discorso". Si riferisce poi del largo interesse e dei risultati più significativi della riflessione fenomenologica antica e moderna sulla memoria. A un secondo livello vengono illustrati i programmi di ricerca recenti della neurofenomenologia su questo argomento all'interno delle scienze cognitive e si dà conto dei risultati più significativi. Ad un terzo e conclusivo livello, si approfondisce il significato teologico della memoria. Les neurosciences ont aujourd'hui un rôle essentiel dans le débat scientifique et philosophique, ainsi que dans celui des sciences humaines. Elles constituent le défi le plus sérieux aux savoir qu'on a construit jusqu'ici sur les fondements de l'expérience de conscience, attendu qu'elles-mêmes se considèrent capables de répondre à la demande sur l'origine e le fonctionnement de la conscience. Les neurosciences cognitives sont aujourd'hui en train de révolutionner notre conception de l'esprit et des ses fonctions. Elles nous offrent des nouvelles données au sujet de la nature de nos sensations, mémoire, perception et procédés d'abstraction. Aussi l'épistémologie est rentrée pleinement dans le domaine d'une discipline expérimentale, comme plusieurs philosophes (de Hume à Quine) l'ont souhaité. Elle s'est enfin adressée, dans l'expérience actuelle, vers la soi-disant "épistémologie expérimentale", lieu qui met en accord la rigueur expérimentale de la science avec la profondeur et la sophistiquée finesse argumentative de la tradition philosophique. Comment en arrivons-nous à connaître? Quels liens mettons-nous à ce qu'on doit être connu? Pourquoi suivons-nous certaines vois au lieu d'autres? Comment en arrivons-nous à formuler des opinions et à prendre des décisions? Quelle valeur a la connaissance qu'on a déjà acquise par l'élaboration des nouvelles expériences? En particulier, quelle est l'importance des attentes et des souvenirs dans cette évolution? Quel est le rapport entre expérience, connaissance e mémoire? Comment fixons et rappelons-nous nos souvenirs? Quel est le rapport entre conscience et mémoire? Ces sont quelques-unes des questions que l'auteur se pose dans cette perspective et aux quelles essaie de répondre a partir de l'analyse et l'évaluation du dialogue-débat entre fra J.-P. Changeux et P. Ricoeur, pour en apprendre le langage, comprendre les problèmes soulevés, s'adapter à la complexité du sujet. Dans le contexte de la philosophie du cerveau, la "lecture" du dialogue reparcourt les parcours des deux interlocuteurs par l'analyse de leur ouvrages, d'une part celles du savant (sur la structure et la dynamique du cerveau, la théorie de l'épigenèse et stabilisation sélective; les spéculations sur l'homme neuronal et les commentaires anthropologiques; les théories de la connaissance et de la conscience, de même que sur la connaissance de la mathématique, les sujets d'esthétique et étique; d'autre part celles du philosophe (du Cogito réflexif à la découverte de l'herméneutique, de les hétérogènes réflexions sur le Conflit des interprétations à la grande théorie sur la créativité du langage, les conclusions théoriques sur l'herméneutique du soi et l'ontologie de l'agir). L'issue est la determination des relatives positions: celle de Changeux parmi les neuro-scientifiques qui s'occupent de questions philosophiques, épistémologiques et éthiques, et celle de Ricoeur parmi les philosophes qui s'occupent de neurosciences. La conclusion de la thèse se développe dans un approfondissement théorétique que de la notion de "trace" à l'expérience de la "mémoire", à l'effet de nouer les fils de la discussion passée en revue et d'assurer un appui pas forcé au débat plus vaste. Le thème de la mémoire a été choisi pour des raisons intrinsèques, puisqu'il est un des thèmes principaux des neurosciences, de la philosophie de l'esprit et de la phénoménologie. Sur un premier plan épistémologique il est établi une comparaison entre la proposition de la neurophénoménologie (Varala, par exemple) et la position soutenue en particulier par Ricoeur au sujet de ce courant phénoménologique et de son "projet unifiant", position défilée et, à certains égards, critiquement hésitante sur le fait qu'on puisse vraiment en venir à un "troisième discours". On rend compte du grand intérêt et des résultats les plus significatifs de la réflexion phénoménologique ancienne et moderne sur la mémoire. Sur un second plan neurophénoménologique on illustre des plans de recherche récents sur cet argument au-dedans des sciences cognitives et on rend compte des résultats les plus distinctives. Sur un troisième et conclusif plan on approfondit le sens théologique de la mémoire.

Assessment of the in vitro synergy of daptomycin plus linezolid against multidrug-resistant enterococci

The widespread incidence of enterococci resistant to ampicillin, vancomycin and aminoglycosides, the first-line anti-enterococcal antibiotics, has made the treatment of severe enterococcal infections difficult and alternatives should be explored. We investigated the activity of daptomycin combined with linezolid against three Enterococcus faecalis and four Enterococcus faecium strains resistant to standard drugs used for therapy. Minimum inhibitory concentrations (MICs) were determined by the broth dilution method. Drug interactions were assessed by the checkerboard and time-kill methods. Synergy was defined by a fractional inhibitory concentration index (FICI) of ≤0.5 or a ≥2 log10 CFU/mL killing at 24 h with the combination in comparison with killing by the most active single agent. Indifference was defined by a FICI > 0.5-4.0 or a 1-2 log10 CFU/mL killing compared with the most active single agent. MICs of daptomycin were 2-4 μg/mL for E. faecalis and 2-8 μg/mL for E. faecium. MICs of linezolid were 1-2 μg/mL for all bacteria. In the checkerboard assay, five isolates showed synergism (FICI < 0.5) and two showed indifference (FICIs of 0.53 and 2). Killing studies revealed synergy of daptomycin plus linezolid against four isolates (2.2-3.7 log10 CFU/mL kill) and indifference (1.1-1.6 log10 CFU/mL kill) for the other three strains. Antagonism was not observed. In conclusion, the combination of daptomycin and linezolid had a synergistic or indifferent effect against multidrug-resistant enterococci. Additional studies are needed to explore the potential of this combination for severe enterococcal infections when first-line antibiotic combinations cannot be used.

Evolutionary branching in deme-structured populations.

Adaptive dynamics shows that a continuous trait under frequency dependent selection may first converge to a singular point followed by spontaneous transition from a unimodal trait distribution into a bimodal one, which is called "evolutionary branching". Here, we study evolutionary branching in a deme-structured population by constructing a quantitative genetic model for the trait variance dynamics, which allows us to obtain an analytic condition for evolutionary branching. This is first shown to agree with previous conditions for branching expressed in terms of relatedness between interacting individuals within demes and obtained from mutant-resident systems. We then show this branching condition can be markedly simplified when the evolving trait affect fecundity and/or survival, as opposed to affecting population structure, which would occur in the case of the evolution of dispersal. As an application of our model, we evaluate the threshold migration rate below which evolutionary branching cannot occur in a pairwise interaction game. This agrees very well with the individual-based simulation results.

Biology and pathogenicity of "Waddlia chondrophila"

Abstract This thesis investigates the pathogenicity of a Chlamydia-related bacterium: Waddlia chondrophila, which is suspected to cause abortion in bovines as well as miscarriages in humans. Macrophages represent the first line of defense of the innate immunity against invading pathogens, we thus studied the interaction between W. chondrophila and human macrophages. We observed that W. chondrophila multiplied very efficiently inside monocyte-derived macrophages. Diagnostic tools to detect obligate intracellular bacteria are lacking so we developed a Waddlia specific real-time PCR based on the 16S rRNA encoding gene. Since W. chondrophila could be involved in human miscarriage, we analyzed samples from women having miscarriage or uneventful pregnancy. Waddlia serologies results confirmed an association between the presence of W. chondrophila antibodies and miscarriage (23.2% versus 14.6% in the control group, p-value 0.044). As W. chondrophila's pathogenicity was suggested, we studied its antibiotic susceptibility. W. chondrophila revealed to be susceptible to macrolides and tetracylines but resistant to beta-lactams and fluoroquinolones. This resistance to fluoroquinolones could be explained by mutations in the quinolone resistance determining region of the gyrase (GyrA) and topoisomerase IV (ParC) encoding genes. In conclusion, this thesis allowed to precise the role of W. chondrophila in human miscarriage. However, more studies will be necessary to fully understand the pathogenesis of W. chondrophila in adverse pregnancy outcomes. Résumé Le but de cette thèse a été d'étudier la pathogénicité d'une bactérie apparentée aux Chlamydia: Waddlia chondrophila. Les macrophages représentant la première ligne de défense du système immunitaire inné contre les pathogènes, nous avons d'abord étudié l'interaction entre W. chondrophila and les macrophages humains. Nous avons pu observer que W. chondrophila résistait aux effecteurs microbicides des macrophages et se multipliait efficacement au sein de ces cellules. Au vu du manque d'outils diagnostiques pour détecter cette bactérie intracellulaire obligatoire, nous avons également développé une PCR en temps réel, spécifique pour Waddlia, basée sur le gène de l'ARN ribosomal 16S. Cette PCR a été utilisée dans les différents projets afin de détecter la présence de W. chondrophila. W. chondrophila étant suspectée de pouvoir causer des fausses couches chez la femme, nous avons analysé des échantillons provenant de femmes ayant souffert de fausse couche, ainsi que, comme contrôles, des femmes ayant eu une grossesse normale. Les sérologies ont révélé une association entre la présence d'anticorps dirigés contre Waddlia et la fausse couche (23.2% versus 14.6% chez les contrôles, p-value=0.044). La présence de la bactérie a aussi été détectée par PCR et immunohistochimie dans plusieurs échantillons. L'implication de W. chondrophila dans la fausse couche se précisant, nous avons étudié sa susceptibilité aux antibiotiques. W. chondrophila s'est révélée sensible aux macrolides et aux tetracyclines mais résistante aux beta-lactames et aux quinolones. Cette résistance aux quinolones peut être expliquée par la présence de mutations dans le QRDR (région déterminant la résistance aux quinolones) des gènes gyrA et parC. En conclusion, cette thèse a permis de préciser l'implication de W. chondrophila dans la fausse couche. Des études complémentaires seront cependant nécessaires pour confirmer et préciser le rôle exact de W. chondrophila dans les problèmes obstétricaux.

School Choice and Student Screening in the Chilean Educational System: Who Chooses Whom?. The Case of the Catholic Education

The student´s screening made by schools corresponds to a regulatory mechanism for school inclusion and exclusion that normally overlaps the parental expectations of school choice. Based in "Parents survey 2006" data (n=188.073) generated by the Chilean Educational Ministry, this paper describe the parents reasons for choosing their children's school, and school´s criteria for screening students. It concludes that the catholic schools are the most selective institutions and usually exceed the capacity of parental choice. One of the reasons to select students would be the direct relationship between this practice and increasing the average score on the test of the Chilean Educational Quality Measurement System (SIMCE).

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.).

Between Equity and Differentiation: An Analytical Schema of the Social Function of Education

The educational sphere has an internal function relatively agreed by social scientists. Nonetheless, the contribution that educational systems provide to the society (i.e., their social function) does not have the same degree of consensus. Taking into consideration such theoretical precedent, the current article raises an analytical schema to grasp the social function of education considering a sociological perspective. Starting from the assumption that there is an intrinsic relationship between the internal and social functions of social systems, we suggest there are particular stratification determinants modifying the internal pedagogical function of education, which impact on its social function by creating simultaneous conditions of equity and differentiation. Throughout the paper this social function is considered a paradoxical mechanism. We highlight how this paradoxical dynamic is deployed in different structural levels of the educational sphere. Additionally, we discuss eventual consequences of this paradoxical social function for the inclusion possibilities that educational systems offer to individuals.

Metacognitive training for schizophrenia: a multicentre randomised controlled trial.

A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning.