Transferts des détenus des prisons vaudoises aux urgences du CHUV

Contexte L'exercice de la médecine en milieu carcéral dans le canton de Vaud est assuré par le Service de Médecine et de Psychiatrie Pénitentiaires (SMPP). La population carcérale est d'environ 720 détenus repartis dans 5 établissements, certains surpeuplés, dont le plus éloigné du CHUV se trouve à 30 kilomètres. Le SMPP assure une prise en charge générale et organise près de 700 consultations spécialisées par année, principalement au CHUV. La prise en charge des urgences dans ces prisons donne lieu à de nombreux transferts au service des urgences du CHUV. Ceux-là augmentent le temps de prise en charge, sont extrêmement coûteux, ils sont risqués du point de vue sécuritaire et souvent désagréables pour la population carcérale, reconnue comme vulnérable du point de vue sanitaire. Les affections psychiatriques, maladies infectieuses et cardiovasculaires sont effectivement très fréquentes. De plus, les transferts représentent également une charge de travail non négligeable pour les urgences qui ne sont, a priori, pas entièrement préparées à soigner ce type de population. Objectif Nous avons souhaité définir si les transferts de 2011 à 2013 étaient ou non justifiés selon la nature de ceux-ci et les prises en charge possibles relatées dans la littérature. Méthodologie Tout d'abord, le travail a nécessité une prise de connaissance du monde carcéral vaudois et de l'organisation des soins en prison qui sont régis par le SMPP. Ensuite, on s'est penché sur la littérature concernant les spécificités de la prise en charge des urgences en milieu carcéral. Une partie importante de ce travail est l'étude rétrospective des dossiers des patients transférés aux urgences depuis les 5 prisons du canton de Vaud des années 2011 à 2013. Les variables observées sont les motifs de transfert, leur gravité selon l'Échelle Suisse du Tri, les types d'examens effectués aux urgences, les heures d'arrivée et les durées d'hospitalisation. Principaux résultats Il y a en moyenne 224 transferts par année et ils sont en constante augmentation depuis 2011. La principale cause de transfert sur les 3 années est l'ingestion de corps étrangers, représentant 16,2% du total des patients transférés. Les autres causes souvent retrouvées sont les tentamens, les abus médicamenteux et les douleurs abdominales. Plus de 50% des transferts sont classés en degrés d'urgence 3 (situation semi-urgente) selon l'Échelle Suisse du Tri. Moins de 10% sont non-urgents selon la même échelle. La durée moyenne de séjour aux urgences est deux fois plus longue que pour les patients « standards » et 70% des transferts ne débouchent que sur des examens « simples », soient des radiographies, examens de laboratoire et électrocardiogrammes. Conclusion Il apparaît qu'en regard des différentes variables observées, ces transferts sont, en l'état actuel et pour la large majorité, justifiés. Les différents motifs de transferts sont difficilement comparables avec la littérature, étant donnée la répartition choisie, mais néanmoins semblables. Si les transferts sont pour la plupart justifiés, ils ne seraient pas inévitables dans un contexte différent. Ainsi, on entrevoit dans ce travail plusieurs pistes d'amélioration de prise en charge qui sont le renforcement du travail de prévention, la télémédecine et l'aménagement d'outils diagnostiques en prison

Tracking and predicting U.S. influenza activity with a real-time surveillance network

Each year in the United States, influenza causes illness in 9.2 to 35.6 million individuals and is responsible for 12,000 to 56,000 deaths. The U.S. Centers for Disease Control and Prevention (CDC) tracks influenza activity through a national surveillance network. These data are only available after a delay of 1 to 2 weeks, and thus influenza epidemiologists and transmission modelers have explored the use of other data sources to produce more timely estimates and predictions of influenza activity. We evaluated whether data collected from a national commercial network of influenza diagnostic machines could produce valid estimates of the current burden and help to predict influenza trends in the United States. Quidel Corporation provided us with de-identified influenza test results transmitted in real-time from a national network of influenza test machines called the Influenza Test System (ITS). We used this ITS dataset to estimate and predict influenza-like illness (ILI) activity in the United States over the 2015-2016 and 2016-2017 influenza seasons. First, we developed linear logistic models on national and regional geographic scales that accurately estimated two CDC influenza metrics: the proportion of influenza test results that are positive and the proportion of physician visits that are ILI-related. We then used our estimated ILI-related proportion of physician visits in transmission models to produce improved predictions of influenza trends in the United States at both the regional and national scale. These findings suggest that ITS can be leveraged to improve "nowcasts" and short-term forecasts of U.S. influenza activity

Comparison in the immunological properties of Borrelia burgdorferi isolates from Ixodes ricinus derived from three endemic areas in Switzerland

Borrelia burgdorferi isolates were obtained from Ixodes ricinus from three sites in Switzerland. They were examined by SDS-PAGE and immunoblotting. The phenotypes, in respect of three outer surface proteins (Osp), differed between the sites of collection. In site 1, most isolates had an OspA of 31 kDa and an OspB of 34 kDa: in site 2, isolates presenting an OspA of 33 kDa dominated and in site 3, the isolates with an OspA of 32 kDa and an OspB of 35 kDa were most frequent. This distribution differed significantly. About half of the isolates from sites 1 and 3 reacted with anti-OspA monoclonal antibody H5332 compared to 29% from site 2. Site 1 isolates reacted significantly more frequently (81 %) with another anti-OspA monoclonal antibody LA-31 than isolates from site 3 (P < 0·0001). These findings have implications for the epidemiology of Lyme borreliosis, for the further development of serodiagnostic reagents and for the development of a vaccin

Chromatin: a tunable spring at work inside chromosomes

This paper focuses on mechanical aspects of chromatin biological functioning. Within a basic geometric modeling of the chromatin assembly, we give for the first time the complete set of elastic constants (twist and bend persistence lengths, stretch modulus and twist-stretch coupling constant) of the so-called 30-nm chromatin fiber, in terms of DNA elastic properties and geometric properties of the fiber assembly. The computation naturally embeds the fiber within a current analytical model known as the ``extensible worm-like rope'', allowing a straightforward prediction of the force-extension curves. We show that these elastic constants are strongly sensitive to the linker length, up to 1 bp, or equivalently to its twist, and might locally reach very low values, yielding a highly flexible and extensible domain in the fiber. In particular, the twist-stretch coupling constant, reflecting the chirality of the chromatin fiber, exhibits steep variations and sign changes when the linker length is varied. We argue that this tunable elasticity might be a key feature for chromatin function, for instance in the initiation and regulation of transcription.Comment: 38 pages 15 figure

The Vitamin A Derivative All-Trans Retinoic Acid Repairs Amyloid-β-Induced Double-Strand Breaks in Neural Cells and in the Murine Neocortex.

The amyloid-β peptide or Aβ is the key player in the amyloid-cascade hypothesis of Alzheimer's disease. Aβ appears to trigger cell death but also production of double-strand breaks (DSBs) in aging and Alzheimer's disease. All-trans retinoic acid (RA), a derivative of vitamin A, was already known for its neuroprotective effects against the amyloid cascade. It diminishes, for instance, the production of Aβ peptides and their oligomerisation. In the present work we investigated the possible implication of RA receptor (RAR) in repair of Aβ-induced DSBs. We demonstrated that RA, as well as RAR agonist Am80, but not AGN 193109 antagonist, repair Aβ-induced DSBs in SH-SY5Y cells and an astrocytic cell line as well as in the murine cortical tissue of young and aged mice. The nonhomologous end joining pathway and the Ataxia Telangiectasia Mutated kinase were shown to be involved in RA-mediated DSBs repair in the SH-SY5Y cells. Our data suggest that RA, besides increasing cell viability in the cortex of young and even of aged mice, might also result in targeted DNA repair of genes important for cell or synaptic maintenance. This phenomenon would remain functional up to a point when Aβ increase and RA decrease probably lead to a pathological state

Single-molecule experiments in biological physics: methods and applications

I review single-molecule experiments (SME) in biological physics. Recent technological developments have provided the tools to design and build scientific instruments of high enough sensitivity and precision to manipulate and visualize individual molecules and measure microscopic forces. Using SME it is possible to: manipulate molecules one at a time and measure distributions describing molecular properties; characterize the kinetics of biomolecular reactions and; detect molecular intermediates. SME provide the additional information about thermodynamics and kinetics of biomolecular processes. This complements information obtained in traditional bulk assays. In SME it is also possible to measure small energies and detect large Brownian deviations in biomolecular reactions, thereby offering new methods and systems to scrutinize the basic foundations of statistical mechanics. This review is written at a very introductory level emphasizing the importance of SME to scientists interested in knowing the common playground of ideas and the interdisciplinary topics accessible by these techniques. The review discusses SME from an experimental perspective, first exposing the most common experimental methodologies and later presenting various molecular systems where such techniques have been applied. I briefly discuss experimental techniques such as atomic-force microscopy (AFM), laser optical tweezers (LOT), magnetic tweezers (MT), biomembrane force probe (BFP) and single-molecule fluorescence (SMF). I then present several applications of SME to the study of nucleic acids (DNA, RNA and DNA condensation), proteins (protein-protein interactions, protein folding and molecular motors). Finally, I discuss applications of SME to the study of the nonequilibrium thermodynamics of small systems and the experimental verification of fluctuation theorems. I conclude with a discussion of open questions and future perspectives.Comment: Latex, 60 pages, 12 figures, Topical Review for J. Phys. C (Cond. Matt

Monte Carlo Simulations indicate that Chromati: Nanostructure is accessible by Light Microscopy

A long controversy exists about the structure of chromatin. Theoretically, this structure could be resolved by scattering experiments if one determines the scattering function - or equivalently the pair distribution function - of the nucleosomes. Unfortunately, scattering experiments with live cells are very difficult and limited to only a couple of nucleosomes

Tuning the translational freedom of DNA for high speed AFM

Direct observation is arguably the preferred way to investigate the interactions between two molecular complexes. With the development of high speed atomic force microscopy it is becoming possible to observe directly DNA protein interactions with relevant spatial and temporal resolutions. These interactions are of central importance to biology, bio-nanotechnology but also functional biologically inspired materials. Critically, sample preparation plays a central role in all microscopy studies and minimal perturbation of the sample is desired. Here, we demonstrate the ability to tune the interactions of DNA molecules with the surface such that an association strong enough to enable high resolution AFM imaging while providing sufficient translational freedom to allow the relevant protein DNA interactions to take place, can be maintained. Furthermore, we describe a quantitative method for measuring the DNA mobility, which also allows the dissection of the different contributions to the overall movement of the DNA molecules. We find that for weak surface association, a significant contribution to the movement arises from the interaction of the AFM tip with the DNA. In combination, these methods enable the tuning of the surface translational freedom of DNA molecules to allow the direct study of a wide range of nucleo-protein interactions by high speed atomic force microscopy