Tele-expertise for diagnosis of skin lesions is cost-effective in a prison setting: A retrospective cohort study of 450 patients.

CONTEXT:The prevalence of skin diseases among prisoners is higher than in the general population. Diagnosing and treating these lesions require a dermatologic advice. A tele-expertise network in dermatology for prisoners including 8 health facilities in prison and 2 hospital dermatological departments was developed to improve access to dermatologists' expertise in correctional facilities. Our objective was to evaluate the effectiveness and costs of tele-expertise in dermatology for prisoners. METHODS:We carried out a retrospective cohort study on data collected by the information system of the tele-expertise network. We used the MAST (Model for ASsessment of Telemedicine) model to perform a multidimensional assessment including the proportion of patients with a completed treatment plan for the skin lesions, the proportion of technical problems, the quality of the pictures, the investment and operating costs and the satisfaction of the professionals. RESULTS:Mean patient age was 34.2 years with 90% men. 511 requests for 450 patients were initiated. The delay from the connection to the tele-expertise software to the validation of the request was inferior to 7 min for 50% of the requests and inferior to 30 min for 85% of the requests. Overall, with tele-expertise, 82% of the patients had a completed treatment plan for the skin lesions, with 2.9% of all patients requiring a later face-to-face appointment or hospitalization, to be compared to a proportion of 35% of patients with a completed treatment plan when tele-expertise was not available. The most frequent lesions were acnea (22%) and atopic dermatitis (18%). The mean cost for one completed treatment plan was €184 by tele-expertise and €315 without tele-expertise. Tele-expertise was well accepted among physicians with all responders (n = 9) willing to continue using it. CONCLUSION:Tele-expertise is a dominant intervention in comparison to a face-to face consultation taking into account the cost of transportation and the proportion of canceled appointments and is acceptable for physicians. TRIAL REGISTRATION:NCT02309905

A new contribution to the chronology of the deglaciation in the Upper Verdon Valley (Lake Allos, Southern French Alps)

International audienceCet article présente les datations 14 C AMS obtenues dans la séquence sédimentaire du lac d'Allos (alt. 2 230 m, vallée du Verdon, Alpes du Sud, France). Ces données contribuent à la connaissance de la chronologie de la déglaciation à l'échelle des Alpes du Sud et permettent de revoir le cadre chronologique proposé antérieurement sur ce site. La sédimentation lacustre démarre entre 12 300 et 13 500 ans cal. BP (2 sigmas). Les deux stades glaciaires identifiés en aval du lac à 1 900 m et sur le verrou glaciaire à 2 300 m sont par conséquent plus anciens. Nous rejoignons ici les conclusions des travaux antérieurs sur les tourbières et lacs d'altitude qui, sur la base des données polliniques, suggéraient une déglaciation très précoce remontant au début du Tardiglaciaire

Données nouvelles sur la chronologie de la déglaciation dans la vallée du Haut-Verdon (lac d’Allos, Alpes françaises du sud)

Cet article présente les datations 14C AMS obtenues dans la séquence sédimentaire du lac d’Allos (alt. 2 230 m, vallée du Verdon, Alpes du Sud, France). Ces données contribuent à la connaissance de la chronologie de la déglaciation à l’échelle des Alpes du Sud et permettent de revoir le cadre chronologique proposé antérieurement sur ce site. La sédimentation lacustre démarre entre 12 300 et 13 500 ans cal. BP (2 sigmas). Les deux stades glaciaires identifiés en aval du lac à 1 900 m et sur le verrou glaciaire à 2 300 m sont par conséquent plus anciens. Nous rejoignons ici les conclusions des travaux antérieurs sur les tourbières et lacs d’altitude qui, sur la base des données polliniques, suggéraient une déglaciation très précoce remontant au début du Tardiglaciaire.This study presents new 14C AMS ages obtained from the sedimentary sequence of Lake Allos (elevation: 2,230 m, Verdon valley, Southern Alps, France). These ages provide new evidence on the last deglaciation over the Southern Alps, enabling us to revise the chronological framework previously established. Sedimentation in the lake began between 12,300 and 13,500 cal. yr BP (2 sigma interval). The two glacial stages identified in a cirque downstream of Lake Allos (at 1,900 m a.s.l.) and on the glacial threshold (at 2,300 m a.s.l.) are hence older. Our results are in good agreement with previous conclusions based on palynological evidence from high-elevations peat bogs and lakes that suggested an earlier deglaciation, at the onset of the Lateglacial