Combinatorial and frequency properties of the ribosome ancestors.

BACKGROUND: The current ribosome has evolved from the primitive stages of life on Earth. Its function is to build proteins and on the basis of this role, we are looking for a universal common ancestor to the ribosome which could: i) present optimal combinatorial properties, and ii) have left vestiges in the current molecules composing the ribosome (rRNA or r-proteins) or helping in its construction and functioning. METHODS: Genomic public databases are used for finding the nucleotide sequences of rRNAs and mRNA of r-proteins and statistical calculations are performed on the occurrence in these genes of some pentamers belonging to the RNA proposed as optimal ribosome ancestor. RESULTS: After having exhibited a possible solution to the problem of an RNA capable of catalyzing peptide genesis, traces of this RNA are found in many rRNAs and mRNA of r-proteins, as well as in factors contributing to the construction of the current ribosome. CONCLUSIONS: The existence of an optimal primordial RNA whose function is to facilitate the creation of peptide bonds between amino acids may have contributed to accelerate the emergence of the first vital processes. Its traces should be found in many living species inside structures structurally and functionally close to the ribosome, which is already the case in the species studied in this article.

Pharmacists' role in the continued care of patients under opiate substitution treatment.

CONTEXT: In France, over 170 000 persons benefit from opiate substitution treatment. The treatment delivery is most often assured by community pharmacies spread out throughout the territory. The aim of this study is to better know the continued care of individuals treated by methadone or high-dose buprenorphine in community pharmacies in Lille (North of France). METHOD: This was a cross-sectional descriptive study with hand-delivered questionnaires. All pharmacies (n=65) in Lille were included. RESULTS: Fifty-eight of pharmacies (89%) responded to the survey and 55 of them (95%) followed patients treated by opiate substitution treatment. Addiction was considered as an illness by 53 of pharmacists (91%). Confidential discussions could only be conducted at one of every two treatment delivery work station. CONCLUSION: Pharmacists are active in the continued care of individuals treated by opiate substitution treatment. They have a privileged relationship with the general practitioner. A rearrangement of pharmacies' premises could foster the development of therapeutic patient education within the pharmacy.

Ethical issues related to computerised family medical histories in sickle cell disease: Inforare.

The Inforare project aims to set up a system for the sharing of clinical and familial data, in order to study how genes are related to the severity of sickle cell disease. While the computerisation of clinical records represents a valuable research goal, an ethical framework is necessary to guarantee patients' protection and their rights in this developing field. Issues relating to patient information during the Inforare study were analysed by the steering committee. Several major concerns were discussed by the committee and formalized in the patients' information letter: educating patients to aid the recruitment of family members, rules of confidentiality and the disclosure of aggregate, individual and unexpected research results. This paper presents the main issues addressed.

Building application-related patient identifiers: what solution for a European country?

We propose a method utilizing a derived social security number with the same reliability as the social security number. We show the anonymity techniques classically based on unidirectional hash functions (such as the secure hash algorithm (SHA-2) function that can guarantee the security, quality, and reliability of information if these techniques are applied to the Social Security Number). Hashing produces a strictly anonymous code that is always the same for a given individual, and thus enables patient data to be linked. Different solutions are developed and proposed in this article. Hashing the social security number will make it possible to link the information in the personal medical file to other national health information sources with the aim of completing or validating the personal medical record or conducting epidemiological and clinical research. This data linkage would meet the anonymous data requirements of the European directive on data protection.

Proposal of a French health identification number interoperable at the European level.

The French ministry of Health is setting up the Personal Medical Record (PMR). This innovative tool has long been expected by French Health Authorities, Associations of Patients, other Health's associations, those defending Individual Liberties and the French National Data Protection Authority. The PMR will lead to improvements in many areas such as Diagnosis (Research and monitoring) Healthcare (Management of emergencies, urgent situations, Temporal health monitoring and evaluation), Therapy (Cohorts of patients for Clinical trials and epidemiological studies). The PMR will foster safe healthcare management, clinical research and epidemiological studies. Nevertheless, it raises many important questions regarding duplicates and the quality, precision and coherence of the linkage with other health data coming from different sources. The currently planned identifying process raises many questions with regard to its ability to deal with potential duplicates and to perform data linkage with other health data sources. Through this article, using the electronic health records, we develop and propose an identification process to improve the French PMR. Our proposed unique patient identifier will guarantee the security, confidentiality and privacy of the personal data, and will prove to be particularly useful for health planning, health policies and research as well as clinical and epidemiological studies. Finally, it will certainly be interoperable with other European health information systems. We propose here an alternative identification procedure that would allow France to broaden the scope of its PMR project by making it possible to contribute to public health research and policy while increasing interoperability with European health information systems and preserving the confidentiality of the data.

How to manage secure direct access of European patients to their computerized medical record and personal medical record.

The multiplication of the requests of the patients for a direct access to their Medical Record (MR), the development of Personal Medical Record (PMR) supervised by the patients themselves, the increasing development of the patients' electronic medical records (EMRs) and the world wide internet utilization will lead to envisage an access by using technical automatic and scientific way. It will require the addition of different conditions: a unique patient identifier which could base on a familial component in order to get access to the right record anywhere in Europe, very strict identity checks using cryptographic techniques such as those for the electronic signature, which will ensure the authentication of the requests sender and the integrity of the file but also the protection of the confidentiality and the access follow up. The electronic medical record must also be electronically signed by the practitioner in order to get evidence that he has given his agreement and taken the liability for that. This electronic signature also avoids any kind of post-transmission falsification. This will become extremely important, especially in France where patients will have the possibility to mask information that, they do not want to appear in their personal medical record. Currently, the idea of every citizen having electronic signatures available appears positively Utopian. But this is yet the case in eGovernment, eHealth and eShopping, world-wide. The same was thought about smart cards before they became generally available and useful when banks issued them.

Unique patient concept: a key choice for European epidemiology.

The French Ministry of Health is setting up the personal medical record (PMR or DMP for Dossier Médical Personnel in French). This innovating tool is highly expected and will be extremely useful for the therapeutic follow-up as well as for epidemiological studies on which public health policies are based. Therefore the currently planned identifying process should prevent any epidemiological use of these data. Numerous scientific organisations have alerted government powers about the threat that this impairment represents, and they wish to promote some secure procedures that exist, which have already proved their efficiency at the national and international level.

The French proposal for a health identification number.

The French ministry of Health is setting up the personal medical record (PMR or DMP for Dossier Medical Personnel in French). This innovating tool is highly expected and will be extremely useful for the therapeutic follow-up as well as for epidemiological studies on which public health policies are based. Therefore the currently planned identifying process should prevent any epidemiological use of these data. Numerous scientific organisations have alerted government powers about the threat that this impairment represents, and they wish to promote some secure procedures that exist, which have already proved their efficiency at the national and international level.

Proposal for the creation of a European healthcare identifier.

In France, the European health card was created in June 2004 to increase the quality of healthcare granted to european citizen anywhere in europe and to facilitate the reimbursement of the healthcare costs. The patient identifier included in this card is essentially based on the healthcare insurance number of the patient and does not allow any linkage with his (her) previous health care data if he (she) is affiliated to another national healthcare insurance system when working for a long duration outside France. The purpose of this paper is to present the concept of a personal identifier based on familial components which has been validated by the French authority for personal data protection in the framework of a genetic study. Results issued from the Burgundy perinatal network demonstrate the interest and the faisability of adding a maternal component to the individual component of the new-born to allow Mother/new-born healthcare data linkage after anonymization. The advantage of adding a familial component to the healthcare insurance number is debated. This proposal will permit to link the data of a patient even when residing outside his country in Europe. It will also contribute to establish european public health statistics by matching healthcare data of the patients' records with other administrative data (mortality, social information ..) after anonymisation of these data in accordance with the European directive on data protection.

Bio-array images processing and genetic networks modelling.

The new tools available for gene expression studies are essentially the bio-array methods using a large variety of physical detectors (isotopes, fluorescent markers, ultrasounds...). Here we present first rapidly an image-processing method independent of the detector type, dealing with the noise and with the peaks overlapping, the peaks revealing the detector activity (isotopic in the presented example), correlated with the gene expression. After this primary step of bio-array image processing, we can extract information about causal influence (activation or inhibition) a gene can exert on other genes, leading to clusters of genes co-expression in which we extract an interaction matrix M and an associated interaction graph G explaining the genetic regulatory dynamics correlated to the studied tissue function. We give two examples of such interaction matrices and graphs (the flowering genetic regulatory network of Arabidopsis thaliana and the lytic/lysogenic operon of the phage Mu) and after some theoretical rigorous results recently obtained concerning the asymptotic states generated by the genetic networks having a given interaction matrix and reciprocally concerning the minimal (in the sense of having a minimal number of non-zero coefficients) matrices having given stationary stable states.

Genetic regulation networks: circuits, regulons and attractors.

We deal in this paper with the concept of genetic regulation network. The genes expression observed through the bio-array imaging allows the geneticist to obtain the intergenic interaction matrix W of the network. The interaction graph G associated to W presents in general interesting features like connected components, gardens of Eden, positive and negative circuits (or loops), and minimal components having 1 positive and 1 negative loop called regulons. Depending on parameters values like the connectivity coefficient K(W) and the mean inhibition weight I(W), the genetic regulation network can present several dynamical behaviours (fixed configuration, limit cycle of configurations) called attractors, when the observation time increases. We give some examples of such genetic regulation networks and analyse their dynamical properties and their biological consequences.