The Crying Clinic: Increasing accessibility to Infant Mental Health services for immigrant parents at risk for peripartum depression.

Peripartum depression (PPD) is considered a major public health concern due to its profound impact on families, including infants. In this paper, we report on a pilot initiative designed to reduce barriers and stigma related to the use of traditional infant mental health services for immigrant parents deemed at high risk of PPD. The Crying Clinic (CC) is an innovative walk-in service offered in a culturally diverse Canadian community to support maternal well-being and healthy parent-infant relationships. The CC was designed to be a gateway to existing infant mental health services, through its emphasis on accessibility and cultural sensitivity. Support for concrete concerns, such as anxiety about normative infant behaviors like crying, is underscored in this approach to attract vulnerable families who would otherwise not access mental health support. A review of 44 users, utilization, plans for the use of additional services, and client evaluations suggests that the CC accomplished most of its goals. We conclude that gateway service models such as the CC have the potential to enhance traditional infant mental health programs by creatively addressing the challenge of engaging highly vulnerable parents from culturally diverse backgrounds.

La depresión durante el período inmediatamente antes, durante e inmediatamente después del parto, o peri-parto (PPD) es considerada una preocupación seria de la salud pública debido a su profundo impacto en las familias, incluyendo los infantes (v.g., Howard, Piot y Stein, 2014). En este ensayo, reportamos acerca de una iniciativa experimental diseñada para reducir barreras y el estigma relacionado con el uso de los servicios tradicionales de salud mental infantil por parte de progenitores inmigrantes a quienes se les considera como de alto riesgo con respecto al PPD. La Clínica del Llanto -The Crying Clinic - (CC) en un innovador servicio al que se puede recurrir sin cita previa y que se ofrece en una comunidad canadiense culturalmente diversa con el fin de apoyar el bienestar materno y las saludables relaciones progenitor-infante. La CC fue diseñada para ser una puerta de entrada a los servicios de salud mental infantil existentes, por medio de enfatizar la accesibilidad y la sensibilidad cultural. El apoyo a preocupaciones concretas, tales como la ansiedad acerca de las conductas normativas del infante -el llanto, por ejemplo- es recalcado por medio de este acercamiento para atraer a familias vulnerables que de otra manera no buscarían acceso al apoyo de salud mental. Una revisión de 44 usuarios, la utilización, planes para el uso de servicios adicionales, así como las evaluaciones de los clientes sugieren que la CC alcanzó la mayoría de sus metas. Concluimos con que los modelos de servicios que sirven de puerta de entrada tales como la CC cuentan con el potencial para mejorar los programas tradicionales de salud mental infantil por medio de responder creativamente al reto de atraer a progenitores altamente vulnerables de trasfondos culturales diversos.

La dépression périnatale (PPD) est considérée comme étant un problème de santé publique extrêmement important du fait de son impact profond sur les familles, y compris les nourrissons (par exemple Hoard, Piot, & Stein, 2014). Dans cet article nous faisons part d'une initiative pilote conçue afin de réduire les barrières et le sigma lié à l'utilisation de services de santé mentale traditionnels pour des parents immigrés à risque élevé de PPD. La Clinique Pleurs (en anglais Crying Clinic, soit ici CC) est un service clinique sans rendez-vous innovateur disponible dans une communauté canadienne culturellement diverse pour soutenir le bien-être maternel et des relations parent-nourrisson saines. La CC a été conçue afin d'être une porte d'entrée à des services de santé mentale du nourrisson existants, à travers son accent sur l'accessibilité et la sensibilité culturelle. Le soutien pour des problèmes concrets, comme par exemple l'anxiété à propos de comportements normatifs du nourrisson comme les pleurs, est souligné dans cette approche afin d'attirer des familles vulnérables qui autrement n'accèderaient pas à un soutien de santé mentale. Une étude de 44 utilisateurs, de l'utilisation, des projets pour l'utilisation de services supplémentaires et des évaluations de clients suggère que la CC a rempli la plupart de ses buts. Nous concluons que des modèles de service d'entrée tels que la CC ont le potentiel de mettre en valeur des programmes traditionnels de santé mentale du nourrisson en répondant au défi qu'il y a d'engager des parents extrêmement vulnérables issus de milieux culturellement divers de manière créative.

Bioelectronic organ-based sensor for microfluidic real-time analysis of the demand in insulin.

On-line and real-time analysis of micro-organ activity permits to use the endogenous analytical power of cellular signal transduction algorithms as biosensors. We have developed here such a sensor using only a few pancreatic endocrine islets and the avoidance of transgenes or chemical probes reduces bias and procures general usage. Nutrient and hormone-induced changes in islet ion fluxes through channels provide the first integrative read-out of micro-organ activity. Using extracellular electrodes we captured this read-out non-invasively as slow potentials which reflect glucose concentration-dependent (3-15 mM) micro-organ activation and coupling. Custom-made PDMS-based microfluidics with platinum black micro-electrode arrays required only some tens of islets and functioned at flow rates of 1-10 µl/min which are compatible with microdialysis. We developed hardware solutions for on-line real-time analysis on a reconfigurable Field-Programmable Gate Array (FPGA) that offered resource-efficient architecture and storage of intermediary processing stages. Moreover, real-time adaptive and reconfigurable algorithms accounted for signal disparities and noise distribution. Based on islet slow potentials, this integrated set-up allowed within less than 40 µs the discrimination and precise automatic ranking of small increases (2 mM steps) of glucose concentrations in real time and within the physiological glucose range. This approach shall permit further development in continuous monitoring of the demand for insulin in type 1 diabetes as well as monitoring of organs-on-chip or maturation of stem-cell derived islets.

A founder mutation in BBS2 is responsible for Bardet-Biedl syndrome in the Hutterite population: utility of SNP arrays in genetically heterogeneous disorders.

Bardet-Biedl syndrome (BBS) is a multisystem genetically heterogeneous disorder, the clinical features of which are largely the consequence of ciliary dysfunction. BBS is typically inherited in an autosomal recessive fashion, and mutations in at least 14 genes have been identified. Here, we report the identification of a founder mutation in the BBS2 gene as the cause for the increased incidence of this developmental disorder in the Hutterite population. To ascertain the Hutterite BBS locus, we performed a genome-wide single nucleotide polymorphism (SNP) analysis on a single patient and his three unaffected siblings from a Hutterite family. The analysis identified two large SNP blocks that were homozygous in the patient but not in his unaffected siblings, one of these regions contained the BBS2 gene. Sequence analysis and subsequent RNA studies identified and confirmed a novel splice site mutation, c.472-2A>G, in BBS2. This mutation was also found in homozygous form in three subsequently studied Hutterite BBS patients from two different leuts, confirming that this is a founder mutation in the Hutterite population. Further studies are required to determine the frequency of this mutation and its role, if any, in the expression of other ciliopathies in this population.

Object-oriented design of medical imaging software.

A special software package for interactive display and manipulation of medical images was developed at the University Hospital of Geneva, as part of a hospital wide Picture Archiving and Communication System (PACS). This software package, called Osiris, was especially designed to be easily usable and adaptable to the needs of noncomputer-oriented physicians. The Osiris software has been developed to allow the visualization of medical images obtained from any imaging modality. It provides generic manipulation tools, processing tools, and analysis tools more specific to clinical applications. This software, based on an object-oriented paradigm, is portable and extensible. Osiris is available on two different operating systems: the Unix X-11/OSF-Motif based workstations, and the Macintosh family.

Effect of undernutrition on the ability of the sheep rumen to absorb volatile fatty acids.

The ability of the rumen to absorb the same quantity of VFA with 4 animals previously fed with 2 levels of intake was tested. Animals received maintenance (P1) and half maintenance (P2) energy and nitrogen requirements successively. Absorption was measured with the empty washed rumen technique. Three litres of a solution buffered at pH 6.30 containing VFA (C2:57.1, C3:49.2 and C4:7.4 mM or C2:79.8, C3:23.5 and C4:11.5 mM) and CoEDTA (7.1 mg Co/l) were introduced in the rumen and regularly sampled for 3 h. VFA absorption was linear during the trials. Rates of absorption were expressed as mmol/h or percentage of initial quantity/h for the comparison between VFA. The order of absorption rate (%/h) was C4 > C3 > C2. Water absorption was not significantly different between the periods whereas VFA absorption rates (mmol/h) were significantly reduced after undernutrition. Composition of the solution had no significant effect on VFA absorption rate (%/h).

Portable image-manipulation software: what is the extra development cost?

A hospital-wide picture archiving and communication system (PACS) project is currently under development at the University Hospital of Geneva. The visualization and manipulation of images provided by different imaging modalities constitutes one of the most challenging component of a PACS. It was necessary to provide this visualization software on a number of types of workstations because of the varying requirements imposed by the range of clinical uses it must serve. The user interface must be the same, independent of the underlying workstation. In addition to a standard set of image-manipulation and processing tools, there is a need for more specific clinical tools that can be easily adapted to specific medical requirements. To achieve this goal, it was elected to develop a modular and portable software called OSIRIS. This software is available on two different operating systems (the UNIX standard X-11/OSF-Motif based workstations and the Macintosh family) and can be easily ported to other systems. The extra effort required to design such software in a modular and portable way was worthwhile because it resulted in a platform that can be easily expanded and adapted to a variety of specific clinical applications. Its portability allows users to benefit from the rapidly evolving workstation technology and to adapt the performance to suit their needs.

A clinical molecular scanner: the Melanie project.

We developed an expert system to analyze and interpret protein maps. This system, Melanie (medical electrophoresis analysis interactive expert), can distinguish between normal and cirrhotic liver and identify various types of cancer on the basis of protein patterns in biopsy specimens. Our findings suggest that some diseases associated with toxic compounds or modifications of the human genome can be diagnosed by expert systems that analyze protein maps. The combination of protein mapping and computer analysis could result in a clinically useful "molecular scanner". The massive amount of information analyzed and stored in such studies requires new strategies, including centralized databases and image transmission over networks. Increased understanding of protein expression and regulation will enhance the importance of the human genome project in medicine and biology.

[Comparative study of cefoperazone and cotrimoxazole in kidney stone surgery via percutaneous approach]. / Etude comparative de la céfopérazone et du cotrimoxazole dans la chirurgie lithiasique rénale par voie per-cutanée.

The effectiveness and drawbacks of cefoperazone and cotrimoxazole in the prevention of postoperative infections following percutaneous removal of renal stones were studied comparatively. 60 patients were divided at random into two groups. 30 subjects were given 1 g cefoperazone IV every 8 hours for 5 consecutive days starting on the day before the procedure. The 30 other patients had an infusion of 800 mg sulfamethoxazole and 160 mg trimethoprim every 12 hours on the same 5 days. Age, sex and type of surgical procedure were comparable in both groups. Results were as follows: in the cefoperazone group, one patient had intraoperative septic shock due to a stone infected by a resistant Pseudomonas aeruginosa; in the cotrimoxazole group, 2 patients had postoperative fever due to stones infected by resistant Gram negative rods (Pseudomonas aeruginosa) and three patients had a urinary tract infection (Candida albicans in 1 case, Escherichia coli in 1 and Pseudomonas aeruginosa in 1). Tolerance was satisfactory for both regimens. The authors conclude that intravenous cefoperazone in the more effective drug and should be continued throughout the first three postoperative days.