Women living with HIV/AIDS who are sexual partners of injecting drug users

OBJECTIVE: To analyze perceptions of risk, prevention strategies, their own relationship with drug use and that of their partner's, and future expectations among women living with HIV/AIDS whose partners are drug users. METHODS: This is a qualitative study of women living with HIV/AIDS who receive specialist treatment in São Paulo Municipality. Semi-structured interviews were carried out with 15 women, whose self-reported means of infection were heterosexual relations with a partner who is an injecting drug user. The script for the interviews covered the following areas: childhood, history of sexual relations, use of drugs, impact of seropositivity on daily life, understanding of the prevention of sexually transmitted infections, and perspectives of the future. The material from the interviews was analyzed using content analysis. RESULTS: The study pointed to a difference in the ways that the women live with their own drug use and with that of their partners. Their partners' use of injecting drugs was not primarily associated with a risk of HIV infection, due to attempts to conceal the fact or because they believed that the monogamy-fidelity-confidence trinity would take precedence as a form of protection. CONCLUSIONS: The women's different experiences of drug use should be taken into account and opportunities to discuss with them about the issue are important to ensure that more effective strategies for prevention and care are adopted.OBJETIVO: Analisar as percepções de risco, as estratégias de prevenção, sua própria relação com o uso de drogas e do parceiro e suas expectativas quanto ao futuro relatadas por mulheres vivendo com HIV/Aids parceiras de usuários de drogas. MÉTODOS: Estudo qualitativo sobre mulheres vivendo com HIV/Aids, atendidas em serviço especializado no Município de São Paulo. Foram aplicadas entrevistas semi-estruturadas a 15 mulheres, cuja via de infecção auto-referida foram as relações heterossexuais com parceiro usuário de drogas injetáveis. O roteiro das entrevistas compreendia: infância, história dos relacionamentos amorosos, uso de drogas, impacto da soropositividade no cotidiano, compreensão sobre prevenção de infecções sexualmente transmissíveis, e visão do futuro. A interpretação das entrevistas foi realizada por meio de análise de conteúdo. RESULTADOS: O estudo indicou diversidade da convivência das mulheres com o uso de drogas próprio e do parceiro. O uso de drogas injetáveis pelo parceiro não foi, prioritariamente, associado ao risco de infecção por HIV/Aids, seja por estratégias de ocultamento do fato, seja por considerarem que a tríade monogamia-fidelidade-confiança teria primazia como forma de proteção. CONCLUSÕES: A diversidade da convivência das mulheres com o uso de drogas deve ser considerada e oportunidades de fala e escuta sobre a questão podem ser importantes para a adoção de estratégias mais efetivas de prevenção e cuidado.Universidade de São Paulo Faculdade de Medicina Departamento de Medicina PreventivaUniversidade Federal de São Paulo (UNIFESP) Departamento de Ciências da SaúdePrefeitura Municipal de São Paulo Secretaria Municipal de SaúdeUNIFESP, Depto. de Ciências da SaúdeSciEL

The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-income and middle-income countries

Every year, an estimated 21 million girls aged 15–19 years become pregnant in low-income and middle-income countries (LMICs). Policy responses have focused on reducing the adolescent birth rate whereas efforts to support pregnant adolescents have developed more slowly. We did a systematic review of interventions addressing any health-related outcome for pregnant adolescents and their newborn babies in LMICs and mapped its results to a framework describing high-quality health systems for pregnant adolescents. Although we identified some promising interventions, such as micronutrient supplementation, conditional cash transfers, and well facilitated group care, most studies were at high risk of bias and there were substantial gaps in evidence. These included major gaps in delivery, abortion, and postnatal care, and mental health, violence, and substance misuse-related outcomes. We recommend that the fields of adolescent, maternal, and sexual and reproductive health collaborate to develop more adolescent-inclusive maternal health care and research, and specific interventions for pregnant adolescents. We outline steps to develop high-quality, evidence-based care for the millions of pregnant adolescents and their newborns who currently do not receive this

Self-interested service-oriented agents based on trust and QoS for dynamic reconfiguration

Progressively increasing complexity of dynamic environments, in which services and applications are demanded by potential clients, requires a high level of reconfiguration of the offer to better match that ever changing demand. In particular, the dynamic change of the client’s needs, leading to higher exigency, may require a smart and flexible automatic composition of more elementary services. By leveraging the service-oriented architectures and multi-agent system benefits, the paper proposes a method to explore the flexibility of the decision support for the services’ reconfiguration based on several pillars, such as trust, reputation and QoS models, which allows the selection based on measuring the expected performance of the agents. Preliminary experimental results, extracted from a real case scenario, allow highlighting the benefits of the proposed distributed and flexible solution to balance the workload of service providers in a simple and fast manner. The proposed solution includes the agents’ intelligent decision-making capability to dynamically and autonomously change services selection on the fly, towards more trustworthy services with better quality when unexpected events happen, e.g. broken machines. We then propose the use of competitive self-interested agents to provide services that best suits to the client through dynamic service composition.info:eu-repo/semantics/publishedVersio

Tools for Remote Exploration: A Lithium (Li) Dedicated Spectral Library of the Fregeneda-Almendra Aplite-Pegmatite Field

The existence of diagnostic features in the visible and infrared regions makes it possible to use reflectance spectra not only to identify mineral assemblages but also for calibration and classification of satellite images, considering lithological and/or mineral mapping. For this purpose, a consistent spectral library with the target spectra of minerals and rocks is needed. Currently, there is big market pressure for raw materials including lithium (Li) that has driven new satellite image applications for Li exploration. However, there are no reference spectra for petalite (a Li mineral) in large, open spectral datasets. In this work, a spectral library was built exclusively dedicated to Li minerals and Li pegmatite exploration through satellite remote sensing. The database includes field and laboratory spectra collected in the Fregeneda-Almendra region (Spain-Portugal) from (i) distinct Li minerals (spodumene, petalite, lepidolite); (ii) several Li pegmatites and other outcropping lithologies to allow satellite-based lithological mapping; (iii) areas previously misclassified as Li pegmatites using machine learning algorithms to allow comparisons between these regions and the target areas. Ancillary data include (i) sample location and coordinates, (ii) sample conditions, (iii) sample color, (iv) type of face measured, (v) equipment used, and for the laboratory spectra, (vi) sample photographs, (vii) continuum removed spectra files, and (viii) statistics on the main absorption features automatically extracted. The potential future uses of this spectral library are reinforced by its major advantages: (i) data is provided in a universal file format; (ii) it allows users to compare field and laboratory spectra; (iii) a large number of complementary data allow the comparison of shape, asymmetry, and depth of the absorption features of the distinct Li minerals

Using florbetapir positron emission tomography to explore cerebrospinal fluid cut points and gray zones in small sample sizes

INTRODUCTION: We aimed to assess the feasibility of determining Alzheimer's disease cerebrospinal fluid (CSF) cut points in small samples through comparison with amyloid positron emission tomography (PET). METHODS: Twenty-three individuals (19 patients, four controls) had CSF measures of amyloid beta (Aβ)1-42 and total tau/Aβ1-42 ratio, and florbetapir PET. We compared CSF measures with visual and quantitative (standardized uptake value ratio [SUVR]) PET measures of amyloid. RESULTS: Seventeen of 23 were amyloid-positive on visual reads, and 14 of 23 at an SUVR of ≥1.1. There was concordance (positive/negative on both measures) in 20 of 23, of whom 19 of 20 were correctly classified at an Aβ1-42 of 630 ng/L, and 20 of 20 on tau/Aβ1-42 ratio (positive ≥0.88; negative ≤0.34). Three discordant cases had Aβ1-42 levels between 403 and 729 ng/L and tau/Aβ1-42 ratios of 0.54-0.58. DISCUSSION: Comparing amyloid PET and CSF biomarkers provides a means of assessing CSF cut points in vivo, and can be applied to small sample sizes. CSF tau/Aβ1-42 ratio appears robust at predicting amyloid status, although there are gray zones where there remains diagnostic uncertainty

Pathological correlates of white matter hyperintensities in a case of progranulin mutation associated frontotemporal dementia

White matter hyperintensities (WMH) are often seen on MRI brain scans in frontotemporal dementia (FTD) due to progranulin (GRN) mutations, but their pathological correlates are unknown. We examined the histological changes underlying WMH in a patient with GRN mutation associated behavioral variant FTD. In vivo and cadaveric MRI showed progressive, asymmetric frontotemporal and parietal atrophy, and asymmetrical WMH predominantly affecting frontal mid-zones. We first performed segmentation and localization analyses of WMH present on cadaveric MRI FLAIR images, then selected five different brain regions directly matched to differing severities of WMH for histological analysis. We used immunohistochemistry to assess vascular pathology, degree of spongiosis, neuronal and axonal loss, TDP-43, demyelination and astrogliosis, and microglial burden and morphology. Brain regions with significant WMH displayed severe cortical and white matter pathology, and prominent white matter microglial activation and microglial dystrophy, but only mild axonal loss and minimal vascular pathology. Our study suggests that WMH in GRN mutation carriers are not secondary to vascular pathology. Whilst cortical pathology induced axonal degeneration could contribute to white matter damage, individuals with GRN mutations could develop selective white matter vulnerability and myelin loss due to chronic, regional microglial dysfunction arising from GRN haploinsufficiency

Symptom clusters in COVID-19: A potential clinical prediction tool from the COVID Symptom Study app

As no one symptom can predict disease severity or the need for dedicated medical support in coronavirus disease 2019 (COVID-19), we asked whether documenting symptom time series over the first few days informs outcome. Unsupervised time series clustering over symptom presentation was performed on data collected from a training dataset of completed cases enlisted early from the COVID Symptom Study Smartphone application, yielding six distinct symptom presentations. Clustering was validated on an independent replication dataset between 1 and 28 May 2020. Using the first 5 days of symptom logging, the ROC-AUC (receiver operating characteristic - area under the curve) of need for respiratory support was 78.8%, substantially outperforming personal characteristics alone (ROC-AUC 69.5%). Such an approach could be used to monitor at-risk patients and predict medical resource requirements days before they are required