The Making of a (vice-) President: Party Politics, Ethnicity, Village Loyalty and Community-Driven Development

African politics are often said to be dominated by ethnic divides, with the ensuing policies implemented by leaders being based almost exclusively on their ethnic power base. In this paper, we demonstrate that the identity of leaders matters for the attribution of development projects in the context of one of the largest Community-Driven Development (CDD) programs in Senegal. After showing that leadership matters, we consider its determinants by focusing on those factors that determine who becomes president and vice-president of a Conseil rural, the smallest administrative unit in Senegal, and which is elected by universal suffrage. We also consider the link between power in the Conseil rural and that in the Conseil de Concertation et de Gestion (CCG), an assembly coopted by the Conseil rural president that is typical of local institutions set up in the context of CDD programs, and which is responsible for the attribution of development projects to individual villages. Using a unique dataset, we show that ethnicity plays almost no role in determining who becomes president (or vice-president) of a Conseil rural and vice-president of the CCG, while party politics, age, political experience, village loyalty, and educational and professional qualifications do. Our results highlight the crucial importance, in terms of development policy, of the local political institutions that are often created alongside CDD programs.Keywords: community-driven development, role and determinants ofleadership, decentralization.

Nanoscopy in nonlinear scanning fluorescence imaging systems

In the last 30 years, superresolution in optical microscopy has been a major field of research. During this time, different techniques have been created to break the diffraction limit in order to make observations at a nanometric scale. Given that optical microscopy is non-invasive, those superresolution methods pave the way for a better understanding of biological mechanism at a molecular level. Most of those methods are based on a nonlinear interaction between the excitation light intensity and the sample response (often fluorescent signal). In the same time, nanodiamonds containing fluorescent defects have been proven to be a choice probe for superresolution nanos-copy since they exhibit a strong and stable fluorescent signal even under high light intensities exposure (often required to obtain nonlinear photoresponse). Nanodiamonds containing Nitrogen Vacancy (NV) defects that exhibit a red fluorescent signal had been previously shown to be a viable biomarker for STED superresolved image. First, we demonstrated that green fluorescent nanodia-monds containing Nitrogen-Vacancy-Nitrogen (NVN) defects can be used with a Stimulated Emission Depletion (STED) superreso-lution microscope. Then, we implemented a STED microscope in our lab and compared the properties of NVN and NV centers for STED imaging. We conclude that even if nanodiamonds with NVN defects are less intense, they can be used as a second color nonbleaching biomarker. To illustrate the potential use of green nanodiamonds as bio-compatible probe, we superresolved them internalized into a cell with STED microscopy. Second, we tried to work on one of the main limitation in STED nanoscopy: the lack of information in the axial direction within a single scan. We combined our home made STED microscope with a Double Helix phase mask that modifies the detection point spread function in order to obtain axial localization of the superresolved emitters. We achieved three dimensional localization of nanometric fluorescent emitters but we note that photobleaching was the main limitation of this approach with organic dyes. We discussed different solutions to limit the photobleaching and their feasibility. We also worked on a different superresolution technique that we named Computational Nonlinear Saturated (CNS) microscopy. We showed that with digital post treatment of the acquired data, a nonlinear photoresponse can be harnessed to any scanning microscope equipped with a camera detector to enhance the resolution. We demonstrated that increasing the excitation power and inducing fluorescence saturation, it is possible to break the diffraction limit in a conventional confocal microscope (after data post-treatment). However, with this method, we did not obtain a gain in resolution as high as with other superresolution tech-niques involving fluorescence saturation, such as saturated structured illumination microscopy. To understand the origin of this limitation, we carried out simulation to investigate the performance of CNS microscopy in noisy environments compared with wide field techniques. We propose alternative implementation and quantify the possible resolution gain with simulations. Finally, we demonstrated how a technique, initially created for optical microscopy, can be adapted to lensless endoscopic imaging..

Multiple-correction hybrid k -exact schemes for high-order compressible RANS-LES simulations on fully unstructured grids

A Godunov's type unstructured finite volume method suitable for highly compressible turbulent scale-resolving simulations around complex geometries is constructed by using a successive correction technique. First, a family of k-exact Godunov schemes is developed by recursively correcting the truncation error of the piecewise polynomial representation of the primitive variables. The keystone of the proposed approach is a quasi-Green gradient operator which ensures consistency on general meshes. In addition, a high-order single-point quadrature formula, based on high-order approximations of the successive derivatives of the solution, is developed for flux integration along cell faces. The proposed family of schemes is compact in the algorithmic sense, since it only involves communications between direct neighbors of the mesh cells. The numerical properties of the schemes up to fifth-order are investigated, with focus on their resolvability in terms of number of mesh points required to resolve a given wavelength accurately. Afterwards, in the aim of achieving the best possible trade-off between accuracy, computational cost and robustness in view of industrial flow computations, we focus more specifically on the third-order accurate scheme of the family, and modify locally its numerical flux in order to reduce the amount of numerical dissipation in vortex-dominated regions. This is achieved by switching from the upwind scheme, mostly applied in highly compressible regions, to a fourth-order centered one in vortex-dominated regions. An analytical switch function based on the local grid Reynolds number is adopted in order to warrant numerical stability of the recentering process. Numerical applications demonstrate the accuracy and robustness of the proposed methodology for compressible scale-resolving computations. In particular, supersonic RANS/LES computations of the flow over a cavity are presented to show the capability of the scheme to predict flows with shocks, vortical structures and complex geometries.A Godunov's type unstructured finite volume method suitable for highly compressible turbulent scale-resolving simulations around complex geometries is constructed by using a successive correction technique. First, a family of k-exact Godunov schemes is developed by recursively correcting the truncation error of the piecewise polynomial representation of the primitive variables. The keystone of the proposed approach is a quasi-Green gradient operator which ensures consistency on general meshes. In addition, a high-order single-point quadrature formula, based on high-order approximations of the successive derivatives of the solution, is developed for flux integration along cell faces. The proposed family of schemes is compact in the algorithmic sense, since it only involves communications between direct neighbors of the mesh cells. The numerical properties of the schemes up to fifth-order are investigated, with focus on their resolvability in terms of number of mesh points required to resolve a given wavelength accurately. Afterwards, in the aim of achieving the best possible trade-off between accuracy, computational cost and robustness in view of industrial flow computations, we focus more specifically on the third-order accurate scheme of the family, and modify locally its numerical flux in order to reduce the amount of numerical dissipation in vortex-dominated regions. This is achieved by switching from the upwind scheme, mostly applied in highly compressible regions, to a fourth-order centered one in vortex-dominated regions. An analytical switch function based on the local grid Reynolds number is adopted in order to warrant numerical stability of the recentering process. Numerical applications demonstrate the accuracy and robustness of the proposed methodology for compressible scale-resolving computations. In particular, supersonic RANS/LES computations of the flow over a cavity are presented to show the capability of the scheme to predict flows with shocks, vortical structures and complex geometries

Comparative effectiveness of cardioprotective drugs in elderly individuals with type 2 diabetes.

Aims: Although many elderly individuals suffer from type 2 diabetes, the effectiveness of cardioprotective drugs in primary prevention of cardiovascular events in clinical practice in this population has rarely been evaluated. We aimed to assess the effectiveness of, (i) angiotensin converting enzyme inhibitors or angiotensin receptor blockers, (ii) statins, (iii) antiplatelet drugs and (iv) the combination of these three drugs, in the prevention of myocardial infarction (MI) and stroke in elderly individuals with type 2 diabetes. Methods: Using Quebec administrative databases, we conducted nested case-control analyses among a cohort of 17,384 individuals without a history of cardiovascular disease. Individuals were aged ≥ 66 years, newly treated with oral antidiabetes drugs and had not used any of the three above classes of cardioprotective drugs in the year before cohort entry. For each case (MI/stroke during follow-up), five controls were matched for age, year of cohort entry and sex. Use of each drug and of their combination was defined as current, past or no use. We calculated adjusted odds ratios (AOR) of MI/stroke. Results: We observed no reduction in the MI/stroke risk for users of ACEI/ARB nor for users of the three drugs combination. Longer exposure to statins was associated with a lower risk (AOR for every 30 days of therapy: 0.97; 95% CI: 0.96–0.99). By contrast, current use of antiplatelet drugs was associated with an increased risk of MI/stroke (1.40; 1.12–1.75). Conclusion: The benefit of cardioprotective drugs in primary prevention was not clear in this cohort of elderly individuals with type 2 diabetes. A short duration of exposure to these drugs might explain the lack of benefit

Association between interpersonal continuity of care and medication adherence in type 2 diabetes : an observational cohort study

Background: Prior studies have shown that, compared to patients with a low level of interpersonal continuity of care, patients with a high level of continuity of care have a lower likelihood of hospital admission and emergency department visits, and a higher likelihood of patient satisfaction. We sought to determine whether higher levels of continuity of care are associated with medication persistence and compliance among new users of oral antidiabetic treatment. Methods: We conducted a medicoadministrative cohort study of new users of oral antidiabetics aged 18 years or more among people covered by the Quebec public drug plan. We excluded people with fewer than 730 days of treatment and those who had been in hospital for 275 days or more in the first or second year after initiation of antidiabetic treatment. We categorized continuity of care observed in the first year after treatment initiation as low, intermediate or high. The association between continuity of care and medication persistence and compliance was assessed using generalized linear models. Results: In this cohort of 60 924 new users of oral antidiabetic treatment, compared to patients with a high level of continuity of care, those with an intermediate and a low level of continuity of care were less likely to be persistent (adjusted prevalence ratio 0.97 [95% confidence interval (CI) 0.96-0.98] and 0.96 [95% CI 0.95-0.97], respectively) and compliant (adjusted prevalence ratio 0.98 [95% CI 0.97-0.99] and 0.95 [0.94-0.97], respectively) with their antidiabetic treatment. Interpretation: A higher level of interpersonal continuity of care was associated with a higher likelihood of drug persistence and compliance. Since the strength of this association was weak, further research is required to determine whether continuity of care plays a role in medication adherence

Patients’ beliefs about adherence to oral antidiabetic treatment : a qualitative study

Purpose: The purpose of this study was to elicit patients’ beliefs about taking their oral antidiabetic drugs (OADs) as prescribed to inform the development of sound adherence-enhancing interventions. Methods: A qualitative study was performed. Adults with type 2 diabetes who had been taking an OAD for >3 months were solicited to participate in one of six focus groups. Discussions were facilitated using a structured guide designed to gather beliefs related to important constructs of the theory of planned behavior. Four coders using this theory as the theoretical framework analyzed the videotaped discussions. Results: Forty-five adults participated. The most frequently mentioned advantages for OAD-taking as prescribed were to avoid long-term complications and to control glycemia. Family members were perceived as positively influential. Carrying the OAD at all times, having the OAD in sight, and having a routine were important facilitating factors. Being away from home, not accepting the disease, and not having confidence in the physician’s prescription were major barriers to OAD-taking. Conclusion: This study elicited several beliefs regarding OAD-taking behavior. Awareness of these beliefs may help clinicians adjust their interventions in view of their patients’ beliefs. Moreover, this knowledge is crucial to the planning, development, and evaluation of interventions that aim to improve medication adherence

Effectiveness and Content Analysis of Interventions to Enhance Oral Antidiabetic Drug Adherence in Adults with Type 2 Diabetes : Systematic Review and Meta-Analysis

We thank Frederic Bergeron, information scientist, for assistance in search strategies. We thank American Journal Experts for editing the text. Source of financial support: This study was funded by the Laval University Chair on Adherence to Treatments. This Chair is supported by nonrestricted grants from AstraZeneca Canada, Merck Canada, Sanofi Canada, and Pfizer Canada and from the Prends soin de toi program (a Quebec provincial program for the improvement of public health).Peer reviewedPostprin

Revisiting the internal consistency and factorial validity of the 8-item Morisky Medication Adherence Scale

Objective: To assess the internal consistency and factorial validity of the adapted French 8-item Morisky Medication Adherence Scale in assessing adherence to noninsulin antidiabetic drug treatment.Study Design and Setting: In a cross-sectional web survey of individuals with type 2 diabetes of the Canadian province of Quebec, self-reported adherence to the antidiabetes drug treatment was measured using the Morisky Medication Adherence Scale-8. We assessed the internal consistency of the Morisky Medication Adherence Scale-8 with Cronbach’s alpha, and factorial validity was assessed by identifying the underlying factors using exploratory factor analyses.Results: A total of 901 individuals completed the survey. Cronbach’s alpha was 0.60. Two factors were identified. One factor comprised five items: stopping medication when diabetes is under control, stopping when feeling worse, feeling hassled about sticking to the prescription, reasons other than forgetting and a cross-loading item (i.e. taking drugs the day before). The second factor comprised three other items that were all related to forgetfulness in addition to the cross-loading item.Conclusion: Cronbach’s alpha of the adapted French Morisky Medication Adherence Scale-8 was below the acceptable value of 0.70. This observed low internal consistency of the scale is probably related to the causal nature of the items of the scale but not necessarily a lack of reliability. The results suggest that the adapted French Morisky Medication Adherence Scale-8 is a two-factor scale assessing intentional (first factor) and unintentional (second factor) non-adherence to the noninsulin antidiabetes drug treatment. The scale could be used to separately identify these outcomes using scores obtained on each of the sub-scale

Reordering Strategy for Blocking Optimization in Sparse Linear Solvers

International audienceSolving sparse linear systems is a problem that arises in many scientific applications, and sparse direct solvers are a time-consuming and key kernel for those applications and for more advanced solvers such as hybrid direct-iterative solvers. For this reason, optimizing their performance on modern architectures is critical. The preprocessing steps of sparse direct solvers—ordering and block-symbolic factorization—are two major steps that lead to a reduced amount of computation and memory and to a better task granularity to reach a good level of performance when using BLAS kernels. With the advent of GPUs, the granularity of the block computation has become more important than ever. In this paper, we present a reordering strategy that increases this block granularity. This strategy relies on block-symbolic factorization to refine the ordering produced by tools such as Metis or Scotch, but it does not impact the number of operations required to solve the problem. We integrate this algorithm in the PaStiX solver and show an important reduction of the number of off-diagonal blocks on a large spectrum of matrices. This improvement leads to an increase in efficiency of up to 20% on GPUs. 1. Introduction. Many scientific applications, such as electromagnetism, astrophysics , and computational fluid dynamics, use numerical models that require solving linear systems of the form Ax = b. In those problems, the matrix A can be considered as either dense (almost no zero entries) or sparse (mostly zero entries). Due to multiple structural and numerical differences that appear in those problems, many different solutions exist to solve them. In this paper, we focus on problems leading to sparse systems with a symmetric pattern and, more specifically, on direct methods which factorize the matrix A in LL t , LDL t , or LU , with L, D, and U, respectively, unit lower triangular, diagonal, and upper triangular according to the problem numerical properties. Those sparse matrices appear mostly when discretizing partial differential equations (PDEs) on two-(2D) and three-(3D) dimensional finite element or finite volume meshes. The main issue with such factorizations is the fill-in—zero entries becoming nonzero—that appears in the factorized form of A during the execution of the algorithm. If not correctly considered, the fill-in can transform the sparse matrix into a dense one which might not fit in memory. In this context, sparse direct solvers rely on two important preprocessing steps to reduce this fill-in and control where it appears. The first one finds a suitable ordering of the unknowns that aims at minimizing the fill-in to limit the memory overhead and floating point operations (Flops) required to complete the factorization. The problem is then transformed into (P AP t)(P x) = P b