Cien años después : Nietzsche con rostro humano

A cien años de su muerte, el pensamiento y la obra de Nietzsche siguen interpelándonos y estimulándonos. ¿Pero es verdaderamente recuperable Nietzsche para una cultura y una sociedad democráticas? Tras examinar algunos de los aspectos más tópicos de las lecturas antidemocráticas de su obra, y aunque no escape en modo alguno a toda crítica, se contesta afirmativamente a la vista de las nociones de crítica, perspectivismo, vitalismo, etc. Ello permite recuperar un Nietzsche con rostro humano.After one hundred years of his death, the ideas and the work of Nietzsche continue appealing and stimulating us. But is Nietzsche really compatible with a democratic culture and society? Some of the most commune topics of the antidemocratic lectures of his work are examined in this paper in order to offer a positive answer to this question. Of course Nietzsche is not free of criticisms, but taking note of his notions of criticism, perspectivism, vitalism, etc., becomes possible to retrieve a Nietzsche with human face

HIV prevention: What have we learned from community experiences in concentrated epidemics?

Drawing on lessons learned from community experiences in concentrated epidemics, this paper explores three imperatives in the effort to reduce the sexual transmission of HIV: combat prevention fatigue, diversify HIV testing and combat stigma and discrimination. The paper argues for a non-judgmental harm reduction approach to the prevention of sexual transmission of HIV that takes into account the interpretation of risk by diverse individuals and communities in the era of antiretroviral therapy. This approach requires greater attention to increasing access to opportunities to know one's serostatus, especially among key populations at greater risk. Novel approaches to diversifying HIV testing approaches at community level are needed. Finally, the paper makes a plea for bold measures to combat stigma and discrimination, which continues to represent a formidable barrier for access to services for affected populations and may contribute to HIV-related risk behaviours. A "triple therapy" approach to address stigma and discrimination is discussed, which includes greater acceptance of people living with HIV and AIDS (PLWHA), improving relevant laws and policies, and involving prevention users- working with people rather than for people-

Méthodes primales pour résoudre le problème de plus court chemin avec contraintes de ressources

RÉSUMÉ: Le problème de plus court chemin avec contraintes de ressources consiste à trouver un chemin entre deux noeuds dans un réseau (une source et une destination) à un coût minimum tout en respectant des contraintes sur la consommation de ressources. Il s’agit d’une généralisation du problème classique du plus court chemin non contraint. Ce problème a été largement étudié dans la littérature. Nous l’utilisons particulièrement comme sous-problème lors de la résolution des problèmes de planification de tournées de véhicules et d’horaires d’équipages par un algorithme de génération de colonnes. L’approche standard pour résoudre le problème de plus court chemin avec les contraintes de ressources est la programmation dynamique. Cette méthode est une extension du fameux algorithme de Bellman-Ford qui prend en considération les contraintes de ressources. Elle consiste à construire une séquence de sous-chemins provenant du noeud source en étendant ceux existants aux noeuds successeurs à l’aide d’une fonction de prolongation. Chaque sous-chemin correspond à un état et est reconnu par une étiquette qui mémorise son coût et ses consommations de ressources. La fonction de prolongation assure l’élimination des étiquettes non réalisables et garantit la mise à jour des coûts et des consommations de ressources après chaque prolongation. Des règles de dominance sont également utilisées pour interdire l’extension d’étiquettes peu prometteuses. D’un côté, cette approche est capable de gérer des règles complexes de travail provenant des conventions collectives et des mesures de sécurité et qui sont généralement non linéaires et même non convexes. D’un autre côté, la méthode de programmation dynamique permet de générer de nombreuses solutions réalisables (chemins réalisables) au lieu d’une seule, ce qui est nécessaire dans un contexte de génération de colonnes. Cependant, lorsqu’il faut gérer un grand nombre de ressources, le nombre d’étiquettes augmente de manière exponentielle, notamment dans le cas de réseaux de grande taille avec des centaines de milliers d’arcs. Par conséquent, le processus de résolution nécessite beaucoup de temps et dans de nombreux cas, nous ne sommes pas en mesure de trouver des solutions optimales. Plusieurs heuristiques ont été proposées pour gérer cette situation ; certaines dominent sur un sous-ensemble de ressources sélectionnées de manière empirique, alors que d’autres se contentent de prolonger un sous-ensemble d’étiquettes de chaque noeud. Bien évidemment, n’étant pas fondées mathématiquement, ces méthodes n’offrent aucune garantie sur la qualité des solutions retournées. Nous proposons dans ce travail différentes idées qui sont capables de remédier aux inconvénients mentionnés ci-dessus, afin d’améliorer la résolution du problème de plus court chemin avec les contraintes de ressources. Les méthodes proposées sont primales, exactes et tirent profit des avantages de la programmation dynamique. La première contribution de cette thèse est un nouvel algorithme primal multi-directionnel appelé MultiDirectional Dynamic Programming Algorithm. L’approche proposée partitionne l’espace d’états en petits sous-espaces disjoints qui sont explorés séquentiellement dans plusieurs itérations. Nous proposons aussi de nouvelles techniques d’apprentissage qui permettent à cet algorithme de tirer profit des résultats des itérations précédentes, afin de réduire la dimension des sous-espaces subséquents et générer rapidement de meilleurs chemins. Les expérimentations numériques sur des instances du problème de planification de tournées de véhicules et d’horaires d’équipages avec plus de 600.000 noeuds et 1.000.000 arcs démontrent que la nouvelle approche vainc l’algorithme standard de programmation dynamique. En particulier, elle est capable de générer des chemins réalisables avec jusqu’à 90% du coût optimal en moins de 10% du temps requis par l’algorithme standard de programmation dynamique. Étant convaincus de l’efficacité de l’exploration itérative de l’espace d’état, nous proposons dans une seconde contribution un autre algorithme primal exact appelé Primal Adjacency-Based algorithm. Nous fournissons d’abord une nouvelle étude polyédrique qui nous permet d’introduire une nouvelle partition de l’espace des états basée sur la notion d’adjacence. L’algorithme proposé utilise cette partition pour explorer de manière itérative l’espace d’états et produit une séquence d’ensembles de chemins réalisables de coûts non décroissants. Ces chemins sont ensuite utilisés pour enrichir l’information primale disponible, ce qui permet d’accélérer le processus de résolution dans les itérations suivantes. Les expérimentations numériques sur les mêmes instances citées ci-dessus montrent d’excellentes performances de cet algorithme. Il est capable, à l’instar de l’algorithme multi-directionnel, de produire des chemins de très bonne qualité dans des délais très courts. De plus, il réduit considérablement le nombre d’étiquettes créées par rapport à l’algorithme standard de programmation dynamique et à l’algorithme multi-directionnel. Les résultats obtenus ont montré que les approches proposées constituent des outils de résolution très efficaces, parfaitement adaptées à la méthode de génération de colonnes. Pour cette raison, nous nous concentrons dans notre troisième contribution sur le développement d’un nouveau cadre de résolution appelé Primal Column Generation Framework qui intègre ces méthodes primales dans un schéma de génération de colonnes. Ceci permet de trouver rapidement et intelligemment les colonnes de coûts réduits négatifs nécessaires en résolvant une séquence de sous-problèmes restreints en fonction des besoins. De plus, ce paradigme primal confère à la génération de colonnes une autonomie et une grande flexibilité. Des résultats expérimentaux montrent que l’outil proposé est capable de trouver des solutions optimales tout en réduisant le temps consommé à résoudre les sous-problèmes par des facteurs allant jusqu’à 7 fois par rapport à un algorithme de génération de colonnes standard. Cela engendre des gains significatifs en matière du temps total de résolution avec un facteur de réduction moyen de 3.5.----------ABSTRACT: The shortest path problem with resource constraints is to find a path between two nodes in a network (a source and a sink) at minimum cost while respecting constraints on resource consumption. This problem is a generalization of the classical non constrained shortest path problem. This problem has been largely studied in the literature. We particularly use it as a subproblem to solve crew scheduling and vehicle routing problems by the column generation method. The standard approach to solve the shortest path problem with resource constraints is dynamic programming. This method is an extension of the well-known Bellman-Ford algorithm that takes into account the resource constraints. It constructs a sequence of subpaths originated from the source node, by extending the existing ones to the successor nodes. Each subpath corresponds to a state and is recognized using a label that stores its cost and its resource consumptions. The extension function ensures the elimination of infeasible labels and guarantees the update of costs and resource consumption after each extension. Dominance rules are also used to prohibit the extension of unpromising labels. This approach is able to handle complex working rules like collective agreement rules and other safety rules that may be nonlinear and even non convex. Also, it allows the generation of many feasible solutions (feasible paths) instead of one, which is required in a column generation context. However, when we have to deal with a large number of resources, the number of labels increases exponentially, especially in the case of huge networks of hundreds of thousands of arcs. Consequently, the solution process becomes time consuming and in many cases we are not able to find optimal solutions. Several heuristics have been proposed to handle this situation, some of them dominate on an empirically selected subset of resources, while others used to extend only limited subsets of labels from each node. Of course, given that these methods are not mathematically founded, they offer no guarantee on the quality of the returned solutions. We propose in this work different ideas that are able to handle the drawbacks mentioned above, in order to improve the resolution of the shortest path problem with resource constraints. The proposed methods are primal, exact and take profits from the advantages of dynamic programming. The first contribution of this thesis is a new primal algorithm called the MultiDirectional Dynamic Programming Algorithm. The proposed approach splits the state space into small disjoint subspaces that are sequentially explored in several iterations. Moreover, we propose new learning techniques that allow the proposed algorithm to build on the results of the previous iterations, to reduce the dimension of the subsequent subspaces and to quickly generate better paths. Numerical experiments on Vehicle and Crew Scheduling Problem instances with up to 600.000 nodes and 1.000.000 arcs demonstrate that the new approach outperforms the standard dynamic programming algorithm. In particular, the multidirectional algorithm is able to generate feasible paths with up to 90% of the optimal cost in less than 10% of the time required by standard dynamic programming. Being convinced of the efficiency of the iterative exploration of the state space, we propose in a second contribution another exact primal algorithm called Primal Adjacency-Based algorithm. We first provide a new polyhedral study that allows us to introduce a new path adjacency-based partition of the state space. The proposed algorithm uses this partition to iteratively explore the state space and produces a sequence of sets of feasible paths of non decreasing costs. These paths are used in order to enrich the available primal information which improve the solution process in the subsequent iterations. Computational experiments on the same instances cited above show the excellent performance of this algorithm. Similarly to the multidirectional algorithm, the Primal Adjacency-Based algorithm is able to produce very interesting paths in very limited portions of time. Moreover, it drastically reduces the number of created labels compared to both standard dynamic programming and multidirectional algorithms. The obtained results have shown that the proposed approaches provide a highly efficient solution tool, nicely suitable for the column generation method. For this reason, we focus in our third contribution on developing a new Primal Column Generation framework that embeds these primal methods inside a column generation scheme. This framework allows finding quickly and intelligently the required negative reduced costs columns by solving a sequence of restricted subproblems as needed. Furthermore, this primal paradigm endows the column generation with a self-acting ability and a large degree of flexibility. Computational experiments show that the proposed tool is able to find optimal solutions while reducing the time spent solving subproblems by factors up to 7 times. This yields significant gains in the total solution times with an average reduction factor of 3.5 compared to the standard column generation algorithm

Patient satisfaction in an acute medicine department in Morocco

<p>Abstract</p> <p>Background</p> <p>Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly more knowledgeable about healthcare. No studies of inpatients' satisfaction with hospital care have been conducted in Morocco. The first objective of the present study was to confirm the reliability and validity of the Arabic version of the EQS-H (Echelle de Qualité des Soins en Hospitalisation). The second objective was to evaluate patient satisfaction in an acute medicine department in Morocco by using the EQS-H questionnaire; and also to assess the influence of certain demographics, socioeconomics, and health characteristics in patient satisfaction.</p> <p>Methods</p> <p>it was a patient survey conducted in an acute medicine department of a Moroccan University Hospital. We surveyed their socio demographic status, and health characteristics at admission. We performed structured face to face interviews with patients who were discharged from hospital. The core of the EQS-H questionnaire was translated to Arabic, adapted to the present setting, and then used to measure patient satisfaction with quality of care. The internal consistency of the EQS-H scale was assessed by Chronbach's coefficient alpha. Validity was assessed by factor analysis. Factors influencing inpatients' satisfaction were identified using multiple linear regression.</p> <p>Results</p> <p>The Arabic version of EQS-H demonstrated an excellent internal consistency for the two dimensions studied (0.889 for 'quality of medical information' (MI) and 0.906 for 'Relationship with staff and daily routine' (RS)). The principal component analysis confirmed the bidimensional structure of the questionnaire and explained 60% of the total variance. In the univariate analysis, urban residence, higher income, better perceived health status compared to admission, better perceived health status compared to people of the same age, and satisfaction with life in general were related to MI dimension; Otherwise, mal gender, urban residence, higher income, staying in double room, better perceived health status compared to admission, and satisfaction with life in general were related to RS dimension. The multiple linear regression showed that four independent variables were associated with higher satisfaction in MI: More than 2 prior hospitalizations, a longer length of stay (10-14 days) (<it>P </it>= 0.002), staying in double room (<it>P </it>= 0.022), and better perceived health status compared to admission (<it>P </it>= 0.036). Three independent variables were associated with higher satisfaction in RS: a longer length of stay (10-14 days) (<it>P </it>= 0.017), better perceived health status compared to admission day (<it>P </it>= 0.013), and satisfaction with life in general (<it>P </it>= 0.006).</p> <p>Conclusions</p> <p>Our current data assessing patient satisfaction with acute health care by the Arabic version of the EQS-H showed that the satisfaction rate was average on MI dimension; and good on RS dimension of the questionnaire. The majority of participants were satisfied with the overall care. Demographic, socioeconomic, and health characteristics may influence in-patients satisfaction in Morocco, a low/middle income country. An appreciation and understanding of these factors is essential to develop socio culturally appropriate interventions in order to improve satisfaction of patients.</p

Effects of Intermittent IL-2 Alone or with Peri-Cycle Antiretroviral Therapy in Early HIV Infection: The STALWART Study

The Study of Aldesleukin with and without antiretroviral therapy (STALWART) evaluated whether intermittent interleukin-2 (IL-2) alone or with antiretroviral therapy (ART) around IL-2 cycles increased CD4+ counts compared to no therapy

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Histoire d’une mobilisation associative contre le VIH/sida au Maroc

Professor Hakima Himmich traces the history of the Association de lutte contre le sida (ALCS), which she founded in Morocco in 1988. The organization first initiated programs targeting the populations most exposed to HIV, fought against the stigmatization and discrimination of people living with HIV, and then launched the fight for access to antiretroviral treatment. Its links with AIDES in France led her to co-found Coalition Plus, an international union of community-based AIDS organizations. Finally, the author shares her concern about the possible termination of funding from the Global Fund, which would put an end to the organization’s programs for groups most at risk of HIV