L’aide par les pairs et les groupes d’entraide comme solutions de rechange et comme compléments à l’aide professionnelle

Compte tenu que le nombre de personnes ayant une formation professionnelle ne sera jamais suffisant pour affronter la crise du VIH, on doit trouver des solutions de rechange. Deux types de ressources sont ici proposées : l'aide par les pairs et les groupes d'entraide. La mise en place de ces formes d'aide exige une formation appropriée. Elles peuvent être des compléments essentiels aux stratégies de prévention, de contrôle et d'aide, et en ce sens, elles devront être intégrées à l'ensemble du système de soins

A computerized model for retail fertilizer dealers' inventory management

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Does the availability of a South Asian language in practices improve reports of doctor-patient communication from South Asian patients? Cross sectional analysis of a national patient survey in English general practices.

BACKGROUND: Ethnic minorities report poorer evaluations of primary health care compared to White British patients. Emerging evidence suggests that when a doctor and patient share ethnicity and/or language this is associated with more positive reports of patient experience. Whether this is true for adults in English general practices remains to be explored. METHODS: We analysed data from the 2010/2011 English General Practice Patient Survey, which were linked to data from the NHS Choices website to identify languages which were available at the practice. Our analysis was restricted to single-handed practices and included 190,582 patients across 1,068 practices. Including only single-handed practices enabled us to attribute, more accurately, reported patient experience to the languages that were listed as being available. We also carried out sensitivity analyses in multi-doctor practices. We created a composite score on a 0-100 scale from seven survey items assessing doctor-patient communication. Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice. Models were adjusted for patient characteristics and a random effect for practice. RESULTS: Availability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents (p < 0.01). Bangladeshi, Pakistani and Indian respondents on average reported poorer communication than White British respondents [-2.9 (95%CI -4.2, -1.6), -1.9 (95%CI -2.6, -1.2) and -1.9 (95%CI -2.5, -1.4), respectively]. However, in practices where a concordant language was offered, the experience reported by Pakistani patients was not substantially worse than that reported by White British patients (-0.2, 95%CI -1.5,+1.0), and in the case of Bangladeshi patients was potentially much better (+4.5, 95%CI -1.0,+10.1). This contrasts with a worse experience reported among Bangladeshi (-3.3, 95%CI -4.6, -2.0) and Pakistani (-2.7, 95%CI -3.6, -1.9) respondents when a concordant language was not offered. CONCLUSIONS: Substantial differences in reported patient experience exist between ethnic groups. Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient's ethnicity

Securing recruitment and obtaining informed consent in minority ethnic groups in the UK

Background: Previous health research has often explicitly excluded individuals from minority ethnic backgrounds due to perceived cultural and communication difficulties, including studies where there might be language/literacy problems in obtaining informed consent. This study addressed these difficulties by developing audio-recorded methods of obtaining informed consent and recording data. This report outlines 1) our experiences with securing recruitment to a qualitative study investigating alternative methods of data collection, and 2) the development of a standardised process for obtaining informed consent from individuals from minority ethnic backgrounds whose main language does not have an agreed written form. Methods: Two researchers from South Asian backgrounds recruited adults with Type 2 diabetes whose main language was spoken and not written, to attend a series of focus groups. A screening tool was used at recruitment in order to assess literacy skills in potential participants. Informed consent was obtained using audio-recordings of the patient information and recording patients' verbal consent. Participants' perceptions of this method of obtaining consent were recorded. Results: Recruitment rates were improved by using telephone compared to face-to-face methods. The screening tool was found to be acceptable by all potential participants. Audio-recorded methods of obtaining informed consent were easy to implement and accepted by all participants. Attrition rates differed according to ethnic group. Snowballing techniques only partly improved participation rates. Conclusion: Audio-recorded methods of obtaining informed consent are an acceptable alternative to written consent in study populations where literacy skills are variable. Further exploration of issues relating to attrition is required, and a range of methods may be necessary in order to maximise response and participation

The Influence of Superpositional Wave Function Oscillations on Shor's Quantum Algorithm

We investigate the influence of superpositional wave function oscillations on the performance of Shor's quantum algorithm for factorization of integers. It is shown that the wave function oscillations can destroy the required quantum interference. This undesirable effect can be routinely eliminated using a resonant pulse implementation of quantum computation, but requires special analysis for non-resonant implementations.Comment: 4 pages, NO figures, revte

Coronagraph design for an extreme adaptive optics system with spatially filtered wavefront sensing on segmented telescopes

High dynamic range coronagraphy targeted at discovering planets around nearby stars is often associated with monolithic, unobstructed aperture space telescopes. With the advent of extreme adaptive optics (ExAO) systems with thousands of sensing and correcting channels, the benefits of placing a near-infrared coronagraph on a large segmented mirror telescope become scientifically interesting. This is because increased aperture size produces a tremendous gain in achievable contrast at the same angular distance from a point source at Strehl ratios in excess of 90\% (and at lower Strehl ratios on future giant telescopes such as the Thirty Meter Telescope). We outline some of the design issues facing such a coronagraph, and model a band-limited coronagraph on an aperture with a Keck-like pupil. We examine the purely diffractive challenges facing the eXtreme AO Planetary Imager (XAOPI) given the Keck pupil geometry, notably its inter-segment gap spacing of 6~mm. Classical Lyot coronagraphs, with hard-edged occulting stops, are not efficient enough at suppressing diffracted light, given XAOPI's scientific goal of imaging a young Jupiter at a separation as close as 0.15 arcseconds (4λD at H on Keck) from its parent star. With a 4000 channel ExAO system using an anti-aliased spatially-filtered wavefront sensor planned for XAOPI, we wish to keep diffracted light due to coronagraphic design at least as low as the noise floor set by AO system limitations. We study the band-limited Lyot coronagraph (BLC) as a baseline design instead of the classical design because of its efficient light suppression, as well as its analytical simplicity. We also develop ways of investigating tolerancing coronagraphic mask fabrication by utilizing the BLC design's mathematical tractability

Dynamics of a Quantum Control-Not Gate for an Ensemble of Four-Spin Molecules at Room Temperature

We investigate numerically a single-pulse implementation of a quantum Control-Not (CN) gate for an ensemble of Ising spin systems at room temperature. For an ensemble of four-spin ``molecules'' we simulate the time-evolution of the density matrix, for both digital and superpositional initial conditions. Our numerical calculations confirm the feasibility of implementation of quantum CN gate in this system at finite temperature, using electromagnetic $\pi$-pulse.Comment: 7 pages 3 figure

Gene expression in hypothalamus, liver, and adipose tissues and food intake response to melanocortin-4 receptor agonist in pigs expressing melanocortin-4 receptor mutations

Transcriptional profiling was used to identify genes and pathways that responded to intracerebroventricular injection of melanocortin-4 receptor (MC4R) agonist [Nle4, D-Phe7]-α-melanocyte stimulating hormone (NDP-MSH) in pigs homozygous for the missense mutation in the MC4R, D298 allele (n = 12), N298 allele (n = 12), or heterozygous (n = 12). Food intake (FI) was measured at 12 and 24 h after treatment. All pigs were killed at 24 h after treatment, and hypothalamus, liver, and back-fat tissue was collected. NDP-MSH suppressed (P \u3c 0.004) FI at 12 and 24 h in all animals after treatment. In response to NDP-MSH, 278 genes in hypothalamus (q ≤ 0.07, P ≤ 0.001), 249 genes in liver (q ≤ 0.07, P ≤ 0.001), and 5,066 genes in fat (q ≤ 0.07, P ≤ 0.015) were differentially expressed. Pathway analysis of NDP-MSH-induced differentially expressed genes indicated that genes involved in cell communication, nucleotide metabolism, and signal transduction were prominently downregulated in the hypothalamus. In both liver and adipose tissue, energy-intensive biosynthetic and catabolic processes were downregulated in response to NDP-MSH. This included genes encoding for biosynthetic pathways such as steroid and lipid biosynthesis, fatty acid synthesis, and amino acid synthesis. Genes involved in direct energy-generating processes, such as oxidative phosphorylation, electron transport, and ATP synthesis, were upregulated, whereas TCA-associated genes were prominently downregulated in NDP-MSH-treated pigs. Our data also indicate a metabolic switch toward energy conservation since genes involved in energy-intensive biosynthetic and catabolic processes were downregulated in NDP-MSH-treated pigs

Comparison of DC Bead-irinotecan and DC Bead-topotecan drug eluting beads for use in locoregional drug delivery to treat pancreatic cancer

DC Bead is a drug delivery embolisation system that can be loaded with doxorubicin or irinotecan for the treatment of a variety of liver cancers. In this study we demonstrate that the topoisomerase I inhibitor topotecan hydrochloride can be successfully loaded into the DC Bead sulfonate-modified polyvinyl alcohol hydrogel matrix, resulting in a sustained-release drug eluting bead (DEBTOP) useful for therapeutic purposes. The in vitro drug loading capacity, elution characteristics and the effects on mechanical properties of the beads are described with reference to our previous work with irinotecan hydrochloride (DEBIRI). Results showed that drug loading was faster when the solution was agitated compared to static loading and a maximum loading of ca. 40–45 mg topotecan in 1 ml hydrated beads was achievable. Loading the drug into the beads altered the size, compressibility moduli and colour of the bead. Elution was shown to be reliant on the presence of ions to perform the necessary exchange with the electrostatically bound topotecan molecules. Topotecan was shown by MTS assay to have an IC50 for human pancreatic adenocarcinoma cells (PSN-1) of 0.22 and 0.27 lM compared to 28.1 and 19.2 lM for irinotecan at 48 and 72 h, respectively. The cytotoxic efficacy of DEBTOP on PSN-1 was compared to DEBIRI. DEPTOP loaded at 6 & 30 mg ml-1, like its free drug form, was shown to be more potent than DEBIRI of comparable doses at 24, 48 & 72 h using a slightly modified MTS assay. Using a PSN-1 mouse xenograft model, DEBIRI doses of 3.3–6.6 mg were shown to be well tolerated (even with repeat administration) and effective in reducing the tumour size. DEBTOP however, was lethal after 6 days at doses of 0.83–1.2 mg but demonstrated reasonable efficacy and tolerability (again with repeat injection possible) at 0.2–0.4 mg doses. Care must therefore be taken when selecting the dose of topotecan to be loaded into DC Bead given its greater potency and potential toxicity