Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions

Action de l'eclairage artificiel sur la production en serre du plant de melon greffe

National audienc

The method of specialized discursive conceptual systematizing: field practice with students of Biology-Chemistry at Oriente University

The experience presented developed in the process of the professors of Biology initial formation, starting from the application, to the practical of field, of the method discursive conceptual systematizing and its procedures: the systematic classification, the discursive conceptual disposition, the discursive production and the reflection. For it, is supported in a methodology that is structured starting from logic in the classification of the stages of the discursive conceptual progression. As particularity, the methodology has support in the focus socio cultural of knowledge, talkative, of the maternal language, quality that contributes to the improvement of the professors of Biology continuous didactic formation in the systematizing from the treatment to the systematic concepts.</p

Ion beam nitriding of single and polycrystalline austenitic stainless steel

Article Number: 083531Polycrystalline and single crystalline [orientations (001) and (011)] AISI 316L austenitic stainless steel was implanted at 400 degrees C with 1.2 keV nitrogen ions using a high current density of 0.5 mA cm(-2). The nitrogen distribution profiles were determined using nuclear reaction analysis (NRA). The structure of nitrided polycrystalline stainless steel samples was analyzed using glancing incidence and symmetric x-ray diffraction (XRD) while the structure of the nitrided single crystalline stainless steel samples was analyzed using x-ray diffraction mapping of the reciprocal space. For identical treatment conditions, it is observed that the nitrogen penetration depth is larger for the polycrystalline samples than for the single crystalline ones. The nitrogen penetration depth depends on the orientation, the being more preferential for nitrogen diffusion than . In both type of samples, XRD analysis shows the presence of the phase usually called "expanded" austenite or gamma(N) phase. The lattice expansion depends on the crystallographic plane family, the (001) planes showing an anomalously large expansion. The reciprocal lattice maps of the nitrided single crystalline stainless steel demonstrate that during nitriding lattice rotation takes place simultaneously with lattice expansion. The analysis of the results based on the presence of stacking faults, residual compressive stress induced by the lattice expansion, and nitrogen concentration gradient indicates that the average lattice parameter increases with the nitrided layer depth. A possible explanation of the anomalous expansion of the (001) planes is presented, which is based on the combination of faster nitriding rate in the (001) oriented grains and the role of stacking faults and compressive stressVytauto Didžiojo universiteta

Evolution of the nanoporous microstructure of sintered Ag at high temperature using in-situ X-ray nanotomography

International audienceSilver pastes sintering is a potential candidate for die bonding in power electronic modules. The joints, obtained by sintering, exhibit a significant pore fraction, thus reducing the density of the material compared to bulk silver. The mechanical properties (Young's modulus, yield strength and ultimate tensile stress) are then drastically altered. However, while careful analysis of the nanoporous structure has been reported in 2D, little is known about its quantitative spatial evolution during thermal aging and more specifically during temperature jumps endured by the assembly during operation. Here, high temperature evolutions of the 3D nanoporous structure have been observed in-situ using a heater fitted into the beamline 6-2c at SLAC-SSRL. Segmentation of the porosity and subsequent statistical analysis of the tomographic dataset reveal a complex evolution of the porous nanostructure including growth, separation and coalescence at a constant density. Such an analysis provides insight into the microstructural evolution of sintered nanoporous Ag joints in-service

Evolution of the nanoporous microstructure of sintered Ag at high temperature using in-situ X-ray nanotomography

International audienceSilver pastes sintering is a potential candidate for die bonding in power electronic modules. The joints, obtained by sintering, exhibit a significant pore fraction, thus reducing the density of the material compared to bulk silver. The mechanical properties (Young's modulus, yield strength and ultimate tensile stress) are then drastically altered. However, while careful analysis of the nanoporous structure has been reported in 2D, little is known about its quantitative spatial evolution during thermal aging and more specifically during temperature jumps endured by the assembly during operation. Here, high temperature evolutions of the 3D nanoporous structure have been observed in-situ using a heater fitted into the beamline 6-2c at SLAC-SSRL. Segmentation of the porosity and subsequent statistical analysis of the tomographic dataset reveal a complex evolution of the porous nanostructure including growth, separation and coalescence at a constant density. Such an analysis provides insight into the microstructural evolution of sintered nanoporous Ag joints in-service

Titania Deposition on PMR-15

The formation, degree of crystallinity and adherence of dense titania (TiO2) thin film coatings on a high-temperature polyimide resin (PMR-15) can be influenced by the chemical composition of the polymer surface. Furthermore, solution deposition conditions can be adjusted to provide additional control over the morphology and crystallinity of the titania films. Recipes for solution-based titania deposition that used a slowly-hydrolyzing titanium fluoride salt in the presence of boric acid as a fluoride scavenger allowed growth of films up to 750 nm thick in 22 h. By adjusting solution pH and temperature, either amorphous titania or oriented crystalline anatase films could be formed. Surface sulfonate groups enhance the adhesion of solution-deposited oxide thin film coatings. While most sulfonation procedures severely damaged the PMR-15 surface, the use of chlorosulfonic acid followed by hydrolysis of the installed chlorosulfonyl groups provided effective surface sulfonation without significant surface damage. In some cases, the oxide deposition solution caused partial hydrolysis of the polymer surface, which itself was sufficient to allow adhesion of the titania film through chelation of titanium ions by exposed benzoic acid groups on the polymer surface