Teoría feminista : un marco teórico para la educación efectiva en la prevención del VIH en mujeres drogadictas

Con el aumento en el número de mujeres infectadas con el VIH, los programas educativos de prevención enfocados en el género pueden ser útiles en asistir mujeres en conductas de riesgo, en reducir los comportamientos sexuales o el uso de drogas consideradas de alto riesgo. El estudio siguiente trata el tema tras la implementación de una intervención para reducir el riesgo de contraer el VIH con mujeres drogadictas. Dicha intervención se desarrolló empleando la teoría feminista que utiliza métodos feministas en su acercamiento. El Proyecto Community Outreach Project on AIDS in Southern Arizona (COPASA) for Women (Proyecto de Promoción Comunitaria sobre el SIDA para Mujeres en el Sur de Arizona) se realizó con 727 mujeres drogadictas que fueron elegidas al azar de cada uno de los dos niveles de intervención (básica y orientada a la mujer). Además, se realizaron entrevistas iniciales, y seguimientos de 6 meses a 12 meses para examinar riesgos en cuanto al uso de drogas o conductas sexuales así como cambios en conductas de riesgo a partir de la intervención. Los resultados del estudio indican que en general, los cambios en reducción de riesgos ocurrieron en mujeres de ambas tipologías; sin embargo, las conductas de riesgo sexual fueron más, para aquéllas que participaron en la intervención orientada a la mujer (durante el seguimiento a los 12 meses). Estos resultados indican lo útil de desarrollar y llevar a cabo intervenciones para reducir los riesgos del VIH empleando teoría y métodos feministas y los relativamente intensificados y sostenidos resultados en proveer una intervención orientada a la mujer.__________________________________With the increasing number of women becoming infected with HIV, gender-specific prevention education programs may be helpful in assisting at-risk women reduce their HIV drug and sex-risk behaviors. This study addressed this issue by implementing an HIV risk reduction intervention program for drug-involved women that was developed from feminist theory and which utilized feminist methods in the approach. The Community Outreach Project on AIDS in Southern Arizona (COPASA) for Women enrolled 727 drug-involved women, randomly assigned the women to one of two levels of intervention (basic and women-centered), and conducted a baseline and a six and 12-month follow-up assessment to examine baseline drug and sex risk behavior and changes in risk behaviors following the intervention. The study findings indicate that, on average, risk reduction changes occurred for women in both the basic and the women-centered interventions; however, sex risk behavior was more highly sustained at the more distal 12-month follow-up for those who participated in the women-centered intervention. These findings indicate the relative helpfulness of developing and delivering an HIV risk reduction interventions using feminist theory and methods and the relatively heightened and sustained outcomes of providing a women- centered intervention

Into the Island: A new technique of non-invasive cortical stimulation of the insula

Study aim. - We describe a new neuronavigation-guided technique to target the posterior-superior insula (PSI) using a cooled-double-cone coil for deep cortical stimulation. Introduction. - Despite the analgesic effects brought about by repetitive transcranial magnetic stimulation (TMS) to the primary motor and prefrontal cortices, a significant proportion of patients remain symptomatic. This encouraged the search for new targets that may provide stronger pain relief. There is growing evidence that the posterior insula is implicated in the integration of painful stimuli in different pain syndromes and in homeostatic thermal integration. Methods. - The primary motor cortex representation of the lower leg was used to calculate the motor threshold and thus, estimate the intensity of PSI stimulation. Results. - Seven healthy volunteers were stimulated at 10 Hz to the right PSI and showed subjective changes in cold perception. The technique was safe and well tolerated. Conclusions. - The right posterior-superior insula is worth being considered in future studies as a possible target for rTMS stimulation in chronic pain patients. (c) 2012 Elsevier Masson SAS. All rights reserved

Dissecting central post-stroke pain:a controlled symptom-psychophysical characterization

Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non-neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far. We compared 39 patients with definite central neuropathic post-stroke pain with two matched control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke. While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (P < 0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n = 32, P < 0.001), tingling (66.7%, n = 26, P < 0.001) and evoked by cold (64.1%, n = 25, P < 0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (P < 0.001), which also presented higher levels of deafferentation (P < 0.012) with more asymmetric cold and warm detection thresholds compared with controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was <41% of the contralateral threshold) odds ratio (OR) was 12 (95% CI: 3.8–41.6) for neuropathic pain. Additionally, cold detection threshold/warm detection threshold ratio correlated with the presence of neuropathic pain (ρ = −0.4, P < 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (ρ = −0.4; P = 0.008) and heat pain thresholds (ρ = 0.5; P = 0.003), burning pain with mechanical detection (ρ = −0.4; P = 0.015) and mechanical pain thresholds (ρ = −0.4, P < 0.013), evoked pain with mechanical pain threshold (ρ = −0.3; P = 0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain. These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials

GRANDMA and HXMT Observations of GRB 221009A -- the Standard-Luminosity Afterglow of a Hyper-Luminous Gamma-Ray Burst

GRB 221009A is the brightest Gamma-Ray Burst (GRB) detected in more than 50 years of study. In this paper, we present observations in the X-ray and optical domains after the GRB obtained by the GRANDMA Collaboration (which includes observations from more than 30 professional and amateur telescopes) and the Insight-HXMT Collaboration. We study the optical afterglow with empirical fitting from GRANDMA+HXMT data, augmented with data from the literature up to 60 days. We then model numerically, using a Bayesian approach, the GRANDMA and HXMT-LE afterglow observations, that we augment with Swift-XRT and additional optical/NIR observations reported in the literature. We find that the GRB afterglow, extinguished by a large dust column, is most likely behind a combination of a large Milky-Way dust column combined with moderate low-metallicity dust in the host galaxy. Using the GRANDMA+HXMT-LE+XRT dataset, we find that the simplest model, where the observed afterglow is produced by synchrotron radiation at the forward external shock during the deceleration of a top-hat relativistic jet by a uniform medium, fits the multi-wavelength observations only moderately well, with a tension between the observed temporal and spectral evolution. This tension is confirmed when using the extended dataset. We find that the consideration of a jet structure (Gaussian or power-law), the inclusion of synchrotron self-Compton emission, or the presence of an underlying supernova do not improve the predictions, showing that the modelling of GRB22109A will require going beyond the most standard GRB afterglow model. Placed in the global context of GRB optical afterglows, we find the afterglow of GRB 221009A is luminous but not extraordinarily so, highlighting that some aspects of this GRB do not deviate from the global known sample despite its extreme energetics and the peculiar afterglow evolution.Comment: Accepted to ApJL for the special issue, 37 pages, 23 pages main text, 6 tables, 13 figure

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Children's constructive social worlds: Existential lives in the balance

Though children are capable of describing themselves and their lives in candid and lucid fashion (e.g., Coles, 1970), their voices are easily supplanted or discredited by the adult (Cahan, Mechling, Sutton-Smith, & White, 1993). A similar phenomenon, girls' loss of self-identity and voice, has been studied by Gilligan (1982). The research design of this dissertation, a qualitative, phenomenological approach, facilitates the documentation of children's social worlds. Extensive observations, interviews, home visits, monolingual and bilingual dialogue journal interactions, and a researcher as "peer" role are among the methodological tools used to provide a panoramic of Mexican and Mexican American language minority children's social worlds. Additionally, the dissertation has been guided by an interdisciplinary approach to the study of children's social worlds and inner lives. This approach is reflected in the dissertation itself, as found, for example, in the following chapters: A Socio-Historic Perspective to Understanding the Development of Childhood in South Tucson, Arizona; A Phenomenological Approach to the Construction of Reality; An Ecological Approach to Human Development and its Social Context; Bronfenbrenner's Ecology of Human Development; and Consequences of El'konin's Theoretical Premise. Children's social worlds or peer cultures are at worst viewed pejoratively, as inferior subcultures, especially for minority children. This perception is misleading, inferring that these worlds are necessarily insignificant and detrimental to the child (Marsh, Rosser & Harre, 1978). Within the many social worlds children create for themselves and those which they participate in, children gain vital knowledge and create networks of support crucial to their development and survival as humans. Those worlds are evidenced in ecological environments where children lead creative, meaningful, and sometimes problematic lives. The educational and societal potential for understanding those social worlds lies in its contributions to the development and practice of pedagogically relevant theory