Readiness in HIV Treatment Adherence: A Matter of Confidence. An Exploratory Study§

Adherence to treatment is recognized as the essence of a successful HIV combination therapy. Optimal adherence implies a readiness to begin the treatment on the part of the patient. A better understanding of the "readiness phenomenon" will become an asset for optimizing HIV treatment. However, few studies have focused on understanding the process underlying the choice to adhere. The aim of this study is to understand the readiness process that leads to adhering to the HIV treatment, from both patient and professional perspectives. Twenty-seven in-depth interviews, with a qualitative exploratory design, were the source of our data. Participants were recruited in two hospitals in Paris. Throughout the data-collection process, analysed data were supplied to all participants and the research team, thus allowing for shared constructions. Four themes, interrelated with a constitutive pattern, emerged from the data we collected. Being ready to begin and adhere to treatment is a matter of confidence in oneself, as well as in relatives, in the treatment and in the health professional team. These themes are not constant and unvarying; instead, they constitute a picture moving across time and life events. Results of this study show that adherence that goes beyond “complying with” the medical instructions, but depends on how much of an active role the patient plays in the choice to adhere

4D Numerical Analysis of Scaffolds: A New Approach

A large range of biodegradable polymers are used to produce scaffoldsfor tissue engineering, which temporarily replace the biomechanical functions ofa biologic tissue while it progressively regenerates its capacities. However, the mechanicalbehavior of biodegradable materials during its degradation, which is an importantaspect of the scaffold design, is still an unexplored subject. For a biodegradablescaffold, performance will decrease along its degradation, ideally in accordanceto the regeneration of the biologic tissue, avoiding the stress shielding effect or thepremature rupture. In this chapter, a new numerical approach to predict the mechanicalbehavior of complex 3D scaffolds during degradation time (the 4th dimension)is presented. The degradation of mechanical properties should ideally be compatibleto the tissue regeneration. With this new approach, an iterative process of optimizationis possible to achieve an ideal solution in terms of mechanical behavior anddegradation time. The scaffold can therefore be pre-validated in terms of functionalcompatibility. An example of application of this approach is demonstrated at the endof this chapter

The association of sex steroid hormone concentrations with non‐alcoholic fatty liver disease and liver enzymes in US men

BACKGROUND & AIMS This study aimed to analyse the association of sex hormone levels with liver enzyme levels and non-alcoholic fatty liver disease (NAFLD) in a nationally representative sample of men. METHODS 919 men from the US National Health and Nutrition Examination Study (NHANES) III were included in this cross-sectional analysis of data from 1988-1991. We used existing data on serum total and free testosterone, total and free estradiol, androstanediol glucuronide (AAG), sex steroid binding globulin (SHBG), and estimated their associations with aspartate aminotransferase (AST), and alanine aminotransferase (ALT) and NAFLD, as determined using ultrasound, after adjusting for possible confounders including age, race, smoking, alcohol, physical activity, waist circumference and steroid hormones. RESULTS Lower total testosterone and higher free estradiol were associated with higher odds of NAFLD after adjusting for confounders including the other sex hormones. Lower total testosterone was associated with higher odds of elevated AST, but not ALT. Free testosterone, total estradiol, SHBG and AAG were not associated with NAFLD or liver enzymes. CONCLUSIONS This study supports an inverse association between total testosterone concentration and NAFLD in men independent of other sex hormones (SHBG, AAG, estradiol) and known risk factors such as obesity, age and lifestyle. Exploration of whether total testosterone might be a non-invasive marker for NAFLD diagnosis is warranted