LANGUAGE, VIOLENCE AND STIGMA: BARRIERS TO CARE FOR HIV-POSITIVE PREGNANT WOMEN IN THE DOMENICAN REPUBLIC

The Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV goal is to reduce the prevalence of HIV in the newborn population respectively to 2% by the year 2015. This Initiative is promoted by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Governments from low and middle income countries have adopted and adapted the international directives of the Initiative to their national context in order to respond to international commitments, including the achievement of the Millennium Development Goals (MDGs) 5 and 6, related to maternal health and preventable diseases and infections, respectively. Even though bio-medical innovations, mainly Anti Retroviral Drugs, and well-known best practices in public health implementation have made it feasible to prevent most of the Mother to Child transmission, approximately 2.5 million children worldwide are currently living with HIV and every day 1000 children are born with HIV (Marcos et al., 2012; UNAIDS, 2010). In the Dominican Republic (DR), regardless a 98% coverage of antenatal services and institutional birth with skilled staff (MSP and UNICEF, 2011), there are lingering shortcomings that result in high maternal mortality and child mortality rates (150 per 100,000 and 36 per thousand, respectively) (UNICEF et al., 2013). If skilled attendance on birth is \u201cthe single most important factor in reducing maternal mortality\u201d (WHO, 1999), how could anyone reconcile Dominican Republic\u2019s quasi-universal skilled attendance with a maternal mortality rate that almost doubles the Latin American average? The answer to this paradox, according to UNDP, is the low quality and inequality of health care services (2010). These systemic and institutional weaknesses also affect the Program for the Prevention of Mother to Child Transmission -PMTCT- where the current transmission rate has been estimated in 6% and the rate of full screening for HIV in pregnant women is only 19% (UNICEF, 2012). Consequently, the implementation of the PMTCT in Dominican Republic faces various challenges that range from the disempowerment and vulnerability of the target population (HIV positive pregnant women) to the weak incorporation of the initiative into mainstream prenatal care in order to avoid parallel programs (MSP and UNICEF, 2011). Prevention of transmission from a HIV positive mother to her child requires the completion of a series of consecutive and necessary steps in a continuum of care, also known as the PMTCT cascade (Towle 2009, Marcos et al., 2012). One of the main problems identified in Low and Middle Income Countries (LMICs) is the poor retention and low adherence along this cascade. This phenomenon also called loss to follow-up (LFU) \u201chas been recognized as a major hurdle by PMTCT programs in resource poor settings\u201d (Panditrao et al., 2011). It affects 40% of women enrolled in India, up to 81% in Malawi, 84% in Cote d\u2019Ivoire and more than 70% in South Africa and Zimbawe (Panditrao et al., 2011; Manzi et al., 2005; Painter et al., 2004). Given such high rates of non-adherence to the PMTCT Cascade, the effectiveness of these programs is eroded \u201cnot only because the objective of reducing pediatric HIV transmissions is compromised but also because of the missed opportunity to link HIV-infected women and their partners to further care and support activities\u201d. (Panditrao et al., 2011). This programmatic failure is compounded by the lack of information and academic literature about the institutional or social mechanisms that trigger a higher or lower adherence level and the risk-factors that influence drop-out in PMTCT (Towle, 2009; Panditrao et al., 2011). According to Horne \u201cnonadherence is often a hidden problem: undisclosed by patients and unrecognised by prescribers\u201d (2005). Notwithstanding massive advance in the evolution of health care services and in the presentation and design of medicine, adherence is still an unsolved problem and therefore the research question has been formulated to investigate: Why are adherence and non-adherence triggered in the intended users of the Program for the reduction of mother to child transmission in the Dominican Republic? In low and middle-income countries, where lack of appropriate data and information systems restrain longitudinal monitoring of patients and hinders systematic investigation, the study of adherence is often confined to epidemiological approaches, leaving the interaction between patient and the health system superficially addressed. Most of the existing literature focuses on the demand for HIV health services (patient behavior), ignoring supply (institutional arrangements and organizational culture). With regards to PMTCT, very few exploratory studies have discussed the social, economic and structural barriers and facilitators to full adherence in low and middle income countries (Towle, 2009; Painter et al., 2004; Castro and Farmer, 2005; Campbell, 2003; Parker, 2001; Trickett, 2005, 2004). In order to analyze and unpack this phenomenon a Fuzzy Set Qualitative Comparative Analysis will be used to address the task of improving the understanding of PMTCT program, its mechanisms and the context in which adherence develops. Service level delivery will be analyzed using in depth interviews with 120 HIV positive women that attended the program. Their experiences with the program have been recorded, translated where necessary, and transcribed. All the data has been systematized, coded and analyzed with fuzzy set Qualitative Comparative Analysis looking at how different combinations of conditions concur to adherence and risk for them and for the baby. Policy designers\u2019 opinions and practices have been studied during one year of participating in the National Technical Group for the Elimination of Mother to Child Transmission in the Dominican Republic that integrate members of the Ministry of Health and International Organization such as UNICEF and PAHO. This participation has endorsed the elaboration of a series of research questions and interest of the Ministry of Health opening up the access to the two main maternities in the country and partly their documents. Health care providers and practitioners\u2019 practices have been studied during two years of observations in maternities and this experience has been essential for creation of the interview questionnaire and in the interpretation of the fsQCA solutions. This thesis is developed in five chapters. Chapter 1 presents the insertion of the study in the trend of analysis of Public Policies in LMICs and the state of the art in this academic field. The Chapter starts by describing current trends and challenges in the literature of health public policies in low and middle-income countries and develops by looking at the importance of adopting a locus at the front line service level to study the experience of non-traditional actors: the women involved in the program. Subsequently, the Chapter presents the factors found in literature that are related to the possible barriers faced by the women in the program from a psychological, social, economical and structural perspective. The chapter ends by presenting the most important and known definitions used to define different types of patient commitment to health programs. The second Chapter presents the outcome, each single condition adopted for the model and their operationalization, the hypothesis and the data set. The third Chapter is divided in two parts. The first one presents the analysis with fuzzy set Qualitative Comparative Analysis starting with the results of the Analysis of Necessary Conditions for Positive and Negative Outcome and following with the Analysis of Sufficiency. The second part describes the result of the episodes of violence\u2019s categorization that emerged during in depth interviews with the women interviewed. The Chapter ends by exploring the most relevant topics encountered during the analysis of the transcriptions related to the program and the mechanisms involved in adherence and non-adherence. The last Chapter presents the discussion of the results and applied policy implication namely that the most significant determinants for adherence in the Dominican case are language and HIV Knowledge. Despite the numerous literature regarding education and female employment as strong determinants of adherence, the evidence collected does not support their status as necesary conditions. This final chapter ends by addressing the limitation of the current research and future possible development in the field of adherence to the PMTCT in LMICs

Chip-scale Simulations in a Quantum-correlated Synthetic Space

An efficient simulator for quantum systems is one of the original goals for the efforts to develop a quantum computer [1]. In recent years, synthetic dimension in photonics [2] have emerged as a potentially powerful approach for simulation that is free from the constraint of geometric dimensionality. Here we demonstrate a quantum-correlated synthetic crystal, based upon a coherently-controlled broadband quantum frequency comb produced in a chip-scale dynamically modulated lithium niobate microresonator. The time-frequency entanglement inherent with the comb modes significantly extends the dimensionality of the synthetic space, creating a massive nearly 400 x 400 synthetic lattice with electrically-controlled tunability. With such a system, we are able to utilize the evolution of quantum correlations between entangled photons to perform a series of simulations, demonstrating quantum random walks, Bloch oscillations, and multi-level Rabi oscillations in the time and frequency correlation space. The device combines the simplicity of monolithic nanophotonic architecture, high dimensionality of a quantum-correlated synthetic space, and on-chip coherent control, which opens up an avenue towards chip-scale implementation of large-scale analog quantum simulation and computation [1,3,4] in the time-frequency domain.Comment: 21 pages, 14 figures (including supplementary materials

Single-mode Fiber and Few-Mode Fiber Photonic Lanterns Performance Evaluated for Use in a Scalable Real-Time Photon Counting Ground Receiver

Photonic lanterns provide an efficient way of coupling light from a single large-core fiber to multiple small-core fibers. This capability is of interest for space to ground communication applications. In these applications, the optical ground receivers require high-efficiency coupling from an atmospherically distorted focus spot to multiple fiber coupled single pixel super-conducting nanowire detectors. This paper will explore the use of photonic lanterns in a real-time ground receiver that is scalable and constructed with commercial parts. The number of small-core fibers that make a photonic lantern determines the number of spatial modes that they couple. For instance, lanterns made with n number of single-mode fibers can couple n number of spatial modes. Although the laser transmitted from a spacecraft originates as a Gaussian shape, the atmosphere distorts the beam profile by scattering energy into higher-order spatial modes. Therefore, if a ground receiver is sized for a target data rate with n number of detectors, the corresponding lantern made with single-mode fibers will couple n number of spatial modes. The energy of the transmitted beam scattered into spatial modes higher than n will be lost. This paper shows this loss may be reduced by making lanterns with few-mode fibers instead of single-mode fibers, increasing the number of spatial modes that can be coupled and therefore increasing the coupling efficiency to single pixel, single photon detectors. The free space to fiber coupling efficiency of these two types of photonic lanterns are compared over a range of the free-space coupling numerical apertures and mode field diameters. Results indicate the few mode fiber lantern has higher coupling efficiency for telescopes with longer focal lengths under higher turbulent conditions. Also presented is analysis of the jitter added to the system by the lanterns, showing the few-mode fiber photonic lantern adds more jitter than the single-mode fiber lantern, but less than a multimode fiber

Biological laterality and peripheral nerve DTI metrics

BACKGROUND AND PURPOSE: Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular). MATERIALS AND METHODS: We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed. RESULTS: A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles. CONCLUSION: For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients’ recovery and how we forecast pain chronification

DTI and MTR Measures of Nerve Fiber Integrity in Pediatric Patients With Ankle Injury

Acute peripheral nerve injury can lead to chronic neuropathic pain. Having a standardized, non-invasive method to evaluate pathological changes in a nerve following nerve injury would help with diagnostic and therapeutic assessments or interventions. The accurate evaluation of nerve fiber integrity after injury may provide insight into the extent of pathology and a patient's level of self-reported pain. The aim of this investigation was to evaluate the extent to which peripheral nerve integrity could be evaluated in an acute ankle injury cohort and how markers of nerve fiber integrity correlate with self-reported pain levels in afferent nerves. We recruited 39 pediatric participants with clinically defined neuropathic pain within 3 months of an ankle injury and 16 healthy controls. Participants underwent peripheral nerve MRI using diffusion tensor (DTI) and magnetization transfer imaging (MTI) of their injured and non-injured ankles. The imaging window was focused on the branching point of the sciatic nerve into the tibial and fibular division. Each participant completed the Pain Detection Questionnaire (PDQ). Findings demonstrated group differences in DTI and MTI in the sciatic, tibial and fibular nerve in the injured ankle relative to healthy control and contralateral non-injured nerve fibers. Only AD and RD from the injured fibular nerve correlated with PDQ scores which coincides with the inversion-dominant nature of this particular ankle injuruy cohort. Exploratory analyses highlight the potential remodeling stages of nerve injury from neuropathic pain. Future research should emphasize sub-acute time frames of injury to capture post-injury inflammation and nerve fiber recovery

Electrically empowered microcomb laser

Optical frequency comb underpins a wide range of applications from communication, metrology, to sensing. Its development on a chip-scale platform -- so called soliton microcomb -- provides a promising path towards system miniaturization and functionality integration via photonic integrated circuit (PIC) technology. Although extensively explored in recent years, challenges remain in key aspects of microcomb such as complex soliton initialization, high threshold, low power efficiency, and limited comb reconfigurability. Here we present an on-chip laser that directly outputs microcomb and resolves all these challenges, with a distinctive mechanism created from synergetic interaction among resonant electro-optic effect, optical Kerr effect, and optical gain inside the laser cavity. Realized with integration between a III-V gain chip and a thin-film lithium niobate (TFLN) PIC, the laser is able to directly emit mode-locked microcomb on demand with robust turnkey operation inherently built in, with individual comb linewidth down to 600 Hz, whole-comb frequency tuning rate exceeding $\rm 2.4\times10^{17}$ Hz/s, and 100% utilization of optical power fully contributing to comb generation. The demonstrated approach unifies architecture and operation simplicity, high-speed reconfigurability, and multifunctional capability enabled by TFLN PIC, opening up a great avenue towards on-demand generation of mode-locked microcomb that is expected to have profound impact on broad applications

A Formação Do Psicólogo Organizacional -: Reflexões A Partir Do Caso Baiano

Based on the profile of professionals working inthe many subareas of organizational psychology, theindispensable skills necessary to the profissional lifes of thesepsychologists were described. These skills were devided in twocathegories: (a) the basic ones or the perfomance in the wholearea; (b) the specific ones, essential for each subárea. Based onthis output, a questionnaire was elaborated and applied to asample of 20 UFBA undergraduate psychology students. The facultystaff that teaches organizational psychology subjects andcourses in prerequisite areas to the organizational psychologysubjects were also interviewed. The results show that the undergraduatesconsidered training insufficient or very insufficient in almostall evaluated aspects, especially in the ones related to thespecific subareas. The theoretical contents were regarded in a morepositive way than the other contents, specially those related toresearch. However, as in the general case, means did not reach theaverage point in the evaluation scale. It was also observed that thestudents interested in working in the area showed more negativeattitudes towards the course than their classmates. An ineffectivetraining in the Human Resources area in the curricular structure(subjects and pre-requisites), the insufficient time schedule, andthe strong emphasis in the area of clinical psychology were pointedout as the causes of the observed reality. Considering that thesecharacteristics are found to be present in most psychology courses,we speculate whether the case of UFBA is only an example ofthe general insufficient preparation of the organizational psychologist.RESUMO - Com base no perfil do psicólogo que atua nas diversas subáreas de aplicação da Psicologia às organizações levantou-se os conhecimentos e habilidades indispensáveis ao desempenho de cada atividade. Estes conhecimentos foram agrupados em duas categorias: aqueles básicos para atuação na área e os específicos de cada subárea. Com base neste produto elaborou-se um questionário que foi aplicado a uma amostra de 20 estudantes, concluintes do curso de Formação de Psicólogos da UFBA. Foram realizadas ainda entrevistas com os docentes da área e das disciplinas que são pré-requisitos imediatos. Os resultados mostraram que a formação é considerada insuficiente ou muito insuficiente em praticamente todos os aspectos avaliados, especialmente nos conteúdos específicos das subáreas de atuação. Os conteúdos  teóricos tiveram uma avaliação ligeiramente mais positiva, especialmente aqueles relacionados com atividade de pesquisa, não fugindo, entretanto, do quadro geral observado (as médias não atingem sequer o ponto médio da escala). Observou-se ainda que os alunos que pretendem atuar na área têm uma avaliação mais negativa do que os demais colegas. Não há efetivamente a formação dentro de uma perspectiva abrangente para atuar na área de RH. A estrutura curricular (definição das disciplinas e pré-requisitos), carga horária insuficiente e a forte ênfase do curso como um todo para formar o psicólogo clínico são apontados como fatores responsáveis pela realidade observada. Sabendo-se que tais fatores estão presentes na maioria dos cursos de psicologia, questiona-se até que ponto o caso da UFBA não faz parte de um quadro geral da formação inadequada do psicólogo organizacional

Effect of dietary simvastatin and L-carnitine supplementation on blood biochemical parameters, carcass characteristics and growth of broiler chickens

The aim of this study was to evaluate the effect of simvastatin (SIM) and L-carnitine (LC) additives and their interactions, on productive performance and carcass quality of broilers. For this purpose, a feeding trial was conducted, under 3×3 factorial design, using SIM at 0, 1 or 2 g/kg level and LC at 0, 150 or 300 mg/kg level in a basal-diet and originating a total of nine treatments: T1 (control-diet, 0/0), T2 (0/150), T3 (0/300), T4 (1/0), T5(1/150), T6 (1/300), T7 (2/0), T8 (2/150), and T9 (2/300). Feed intake was higher in T2 (4716 g), T7 (4722 g) and T9 (4698 g) than in T1 (4545 g; P<0.05) considering the last growing phase (35-42 days) or whole 42-day production cycle. An improvement of feed efficiency was also observed in T8 (1.64) and T9 (1.67) when compared to T1 (1.77; P<0.05), and these were mainly due to SIM × LC interactions (P<0.05). The LC influenced positively (P<0.05) the weight of eviscerated carcass, breast, drumsticks and abdominal fat, as well as plasma triglycerides level. This findings suggests that the combination of SIM and LC additives have a positive influence on growth performance and carcass traits of broiler chickens

Integrated Pockels Laser

The development of integrated semiconductor lasers has miniaturized traditional bulky laser systems, enabling a wide range of photonic applications. A progression from pure III-V based lasers to III-V/external cavity structures has harnessed low-loss waveguides in different material systems, leading to significant improvements in laser coherence and stability. Despite these successes, however, key functions remain absent. In this work, we address a critical missing function by integrating the Pockels effect into a semiconductor laser. Using a hybrid integrated III-V/Lithium Niobate structure, we demonstrate several essential capabilities that have not existed in previous integrated lasers. These include a record-high frequency modulation speed of 2 exahertz/s (2.0$\times$10$^{18}$ Hz/s) and fast switching at 50 MHz, both of which are made possible by integration of the electro-optic effect. Moreover, the device co-lases at infrared and visible frequencies via the second-harmonic frequency conversion process, the first such integrated multi-color laser. Combined with its narrow linewidth and wide tunability, this new type of integrated laser holds promise for many applications including LiDAR, microwave photonics, atomic physics, and AR/VR