Legitimate and underground needle exchange programs, specifically targeted for intravenous drug users (IVDUs) (i.e., currently the second largest risk group in the AIDS epidemic), have emerged in various locales in a desperate attempt to change their drug use practices and behaviors associated with the transmission of HIV-1/AIDS. This study focuses on one such program, the Tacoma-Pierce County Needle Exchange Program, in which the pioneering efforts of a private individual are provided, the manifestations of public entrepreneurism are examined, and in which various attributes of program acceptance are identified and explored. An introductory and exploratory case study approach is the research strategy used in this dissertation, since it is adaptive and flexible to accommodate the use of multiple data sources. Data have been collected through semi-structured interviews involving four law enforcement personnel and 21 program clients (i.e., IVDUs), which consisted of open-and close-ended questions regarding program acceptance. Existing data sources, such as court documents, published interviews with key officials, journals, and various news articles provide an assessment of the events and activities that relate to the evolution and success of the Tacoma-Pierce County Needle Exchange Program. The attributes identified and explored in this study include: settings, type of staff, method of service delivery (including spillover effects), nature of the geographic area, concern over the effects of AIDS, external environmental conduits (the informal communication network and the media), and characteristics of program clients. These attributes were found to be important to program acceptance of the Tacoma-Pierce County Needle Exchange Program; however, they should be further examined in other communities to see if they remain important. To this extent, the findings indicated that needle exchange programs have complex characteristics attached to them, and that they deserve to be further studied to understand those complexities. Other benefits of the Tacoma-Pierce County Needle Exchange Program found to be important include: (1) fewer citizen complaints about the carelessly discarded, used syringes often found in gutters, parks, greenbelts, alleys, and streets; and (2) fewer reports of infections caused by accidental needle stick injuries among law enforcement personnel (which can occur when a law enforcement officer frisks a suspect), maintenance employees, and grounds-keepers. Overall, phenomenal savings can accrue from such unintentional and additional benefits of needle exchange programs. In light of this debilitating disease, and of the high cost associated with medical care, such innovative interventions are perceived worthy in the course of this deadly epidemic.

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Background: Drug use is a public health problem associated with increased mortality, morbidity and lack of contact with healthcare. Stigmatization and discrimination surround drug use. Harm reduction aims to improve health without coercive measures to become drug-free in collaboration with people who inject drugs. Harm reduction is evidence-based, cost-effective and reduces the spread of infectious diseases. Needle exchanges provide information about drug-related risks and offer protection against this.  Aim: The aim was to describe experiences of harm reduction in needle exchanges in people who inject drugs.  Method: A qualitative literature study was carried out according to Polit and Beck's nine-step model. 11 articles were included and analyzed thematically according to the model of Braun and Clarke.  Results: The main finding is that people who inject drugs experience that needle exchanges offer knowledge and enable harm reduction. Needle exchanges are a place of health promotion for people who inject drugs.  Conclusion: How people who inject drugs experience the services and what makes them return is important knowledge for harm reduction to reach more people. Continued research is needed on how needle exchanges can reach more people who inject drugs. / Bakgrund: Drogbruk är ett folkhälsoproblem förenat med ökad dödlighet, sjuklighet och bristande kontakt med hälso- och sjukvård. Stigmatisering och diskriminering omgärdar drogbruk. Skadereduktion syftar till att förbättra hälsan utan tvingande åtgärder rörande drogfrihet. Skadereduktion är evidensbaserat, kostnadseffektivt och minskar spridningen av smittsamma sjukdomar. Sprututbyten ger information om drogrelaterade risker och erbjuder skydd mot dessa.  Syftet: Att beskriva erfarenheter av skadereduktion vid sprututbyten hos personer som injicerar droger. Metod: En kvalitativ litteraturstudie enligt Polit och Becks niostegsmodell. Elva artiklar inkluderades och analyserades tematiskt enligt modell av Braun och Clarke. Resultat: Huvudfynd är att personer som injicerar droger upplever att sprututbyten erbjuder kunskap och möjliggör skadereduktion. Sprututbyten är en plats för hälsopromotion för personer som injicerar droger.  Slutsats: Hur personer som injicerar droger upplever erbjuden skadereduktion vid sprututbyten och vad som får dem att återkomma är betydelsefull kunskap för att skadereduktion ska nå fler. Fortsatt forskning behövs om hur sprututbyten kan nå fler personer som injicerar droger.

Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly.

Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even in a state where syringes are legal. During the first four years, nearly 2,000 drug injectors made approximately 16,000 visits to the Exchange. Clients of the Exchange reduced risky behavior from intake to six months. Change lasted over time: at twelve months, change in behaviors continued to be significant. Frequent users of the Exchange were better on two variables than infrequent users: they borrowed syringes less, and were less likely to use a syringe and throw it away. Drug injectors using the Exchange were compared to those not using the Exchange, but using a bleach/outreach project. Clients of both projects reduced risky behaviors, with Exchange clients better on two variables: re-using syringes without cleaning, and throwing away used syringes. The two projects attracted different drug injectors, and should be viewed as complementary rather than competing AIDS prevention strategies. The impact of the Exchange on the community was evaluated by the change in the number of discarded syringes found on the streets. The number of syringes found per month decreased from 5.14 before the Exchange opened to 1.9 after it began -- a significant side benefit. The data presented here support the growing evidence that needle exchange programs produce behavioral risk reductions, and that the number of potentially infected syringes in public places can be reduced.

The training of specialists who understand the specific aspects of the country they work with is one of the most important aspects of the country's economic development. According to the "Concept of Long-Term Socio-Economic Development of the Russian Federation until 2020", the government is challenged to place at least five Russian universities in the "Top 100" world ranking, and the number of foreign students studying at the university, as well as the number of international cooperation and exchange programs are among the indicators of success in the global education market. Therefore, studying and solving the problems of adaptation of foreign students in the academic space is undoubtedly becoming relevant in today's world. / Подготовка специалистов, понимающих специфику страны, с которой они работают, является одним из важных условий экономического развития страны. Согласно утвержденной правительством «Концепции долгосрочного социально-экономического развития Российской Федерации на период до 2020 года». перед государством стоит задача вывести не менее пяти вузов России в мировой рейтинг «Топ 100», и количество иностранных студентов, обучающихся в вузе, а также количество международных сотрудничеств и программ обмена являются одними из показателей успешности на мировом рынке образования. Следовательно, изучение и решение проблем адаптации иностранных обучающихся в академическом пространстве, несомненно, приобретает актуальность в современном мире.

Bakgrund Personer som injicerar droger uppsöker vården mindre frekvent än övriga befolkningen men löper ökad risk för ohälsa utifrån olika riskbeteenden såsom att dela injektionsmaterial och bruka olagliga substanser. Ohälsa som uppkommer kopplat till injicering av droger orsakar lidande hos individen samt stora kostnader för sjukvården. Förmåga att ta hand om egenvård påverkar möjligheten att bibehålla hälsa och inkluderas i samhället. Syfte Att utforska hur egenvård uppfattas av personer som injicerar droger samt vilket behov av vård dessa personer ger uttryck för. Metod Kvalitativ intervjustudie med explorativ ansats. Semistrukturerade intervjuer genomfördes med 12 personer som besökte sprututbytesmottagningen vid Karolinska universitetssjukhuset i Stockholm. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat Analysen resulterade i tre kategorier: Önskan om att bibehålla hälsa trots substansbrukssyndrom, Behov av specifik kompetens och personcentrerad vård och Behov av specifik vård och säkra miljöer. I kategorin Önskan om att bibehålla hälsa trots substansbrukssyndrom beskrivs att egenvård uppfattas som att använda droger säkert och att i övrigt upprätthålla en god fysik och psykisk hälsa. I kategorin Behov av specifik kompetens och personcentrerad vård framkom att specifik omvårdnadskompetens och kunskap om substansbrukssyndrom inom hälso- och sjukvården efterfrågas. I kategorin behov av Specifik vård och säkra miljöer beskrivs att personer som injicerar droger efterfrågar tillgång till vård anpassad efter de specifika behov och hälsorisker som droganvändning medför.  Slutsats Egenvård uppfattas som att bibehålla hälsa genom att injicera droger på ett säkert sätt, minska riskbeteende samt att undvika att exkluderas från samhället genom att ta hand om utseende, hygien och sträva mot en meningsfull vardag. Respondenterna uttrycker behov av personcentrerad vård, värdigt bemötande samt kompetens avseende droganvändande hos vårdpersonal. En personlig och kontinuerlig kontakt ses som essentiellt för att förbättra upplevelsen av vård hos denna målgrupp. / Background People who inject drugs are less able to access healthcare than the general population, but are at increased risk of illness related to risk behaviors such as sharing injection equipment and use of illegal substances. Illness caused by injection drug use is related to individual suffering as well as increased health care costs. The ability to perform self-care affects the ability to maintain health and being included in society. Aim The aim was to explore how self-care is percieved by people who inject drugs, as well as the needs of healthcare expressed by these individuals.  Method Qualitative interview study with explorative design. Semi structured interviews were conducted with 12 people visiting a needle exchange clinic at the Karolinska University Hospital in Stockholm, Sweden. The interviews were analyzed using content analysis. Results The analysis resulted in three categories: A wish to maintain good health despite substance use disorder, Need for specific competence and patient-centered care and Need for specific care and safe environments. The category A wish to maintain good health despite substance use disorder showed that self-care was perceived as using drugs in a safe way and to maintain a good physical and mental health overall. The category Need for specific competence and patient-centered care describes a wish for specific nursing skills and increased knowledge of substances use disorders within the health care system. The category Need for specific care and safe environments demonstrate that people who inject drugs are requesting access to healthcare adjusted to their specific needs and health risks. Conclusions The respondents perceive self-care as maintaining health by injecting drugs safely, reduce risk behavior and avoid being excluded from society by caring for appearance, hygiene and striving for a meaningful life. The respondents in this study express the need for person-centered care, dignified treatment and drug use expertise within the health care system. An individual and continuous contact at the needle exchange clinic is essential to improve the experience of health care for these individuals.

Dans le cadre de l'essor des Etats-Unis comme puissance mondiale, nous étudions dans quelle mesure leur croissanceintellectuelle est favorisée par les transferts d'étudiants dans les deux sens ou d'institutions françaises en Amérique. Parmicelles-ci, une attention toute particulière est donnée à l'Ecole Libre des Sciences Politiques de Paris, dont nous avons dépouilléles archives, recensé les élèves américains depuis sa création jusqu'à la fin de notre période en 1932. Nous montronsl'importance de certains élèves, et étudions les établissements auxquels elle donne naissance en Amérique. Nous expliquons letransfert aux Etats-Unis du Musée Social de Paris. Nous tenons compte des réseaux d'historiens, de géographes,d'économistes, de sociologues et d'autres universitaires français et américains. Nous analysons les étudiants, y compris ceuxprovenant de programmes créés par James Hyde et Albert Kahn, où l'Université Harvard tient une place de choix. Ladétermination de la France à attirer les étudiants étrangers est au détriment de l'Allemagne où la plupart des grandsuniversitaires américains étaient formés. Nous étudions donc à travers une biographie intellectuelle de Jean Jules Jusserand,ambassadeur de France aux Etats-Unis pendant 22 ans, la guerre d'influence que les intellectuels allemands et français selivrent en Amérique, avant et pendant la Grande Guerre. / Within the context of the expansion of the United States as a world power, we study the extent to which their intellectualdevelopment is enhanced by bidirectional exchanges of students or transfers from French institutions to America. Amongthose, we take in in-depth look at the Ecole Libre des Sciences Politiques in Paris. Having combed its archives, we could list theAmerican students there, from its founding to the end of our period of study in 1932. We point out the importance of somestudents and study the schools it gave birth to in America. We explain the transfer from the Musée Social or Paris to the U.S..We take into account the networking between French and American historians, geographers, economists, sociologists andother university scholars. We analyze exchange students, including those from programs created by James Hyde and AlbertKahn, with a particular emphasis on Harvard University. France is determined to attract foreign students at the expense ofGermany where the majority of the best American scholars were trained. Therefore, by way of an intellectual biography of JeanJules Jusserand, French ambassador to the U.S. for 22 years, we study the war of influence on American soil between Frenchand German intellectuals, before and during World War I.

Le traitement médical de choix pour la maladie rénale chronique est la transplantation d'organe. Cependant, plusieurs patients ne sont en mesure que de trouver un donneur direct avec lequel ils ne sont pas compatibles. Les Programmes de Don Croisé de Reins peuvent aider plusieurs paires donneur-patient incompatibles à échanger leur donneur entre elles. Typiquement, l'objectif principal d'un tel programme est de maximiser le nombre total de transplantations qui seront effectuées grâce à un plan d'échange. Plusieurs solutions optimales peuvent co-exister et comme la plupart correspondent à différents ensembles de patients obtenant un donneur compatible, il devient important de considérer quels individus seront sélectionnés. Fréquemment, ce problème n'est pas abordé et la première solution fournie par un solveur est choisie comme plan d'échange. Ceci peut mener à des parti-pris en faveur ou défaveur de certains patients, ce qui n'est pas considéré une approche juste. De plus, il est de la responsabilité des informaticiens de s'assurer du contrôle des résultats fournis par leurs algorithmes. Pour répondre à ce besoin, nous explorons l'emploi de multiples solutions optimales ainsi que la manière dont il est possible de sélectionner un plan d'échange parmi celles-ci. Nous proposons l'emploi de politiques aléatoires pour la sélection de solutions optimales suite à leur enumération. Cette tâche est accomplie grâce à la programmation en nombres entiers et à la programmation par contraintes. Nous introduisons aussi un nouveau concept intitulé équité individuelle. Ceci a pour but de trouver une politique juste pouvant être utilisée en collaboration avec les solutions énumerées. La mise à disposition de plusieurs métriques fait partie intégrante de la méthode. En faisant usage de la génération de colonnes en combinaison au métrique $L_1$, nous parvenons à applique la méthode à de plus larges graphes. Lors de l'évaluation de l'équité individuelle, nous analysons de façon systématique d'autres schémas d'équité tels que le principle d'Aristote, la justice Rawlsienne, le principe d'équité de Nash et les valeurs de Shapley. Nous étudions leur description mathématiques ainsi que leurs avantages et désavantages. Finalement, nous soulignons le besoin de considérer de multiples solutions, incluant des solutions non optimales en ce qui concerne le nombre de transplantations d'un plan d'échange. Pour la sélection d'une politique équitable ayant comme domaine un tel ensemble de solutions, nous notons l'importance de trouver un équilibre entre les mesures d'utilité et d'équité d'une solution. Nous utilisons le Programme de Bien-être Social de Nash afin de satisfaire à un tel objectif. Nous proposons aussi une méthodologie de décomposition qui permet d'étendre le système sous-jacent et de faciliter l'énumeration de solutions. / The preferred treatment for chronic kidney disease is transplantation. However, many patients can only find direct donors that are not fully compatible with them. Kidney Exchange Programs (KEPs) can help these patients by swapping the donors of multiple patient-donor pairs in order to accommodate them. Usually, the objective is to maximize the total number of transplants that can be realized as part of an exchange plan. Many optimal solutions can co-exist and since a large part of them features different subsets of patients that obtain a compatible donor, the question of who is selected becomes relevant. Often, this problem is not even addressed and the first solution returned by a solver is chosen as the exchange plan to be performed. This can lead to bias against some patients and thus is not considered a fair approach. Moreover, it is of the responsibility of computer scientists to have control of the output of the algorithms they design. To resolve this issue, we explore the use of multiple optimal solutions and how to pick an exchange plan among them. We propose the use of randomized policies for selecting an optimal solution, first by enumerating them. This task is achieved through both integer programming and constraint programming methods. We also introduce a new concept called individual fairness in a bid to find a fair policy over the enumerated solutions by making use of multiple metrics. We scale the method to larger instances by adding column generation as part of the enumeration with the $L_1$ metric. When evaluating individual fairness, we systematically review other fairness schemes such as Aristotle's principle, Rawlsian justice, Nash's principle of fairness, and Shapley values. We analyze their mathematical descriptions and their pros and cons. Finally, we motivate the need to consider solutions that are not optimal in the number of transplants. For the selection of a good policy over this larger set of solutions, we motivate the need to balance utility and our individual fairness measure. We use the Nash Social Welfare Program in order to achieve this, and we also propose a decomposition methodology to extend the machinery for an efficient enumeration of solutions.

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