No description available.

No description available.

Objetivo: sintetizar la evidencia acerca de la resistencia a inhibidores nucleósidos de la transcriptasa reversa (NRTI) en personas que reciben PrEP. Métodos: se realizó una revisión sistemática de estudios experimentales. Se incluyeron estudios que comparaban el uso de PrEP frente a placebo o su no uso en población de riesgo para la infección de VIH; siendo el outcome evaluado el desarrollo de resistencia a NRTI. La selección de artículos y la extracción de datos fueron realizadas por dos revisores de manera independiente. Se realizó un metaanálisis de efectos aleatorios tanto de manera total como en subpoblaciones y según el momento de seroconversión. Para valorar el riesgo de sesgo se utilizó herramienta Risk of Bias 2.0 (RoB 2.0). Se usó como referencia el Software Review Manager 5. Resultados: se incluyeron nueve artículos correspondientes a seis estudios. Se encontró que el uso de PrEP no incrementa el riesgo de resistencia a TDF/FTC en la población total que recibió la intervención, haya o no presentado la infección. Sin embargo, en el grupo que seroconvirtió sí se encontró un mayor riesgo de resistencia en los que usaron PrEP (RR: 2,76; IC95%: 1,22 a 6,26; I2: 0%); el cual correspondía sólo al grupo que tenía infección por VIH latente al momento de iniciar la intervención (RR: 3,91; IC95%: 1,30 a 1,70; I2: 0%). Conclusiones: el uso de PrEP no incrementa el riesgo de resistencia a TDF/FTC en el total de usuarios, pero sí en pacientes con infección latente por el VIH al enrolamiento. / Objective: Synthesize the evidence on the development of nucleoside reverse transcriptase inhibitor (NRTI) resistance in people receiving PrEP for the prevention HIV. Methods: We conducted a systematic review of experimental studies, we carried-out a search in electronic databases, as well as a gray literature search. We included studies comparing the use of PrEP against placebo or nothing, in the population at risk of HIV infection; the outcome evaluated was the development of NRTI resistance. The selection of articles and the extraction of data were carried out by two reviewers independently. A meta-analysis of random effects was carried-out for the global populations as well as a sub-analysis according to the risk group and the time of seroconversion. We used The Review Manager 5 Software. Results: We included nine articles corresponding to six studies. We found that the use of PrEP does not increase the risk of resistance to TDF/FTC in the total of population who received the intervention. But, in the group that seroconverted, we found that the use of PrEP increases the risk of resistance (RR: 2,76; IC95%: 1,22 a 6,26; I2: 0%); this risk mainly corresponds to the group that had a latent HIV infection at the time of initiating the intervention (RR: RR: 3,91; IC95%: 1,30 a 1,70, I2: 0%). Conclusions: The use of PrEP does not increase the risk of resistance to TDF / FTC in the total of PrEP users, but it does in patients with latent HIV infection upon enrollment. / Tesis

The purpose of this study was to analyze the leadership decision making process associated with pursuing innovative educational programs. The study investigated the experiences of leaders involved in pursuing Tech Prep Demonstration Project grants at two early-innovator California community colleges. A qualitative investigation was conducted utilizing descriptive case study methodologies. The researcher conducted focused interviews with individuals in leadership positions at the time the decision to pursue a Tech Prep Demonstration Project grant was made at these two community colleges. The study was guided by a data-analysis spiral. The data analysis spiral enabled the researcher to organize and examine large amounts of data in a systematic fashion. The study found that the decision-making process was facilitated by eight factors: (a) Environmental scanning by a designated person or by middle management; (b) preexisting intersegmental long term relationships with key individuals outside their institution; (c) prior knowledge of a related innovation; (d) personal and professional experience and frustration with a lack of educational options for K-12 students; (e) educational values that aligned with the innovation being pursued; (f) preexisting structures that allowed leaders to expand existing programming rather than to initiate new programming; (g) early reservations and challenges; and (h) post decision-making issues. These factors each played a large part in defining whether an environment in which innovations are considered exists in certain community colleges, as well as in K-12 schools. The community college leaders who took part in this decision making process had a great deal of professional experience to build upon. They used that experience to form relationships with K-12 leaders, who became their partners in educational reform. These partnerships were made possible because the colleges possessed sufficient organizational slack, and utilized that slack to pursue innovative programming. An earlier federal policy, the Tech Prep component of the 1990 Carl Perkins Vocational and Technical Education Act, may have had limited success in meeting its own goals, but produced the strong intersegmental relationships that the TPDP was built upon. In addition, the study confirmed the decision-making stages described by Rogers (2003) and defined a sixth stage, the "resolution stage," in which decision makers step back and take time to reflect on the innovation itself and the process used to make the decision to implement or not implement the innovation, as well as correcting early assumptions that proved to be false. The resolution stage provided leaders with time to step back and reflect on their original goals and on the progress of the innovation in order to make course corrections as necessary.

La PrEP pourrait avoir un impact sur la perception du risque du VIH et ainsi influencer les comportements sexuels d’hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec d’autres hommes (gbHARSAH). Les buts de l’étude étaient 1) de comparer les caractéristiques sociodémographiques, les habitudes de vie, les comportements sexuels et relationnels, les antécédents d’infections transmissibles sexuellement et des facteurs psychosociaux liés à la prise de risque d’hommes gbHARSAH en fonction de la perception du risque du VIH et 2) d’examiner l’association entre cette perception du risque et les relations anales sans condom (RASC) selon l'utilisation de la PrEP. Cette étude descriptive corrélative consistait en une analyse secondaire de l’étude ENGAGE réalisée auprès de 945 hommes gbHARSAH. Comparativement au groupe qui se percevait moins à risque du VIH (n = 773), celui qui se percevait plus à risque (n = 172) différait quant aux comportements sexuels. Dans l’analyse non stratifiée, le risque perçu élevé du VIH était associé aux RASC (RC = 2,87; 95 % IC = 1,84 - 4,47) et l’utilisation de la PrEP était associée aux RASC (RC = 12,75; 95 % IC = 3,43 - 47,41). Dans l’analyse stratifiée, parmi les hommes qui n’étaient pas sous PrEP, seule l’association entre le risque perçu élevé du VIH et des RASC était maintenue (RC = 2,91; 95 % IC = 1,86 - 4,57). Cette étude montre l’influence de la perception du risque sur les comportements sexuels, suggérant ainsi la pertinence d’une approche globale de la prévention du VIH. / PrEP may impact self-perceived risk for HIV infection and influence the sexual behaviors among gay, bisexual and other men who have sex with men (gbMSM). The aims of this study were 1) to compare the sociodemographic characteristics and lifestyles, sexual and relational behaviors, history of sexually transmitted and blood-borne infections, and psychosocial factors related to risk-taking behaviors of gbMSM according to self-perceived risk for HIV infection, and 2) to examine the association between self-perceived risk for HIV infection and condomless anal intercourse (CAI) according to PrEP use. This descriptive and correlational study was a secondary analysis of data collected by the ENGAGE study which involved 945 gbMSM. Compared with gbMSM with lower self-perceived risk for HIV (n = 773), those with higher self-perceived risk (n = 172) differed in terms of sexual behaviors. An unstratified analysis showed high self-perceived risk for HIV infection to be associated with CAI (aOR: 2.87, 95% CI: 1.84–4.47) and PrEP use to be associated with CAI (aOR: 12.75, 95% CI: 3.43–47.41). A stratified analysis by PrEP use showed that, among gbMSM who did not use PrEP, only the association between high self-perceived risk for HIV infection and CAI was maintained (aOR: 2.91, 95% CI: 1.86–4.57). This study reveals the influence of risk perception on sexual behaviors and highlights the importance of a global approach to prevention of HIV infection.

No description available.

Construit en multiréférentialité, sur les postulats de la psychologie socioculturelle de Vygotski, de l’analyse clinique de l’activité (Y. Clot), de l’ergonomie de l’activité, cette étude a pour finalité de construire une intelligibilité des pratiques, habitus et singularité entremêlés, dans une approche compréhensive et développementale des actions de préparation, comme « une présence au futur » .Quel(s) liens font les enseignants entre le sens, la forme et les modalités de leur action anticipatrice de préparation et le cours d’action de leur conduite effective de la classe, leur pilotage des tâches, dans la complexité d’une situation d’enseignement-apprentissage, à l’école élémentaire au cours d’une expérimentation de terrain en autoconfrontation croisée ?Cette PROBLEMATIQUE s’organise dans une démarche descriptive et compréhensive autour de trois HYPOTHESES : L’hypothèse 1, sur la nature de la pratique - chaque professionnel interprète différemment la préparation. L’hypothèse 2, entre ce sur quoi porte l’anticipation de la séance (facilitant ou non la gestion de l’imprévu) et son pilotage effectif. L’hypothèse 3, sur les prolongements possibles en formation.La METHODE, une « quasi-expérimentation », permet l’accès à la réalité quotidienne des pratiques, dans un espace de co-construction praticiens / chercheur, en appui de l’autoconfrontation qui permet de «faire vivre la conscience pour l’étudier» (Vygotski), lorsque celle-ci est mise à disposition d’un collectif professionnel, constituant le corpus, arrêté, in fine, sur cinq acteurs singuliers, pour une recherche de typicalité de cas d’enseignants.Les INDICATEURS d’analyse, organisés autour des traces et des conceptions de la préparation, permettent d’éclairer le paradigme d’anticipation et la préparation :- Il existe plusieurs configurations déterminées par le rapport au support-outil et la gestion des interactions langagières.- Le déroulement effectif de la classe est le résultat d’un système d’interactions entre le pilotage à partir de la préparation et les interprétations, incertitudes majeures, que les élèves font des tâches. - En anticipant avec le cadre linéaire de la préparation « canonique » l’enseignant pilote du linéaire, a contrario de l’apprentissage et n’intègre pas de possibilité d’improvisation . Ce n’est pas un outil suffisant du métier, il permet d’établir des relations de détermination, mais peu de relations de signification : l’interprétation reste donc en tension. Pour résoudre cette tension, on peut envisager une voie complémentaire, au croisement d’une clinique de la relation éducative et d’une clinique de l’activité : une post-paration individuelle et collective. Cette POST-PARATION – qui permet de problématiser, d’introduire quelque chose qui n’est pas dans le constat de situation et de se positionner dans cette présence au futur pour permettre l’ajustement de l’action - corrélée avec le style professionnel, en lien avec le genre est constitutive d’un capital de mise en mots et d’un répertoire de mise en actes, qui sont des ressources pour préfigurer l’action. / Built in multireferentiality, on the postulates of the sociocultural psychology of Vygotski, of the clinical analysis of activity (Y. Clot), of the ergonomics of the activity, the finality of this study is to build an intelligibility of the practices, habitus and singularity intermingled, in an understanding and développementale approach of the actions of preparation, like “a presence with the future” .Which bonds make the teachers between the direction, the form and the methods of their anticipatrice action of preparation and the action in progress of their effective control of the class, their leading (piloting) of the tasks, with the complexity of a situation of teaching-training, at the elementary school during an experimentation of ground in cross autoconfrontation?This PROBLEMATIC is organized in a descriptive and understanding step around three ASSUMPTIONS: Assumption 1, about the nature of the practice - each professional interprets the preparation differently. Assumption 2, between it to what the anticipation of the meeting relates (facilitating or not the management of unforeseen) and its effective piloting. Assumption 3, on the possible prolongations in formation.The METHOD, a “quasi-experimentation”, the access to the daily reality of the practices allows, in an enquiring space of co-construction experts / researcher, in support of the autoconfrontation which makes it possible “to make live the conscience to study it” (Vygotski), when this one is placed at the group of professional’s disposal, constituting the corpus, decree, in fine, on five singular actors, for a search for typicality of case of teachers.The INDICATORS of analysis, organized around the traces and of the designs of the preparation, make it possible to clarify the paradigm of anticipation and the preparation:- There are several configurations determined by the report with the support-tool and the management of the linguistic interactions.- The progress of the real enfolding class is the result of a system of interactions between piloting starting from the preparation and interpretations, major uncertainties, that the pupils make with the tasks. - While anticipating with the linear framework of the “canonical” preparation the teacher controls the linear one, on the opposite of the training and does not integrate a possibility of improvisation . It is not a sufficient tool of the trade, it makes it possible to establish relations of determination, but few relations of significance: interpretation thus remains in tension.To solve this tension, one can plan a complementary way, with the crossing of a private clinic of the educational relation and a private clinic of the activity: an individual and collective post-paration. This POST-PARATION - which allows problématiser, to introduce something which is not in the report of situation and to be in this presence with the future to allow the adjustment of the action - correlated with the professional style, in bond with the kind is constitutive of a capital of setting in words and of a repertory of acting out, which is resources to precede the action.

Prenatal assessment of fetal health is routinely offered throughout pregnancy to ensure that the most effective management can be provided to maintain fetal and maternal well-being. Currently, invasive testing is used for definitive diagnosis of fetal aneuploidy, which is associated with a 1% risk of iatrogenic fetal loss. Developing non-invasive prenatal testing (NIPT) is a key area of research and methods to increase the level of cell-free fetal DNA (cffDNA) within the maternal circulation have been discussed to improve accuracy of such tests. In this study, three strategies; co-amplification at lower denaturation temperature polymerase chain reaction (COLD-PCR), inverse-PCR and Pippin Prep™ gel electrophoresis, were analysed to identify a novel approach to selectively enrich shorter cffDNA fragments from larger maternal cell-free DNA (cfDNA). The sensitivity of droplet digital PCR (ddPCR) against real-time PCR (qPCR) was compared for fetal sex and RHD genotyping. In addition RHD zygosity testing was carried out for non-maternal samples. Consequently, Pippin Prep™ gel electrophoresis was combined with ddPCR analysis for the NIPD of Down Syndrome (DS) in pseudo-maternal samples. The results revealed that the Pippin Prep™ gel electrophoresis enrichment approach successfully demonstrated 2-fold to 5-fold increases in the cffDNA fraction. However, further optimisation assays of COLD-PCR and inverse-PCR using actual maternal samples were required. The spike experiments for DS detection revealed that with the present assay IV overrepresentation of the chromosome 21 target could be significantly detected for samples with ≥15% ‘cffDNA fraction’. In conjunction with the Pippin Prep™ enrichment method, this would have enabled assessment of all 10 maternal samples. Alternatively, fetal sex and RHD genotyping results determined that ddPCR provides a more sensitive platform compared to qPCR approaches, particularly for samples that express low cffDNA fractions (<2%). The ddPCR platform also proved to be a rapid and accurate system for the determination of RHD zygosity. This study highlights that ddPCR could be used as opposed to qPCR for accurate determination of fetal sex and RHD status. While sequencing approaches currently provide the most sensitive platforms for NIPT of fetal aneuploidy, high costs (>£400) prevent universal application. The combination of cffDNA enrichment with ddPCR analysis could provide a cheaper and more widely available platform for NIPD. However, further large scale validation studies using actual maternal samples are required.