Discrimination in clinical settings and its relationship to depression and anger in women living with HIV

Objectives: To describe the frequency of feared discrimination in various social situations and of perceived discrimination in clinical settings, as well as to study the relationship between discrimination and depression and anger in women living with human immunodeiciency virus (HIV). Material and methods: The scale of Feared and Perceived Discrimination for Women with HIV (DTP-40-MV), the Beck Depression Inventory (BDI-2), and the Anger Expression scale of State-Trait-anger expression inventory (STaXi-2-aX/eX) were applied to a random sample of 200 women living with HIV. Results: These women feared being discriminated against, perceived discrimination upon the review of medical records, but perceived little discrimination in clinical care. a model with good adjustment to the data showed that the fear of being discriminated against creates a disposition toward perception of discrimination in the clinical settings (latent variable with 2 indicators: review of the medical records and clinical care) and increases cognitive/affective depressive symptoms; higher anger control decreases the anger manifestation; greater discrimination perceived in the clinical settings decreases anger control, which facilitates the expression of anger and slows cognitive/affective depressive symptoms; and these latter symptoms sensitize the perception of discrimination before the clinical records. Conclusion: Feared discrimination is a clinically relevant aspect due to its frequency and effect on depressive symptoms and perception of discrimination before the review of medical records.

How are Canadian universities training and supporting undergraduate medical, physiotherapy and occupational students for global health experiences in international low-resource settings?

Abstract : OBJECTIVES : Canadian medical (MD), physiotherapy (PT) and occupational therapy (OT) students increasingly show an interest in global health experiences (GHEs). As certain moral hazards can occur as a result of student GHEs, a growing consensus exists that universities must have an established selection process, in-depth pre-departure training (PDT), adequate onsite supervision and formal debriefing for their students. This study aimed at identifying current practices in Canadian MD, PT and OT programs and discussing areas for improvement by comparing them with recommendations found in the literature. METHODS : Canadian MD, PT and OT programs (n = 45) were invited to answer an online survey about their current practices for GHE support and training. The survey included 24 close-ended questions and 18 open-ended questions. Descriptive statistics and a thematic analysis were performed on the data and results were discussed with recommendations found in the literature. RESULTS : Twenty-three programs responded to the survey. Student selection processes varied across universities; examples included using academic performance, interviews and motivation letters. All but 1 MD program had mandatory PDT; content and teaching formats varied, as did training duration (2-38 hours). All but 1 MD program had onsite supervision; local clinicians were frequently involved. Debriefing, although not systematic, covered similar content; debriefing was variable in duration (1-8 hours). CONCLUSIONS : Many current practices are encouraging but areas for improvement exist. Integrating global health content into the regular curriculum with advanced study option in global health for students participating in GHEs could help universities standardize support and training.

TECTONIC CONTROLS ON FLUVIAL LANDSCAPE DEVELOPMENT IN CENTRAL-EASTERN PORTUGAL: INSIGHTS FROM LONG PROFILE TRIBUTARY STREAM ANALYSES

This study examines the long profiles of tributaries of the Tejo (Tagus) and Zêzere rivers in central eastern Portugal (West Iberia) in order to provide new insights into the patterns, timing and controls on drainage development during the Pleistocene to Holocene incision stage. The long profiles were extracted from lower order tributary streams associated with the trunk drainage of the Tejo River and one main tributary, the Zêzere River (Fig. 1). These streams flow through a landscape strongly influenced by variations in bedrock lithology (mainly granites and metasediments), fault structures delimiting crustal blocks with distinct uplift rates, and a base-level lowering history (tectonic uplift / eustatic). The long profiles of the tributaries of the Tejo and Zêzere rivers record a series of transient and permanent knickpoints. The permanent knickpoints have direct correlation with the bedrock strength, corresponding to the outcropping of very hard quartzites or to the transition from softer (slates/metagreywaques) to harder (granite) basement. The analyzed streams/rivers record also an older transient knickpoint/knickzone separating: a) an upstream relict graded profile, with lower steepness and higher concavity, that reflects a long period of quasi-equilibrium conditions reached after the beginning of the incision stage; and b) a downstream reach displaying a rejuvenated long profile, with steeper gradient and lower concavity, particularly for the final segment, which is often convex (Fig. 2). The rejuvenated reaches testify the upstream propagation of several incision waves that are the response of each stream to continuous or increasing crustal uplift and dominant periods of base-level lowering by the trunk drainages, coeval of low sea level conditions. The long profiles and their morphological configurations enabled spatial and relative temporal patterns of incision to be quantified for each individual tributary stream. The incision values of streams flowing in uplifted blocks of the Portuguese Central Range (PCR) (ca.380-280 m) indicate differential uplift and are higher than the incision values of streams flowing on the adjacent South Portugal planation surface – the Meseta (ca. 200 m). The normalized steepness index, calculated using the method of Wobus et al. (2006), proved to be sensitive to active tectonics, as lower ksn values were found in relict graded profiles of streams located in less uplifted blocks, (e.g. Sertã stream in the PCR), or in those flowing through tectonic depressions. Fig. 1 – Geological map of the study area. 1 – fluvial terraces (Pleistocene); 2 – sedimentary cover (Paleogene and Neogene); 3 – slates and metasandstones (Devonian); 4 – slates and quartzites (Silurian); 5 – quartzites (Ordovician); 6 – slates and metagreywackes (Precambrian to Cambrian); 7 – slates, metagreywackes and limestones (Precambrian); 8 – granites and ortogneisses; 9 – diorites and gabros; 10 - fault. SFf – Sobreira Formosa fault; Sf – Sertã fault; Pf – Ponsul fault; Gf – Grade fault. The differential uplift indicated by the distribution of the ksn values and by the fluvial incision was likely accumulated on a few major faults, as the Sobreira Formosa fault (SFf), thus corroborating the tectonic activity of these faults. Due to the fact that the relict graded profiles can be correlated with other geomorphic references documented in the study area, namely the T1 terrace of the Tagus River (with an age of ca. 1 Myr), the following incision rates can be estimated: a) for the studied streams located in uplifted blocks of the PCR, 0.38 m/kyr to 0.28 m/kyr; b) for the streams flowing on the South Portugal planation surface, 0.20 m/kyr. The differential uplift inferred between crustal blocks in the study area corroborates the neotectonic activity of the bordering faults, which has been proposed in previous studies based upon less robust data. Fig. 2 – Longitudinal profile of the Nisa stream a tributary of the Tejo River. Note the equilibrium relict profile upstream the older transient knickpoint (hatched line) and the downstream rejuvenated profile (continuous line). Legend: tKP – transient knickpoint; rKp – resistant knickpoint; Mt – schist and phyllite; Gr – granite; Hf – hornfels; Og – orthogneisse. In the inset Distance – Slope plots, fill circles correspond to the relict graded profile, crosses correspond to the rejuvenated profile located downstream the older transient knickpoint (tKP).

Tectonic and lithological controls on fluvial landscape development in central-eastern Portugal: Insights from long profile tributary stream analyses

This study examines the long profiles of tributaries of the Tagus and Zêzere rivers in Portugal (West Iberia) in order to provide new insights into patterns, timing, and controls on drainage development during the Quaternary incision stage. The studied streams are incised into a relict culminant fluvial surface, abandoned at the beginning of the incision stage. The streams flow through a landscape with bedrock variations in lithology (mainly granites and metasediments) and faulted blocks with distinct uplift rates. The long profiles of the analyzed streams record an older transitory knickpoint/knickzone separating (1) an upstream relict graded profile, with lower steepness and higher concavity, that reflects a long period of quasi-equilibrium conditions reached after the beginning of the incision stage, and (2) a downstream rejuvenated long profile, with steeper gradient and lower concavity, particularly for the final reach, which is often convex. The rejuvenated reaches testify to the upstream propagation of several incision waves, interpreted as the response of each stream to increasing crustal uplift and prolonged periods of base-level lowering by the trunk drainages, coeval with low sea level conditions. The morphological configurations of the long profiles enabled spatial and relative temporal patterns of incisions to be quantified. The incision values of streams flowing on the Portuguese Central Range (PCR; ca. 380–150 m) are variable but generally higher than the incision values of streams flowing on the adjacent South Portugal Planation Surface (SPPS; ca. 220–110 m), corroborating differential uplift of the PCR relative to the SPPS. Owing to the fact that the relict graded profiles can be correlated with the Tagus River T1 terrace (1.1–0.9 My) present in the study area, incision rates can be estimated (1) for the streams located in the PCR, 0.38–0.15 m/ky and (2) for the streams flowing on the SPPS, 0.22–0.12 m/ky. The differential uplift inferred in the study area supports the neotectonic activity of the bordering faults, as proposed in previous studies based upon other geological evidence.

Tectonic and lithological controls on fluvial landscape development in central-eastern Portugal: Insights from long profile tributary stream analyses

This study examines the long profiles of tributaries of the Tagus and Zêzere rivers in Portugal (West Iberia) in order to provide new insights into patterns, timing, and controls on drainage development during the Quaternary incision stage. The studied streams are incised into a relict culminant fluvial surface, abandoned at the beginning of the incision stage. The streams flow through a landscape with bedrock variations in lithology (mainly granites and metasediments) and faulted blocks with distinct uplift rates. The long profiles of the analyzed streams record an older transitory knickpoint/knickzone separating (1) an upstream relict graded profile, with lower steepness and higher concavity, that reflects a long period of quasi-equilibrium conditions reached after the beginning of the incision stage, and (2) a downstream rejuvenated long profile, with steeper gradient and lower concavity, particularly for the final reach, which is often convex. The rejuvenated reaches testify to the upstream propagation of several incision waves, interpreted as the response of each stream to increasing crustal uplift and prolonged periods of base-level lowering by the trunk drainages, coeval with low sea level conditions. The morphological configurations of the long profiles enabled spatial and relative temporal patterns of incisions to be quantified. The incision values of streams flowing on the Portuguese Central Range (PCR; ca. 380–150 m) are variable but generally higher than the incision values of streams flowing on the adjacent South Portugal Planation Surface (SPPS; ca. 220–110 m), corroborating differential uplift of the PCR relative to the SPPS. Owing to the fact that the relict graded profiles can be correlated with the Tagus River T1 terrace (1.1–0.9 My) present in the study area, incision rates can be estimated (1) for the streams located in the PCR, 0.38–0.15 m/ky and (2) for the streams flowing on the SPPS, 0.22–0.12 m/ky. The differential uplift inferred in the study area supports the neotectonic activity of the bordering faults, as proposed in previous studies based upon other geological evidence.

Tectonic evolution of Variscan Iberia: Gondwana–Laurussia

An integrated interpretation of the late Paleozoic structural and geochronological record of the Iberian Massif is presented and discussed under the perspective of a Gondwana-Laurussia collision giving way to the Variscan orogen. Compressional and extensional structures developed during the building of the Variscan orogenic crust of Iberia are linked together into major tectonic events operating at lithosphere scale. A review of the tectonometamorphic and magmatic evolution of the IberianMassif reveals backs and forths in the overall conver- gence between Gondwana and Laurussia during theamalgamation of Pangea in late Paleozoic times. Stages dom- inated by lithosphere compression are characterized by subduction, both oceanic and continental, development of magmatic arcs, (over- and under-) thrusting of continental lithosphere, and folding. Variscan convergence re- sulted in the eventual transference of a large allochthonous set of peri-Gondwanan terranes, the Iberian Allochthon, onto the Gondwana mainland. The Iberian Allochthon bears the imprint of previous interaction be- tween Gondwana and Laurussia, including their juxtaposition after the closure of the Rheic Ocean in Lower De- vonian times. Stages governed by lithosphere extension are featured by the opening of two short-lived oceanic basins that dissected previous Variscan orogenic crust, first in the Lower-Middle Devonian, following the closure of the Rheic Ocean, and then in the early Carboniferous, following the emplacement of the peri-Gondwanan allochthon. An additional, major intra-orogenic extensional event in the early-middle Carboniferous dismem- bered the Iberian Allochthon into individual thrust stacks separated by extensional faults and domes. Lateral tec- tonics played an important role through the Variscan orogenesis, especially during the creation of new tectonic blocks separated by intracontinental strike-slip shear zones in the late stages of continental convergence.

Prediction Nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for Prostate Cancer

Objective The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure. Materials and methods Seven hundred three (n = 703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced stage PCa before second-line systemic therapies: group 4). First, we assessed 68Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive 68Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram’s derived cut-off. Decision curve analysis (DCA) was implemented to quantify nomogram’s clinical benefit. Results 68Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p < 0.001). At multivariable analyses, ISUP grade, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.04). A nomogram based on covariates included in the multivariate model demonstrated a bootstrap-corrected accuracy of 82%. The nomogram-derived best cut-off value was 40%. In DCA, the nomogram revealed clinical net benefit of > 10%. Conclusions This novel nomogram proved its good accuracy in predicting a positive scan, with values ≥ 40% providing the most informative cut-off in counselling patients to 68Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.

Landslide activity in contrasting land-cover settings constrained by multi-temporal inventorying

This doctoral thesis focuses on the study of historical shallow landslide activity over time in response to anthropogenic forcing on land use, through the compilation of multi-temporal landslide inventories. The study areas, located in contrasting settings and characterized by different history of land-cover changes, include the Sillaro River basin (Italy) and the Tsitika and Eve River basins (coastal British Columbia). The Sillaro River basin belongs to clay-dominated settings, characterized by extensive badland development, and dominated by earth slides and earthflows. Here, forest removal began in the Roman period and has been followed by agricultural land abandonment and natural revegetation in recent time. By contrast, the Tsitika-Eve River basins are characterized by granitic and basaltic lithologies, and dominated by debris slides, debris flows and debris avalanches. In this setting, anthropogenic impacts started in 1960’s and have involved logging operation. The thesis begins with an introductory chapter, followed by a methodological section, where a multi-temporal mapping approach is proposed and tested at four landslide sites of the Sillaro River basin. Results, in terms of inventory completeness in time and space, are compared against the existing region-wide Emilia-Romagna inventory. This approach is then applied at the Sillaro River basin scale, where the multi-temporal inventory obtained is used to investigate the landslide activity in relation to historical land cover changes across geologic domains and in relation to hydro-meteorological forcing. Then, the impact of timber harvesting and road construction on landslide activity and sediment transfer in the Tsitika-Eve River basins is investigated, with a focus on the controls that interactions between landscape morphometry and cutblock location may have on landslide size-frequency relations. The thesis ends with a summary of the main findings and discusses advantages and limitations associated with the compilation of multi-temporal inventories in the two settings during different periods of human-driven, land-cover dynamics.

Concepts and methods for efficient decentralized learning in federated settings

Deep Neural Networks (DNNs) have revolutionized a wide range of applications beyond traditional machine learning and artificial intelligence fields, e.g., computer vision, healthcare, natural language processing and others. At the same time, edge devices have become central in our society, generating an unprecedented amount of data which could be used to train data-hungry models such as DNNs. However, the potentially sensitive or confidential nature of gathered data poses privacy concerns when storing and processing them in centralized locations. To this purpose, decentralized learning decouples model training from the need of directly accessing raw data, by alternating on-device training and periodic communications. The ability of distilling knowledge from decentralized data, however, comes at the cost of facing more challenging learning settings, such as coping with heterogeneous hardware and network connectivity, statistical diversity of data, and ensuring verifiable privacy guarantees. This Thesis proposes an extensive overview of decentralized learning literature, including a novel taxonomy and a detailed description of the most relevant system-level contributions in the related literature for privacy, communication efficiency, data and system heterogeneity, and poisoning defense. Next, this Thesis presents the design of an original solution to tackle communication efficiency and system heterogeneity, and empirically evaluates it on federated settings. For communication efficiency, an original method, specifically designed for Convolutional Neural Networks, is also described and evaluated against the state-of-the-art. Furthermore, this Thesis provides an in-depth review of recently proposed methods to tackle the performance degradation introduced by data heterogeneity, followed by empirical evaluations on challenging data distributions, highlighting strengths and possible weaknesses of the considered solutions. Finally, this Thesis presents a novel perspective on the usage of Knowledge Distillation as a mean for optimizing decentralized learning systems in settings characterized by data heterogeneity or system heterogeneity. Our vision on relevant future research directions close the manuscript.

Understanding food waste through behavioural theories in different settings

SDG 12.3 aims to promote sustainable consumption and production patterns by addressing the global food loss and waste problem. Given the multiple interrelated impacts, food waste is recognized as one of the major food system challenges. The scope of this work is to contribute to the understanding on food waste generation and potential approaches to tackle it. This work was specifically designed to achieve the following goals: 1) Understand specific factors that affect individual behaviours to generate FW at household, 2) Analyse the effective ways to reduce FW through behaviour change perspective given the catering and hospitality sector, and 3) Provide an evidence synthesis on intervention study that incorporate stakeholder insights focus on school meals. The first goal of identifying food waste drivers was achieved by the systematically reviewing on peer-reviewed and grey literature. The Motivation-Opportunity-Ability (MOA) framework was applied to frame consumer behavioural drivers and identify levers that could be potentially utilized to reduce food waste. Consumer segmentation was further discussed to provide insights for developing tailored food waste reduction interventions. The second goal required the identification on practical interventions, which has been accomplished by systematic literature review basing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The efficiency and working mechanism of interventions were evaluated basing on the combination of MOA and behavioural change wheel. Building on the evidence of effective interventions, a roadmap was developed for policymakers and practitioners to lead their own pathway on intervention study and upscaling. The third aim has been achieved with a school meals interventions mapping and the implementation of stakeholder workshops. The method was built on the literature review and then enriched by intervention co-design dialogue among stakeholders. The overall conclusion addressed challenges of food waste determents identification, tailored reduction interventions developing, sustainable consumption promotion with school meals.

Diffusing alpha particles radiation treatment optimization in clinical settings

Alpha-particle emitters, notably used in 224Ra-DaRT, have emerged as effective in overcoming radiation resistance and providing targeted cancer therapy. These emitters cause DNA double-strand breaks, visualizable in human lymphocytes. The 224Ra DaRT technique, using a decay chain from seeds, extends alpha particle range, achieving complete tumor destruction while sparing healthy tissue. This thesis examines a biokinetic model, validated with patient data, and a feasibility study on skin squamous cell carcinomas are discussed. The study reports 75% tumor complete response rate and 48% patients experiencing acute grade 2 toxicity, resolving within a month. An observed abscopal effect (AE), where tumor regression occurs at non-irradiated sites, is examined, highlighting DaRT's potential in triggering anti-tumor immune responses. This effect, coupled with DaRT's high-linear energy transfer (LET), suggests its superiority over low-LET radiation in certain clinical scenarios. Improvements to DaRT, including the use of an external radio-opaque template for treatment planning, are explored. This advancement aids in determining source numbers for optimal tumor coverage, enhancing DaRT’s safety. The thesis outlines a typical DaRT procedure, from tumor measurements to source assessment and administration, emphasizing the importance of precise seed positioning. Furthermore, the thesis discusses DaRT's potential in treating prostate cancer, a prevalent global health issue, by offering an alternative to traditional salvage therapies. DaRT seeds, delivering alpha particle-based interstitial radiation, require precision in seed insertion due to their limited tissue range. In conclusion, the thesis advocates for DaRT's role in treating solid tumors, emphasizing its improved radiobiological potency and potential benefits over beta and gamma source-based therapies. Ongoing studies are assessing DaRT's feasibility in treating various solid tumors, including pancreatic, breast, prostate, and vulvar malignancies, suggesting a promising future in cancer treatment.

Asymmetries in Adversarial Settings

Even without formal guarantees of their effectiveness, adversarial attacks against Machine Learning models frequently fool new defenses. We identify six key asymmetries that contribute to this phenomenon and formulate four guidelines to build future-proof defenses by preventing such asymmetries. We also prove that attacking a classifier is NP-complete, while defending from such attacks is Sigma_2^P-complete. We then introduce Counter-Attack (CA), an asymmetry-free metadefense that determines whether a model is robust on a given input by estimating its distance from the decision boundary. Under specific assumptions CA can provide theoretical detection guarantees. Additionally, we prove that while CA is NP-complete, fooling CA is Sigma_2^P-complete. Even when using heuristic relaxations, we show that our method can reliably identify non-robust points. As part of our experimental evaluation, we introduce UG100, a new dataset obtained by applying a provably optimal attack to six limited-scale networks (three for MNIST and three for CIFAR10), each trained in three different manners.

Selection And Validation Of Reference Genes For Functional Studies In The Calliphoridae Family.

The genera Cochliomyia and Chrysomya contain both obligate and saprophagous flies, which allows the comparison of different feeding habits between closely related species. Among the different strategies for comparing these habits is the use of qPCR to investigate the expression levels of candidate genes involved in feeding behavior. To ensure an accurate measure of the levels of gene expression, it is necessary to normalize the amount of the target gene with the amount of a reference gene having a stable expression across the compared species. Since there is no universal gene that can be used as a reference in functional studies, candidate genes for qPCR data normalization were selected and validated in three Calliphoridae (Diptera) species, Cochliomyia hominivorax Coquerel, Cochliomyia macellaria Fabricius, and Chrysomya albiceps Wiedemann . The expression stability of six genes ( Actin, Gapdh, Rp49, Rps17, α -tubulin, and GstD1) was evaluated among species within the same life stage and between life stages within each species. The expression levels of Actin, Gapdh, and Rp49 were the most stable among the selected genes. These genes can be used as reliable reference genes for functional studies in Calliphoridae using similar experimental settings.

Low Hdl Cholesterol But Not High Ldl Cholesterol Is Independently Associated With Subclinical Coronary Atherosclerosis In Healthy Octogenarians.

Although low-density lipoprotein cholesterol (LDL-C) has been consistently demonstrated a predictor of atherosclerotic disease in a large spectrum of clinical settings, among individuals aged of 80 years or older this concept is uncertain. This study was evaluated in a carefully selected population if the association between LDL-C and coronary atherosclerotic burden remains significant in the very elderly. Individuals aged of 80 years or older (n = 208) who spontaneously sought primary prevention care and have never manifested cardiovascular disease, malnutrition, neoplastic or consumptive disease were enrolled for a cross-sectional analysis. Medical evaluation, anthropometric measurements, blood tests and cardiac computed tomography were obtained. In analyses adjusted for age, gender, diabetes, systolic and diastolic blood pressure, smoking and statin therapy, no association was found between coronary calcium score (CCS) and LDL-C [1.79 (0.75-4.29)]. There was no association between triglycerides and CCS. The association between high-density lipoprotein cholesterol (HDL-C) and CCS was significant and robust in unadjusted [0.32 (0.15-0.67)] as well as in the fully adjusted analysis [0.34 (0.15-0.75)]. The present study confirms in a healthy cohort of individuals aged of 80 years or more that while the association between LDL-C and coronary atherosclerosis weakens with aging, the opposite occurs with the levels of HDL-C.