Asking about adherence - from flipping the coin to strong evidence.

In the era of antiretroviral therapy (ART) as prevention for transmission of HIV as well as treatment for HIV-positive individuals irrespective of CD4 cell counts, the importance of adherence has grown. Although adherence is not the only determinant of treatment success, it is one of the only modifiable risk factors. Treatment failure reduces future treatment options and therefore long-term clinical success as well as increases the possibility of developing drug resistant mutations. Drug-resistant strains of HIV can then be transmitted to uninfected or drug-naïve individuals limiting their future treatment options, making adherence an important public-health topic, especially in resource-limited settings. Adherence should be monitored as a part of routine clinical care; however, no gold standard for assessment of adherence exists. For use in daily clinical practice, self-report is the most likely candidate for widespread use due to its many advantages over other measurement methods, such as low cost and ease of administration. Asking individuals about their adherence behaviour has been shown to yield valid and predictive data - well beyond the mere flip of a coin. However, there is still work to be done. This article reviews the literature and evidence on self-reported adherence, identifies gaps in adherence research, and makes recommendations for clinicians on how to best utilise self-reported adherence data to support patients in daily clinical practice.

The impact of cyclin D1 mRNA isoforms, morphology and p53 in mantle cell lymphoma: p53 alterations and blastoid morphology are strong predictors of a high proliferation index.

BACKGROUND: Mantle cell lymphoma is a clinically heterogeneous disease characterized by overexpression of cyclin D1 protein. Blastoid morphology, high proliferation, and secondary genetic aberrations are markers of aggressive behavior. Expression profiling of mantle cell lymphoma revealed that predominance of the 3'UTR-deficient, short cyclin D1 mRNA isoform was associated with high cyclin D1 levels, a high "proliferation signature" and poor prognosis. DESIGN AND METHODS: Sixty-two cases of mantle cell lymphoma were analyzed for cyclin D1 mRNA isoforms and total cyclin D1 levels by real-time reverse transcriptase polymerase chain reaction, and TP53 alterations were assessed by immunohistochemistry and molecular analysis. Results were correlated with proliferation index and clinical outcome. RESULTS: Predominance of the short cyclin D1 mRNA was found in 14 (23%) samples, including four with complete loss of the standard transcript. TP53 alterations were found in 15 (24%) cases. Predominance of 3'UTR-deficient mRNA was significantly associated with high cyclin D1 mRNA levels (P=0.009) and more commonly found in blastoid mantle cell lymphoma (5/11, P=0.060) and cases with a proliferation index of >20% (P=0.026). Both blastoid morphology (11/11, P<0.001) and TP53 alterations (15/15, P<0.001) were significantly correlated with a high proliferation index. A proliferation index of 10% was determined to be a significant threshold for survival in multivariate analysis (P=0.01). CONCLUSIONS: TP53 alterations are strongly associated with a high proliferation index and aggressive behavior in mantle cell lymphoma. Predominance of the 3'UTR-deficient transcript correlates with higher cyclin D1 levels and may be a secondary contributing factor to high proliferation, but failed to reach prognostic significance in this study.

Comparative electron impact and fast atom bombardment mass spectrometric studies of some HMPA adducts of phenyltin and phenyllead halides and studies of strong hydrogen bonding by FAB-MS

The fragmentation patterns and mass spectra of some phenyl tin and -lead halide adducts with hexamethylphosphoramide are compared by subjecting them t~ electron impact and fast atom bombardment ionization in a mass spectrometer. This comparison is restricted to the metal-containing ions. Ligand-exchange mechanisms of some of the metal-containing species are explored by FAB-MS. Several moisturesensitive organo-metallics and H-bonded systems have been examined by FAB for attempted characterization, but without any success. Scavenging and trapping of water molecules by complex aggregates in solutions of quaternary ammonium fluorides and hydroxides are investigated by FAB to complement previous NMR-studies.

NMR studies of strong hydrogen bond to fluoride ion

Systems such as MF/diol (M = alkali metal) and }1F/carboxylic acid were subjected to IH, I9F and 13C nmr study to investigate the nature of the very strong H-bonding of fluoride ions with these systems. Evidence indicates a strong H-bond in diol-fluoride systems (~H ~ -(56) kJ mol-I) which is stronger than most 'typical' H-bonds (~H = -(12-40) kJ mol-I), but weaker than that reported for carboxylic acid-fluoride systems (~H ~ -(120) kJ mol-I). Approximate fluoride H-bonded shifts (o(OH)OHF) were evaluated for MF/diol systems from IH chemical shift measurements. No direct correlation was observed between I9F chemical shift and H-bond strength. Thermodynamic parameters were calculated from temperature dependent IH and 19F shifts. Preliminary studies of BUn 4NF-acetylacetone by I9F nmr were conducted at low temperatures and a possible Jmax (ca. 400 Hz) is reported for the fluoride ion H-bonded to acetylacetone. Highfield shift for non-protonated carbons and downfield shift for protonated carbons were observed in carboxylic acid/KF systems. Significant decreas$in I3C TI due to strong H-bonding to fluoride ions were also detected in both diol and carboxylic acid systems. Anomalous results were obtained, such as increasing NOE with increasing temperature in neat 1,2-ethanediol (values above the theoretical maximum of 1.988) and in 1,2-ethanediol/KF. The large 13C NOE's for carboxy carbons in neat carboxylic acids which are. further enhanced by the addition of KF are also unusual.

Strong hydrogen bonding in organic synthesis

The preparation of phenacyl and para-phenylphenacyl esters, the reactions of carboxylic acids, phenols, 2-nitropropane and alcohols with alkyl halides in the presence of fluoride anion are described. The reactions are thought to be accelerated by the formation of hydrogen bonds between the fluoride anion and the organic electron acceptor. The fluoride ,carboxylic acids, fluoride-phenols and fluoride-2-nitropropane are better reaction systems than the fluoride-alcohol. The source of the fluoride anion and the choice of solvents are also discussed.

Reactions of steroidal epoxides with strong organic bases and an investigation into the syntheses of some labelled pregnane derivatives

Reactions of 5,6- and 4,5-epoxycholestane derivatives with strong bases were investigated. Epoxidation of 3a-acetoxycholest-5-ene also gave a new compound along with the anticipated epoxides. Interconversions of the latter were observed. Some possible mechanisms of its formation and rearrangements have been pIioposed. No reaction was observed with any of the 5,6- and 4,5-steroidal epoxides employed in the present study, using potassium tertiary butoxide under refluxing conditions. n-Butyllithium reacted only with 5,6-epoxycholestanes bearing a ketal moiety at the C3 carbon. Opening of the ketal group was observed with n-butyllithium in the case of a ~-epoxide. The reaction was also investigated in the absence of epoxide functionality. A possible mechanism for the opening of ketal group has been proposed. Lithium diethylamide (LDEA) was found effective in rearranging 5,6- and 4,5-epoxides to their ~orresponding allylic alcohols. These rearrangements presumably proceed via syn-eliminations, however the possibility of a corresponding anti-elimination has not been eliminated. A substituent effect of various functional groups (R = H, OH, OCH2CH20) at C3 has-been observed on product distribution in the LDEApromoted rearrangements of the corresponding epoxides. No reaction of these epoxides was observed with lithium diisopropylamide (LDA) • In the second part of the project, several attempts were made towards the sYRthesis of deoxycorticoste~one~17,2l,2l~d3' a compound desirable for the 2l-dehydroxylation studies of deoxycorticosterone. Several routes were investigated, and some deuterium labelled pregnane derivatives were prepared in this regard. Microbial 21-hydroxylation of progesteronel7,21,21,2l- d4 by ~ niger led to loss of deuterium from C21 of the product. An effort was made to hydroxylate progesterone microbially under neutral condtions.

L-Fuzzy Relations in Coq

Heyting categories, a variant of Dedekind categories, and Arrow categories provide a convenient framework for expressing and reasoning about fuzzy relations and programs based on those methods. In this thesis we present an implementation of Heyting and arrow categories suitable for reasoning and program execution using Coq, an interactive theorem prover based on Higher-Order Logic (HOL) with dependent types. This implementation can be used to specify and develop correct software based on L-fuzzy relations such as fuzzy controllers. We give an overview of lattices, L-fuzzy relations, category theory and dependent type theory before describing our implementation. In addition, we provide examples of program executions based on our framework.

An Abstract Algebraic Theory of L-Fuzzy Relations for Relational Databases

Classical relational databases lack proper ways to manage certain real-world situations including imprecise or uncertain data. Fuzzy databases overcome this limitation by allowing each entry in the table to be a fuzzy set where each element of the corresponding domain is assigned a membership degree from the real interval [0…1]. But this fuzzy mechanism becomes inappropriate in modelling scenarios where data might be incomparable. Therefore, we become interested in further generalization of fuzzy database into L-fuzzy database. In such a database, the characteristic function for a fuzzy set maps to an arbitrary complete Brouwerian lattice L. From the query language perspectives, the language of fuzzy database, FSQL extends the regular Structured Query Language (SQL) by adding fuzzy specific constructions. In addition to that, L-fuzzy query language LFSQL introduces appropriate linguistic operations to define and manipulate inexact data in an L-fuzzy database. This research mainly focuses on defining the semantics of LFSQL. However, it requires an abstract algebraic theory which can be used to prove all the properties of, and operations on, L-fuzzy relations. In our study, we show that the theory of arrow categories forms a suitable framework for that. Therefore, we define the semantics of LFSQL in the abstract notion of an arrow category. In addition, we implement the operations of L-fuzzy relations in Haskell and develop a parser that translates algebraic expressions into our implementation.

L-Fuzzy Structured Query Language

Lattice valued fuzziness is more general than crispness or fuzziness based on the unit interval. In this work, we present a query language for a lattice based fuzzy database. We define a Lattice Fuzzy Structured Query Language (LFSQL) taking its membership values from an arbitrary lattice L. LFSQL can handle, manage and represent crisp values, linear ordered membership degrees and also allows membership degrees from lattices with non-comparable values. This gives richer membership degrees, and hence makes LFSQL more flexible than FSQL or SQL. In order to handle vagueness or imprecise information, every entry into an L-fuzzy database is an L-fuzzy set instead of crisp values. All of this makes LFSQL an ideal query language to handle imprecise data where some factors are non-comparable. After defining the syntax of the language formally, we provide its semantics using L-fuzzy sets and relations. The semantics can be used in future work to investigate concepts such as functional dependencies. Last but not least, we present a parser for LFSQL implemented in Haskell.

The Search for New Resonances in Strong Symmetry Breaking Scenarios with the ATLAS Detector

Utilisant les plus récentes données recueillies par le détecteur ATLAS lors de collisions pp à 7 et 8 TeV au LHC, cette thèse établira des contraintes sévères sur une multitude de modèles allant au-delà du modèle standard (MS) de la physique des particules. Plus particulièrement, deux types de particules hypothétiques, existant dans divers modèles théoriques et qui ne sont pas présentes dans le MS, seront étudiés et sondés. Le premier type étudié sera les quarks-vectoriels (QV) produits lors de collisions pp par l’entremise de couplages électrofaibles avec les quarks légers u et d. On recherchera ces QV lorsqu’ils se désintègrent en un boson W ou Z, et un quark léger. Des arguments théoriques établissent que sous certaines conditions raisonnables la production simple dominerait la production en paires des QV. La topologie particulière des évènements en production simple des QV permettra alors la mise en oeuvre de techniques d’optimisation efficaces pour leur extraction des bruits de fond électrofaibles. Le deuxième type de particules recherché sera celles qui se désintègrent en WZ lorsque ces bosons de jauges W, et Z se désintègrent leptoniquement. Les états finaux détectés par ATLAS seront par conséquent des évènements ayant trois leptons et de l’énergie transverse manquante. La distribution de la masse invariante de ces objets sera alors examinée pour déterminer la présence ou non de nouvelles résonances qui se manifesterait par un excès localisé. Malgré le fait qu’à première vue ces deux nouveaux types de particules n’ont que très peu en commun, ils ont en réalité tous deux un lien étroit avec la brisure de symétrie électrofaible. Dans plusieurs modèles théoriques, l’existence hypothétique des QV est proposé pour annuler les contributions du quark top aux corrections radiatives de la masse du Higgs du MS. Parallèlement, d’autres modèles prédisent quant à eux des résonances en WZ tout en suggérant que le Higgs est une particule composite, chambardant ainsi tout le sector Higgs du MS. Ainsi, les deux analyses présentées dans cette thèse ont un lien fondamental avec la nature même du Higgs, élargissant par le fait même nos connaissances sur l’origine de la masse intrinsèque des particules. En fin de compte, les deux analyses n’ont pas observé d’excès significatif dans leurs régions de signal respectives, ce qui permet d’établir des limites sur la section efficace de production en fonction de la masse des résonances.

Studies on Fuzzy Graphs

In this thesis an attempt to develop the properties of basic concepts in fuzzy graphs such as fuzzy bridges, fuzzy cutnodes, fuzzy trees and blocks in fuzzy graphs have been made. The notion of complement of a fuzzy graph is modified and some of its properties are studied. Since the notion of complement has just been initiated, several properties of G and G available for crisp graphs can be studied for fuzzy graphs also. Mainly focused on fuzzy trees defined by Rosenfeld in [10] , several other types of fuzzy trees are defined depending on the acyclicity level of a fuzzy graph. It is observed that there are selfcentered fuzzy trees. Some operations on fuzzy graphs and prove that complement of the union two fuzzy graphs is the join of their complements and complement of the join of two fuzzy graphs is union of their complements. The study of fuzzy graphs made in this thesis is far from being complete. The wide ranging applications of graph theory and the interdisciplinary nature of fuzzy set theory, if properly blended together could pave a way for a substantial growth of fuzzy graph theory.

Fuzzy Absolutes and Related Topics

The study on the fuzzy absolutes and related topics. The different kinds of extensions especially compactification formed a major area of study in topology. Perfect continuous mappings always preserve certain topological properties. The concept of Fuzzy sets introduced by the American Cyberneticist L. A Zadeh started a revolution in every branch of knowledge and in particular in every branch of mathematics. Fuzziness is a kind of uncertainty and uncertainty of a symbol lies in the lack of well-defined boundaries of the set of objects to which this symbol belongs. Introduce an s-continuous mapping from a topological space to a fuzzy topological space and prove that the image of an H-closed space under an s-continuous mapping is f-H closed. Here also proved that the arbitrary product fi and sum of  fi of the s-continuous maps fi are also s-continuous. The original motivation behind the study of absolutes was the problem of characterizing the projective objects in the category of compact spaces and continuous functions.

Some Generalizations of Fuzzy Metrizability

The main purpose of the study is to extent concept of the class of spaces called ‘generalized metric spaces’ to fuzzy context and investigates its properties. Any class of spaces defined by a property possessed by all metric spaces could technically be called as a class of ‘generalized metric spaces’. But the term is meant for classes, which are ‘close’ to metrizable spaces in some under certain kinds of mappings. The theory of generalized metric spaces is closely related to ‘metrization theory’. The class of spaces likes Morita’s M- spaces, Borges’s w-spaces, Arhangelskii’s p-spaces, Okuyama’s  spaces have major roles in the theory of generalized metric spaces. The thesis introduces fuzzy metrizable spaces, fuzzy submetrizable spaces and proves some characterizations of fuzzy submetrizable spaces, and also the fuzzy generalized metric spaces like fuzzy w-spaces, fuzzy Moore spaces, fuzzy M-spaces, fuzzy k-spaces, fuzzy -spaces study of their properties, prove some equivalent conditions for fuzzy p-spaces. The concept of a network is one of the most useful tools in the theory of generalized metric spaces. The -spaces is a class of generalized metric spaces having a network.