Addressing Adherence to Antiretroviral Therapy in Ouagadougou, Burkina Faso: Insights from hospital ethnography

L'épidémie de l'infection au virus de l'immunodéficience humaine (VIH) constitue une crise majeure en santé publique de nos jours. Les efforts de la communauté internationale visent à rendre les traitements antirétroviraux (TARV) plus accessibles aux personnes vivant avec le VIH, particulièrement dans les contextes à ressources limitées. Une observance quasi-parfaite aux TARV est requise pour tirer le maximum de bénéfices thérapeutiques à l'échelle individuelle et à l'échelle populationnelle. Cependant, l’accroissement de la disponibilité des TARV s'effectue dans des pays africains qui disposent de systèmes de santé fragiles et sous-financés. Ceux-ci souffrent également d'une pénurie de personnel de santé, lequel joue un rôle central dans la mise en oeuvre et la pérennité des interventions, notamment celle du soutien à l'observance thérapeutique. La présente étude ethnographique relate l'expérience de personnel de santé dans la fourniture des services de soutien à l'observance dans un contexte de ressources limitées et d'accroissement de l'accès aux TARV. L'étude a été menée dans deux centres hospitaliers de la capitale du Burkina Faso, Ouagadougou. Trois conclusions principales sont mises au jour. Tout d'abord, une bonne organisation – tant logistique que matérielle – dans la provision de services de soutien à l'observance est capitale. L’infrastructure d’observance doit aller au-delà des unités de prise en charge et s’intégrer au sein du système de santé pour assurer un impact durable. De plus, la provision des TARV dans le cadre d'une prise en charge médicale exhaustive est essentielle pour un soutien à l'observance efficace. Ceci implique la présence de professionnelles de santé en nombre suffisant et disposant d‘outils pour soutenir leur pratique clinique (tests de laboratoire, traitements pour infections opportunistes), ainsi que des mécanismes pour leur permettre d’aider les patients à gérer la vie quotidienne (gratuité des services, programmes d’alphabétisation et soutien psychosociale). Enfin, une amélioration de la coordination des programmes VIH au niveau national et international est nécessaire pour assurer une prise en charge cohérente au niveau local. La programmation conçue dans les pays étrangers qui est incomplète et de courte durée a un impact majeur sur la disponibilité de ressources humaines et matérielles à long terme, ainsi que sur les conditions de travail et de prestation de services dans les unités de soins.

Access to care for the poor living with chronic disease in India : an analysis of selected national health policies

Cette recherche sur les barrières à l’accès pour les pauvres atteints de maladies chroniques en Inde a trois objectifs : 1) évaluer si les buts, les objectifs, les instruments et la population visée, tels qu'ils sont formulés dans les politiques nationales actuelles de santé en Inde, permettent de répondre aux principales barrières à l’accès pour les pauvres atteints de maladies chroniques; 2) évaluer les types de leviers et les instruments identifiés par les politiques nationales de santé en Inde pour éliminer ces barrières à l’accès; 3) et évaluer si ces politiques se sont améliorées avec le temps à l’égard de l’offre de soins à la population pour les maladies chroniques et plus spécifiquement chez les pauvres. En utilisant le Framework Approach de Ritchie et Spencer (1993), une analyse qualitative de contenu a été complétée avec des politiques nationales de santé indiennes. Pour commencer, un cadre conceptuel sur les barrières à l’accès aux soins pour les pauvres atteints de maladies chroniques en Inde a été créé à partir d’une revue de la littérature scientifique. Par la suite, les politiques ont été échantillonnées en Inde en 2009. Un cadre thématique et un index ont été générés afin de construire les outils d’analyse et codifier le contenu. Finalement, les analyses ont été effectuées en utilisant cet index, en plus de chartes, de maps, d'une grille de questions et d'études de cas. L’analyse a tété effectuée en comparant les barrières à l’accès qui avaient été originalement identifiées dans le cadre thématique avec celles identifiées par l’analyse de contenu de chaque politique. Cette recherche met en évidence que les politiques nationales de santé indiennes s’attaquent à un certain nombre de barrières à l’accès pour les pauvres, notamment en ce qui a trait à l’amélioration des services de santé dans le secteur public, l’amélioration des connaissances de la population et l’augmentation de certaines interventions sur les maladies chroniques. D’un autre côté, les barrières à l’accès reliées aux coûts du traitement des maladies chroniques, le fait que les soins de santé primaires ne soient pas abordables pour beaucoup d’individus et la capacité des gens de payer sont, parmi les barrières à l'accès identifiées dans le cadre thématique, celles qui ont reçu le moins d’attention. De plus, lorsque l’on observe le temps de formulation de chaque politique, il semble que les efforts pour augmenter les interventions et l’offre de soins pour les maladies chroniques physiques soient plus récents. De plus, les pauvres ne sont pas ciblés par les actions reliées aux maladies chroniques. Le risque de les marginaliser davantage est important avec la transition économique, démographique et épidémiologique qui transforme actuellement le pays et la demande des services de santé.

Synthèse de nouveaux matériaux conducteurs comportant des unités aromatiques conjuguées et analyse de leurs propriétés physico-chimiques

Les matériaux conjugués ont fait l’objet de beaucoup de recherches durant les dernières années. Les nouveaux matériaux présentent des propriétés intéressantes que ce soit au niveau optique, électrique, mécanique ou même les trois en même temps. La synthèse reste la difficulté principale dans la fabrication de dispositifs électroniques. Les méthodes utilisées pour y parvenir sont l’électropolymérisation, le couplage de Suzuki ou de Wittig. Ces techniques comportent encore de nombreuses contraintes et s’avèrent difficilement réalisables à grande échelle. Les thiophènes, les pyrroles et les furanes ont démontré une bonne conductibilité et une bande de conduction basse due à une conjugaison accrue. L’objectif ici est de synthétiser des oligomères principalement composés de thiophènes dans le but d’en caractériser les propriétés spectroscopiques, électrochimiques et de conduction. La synthèse est souvent l’étape délicate de la fabrication de matériaux conjugués. Nous présentons ici une méthode de synthèse simple par modules avec des unités hétérocycliques. Les modules complémentaires sont attachés par condensation entre un aldéhyde et une amine menant à la formation d’un lien robuste, l’azomethine. Les résultats des propriétés photophysiques et électrochimiques de ces matériaux conjugués seront présentés. En ayant recours à différents groupes électrodonneurs et électroaccepteurs, en variant le degré de conjugaison ou en utilisant différents hétérocycles, les propriétés spectroscopiques, électrochimiques et de bande de conduction peuvent être adaptées à volonté, ce qui en fait des matériaux aux propriétés modelables. Ces nouvelles molécules seront analysées pour en déceler les propriétés recherchées dans la fabrication d’OLED. Nous explorerons les domaines de l’oxidation electrochimique réversible et de la polymérisation menant à la fabrication de quelques prototypes simples.

Process Optimization for Mass Production of Marine Yeast Candida sp. S 27 and its Nutritional Characterization

The main source of protein for human and animal consumption is from the agricultural sector, where the production is vulnerable to diseases, fluctuations in climatic conditions and deteriorating hydrological conditions due to water pollution. Therefore Single Cell Protein (SCP) production has evolved as an excellent alternative. Among all sources of microbial protein, yeast has attained global acceptability and has been preferred for SCP production. The screening and evaluation of nutritional and other culture variables of microorganisms are very important in the development of a bioprocess for SCP production. The application of statistical experimental design in bioprocess development can result in improved product yields, reduced process variability, closer confirmation of the output response to target requirements and reduced development time and overall cost.The present work was undertaken to develop a bioprocess technology for the mass production of a marine yeast, Candida sp.S27. Yeasts isolated from the offshore waters of the South west coast of India and maintained in the Microbiology Laboratory were subjected to various tests for the selection of a potent strain for biomass production. The selected marine yeast was identified based on ITS sequencing. Biochemical/nutritional characterization of Candida sp.S27 was carried out. Using Response Surface Methodology (RSM) the process parameters (pH, temperature and salinity) were optimized. For mass production of yeast biomass, a chemically defined medium (Barnett and Ingram, 1955) and a crude medium (Molasses-Yeast extract) were optimized using RSM. Scale up of biomass production was done in a Bench top Fermenter using these two optimized media. Comparative efficacy of the defined and crude media were estimated besides nutritional evaluation of the biomass developed using these two optimized media.

Modification of Polypropylene and Polystyrene Using Nanosilica

The present work focuses on the modification of the commonly used thermoplastics, polypropylene and polystyrene using nanosilica preparcd from a cheap source of sodium silicate. Melt compounding technique has been used for nanocomposite preparation as it is simple and suited to injection moulding. Nanosilica in a polymer matrix provide significant enhancement in strength, stiffness and impact strength. Incorporation of silica particles in a polymer also improves its thennal stability. To achieve better dispersion of fillers in polymer matrices the mixing was done at different shear rates. The enhancement in material properties indicates that at higher shear rates there is greater interaction between particles and the matrix and it depends on filler concentration and type of polymer used. N anosilica is a useful filler in thennoplastic polymers and has been applied in automotive applications, electronic appliances and consumer goods.This thesis is divided into six chapters. General introduction to the topic is described in chapter 1. Salient features of polymer nanocomposites, their synthesis, properties and applications are presented. A review of relevant literature and the scope and objectives are also mentioned in this chapter.The materials used and the vanous experimental method and techniques employed in the study are described in chapter 2. Preparation of nanocomposites by melt blending using Thenno Haake Rheocord, preparation of samples, evaluation of mechanical and thennal properties using UTM, Impact testing and characterization using DMA, TGA and DSC and morphology by SEM are described.The preparation of nanosilica from a laboratory scale to a pilot plant scale is described in chapter 3. Generation of surface modified silica, evaluation of kinetic parameters of the synthesis reaction, scale up of the reactor and modeling of the reactor are also dealt with in this chapter.The modification of the commodity thennoplastic, Polypropylene using nanosilica is described in chapter 4. Preparation of PP/silica nanocomposites, evaluation of mechanical properties, thermal and crystallization characteristics, water absorption and ageing resistance studies are also presented.The modification of Polystyrene using synthesized nanosilica IS described in chapter 5. The method of preparation of PS/silica nanocomposites, evaluation of mechanical properties (static and dynamic), thermal properties melt flow characteristics using Haake Rheocord, water absorption and ageing resistance of these nanocomposites are studied.

Alkaline Protease from a Non-toxigenic Vibrio sp.(V26) and its Applications

The thesis presents a detailed account of the alkaline protease produced by Vibrio sp.(V26) a mangrove isolate,and the application of this enzyme in different fields.The protease producer strain was identified on the basis of biochemical characteristice,putative virulence traits and 16S rRNA gene sequencing.The purification and characterization of the protease has been carried out. Along with this, an attempt has been made to identifiy the protease gene. The physical parameters as well as the media components influencing protease production were optimized using Response Surfce Methodology(RSM).The scale up of the application of the protease from Vibrio sp.(V26) in the dissociation of cells in animal cell culture,in the recovery of silver from used X-ray films as well as an ingredient in commercial detergents were investigated.

Extracellular beta-Glucosidase production by marine Aspergillus sydowii BTMFS 55

The beta-glucosidase enzyme purified from the marine fungus, Aspergillus sydowii BTMFS 55 showed a good yield of enzyme production under solid state fermentation. The statistical optimization of the media components revealed that moisture content, concentration of peptone and inoculum are the major parameters which supported the maximal enzyme production. The purified enzyme showed low pH activity and stability, glucose tolerance and activation by ethanol. It could produce ethanol from wheat bran and rice straw by simultaneous saccharification and fermentation with yeast.The glucosidase purified from Aspergillus sydowii BTMFS 55 shows great potential for several biotechnological applications such as the production of bio-ethanol from agricultural biomass and improvement in the aromatic character of wines and fruit juices through the hydrolysis of flavour glucosidic precursors. There is immense scope for the application of this marine fungus in the biofuel production besides in other industries provided further studies are pursued in exploiting this enzyme and the organism particularly scale up studies with respect to application. There is also ample scope for cloning of the gene encoding beta-glucosidase in domesticated hosts such as Pichia pastoris or S. cerevisiae that can produce ethanol directly from cellulosic biomass.

Separation of astaxanthin from cells of Phaffia rhodozyma using colloidal gas aphrons (CGA) in a flotation column

The aim of this study is to investigate the separation of astaxanthin from the cells of Phaffia rhodozyma using colloidal gas aphrons (CGA), which are surfactant stabilized microbubbles, in a flotation column. It was reported in previous studies that optimum recoveries are achieved at conditions that favor electrostatic interactions. Therefore, in this study, CGA generated from the cationic surfactant hexadecyl trimethyl ammonium bromide (CTAB) were applied to suspensions of cells pretreated with NaOH. The different operation modes (batch or continuous) and the effect of volumetric ratio of CGA to feed, initial concentration of feed, operating height, and flow rate of CGA on the separation of astaxanthin were investigated. The volumetric ratio was found to have a significant effect on the separation of astaxanthin for both batch and continuous experiments. Additionally, the effect of homogenization of the cells on the purity of the recovered fractions was investigated, showing that the homogenization resulted in increased purity. Moreover, different concentrations of surfactant were used for the generation of CGA for the recovery of astaxanthin on batch mode; it was found that recoveries up to 98% could be achieved using CGA generated from a CTAB solution 0.8 mM, which is below the CTAB critical micellar concentration (CMC). These results offer important information for the scale-up of the separation of astaxanthin from the cells of P. rhodozyma using CGA.

Recovery of gallic acid with colloidal gas aphrons generated from a cationic surfactant

In a previous study we have demonstrated that gallic acid (GA) in its anionic form can be recovered from aqueous solutions using colloidal gas aphrons (CGA) generated from the cationic surfactant cetyltrimethylammonium bromide (CTAB). The aim of the present work is to get a better understanding of the separation mechanism in order to determine the optimum operating conditions to maximise the recovery of GA while preserving its antioxidant properties. Zeta potential measurements were carried out to characterise the surface charge of GA, CTAB and their mixtures at three different pH conditions (both in buffers and in aqueous solutions). GA interacted strongly with CTAB at pH higher than its pKa 3.14 where it is ionised and negatively charged. However, at pH higher than 7 GA becomes oxidised and loses its antioxidant power. GA recovery was mainly affected by pH, ionic strength, surfactant/GA molar ratio, mixing conditions and contact time. Scale-up of the separation using a flotation column resulted in both higher recovery and reproducibility. Preliminary experiments with grape marc extracts confirmed the potential application of this separation for the recovery of polyphenols from complex feedstocks

The wind in the willows: flows in forest canopies in complex terrain

Forest canopies are important components of the terrestrial carbon budget, which has motivated a worldwide effort, FLUXNET, to measure CO2 exchange between forests and the atmosphere. These measurements are difficult to interpret and to scale up to estimate exchange across a landscape. Here we review the effects of complex terrain on the mean flow, turbulence, and scalar exchange in canopy flows, as exemplified by adjustment to forest edges and hills, including the effects of stable stratification. We focus on the fundamental fluid mechanics, in which developments in theory, measurements, and modeling, particularly through large-eddy simulation, are identifying important processes and providing scaling arguments. These developments set the stage for the development of predictive models that can be used in combination with measurements to estimate exchange at the landscape scale.

PMCRI: a parallel modular classification rule induction framework

In a world where massive amounts of data are recorded on a large scale we need data mining technologies to gain knowledge from the data in a reasonable time. The Top Down Induction of Decision Trees (TDIDT) algorithm is a very widely used technology to predict the classification of newly recorded data. However alternative technologies have been derived that often produce better rules but do not scale well on large datasets. Such an alternative to TDIDT is the PrismTCS algorithm. PrismTCS performs particularly well on noisy data but does not scale well on large datasets. In this paper we introduce Prism and investigate its scaling behaviour. We describe how we improved the scalability of the serial version of Prism and investigate its limitations. We then describe our work to overcome these limitations by developing a framework to parallelise algorithms of the Prism family and similar algorithms. We also present the scale up results of a first prototype implementation.

Parallel rule induction with information theoretic pre-pruning

In a world where data is captured on a large scale the major challenge for data mining algorithms is to be able to scale up to large datasets. There are two main approaches to inducing classification rules, one is the divide and conquer approach, also known as the top down induction of decision trees; the other approach is called the separate and conquer approach. A considerable amount of work has been done on scaling up the divide and conquer approach. However, very little work has been conducted on scaling up the separate and conquer approach.In this work we describe a parallel framework that allows the parallelisation of a certain family of separate and conquer algorithms, the Prism family. Parallelisation helps the Prism family of algorithms to harvest additional computer resources in a network of computers in order to make the induction of classification rules scale better on large datasets. Our framework also incorporates a pre-pruning facility for parallel Prism algorithms.

Parallel random prism: a computationally efficient ensemble learner for classification

Generally classifiers tend to overfit if there is noise in the training data or there are missing values. Ensemble learning methods are often used to improve a classifier's classification accuracy. Most ensemble learning approaches aim to improve the classification accuracy of decision trees. However, alternative classifiers to decision trees exist. The recently developed Random Prism ensemble learner for classification aims to improve an alternative classification rule induction approach, the Prism family of algorithms, which addresses some of the limitations of decision trees. However, Random Prism suffers like any ensemble learner from a high computational overhead due to replication of the data and the induction of multiple base classifiers. Hence even modest sized datasets may impose a computational challenge to ensemble learners such as Random Prism. Parallelism is often used to scale up algorithms to deal with large datasets. This paper investigates parallelisation for Random Prism, implements a prototype and evaluates it empirically using a Hadoop computing cluster.

Non-uniform data distribution for communication-efficient parallel clustering

Global communicationrequirements andloadimbalanceof someparalleldataminingalgorithms arethe major obstacles to exploitthe computational power of large-scale systems. This work investigates how non-uniform data distributions can be exploited to remove the global communication requirement and to reduce the communication costin parallel data mining algorithms and, in particular, in the k-means algorithm for cluster analysis. In the straightforward parallel formulation of the k-means algorithm, data and computation loads are uniformly distributed over the processing nodes. This approach has excellent load balancing characteristics that may suggest it could scale up to large and extreme-scale parallel computing systems. However, at each iteration step the algorithm requires a global reduction operationwhichhinders thescalabilityoftheapproach.Thisworkstudiesadifferentparallelformulation of the algorithm where the requirement of global communication is removed, while maintaining the same deterministic nature ofthe centralised algorithm. The proposed approach exploits a non-uniform data distribution which can be either found in real-world distributed applications or can be induced by means ofmulti-dimensional binary searchtrees. The approachcanalso be extended to accommodate an approximation error which allows a further reduction ofthe communication costs. The effectiveness of the exact and approximate methods has been tested in a parallel computing system with 64 processors and in simulations with 1024 processing element

Culture bag systems for clinical applications of adult human neural crest-derived stem cells

Introduction Facing the challenging treatment of neurodegenerative diseases as well as complex craniofacial injuries such as those common after cancer therapy, the field of regenerative medicine increasingly relies on stem cell transplantation strategies. Here, neural crest-derived stem cells (NCSCs) offer many promising applications, although scale up of clinical-grade processes prior to potential transplantations is currently limiting. In this study, we aimed to establish a clinical-grade, cost-reducing cultivation system for NCSCs isolated from the adult human nose using cGMP-grade Afc-FEP bags. Methods We cultivated human neural crest-derived stem cells from inferior turbinate (ITSCs) in a cell culture bag system using Afc-FEP bags in human blood plasma-supplemented medium. Investigations of viability, proliferation and expression profile of bag-cultured ITSCs were followed by DNA-content and telomerase activity determination. Cultivated ITSCs were introduced to directed in vitro differentiation assays to assess their potential for mesodermal and ectodermal differentiation. Mesodermal differentiation was determined using an enzyme activity assay (alkaline phosphatase, ALP), respective stainings (Alizarin Red S, Von Kossa and Oil Red O), and RT-PCR, while immunocytochemistry and synaptic vesicle recycling were applied to assay neuroectodermal differentiation of ITSCs. Results When cultivated within Afc-FEP bags, ITSCs grew three-dimensionally in a human blood plasma-derived matrix, thereby showing unchanged morphology, proliferation capability, viability and expression profile in comparison to three dimensionally-cultured ITSCs growing in standard cell culture plastics. Genetic stability of bag-cultured ITSCs was further accompanied by unchanged telomerase activity. Importantly, ITSCs retained their potential to differentiate into mesodermal cell types, particularly including ALP-active, Alizarin Red S-, and Von Kossa-positive osteogenic cell types, as well as adipocytes positive in Oil Red O assays. Bag culture further did not affect the potential of ITSCs to undergo differentiation into neuroectodermal cell types coexpressing β-III-tubulin and MAP2 and exhibiting the capability for synaptic vesicle recycling. Conclusions Here, we report for the first time the successful cultivation of human NCSCs within cGMP-grade Afc-FEP bags using a human blood plasma-supplemented medium. Our findings particularly demonstrate the unchanged differentiation capability and genetic stability of the cultivated NCSCs, suggesting the great potential of this culture system for future medical applications in the field of regenerative medicine.