Exploring sexualized substance use, sexual behaviors and HIV-screening practices in people attending erotic industry shows

Previous studies showed that Erotic industry sShows (ES) were appropriate events for sexual health promotion and testing interventions. A cross-sectional survey exploring screening practices, sexual behaviors, substance use, and sexual motives for substance use was conducted in ES in December 2017 and completed by 781 respondents. Overall, . Eighteen18% percent reported substance use in the last 3 months (51% alcohol), 26%. Twenty-six percent reported a sexual purpose for substance use. Main sexual partners were spouse (68%), regular (21%), unknown (18%) and several (17%) partners. Main sexual practices were libertinism (22%), partner swapping (15%) and threesome (15%). Twenty-seven percent of respondents reported cContactless sex was reported by 27% of the respondents. 18% reported no previous HIV test. Univariate analysis showed that having or not previous HIV test was linked to male sex (76.8% vs. 54.5%, p < 10-3), alcohol consumption in the last three months (58.7% vs. 49.4%, p = .043), number of drugs in a lifetime (1.3% vs. 1.6%, p = .022), sexual partnership with spouse/long-term partner (57.3% vs. 70.5%; p = .002), at least one multiple-partner sexual practice (23.1% vs. 31.8%, p = .040) and type of sexual attraction (p = <10-3). Results contribute to establishing the usefulness of HIV-testing and awareness campaigns in ES eventsand informing potential combined risk behaviors and related interventions.

Heterogeneous value coding in orbitofrontal populations

Value signals in the brain are important for learning, decision-making, and orienting behavior toward relevant goals. Although they can play different roles in behavior and cognition, value representations are often considered to be uniform and static signals. Nonetheless, contextual and mixed representations of value have been widely reported. Here, we review the evidence for heterogeneity in value coding and dynamics in the orbitofrontal cortex. We argue that this diversity plays a key role in the representation of value itself and allows neurons to integrate value with other behaviorally relevant information. We also discuss modeling approaches that can dissociate potential functions of heterogeneous value codes and provide further insight into its importance in behavior and cognition. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Stable and dynamic representations of value in the prefrontal cortex

Optimal decision-making requires that stimulus-value associations are kept up to date by constantly comparing the expected value of a stimulus with its experienced outcome. To do this, value information must be held in mind when a stimulus and outcome are separated in time. However, little is known about the neural mechanisms of working memory (WM) for value. Contradicting theories have suggested WM requires either persistent or transient neuronal activity, with stable or dynamic representations, respectively. To test these hypotheses, we recorded neuronal activity in the orbitofrontal and anterior cingulate cortex of two monkeys performing a valuation task. We found that features of all hypotheses were simultaneously present in prefrontal activity, and no single hypothesis was exclusively supported. Instead, mixed dynamics supported robust, time invariant value representations while also encoding the information in a temporally specific manner. We suggest that this hybrid coding is a critical mechanism supporting flexible cognitive abilities.

Sustainable computational science: the ReScience initiative

Computer science offers a large set of tools for prototyping, writing, running, testing, validating, sharing and reproducing results; however, computational science lags behind. In the best case, authors may provide their source code as a compressed archive and they may feel confident their research is reproducible. But this is not exactly true. James Buckheit and David Donoho proposed more than two decades ago that an article about computational results is advertising, not scholarship. The actual scholarship is the full software environment, code, and data that produced the result. This implies new workflows, in particular in peer-reviews. Existing journals have been slow to adapt: source codes are rarely requested and are hardly ever actually executed to check that they produce the results advertised in the article. ReScience is a peer-reviewed journal that targets computational research and encourages the explicit replication of already published research, promoting new and open-source implementations in order to ensure that the original research can be replicated from its description. To achieve this goal, the whole publishing chain is radically different from other traditional scientific journals. ReScience resides on GitHub where each new implementation of a computational study is made available together with comments, explanations, and software tests.

Reservoir Computing Properties of Neural Dynamics in Prefrontal Cortex

Primates display a remarkable ability to adapt to novel situations. Determining what is most pertinent in these situations is not always possible based only on the current sensory inputs, and often also depends on recent inputs and behavioral outputs that contribute to internal states. Thus, one can ask how cortical dynamics generate representations of these complex situations. It has been observed that mixed selectivity in cortical neurons contributes to represent diverse situations defined by a combination of the current stimuli, and that mixed selectivity is readily obtained in randomly connected recurrent networks. In this context, these reservoir networks reproduce the highly recurrent nature of local cortical connectivity. Recombining present and past inputs, random recurrent networks from the reservoir computing framework generate mixed selectivity which provides pre-coded representations of an essentially universal set of contexts. These representations can then be selectively amplified through learning to solve the task at hand. We thus explored their representational power and dynamical properties after training a reservoir to perform a complex cognitive task initially developed for monkeys. The reservoir model inherently displayed a dynamic form of mixed selectivity, key to the representation of the behavioral context over time. The pre-coded representation of context was amplified by training a feedback neuron to explicitly represent this context, thereby reproducing the effect of learning and allowing the model to perform more robustly. This second version of the model demonstrates how a hybrid dynamical regime combining spatio-temporal processing of reservoirs, and input driven attracting dynamics generated by the feedback neuron, can be used to solve a complex cognitive task. We compared reservoir activity to neural activity of dorsal anterior cingulate cortex of monkeys which revealed similar network dynamics. We argue that reservoir computing is a pertinent framework to model local cortical dynamics and their contribution to higher cognitive function.

One of the most noteworthy properties of primate behavior is its diversity and adaptability. Human and non-human primates can learn an astonishing variety of novel behaviors that could not have been directly anticipated by evolution. How then can the nervous system be prewired to anticipate the ability to represent such an open class of behaviors? Recent developments in a branch of recurrent neural networks, referred to as reservoir computing, begins to shed light on this question. The novelty of reservoir computing is that the recurrent connections in the network are fixed, and only the connections from these neurons to the output neurons change with learning. The fixed recurrent connections provide the network with an inherent high dimensional dynamics that creates essentially all possible spatial and temporal combinations of the inputs which can then be selected, by learning, to perform the desired task. This high dimensional mixture of activity inherent to reservoirs has begun to be found in the primate cortex. Here we make direct comparisons between dynamic coding in the cortex and in reservoirs performing the same task, and contribute to the emerging evidence that cortex has significant reservoir properties.

Behavioral Regulation and the Modulation of Information Coding in the Lateral Prefrontal and Cingulate Cortex

To explain the high level of flexibility in primate decision-making, theoretical models often invoke reinforcement-based mechanisms, performance monitoring functions, and core neural features within frontal cortical regions. However, the underlying biological mechanisms remain unknown. In recent models, part of the regulation of behavioral control is based on meta-learning principles, for example, driving exploratory actions by varying a meta-parameter, the inverse temperature, which regulates the contrast between competing action probabilities. Here we investigate how complementary processes between lateral prefrontal cortex (LPFC) and dorsal anterior cingulate cortex (dACC) implement decision regulation during exploratory and exploitative behaviors. Model-based analyses of unit activity recorded in these 2 areas in monkeys first revealed that adaptation of the decision function is reflected in a covariation between LPFC neural activity and the control level estimated from the animal's behavior. Second, dACC more prominently encoded a reflection of outcome uncertainty useful for control regulation based on task monitoring. Model-based analyses also revealed higher information integration before feedback in LPFC, and after feedback in dACC. Overall the data support a role of dACC in integrating reinforcement-based information to regulate decision functions in LPFC. Our results thus provide biological evidence on how prefrontal cortical subregions may cooperate to regulate decision-making.

Comparison of classifiers for decoding sensory and cognitive information from prefrontal neuronal populations

Decoding neuronal information is important in neuroscience, both as a basic means to understand how neuronal activity is related to cerebral function and as a processing stage in driving neuroprosthetic effectors. Here, we compare the readout performance of six commonly used classifiers at decoding two different variables encoded by the spiking activity of the non-human primate frontal eye fields (FEF): the spatial position of a visual cue, and the instructed orientation of the animal's attention. While the first variable is exogenously driven by the environment, the second variable corresponds to the interpretation of the instruction conveyed by the cue; it is endogenously driven and corresponds to the output of internal cognitive operations performed on the visual attributes of the cue. These two variables were decoded using either a regularized optimal linear estimator in its explicit formulation, an optimal linear artificial neural network estimator, a non-linear artificial neural network estimator, a non-linear naïve Bayesian estimator, a non-linear Reservoir recurrent network classifier or a non-linear Support Vector Machine classifier. Our results suggest that endogenous information such as the orientation of attention can be decoded from the FEF with the same accuracy as exogenous visual information. All classifiers did not behave equally in the face of population size and heterogeneity, the available training and testing trials, the subject's behavior and the temporal structure of the variable of interest. In most situations, the regularized optimal linear estimator and the non-linear Support Vector Machine classifiers outperformed the other tested decoders.

Medial prefrontal cortex and the adaptive regulation of reinforcement learning parameters

Converging evidence suggest that the medial prefrontal cortex (MPFC) is involved in feedback categorization, performance monitoring, and task monitoring, and may contribute to the online regulation of reinforcement learning (RL) parameters that would affect decision-making processes in the lateral prefrontal cortex (LPFC). Previous neurophysiological experiments have shown MPFC activities encoding error likelihood, uncertainty, reward volatility, as well as neural responses categorizing different types of feedback, for instance, distinguishing between choice errors and execution errors. Rushworth and colleagues have proposed that the involvement of MPFC in tracking the volatility of the task could contribute to the regulation of one of RL parameters called the learning rate. We extend this hypothesis by proposing that MPFC could contribute to the regulation of other RL parameters such as the exploration rate and default action values in case of task shifts. Here, we analyze the sensitivity to RL parameters of behavioral performance in two monkey decision-making tasks, one with a deterministic reward schedule and the other with a stochastic one. We show that there exist optimal parameter values specific to each of these tasks, that need to be found for optimal performance and that are usually hand-tuned in computational models. In contrast, automatic online regulation of these parameters using some heuristics can help producing a good, although non-optimal, behavioral performance in each task. We finally describe our computational model of MPFC-LPFC interaction used for online regulation of the exploration rate and its application to a human-robot interaction scenario. There, unexpected uncertainties are produced by the human introducing cued task changes or by cheating. The model enables the robot to autonomously learn to reset exploration in response to such uncertain cues and events. The combined results provide concrete evidence specifying how prefrontal cortical subregions may cooperate to regulate RL parameters. It also shows how such neurophysiologically inspired mechanisms can control advanced robots in the real world. Finally, the model's learning mechanisms that were challenged in the last robotic scenario provide testable predictions on the way monkeys may learn the structure of the task during the pretraining phase of the previous laboratory experiments.

Robot cognitive control with a neurophysiologically inspired reinforcement learning model

A major challenge in modern robotics is to liberate robots from controlled industrial settings, and allow them to interact with humans and changing environments in the real-world. The current research attempts to determine if a neurophysiologically motivated model of cortical function in the primate can help to address this challenge. Primates are endowed with cognitive systems that allow them to maximize the feedback from their environment by learning the values of actions in diverse situations and by adjusting their behavioral parameters (i.e., cognitive control) to accommodate unexpected events. In such contexts uncertainty can arise from at least two distinct sources – expected uncertainty resulting from noise during sensory-motor interaction in a known context, and unexpected uncertainty resulting from the changing probabilistic structure of the environment. However, it is not clear how neurophysiological mechanisms of reinforcement learning and cognitive control integrate in the brain to produce efficient behavior. Based on primate neuroanatomy and neurophysiology, we propose a novel computational model for the interaction between lateral prefrontal and anterior cingulate cortex reconciling previous models dedicated to these two functions. We deployed the model in two robots and demonstrate that, based on adaptive regulation of a meta-parameter β that controls the exploration rate, the model can robustly deal with the two kinds of uncertainties in the real-world. In addition the model could reproduce monkey behavioral performance and neurophysiological data in two problem-solving tasks. A last experiment extends this to human–robot interaction with the iCub humanoid, and novel sources of uncertainty corresponding to “cheating” by the human. The combined results provide concrete evidence for the ability of neurophysiologically inspired cognitive systems to control advanced robots in the real-world.

Evaluating counseling outcome on adherence to prophylaxis and follow-up after sexual HIV-risk exposure: a randomized controlled trial

OBJECTIVE

Post-exposure prophylaxis (PEP) is recommended for the management of sexual HIV-risk exposure. However, a high percentage of exposed patients discontinue both their 28-day prophylaxis course before 15 days and HIV testing follow-up before M3. The objective of this study is to assess the efficacy of a counseling intervention in enhancing both adherence to PEP and HIV testing follow-up.

METHODS

Between 1 June 2004 and 31 December 2005, 54 patients exposed to sexual HIV-risk exposure were included in a multicenter, prospective, controlled, randomized trial, comparing a group receiving a counseling intervention in addition to traditional medical management (intervention group (IG), n=28) vs. a control group (CG, n=26). Patients in the IG received interactive counseling interventions focused on adherence to PEP and to HIV testing follow-up, led by specially trained nurses. The main outcome measures were proportion of patients achieving 100% adherence to PEP as evaluated on D15 by a self-completed patient questionnaire and on HIV testing on D45 and M3.

RESULTS

Groups were well balanced at baseline for age, sex, and circumstances of exposure. The proportion of 100% adherent patients to PEP was significantly higher in the IG compared to the CG (54% vs. 23%, p=0.036). Patients in the IG were more likely to complete the HIV testing follow-up at D45 (86% vs. 54%, p=0.023) and M3 (68% vs. 38%, p=0.056).

CONCLUSIONS

This study suggests the effectiveness of a counseling program to enhance adherence to both PEP and HIV testing follow-up after sexual exposure.

Prise en charge de l'infection à VIH en 2005 en France à travers 7416 patients de la cohorte NADIS

OBJECTIVE

This study had for aim to evaluate the immuno-virological and therapeutic profile of a cohort of 7416 HIV-1 infected patients followed in six French hospital with the Nadis software.

METHOD

This cross sectional and retrospective study was performed between June 1, 2004 and June 1, 2005. We analyzed the demographic (sex, age, HIV infection route), immunovirological, and therapeutic characteristics (last treatment prescribed) of the 7416 cohort patients.

RESULTS

The mean age was 43 years, 29% were women and 29% HCV/HBV co infected. The viral load was 1.9 log(10)copies/ml (IQR: 1.5-3.3) and the CD4 cells count was 452/mm(3) [IQR: 306-630]. Among the 5,913 antiretroviral treated patients, VL was less than 200 copies/ml for 74.7% of patients and 50% of them had a CD4 cell count superior to 500/mm(3); the drug regimen was 2 or 3 nucleosides reverse transcriptase inhibitors (NRTI) combined with one protease inhibitor (88% Ritonavir boosted) in 42% of the patients, 26% of them were treated with 2 NRTI and 1 non-NRTI, and 14% with 3NRTI. Patients with undetectable VL were followed 5.1/year versus 7.2 for non- VL controlled patients (P<10(-3)). The heterosexual route predominated among the new 531 HIV-diagnosed patients among whom 25% had a median CD4 cell count of 242/ m(3).

CONCLUSION

Close to 75% of antiretroviral treated patients had a VL<200 copies/ml but 15% kept a low CD4 cell count. The characteristics of recently diagnosed HIV positive patients stresses the need for more information on prevention and an early diagnosis.

In the era of highly active antiretroviral therapy, why are HIV-infected patients still admitted to hospital for an inaugural opportunistic infection?

OBJECTIVES

To identify factors related to delayed testing, and delayed or interrupted care-seeking or treatment uptake, among HIV-infected patients.

DESIGN

HIV-infected patients hospitalized for an opportunistic infection (OI) cases were included in a prospective study and compared with controls matched by age and sex who had regular follow-up and treatment. Patients were asked to complete a questionnaire about their therapeutic itinerary and their socioeconomic, psychological and medical characteristics.

RESULTS

Seventy patients were matched with 140 controls. According to their therapeutic itinerary prior to admission, cases were subdivided into four groups among which three will be more particularly studied: nontested patients (NT) (24%; n=17), known HIV-infected patients with no medical follow-up (NF) (30%; n=21); and noncompliant patients (NC) (36%, n=25). Characteristics of NT and NF patients included a predominantly sexual mode of contamination (P=0.01), continuing occupational activity (P=0.01) despite a low mean Karnofsky index (P=0.001) and unfavourable virological and immunological parameters. NT patients displayed a low degree of anxiety, and lacked awareness concerning risk of contamination and HIV-related symptoms. HIV-status announcement (P=0.04) and the benefits of medical follow-up (P=0.05) were less favourably perceived by NF patients than by controls, and were associated with a high degree of anxiety in NF patients. NC patients had a weaker commitment to follow-up and treatment, and more frequent treatment discontinuation associated with a higher rate of interruption of follow-up in a context of social difficulties.

CONCLUSIONS

Patients ignorant of their HIV status, patients NF and NC have very specific characteristics. More appropriate approaches are needed regarding screening and access to care in order to reduce the incidence of delayed care-seeking.

[The Nadis cohort: 6236 HIV-infected patients followed up in French university hospitals]

OBJECTIVE

The Nadis electronic medical patient record allows real time constitution of a database including the clinical, therapeutic, biological, and epidemiological features of HIV-positive patients.

METHODS

Data concerning HIV-infected patients followed-up in 6 French University Hospitals was collected. Data quality was assessed on a regular basis in each center.

RESULTS

The 6 first University hospitals using Nadis agreed to group their data on March 15, 2004, concerning 6236 patients having consulted at least once in the previous year. Among these, 29% were female patients, 80% were under treatment on March 15, 2004, 9% were off treatment, 29% were co-infected by hepatitis B or C virus, 57% had an undetectable viral load, 15% of the treated patients were in a worrying immunovirological situation, 358 were diagnosed HIV-positive in 2003. 35% of these "new patients" were women, the mode of infection was sexual in 80%, 45% were under treatment on March 15, 04. This recent data allowed us to have an accurate assessment of this population's management in 2004.

Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals

Objective

To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs).

Design

Cohort study. Setting: French Hospital Database on HIV.

Patients

Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml.

Main outcome measures

Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline.

Results

The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk.

Conclusions

The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.

[NADIS 2000, development of an electronic medical record for patients infected by HIV, HBV and HCV]

OBJECTIVE

to develop an electronic medical record for patients living with HIV, HBV or HCV in order to improve their management, facilitate communication between all the caregivers, and to create a useful medical database for research and assessments. This project (NADIS 2000) involved 6 centres of Infectious Diseases in France in partnership with Fédialis Médica (subsidiary of the GSK group in France).

METHODS

A specifications sheets was drawn-up by a piloting Committee regrouping the various correspondents in each centre and a computer expert representing Fédialis Médica. A Scientific and Development committee regrouped the heads of departments of each centre and the representatives from Fédialis Médica and GSK and was charged with defining the general concept of the project and guaranteeing the scientific and clinical aspects.

RESULTS

NADIS 2000 version 1.0 was activated in the departments of infectious diseases in Nice and Toulouse in November 2000 and in others Units at the end of 2001. NADIS 2000 permitted real-time use by the physicians in the Outpatients and Day-care Units and was easily handled by all the practitioners. Its use was eased by the principles clearly defined before its application (department project, progressive but exhaustive use), an intuitive interface simulating a consultation, and functions proposing direct benefits for the physicians (graphical visualization of the biological variables, printing of prescriptions and letters).

CONCLUSION

The activation and input methods of NADIS 2000 are user friendly and the physicians find it rapidly easy to use. New functional aspects are being developed as well as its use in other hospital departments.

Ethical problems raised by anti-HIV vaccination

At present questions are being asked world-wide about the risk of the AIDS epidemic. The discovery of an anti-HIV vaccine has become an urgent priority, but it also raises a number of sensitive questions. Ethical problems in this field are particularly delicate, since the perspectives of individual health and public health do not seem to coincide. Our research team conducted a review of more than 400 articles on the ethical problems raised by AIDS. We concentrated particularly on the ethical and legal issues raised by research on anti-HIV vaccine. These problems fall into three main categories: therapeutic assays, which must be controlled by a strict agreement defined by international norms; manufacture of the future vaccine, raising legal difficulties which must be faced and solved now; distribution of the vaccine to the population, which should be conducted on a general basis, i.e. it should be offered to all individuals and not only to risk groups.

AIDS, a social dilemma: detection of seropositives

At present, we can observe an evolution in ideas about the detection of HIV seropositivity through a qualitative analysis of specialised literature on the ethical aspects of AIDS. In the case of this disease, systematic screening of the population does not correspond to epidemiological criteria: it is wasteful, troublesome and costly. Whether it is voluntary, and therefore biased, or compulsory, and therefore controversial, systematic screening seems an unlikely option. This situation has prompted many versions of target-group screening, which correspond to two options: systematic screening of known risk-groups, discriminatory, confidential and anonymous; target-group screening linked to particular circumstances: recognised as necessary by blood-donors and well-accepted by pregnant mothers. This method can be institutionalised and applied in the armed forces and in prisons,.... Lastly, we consider measures taken by different countries and organisations.

The ethical approach to AIDS: a bibliographical review

This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society.