Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya

BACKGROUND: Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation. METHODS: Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes. RESULTS: Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing. COM-B Model [Figure: see text] Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya CONCLUSION: ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms. DISCLOSURES: All Authors: No reported disclosures

Preserving Finite-Volume Schemes for Two-Time Reaction-Diffusion Model

In this paper, we propose an auto adaptive time-step finite volume scheme for a class of two-time reaction-diffusion models of spatially structured population dynamics. Under specific assumptions, we prove that the privileged scheme preserves, at the discrete level, the main features of the continuous problem, namely the non-negativity of the solutions, monotonicity and boundedness. Finally, we present some numerical results to illustrate the efficiency of the proposed algorithm and the behaviour of the model and of the scheme

A posteriori analysis of the finite element discretization of some parabolic equations

Abstract. We are interested in the discretization of parabolic equations, either linear or semilinear, by an implicit Euler scheme with respect to the time variable and finite elements with respect to the space variables. The main result of this paper consists of building error indicators with respect to both time and space approximations and proving their equivalence with the error, in order to work with adaptive time steps and finite element meshes. Résumé. Nous considérons la discrétisation d’équations paraboliques, soit linéaires soit semi-linéaires, par un schéma d’Euler implicite en temps et par éléments finis en espace. L’idée de cet article est de construire des indicateurs d’erreur liés à l’approximation en temps et en espace et de prouver leur équivalence avec l’erreur, dans le but de travailler avec des pas de temps adaptatifs et des maillages d’éléments finis adaptés à la solution. 1

Adaptive mesh techniques based on a posteriori error estimates for an inverse Cauchy problem

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Structural properties of the tubular appendage spinae from marine bacterium Roseobacter sp. strain YSCB.

International audienceSpinae are tubular surface appendages broadly found in Gram-negative bacteria. Little is known about their architecture, function or origin. Here, we report structural characterization of the spinae from marine bacteria Roseobacter sp. YSCB. Electron cryo-tomography revealed that a single filament winds into a hollow flared base with progressive change to a cylinder. Proteinase K unwound the spinae into proteolysis-resistant filaments. Thermal treatment ripped the spinae into ribbons that were melted with prolonged heating. Circular dichroism spectroscopy revealed a dominant beta-structure of the spinae. Differential scanning calorimetry analyses showed three endothermic transformations at 50-85°C, 98°C and 123°C, respectively. The heating almost completely disintegrated the spinae, abolished the 98°C transition and destroyed the beta-structure. Infrared spectroscopy identified the amide I spectrum maximum at a position similar to that of amyloid fibrils. Therefore, the spinae distinguish from other bacterial appendages, e.g. flagella and stalks, in both the structure and mechanism of assembly

Severely damaged reinforced concrete circular columns repaired by turned steel rebar and high-performance concrete jacketing with steel or polymer fibers

A new strategy that repairs severely damaged reinforced concrete (RC) columns after an earthquake is proposed as a simpler and quicker solution with respect to the strategies currently available in the literature. The external concrete parts are removed from the column surface along the whole plastic hinge region to uncover the steel reinforcement. The transverse steel is cut away, and each longitudinal rebar is locally substituted by steel rebar segments connected by welding connections to the original undamaged rebar pieces outside the intervention zone. The new rebar segments have a reduced diameter achieved by turning to ensure plastic deformation only in the plastic hinge, protecting the original rebar and the welding connections. The connection is specifically designed to be effective and simple, and is directly realized on column reinforcement. Finally, the removed concrete is restored by a jacket built with high-performance concrete with steel or polymer fibers. The use of concrete with high volume fraction of polymer fibers to repair the column is investigated for the first time in this paper. This concrete was characterized by compression and flexural tests in the laboratory and its mechanical characteristics were compared with those of the concrete with steel fibers, which are being increasingly used in construction. The repair strategy was applied to two RC columns (1:6 scaled bridge piers), tested by asymmetric cyclic tests. The results show that the column strength, stiffness, and ductility were restored, and the energy dissipation capacity improved. The experimental evidence was investigated by fiber models in OpenSees

Apolipoprotein E Regulates Amyloid Formation within Endosomes of Pigment Cells

Accumulation of toxic amyloid oligomers is a key feature in the pathogenesis of amyloid-related diseases. Formation of mature amyloid fibrils is one defense mechanism to neutralize toxic prefibrillar oligomers. This mechanism is notably influenced by apolipoprotein E variants. Cells that produce mature amyloid fibrils to serve physiological functions must exploit specific mechanisms to avoid potential accumulation of toxic species. Pigment cells have tuned their endosomes to maximize the formation of functional amyloid from the protein PMEL. Here, we show that ApoE is associated with intraluminal vesicles (ILV) within endosomes and remain associated with ILVs when they are secreted as exosomes. ApoE functions in the ESCRT-independent sorting mechanism of PMEL onto ILVs and regulates the endosomal formation of PMEL amyloid fibrils in vitro and in vivo. This process secures the physiological formation of amyloid fibrils by exploiting ILVs as amyloid nucleating platforms