Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning

Late diagnosis of HIV remains a major challenge in the HIV epidemic. In Europe, about 50% of all people living with HIV are diagnosed late after infection has occurred. Insight into the reasons for late diagnoses is necessary to increase the number of early diagnoses and optimize treatment options. This qualitative study explored the experiences of 34 late-presenters through in-depth semi-structured interviews. A variety of reasons for late diagnoses emerged from our data and led to a division into four groups, characterized by two dimensions. Regarding vocational functioning, the consequences of late diagnoses were health-related problems prior to and since diagnosis, and problems concealing the HIV status. Healthcare providers should offer HIV tests to groups at risk, and be alert for clinical HIV indicator conditions. It is recommended to increase awareness of HIV transmission routes, symptoms and tests, and the benefits of early testing and early entry to HIV care

GMD perspective: The quest to improve the evaluation of groundwater representation in continental- to global-scale models

Continental- to global-scale hydrologic and land surface models increasingly include representations of the groundwater system. Such large-scale models are essential for examining, communicating, and understanding the dynamic interactions between the Earth system above and below the land surface as well as the opportunities and limits of groundwater resources. We argue that both large-scale and regional-scale groundwater models have utility, strengths, and limitations, so continued modeling at both scales is essential and mutually beneficial. A crucial quest is how to evaluate the realism, capabilities, and performance of large-scale groundwater models given their modeling purpose of addressing large-scale science or sustainability questions as well as limitations in data availability and commensurability. Evaluation should identify if, when, or where large-scale models achieve their purpose or where opportunities for improvements exist so that such models better achieve their purpose. We suggest that reproducing the spatiotemporal details of regional-scale models and matching local data are not relevant goals. Instead, it is important to decide on reasonable model expectations regarding when a large-scale model is performing “well enough” in the context of its specific purpose. The decision of reasonable expectations is necessarily subjective even if the evaluation criteria are quantitative. Our objective is to provide recommendations for improving the evaluation of groundwater representation in continental- to global-scale models. We describe current modeling strategies and evaluation practices, and we subsequently discuss the value of three evaluation strategies: (1) comparing model outputs with available observations of groundwater levels or other state or flux variables (observation-based evaluation), (2) comparing several models with each other with or without reference to actual observations (model-based evaluation), and (3) comparing model behavior with expert expectations of hydrologic behaviors in particular regions or at particular times (expert-based evaluation). Based on evolving practices in model evaluation as well as innovations in observations, machine learning, and expert elicitation, we argue that combining observation-, model-, and expert-based model evaluation approaches, while accounting for commensurability issues, may significantly improve the realism of groundwater representation in large-scale models, thus advancing our ability for quantification, understanding, and prediction of crucial Earth science and sustainability problems. We encourage greater community-level communication and cooperation on this quest, including among global hydrology and land surface modelers, local to regional hydrogeologists, and hydrologists focused on model development and evaluation

Acute epiglottitis in childhood: Report of an increased incidence in Victoria

The incidence of acute epiglottitis treated in Melbourne, Australia at the Royal Children's Hospital (RCH) has increased from an average of 14 cases per year during 1975-79 to 49 cases per year during 1980-81. Less marked increases have occurred for H. influenzae meningitis and bacteremia and H. influenzae (untyped) isolation from respiratory tract cultures. A review of 171 cases of acute epiglottitis showed no significant differences between the 1975-79 and 1980-81 patients with respect to sex, age, seasonal incidence, prodromal length, prodromal symptoms geographical location, polymorphonuclear cell count, or disease severity. Patients treated in 1980-81 had fewer complications (12% versus 22%,

Apparent Triclabendazole-Resistant Human Fasciola hepatica Infection, the Netherlands

TO THE EDITOR: In December 2007, a 71-year-old sheep farmer sought care with a 4-month history of intermittent right upper quadrant pain, night sweats, anorexia, and a 5-kg weight loss. His medical history was unremarkable, and he had not traveled outside the Netherlands for ≈30 years. Physical examination revealed no abnormalitie