HIV testing within general practices in Europe : A mixed-methods systematic review

Funding Information: This work was supported by IWT (Belgium) and the ANRS (France) through the framework of HIVERA JTC 2014. Publisher Copyright: © 2018 The Author(s).Background: Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. Methods: The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. Results: The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. Conclusions: GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.publishersversionPeer reviewe

Electrochemical Li-Ion Battery Modelisation for Electric Vehicles

International audienceThe future development of electric vehicles is now strictly linked with their batteries. In parallel of the actual research focused on the development of new materials and increase their performances in terms of energy, power, cost, durability and weight, it is necessary to develop modeling tools. The simulations are helpful for improving the knowledge of both physical and chemical phenomena, optimize the battery design according with the user requirements, and reduce the test/validation phase. In this framework, this articles, contributes to the development on an electrochemical based model for Li-ion batteries [1], using the powerful COMSOL Multiphysics® software, allowing to use custom equation systems. The partial differential equations are resolved coupling a 1D geometry, describing the cell cross section, with a 2D geometry describing the active material particles using the "coefficient form PDE"[2]. This work revisits one of the most used porous electrodes based model to describe the behavior of lithium-ion batteries. Firstly, all the physical quantities are set in a dimensionless form, as commonly used in fluid mechanics: the parameters that act in the same or the opposite ways are regrouped and the total number of simulation parameter is thus reduced. Then the numerical explorations with the limit conditions, allow to understand the effect of each dimensionless parameter, in the overall equation system. The Figure 1 shows the effect of the solid phase diffusion over the practical retained capacity for a galvanostatic discharge, while in Figure 2 shows the voltage drop and relaxation for pulses. The simulations are finally compared with half-cell obtained from commercial 18650 Lithium ion cells for EV. The mid-term perspectives includes the simulation of ageing and temperature [3]

Electrochemical Li-Ion Battery Modelisation for Electric Vehicles

International audienceThe future development of electric vehicles is now strictly linked with their batteries. In parallel of the actual research focused on the development of new materials and increase their performances in terms of energy, power, cost, durability and weight, it is necessary to develop modeling tools. The simulations are helpful for improving the knowledge of both physical and chemical phenomena, optimize the battery design according with the user requirements, and reduce the test/validation phase. In this framework, this articles, contributes to the development on an electrochemical based model for Li-ion batteries [1], using the powerful COMSOL Multiphysics® software, allowing to use custom equation systems. The partial differential equations are resolved coupling a 1D geometry, describing the cell cross section, with a 2D geometry describing the active material particles using the "coefficient form PDE"[2]. This work revisits one of the most used porous electrodes based model to describe the behavior of lithium-ion batteries. Firstly, all the physical quantities are set in a dimensionless form, as commonly used in fluid mechanics: the parameters that act in the same or the opposite ways are regrouped and the total number of simulation parameter is thus reduced. Then the numerical explorations with the limit conditions, allow to understand the effect of each dimensionless parameter, in the overall equation system. The Figure 1 shows the effect of the solid phase diffusion over the practical retained capacity for a galvanostatic discharge, while in Figure 2 shows the voltage drop and relaxation for pulses. The simulations are finally compared with half-cell obtained from commercial 18650 Lithium ion cells for EV. The mid-term perspectives includes the simulation of ageing and temperature [3]

The Assessment and Clinical Utility of the Respiratory Arousal Threshold in Obstructive Sleep-Disordered Breathing

Purpose of Review The purpose of this review is to examine the pathogenesis of obstructive sleep apnea with emphasis on the respiratory arousal threshold, as its estimation and modification through medical interventions is a purported target to treat obstructive sleep apnea. Recent Findings Low respiratory arousal threshold endotype OSA can be readily identified by routine PSG, and is common among Caucasians, Australians, patients with BMI < 30 kg/m 2 , increasing age, those taking antidepressants, and up to 55% of patients with posttraumatic stress disorder. This trait may be predictive of low adherence to positive airway pressure therapy. Intervention aiming to increase low respiratory arousal threshold intervention may enhance positive airway pressure treatment adherence. Furthermore, in obstructive sleep apnea mediated primarily or solely by low respiratory arousal threshold, its manipulation with pharmaceuticals offers opportunity for precision intervention. Summary A significant number of obstructive sleep apnea patients have abnormally low respiratory arousal threshold as a primary pathogenic driver of upper airway instability during sleep. Increasing the respiratory arousal threshold may reduce apnea–hypopnea index in such patients. Furthermore, lowering of abnormally elevated respiratory arousal threshold in obstructive sleep apnea patients can reduce apnea–hypopnea index. Therefore, perturbation of the respiratory arousal threshold might serve as primary therapy in some and adjuvant therapy in others with obstructive sleep apnea. However, further studies are necessary to determine if pharmaceutically targeting the respiratory arousal threshold in obstructive sleep apnea improves symptoms and health outcomes

A case of SARS-CoV-2 reinfection in a patient with obstructive sleep apnea managed with telemedicine

The novel coronavirus (SARS-CoV-2) has produced millions of infections and deaths worldwide. It is believed that adaptive immunity to the virus occurs although with variation in its pattern and duration. While uncommon, confirmed reinfection with the novel coronavirus has been reported. Telemedicine has emerged as a viable tool for the delivery of healthcare in lieu of in-person patient contact. The variable and occasionally rapid course of clinical disease raises safety concerns of using telemedicine in the clinical management of acute infection with the novel coronavirus. We present a case of novel coronavirus infection in an immunocompetent individual with obstructive sleep apnea (OSA) who failed to manifest an adaptive immune response to acute infection and was subsequently reinfected. The case highlights the use of telemedicine in managing novel coronavirus respiratory disease and the potential role of OSA as a disease facilitator

Financial versus Monetary Mercantilism-Long-run View of Large International Reserves Hoarding

The sizable hoarding of international reserves by several East Asian countries has been frequently attributed to a modern version of monetary mercantilism – hoarding international reserves in order to improve competitiveness. From a long-run perspective, manufacturing exporters in East Asia adopted financial mercantilism—subsidizing the cost of capital— during decades of high growth. They switched to hoarding large international reserves when growth faltered, making it harder to disentangle the monetary mercantilism from precautionary response to the heritage of past financial mercantilism. Monetary mercantilism also lowers the cost of hoarding, but may be associated with negative externalities leading to competitive hoarding