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In October 2009 the French National Authority for Health recommended that HIV testing be proposed at least once to all persons aged 15 to 70 years in all healthcare settings. We examined whether routine HIV screening with a rapid test in emergency departments (EDs) was feasible without dedicated staff, and whether newly diagnosed persons could be linked to care. This one-year study started in December 2009 in 6 EDs in the Paris area, using the INSTI™ test. Eligible individuals were persons 18 to 70 years old who did not present for a vital emergency, for blood or sexual HIV exposure, or for HIV screening. Written informed consent was required. Among 183 957 eligible persons, 11 401 were offered HIV testing (6.2%), of whom 7936 accepted (69.6%) and 7215 (90.9%) were tested (overall screening rate 3.9%); 1857 non eligible persons were also tested. Fifty-five new diagnoses of HIV infection were confirmed by Western blot (0.61% (95% CI 0.46-0.79). There was one false-positive rapid test result. Among the newly diagnosed persons, 48 (87%) were linked to care, of whom 36 were not lost to follow-up at month 6 (75%); median CD4 cell count was 241/mm(3) (IQR: 52-423/mm(3)). Screening rates were similar to those reported in opt-in studies with no dedicated staff. The rate of new diagnoses was similar to that observed in free anonymous test centres in the Paris area, and well above the prevalence (0.1%) at which testing has been shown to be cost-effective.

World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource?limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic?based cohort across four African countries. The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ?2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm[sup.3] (IQR: 81 to 286) to 298 cells/mm[sup.3] (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ?500 cells/mm[sup.3] was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm[sup.3] (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.

Both gaming and group (decision) support systems (GDSS) are frequently used to support decision-making and policymaking in multi-actor settings. Despite the fact that there are a number of ways in which gaming and GDSS can be used in a complementary manner, there are only sporadic examples of their combined use. No systematic overview or framework exists in which GDSS are related to the functions of gaming or vice versa. In this article, we examine, why, how and for what purpose GDSS can be used to enrich and improve gaming simulation for decision support, and vice versa. In addition to a review of examples found in the literature, four games are discussed where we combined gaming and GDSS for complex decision making in a multi actor context: incodelta, a game about transportation corridors; infrastratego, a game about a liberalizing electricity market; containers a drift, a game about the planning of a container terminal, and; dubes, a game about sustainable urban renewal. Based on the literature and these four experiences, a classification is presented of (at least) four ways in which GDSS and gaming can be used in a complementary or even mutually corrective, manner: the use of GDSS for game design, for game evaluation, for game operation and the use of gaming for research, testing and training of GDSS. [PUBLICATION ABSTRACT]

Peroxisome proliferator-activated receptors (PPARs) are nuclear hormone receptors that are activated by a number of fatty acids and fatty acid derivatives. By contrast, we have recently shown that acyl-CoA esters display PPAR antagonistic properties in vitro. We have also shown that the adipocyte lipid binding protein (ALBP), the keratinocyte lipid binding protein (KLBP) and the acyl-CoA binding protein (ACBP) exhibit a prominent nuclear localization in differentiating 3T3-L1 adipocytes. Similarly, ectopic expression of these proteins in CV-1 cells resulted in a primarily nuclear localization. We therefore speculated that FABPs and ACBP might regulate the availability of PPAR agonists and antagonists by affecting not only their esterification in the cytoplasm but also their transport to and availability in the nucleus. We show here that coexpression of ALBP or ACBP exerts a negative effect on ligand-dependent PPAR transactivation, when tetradecylthioacetic (TTA) is used as ligand but not when the thiazolidinedione BRL49653 is used as ligand. The results presented here do not support the hypothesis that ALBP facilitates the transport of the fatty acid-type ligands to the nucleus, rather ALBP appears to sequester or increase the turn-over of the agonist. Similarly, our results are in keeping with a model in which ACBP increase the metabolism of these ligands.

Transport characteristics of certain inorganic elements such as copper, magnesium, selenium and iron have been studied in maternal-fetal direction in normal pregnancies, using in vitro perfusion of isolated placental lobules. Copper, selenium, magnesium and iron salts corresponding to twice physiological concentrations were injected as a 100 microl bolus, into the maternal arterial perfusate. Serial perfusate samples were collected from venous outflows for a study period of 5 min. Concentrations of various inorganic elements and their transport kinetics were determined. Transport fractions of copper, selenium, magnesium and iron averaged 0.14, 0.19, 0.06 and 0.23% of maternal load respectively. The pharmacokinetic parameters such as area under the curve, clearance, elimination constant, and time for maximum response showed some significant differences between the various elements. We speculate that copper and selenium share the same transport pathway along a concentration gradient in maternal-fetal direction, while for iron and magnesium, active transport plays a predominant role for element transfer across the human placental membrane.

The observations reported in this article demonstrate that lipoic acid strongly influences the activity of a purified preparation of choline acetyl transferase. The reduced form, dihydrolipoic acid, is a powerful activator of the enzyme while lipoic acid itself has an inhibitory effect and counteracts the stimulatory effect of dihydrolipoic acid. It is proposed that dihydrolipoic acid serves an essential function in the action of this enzyme and that the ratio of reduced to oxidized lipoic acid in the cell may play an important role in the regulation of the activity of the enzyme. The implications of these findings for cell function and acetyl choline formation are discussed.