Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

Mutation of a single residue in the ba 3 oxidase specifically impairs protonation of the pump site

The ba3-type cytochrome c oxidase from Thermus thermophilus is a membrane-bound protein complex that couples electron transfer to O2 to proton translocation across the membrane. To elucidate the mechanism of the redox-driven proton pumping, we investigated the kinetics of electron and proton transfer in a structural variant of the ba3 oxidase where a putative "pump site" was modified by replacement of Asp372 by Ile. In this structural variant, proton pumping was uncoupled from internal electron transfer and O2 reduction. The results from our studies show that proton uptake to the pump site (time constant ∼65 μs in the wild-type cytochrome c oxidase) was impaired in the Asp372Ile variant. Furthermore, a reaction step that in the wild-type cytochrome c oxidase is linked to simultaneous proton uptake and release with a time constant of ∼1.2 ms was slowed to ∼8.4 ms, and in Asp372Ile was only associated with proton uptake to the catalytic site. These data identify reaction steps that are associated with protonation and deprotonation of the pump site, and point to the area around Asp372 as the location of this site in the ba3 cytochrome c oxidase.

Climate sensitivity of Mediterranean pine growth reveals distinct east-west dipole

The European Mediterranean region is governed by a characteristic climate of summer drought that is likely to increase in duration and intensity under predicted climate change. However, large-scale network analyses investigating spatial aspects of pre-instrumental drought variability for this biogeographic zone are still scarce. In this study we introduce 54 mid- to high-elevation tree-ring width (TRW) chronologies comprising 2186 individual series from pine trees (Pinus spp.). This compilation spans a 4000-km east–west transect from Spain to Turkey, and was subjected to quality control and standardization prior to the development of site chronologies. A principal component analysis (PCA) was applied to identify spatial growth patterns during the network's common period 1862–1976, and new composite TRW chronologies were developed and investigated. The PCA reveals a common variance of 19.7% over the 54 Mediterranean pine chronologies. More interestingly, a dipole pattern in growth variability is found between the western (15% explained variance) and eastern (9.6%) sites, persisting back to 1330 AD. Pine growth on the Iberian Peninsula and Italy favours warm early growing seasons, but summer drought is most critical for ring width formation in the eastern Mediterranean region. Synoptic climate dynamics that have been in operation for the last seven centuries have been identified as the driving mechanism of a distinct east–west dipole in the growth variability of Mediterranean pines.

Integration of a World Heritage Site in an agricultural environment in the Simen Mountains (Ethiopia)

The conflict between nature-orientated conservation and man-orientated rural development is examined, along with the degree to which ecological research contributes to mountain development, and whether conservation areas can be protected from being areas of natural resources ultimately to be used by man in life-threatening need. A high mountain national park in Ethiopia is taken as an example within UNESCO's concept of Biosphere Reserves. The main finding is that conservation without development will fail, and therefore the focus is more on the area surrounding a national park than on the park itself. A buffer zone must be developed as an economically stable and socially secure area for man, so that his needs do not drive him to exploit the last natural resource area in his vicinity. Simen is a World Heritage Site for future generations. Man and nature, development and conservation, belong together in this unique mountain area.

“Crye Fredome”? Medievalism and Twenty-First-Century Scottish National Identity

It is a well-documented fact that the Middle Ages have had a long history of instrumentalisation by nationalisms. 19th-century Eu¬rope in particular witnessed an origins craze during the process of nation-building. In the post-Shoah, post-modern West, on the other hand, we might expect this kind of medievalist master nar¬rative to have been consigned to the dustbin of history. And yet, as nationalism surges again in Europe, negotiations of national identi¬ties in medieval dress seem to have become fashionable once more. In order to come to terms with the fragmented and often contradictory presence of the Middle Ages in these discourses of national identity, I propose we consider medievalism a utilitarian product of the cultural memory. Rather than representing any ‘real’ Middle Ages, then, medievalism tailors available knowledge of the medieval past to the diverse social needs and ideologies of the present. This paper looks at a selection of Scottish examples of present-day medievalism in an attempt to investigate, in particular, the place of the medieval Wars of Scottish Independence in contemporary negotiations of ‘Scottishness’. Both the relationships envisioned between self and other and the role played by ‘the land’ in these cultural, social and political instances of national introspection offer starting points for critical inquiry. Moreover, the analysis of a scholarly intervention in the run-up to the 2014 Scottish independence referendum indicates an intriguing dialogue of academic and non-academic voices in the context of Scottish medievalist cultural memory. We thus find a wide array of uses of the Scottish Middle Ages, some of which feed into the burgeoning nationalism of recent years, while others offer more pensive and ambivalent answers to the question of what it means to be Scottish in the 21st century.

Room for Experiment: The Countess of Arundel’s "Site of Medication"

The so-called Dutch Pranketing Room of Alethea Talbot, Countess of Arundel, at Tart Hall was a site of domestic experiments, courtly splendour and global ambition. Lady Arundel, the probable author of a famous recipe book, would have used Tart Hall for cooking and experiments as well as for impressive dinner parties, and she would have used large amounts of sugar to create intricate imitations of meat and vegetables to astonish, entertain and delight her guests. Linking household practice with global trade as well as artistic creation, Lady Arundel’s banquets are situated not only between a national tradition of cooking, as it appears in Markham’s manuals, and the new possibilities the arising global trade provided, but also played with a mismatch between taste and sight. This mediating role could be compared to that played by the artists the Countess employed. Within this context it is worth noting that a series of paintings displayed in the building’s gallery showed still lifes, markets, and a cook. The inventory of Tart Hall gives an insight into the world of the widely travelled collector and patron of Van Dyck and Rubens, but raises also a number of questions. In my talk I would like to explore the Countess’ Pranketing Room as a site of mediation between alimentary and painterly experiments, considering the use of recipes, experience, invention and transformation

Geomorphology and spectrophotometry of Philae's landing site on comet 67P/Churyumov-Gerasimenko

Context. On 12 November 2014 the European mission Rosetta succeeded in delivering a lander, named Philae, on the surface of one of the smallest, low-gravity and most primitive bodies of the solar system, the comet 67P/Churyumov-Gerasimenko (67P). Aims. The aim of this paper is to provide a comprehensive geomorphological and spectrophotometric analysis of Philae's landing site (Agilkia) to give an essential framework for the interpretation of its in situ measurements. Methods. OSIRIS images, coupled with gravitational slopes derived from the 3D shape model based on stereo-photogrammetry were used to interpret the geomorphology of the site. We adopted the Hapke model, using previously derived parameters, to photometrically correct the images in orange filter (649.2 nm). The best approximation to the Hapke model, given by the Akimov parameter-less function, was used to correct the reflectance for the effects of viewing and illumination conditions in the other filters. Spectral analyses on coregistered color cubes were used to retrieve spectrophotometric properties. Results. The landing site shows an average normal albedo of 6.7% in the orange filter with variations of similar to 15% and a global featureless spectrum with an average red spectral slope of 15.2%/100 nm between 480.7 nm (blue filter) and 882.1 nm (near-IR filter). The spatial analysis shows a well-established correlation between the geomorphological units and the photometric characteristics of the surface. In particular, smooth deposits have the highest reflectance a bluer spectrum than the outcropping material across the area. Conclusions. The featureless spectrum and the redness of the material are compatible with the results by other instruments that have suggested an organic composition. The observed small spectral variegation could be due to grain size effects. However, the combination of photometric and spectral variegation suggests that a compositional differentiation is more likely. This might be tentatively interpreted as the effect of the efficient dust-transport processes acting on 67P. High-activity regions might be the original sources for smooth fine-grained materials that then covered Agilkia as a consequence of airfall of residual material. More observations performed by OSIRIS as the comet approaches the Sun would help interpreting the processes that work at shaping the landing site and the overall nucleus.