Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe

OBJECTIVES The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.

Efficiency of frost-cracking processes through space and time: An example from the eastern Italian Alps

It is widely accepted that climate has a strong impact and exerts important feedbacks on erosional processes and sediment transport mechanisms. However, the extent at which climate influences erosion is still a matter of debate. In this paper we test whether frost-cracking processes and related temperature variations can influence the sediment production and surface erosion in a small catchment situated in the eastern Italian Alps. To this extent, we first present a geomorphic map of the region that we complement with published 10Be-based denudation rates. We then apply a preexisting heat-flow model in order to analyze the variations of the frost-cracking intensity (FCI) in the study area, which could have controlled the sediment production in the basin. Finally, we compare the model results with the pattern of denudation rates and Quaternary deposits in the geomorphic map. The model results, combined with field observations, mapping, and quantitative geomorphic analyses, reveal that frost-cracking processes have had a primary role in the production of sediment where the intensity of sediment supply has been dictated and limited by the combined effect of temperature variations and conditions of bedrock preservation. These results highlight the importance of a yet poorly understood process for the production of sediment in mountain areas.

Registration And Visualisation Of Deformation Maps From Terrestrial Radar Interferometry Using Photogrammetry And Structure From Motion

This paper describes a general workflow for the registration of terrestrial radar interferometric data with 3D point clouds derived from terrestrial photogrammetry and structure from motion. After the determination of intrinsic and extrinsic orientation parameters, data obtained by terrestrial radar interferometry were projected on point clouds and then on the initial photographs. Visualisation of slope deformation measurements on photographs provides an easily understandable and distributable information product, especially of inaccessible target areas such as steep rock walls or in rockfall run-out zones. The suitability and error propagation of the referencing steps and final visualisation of four approaches are compared: (a) the classic approach using a metric camera and stereo-image photogrammetry; (b) images acquired with a metric camera, automatically processed using structure from motion; (c) images acquired with a digital compact camera, processed with structure from motion; and (d) a markerless approach, using images acquired with a digital compact camera using structure from motion without artificial ground control points. The usability of the completely markerless approach for the visualisation of high-resolution radar interferometry assists the production of visualisation products for interpretation.

Impact of a Reduced Arctic Sea Ice Cover on Ocean and Atmospheric Properties

The Arctic sea ice cover declined over the last few decades and reached a record minimum in 2007, with a slight recovery thereafter. Inspired by this the authors investigate the response of atmospheric and oceanic properties to a 1-yr period of reduced sea ice cover. Two ensembles of equilibrium and transient simulations are produced with the Community Climate System Model. A sea ice change is induced through an albedo change of 1 yr. The sea ice area and thickness recover in both ensembles after 3 and 5 yr, respectively. The sea ice anomaly leads to changes in ocean temperature and salinity to a depth of about 200 m in the Arctic Basin. Further, the salinity and temperature changes in the surface layer trigger a “Great Salinity Anomaly” in the North Atlantic that takes roughly 8 yr to travel across the North Atlantic back to high latitudes. In the atmosphere the changes induced by the sea ice anomaly do not last as long as in the ocean. The response in the transient and equilibrium simulations, while similar overall, differs in specific regional and temporal details. The surface air temperature increases over the Arctic Basin and the anomaly extends through the whole atmospheric column, changing the geopotential height fields and thus the storm tracks. The patterns of warming and thus the position of the geopotential height changes vary in the two ensembles. While the equilibrium simulation shifts the storm tracks to the south over the eastern North Atlantic and Europe, the transient simulation shifts the storm tracks south over the western North Atlantic and North America. The authors propose that the overall reduction in sea ice cover is important for producing ocean anomalies; however, for atmospheric anomalies the regional location of the sea ice anomalies is more important. While observed trends in Arctic sea ice are large and exceed those simulated by comprehensive climate models, there is little evidence based on this particular model that the seasonal loss of sea ice (e.g., as occurred in 2007) would constitute a threshold after which the Arctic would exhibit nonlinear, irreversible, or strongly accelerated sea ice loss. Caution should be exerted when extrapolating short-term trends to future sea ice behavior.

Hazard index maps for woody material recruitment and transport in alpine catchments

A robust and reliable risk assessment procedure for hydrologic hazards deserves particular attention to the role of transported woody material during flash floods or debris flows. At present, woody material transport phenomena are not systematically considered within the procedures for the elaboration of hazard maps. The consequence is a risk of losing prediction accuracy and of underestimating hazard impacts. Transported woody material frequently interferes with the sediment regulation capacity of open check dams and moreover, when obstruction phenomena at critical crosssections of the stream occur, inundations can be triggered. The paper presents a procedure for the determination of the relative propensity of mountain streams to the entrainment and delivery of recruited woody material on the basis of empirical indicators. The procedure provided the basis for the elaboration of a hazard index map for all torrent catchments of the Autonomous Province of Bolzano/Bozen. The plausibility of the results has been thoroughly checked by a backward oriented analysis on natural hazard events, documented since 1998 at the Department of Hydraulic Engineering of the aforementioned Alpine Province. The procedure provides hints for the consideration of the effects, induced by woody material transport, during the elaboration of hazard zone maps.

Climatology of Vb cyclones, physical mechanisms and their impact on extreme precipitation over Central Europe

Cyclones, which develop over the western Mediterranean and move northeastward are a major source of extreme weather and known to be responsible for heavy precipitation over the northern side of the Alpine range and Central Europe. As the relevant processes triggering these so-called Vb events and their impact on extreme precipitation are not yet fully understood, this study focuses on gaining insight into the dynamics of past events. For this, a cyclone detection and tracking tool is applied to the ERA-Interim reanalysis (1979–2013) to identify prominent Vb situations. Precipitation in the ERA-Interim and the E-OBS data sets is used to evaluate case-to-case precipitation amounts and to assess consistency between the two data sets. Both data sets exhibit high variability in precipitation amounts among different Vb events. While only 23 % of all Vb events are associated with extreme precipitation, around 15 % of all extreme precipitation days (99 percentile) over the northern Alpine region and Central Europe are induced by Vb events, although Vb cyclones are rare events (2.3 per year). To obtain a better understanding of the variability within Vb events, the analysis of the 10 heaviest and lowest precipitation Vb events reveals noticeable differences in the state of the atmosphere. These differences are most pronounced in the geopotential height and potential vorticity field, indicating a much stronger cyclone for heavy precipitation events. The related differences in wind direction are responsible for the moisture transport around the Alps and the orographical lifting along the northern slopes of the Alps. These effects are the main reasons for a disastrous outcome of Vb events, and consequently are absent in the Vb events associated with low precipitation. Hence, our results point out that heavy precipitation related to Vb events is mainly related to large-scale dynamics rather than to thermodynamic processes.

A regional climate palaeosimulation for Europe in the period 1500–1990 – Part 2: Shortcomings and strengths of models and reconstructions

This study compares gridded European seasonal series of surface air temperature (SAT) and precipitation (PRE) reconstructions with a regional climate simulation over the period 1500–1990. The area is analysed separately for nine subareas that represent the majority of the climate diversity in the European sector. In their spatial structure, an overall good agreement is found between the reconstructed and simulated climate features across Europe, supporting consistency in both products. Systematic biases between both data sets can be explained by a priori known deficiencies in the simulation. Simulations and reconstructions, however, largely differ in the temporal evolution of past climate for European subregions. In particular, the simulated anomalies during the Maunder and Dalton minima show stronger response to changes in the external forcings than recorded in the reconstructions. Although this disagreement is to some extent expected given the prominent role of internal variability in the evolution of regional temperature and precipitation, a certain degree of agreement is a priori expected in variables directly affected by external forcings. In this sense, the inability of the model to reproduce a warm period similar to that recorded for the winters during the first decades of the 18th century in the reconstructions is indicative of fundamental limitations in the simulation that preclude reproducing exceptionally anomalous conditions. Despite these limitations, the simulated climate is a physically consistent data set, which can be used as a benchmark to analyse the consistency and limitations of gridded reconstructions of different variables. A comparison of the leading modes of SAT and PRE variability indicates that reconstructions are too simplistic, especially for precipitation, which is associated with the linear statistical techniques used to generate the reconstructions. The analysis of the co-variability between sea level pressure (SLP) and SAT and PRE in the simulation yields a result which resembles the canonical co-variability recorded in the observations for the 20th century. However, the same analysis for reconstructions exhibits anomalously low correlations, which points towards a lack of dynamical consistency between independent reconstructions.

Eastern Equatoria

The present map sheet is composed of four field maps (1:250'000) and is one of five maps in the overview series (1:500'000). The maps and the geodatabase werde prepared by the Centre for Development and Environment of the Univeristy of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Eastern Equatoria State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

A novel approach for assessing shifting cultivation dynamics in a regional conservation hotspot - insights from nort-eastern Madagascar

The north-eastern escarpment of Madagascar has been deemed a global hotspot of biodiversity due to its high levels of endemic speciesbeing heavily threatened by accelerated deforestation rates and landscape changes. The main concern for conservation of the remaining humid primary forests is the shifting cultivation practices of local smallholder farmers for rice production. According to the mainstream narrative, human population growth leads to a shortening of crop-fallow cycles and thus to the accelerated conversion of forests to agricultural land. However, little is currently known about the dynamic changes between forest and shifting cultivation systems at the regional level. Existing land cover change analyses in this area have so far only focused on binary forest to non-forest changes and have therefore failed to account for the dynamic nature of the change processes between forest and different agriculture land use systems. This can be partly explained by the significant challenge to delineate shifting cultivation systems on land cover maps using traditional remote sensing classification approaches. To address this gap we therefore applied a novel GIS approach, that was originally developed for the assessment of shifting cultivation dynamics in Laos and has so far never been applied elsewhere, to map shifting cultivation of different crop-fallow lengths as well as permanent agriculture land use at the regional level. Change analyses of land use maps between 1995 and 2011 allowed us to comprehend the general trends of land use trajectories and their spatial variation. This more detailed understanding of land use change dynamics is key to plan for successful interventions to slow forest loss while at the same time improving local livelihoods. We further believe that this approach holds great potential for conservation monitoring in this resource-rich but povertyprone conservation hotspot.

Millennial to orbital-scale variations of drought intensity in the Eastern Mediterranean

Millennial to orbital-scale rainfall changes in the Mediterranean region and corresponding variations in vegetation patterns were the result of large-scale atmospheric reorganizations. In spite of recent efforts to reconstruct this variability using a range of proxy archives, the underlying physical mechanisms have remained elusive. Through the analysis of a new high-resolution sedimentary section from Lake Van (Turkey) along with climate modeling experiments, we identify massive droughts in the Eastern Med- iterranean for the past four glacial cycles, which have a pervasive link with known intervals of enhanced North Atlantic glacial iceberg calving, weaker Atlantic Meridional Overturning Circulation and Dansgaard-Oeschger cold conditions. On orbital timescales, the topographic effect of large Northern Hemisphere ice sheets and periods with minimum insolation seasonality further exacerbated drought intensities by suppressing both summer and winter precipitation.

Distributed transpressive continental deformation: The Varto Fault Zone, eastern Turkey

The convergence between the Eurasian and Arabian plates has created a complicated structural setting in the Eastern Turkish high plateau (ETHP), particularly around the Karlıova Triple Junction (KTJ) where the Eurasian, Arabian, and Anatolian plates intersect. This region of interest includes the junction of the North Anatolian Shear Zone (NASZ) and the East Anatolian Shear Zone (EASZ), which forms the northern border of the westwardly extruding Anatolian Scholle and the western boundary of the ETHP, respectively. In this study, we focused on a poorly studied component of the KTJ, the Varto Fault Zone (VFZ), and the adjacent secondary structures, which have complex structural settings. Through integrated analyses of remote sensing and field observations, we identified a widely distributed transpressional zone where the Varto segment of the VFZ forms the most northern boundary. The other segments, namely, the Leylekdağ and Çayçatı segments, are oblique-reverse faults that are significantly defined by uplifted topography along their strikes. The measured 515 and 265 m of cumulative uplifts for Mt. Leylek and Mt. Dodan, respectively, yield a minimum uplift rate of 0.35 mm/a for the last 2.2 Ma. The multi-oriented secondary structures were mostly correlated with “the distributed strike-slip” and “the distributed transpressional” in analogue experiments. The misfits in strike of some of secondary faults between our observations and the experimental results were justified by about 20° to 25° clockwise restoration of all relevant structures that were palaeomagnetically measured to have happened since ~ 2.8 Ma ago. Our detected fault patterns and their true nature are well aligned as being part of a transpressional tectonic setting that supports previously suggested stationary triple junction models.