Mortality from HIV and TB coinfections is higher in Eastern Europe than in Western Europe and Argentina

BACKGROUND AND OBJECTIVES: Tuberculosis (TB) is a leading cause of death in HIV-infected patients worldwide. We aimed to study clinical characteristics and outcome of 1075 consecutive patients diagnosed with HIV/TB from 2004 to 2006 in Europe and Argentina. METHODS: One-year mortality was assessed in patients stratified according to region of residence, and factors associated with death were evaluated in multivariable Cox models. RESULTS: At TB diagnosis, patients in Eastern Europe had less advanced immunodeficiency, whereas a greater proportion had a history of intravenous drug use, coinfection with hepatitis C, disseminated TB, and infection with drug-resistant TB (P < 0.0001). In Eastern Europe, fewer patients initiated TB treatment containing at least rifamycin, isoniazid, and pyrazinamide or combination antiretroviral therapy (P < 0.0001). Mortality at 1 year was 27% in Eastern Europe, compared with 7, 9 and 11% in Central/Northern Europe, Southern Europe, and Argentina, respectively (P < 0.0001). In a multivariable model, the adjusted relative hazard of death was significantly lower in each of the other regions compared with Eastern Europe: 0.34 (95% confidence interval 0.17-0.65), 0.28 (0.14-0.57), 0.34 (0.15-0.77) in Argentina, Southern Europe and Central/Northern Europe, respectively. Factors significantly associated with increased mortality were CD4 cell count less than 200 cells/microl [2.31 (1.56-3.45)], prior AIDS [1.74 (1.22-2.47)], disseminated TB [2.00 (1.38-2.85)], initiation of TB treatment not including rifamycin, isoniazid and pyrazinamide [1.68 (1.20-2.36)], and rifamycin resistance [2.10 (1.29-3.41)]. Adjusting for these known confounders did not explain the increased mortality seen in Eastern Europe. CONCLUSION: The poor outcome of patients with HIV/TB in Eastern Europe deserves further study and urgent public health attention.

A perfect ‘treatment-society’?

The Danish Minister of Social Affairs is a very eager protagonist of quality in treatment, almost searching for the “perfect“ treatment for children, youngsters, disabled, etc. Many expensive research projects dealing with quality management as well as developmental projects have been launched during the latest years in order to improve professional practice. Within that context this article will deal with the relations between paternalism and ignorance and between pro-social behaviour and anti-social treatment in order to grasp “why professions are doing vicious things“. The main focus is concerned with the knowledge field of social pedagogy.

Marginalization of the Youth – a Current Societal Development?

The last two years a discussion on reforming the public sector has emerged. At its very heart we find important concepts like ‘quality reform’, ‘democracy’, and ‘development’. Recently I have presented an example of the ‘quality reform’ in SocMag, and this leads me to prolong that discussion on central themes on welfare state and democracy. Much energy is invested in arguing about management of the public sector: Do we need more competition from private companies? Do we need more control? Are more contracts concerning outcome needed? Can we be sure about the accountability needed from politicians? How much documentation, effectiveness measurement, bureaucracy, and evidence-based policy and practice are we looking for? A number of interesting questions – but strange enough we do not discuss the purpose of ‘keeping a welfare state’. What sort of understanding is lying behind the welfare state, and what kind of democracy are we drawing upon?

Adaptive Rückmeldungen im intelligenten Tutorensystem LARGO

Das intelligente Tutorensystem LARGO für die Rechtswissenschaften soll Jurastudenten helfen, Argumentationsstrategien zu lernen. Im verwendeten Ansatz werden Gerichtsprotokolle als Lernmaterialien verwendet: Studenten annotieren diese und erstellen graphische Repräsentationen des Argumentationsverlaufs. Das System kann dabei zur Reflexion über die von Anwälten vorgebrachten Argumente anregen und Lernende auf mögliche Schwächen in ihrer Analyse des Disputs hinweisen. Zur Erkennung von Schwächen verwendet das System Graphgrammatiken und kollaborative Filtermechanismen. Dieser Artikel stellt dar, wie in LARGO auf Basis der Bestimmung eines „Benutzungskontextes“ die Rückmeldungen im System benutzungsadaptiv gestaltet werden. Weiterhin diskutieren wir auf Basis der Ergebnisse einer kontrollierten Studie mit dem System, welche mit Jurastudierenden an der University of Pittsburgh stattfand, in wie weit der automatisch bestimmte Benutzungskontext zur Vorhersage von Lernerfolgen bei Studenten verwendbar ist.

Efforts and Models of Education for Parents: the Danish Approach

The report examines the relationship between day care institutions, schools and so called “parents unfamiliar to education” as well as the relationship between the institutions. With in Danish public and professional discourse concepts like parents unfamiliar to education are usually referring to environments, parents or families with either no or just very restricted experience of education except for the basic school (folkeskole). The “grand old man” of Danish educational research, Prof. Em. Erik Jørgen Hansen, defines the concept as follows: Parents who are distant from or not familiar with education, are parents without tradition of education and by that fact they are not able to contribute constructively in order to back up their own children during their education. Many teachers and pedagogues are not used to that term; they rather prefer concepts like “socially exposed” or “socially disadvantaged” parents or social classes or strata. The report does not only focus on parents who are not capable to support the school achievements of their children, since a low level of education is usually connected with social disadvantage. Such parents are often not capable of understanding and meeting the demands from side of the school when sending their children to school. They lack the competencies or the necessary competence of action. For the moment being much attention is done from side of the Ministries of Education and Social Affairs (recently renamed Ministry of Welfare) in order to create equal possibilities for all children. Many kinds of expertise (directions, counsels, researchers, etc.) have been more than eager to promote recommendations aiming at achieving the ambitious goal: 2015 95% of all young people should complement a full education (classes 10.-12.). Research results are pointing out the importance of increased participation of parents. In other word the agenda is set for ‘parents’ education’. It seems necessary to underline that Danish welfare policy has been changing rather radical. The classic model was an understanding of welfare as social assurance and/or as social distribution – based on social solidarity. The modern model looks like welfare as social service and/or social investment. This means that citizens are changing role – from user and/or citizen to consumer and/or investor. The Danish state is in correspondence with decisions taken by the government investing in a national future shaped by global competition. The new models of welfare – “service” and “investment” – imply severe changes in hitherto known concepts of family life, relationship between parents and children etc. As an example the investment model points at a new implementation of the relationship between social rights and the rights of freedom. The service model has demonstrated that weakness that the access to qualified services in the field of health or education is becoming more and more dependent of the private purchasing power. The weakness of the investment model is that it represents a sort of “The Winner takes it all” – since a political majority is enabled to make agendas in societal fields former protected by the tripartite power and the rights of freedom of the citizens. The outcome of the Danish development seems to be an establishment of a political governed public service industry which on one side are capable of competing on market conditions and on the other are able being governed by contracts. This represents a new form of close linking of politics, economy and professional work. Attempts of controlling education, pedagogy and thereby the population are not a recent invention. In European history we could easily point at several such experiments. The real news is the linking between political priorities and exercise of public activities by economic incentives. By defining visible goals for the public servants, by introducing measurement of achievements and effects, and by implementing a new wage policy depending on achievements and/or effects a new system of accountability is manufactured. The consequences are already perceptible. The government decides to do some special interventions concerning parents, children or youngsters, the public servants on municipality level are instructed to carry out their services by following a manual, and the parents are no longer protected by privacy. Protection of privacy and minority is no longer a valuable argumentation to prevent further interventions in people’s life (health, food, school, etc.). The citizens are becoming objects of investment, also implying that people are investing in their own health, education, and family. This means that investments in changes of life style and development of competences go hand in hand. The below mentioned programmes are conditioned by this shift.

Simulation von Förderprozessen bei Vibrationsförderanlagen

Die erzielbare Fördergeschwindigkeit bei Vibrationsförderern hängt maßgeblich von der Bewegungsfunktion des Förderorganes ab. Für die gezielte Simulation dieser Anlagen mittels der diskreten Elemente Methode (DEM) ist es notwendig die geometrisch vernetzen Förderorgannachbildungen mit praxisrelevanten Bewegungsfunktionen zu beaufschlagen. Der Artikel beschreibt die Einbindung dieser Bewegungsfunktionen in die quellenoffene DEM-Software LIGGGHTS. Während des Simulationsprozesses wird eine Bewegung vernetzter CAD-Modelle durch trigonometrische Reihen ermöglicht.

Berechnungsmodell zur Beschreibung des dynamischen Verhaltens eines Vibrationsförderers – Erläuterung anhand des Beispiels eines Linearvibrationsförderers

Die Möglichkeit der Berechnung des dynamischen Verhaltens eines Vibrationsförderers hat für die Praxis eine große Bedeutung. Es erleichtert die Optimierung des Förderprozesses sowie des Förderers selbst und dessen Anpassung auf das Einsatzgebiet. Das Grundprinzip des Modellaufbaus ist dabei für alle Vibrationsförderer ähnlich und wird anhand eines Beispiels vorgestellt. Weiterhin werden Möglichkeiten zur Nutzung der gewonnen Kenntnisse aus der Berechnung aufgezeigt. Damit schafft das Berechnungsmodell eine erheblich genauere Charakterisierung der Dynamik des Förderers.

ProFormA: An XML-based exchange format for programming tasks

Unterstützungssysteme für die Programmierausbildung sind weit verbreitet, doch gängige Standards für den Austausch von allgemeinen (Lern-) Inhalten und Tests erfüllen nicht die speziellen Anforderungen von Programmieraufgaben wie z. B. den Umgang mit komplexen Einreichungen aus mehreren Dateien oder die Kombination verschiedener (automatischer) Bewertungsverfahren. Dadurch können Aufgaben nicht zwischen Systemen ausgetauscht werden, was aufgrund des hohen Aufwands für die Entwicklung guter Aufgaben jedoch wünschenswert wäre. In diesem Beitrag wird ein erweiterbares XML-basiertes Format zum Austausch von Programmieraufgaben vorgestellt, das bereits von mehreren Systemen prototypisch genutzt wird. Die Spezifikation des Austauschformats ist online verfügbar [PFMA].

Short- and long-term mortality and causes of death in HIV/tuberculosis patients in Europe

Mortality of HIV/tuberculosis (TB) patients in Eastern Europe is high. Little is known about their causes of death. This study aimed to assess and compare mortality rates and cause of death in HIV/TB patients across Eastern Europe and Western Europe and Argentina (WEA) in an international cohort study. Mortality rates and causes of death were analysed by time from TB diagnosis (<3 months, 3-12 months or >12 months) in 1078 consecutive HIV/TB patients. Factors associated with TB-related death were examined in multivariate Poisson regression analysis. 347 patients died during 2625 person-years of follow-up. Mortality in Eastern Europe was three- to ninefold higher than in WEA. TB was the main cause of death in Eastern Europe in 80%, 66% and 61% of patients who died <3 months, 3-12 months or >12 months after TB diagnosis, compared to 50%, 0% and 15% in the same time periods in WEA (p<0.0001). In multivariate analysis, follow-up in WEA (incidence rate ratio (IRR) 0.12, 95% CI 0.04-0.35), standard TB-treatment (IRR 0.45, 95% CI 0.20-0.99) and antiretroviral therapy (IRR 0.32, 95% CI 0.14-0.77) were associated with reduced risk of TB-related death. Persistently higher mortality rates were observed in HIV/TB patients in Eastern Europe, and TB was the dominant cause of death at any time during follow-up. This has important implications for HIV/TB programmes aiming to optimise the management of HIV/TB patients and limit TB-associated mortality in this region.