Pharmacotherapy, vaccines and malaria advice for HIV-infected travellers

Since the introduction of effective antiretroviral therapy (ART), HIV-infected individuals are travelling more frequently and international travel has become much safer. Specific concerns include the safety of ART during travel, drug adherence and interaction considerations, and effects of immunosuppression. This review describes potentially important infections, vaccine effectiveness, safety and special approaches for their use, and HIV-related issues regarding predeparture counselling. With advanced immunosuppression (CD4+ T-cell count < 200/microl or < 14%), the immunogenicity of several vaccines is reduced, complications could occur after live attenuated vaccines and certain infections acquired during travel may be more frequent or severe. Challenges include the best options for malaria chemoprophylaxis, standby treatment and medical follow-up of the increasing number of HIV-infected long-term travellers.

AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patients

Background Access to health care can be described along four dimensions: geographic accessibility, availability, financial accessibility and acceptability. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount. Combining these two types of measure into a single index provides a measure of geographic (or spatial) coverage, which is an important measure for assessing the degree of accessibility of a health care network. Results This paper describes the latest version of AccessMod, an extension to the Geographical Information System ArcView 3.×, and provides an example of application of this tool. AccessMod 3 allows one to compute geographic coverage to health care using terrain information and population distribution. Four major types of analysis are available in AccessMod: (1) modeling the coverage of catchment areas linked to an existing health facility network based on travel time, to provide a measure of physical accessibility to health care; (2) modeling geographic coverage according to the availability of services; (3) projecting the coverage of a scaling-up of an existing network; (4) providing information for cost effectiveness analysis when little information about the existing network is available. In addition to integrating travelling time, population distribution and the population coverage capacity specific to each health facility in the network, AccessMod can incorporate the influence of landscape components (e.g. topography, river and road networks, vegetation) that impact travelling time to and from facilities. Topographical constraints can be taken into account through an anisotropic analysis that considers the direction of movement. We provide an example of the application of AccessMod in the southern part of Malawi that shows the influences of the landscape constraints and of the modes of transportation on geographic coverage. Conclusion By incorporating the demand (population) and the supply (capacities of heath care centers), AccessMod provides a unifying tool to efficiently assess the geographic coverage of a network of health care facilities. This tool should be of particular interest to developing countries that have a relatively good geographic information on population distribution, terrain, and health facility locations.

Changing Europe and The Relevance of Care and The Caring Professions

The aim of the paper is to introduce the challenges of the international care debate of the last ten years in order to grasp basic social needs, to analyse their treatment in the public and private sphere and to look at the orientation of professional answers by the care-professions. The concept of care enhances the societal dealing with - or ignoring of - different forms of dependency on informal and formal personal and social services throughout the life-cycle (child-care, nursing sick or handicapped persons, supporting the elderly) and in special life situations (from help to lone mothers and their children, via help to drug-addicts to help for homeless people). All societies have different approaches to deal with these life-situations, they do so by employ-ing various mixtures of: familial support, mostly provided by women, social politics, organized by the state, public and/or private social services. This welfare-mix shows different combinations of private and public obligations, paid and und unpaid work, professional and laymen's tasks based on a specific understanding of mo-rality and justice embedded in the gender structure and intergenerational relationships. The importance of social work as a profession in this context differs according to the historical developments and cultural traditions. Characteristic for the profile of social work is the rele-vance of a care ethics and the existence of social rights, the tension of mothering and profes-sional methods, the relationship between help, denial and punishment and the ways of institu-tionalisation. The actuality of this debate is closely intertwined with the restructuring of societal bonds in the face of globalisation, the political reorganisation of states, the changes in the living to-gether of different generations and both sexes and the consequences for the organisation and contents of welfare. Looking at Germany and Eastern Europe two new phenomena of social relevance for the dis-cussion of care work and care needs can be taken as an example: the extent of cheap illegal women laborers travelling between east and west, especially Polish women working intermit-tendly in private care for old people and the highly organized traffiking of women from Russia to Germany to work in the sex business. The care debate entails a reframing of welfare issues in the light of social justice between classes, ethnicities and gender groups.

HIV infection disrupts the sympatric host-pathogen relationship in human tuberculosis

The phylogeographic population structure of Mycobacterium tuberculosis suggests local adaptation to sympatric human populations. We hypothesized that HIV infection, which induces immunodeficiency, will alter the sympatric relationship between M. tuberculosis and its human host. To test this hypothesis, we performed a nine-year nation-wide molecular-epidemiological study of HIV-infected and HIV-negative patients with tuberculosis (TB) between 2000 and 2008 in Switzerland. We analyzed 518 TB patients of whom 112 (21.6%) were HIV-infected and 233 (45.0%) were born in Europe. We found that among European-born TB patients, recent transmission was more likely to occur in sympatric compared to allopatric host-pathogen combinations (adjusted odds ratio [OR] 7.5, 95% confidence interval [95% CI] 1.21-infinity, p = 0.03). HIV infection was significantly associated with TB caused by an allopatric (as opposed to sympatric) M. tuberculosis lineage (OR 7.0, 95% CI 2.5-19.1, p<0.0001). This association remained when adjusting for frequent travelling, contact with foreigners, age, sex, and country of birth (adjusted OR 5.6, 95% CI 1.5-20.8, p = 0.01). Moreover, it became stronger with greater immunosuppression as defined by CD4 T-cell depletion and was not the result of increased social mixing in HIV-infected patients. Our observation was replicated in a second independent panel of 440 M. tuberculosis strains collected during a population-based study in the Canton of Bern between 1991 and 2011. In summary, these findings support a model for TB in which the stable relationship between the human host and its locally adapted M. tuberculosis is disrupted by HIV infection.

Non-invasive and non-occlusive blood pressure estimation via a chest sensor

The clinical demand for a device to monitor Blood Pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is increasing. Based on the so-called Pulse Wave Velocity (PWV) principle, this paper introduces and evaluates a novel concept of BP monitor that can be fully integrated within a chest sensor. After a preliminary calibration, the sensor provides non-occlusive beat-by-beat estimations of Mean Arterial Pressure (MAP) by measuring the Pulse Transit Time (PTT) of arterial pressure pulses travelling from the ascending aorta towards the subcutaneous vasculature of the chest. In a cohort of 15 healthy male subjects, a total of 462 simultaneous readings consisting of reference MAP and chest PTT were acquired. Each subject was recorded at three different days: D, D+3 and D+14. Overall, the implemented protocol induced MAP values to range from 80 ± 6 mmHg in baseline, to 107 ± 9 mmHg during isometric handgrip maneuvers. Agreement between reference and chest-sensor MAP values was tested by using intraclass correlation coefficient (ICC = 0.78) and Bland-Altman analysis (mean error = 0.7 mmHg, standard deviation = 5.1 mmHg). The cumulative percentage of MAP values provided by the chest sensor falling within a range of ±5 mmHg compared to reference MAP readings was of 70%, within ±10 mmHg was of 91%, and within ±15mmHg was of 98%. These results point at the fact that the chest sensor complies with the British Hypertension Society (BHS) requirements of Grade A BP monitors, when applied to MAP readings. Grade A performance was maintained even two weeks after having performed the initial subject-dependent calibration. In conclusion, this paper introduces a sensor and a calibration strategy to perform MAP measurements at the chest. The encouraging performance of the presented technique paves the way towards an ambulatory-compliant, continuous and non-occlusive BP monitoring system.

Steady streaming in a two-dimensional box model of a passive cochlea

Acoustic stimulation of the cochlea leads to a travelling wave in the cochlear fluids and on the basilar membrane (BM). It has long been suspected that this travelling wave leads to a steady streaming flow in the cochlea. Theoretical investigations suggested that the steady streaming might be of physiological relevance. Here, we present a quantitative study of the steady streaming in a computational model of a passive cochlea. The structure of the streaming flow is illustrated and the sources of streaming are closely investigated. We describe a source of streaming which has not been considered in the cochlea by previous authors. This source is also related to a steady axial displacement of the BM which leads to a local stretching of this compliant structure. We present theoretical predictions for the streaming intensity which account for these new phenomena. It is shown that these predictions compare well with our numerical results and that there may be steady streaming velocities of the order of millimetres per second. Our results indicate that steady streaming should be more relevant to low-frequency hearing because the strength of the streaming flow rapidly decreases for higher frequencies.

High colonization rates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli in Swiss Travellers to South Asia- a prospective observational multicentre cohort study looking at epidemiology, microbiology and risk factors.

BACKGROUND International travel contributes to the worldwide spread of multidrug resistant Gram-negative bacteria. Rates of travel-related faecal colonization with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae vary for different destinations. Especially travellers returning from the Indian subcontinent show high colonization rates. So far, nothing is known about region-specific risk factors for becoming colonized. METHODS An observational prospective multicentre cohort study investigated travellers to South Asia. Before and after travelling, rectal swabs were screened for third-generation cephalosporin- and carbapenem-resistant Enterobacteriaceae. Participants completed questionnaires to identify risk factors for becoming colonized. Covariates were assessed univariately, followed by a multivariate regression. RESULTS Hundred and seventy persons were enrolled, the largest data set on travellers to the Indian subcontinent so far. The acquired colonization rate with ESBL-producing Escherichia coli overall was 69.4% (95% CI 62.1-75.9%), being highest in travellers returning from India (86.8%; 95% CI 78.5-95.0%) and lowest in travellers returning from Sri Lanka (34.7%; 95% CI 22.9-48.7%). Associated risk factors were travel destination, length of stay, visiting friends and relatives, and eating ice cream and pastry. CONCLUSIONS High colonization rates with ESBL-producing Enterobacteriaceae were found in travellers returning from South Asia. Though risk factors were identified, a more common source, i.e. environmental, appears to better explain the high colonization rates.

Eco-Evolutionary Spatial Dynamics. Rapid Evolution and Isolation Explain Food Web Persistence

One of the current challenges in evolutionary ecology is understanding the long-term persistence of contemporary-evolving predator–prey interactions across space and time. To address this, we developed an extension of a multi-locus, multi-trait eco-evolutionary individual-based model that incorporates several interacting species in explicit landscapes. We simulated eco-evolutionary dynamics of multiple species food webs with different degrees of connectance across soil-moisture islands. A broad set of parameter combinations led to the local extinction of species, but some species persisted, and this was associated with (1) high connectance and omnivory and (2) ongoing evolution, due to multi-trait genetic variability of the embedded species. Furthermore, persistence was highest at intermediate island distances, likely because of a balance between predation-induced extinction (strongest at short island distances) and the coupling of island diversity by top predators, which by travelling among islands exert global top-down control of biodiversity. In the simulations with high genetic variation, we also found widespread trait evolutionary changes indicative of eco-evolutionary dynamics. We discuss how the ever-increasing computing power and high-resolution data availability will soon allow researchers to start bridging the in vivo–in silico gap.

Mobilities and Pottery Production Archaeological and Anthropological Perspectives

Our workshop aims at a deeper understanding of various itineraries of pottery and dif-ferent forms of human mobilities in which pottery is relevant, bringing together archae-ological and anthropological perspectives. For thousands of years, pottery has been an important part of many societies’ material culture and therefore a major research topic in both disciplines. In past and present societies the material existence of ceramic vessels is informed by various movements across time and space but also by periods of stasis: from the mo-ment of their production until their exclusion from daily practices, either disposed as waste, excluded as funerary objects or stored as collectibles. In their seemingly endless material durability, ceramic vessels might outlive their human producers, distributors or consumers and travel farther and longer. Still they are embedded in the regimes of human mobility, ranging from daily subsistence-based mobility to long-term migrations. In such processes, pottery shifts between spatial, temporal, social, economic and cultural contexts. Thereby ceramic vessels are appropriated and integrated in new contexts of action and meaning, sometimes leading to material transformations. This workshop takes place in the context of our archaeological research project „Mobili-ties, Entanglements and Transformations in Neolithic Societies on the Swiss Plateau (3900-3500 BC)“ to which our PhDs are connected. We address the above outlined topic by analysing the production of pottery. Based on dendrochronologically dated settle-ments between 3900 and 3500 BC, two regional pottery styles and their local variations are well known, Pfyn and Cortaillod. The vessels share the same habitus and were made of clays and temper deriving from the settlements’ surroundings. However, some vessels specific to other pottery styles are also present on the sites. They are characteristic for pottery styles known from more or less far off regions (Michelsberg, Munzingen or Néo-lithique Moyen Bourguignon). Some of them were travelling objects, as their non local raw materials show. Others seem to have been produced locally, pointing to long-term mobility and a change of residence from neighbouring social groups.

Novel insight into etiology, diagnosis and management of primary adrenal insufficiency

Primary adrenal insufficiency (PAI) is a rare condition in childhood which is either inherited (mostly) or acquired. It is characterized by glucocorticoid and maybe mineralocorticoid deficiency. The most common form in children is 21-hydroxylase deficiency, which belongs to the steroid biosynthetic defects causing PAI. Newer forms of complex defects of steroid biosynthesis are P450 oxidoreductase deficiency and (apparent) cortisone reductase deficiency. Other forms of PAI include metabolic disorders, autoimmune disorders and adrenal dysgenesis, e.g. the IMAGe syndrome, for which the underlying genetic defect has been recently identified. Newer work has also expanded the genetic causes underlying isolated, familial glucocorticoid deficiency (FGD). Mild mutations of CYP11A1 or StAR have been identified in patients with FGD. MCM4 mutations were found in a variant of FGD in an Irish travelling community manifesting with PAI, short stature, microcephaly and recurrent infections. Finally, mutations in genes involved in the detoxification of reactive oxygen species were identified in patients with unsolved FGD. Most mutations were found in the enzyme nicotinamide nucleotide transhydrogenase, which uses the mitochondrial proton pump gradient to produce NADPH. NADPH is essential in maintaining high levels of reduced forms of antioxidant enzymes for the reduction of hydrogen peroxide. Similarly, mutations in the gene for TXNRD2 involved in this system were found in FGD patients, suggesting that the adrenal cortex is particularly susceptible to oxidative stress.

Seelsorge, Psychologie und Medizin im Gespräch mit Spiritual Care (Psychologische Perspektive)

Spirituality is a travelling concept among different disciplines. As for psychology, spirituality has long been a neglected topic – especially in the academic context. However, during the last dec-ade there has been an increase of theoretical and empirical work, mainly emerging from positive and life-span developmental psychology. This research focuses spirituality either as an element of well-being or as predictor of well-being and health (e.g. as a coping strategy), or finally as an outcome after dealing with critical life events (i.e. spiritual growth). This knowledge has an impact on spiritual care – and vice-versa spiritual care – as a growing inter- and transdisciplinary field – has an impact on clinical psychological practice.

Itineraries of pottery: a mixed methods approach to mobility

Neolithic wetland sites in the Swiss Plateau provide an extraordinary database for the study of mobilities, entanglements and transformations in material culture. Based on dendrochronologically dated settlements between 3900 and 3500 BC, two regional pottery styles and their local variations are well known, Pfyn and Cortaillod. The vessels share the same habitus and were made of local raw materials. However, some vessels specific to other pottery styles are also present in the sites. By focusing on itineraries of vessels and shifts in pottery knowledge, their appropriation in different contexts and the resulting material entanglements, we want to approach the multiple regimes of mobility: At Lake Constance - known for Pfyn pottery - specific Michelsberg vessels like tulip beakers and lugged jars occur in small numbers. These travelling objects were produced with exogenous raw materials and transported to the sites from Southern Germany. At Concise (Lake Neuchâtel) besides the local Cortaillod pottery the whole repertoire of NMB pottery, characteristic for Eastern France, was also produced. Further cases from the same space-time frame point to other regimes of mobility. In our two PhD-projects we compare pottery practices - styles, techniques, raw materials - from over 20 key sites in the region. Based on Bourdieu’s reflexive anthropology, we apply different qualitative and quantitative archaeological and archaeometrical methods, thus striving for a deeper understanding of habitus and the transformative potential of moving people, objects and ideas on local and regional scales and related social contexts.

Pottery as an indication of mobilities?

Pottery is one of the most common and stylistically differentiated sources in prehistoric archaeology. This might be the reason why it served as a waste projection surface for archaeological notions about culture, identity, and mobility in the past. As we do not have access to emic categorisations of Neolithic societies we focus on contexts of practice in which pottery was incorporated. It is the moment of production, which left some of the clearest traces on the vessels. Different ways of using raw materials, specific techniques, and characteristic pottery styles can be observed. We understand them as a result of habitus, as socially shared internalized schemes, patterns and habits in pottery production. Taking this as a staring point, two main pottery groups can be differed on the Swiss Plateau between 3900 and 3500 BC: the Mediterranean influenced Cortaillod pottery in Western Switzerland and the Danubian influenced Pfyn pottery in North-Eastern Switzerland. These pottery styles were not only entangled to some degree. Furthermore, in some settlements vessels made in “foreign” styles - Michelsberg, Munzingen, Néolithique Moyen Bourguignon - are present too. Some of them were travelling objects, as their nonlocal raw materials show. Others were locally made, indicating long-term mobility of their producers. To analyse these phenomena of mobilites and entanglements in our PhDs we plan to apply different archaeological and archaeometrical methods, thus striving for a deeper understanding of the transformative potential of moving people, objects and ideas in Neolithic societies on the Swiss Plateau.

Uncertain Belongings. Absent mourning, burial, and post-mortem repatriations at the external border of the EU in Spain

Since the mid-1980s, migrants from North African and sub-Saharan countries have irregularly crossed the Strait of Gibraltar, in the hope of a better future for themselves and their families. Travelling in small, poorly equipped boats without experienced captains has cost the lives of myriad border crossers. Many of these bodies will never be recovered and the bereaved will never know whether their relatives and friends are alive or not. The bereaved are thus condemned to a state of not knowing and uncertainty. Exploring the junction of death and belonging, I firstly open a discussion about the enigmatic relation between a dead body and a dead person and argue for the importance of the physical presence of the body for mourning. Secondly, I show how the anonymity of dead border crossers and their uncertain belongings are generated, concealed, or rewritten. Following the story of an undertaker, I thirdly examine post-mortem border crossings. Depicting the power relations within identification processes, I outline the ambiguity of the term belonging by emphasising the constitutive significance of personal belongings such as clothes to restore a person’s identity. Reflecting on the ethical relationships which different actors (including the researcher) undertake with the deceased, I aim at gaining a better understanding of the multiple belonging of dead border crossers found on Spanish shores.

A Word. Palaver and Its Transferal Residues

The word 'palaver' is colloquially associated with useless verbiage and the nuisance of a tediously long, aimless and superfluous debate. At the same time, it insinuates an uncivilized culture of discourse beyond reason. Thus it appears to be of vaguely exotic origin but still firmly set in the European lexicon. Yet behind this contemporary meaning there lies a long history of linguistic and cultural transfers which is encased in a context of different usages of language and their intersections. By tracing the usage and semantics of 'palaver' in various encyclopaedias, glossaries and dictionaries of English, French, German, Portuguese and Spanish, the following article explores the rich history of this word. Moreover, it also regards the travelling semantics of the term 'palaver' as a process of cultural transfer that can be likened to the microcellular workings of a (retro)virus. Viral reproduction and evolution work through processes of transfer that enable the alteration of the host to adjust it to the replication and reproduction of the virus. In some cases, these processes also allow for the mutation or modification of the virus, making it suitable for transfer from one host to another. The virus is thus offered here as a vital model for cultural transfer: It not only encompasses the necessary adoption and adaption of contents or objects of cultural transfer in different contexts. It contributes to a conceptual understanding of the transferal residue that the transferred content is endowed with by its diversifying contexts. This model thereby surpasses an understanding of cultural transfer as literal translation or transmission: it conceptualizes cultural transfer as an agent of evolutionary processes, allowing for mutational effects of transfer as endowment.