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.

Vienna, Austria, 1770 (Image 1 of 4) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Grund Riss der Ka�. K�ningl. residenz stadt Wien unter glorw�rdigster Regierung be�der ma�ten. Josephs des IIten. R�m. Ka�sers un Mari� Theresi� R�m. Ka�serin und Apost. K�nigin auf allerh�chsten Befehl, unter der Direction dero hof Mathematici Joseph Nagel aufgenommen von den N.�. Reg.Ingenieur Franz Gruss und Joseph Ne�ssner ; J.E. Mansfeld Sculp. It was published in 1770. Scale [ca. 1:1,300]. Covers Vienna, Austria. This layer is image 1 of 4 total images, representing the southeast portion of the four sheet source map. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to the MGI 3-Degree Gauss Kruger coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map.This map shows features such as roads, drainage, built-up areas and selected buildings, fortification and more.This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Vienna, Austria, 1770 (Image 2 of 4) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Grund Riss der Ka�. K�ningl. residenz stadt Wien unter glorw�rdigster Regierung be�der ma�ten. Josephs des IIten. R�m. Ka�sers un Mari� Theresi� R�m. Ka�serin und Apost. K�nigin auf allerh�chsten Befehl, unter der Direction dero hof Mathematici Joseph Nagel aufgenommen von den N.�. Reg.Ingenieur Franz Gruss und Joseph Ne�ssner ; J.E. Mansfeld Sculp. It was published in 1770. Scale [ca. 1:1,300]. Covers Vienna, Austria. This layer is image 2 of 4 total images, representing the southwest portion of the four sheet source map. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to the MGI 3-Degree Gauss Kruger coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map.This map shows features such as roads, drainage, built-up areas and selected buildings, fortification and more.This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Vienna, Austria, 1770 (Image 3 of 4) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Grund Riss der Ka�. K�ningl. residenz stadt Wien unter glorw�rdigster Regierung be�der ma�ten. Josephs des IIten. R�m. Ka�sers un Mari� Theresi� R�m. Ka�serin und Apost. K�nigin auf allerh�chsten Befehl, unter der Direction dero hof Mathematici Joseph Nagel aufgenommen von den N.�. Reg.Ingenieur Franz Gruss und Joseph Ne�ssner ; J.E. Mansfeld Sculp. It was published in 1770. Scale [ca. 1:1,300]. Covers Vienna, Austria. This layer is image 3 of 4 total images, representing the northeast portion of the four sheet source map. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to the MGI 3-Degree Gauss Kruger coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map.This map shows features such as roads, drainage, built-up areas and selected buildings, fortification and more.This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Vienna, Austria, 1770 (Image 4 of 4) (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Grund Riss der Ka�. K�ningl. residenz stadt Wien unter glorw�rdigster Regierung be�der ma�ten. Josephs des IIten. R�m. Ka�sers un Mari� Theresi� R�m. Ka�serin und Apost. K�nigin auf allerh�chsten Befehl, unter der Direction dero hof Mathematici Joseph Nagel aufgenommen von den N.�. Reg.Ingenieur Franz Gruss und Joseph Ne�ssner ; J.E. Mansfeld Sculp. It was published in 1770. Scale [ca. 1:1,300]. Covers Vienna, Austria. This layer is image 4 of 4 total images, representing the northwest portion of the four sheet source map. Map in German. The image inside the map neatline is georeferenced to the surface of the earth and fit to the MGI 3-Degree Gauss Kruger coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map.This map shows features such as roads, drainage, built-up areas and selected buildings, fortification and more.This layer is part of a selection of digitally scanned and georeferenced historic maps from The Harvard Map Collection as part of the Imaging the Urban Environment project. Maps selected for this project represent major urban areas and cities of the world, at various time periods. These maps typically portray both natural and manmade features at a large scale. The selection represents a range of regions, originators, ground condition dates, scales, and purposes.

Barnstable, Dukes, and Nantucket counties, Massachusetts, 1858 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: Map of the counties of Barnstable, Dukes and Nantucket, Massachusetts, the details from actual surveys under the direction of Henry F. Walling, supt. of the state map. It was published by D.R. Smith & Co., in 1858. Scale 1:63,360. The image inside the map neatline is georeferenced to the surface of the earth and fit to the Massachusetts State Plane Coordinate System, Mainland Zone (in Feet) (Fipszone 2001). All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, or other information associated with the principal map. This map shows features such as roads, railroads, drainage, public buildings, schools, churches, cemeteries, industry locations (e.g. mills, factories, mines, etc.), private buildings with names of property owners, town and county boundaries and more. Relief is shown by hachures. It includes many cadastral insets of individual county towns and villages, and an inset geological map of county. Includes also ill., business directories, and tables of statistics and distances. This layer is part of a selection of digitally scanned and georeferenced historic maps of Massachusetts from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of regions, originators, ground condition dates (1755-1922), scales, and purposes. The digitized selection includes maps of: the state, Massachusetts counties, town surveys, coastal features, real property, parks, cemeteries, railroads, roads, public works projects, etc.

An outline for the study of poultry diseases, with a discussion of digestion in the chicken

Mimeographed.

Teaching and organisation, with special reference to secondary schools, a manual of practice,

Contains bibliographies.

Urkundenbuch der Klöster der Grafschaft Mansfeld /

Text in German and Latin; introduction and notes in German.

Die Mundart der sogenannten Grunddorfer in der Grafschaft Mansfeld : I. Teil: Lautlehre.

Thesis (doctoral)--Ruprecht-Karls-Universitat Heidelberg.

Characterization of tumour-infiltrating lymphocytes and apoptosis in colitis-associated neoplasia: comparison with sporadic colorectal cancer

The development of colorectal cancer is a major complication for patients with chronic idiopathic colitis. Colitis-associated tumours tend to occur at a younger age and be more aggressive than sporadic colorectal cancers. While we have previously associated the presence of tumour-infiltrating lymphocytes (TILs) and increased apoptosis in sporadic colorectal cancer with high-level microsatellite instability and improved prognosis, little is known of the relationship between these variables in colitis-associated colorectal cancer. The aim of this study was to correlate TILs and tumour cell apoptosis in colitis-associated neoplasms stratified according to microsatellite instability. Twenty tumour and 11 dysplastic samples resected from 21 patients with long-standing colitis were analysed for microsatellite instability at 10 microsatellite markers. TIL distribution (CD3, CD8) and function (granzyme B) were quantified by immunohistochemistry. Neoplastic cell apoptosis was assessed using the M30 CytoDEATH antibody. These findings were compared with 40 microsatellite stable (MSS) sporadic colorectal cancers previously evaluated for TILs and neoplastic apoptosis. Low-level microsatellite instability was found in 1/20 colitis-associated tumours. All other colitis-associated lesions were designated MSS. CD3(+) and CD8(+) TIL counts were significantly higher in colitis-associated lesions compared with NISS sporadic colorectal cancer (p < 0.0001, p = 0.001 respectively). Despite their higher TIL density, colitis-associated tumours were more likely to present late (Dukes' stage C or D) (P = 0.02). Functionally, colitis-associated TILs demonstrated significantly less granzyme B expression compared to sporadic cancers (p = 0.002). The level of tumour cell apoptosis was similar between the two groups (sporadic, 1.53%; colitis cancers, 1.45%). In conclusion, NISS colitis-associated tumours have a higher prevalence of CD3(+)/CD8(+) TILs but no associated increase in tumour cell killing by apoptosis. Unlike cytotoxic T cells in sporadic colorectal cancer, TILs do not appear to enhance the prognosis of colitis-associated colorectal cancer. This may be related to an impairment of granzyme B expression within these lesions. Copyright (c) 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

'Putting up your Dukes': Statues, social memory and Duke Paoa Kahanamoku

Public statues that commemorate the lives and achievements of athletes are pervasive and influential forms of social memory in Western societies. Despite this important nexus between cultural practice and history making, there is a relative void of critical studies of statuary dedicated to athletes. This article will attempt to contribute to a broader understanding in this area by considering a bronze statue of Duke Paoa Kahanamoku, the Hawaiian Olympian, swimmer and surfer, at Waikīkī, Hawaii. This prominent monument demonstrates the processes of remembering and forgetting that are integral to acts of social memory. In this case, Kahanamoku's identity as a surfer is foregrounded over his legacy as a swimmer. The distillation and use of Kahanamoku's memory in this representation is enmeshed in deeper cultural forces about Hawaii's identity. Competing meanings of the statue's symbolism indicate its role as a 'hollow icon', and illustrate the way that apparently static objects representing the sporting past are in fact objects of the present.

Neurophysiological evaluation of convergent afferents innervating the human esophagus and area of referred pain on the anterior chest wall

Noxious stimuli in the esophagus cause pain that is referred to the anterior chest wall because of convergence of visceral and somatic afferents within the spinal cord. We sought to characterize the neurophysiological responses of these convergent spinal pain pathways in humans by studying 12 healthy subjects over three visits (V1, V2, and V3). Esophageal pain thresholds (Eso-PT) were assessed by electrical stimulation and anterior chest wall pain thresholds (ACW-PT) by use of a contact heat thermode. Esophageal evoked potentials (EEP) were recorded from the vertex following 200 electrical stimuli, and anterior chest wall evoked potentials (ACWEP) were recorded following 40 heat pulses. The fear of pain questionnaire (FPQ) was administered on V1. Statistical data are shown as point estimates of difference +/- 95% confidence interval. Pain thresholds increased between V1 and V3 [Eso-PT: V1-V3 = -17.9 mA (-27.9, -7.9) P < 0.001; ACW-PT: V1-V3 = -3.38 degrees C (-5.33, -1.42) P = 0.001]. The morphology of cortical responses from both sites was consistent and equivalent [P1, N1, P2, N2 complex, where P1 and P2 are is the first and second positive (downward) components of the CEP waveform, respectively, and N1 and N2 are the first and second negative (upward) components, respectively], indicating activation of similar cortical networks. For EEP, N1 and P2 latencies decreased between V1 and V3 [N1: V1-V3 = 13.7 (1.8, 25.4) P = 0.02; P2: V1-V3 = 32.5 (11.7, 53.2) P = 0.003], whereas amplitudes did not differ. For ACWEP, P2 latency increased between V1 and V3 [-35.9 (-60, -11.8) P = 0.005] and amplitudes decreased [P1-N1: V1-V3 = 5.4 (2.4, 8.4) P = 0.01; P2-N2: 6.8 (3.4, 10.3) P < 0.001]. The mean P1 latency of EEP over three visits was 126.6 ms and that of ACWEP was 101.6 ms, reflecting afferent transmission via Adelta fibers. There was a significant negative correlation between FPQ scores and Eso-PT on V1 (r = -0.57, P = 0.05). These data provide the first neurophysiological evidence of convergent esophageal and somatic pain pathways in humans.

The effectiveness of training educators on their ability to identify function of problem behavior

The purpose of this study was to investigate the effectiveness of training educators in the pre-behavioral intervention process of functional behavioral assessment. An original evaluation instrument was developed entitled, The Survey for Students Exhibiting Challenging Behavior. The instrument included measures of participating educators, knowledge of function of problem behavior and their ability to generate recommendations for a behavior intervention plan. The instrument was distributed to schools in a large urban district and completed by special educators. Educators trained and untrained in the functional behavioral assessment process were compared in the study. ^ The study incorporated a post-test only design. All instruments were analyzed using a factorial ANOVA. Those educators who were trained in the district functional behavioral assessment program answered general questions related to function of problem behavior significantly better than those who did not receive training. There is no significant difference between educators on their ability to generate recommendations for behavior intervention plans. It is important that educators receive training in functional behavioral assessment to gain an understanding of the basic notions being function of problem behavior. Current training does not translate into educators' ability to make strong recommendations for behavior intervention plans. ^

Discovery and settlement of Alaska coaster

Tsar Peter the Great ruled Russia between 1689 and 1725. Its domains, stretching from the Baltic Sea in the west to the Pacific Ocean in the east. From north to south, its empire stretching from the Arctic Ocean to the borders with China and India. Tsar Peter I tried to extend the geographical knowledge of his government and the rest of the world. He was also interested in the expansion of trade in Russia and in the control of trade routes. Feodor Luzhin and Ivan Yeverinov explored the eastern border of the Russian Empire, the trip between 1719 and 1721 and reported to the Tsar. They had crossed the peninsula of Kamchatka, from west to east and had traveled from the west coast of Kamchatka to the Kuril Islands. The information collected led to the first map of Kamchatka and the Kuril Islands. Tsar Peter ordered Bering surf the Russian Pacific coast, build ships and sail the seas north along the coast to regions of America. The second expedition found equal to those of the previous explorers difficulties. Two ships were eventually thrown away in Okhotsk in 1740. The explorers spent the winter of 1740-1741 stockpiling supplies and then navigate to Petropavlovsk. The two ships sailed eastward and did together until June 20, then separated by fog. After searching Chirikov and his boat for several days, Bering ordered the San Pedro continue to the northeast. There the Russian sailors first sighted Alaska. According to the log, "At 12:30 (pm July 17) in sight of snow-capped mountains and between them a high volcano." This finding came the day of St. Elijah and so named the mountain.