Major challenges in clinical management of TB/HIV co-infected patients in Eastern Europe compared with Western Europe and Latin America.

INTRODUCTION Rates of both TB/HIV co-infection and multi-drug-resistant (MDR) TB are increasing in Eastern Europe (EE). Data on the clinical management of TB/HIV co-infected patients are scarce. Our aim was to study the clinical characteristics of TB/HIV patients in Europe and Latin America (LA) at TB diagnosis, identify factors associated with MDR-TB and assess the activity of initial TB treatment regimens given the results of drug-susceptibility tests (DST). MATERIAL AND METHODS We enrolled 1413 TB/HIV patients from 62 clinics in 19 countries in EE, Western Europe (WE), Southern Europe (SE) and LA from January 2011 to December 2013. Among patients who completed DST within the first month of TB therapy, we linked initial TB treatment regimens to the DST results and calculated the distribution of patients receiving 0, 1, 2, 3 and ≥4 active drugs in each region. Risk factors for MDR-TB were identified in logistic regression models. RESULTS Significant differences were observed between EE (n=844), WE (n=152), SE (n=164) and LA (n=253) for use of combination antiretroviral therapy (cART) at TB diagnosis (17%, 40%, 44% and 35%, p<0.0001), a definite TB diagnosis (culture and/or PCR positive for Mycobacterium tuberculosis; 47%, 71%, 72% and 40%, p<0.0001) and MDR-TB prevalence (34%, 3%, 3% and 11%, p <0.0001 among those with DST results). The history of injecting drug use [adjusted OR (aOR) = 2.03, (95% CI 1.00-4.09)], prior TB treatment (aOR = 3.42, 95% CI 1.88-6.22) and living in EE (aOR = 7.19, 95% CI 3.28-15.78) were associated with MDR-TB. For 569 patients with available DST, the initial TB treatment contained ≥3 active drugs in 64% of patients in EE compared with 90-94% of patients in other regions (Figure 1a). Had the patients received initial therapy with standard therapy [Rifampicin, Isoniazid, Pyrazinamide, Ethambutol (RHZE)], the corresponding proportions would have been 64% vs. 86-97%, respectively (Figure 1b). CONCLUSIONS In EE, TB/HIV patients had poorer exposure to cART, less often a definitive TB diagnosis and more often MDR-TB compared to other parts of Europe and LA. Initial TB therapy in EE was sub-optimal, with less than two-thirds of patients receiving at least three active drugs, and improved compliance with standard RHZE treatment does not seem to be the solution. Improved management of TB/HIV patients requires routine use of DST, initial TB therapy according to prevailing resistance patterns and more widespread use of cART.

Spring temperature variability and eutrophication history inferred from sedimentary pigments in the varved sediments of Lake Żabińskie, north-eastern Poland, AD 1907–2008

Varved lake sediments are excellent natural archives providing quantitative insights into climatic and environmental changes at very high resolution and chronological accuracy. However, due to the multitude of responses within lake ecosystems it is often difficult to understand how climate variability interacts with other environmental pressures such as eutrophication, and to attribute observed changes to specific causes. This is particularly challenging during the past 100 years when multiple strong trends are superposed. Here we present a high-resolution multi-proxy record of sedimentary pigments and other biogeochemical data from the varved sediments of Lake Żabińskie (Masurian Lake District, north-eastern Poland, 54°N–22°E, 120 m a.s.l.) spanning AD 1907 to 2008. Lake Żabińskie exhibits biogeochemical varves with highly organic late summer and winter layers separated by white layers of endogenous calcite precipitated in early summer. The aim of our study is to investigate whether climate-driven changes and anthropogenic changes can be separated in a multi-proxy sediment data set, and to explore which sediment proxies are potentially suitable for long quantitative climate reconstructions. We also test if convoluted analytical techniques (e.g. HPLC) can be substituted by rapid scanning techniques (visible reflectance spectroscopy VIS-RS; 380–730 nm). We used principal component analysis and cluster analysis to show that the recent eutrophication of Lake Żabińskie can be discriminated from climate-driven changes for the period AD 1907–2008. The eutrophication signal (PC1 = 46.4%; TOC, TN, TS, Phe-b, high TC/CD ratios total carotenoids/chlorophyll-a derivatives) is mainly expressed as increasing aquatic primary production, increasing hypolimnetic anoxia and a change in the algal community from green algae to blue-green algae. The proxies diagnostic for eutrophication show a smooth positive trend between 1907 and ca 1980 followed by a very rapid increase from ca. 1980 ± 2 onwards. We demonstrate that PC2 (24.4%, Chl-a-related pigments) is not affected by the eutrophication signal, but instead is sensitive to spring (MAM) temperature (r = 0.63, pcorr < 0.05, RMSEP = 0.56 °C; 5-yr filtered). Limnological monitoring data (2011–2013) support this finding. We also demonstrate that scanning visible reflectance spectroscopy (VIS-RS) data can be calibrated to HPLC-measured chloropigment data and be used to infer concentrations of sedimentary Chl-a derivatives {pheophytin a + pyropheophytin a}. This offers the possibility for very high-resolution (multi)millennial-long paleoenvironmental reconstructions.

Geomorphology and evolution of the late Pleistocene to Holocene fluvial system in the south-eastern Llanos de Moxos, Bolivian Amazon

In the Bolivian Amazon several paleochannel generations are preserved. Their wide spectrum of morphologies clearly provides crucial information on the type and magnitude of geomorphic and hydrological changes within the drainage network of the Andean foreland. Therefore, in this study we mapped geomorphological characteristics of paleochannels, and applied radiocarbon and optically stimulated luminescence dating. Seven paleochannel generations are identified. Significant changes in sinuosity, channel widths and river pattern are observed for the successive paleochannel generations. Our results clearly reflect at least three different geomorphic and hydrological periods in the evolution of the fluvial system since the late Pleistocene. Changes in discharge and sediment load may be controlled by combinations of two interrelated mechanisms: (i) spatial changes and re-organizations of the drainage network in the upper catchment, and/or (ii) climate changes with their associated local to catchment-scale modifications in vegetation cover, and changes in discharge, inundation frequencies and magnitudes, which have likely affected the evolution of the fluvial system in the Llanos de Moxos. In summary, our study has revealed the enormous potential which geomorphic mapping and analysis combined with luminescence based chronologies hold for the reconstruction of the late Pleistocene to recent fluvial system in a large portion of Amazonia.

The Road Not Taken: Enabling and Limiting Mobility in the Eastern Pamirs

Based on fieldwork conducted between 2008 and 2011, this article explores the role of roads in enabling and limiting the movement of people and goods in Tajikistan’s Eastern Pamirs. The article focuses on the Pamir Highway and a newly established trade route linking Tajikistan with China. Besides materially facilitating mobility, both roads serve as trajectories for opportunities, but often also signify the lack of such to those who live along them. This article thus seeks to analyse the shifting roles of roads against the backdrop of past and present state dispensations, shifting ideologies and newly emerging economic practices. By emphasising roads as both enabling and limiting spatial entities shaped by materiality, politics and economics, this article argues, on the one hand, that roads are important factors in directing and accelerating the mobility of people and goods and, on the other, that roads are also symbols of immobility inasmuch as they set limitations on the movement of people.

The jews of eastern Europe

by Arnold D. Margolin. Foreword by James W. Gerard

Molecular Epidemiology Issues of BVDV Infection in the Eastern Ukraine

Aim. This study was focused on (i) detection of specific BVDV-antibodies within selected cattle farms, (ii) identification of persistently infected (PI) animals and (iii) genetic typing of selected BVDV isolates. Methods. RNA extraction, real-time polymerase chain reaction, ELISA technique, sequencing. Results. Specific BVDV-antibodies were detected in 713 of 1,059 analyzed samples (67.3 per cent). This number is in agreement with findings in many cattle herds around the world. However, the number of positive samples differed in the herds. While 57 samples out of 283 (20.1 per cent) were identified in the first herd, 400 out of 475 (84.2 per cent) and 256 out of 301 (85 per cent) animals were positive in the second and third herd. High number of animals with BVDV RNA was detected in all herds. The real-time PCR assay detected BVDV RNA in 5 of 1068 samples analyzed (0.5 per cent). 4 positive samples out of 490 (0.8 per cent) and 1 out of 301 (0.33 per cent) were found in the second and third herd. The genetic materials of BVDV were not found in the first herd. Data on the number of PI animals were in accord with serological findings in the cattle herds involved in our study. The genetic typing of viral isolates revealed that only BVDV, Type 1 viruses were present. The hylogenetic analysis confirmed two BVDV-1 subtypes, namely b and f and revealed that all 4 viruses from the second farm were typed as BVDV-1b and all of them were absolutely identical in 5’-UTR, but virus from the third farm was typed as BVDV-1f. Conclusion. Our results indicated that the BVDV infection is widespread in cattle herds in the eastern Ukraine, that requires further research and development of new approaches to improve the current situation.

Age of cleft monazites in the eastern Tauern Window: constraints on crystallization conditions of hydrothermal monazite

Monazite-bearing Alpine clefts located in the Sonnblick region of the eastern Tauern Window, Austria, are oriented perpendicular to the foliation and lineation. Ion probe (SIMS) Th–Pb and U–Pb dating of four cleft monazites yields crystallization ages of different growth domains and aggregate regions ranging from 18.99 ± 0.51 to 15.00 ± 0.51 Ma. The crystallization ages obtained are overlapping or slightly younger than zircon fission track ages but older than zircon (U–Th)/He cooling ages from the same area. This constrains cleft monazite crystallization in this area to *300–200 �C. LA-ICP-MS data of dated hydrothermal monazites indicate that in graphite-bearing, reduced host lithologies, cleft monazite is poor in As and has higher La/Yb values and U concentrations, whereas in oxidised host rocks opposite trends are observed. Monazites show negative Eu anomalies and variable La/Yb values ranging from 520 to 6050. The positive correlation between Ca and Sr concentration indicates dissolution of plagioclase or carbonates as the source of these elements. The data show that early exhumation and cleft formation in the Tauern is related to metamorphic dome formation caused by the collision of the Adriatic with the European plate and that monazite crystallization in the clefts occurred later. Our data also demonstrate that hydrothermal monazite ages offer great potential in helping to constrain the chronology of exhumation in collisional orogens.

Revealing regional deforestation dynamics in north-eastern Madagascar - Insights from multi-temporal land cover change analysis

The north-eastern escarpment of Madagascar harbours the island’s last remaining large-scale humid forest massifs surrounded by a small-scale agricultural mosaic. There is high deforestation, commonly thought to be caused by shifting cultivation practiced by local land users to produce upland rice. However, little is known about the dynamics between forest and shifting cultivation systems at a regional level. Our study presents a first attempt to quantify changes in the extent of forest and different agricultural land cover classes, and to identify the main dynamics of land cover change for two intervals, 1995–2005 and 2005–2011. Over the 16-year study period, the speed of forest loss increased, the total area of upland rice production remained almost stable, and the area of irrigated rice fields slightly increased. While our findings seem to confirm a general trend of land use intensification, deforestation through shifting cultivation is still on the rise. Deforestation mostly affects the small forest fragments interspersed in the agricultural mosaic and is slowly leading to a homogenization of the landscape. These findings have important implications for future interventions to slow forest loss in the region, as the processes of agricultural expansion through shifting cultivation versus intensified land use cannot per se be considered mutually exclusive.