The prevalence and predictive value of dipstick urine protein in HIV-positive persons in Europe.

INTRODUCTION Proteinuria (PTU) is an important marker for the development and progression of renal disease, cardiovascular disease and death, but there is limited information about the prevalence and factors associated with confirmed PTU in predominantly white European HIV+ persons, especially in those with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m(2). PATIENTS AND METHODS Baseline was defined as the first of two consecutive dipstick urine protein (DPU) measurements during prospective follow-up >1/6/2011 (when systematic data collection began). PTU was defined as two consecutive DUP >1+ (>30 mg/dL) >3 months apart; persons with eGFR <60 at either DPU measurement were excluded. Logistic regression investigated factors associated with PTU. RESULTS A total of 1,640 persons were included, participants were mainly white (n=1,517, 92.5%), male (n=1296, 79.0%) and men having sex with men (n=809; 49.3%). Median age at baseline was 45 (IQR 37-52 years), and CD4 was 570 (IQR 406-760/mm(3)). The median baseline date was 2/12 (IQR 11/11-6/12), and median eGFR was 99 (IQR 88-109 mL/min/1.73 m(2)). Sixty-nine persons had PTU (4.2%, 95% CI 3.2-4.7%). Persons with diabetes had increased odds of PTU, as were those with a prior non-AIDS (1) or AIDS event and those with prior exposure to indinavir. Among females, those with a normal eGFR (>90) and those with prior abacavir use had lower odds of PTU (Figure 1). CONCLUSIONS One in 25 persons with eGFR>60 had confirmed proteinuria at baseline. Factors associated with PTU were similar to those associated with CKD. The lack of association with antiretrovirals, particularly tenofovir, may be due to the cross-sectional design of this study, and additional follow-up is required to address progression to PTU in those without PTU at baseline. It may also suggest other markers are needed to capture the deteriorating renal function associated with antiretrovirals may be needed at higher eGFRs. Our findings suggest PTU is an early marker for impaired renal function.

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.

Laboratory diagnosis of ruminant abortion in Europe.

Abortion in ruminants is a major cause of economic loss worldwide, and the management and control of outbreaks is important in limiting their spread, and in preventing zoonotic infections. Given that rapid and accurate laboratory diagnosis is central to controlling abortion outbreaks, the submission of tissue samples to laboratories offering the most appropriate tests is essential. Direct antigen and/or DNA detection methods are the currently preferred methods of reaching an aetiological diagnosis, and ideally these results are confirmed by the demonstration of corresponding macroscopic and/or histopathological lesions in the fetus and/or the placenta. However, the costs of laboratory examinations may be considerable and, even under optimal conditions, the percentage of aetiological diagnoses reached can be relatively low. This review focuses on the most commonly occurring and important abortifacient pathogens of ruminant species in Europe highlighting their epizootic and zoonotic potential. The performance characteristics of the various diagnostic methods used, including their specific advantages and limitations, are discussed.

Central European vegetation response to abrupt climate change at 8.2 ka

Oxygen isotope records show a major climatic reversal at 8.2 ka in Greenland and Europe. Annually laminated sediments from two lakes in Switzerland and Germany were sampled contiguously to assess the response of European vegetation to climate change ca. 8.2 ka with time resolution and precision comparable to those of the Greenland ice cores. The pollen assemblages show pronounced and immediate responses (0–20 yr) of terrestrial vegetation to the climatic change at 8.2 ka. A sudden collapse of Corylus avellana (hazel) was accompanied by the rapid expansion of Pinus (pine), Betula (birch), and Tilia (linden), and by the invasion of Fagus silvatica (beech) and Abies alba (fir). Vegetational changes suggest that climatic cooling reduced drought stress, allowing more drought-sensitive and taller growing species to out-compete Corylus avellana by forming denser forest canopies. Climate cooling at 8.2 ka and the immediate reorganization of terrestrial ecosystems has gone unrecognized by previous pollen studies. On the basis of our data we conclude that the early Holocene high abundance of C. avellana in Europe was climatically caused, and we question the conventional opinion that postglacial expansions of F. silvatica and A. alba were controlled by low migration rates rather than by climate. The close connection between climatic change and vegetational response at a subcontinental scale implies that forecasted global warming may trigger rapid collapses, expansions, and invasions of tree species.

Larix decidua and other larches in Europe: distribution, habitat, usage and threats

The European larch (Larix decidua Mill.) is a pioneer, very long-lived, fast-growing coniferous tree, which occurs in the central and eastern mountains of Europe, forming open forests or pasture woods at the upper tree limits. Larch is the only deciduous conifer in Europe as an adaptation to continental alpine climates. In fact, it is able to tolerate very cold temperatures during winter and, by losing its needles, avoids foliage desiccation. It is a transitional species, colonising open terrain after natural disturbances. It forms pure stands but more often it is found with other alpine tree species, which tend to replace it if no other disturbances occur. Thanks to its adaptability and the durability of its wood, the European larch represents an important silvicultural tree species in the alpine regions, planted even outside its natural ranges. Its wood is largely used for carpentry, furniture and pulp for paper. In lower altitudes or with high precipitation rates, larch is more susceptible to fungal diseases. Outbreaks of insect defoliators, principally caused by the larch bud moth (Zeiraphera diniana), can limit tree development, with economic losses in plantations, but they rarely lead to the death of the trees.

Innovation in Eastern Europe : a case study of Czech Republic

In this study we evaluate innovative performance of the economies of Central and Eastern Europe (CEE) based on the available statistics of innovation processes. We compare such country-level indicators as educational levels, investments in R&D, FDI, trade and licensing flows, patents and scientific articles, and find that the most developed CEE economies are also the most innovative. At the same time, as supported by the results of the interviews in Czech Republic, one of the top performers in the CEE region, its economy is facing a number of challenges that are similar to other middle-income countries around the world. We suggest addressing these challenges from the prospective of the Middle Income Trap, when a middle-income economy to sustain growth must learn to compete with advanced economies in high-skill innovation. Development of effective innovation policy should be a priority for the CEE countries to escape from the middle income trap.

Historia holocena de los pinares montanos de los sistemas Central y Cantábrico: Un objetivo con dos enfoques, biogeográfico y dendroecológico

Los estudios paleoecológicos holocenos basados en macro- y megafósiles encierran un gran valor debido a que su información tiene generalmente carácter local, su origen es conocido, pueden ser datados directamente mediante el método radiocarbónico, y pueden identificarse a un nivel taxonómicamente preciso. Sin embargo son pocas las áreas del Sur de Europa en las que sea conocida una alta densidad de yacimientos con restos leñosos de gran tamaño. En esta tesis, se presentan datos de 53 yacimientos de la sierra de Gredos y de la cordillera Cantábrica (Península Ibérica). Los restos fueron hallados en ambientes variados, como zonas higroturbosas, turberas erosionadas o lagos, y fueron identificadas mediante el estudio de la anatomía de la madera o mediante rasgos morfológicos. En la sierra de Gredos, la evidencia paleobotánica indica la existencia de un panorama relativamente estable a lo largo del Holoceno medio y principio del Holoceno final y sugiere la persistencia, a lo largo de milenios, de un piso de pinares ampliamente distribuído en cotas altas de la sierra. La información obtenida de piñas y frutos mejoran la información taxonómica disponible y revelan la existencia tanto de Pinus sylvestris como de Pinus nigra en estas sierras durante el Holoceno. La datación radiocarbónica, medición de anillos de crecimiento y sincronización preliminar de 26 secciones de troncos de subfósiles demuestran el potencial de este material de las montañas de Iberia central en la obtención de cronologías holocenas de pino. En la cordillera Cantábrica, los datos aportan información espacialmente precisa de distribuciones de ciertas especies arbóreas durante el Holoceno. En las zonas centrales de la cordillera, han sido hallados fundamentalmente restos de pino, mientras que en las zonas más occidentales los pinos estás ausentes y los restos encontrados corresponden a otras especies de caducifolios (Betula, Salix, Quercus) y arbustos (Erica, Fabaceae) Esta información paleobiogeográfica constrasta con la distribución natural actual de Pinus sylvestris y Pinus nigra en el área de estudio. En la sierra de Gredos, la naturalidad de las escasos rodales de pinos que aún persisten ha sido discutida, mientras que en la cordillera Cantábrica, la única especie del grupo que persiste es P. sylvestris y está localizada en unos pocos relictos. El clima pudo haber jugado un papel importante en una primera fase de declive de los pinares durante el Holoceno inicial, mostrado en numerosos registros polínicos de manera casi sincrónica y asociada a una expansión de frondosas. Sin embargo la información histórica disponible y la comparación entre las áreas de distribución de los pinares en el presente, modelizada y en momentos anteriores a la la generalización de la presión antrópica sugiere que durante los últimos dos milenios, la actividad humana ha sido responsable de la desaparición de estas especies como árboles naturales en áreas extensas. ABSTRACTMacro- and megafossil studies provide information of great value in palaeoecology because such evidence is spatially precise, directly radiocarbon dated and usually taxon-specific. However, few areas of southern Europe have a high density of sites with Holocene woody remains. Here, local data from 53 sites in the Gredos Mountains and the Cantabrian Range (Iberian Peninsula) is presented. Woody remains were recovered from mires, eroded peat bogs and lakes and were identified by their wood anatomy or morphological traits. In the Gredos Mountains, palaeobotanical evidence portrays a relatively stable picture of tree distribution over the mid- and beggining of the late-Holocene, and suggests the persistence of a widespread belt of pinewoods. Cones and fruits enlarge the taxonomic information available and reveal that both Pinus sylvestris and Pinus nigra were present locally during the Holocene. Radiocarbon dating, tree ring measurement and preliminary cross-dating of 26 pine sub-fossil logs demonstrate the potential of obtaining a long pine chronology from subfossil wood from the mountains of Central Iberia. In the Cantabrian Range the data provide spatially precise evidence of tree distribution in the region during the Holocene. Pines were mostly identified in the central areas, whereas at the western edge no pine evidence was detected and deciduous trees (Betula, Salix, Quercus) and shrubs (Erica, Fabaceae) were identified. This palaeoecological information contrasts with the current natural distribution ranges of P. sylvestris and P. nigra in the study area. In the Gredos Mountains, the naturality of the few pine stands currently growing has been heavily debated. In the Cantabrian Range P. sylvestris is the only pine species that is today present, and its natural presence is now limited to a few enclaves. Climate may have played a key role in the early-Holocene, as pollen archives document a pine demise that is synchronous with the spread of broadleaved taxa. However, available historical data and the comparison of the reconstructed distribution of pinewoods before extensive human forest disturbance with both present and modelled distributions suggests that during the last two millennia, anthropogenic activity may have removed these species as native trees from a large territory.

Extreme pointer years in tree-ring records of central Spain as evidence of climatic events and the eruption of the Huaynaputina Volcano (Peru, 1600 AD)

The study of pointer years of numerous tree-ring chronologies of the central Iberian Peninsula (Sierra de Guadarrama) could provide complementary information about climate variability over the last 405 yr. In total, 64 pointer years have been identified: 30 negative (representing minimum growths) and 34 positive (representing maximum growths), the most significant of these being 1601, 1963 and 1996 for the negative ones, and 1734 and 1737 for the positive ones. Given that summer precipitation was found to be the most limiting factor for the growth of Pinus in the Sierra de Guadarrama in the second half of the 20th century, it is also an explanatory factor in almost 50% of the extreme growths. Furthermore, these pointer years and intervals are not evenly distributed throughout time. Both in the first half of the 17th and in the second half of 20th, they were more frequent and more extreme and these periods are the most notable for the frequency of negative pointer years in Central Spain. The interval 1600–1602 is of special significance, being one of the most unfavourable for tree growth in the centre of Spain, with 1601 representing the minimum index in the regional chronology. We infer that this special minimum annual increase was the effect of the eruption of Huaynaputina, which occurred in Peru at the beginning of 1600 AD. This is the first time that the effects of this eruption in the tree-ring records of Southern Europe have been demonstrated.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Short-Term Effects of a Wildfire on the Endangered Dupont's Lark Chersophilus duponti in an Arid Shrub-Steppe of Central Spain

In Europe, Dupont’s Lark Chersophilus duponti is a threatened open-habitat bird. Prescribed burning has sometimes been proposed for its conservation, but without evidence of its effectiveness. To evaluate the short-term effects of a summer wildfire on this species, we performed several transect counts in the burnt and unburnt parts of a shrubsteppe in central Spain. The same transects were counted within a three-year interval prior to the fire and were repeated during the first two springs after the fire. We also measured the vegetation during the first two springs after the fire. In the burnt area, we observed a decrease of about 85–100% in Dupont’s Lark abundance, and about 7–15% in the control area. The disappearance of the scrub cover after fire and its slow regeneration, as well as the large increase in grass cover during the second year, may explain the decrease in this habitat-specialist bird species. Fire should be avoided in areas occupied by the Dupont’s Lark, as its negative effects in the short-term may cause local extinctions. However, prescribed burning may be used in neighboring areas to create new open habitats that may be subsequently colonized by this species.

Geodynamic events reconstructed in the Betic, Maghrebian, and Apennine chains (central-western Tethys)

A synthetic study has been made to identify main tectono-sedimentary and geodynamic events in central-western Tethys. For this, an interdisciplinary analysis has been performed on successions belonging to tectonic units derived from Betic-Maghrebian-southern Apennine “Flysch basin” domain. The stratigraphic records of the internal, external, and mixed successions deposited in lateral basins of different chains show very similar characters, especially regarding: (a) lithostratigraphy and ages; (b) kind and provenance of supplies (immature and supermature petrofacies from internal and external margins, respectively); (c) presence of “mixed successions” (composed of alternating internal and external petrofacies) attesting to clear palaeogeographic relationships between opposite depositional systems; and (d) timing of the deformation. In addition, specific lithofacies reveal correspondence with similar sedimentary events, such as: (1) very thick silicoclastic supply concentrated in restricted time ranges indicating the main deformational phases in the margin/basin systems; (2) levels rich in black-shales, glauconian, siliceous-producers, and volcaniclastic intercalations, widespread in the studied successions and linked to particular events at the Tethyan scale (anoxic periods, starvation-upwelling, acid-intermediate penecontemporaneous volcanic activity, respectively). Tectonic influence has also been recorded by means of unconformities and tectofacies (such as turbidites, slumps, or olisthostromes, etc.), being correlated with the main deformational phases. Similar stratigraphic and tectonic events have also been found in the Calvana unit of Val Marecchia nappe (Ligurides, northern Apennine). Correlations of stratigraphic and tectonic events support the proposal of an evolutionary geodynamic model involving the presence of a “Mesomediterranean microplate” in intermediate position during Africa-Europe convergence. The closure of central-western Tethys occasioned the Betic-Maghrebian-southern Apennine oceanic branch deformation and the birth of perimediterranean chains during middle-late Miocene.

Central & Eastern Africa, 1889 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: The African news map of Central Africa with Powell's radial key showing approximate distances and directions from Leopoldville & Kimpoko, on Stanley Pool. It was published by African news in 1889. Scale 1:6,336,000. Covers portions of Central & Eastern Africa.The image inside the map neatline is georeferenced to the surface of the earth and fit to the Africa Sinusoidal projected 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 drainage, cities and other human settlements, shoreline features, the Congo Free Trade Area, Baptist missionary stations, proposed railway lines, areas of colonial influence, and more. Relief shown by hachures. Includes insets: Part of Southern Africa -- Africa -- Delta of the Nile -- Map of Liberia -- Loanda -- Coanza River, etc. -- [Map of sea routes between Europe, Africa and Northern America] -- Bishop Taylor's missions on the lower Congo and a View of the pyramids from the Nile.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Greece and the European Agenda: EU Enlargement and European Monetary Union. Program for the Study of Germany & Europe Working Paper 8.2

In the decade to come, the European Union will embark on two new projects, each destined to transform it in fundamental ways: (i) Eastern enlargement, and (ii) economic and monetary union. Neither of these projects will affect all members equally or in the same way. But Greece will, for two reasons, be affected in a manner qualitatively different to all other member states. First, Greece is the only country physically affected by the Luxembourg Summit's decision to begin accession negotiations with some, but not all, Central and Eastern European applicant countries: as a result of this decision, she will continue, for at least another eight to ten years, to be the only member country not to share a common border with another member state, with all the consequent implications in economic and geostrategic tenns. Second, when the European Council meets in early May to select those member states that are deemed to have met the convergence criteria, it will find that Greece is the only member state falling short of those criteria. This development may create additional difficulties for her economy during the transitional period of derogation. It will also pose new risks to Greece, insofar as she will be absent during the initial-and crucial-years of establishing a common monetary policy.