Major Challenges in Clinical Management of TB/HIV Coinfected Patients in Eastern Europe Compared with Western Europe and Latin America.

OBJECTIVES Rates of TB/HIV coinfection and multi-drug resistant (MDR)-TB are increasing in Eastern Europe (EE). We aimed to study clinical characteristics, factors associated with MDR-TB and predicted activity of empiric anti-TB treatment at time of TB diagnosis among TB/HIV coinfected patients in EE, Western Europe (WE) and Latin America (LA). DESIGN AND METHODS Between January 1, 2011, and December 31, 2013, 1413 TB/HIV patients (62 clinics in 19 countries in EE, WE, Southern Europe (SE), and LA) were enrolled. RESULTS Significant differences were observed between EE (N = 844), WE (N = 152), SE (N = 164), and LA (N = 253) in the proportion of patients with a definite TB diagnosis (47%, 71%, 72% and 40%, p<0.0001), MDR-TB (40%, 5%, 3% and 15%, p<0.0001), and use of combination antiretroviral therapy (cART) (17%, 40%, 44% and 35%, p<0.0001). Injecting drug use (adjusted OR (aOR) = 2.03 (95% CI 1.00-4.09), prior anti-TB treatment (3.42 (1.88-6.22)), and living in EE (7.19 (3.28-15.78)) were associated with MDR-TB. Among 585 patients with drug susceptibility test (DST) results, the empiric (i.e. without knowledge of the DST results) anti-TB treatment included ≥3 active drugs in 66% of participants in EE compared with 90-96% in other regions (p<0.0001). CONCLUSIONS In EE, TB/HIV patients were less likely to receive a definite TB diagnosis, more likely to house MDR-TB and commonly received empiric anti-TB treatment with reduced activity. Improved management of TB/HIV patients in EE requires better access to TB diagnostics including DSTs, empiric anti-TB therapy directed at both susceptible and MDR-TB, and more widespread use of cART.

The Early Spörer Minimum – A Period of Extraordinary Climate and Socio-economic Changes in Western and Central Europe

Throughout the last millennium, mankind was affected by prolonged deviations from the climate mean state. While periods like the Maunder Minimum in the 17th century have been assessed in greater detail, earlier cold periods such as the 15th century received much less attention due to the sparse information available. Based on new evidence from different sources ranging from proxy archives to model simulations, it is now possible to provide an end-to-end assessment about the climate state during an exceptionally cold period in the 15th century, the role of internal, unforced climate variability and external forcing in shaping these extreme climatic conditions, and the impacts on and responses of the medieval society in Central Europe. Climate reconstructions from a multitude of natural and human archives indicate that, during winter, the period of the early Spörer Minimum (1431–1440 CE) was the coldest decade in Central Europe in the 15th century. The particularly cold winters and normal but wet summers resulted in a strong seasonal cycle that challenged food production and led to increasing food prices, a subsistence crisis, and a famine in parts of Europe. As a consequence, authorities implemented adaptation measures, such as the installation of grain storage capacities, in order to be prepared for future events. The 15th century is characterised by a grand solar minimum and enhanced volcanic activity, which both imply a reduction of seasonality. Climate model simulations show that periods with cold winters and strong seasonality are associated with internal climate variability rather than external forcing. Accordingly, it is hypothesised that the reconstructed extreme climatic conditions during this decade occurred by chance and in relation to the partly chaotic, internal variability within the climate system.

Differences into HT and HTO concentrations in air into the Western Mediterranean Basin and Continental Europe and Safety Related Issues.

Real time Tritium concentrations in air in two chemical forms, HT and HTO, coming from an ITER-like fusion reactor as source were coupled the European Centre Medium Range Weather Forecast (ECMWF) numerical model with the Lagrangian Atmospheric-particle dispersion model FLEXPART. This tool was analyzed in nominal tritium discharge operational reference and selected incidental conditions affecting the Western Mediterranean Basin during 45 days during summer 2010 together with surface “wind observations” or weather data based in real hourly observations of wind direction and velocity providing a real approximation of the tritium behavior after the release to the atmosphere from a fusion reactor. From comparison with NORMTRI - a code using climatologically sequences as input - over the same area, the real time results have demonstrated an apparent overestimation of the corresponding climatologically sequence of Tritium concentrations in air outputs, at several distances from the reactor. For this purpose two development patterns were established. The first one was following a cyclonic circulation over the Mediterranean Sea and the second one was based on the plume delivered over the Interior of the Iberian Peninsula and Continental Europe by another stabilized circulation corresponding to a High Pressure System. One of the important remaining activities defined then, was the qualification tool. In order to validate the model of ECMWF/FLEXPART we have developed of a new complete data base of tritium concentrations for the months from November 2010 to March 2011 and defined a new set of four patterns of HT transport in air, in each case using real boundary conditions: stationary to the North, stationary to the South, fast and very fast displacement. Finally the differences corresponding to those four early patterns (each one in assessments 1 and 2) has been analyzed in terms of the tuning of safety related issues and taking into account the primary phase o- - f tritium modeling, from its discharge to the atmosphere to the deposition on the ground, will affect to the complete tritium environmental pathway altering the chronic dose by absorption, reemission and ingestion both from elemental tritium, HT and from the oxide of tritium, HTO

Early human occupation of Western Europe: Paleomagnetic dates for two paleolithic sites in Spain

The lacustrine deposits infilling the intramontane Guadix-Baza Basin, in the Betic Range of Southern Spain, have yielded abundant well-preserved lithic artifacts. In addition, the lake beds contain a wide range of micromammals including Mimomys savini and Allophaiomys burgondiae and large mammals such as Mammuthus and Hippopotamus together with the African saber-toothed felid Megantereon. The association of the lithic artifacts along with the fossil assemblages, themselves of prime significance in the Eurasian mammal biochronology, is providing new insight into the controversy of the human settlement in Southern Europe. Despite the importance of the artifacts and fossil assemblage, estimates of the geological age of the site are still in conflict. Some attempts at dating the sediments have included biochronology, uranium series, amino acid racemization, and stratigraphic correlation with other well-dated sections in the basin, but so far have failed to yield unambiguous ages. Here we present paleomagnetic age dating at the relevant localities and thus provide useful age constraints for this critical paleoanthropological and mammal site. Our data provide firm evidence for human occupation in Southern Europe in the Lower Pleistocene, around 1 mega-annum ago. The current view of when and how hominids first dispersed into Europe needs to be reevaluated.

Western Europe and Japan: Trade War or Trade Peace. Congressional Record, proceedings and debates of the 91st Congress, first session. Volume 115, No. 187, 13 November 1969

Western Europe and Japan: Trade war and trade peace