Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

Palynostratigraphy of the last centuries in Switzerland based on 23 lake and mire deposits: chronostratigraphic pollen markers, regional patterns, and local histories

A total of 23 pollen diagrams [stored in the Alpine Palynological Data-Base (ALPADABA), Geobotanical Institute, Bern] cover the last 100 to over 1000 years. The sites include 15 lakes, seven mires, and one soil profile distributed in the Jura Mts (three sites), Swiss Plateau (two sites), northern Pre-Alps and Alps (six sites), central Alps (five sites), southern Alps (three sites), and southern Pre-Alps (four sites) in the western and southern part of Switzerland or just outside the national borders. The pollen diagrams have both a high taxonomic resolution and a high temporal resolution, with sampling distances of 0.5–3 cm, equivalent to 1 to 11 years for the last 100 years and 8 to 130 years for earlier periods. The chronology is based on absolute dating (14 sites: 210Pb 11 sites; 14C six sites; varve counting two sites) or on biostratigraphic correlation among pollen diagrams. The latter relies mainly on trends in Cannabis sativa, Ambrosia, Mercurialis annua, and Ostrya-type pollen. Individual pollen stratigraphies are discussed and sites are compared within each region. The principle of designating local, extra-local, and regional pollen signals and vegetation is exemplified by two pairs of sites lying close together. Trends in biostratigraphies shared by a major part of the pollen diagrams allow the following generalisations. Forest declined in phases since medieval times up to the late 19th century. Abies and Fagus declined consistently, whereas the behaviour of short-lived trees and trees of moist habitats differed among sites (Alnus glutinosa-type, Alnus viridis, Betula, Corylus avellana). In the present century, however, Picea and Pinus increased, followed by Fraxinus excelsior in the second half of this century. Grassland (traced by Gramineae and Plantago lanceolata-type pollen) increased, replacing much of the forest, and declined again in the second half of this century. Nitrate enrichment of the vegetation (traced by Urtica) took place in the first half of this century. These trends reflect the intensification of forest use and the expansion of grassland from medieval times up to the end of the last century, whereas subsequently parts of the grassland became used more intensively and the marginal parts were abandoned for forest regrowth. In most pollen diagrams human impact is the dominant factor in explaining inferred changes in vegetation, but climatic change plays a role at three sites.

Geochemistry and stratigraphy on sediment cores from Leg198 and Leg 208

The first complete cyclic sedimentary successions for the early Paleogene from drilling multiple holes have been retrieved during two ODP expeditions: Leg 198 (Shatsky Rise, NW Pacific Ocean) and Leg 208 (Walvis Ridge, SE Atlantic Ocean). These new records allow us to construct a comprehensive astronomically calibrated stratigraphic framework with an unprecedented accuracy for both the Atlantic and the Pacific Oceans covering the entire Paleocene epoch based on the identification of the stable long-eccentricity cycle (405-kyr). High resolution X-ray fluorescence (XRF) core scanner and non-destructive core logging data from Sites 1209 through1211 (Leg 198) and Sites 1262, 1267 (Leg 208) are the basis for such a robust chronostratigraphy. Former investigated marine (ODP Sites 1001 and 1051) and land-based (e.g., Zumaia) sections have been integrated as well. The high-fidelity chronology is the prerequisite for deciphering mechanisms in relation to prominent transient climatic events as well as completely new insights into Greenhouse climate variability in the early Paleogene. We demonstrate that the Paleocene epoch covers 24 long eccentricity cycles. We also show that no definite absolute age datums for the K/Pg boundary or the Paleocene - Eocene Thermal Maximum (PETM) can be provided by now, because of still existing uncertainties in orbital solutions and radiometric dating. However, we provide two options for tuning of the Paleocene which are only offset by 405-kyr. Our orbitally calibrated integrated Leg 208 magnetostratigraphy is used to revise the Geomagnetic Polarity Time Scale (GPTS) for Chron C29 to C25. We established a high-resolution calcareous nannofossil biostratigraphy for the South Atlantic which allows a much more detailed relative scaling of stages with biozones. The re-evaluation of the South Atlantic spreading rate model features higher frequent oscillations in spreading rates for magnetochron C28r, C27n, and C26n.

Stable isotope organic chemistry of ODP Leg 105 sites

Stable carbon and nitrogen isotopic compositions as well as organic carbon and total nitrogen contents are reported for Site 645 in Baffin Bay and Sites 646 and 647 in the Labrador Sea. Both low-resolution analyses (1 sample/section) and high-resolution results (up to 7 samples/section) are presented. These records indicate that large-scale changes in productivity since the middle Miocene have occurred in Baffin Bay. Such changes are not evident in samples from the Labrador Sea. Isotopic records of all the sites are influenced strongly by rapidly changing influxes that combine terrigenous debris with planktonic production. In parts of the cores, relationships to other phenomena, such as ice stages, are present. However, these correlations are not common and indicate that these events were masked by the dynamic changes in sources of organic matter occurring in this complex system.

Biogenic and terrigeneous components in ODP Leg 108 holes

Five Ocean Drilling Program sites (657-661), which form a north-south transect off the western periphery of the Sahara, were selected to measure the long-term history of Saharan/Sahelian dust flux and fluvial sediment discharge and the fluxes of marine CaCO3 and opal over the last 8 m.y. Sites 658 and 659 served for high-resolution studies, and Sites 657, 660, and 661 for insights into the spatial patterns of dust flux. The nearshore mean flux of opal off Cap Blanc (21 °N) showed an abrupt increase about 3 Ma that appears to reflect the main onset of coastal upwelling fertility and enhanced trade winds. At the same time, the input of river-borne clay strongly decreased, suggesting a dry up of the central Saharan rivers. Later, marked short-lived spikes of clay and opal may indicate ongoing ephemeral pulses of fluvial runoff linked to peak interglacial stages. Given the zonal dust discharge centered near 18 °N at Site 659, the aridification of the south Sahara and Sahel increased in several steps: at 4.6, 4.3, and especially at 4.0, 3.6, and 2.1 Ma, and again, at 0.8 Ma. The late Miocene and earliest Pliocene were humid. Although the central and north Saharan climate appears to be linked to the glaciation history of the Northern Hemisphere, the long-term aridification further south followed a different schedule. The spatial distribution of quartz accumulation suggests that the dust outbreaks linked to the Intertropical Convergence Zone during summer did not shift in latitude back to 4.0 Ma, at least. The short-term variations of dust output over the last 0.5 m.y. followed orbital scale pulses with a strong precessional signal, showing a link of Sahelian humidity changes to the variation of sea-surface temperature and evaporation in the tropical Atlantic.

Major and trace elements at DSDP Leg 74 Holes

Deep Sea Drilling Project Leg 74 drilled basement on the Walvis Ridge at Sites 525, 527, and 528. These sites are located on the crest and flanks of the segment of the Ridge about 68 to 70 m.y. old in the central province of the Ridge. Each site has a number of distinct subaqueous flows separated by sediment layers. Although variation in geochemistry among units and sites is related in part to alteration or crystal fractionation, some is caused by small-scale compositional variation in the mantle source of the basalts. Leg 74 basalts are similar to other basalts recovered from the Walvis Ridge and the Rio Grande Rise. They show distinct compositional differences to mid-ocean ridge basalts in general, to those recovered from the South Atlantic at this latitude, and to basalts presently erupting in Tristan da Cunha. The composition of the Walvis Ridge basalts does not suggest simple mixtures of present-day MORB and Tristan da Cunha melts. If the Walvis Ridge represents the trace of the Tristan da Cunha hot spot as the plates separated, then the composition of the mantle source has differed at different times in the past, which suggests mantle heterogeneity.

Radiocarbon ages and diatom isotope data for Lake El'gygytgyn sediment core Lz1029

Determining the response of sites within the Arctic Circle to long-term climatic change remains an essential pre-requisite for assessing the susceptibility of these regions to future global warming and Arctic amplification. To date, existing records from North East Russia have demonstrated significant spatial variability across the region during the late Quaternary. Here we present diatom d18O and d30Si data from Lake El'gygytgyn, Russia, and suggest environmental changes that would have impacted across West Beringia from the Last Glacial Maximum to the modern day. In combination with other records, the results raise the potential for climatic teleconnections to exist between the region and sites in the North Atlantic. The presence of a series of 2-3 per mil decreases in d18Odiatom during both the Last Glacial and the Holocene indicates the sensitivity of the region to perturbations in the global climate system. Evidence of an unusually long Holocene thermal maximum from 11.4 ka BP to 7.6 ka BP is followed by a cooling trend through the remainder of the Holocene in response to changes in solar insolation. This is culminated over the last 900 years by a significant decrease in d18Odiatom of 2.3 per mil, which may be related to a strengthening and easterly shift of the Aleutian Low in addition to possible changes in precipitation seasonality.

Cretaceous calcareous nannofossils from Exmouth and Wombat Plateau, Northwest Australia

Three sites drilled during Leg 122, Site 761 on the Wombat Plateau and Sites 762 and 763 on the Exmouth Plateau, provide a composite Cretaceous section ranging in age from Berriasian to Maestrichtian. Together, these sites contain an apparently complete, expanded Aptian-Maestrichtian record. Consistently occurring and moderately well-preserved nannofossil assemblages allow reasonably high biostratigraphic resolution. Our data indicate that traditional middle and Upper Cretaceous nannofossil biozonations are not entirely applicable in this region. In this investigation, we compare in detail the relative ranges of key Cretaceous nannofossil markers in the eastern Indian Ocean and in sections from Europe and North Africa. We have determined which previously used events are applicable, and which additional markers have biostratigraphic utility in this region. Significant differences in Campanian-Maestrichtian assemblages exist between the more northern Site 761 and Sites 762 and 763. Such differences are surprising, considering that these sites are only separated by 3° of latitude. We interpret them as marking a strong thermal gradient over the Exmouth Plateau region. Other results include the recovery of an expanded Albian-Cenomanian sequence containing a mixture of Austral and Tethyan floras, which will enable correlation of biozonations established for these two realms; the recovery of two condensed but apparently complete Cenomanian-Turonian boundary sections; correlation of Upper Cretaceous calcareous nannofossil biostratigraphy with magneto- and foraminifer stratigraphy; and correlation of portions of the Barrow Group equivalents to the Berriasian and Valanginian stages.

(Table 1) Chemical compositions of beryllium in sediments and pore waters of ODP Hole 131-808

Studies of Be distributions in subduction zone sediments will help to understand questions regarding the enrichments of cosmogenic Be-10 in arc volcanic rocks. Analyses of Be-10 and Be-9 in sediments of Ocean Drilling Program Site 808, Nankai Trough and Be-9 in porewaters of Site 808 and Sites 671 and 672, Barbados ridge complex, show significant decreases in solid phase Be-10 and large increases of porewater Be-9 at the location of the décollement zone and below or at potential flow conduits. These data imply the potential mobilization of Be during pore fluid expulsion upon sediment burial. Experiments involving reaction between a décollement sediment and a synthetic NaCl-CaCl2 solution at elevated pressure and temperatures were conducted in an attempt to mimic early subduction zone processes. The results demonstrate that Be is mobilized under elevated pressure and temperature with a strong pH dependence. The Be mobilization provides an explanation of Be-10 enrichment in arc volcanic rocks and supports the argument of the importance of the fluid processes in subduction zones at convergent margins.

Ethics and materials: Some Spanish Cases

The problem is general: modern architects and engineers are trying to understand historic structures using the wrong theoretical frame, the classic (elastic) thery of structures developed in the 19th Century for iron and stell, and in the 20th century for reinforced concrete, disguised with "modern" computer packages, mainly FEM, but also others. Masonry is an essentially different material, and the structural equations must be adapted accordingly. It is not a matter of "taste" or "opinion", and the consequences are before us. Since, say 1920s, historic monuments have suffered the aggression of generations of archietcts and engineers, trying to transform masonry in reinfored concrete or steel. The damage to the monuments and the expense has been, and is, enormous. However, as we have an adequate theory (modern limit analysis of masonry structures, Heyman 1966) which encompasses the "old theory" used successfully by the 18th and 19th Century practical engineers (from Perronet to Sejourné), it is a matter of "Ethics" not to use the wrong approach. It is also "contra natura" to modify the material masonry with indiscriminate injections, stitchings, etc. It is insane to consider, suddenly, that buildings which are Centuries or milennia old, are suddenly in danger of collapse. Maintenance is necessary but not the actual destruction of the constructive essence of the monument. A cocktail of "ignorance, fear and greed" is acting under the best of intentions.

Study of PM10 and PM2.5 levels in three European cities: Analysis of intra and inter urban variations

In the present paper, 1-year PM10 and PM 2.5 data from roadside and urban background monitoring stations in Athens (Greece), Madrid (Spain) and London (UK) are analysed in relation to other air pollutants (NO,NO2,NOx,CO,O3 and SO2)and several meteorological parameters (wind velocity, temperature, relative humidity, precipitation, solar radiation and atmospheric pressure), in order to investigate the sources and factors affecting particulate pollution in large European cities. Principal component and regression analyses are therefore used to quantify the contribution of both combustion and non-combustion sources to the PM10 and PM 2.5 levels observed. The analysis reveals that the EU legislated PM 10 and PM2.5 limit values are frequently breached, forming a potential public health hazard in the areas studied. The seasonal variability patterns of particulates varies among cities and sites, with Athens and Madrid presenting higher PM10 concentrations during the warm period and suggesting the larger relative contribution of secondary and natural particles during hot and dry days. It is estimated that the contribution of non-combustion sources varies substantially among cities, sites and seasons and ranges between 38-67% and 40-62% in London, 26-50% and 20-62% in Athens, and 31-58% and 33-68% in Madrid, for both PM10 and PM 2.5. Higher contributions from non-combustion sources are found at urban background sites in all three cities, whereas in the traffic sites the seasonal differences are smaller. In addition, the non-combustion fraction of both particle metrics is higher during the warm season at all sites. On the whole, the analysis provides evidence of the substantial impact of non-combustion sources on local air quality in all three cities. While vehicular exhaust emissions carry a large part of the risk posed on human health by particle exposure, it is most likely that mitigation measures designed for their reduction will have a major effect only at traffic sites and additional measures will be necessary for the control of background levels. However, efforts in mitigation strategies should always focus on optimal health effects.

Repair works at Saint Claire Convent in Chinchón (Madrid, Spain)

The Chinchón Saint Claire Convent is a Count Foundation of 1653. Some repair works were made around 1965, but some important cracks were remained. This paper describes the soil study made to know, its properties, the reason of these movements and its consequences to the convent and the repair works done. A high swelling phenomenon has been detected. The convent is on a high plasticity clayey soil with soil sandy insertions. The soil water has a high content of sulphates. In addition, some sewer system piping was broken around the convent and frequently flooded the convent crypt. A micropiles underpinning was made and the water leaked has lead to the sewer system to avoid the crypt flooding, also a drainage system has been made and the ground around the church has been paved.

CCAAT/enhancer binding protein (C/EBP) sites are required for HIV-1 replication in primary macrophages but not CD4+ T cells

The importance of CCAAT/enhancer binding proteins (C/EBPs) and binding sites for HIV-1 replication in primary macrophages, T cell lines and primary CD4+ T cells was examined. When lines overexpressing the C/EBP dominant-negative protein LIP were infected with HIV-1, replication occurred in Jurkat T cells but not in U937 promonocytes, demonstrating a requirement for C/EBP activators by HIV-1 only in promonocytes. Primary macrophages did not support the replication of HIV-1 harboring mutant C/EBP binding sites in the long terminal repeat but Jurkat, H9 and primary CD4+ T cells supported replication of wild-type and mutant HIV-1 equally well. Thus the requirement for C/EBP sites is also confined to monocyte/macrophages. The requirement for C/EBP proteins and sites identifies the first uniquely macrophage-specific regulatory mechanism for HIV-1 replication.

Proteome Analysis Database: online application of InterPro and CluSTr for the functional classification of proteins in whole genomes

The SWISS-PROT group at EBI has developed the Proteome Analysis Database utilising existing resources and providing comparative analysis of the predicted protein coding sequences of the complete genomes of bacteria, archaea and eukaryotes (http://www.ebi.ac.uk/proteome/). The two main projects used, InterPro and CluSTr, give a new perspective on families, domains and sites and cover 31–67% (InterPro statistics) of the proteins from each of the complete genomes. CluSTr covers the three complete eukaryotic genomes and the incomplete human genome data. The Proteome Analysis Database is accompanied by a program that has been designed to carry out InterPro proteome comparisons for any one proteome against any other one or more of the proteomes in the database.

Vitrinite reflectance and carbon chemistry of ODP Leg 122 samples (Table 1)

A summary of shipboard Rock-Eval measurements shows that organic matter in Upper Triassic siltstone from the Wombat Plateau is dominated by Type III kerogen and is thermally immature. Neocomian siltstone from the Exmouth Plateau similarly contain thermally immature Type III organic matter. Overlying Upper Cretaceous to Quaternary carbonates are poor in organic matter at both locations, yet significant amounts of methane-dominated gas are dissolved in the pore waters of the thick carbonate sequence present on the Exmouth Plateau. This dry gas is believed to have migrated from deeper and more mature strata containing Type III kerogen.