TB control: a matter of lifestyle

In the West, TB was controlled before there was medication on the market. In South Africa this is far from the case: the inheritance of apartheid, poverty among certain social groups, and an exponential increase in HIV/AIDS make TB control almost impossible. The co-existence of two medical traditions (the Western medical system and traditional healing) exacerbates the challenge of finding effective measures for TB control. This paper aims to understand the underlying patterns of the persistant spread of this disease. Its point of reference is Max Weber’s notion of Stilisierung des Lebens, or lifestyle, in which the dialectic process of “chance” and “choice” plays an important role. In the category of chance, much can be done by policy-makers to create successful healthcare programmes, such as DOTS within TB control. Policy-makers, however, are not the only players responsible. Individuals must also take responsibility by opting for the chances provided. Even then, the spectre of the past may continue to bedevil the health outcomes of South Africans as they endeavour to build a new nation

Differences in Tumor-Associated Protein Levels among Middle-Age Flemish Women in Association with Area of Residence and Exposure to Pollutants

We measured tumor-associated proteins (TAPs) and pollutants in blood, serum, and urine of 200 nonsmoking women 50–65 years of age, residing in the rural municipality of Peer or in Hoboken or Wilrijk, industrial suburbs of Antwerp, Belgium. Persons with occupational exposures or commuting to other towns were excluded. Residents from Hoboken had significantly higher levels of blood lead and serum zinc and polychlorinated biphenyls. Surprisingly, residents of Peer had significantly higher levels of serum cadmium, dioxin-like activity in blood fat, and urinary 1-hydroxypyrene. For 5 of the 12 TAPs assessed in this study, we observed significant differences in serum levels among residents of the three municipalities after adjusting for personal or lifestyle parameters. Although we found levels of internal exposure to pollutants to be quite homogeneous in Flanders, we found significantly higher levels of TAPs only in the industrial suburbs. In multiple regression with all 29 available personal, lifestyle, and internal exposure parameters, blood lead levels showed a positive association with serum levels of anti-p53, carcino-embryonic antigen (CEA), and tissue polypeptide–specific antigen (TPS) and with an index for mean TAP level (I(tap)); dioxin-like activity in serum and serum copper showed a positive association with serum CA 125 (cancer antigen 125); and serum zinc showed a positive association with serum levels of c-erbB-2 ectodomain and TPS. An index of internal exposure showed a positive association with serum levels of both CEA and anti-p53 and with I(tap). This study provides some evidence that levels of internal exposure such as those present in Flanders, in particular concerning lead, are indeed associated with biologic effects

Copernicus and Earth observation in support of EU policies

The Copernicus programme for Earth observation represents a big investment by the EU, justified by expected returns in public governance and private business. Copernicus is user and policy driven, and provides cross-domain products and services with a full free and open data policy and where possible taking up new technologies and research. This study has made a survey of the extent that Copernicus is used to support policy making in the European Commission, also assessing the perspectives for increased uptake. Also other Earth observation data and information has been looked at. An extensive use of the services is observed for policies monitoring landuse, climatic and environmental conditions, and this is expected to increase further with e.g. the new Common Agricultural Policy and the Land Use, Land-Use Change and Forestry Regulation. Information of the Climate Change Service on optimal land-use targeting specific human activities, harnessing the beneficial opportunities of climate change, provides policy makers with a new set of adaptation measures. While air quality measures can be monitored by the atmosphere service, the marine service provides input to the information system for marine knowledge. The emergency service supports disaster risk reduction measures and a resilient build-up of society. Security is of increasing importance where land and water resources are at the origin of conflict and migration. Several lines of action have been identified to improve uptake: Increasing engagement within the policy Directorates-General, fostering feedback loops between the end-users and Copernicus services, Increasing communication, information and training, setting standards and guaranteeing quality controls, enabling full integration of different datasets. The Copernicus programme brings a unique opportunity to the EU for being a global player, addressing SDGs and International Conventions because of its a long-term sustained commitment and strong international dimension. No such space programme is currently available elsewhere.JRC.D.6-Knowledge for Sustainable Development and Food Securit

Europe's Space capabilities for the benefit of the Arctic

In recent years, the Arctic region has acquired an increasing environmental, social, economic and strategic importance. The Arctic’s fragile environment is both a direct and key indicator of the climate change and requires specific mitigation and adaptation actions. The EU has a clear strategic interest in playing a key role and is actively responding to the impacts of climate change safeguarding the Arctic’s fragile ecosystem, ensuring a sustainable development, particularly in the European part of the Arctic. The European Commission’s Joint Research Centre has recently completed a study aimed at identifying the capabilities and relevant synergies across the four domains of the EU Space Programme: earth observation, satellite navigation, satellite communications, and space situational awareness (SSA). These synergies are expected to be key enablers of new services that will have a high societal impact in the region, which could be developed in a more cost-efficient and rapid manner. Similarly, synergies will also help exploit to its full extent operational services that are already deployed in the Arctic (e.g., the Copernicus emergency service or the Galileo Search and rescue service could greatly benefit from improved satellite communications connectivity in the region).JRC.E.2-Technology Innovation in Securit

A trial like ALIC4E: why design a platform, response-adaptive, open, randomised controlled trial of antivirals for influenza-like illness?

ALIC4E is the first publicly funded, multicountry, pragmatic study determining whether antivirals should be routinely prescribed for influenza-like illness in primary care. The trial aims to go beyond determining the average treatment effect in a population to determining effects in patients with combinations of participant characteristics (age, symptom duration, illness severity, and comorbidities). It is one of the first platform, response-adaptive, open trial designs implemented in primary care, and this article aims to provide an accessible description of key aspects of the study design. 1) The platform design allows the study to remain relevant to evolving circumstances, with the ability to add treatment arms. 2) Response adaptation allows the proportion of participants with key characteristics allocated to study arms to be altered during the course of the trial according to emerging outcome data, so that participants' information will be most useful, and increasing their chances of receiving the trial intervention that will be most effective for them. 3) Because the possibility of taking placebos influences participant expectations about their treatment, and determining effects of the interventions on patient help seeking and adherence behaviour in real-world care is critical to estimates of cost-effectiveness, ALIC4E is an open-label trial

International Perspectives on the Legal Environment for Selection

Perspectives from 22 countries on aspects of the legal environment for selection are presented in this article. Issues addressed include (a) whether there are racial/ethnic/religious subgroups viewed as "disadvantaged,” (b) whether research documents mean differences between groups on individual difference measures relevant to job performance, (c) whether there are laws prohibiting discrimination against specific groups, (d) the evidence required to make and refute a claim of discrimination, (e) the consequences of violation of the laws, (f) whether particular selection methods are limited or banned, (g) whether preferential treatment of members of disadvantaged groups is permitted, and (h) whether the practice of industrial and organizational psychology has been affected by the legal environmen

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents

Background: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. Methods: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2–18 years) from 18 different European countries. Results: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age. Conclusions: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.peer-reviewe