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BioMed CentralPage 1 of 10(page number not for citation purposes)Conflict and HealthOpen AccessResearchImpact of the Kenya post-election crisis on clinic attendance and medication adherence for HIV-infected children in western KenyaRachel C Vreeman*1,2,3, Winstone M Nyandiko3,4, Edwin Sang3, Beverly S Musick3,5, Paula Braitstein3,5 and Sarah E Wiehe1,2,3Address: 1Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA, 2The Regenstrief Institute, Inc, Indianapolis, IN, USA, 3USAID – Academic Model Providing Access to Healthcare (AMPATH) Partnership, Eldoret, Kenya, 4Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya and 5Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USAEmail: Rachel C Vreeman* - rvreeman@iupui.edu; Winstone M Nyandiko - nyandikom@yahoo.com; Edwin Sang - eddusang@yahoo.com; Beverly S Musick - bsmusick@iupui.edu; Paula Braitstein - pbraitstein@yahoo.com; Sarah E Wiehe - swiehe@iupui.edu* Corresponding author AbstractBackground: Kenya experienced a political and humanitarian crisis following presidential elections on 27December 2007. Over 1,200 people were killed and 300,000 displaced, with disproportionate violence inwestern Kenya. We sought to describe the immediate impact of this conflict on return to clinic andmedication adherence for HIV-infected children cared for within the USAID-Academic Model ProvidingAccess to Healthcare (AMPATH) in western Kenya.Methods: We conducted a mixed methods analysis that included a retrospective cohort analysis, as wellas key informant interviews with pediatric healthcare providers. Eligible patients were HIV-infectedchildren, less than 14 years of age, seen in the AMPATH HIV clinic system between 26 October 2007 and25 December 2007. We extracted demographic and clinical data, generating descriptive statistics for pre-and post-conflict antiretroviral therapy (ART) adherence and post-election return to clinic for this cohort.ART adherence was derived from caregiver-report of taking all ART doses in past 7 days. We usedmultivariable logistic regression to assess factors associated with not returning to clinic. Interview dialoguefrom was analyzed using constant comparison, progressive coding and triangulation.Results: Between 26 October 2007 and 25 December 2007, 2,585 HIV-infected children (including 1,642on ART) were seen. During 26 December 2007 to 15 April 2008, 93% (N = 2,398) returned to care. Attheir first visit after the election, 95% of children on ART (N = 1,408) reported perfect ART adherence,a significant drop from 98% pre-election (p < 0.001). Children on ART were significantly more likely toreturn to clinic than those not on ART. Members of tribes targeted by violence and members of minoritytribes were less likely to return. In qualitative analysis of 9 key informant interviews, prominent barriersto return to clinic and adherence included concerns for personal safety, shortages of resources, hangingpriorities, and hopelessness.Conclusion: During a period of humanitarian crisis, the vulnerable, HIV-infected pediatric population haddisruptions in clinical care and in medication adherence, putting children at risk for viral resistance andincreased morbidity. However, unique program Vietnam Academy of Science and Technology University of Science and Technology of Hanoi CERTIFICATE OF ARRIVAL 201… / 201… We hereby confirm, that Ms/ Mr: DOB: Nationality: coming from the home institution: has arrived in the host institution: Date of arrival: Name and title of the authorized person: Signature: _ Vietnam Academy of Science and Technology University of Science and Technology of Hanoi CERTIFICATE OF ATTENDANCE 201… / 201… We hereby confirm, that Ms/ Mr: DOB: Nationality: coming from the home institution: has performed a study placement from ……./……/201… to ……./……/201… Name and title of the authorized person: Signature _ 600 SENTENCES OF CERTIFICATE AI. GRAMMAR (300 SENTENCES)1. Is Susan . home?a. inb. atc. ond. under--> b2. "Do the children go to school every day?"" ."a. Yes, they go.b. Yes, they do.c. They go.d. No, they don't go.--> b3. What now?a. is the timeb. does the timec. is timed. is it--> a4. They always go to school . bicycle.a. withb. inc. ond. by--> d5. What color . his new car?a. haveb. isc. doesd. are--> b6. Are there many students in Room 12?- " ."a. Yes there are.b. Yes, they are.c. Some are.d. No they aren't.--> a7. You should do your . before going to class.a. home workb. homeworkc. homeworksd. housework --> b8. Mr. Pike us English.a. teachb. teachesc. teachingd. to teach--> b9. Tom and . are going to the birthday party together.a. Ib. mec. myd. mine--> a10. Our English lessons are . long.a. manyb. muchc. a lot ofd. very--> d11. Bangkok is capital of Thailand.a. ab. onec. thed. an--> c12. Are you free Saturday?a. onb. atc. ind. into a13. There are girls in our class.a. nob. notc. noned. none of--> a14. Let go for a walk.a. web. usc. youd. our--> b15. What is your name?- name is Linda.a. Your b. Hisc. Myd. Her--> c16. What's . name?- His name is Henry.a. hisb. herc. yourd. my--> a17. I'm a pupil.- I'm a , too.a. teacherb. pupilc. studentd. doctor--> b18. Is this your pencil? No, it isn't. It is pencil.a. hisb. myc. yourd. hers--> a19. Are these your coats?Yes they are .a. their coatsb. oursc. our coatsd. yours--> b20. Are your free Friday evening?a. inb. atc. ond. from--> c21. There are six pencils . the box.a. inb. atc. ond. into--> a22. Where is your mother?She's the kitchen.a. in b. onc. intod. at--> a23. How many pictures are there . the wall?a. inb. onc. intod. at--> b24. Are you Vietnam?- Yes, I am.a. tob. onc. intod. from--> d25. I'm cleaning the floor. Can your help ?a. Ib. mec. myd. mine--> b26. What are you doing? - . are planting some trees.a. web. usc. ourd. ours--> a27. Mary is doing her homework and . brother is helping her.a. sheb. hersc. herd. she's--> c28. Jane's books are on the floor. Please, put . on the table.a. theyb. themc. theird. theirs--> b29. Please put this pencil in the box.- I'm putting . in the box.a. itb. itsc. them d. they--> a30. When's birthday?a. hisb. hec. himd. he's--> a31. Whose bicycle is it? It's .a. heb. herc. hersd. she--> c32. How old is .?a. sheb. herc. hersd. his--> a33. There are eggs on the table.a. someb. anyc. manyd. much--> a34. Is there cheese on the table?a. someb. anyc. manyd. much--> b35. How cakes does she want?a. someb. anyc. manyd. much--> c36. Peter doesn't want . eggs, but he wants some soup.a. someb. anyc. manyd. much--> b37. There is milk in the glass.a. some b. anyc. manyd. much--> a38. How . meat do you want?a. someb. anyc. manyd. much--> d39. There isn't coffee in the cup.a. someb. anyc. manyd. much--> b40. They want . coffee, but they don't want any bread.a. someb. anyc. manyd. much--> a41. Is this your pencil? No, it isn't. It's pencil.a. myb. herc. ourd. hers--> b42. . parents are workers.a. Web. Theyc. Ourd. I--> c43. This is my new shirt. - Oh, color is pretty.a. itb. itsc. theird. they--> b44. He is . engineer.a. anb. ac. thed. no article--> a 45. Your sister is a student and his sister is a student, a. bothb. alsoc. andd. too--> d46. My brother is 6.68 m a. shortb. tallc. tallerd. Modeling the Statistical Time and Angle of ArrivalCharacteristics of an Indoor Multipath ChannelQuentin H. SpencerA Thesis Presented toThe Department of Electrical and Computer EngineeringBrigham Young UniversityProvo, Utah, USACommittee Members:Brian D. Jeffs, chairMichael D. RiceMichael A. JensenNovember 22, 1996 AbstractMost previously proposed statistical models for the indoor multipath channel in-clude only time of arrival characteristics. However, in order to use statistical models insimulating or analyzing the performance of array processing or diversity combining, it alsonecessary to know the statistics of the angle of arrival and its correlation with time of arrival.In this paper, a system is described which was used to collect simultaneous time and angleof arrival data at 7 GHz. Data processing methods are outlined, and results of data taken intwo different buildings are presented. Based on the results, a model is proposed that employsthe clustered “double Poisson” time of arrival model proposed by Saleh and Valenzuela [1].The observed angular distribution is also clustered, with uniformly distributed clusters, andarrivals within clusters that have a Laplacian distribution.1 Chapter 1INTRODUCTIONRadio has recently become an increasingly viable option for indoor communica-tions applications. The availability of higher frequency bands in the 900 MHz and 2.4 GHzrange has made wireless an attractive option for high bandwidth digital communications ap-plications such as local area networks. Wireless networks can be particularly advantageousfor applications which require portability, or where installation of wiring is undesirable orimpractical.Multipath interference, or interference due to the reception of multiple copies of asignal due to reflections, is known to be a problem in many outdoor communication channels.However, multipath can also be particularly problematic in an indoor environment. At UHFand microwave frequencies, the presence of walls and large objects in rooms makes the indoormultipath environment quite different from most outdoor scenarios. As a result, the studyof indoor propagation characteristics has become an area of increased study.In order to analyze or simulate the performance of a communications system, somekind of model for the channel is needed. One of the first statistical models for the indoormultipath channel was proposed by Saleh and Valenzuela [1]. Their data showed multipatharrivals which were grouped in clusters over time. The relative delay between clusters wasrepresented by a Poisson distribution, and the separation between elements within clusterswas modeled by a second Poisson distribution with a different delay parameter.There have been many different approaches to overcoming the problem of multi-path interference, both in outdoor and indoor applications. Some of them include channelequalization, directional antennas, and multiple antenna systems. Each of these tends to bemore particularly suited to different applications. This thesis will focus on multiple antennasystems. The signals from different antennas can be combined in various ways, including di-versity combining, phased array processing, and adaptive array algorithms. Adaptive arraysytems are becoming increasingly feasible for high bandwidth applications with continuingimprovements in digital signal processors. The RESEARC H Open Access Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study Louise C Ivers 1,2,3,4*† , Yuchiao Chang 3,4† , J Gregory Jerome 5† , Kenneth A Freedberg 3,4† Abstract Background: Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection. We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospective observational cohort study. Methods: Adults with HIV infection were eligible for monthly food rations if they had any one of: tuberculosis, body mass index (BMI) <18.5kg/m 2 , CD4 cell count <350/mm 3 (in the prior 3 months) or severe socio-economic conditions. A total of 600 individuals (300 eligible and 300 ineligible for food assistance) were interviewed before rations were distributed, at 6 months and at 12 months. Data collected included demographics, BMI and food insecurity score (range 0 - 20). Results: At 6- and 12-month time-points, 488 and 340 subjects were eligible for analysis. Multivariable analysis demonstrated that at 6 months, food security significantly improved in those who received food assistance versus who did not (-3.55 vs -0.16; P < 0.0001); BMI decreased significantly less in the food assistance group than in the non-food group (-0.20 vs -0.66; P = 0.020). At 12 months, food assistance was associated with improved food security (-3.49 vs -1.89, P = 0.011) and BMI (0.22 vs -0.67, P = 0.036). Food assistance was associated with improved adherence to monthly clinic visits at both 6 (P < 0.001) and 12 months (P = 0.033). Conclusions: Food assistance was associated with improved food security, increased BMI, and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be pa rt of routine care where HIV and food insecurity overlap. Introduction Food insecurity and undernutrition are increasingly recognized as factors that are important in the health and livelihoods of individuals living with HIV infection in poor settings [1,2]. HIV infection has long been asso- ciated with wasting syndrome and being underweight with HIV is predictive of a poor prognosis, even in people rece iving antiretroviral therapy (ART) [1,3-5]. Food inse- curity–meaning lack of access to food of sufficient quality and quantity to perform usual daily activities–contributes to a negative cycle of events that often worsens the effect of HIV infection on ability to work, attend school, contri- bute to family livelihoods and adhere to medications [6-8]. International organizations have called for food assistance to be integrated into HIV treatment and pre- vention programs, but evidence-based guidance on how exactly to implement such programs, on what benefici- aries to target, and on what the optimal components or duration of food assistance should be is limited [9-14]. A recent study showed that food rations were associated with improved adherence to ART, but thes e data did not show any quantitative clinical benefit [15]. Attention to adequate nutrition during HIV care has the potential to contribute to improved clinical HIV-related * Correspondence: livers@pih.org † Contributed equally 1 Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA Full list of author information is available at the end of the article Ivers et al. AIDS Research and Therapy 2010, 7:33 http://www.aidsrestherapy.com/content/7/1/33 © 2010 Ivers et al; lic ensee BioMed Central Ltd. Thi s is an Open Access article distribu ted under the terms of the Creativ e Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. outcomes, improved nutritional outcomes fo r the indivi- dual, as RESEARC H Open Access Assessment of efficacy and impact on w ork productivity and attendance after a m andatory switch to generic second-generation antihistamines: results of a patient survey in Norway Fredrik Thorn 1 , Halvor Celius 2 , Tone Ødegård 2* , Randeep Mandla 2 , Erik Hexeberg 3 Abstract Background: In 2006, the Norwegian Medicines Age ncy mandated a switch from desloratadine, ebastine, or fexofenadine to cetirizine or loratadine in patients with allergic rhinitis (AR) or chronic urticaria (CU). In an online survey, patients whose medication was switched assessed the impact on efficacy, fatigue, and work productivity/ attendance. Methods: Allergy patients in Norway completed a 25-item online survey. Patients aged ≥ 18 years with AR or CU who were switched to cetirizine or loratadine from desloratadine, ebastine, or fexofenadine were included. Participants rated post-switch efficacy, fatigue, and effect on work productivity/attendance compared with their pre-switch medication. Patients also reported post-switch change in number of doctor visits required, total treatment cost, and whether they had switched or wanted to switch back to their previous medications. Results: Of 1920 patients invited, 493 responded and 409 of these were eligible. Previous antihistamines were desloratadine (78.4% of respondents), ebastine (16.0%), and fexofenadine (5.6%). Post-switch, 64.7% received cetirizine and 35.3% loratadine. Compared with previous therapy, cetirizine and loratadine were rated less effective by 46.3% of respondents; 28.7% reported increased fatigue; and 31.6% reported decreased work productivity with the generic agents. At the time of the survey, 26% of respondents had switched back to their previous medication. Conclusions: This is the first survey to assess the impact on patient-reported outcomes of a mandated switch from prescription to generic anti histamines in Norway. The findings suggest that patient response to different antihistamines will vary and that treatment decisions should be individualized for optimal results. Background Allergic rhinitis (AR) and chronic urticaria (CU) are common diseases that disturb sleep and reduce work/ school productivity [1,2]. Treatment guidelines r ecom- mend second-generation antihistamines, including cetiri- zine, desloratadine, ebastine, fexofenadine, levocetirizine, and loratadine, as a f irst-line treatment for AR [1] and CU [2]. Although data on comparative efficacy of second-gen- eration antihistamines are limited, clinical studies demonstrate that patients with AR or CU who fail to respond to one antihistamine may b enefit from a switch to another [3-6]. In 2006, based on a report [7] that drew no conclusions regarding efficacy or safety differ- ences among the 6 antihistamines mentioned above, the Norwegian Medicines Agency mandated, as a cost-cut- ting measure and requirement for continued govern- mental reimbursement, that health care providers substitute generic cetirizine or loratadine for deslorata- dine, ebastine, or fexofenadine in their AR and CU patients, irrespective of treatment success or patient satisfaction with their current regimen [8]. Only those patients who failed treatment with both cetirizine and loratadine could switch back to the newer agents [8]. * Correspondence: tone.odegard@merck.com 2 MSD Norge AS, Drammen, Norway Full list of author information is available at the end of the article Thorn et al. Clinical and Molecular Allergy 2011, 9:5 http://www.clinicalmolecularallergy.com/content/9/1/5 CMA © 2011 Thorn et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. An online survey conducted in 2007 in Norwegian general practice settings evaluated patient experiences regarding efficacy, fatigue, ...Vietnam Academy of Science and Technology University of Science and Technology of Hanoi CERTIFICATE OF ATTENDANCE 201… / 201… We hereby confirm, that Ms/ Mr: ... has performed a study placement from ……./……/201… to ……./……/201… Name and title of the authorized person: Signature