Introduction

This chapter: ■ explains what is meant by a complex emergency and the different phases of an emergency ■ discusses the impact of complex emergencies, explaining who is affected ■ provides basic information about malaria parasites, malaria transmission and populations at risk, and why malaria is signifi cant in emergency situations ■ sets out the key steps of an effective emergency response

Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp.

BACKGROUND: Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011-2013) were compared on outcome measures that included viral suppression and adherence to ART. METHODS: This study used a repeated cross-sectional design (Round One and Round Two). All adults (≥18 years) receiving care from the refugee camp clinic and taking antiretroviral therapy (ART) for ≥30 days were invited to participate. Adherence was measured by self-report and monthly pharmacy refills. Whole blood was measured on dried blood spots. HIV-1 RNA was quantified and treatment failures were submitted for drug resistance testing. A remedial intervention was implemented in response to baseline testing. The primary outcome was viral load <5000 copies/mL. The two study rounds took place in 2011-2013. RESULTS: Among eligible adults, 86% (73/85) of refugees and 84% (86/102) of Kenyan host nationals participated in the Round One survey; 60% (44/73) and 58% (50/86) of Round One participants were recruited for Round Two follow-up viral load testing. In Round One, refugees were older than host nationals (median age 36 years, interquartile range, IQR 31, 41 vs 32 years, IQR 27, 38); the groups had similar time on ART (median 147 weeks, IQR 38, 64 vs 139 weeks, IQR 39, 225). There was weak evidence for a difference between proportions of refugees and host nationals who were virologically suppressed (<5000 copies/mL) after 25 weeks on ART (58% vs 43%, p = 0.10) and no difference in the proportions suppressed at Round Two (74% vs 70%, p = 0.66). Mean adherence within each group in Round One was similar. Refugee status was not associated with viral suppression in multivariable analysis (adjusted odds ratio: 1.69, 95% CI 0.79, 3.57; p = 0.17). Among those not suppressed at either timepoint, 69% (9/13) exhibited resistance mutations. CONCLUSIONS: Virologic outcomes among refugees and host nationals were similar but unacceptably low. Slight improvements were observed after a remedial intervention. Virologic monitoring was important for identifying an underperforming ART program in a remote facility that serves refugees alongside host nationals. This work highlights the importance of careful laboratory monitoring of vulnerable populations accessing ART in remote settings

Modelling societal transitions with agent transformation

Transition models explain long-term and large-scale processes fundamentally changing the structure of a societal system. Our concern is that most transition models are too static. Although they capture a move of focus from static equilibria to transitions between dynamic equilibria, they are still rooted in an "equilibriumist" approach. Improvement is possible with agent-based models that give attention to endogenous system processes called "transformation processes". These models can render far more dynamic pictures of societal systems in transition, and are no longer remote from descriptions in the emerging transition literature

If You Could Only Choose Five Psychotropic Medicines: Updating the Interagency Emergency Health Kit

Mark van Ommeren and colleagues describe how they chose five psychotropic medicines to add to the Interagency Emergency Health Kit, which is a box with medicines and medical supplies designed to help people in major humanitarian emergencies

Metaphor and intertextuality in media framings of the (1984-85) British Miners' Strike:a multimodal analysis

The British Miners’ Strike of 1984-1985 represents one of the most pivotal periods in British industrial relations. Media stance toward the miners remains a controversial issue today, as attested by recent publications looking back at the strike (Williams 2009a, 2014). Here, authors including miners, journalists and other commentators argue that media coverage of the strike followed a consistently anti trade union agenda in which the media sought to destabilise the strike. An internal BBC report only recently made public shows that the BBC themselves had concerns over possible imbalances in their coverage of the so-called ‘Battle of Orgreave’ (Harcup 2014). Despite the weight attached to media coverage in this context, however, surprisingly little research has been conducted from a discourse-analytical perspective to show systematically and empirically how such an agenda may have been manifested across media texts. In this paper, drawing on Critical Cognitive Linguistics, I show how one particular metaphorical framing of the strike, which construed the strike as a war between the State and the National Union of Miners, persisted through the year long period and consider the potential ideological functions of this framing in media strategies of (de)legitimation. I show how this metaphor featured in linguistic, visual and multimodal forms of media representatio

The Effect of Keyboard-Based Word Processing on Students With Different Working Memory Capacity During the Process of Academic Writing

This study addresses the current debate about the beneficial effects of text processing software on students with different working memory (WM) during the process of academic writing, especially with regard to the ability to display higher-level conceptual thinking. A total of 54 graduate students (15 male, 39 female) wrote one essay by hand and one by keyboard. Our results show a beneficial effect of text processing software, in terms of both the qualitative and quantitative writing output. A hierarchical cluster analysis was used to detect distinct performance groups in the sample. These performance groups mapped onto three differing working memory profiles. The groups with higher mean WM scores manifested superior writing complexity using a keyboard, in contrast to the cluster with the lowest mean WM. The results also point out that more revision during the writing process itself does not inevitably reduce the quality of the final output

Introduction of Heated Cow's Milk Protein in Challenge-Proven Cow's Milk Allergic Children:The iAGE Study

The introduction of baked milk products in cow's milk (CM) allergic children has previously been shown to accelerate induction tolerance in a selected group of children. However, there is no standardized baked milk product on the market. Recently, a new standardized, heated and glycated cow's milk protein (HP) product was developed. The aim of this study was to measure safety and tolerability of a new, well characterized heated CM protein (HP) product in cow's milk allergic (CMA) children between the age of 3 and 36 months. The children were recruited from seven clinics throughout The Netherlands. The HP product was introduced in six incremental doses under clinical supervision. Symptoms were registered after introduction of the HP product. Several questionnaires were filled out by parents of the children. Skin prick tests were performed with CM and HP product, sIgE to CM and α-lactalbumin (Bos d4), β-lactoglobulin (Bos d5), serum albumin (Bos d 6), lactoferrin (Bos d7) and casein (Bos d8). Whereas 72% percent (18 out of 25) of the children tolerated the HP product, seven children experienced adverse events. Risk factors for intolerance to the HP product were higher skin prick test (SPT) histamine equivalent index (HEP) results with CM and the HP product, higher specific IgE levels against Bos d4 and Bos d8 levels and Bos d5 levels. In conclusion, the HP product was tolerated by 72% of the CM allergic children. Outcomes of SPT with CM and the HP product, as well as values of sIgE against caseins, α-lactalbumin, and β-lactoglobulin may predict the tolerability of the HP product. Larger studies are needed to confirm these conclusions.</p