Treatment Buddies Improve Clinic Attendance among Women but Not Men on Antiretroviral Therapy in the Nyanza Region of Kenya.

Background. Kenyan antiretroviral (ART) guidelines encourage treatment buddies (TBy) to maximize treatment adherence. This study examined the effect of TBys on clinic attendance in men and women on ART. Methods. This retrospective cohort study included all adult patients initiating ART from August 2007 to December 2011 at four health facilities in Kenya. Data were abstracted from electronic medical records and analyzed using Poisson regression. Results. Of 2,430 patients, 2,199 (91%) had a TBy. Relationship between TBy and clinic attendance differed in females and males (interaction p = 0.09). After demographic and clinic factor adjustment, females with a TBy were 28% more likely to adhere to all appointments than those without (adjusted aRR = 1.28; 95% CI 1.08-1.53), whereas males were no more likely to adhere (aRR = 1.01; 95% CI 0.76-1.32). Males reported partner/spouse (33%) or brother (11%) as the TBy while females reported sister (17%), partner/spouse (14%), or another family member (12%). Multivariable analysis found no association between clinic attendance and TBy relationship in either gender. Conclusion. Clinic attendance was higher among women with TBys but not men. Results support TBys to help women achieve ART success; alternate strategies to bolster TBy benefits are needed for men

Experimental Verification of PCH-EM Algorithm for Characterizing DSERN Image Sensors

The Photon Counting Histogram Expectation Maximization (PCH-EM) algorithm has recently been reported as a candidate method for the characterization of Deep Sub-Electron Read Noise (DSERN) image sensors. This work describes a comprehensive demonstration of the PCH-EM algorithm applied to a DSERN capable quanta image sensor. The results show that PCH-EM is able to characterize DSERN pixels for a large span of quanta exposure and read noise values. The per-pixel characterization results of the sensor are combined with the proposed Photon Counting Distribution (PCD) model to demonstrate the ability of PCH-EM to predict the ensemble distribution of the device. The agreement between experimental observations and model predictions demonstrates both the applicability of the PCD model in the DSERN regime as well as the ability of the PCH-EM algorithm to accurately estimate the underlying model parameters.Comment: 8 pages, 9 figure

Studi Numerik Interaksi Vortex-Induced Vibrations (VIV) Antara Empat Silinder Tegak Fleksibel Dengan Konfigurasi In-Line Square Dalam Aliran Uniform

Vortex-induced Vibration (VIV) di sekitar sekelompok silinder adalah suatu fenomena yang umum ditemui pada aplikasi teknik saat ini, seperti aliran fluida yang melewati kabel, struktur lepas pantai, dan lain sebagainya. VIV dapat menyebabkan berkurangnya umur operasi suatu equipment dan dapat berakibat pada kecelakaan atau kegagalan operasi. Oleh karena itu, sangat penting untuk memahami mekanisme terjadinya VIV dan rangkaian interaksi fluida-struktur dalam rangka meningkatkan kualitas desain equipment. Makalah ini menyajikan studi numeris tiga dimensi (3-D) aliran laminar di sekitar empat silinder tegak fleksibel dalan konfigurasi in-line square. Penelitian difokuskan pada pengaruh spacing ratio (S*x dan S*y), aspect ratio (L/D), dan Reynold Number (Re) terhadap karakteristik aliran tiga dimensi di sekitar silinder. Hasil yang didapat menunjukkan bahwa pada small spacing ratio, nilai koefisien gaya lift (CL) dan koefisien gaya drag (CD) cenderung mengecil karena mendapat pengaruh redaman dari silinder lain, namun kemudian kembali normal pada konfigurasi di atas critical spacing ratio 3.5D. Perpindahan silinder yang terjadi sangat kecil dengan A/D maksimum searah aliran sebesar 0.00053, dan A/D maksimum tegak lurus aliran sebesar 0.0003. Variasi aspect ratio memberikan efek penurunan nilai CL pada downstream cylinder pada spacing ratio 3.5-5. Sedangkan pengaruh variasi Reynold Number yang semakin besar memberikan nilai CD dan CL yang semakin menurun, dan sebaliknya besarnya displacement silinder yang terjadi semakin meningkat. Pada Re=100 dan Re=200, VIV yang terjadi pada upstream cylinder adalah in-line vibrations, sedangkan downstream cylinder mengalami cross-flow vibrations. Pada Re=300, baik upstream maupun downstream cylinder mengalami in-line vibrations

Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya.

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32-5.56), HIV education (aOR 3.28, 95% CI 1.92-6.83), and wait time (aOR 1.97 95% CI 1.03-3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06-3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33-8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction

Integration of family planning services into HIV care clinics: Results one year after a cluster randomized controlled trial in Kenya.

OBJECTIVES:To determine if integration of family planning (FP) and HIV services led to increased use of more effective contraception (i.e. hormonal and permanent methods, and intrauterine devices) and decreased pregnancy rates. DESIGN:Cohort analysis following cluster randomized trial, when the Kenya Ministry of Health led integration of the remaining control (delayed integration) sites and oversaw integrated services at the original intervention (early integration) sites. SETTING:Eighteen health facilities in Kenya. SUBJECTS:Women aged 18-45 receiving care: 5682 encounters at baseline, and 11628 encounters during the fourth quarter of year 2. INTERVENTION:"One-stop shop" approach to integrating FP and HIV services. MAIN OUTCOME MEASURES:Use of more effective contraceptive methods and incident pregnancy across two years of follow-up. RESULTS:Following integration of FP and HIV services at the six delayed integration clinics, use of more effective contraception increased from 31.7% to 44.2% of encounters (+12.5%; Prevalence ratio (PR) = 1.39 (1.19-1.63). Among the twelve early integration sites, the proportion of encounters at which women used more effective contraceptive methods was sustained from the end of the first to the second year of follow-up (37.5% vs. 37.0%). Pregnancy incidence including all 18 integrated sites in year two declined in comparison to the control arm in year one (rate ratio: 0.72; 95% CI 0.60-0.87). CONCLUSIONS:Integration of FP services into HIV clinics led to a sustained increase in the use of more effective contraceptives and decrease in pregnancy incidence 24 months following implementation of the integrated service model. TRIAL REGISTRATION:ClinicalTrials.gov NCT01001507

The Oral and Skin Microbiomes of Captive Komodo Dragons Are Significantly Shared with Their Habitat.

Examining the way in which animals, including those in captivity, interact with their environment is extremely important for studying ecological processes and developing sophisticated animal husbandry. Here we use the Komodo dragon (Varanus komodoensis) to quantify the degree of sharing of salivary, skin, and fecal microbiota with their environment in captivity. Both species richness and microbial community composition of most surfaces in the Komodo dragon's environment are similar to the Komodo dragon's salivary and skin microbiota but less similar to the stool-associated microbiota. We additionally compared host-environment microbiome sharing between captive Komodo dragons and their enclosures, humans and pets and their homes, and wild amphibians and their environments. We observed similar host-environment microbiome sharing patterns among humans and their pets and Komodo dragons, with high levels of human/pet- and Komodo dragon-associated microbes on home and enclosure surfaces. In contrast, only small amounts of amphibian-associated microbes were detected in the animals' environments. We suggest that the degree of sharing between the Komodo dragon microbiota and its enclosure surfaces has important implications for animal health. These animals evolved in the context of constant exposure to a complex environmental microbiota, which likely shaped their physiological development; in captivity, these animals will not receive significant exposure to microbes not already in their enclosure, with unknown consequences for their health. IMPORTANCE Animals, including humans, have evolved in the context of exposure to a variety of microbial organisms present in the environment. Only recently have humans, and some animals, begun to spend a significant amount of time in enclosed artificial environments, rather than in the more natural spaces in which most of evolution took place. The consequences of this radical change in lifestyle likely extend to the microbes residing in and on our bodies and may have important implications for health and disease. A full characterization of host-microbe sharing in both closed and open environments will provide crucial information that may enable the improvement of health in humans and in captive animals, both of which experience a greater incidence of disease (including chronic illness) than counterparts living under more ecologically natural conditions