PEPFAR Public Health Evaluation -Care and Support -Phase I Uganda

Phase 1, a survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies

PEPFAR Public Health Evaluation - Care and Support - Phase 2 Kenya

Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences

PEPFAR Public Health Evaluation-Care and Support -Phase I Kenya

Phase 1, a survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies

PEPFAR Public Health Evaluation - Care and Support - Phase 2 Uganda

Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences

Analytical and experimental investigations of the behavior of thermal neutrons in lattices of uranium metal rods in heavy water

Statement of responsibility on title-page reads: R. Simms, I. Kaplan, T. J. Thompson, D. D. Lanning"October 11, 1963.""NYO-10211."Also issued by the first author as a Ph. D. thesis, Massachusetts Institute of Technology, Dept. of Nuclear Engineering, 1964Includes bibliographical references (leaves 193-199)Measurements of the intracellular distribution of the activation of foils by neutrons were made in lattices of 1/4-inch diameter, 1.03% U-235, uranium rods moderated by heavy water, with bare and cadmium-covered foils of gold, depleted uranium, lutetium, europium and copper. The measurements were made in the M.I.T. Heavy Water Lattice Facility with source neutrons from the M.I.T. Reactor. Two lattices were studied in detail in this work. The more closely packed lattice had a triangular spacing of 1.25 inches, and the less closely packed lattice had a triangular spacing of 2.5 inches. The results of the experiments were compared to one-dimensional, 30-energy group, THERMOS calculations based on the available energy exchange kernels. The comparison indicated that the approximation that the hexagonal cell may be replaced by an equivalent circular cell (the Wigner-Seitz approximation) can lead to serious discrepancies in closely packed lattices moderated b! y heavy water.A modified one-dimensional, and a two-dimensional, calculation were shown to predict the intracellular activation distribution in the closely packed lattice. An analytical treatment of the problem of the flux perturbation in a foil was developed and compared to the experimental results obtained by using gold foils of four different thicknesses in the lattice cell; the method was shown to be adequate. An analytical method to treat the effect of leakage from an exponential assembly was formulated; the results indicated that only in small exponential assemblies would leakage be a significant problem in intracellular flux measurements. A method was developed to predict the cadmium ratio of the foils used in the lattice cell; comparison with available measurements with gold foils indicated good agreement between theory and experiment, except for a lattice having very large ratios of moderator volume, to fuel volume, e.g., 100:1.Calculations of the fuel disadvantage factor by the method of successive generations for gold, lutetium and europium detector foils were compared to the results of THERMOS calculations, because THERMOS was shown to predict the experimental distributions. The comparison indicated that the method of successive generations is a good alternative to the THERMOS calculation, if all that is required is 17 and the thermal utilization.U.S. Atomic Energy Commission contract AT(30-1)234

The Making of The Letter

None provided

Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study

BACKGROUND: Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities. METHODS: In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual). RESULTS: Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002). CONCLUSIONS: Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment