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BACKGROUND: Adherence to TB treatment and therefore treatment success could be improved using digital adherence technology. OBJECTIVE: To evaluate the effectiveness of a medication event reminder monitor system (MERM) on treatment success and treatment adherence in patients with drug-susceptible pulmonary TB in Perú. METHODS: This was an experimental, randomised, open-label, controlled study conducted among patients in the second phase of TB treatment. The intervention group received their medications through MERM with the support of a treatment monitor, whereas the control group used the usual strategy. Participants were followed until they completed the 54 doses of the second phase of treatment. RESULTS: The study included 53 patients in each group; four in the intervention group withdrew from the study. Treatment success was significantly more frequent in the MERM group (RR 1.15, 95% CI 1.02–1.30; P = 0.0322). There was no significant difference in the adherence outcomes; however, the percentage of patients who missed at least one dose and patients with more than 10% of total doses missed were lower in the intervention group. CONCLUSION: The use of MERM in the second phase of treatment showed a significant improvement in the treatment success rate in patients with drug-susceptible pulmonary TB. / National Institutes of Health / Revisión por pares

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The triple layer pillbox antenna is an antenna topology well suited for use as a stackable "plank" element in radar applications. Its suitability arises from the folding which makes it compact, and from the layered nature which can be exploited for low cost manufacture. Existing designs of these "cheese" antennas, whether two or three layers, suff er from two drawbacks: a) The bend or fold between layers introduces undesirable reflections and b) Due to their parabolic sector geometry virtually no pattern control is available to the designer. This work addresses both of these shortcomings. A low reflection transition is realized by introducing simple compensating elements into the design which, with minimal manufacturing complexity, off er high performance over a broad frequency and incidence angle range. To cater for pattern control the concept of "dual shaped reflectors" is borrowed from the high performance dish antenna literature and implemented in the pillbox geometry. This shaping off ers limited but useful control of the aperture distribution and thus indirectly over the radiation pattern. To test these innovations three X-band antennas have been designed, built and measured. An initial unshaped geometry is used for the fi rst design to show the fold or bend performance. This antenna has a simulated and measured 2GHz usable bandwidth, with a reflection coeffi cient below -10dB and side-lobes below -27dB over a bandwidth in excess of 20%. Shaping is then added to show how either side-lobe levels can be lowered to below -32dB, or the gain enhanced by 2dB. The enhanced designs have been built and experimentally veri fied. / AFRIKAANSE OPSOMMING: Die drie-dubbel gevoude pildoos antenna is `n antenna topologie wat goed gepas is vir die gebruik as `n stapelbare "plank" element vir radar aanwending. Sy geskiktheid kom vanwee die vou van die struktuur wat dit meer kompak maak sowel as die konstruksie moontlik goedkoper maak. Huidige ontwerpe van die antenna strukture, hetsy twee of drie lae, ly aan twee tekortkominge: a) Die buiging of vou tussen die lae veroorsaak ongewensde weerkaatsings en b) Weens hul paraboliese meetkunde is feitlik geen beheer oor die stralings patroon beskikbaar nie. Hierdie werk spreek beide hierdie tekortkominge aan. `n Lae weerkaatsing by die oorgang is verkry deur eenvoudige kompenserende elemente by die ontwerp in te voeg wat, met minimale vervaardigings kompleksiteit, hoë werkverrigting lewer oor `n breë frekwensie en invals hoek spektrum. Om patroon beheer te voorsien is die konsep van "dubbele gevormende weerkaatsers" geleen vanaf die hoë verkverrigting skottel antenna literatuur en in die pildoos meetkunde ingestel. Hierdie vorming lewer beperkte dog nuttige beheer oor die openings verspreiding en dus indirek oor die stralings patroon. Om hierdie nuwighede te toets is drie X-band antennas ontwerp wat gebou en gemeet is. 'n Aanvanklike ongevormende meetkunde is gebruik vir die eerste ontwerp om die vou of buiging se werksverrigting te bewys. Hierdie antenna het `n gesimuleerde en gemete 2GHz bruikbare bandwydte met `n weerkaatsings kwosiënt onder -10dB en sylobbe van minder as -27dB oor `n bandwydte van meer as 20%. Vorming is dan bygevoeg om te bewys dat of verlaagde sylobbe van onder -32dB of verhoogde aanwins met 2dB verkrygbaar is. Die verbeterde ontwerpe is gebou en eksperimenteel bewys.

The number of adults in the United States who are age 65 or older is rapidly increasing. With longer lifespan comes an increase in chronic diseases such as dementia, diabetes, and depression. This study used archival data from a larger study conducted at the Memory Clinic at John Peter Smith County Hospital in Ft. Worth, Texas to examine several hypotheses and research questions related to the influence of type of dementia, presence of Type II diabetes, and presence of depression on neuropsychological test performance. First, this study attempted to identify specific patterns of performance on neuropsychological measures for those with Alzheimer's dementia (AD), vascular dementia (VaD), or mild cognitive impairment (MCI). The results indicated that those with MCI perform better than those with AD or VaD on all neuropsychological measures, and that those with VaD perform better than those with AD on a measure of verbal memory. Another purpose of the study was to determine how the presence of Type II diabetes affects this pattern of functioning; the overall finding in this study was that the presence or absence of diabetes did not affect performance on measures of cognitive functioning. Additionally, the study attempted to add to literature examining the influence of depression on older adults with diabetes and/or dementia; no significant differences emerged.

Les travaux de cette thèse portent sur la conception d'antennes multi-faisceaux. Ces dernières permettent à plusieurs faisceaux de partager la même partie rayonnante et offrent la possibilité d'avoir simultanément un fort gain et une grande couverture angulaire. Pour leur fonctionnement, ces antennes se basent sur des réseaux à formation de faisceaux, qui peuvent être groupés en deux catégories : les réseaux formateurs de faisceaux de type quasi-optique et les réseaux formateurs de faisceaux de type circuit. Plusieurs structures antennaires reposant sur ces types de réseaux à formation de faisceaux sont proposés dans cette thèse : structures pillbox simples intégrant les deux variantes de la technique mono-pulse pour augmenter la résolution angulaire de l'antenne, lentilles de Rotman bicouche et multicouche, pour le cas quasi-optique ; réseaux phasés pour applications SATCOM (projet ANR) et matrice de Butler avec circuit de contrôle des niveaux de lobes secondaires pour le cas circuit. Les différents concepts ont été étudiés dans différentes bandes de fréquences : Ku, K et V. Pour des raisons de coût essentiellement, deux technologies ont été retenues : La technologie SIW (Substrate Integrated Waveguide), qui associe les avantages de la technologie des circuits imprimés et celles de la technologie guide d'ondes. Des efforts particuliers ont été faits pour l'implémentation de structures multicouches car nous arrivons à ce stade à la limite du savoir faire industriel national dans ce domaine. La technique de « Diffusion Bounding » développée au « Ando and Hirokawa lab » du TIT (Tokyo Institute of Technology) et qui consiste à assembler de fines couches métalliques sous haute température et haute pression. Cette technique permet le développement d'antennes en guides creux avec des efficacités supérieures à 80% en bande millimétrique. / This PhD thesis deals with the design of multi-beam antennas. A single radiating aperture is used to generate several beams with high gain and a large field of view. The multi beam operation is achieved by using two topologies of Beam Forming Networks (BFN): quasi optical BFN, and circuit-based BFN. For each category, several solutions have been proposed and validated experimentally. In particular, for the quasi-optical configurations, pillbox structures, mono-pulse antennas in pillbox technology, and multi-layer Rotman lenses have been considered. On the other hand, for circuit-based multi-beam antennas, two solutions have been analyzed: a phased array for SATCOM applications in the framework of a national ANR project and a Butler matrix with controlled side-lobe levels for the radiated beams within a collaboration with the Tokyo Institute of Technology, Japan. The proposed concepts and antenna solutions have been considered in different frequency bands: Ku, K and V. Two technologies have been mainly adopted for the fabrication of the various prototypes: Substrate Integrated Waveguide technology (SIW) which combines the advantages in terms of cost of the printed circuit board (PCB) fabrication process with the efficiency of classical waveguide technology. Considerable efforts have been devoted to the implementation of multilayer SIW structures to overcome and go beyond the current state of the art at national level on PCB fabrication process. Diffusion Bounding Technique, developed at “Ando and Hirokawa lab” at the Tokyo Institute of Technology, which consists of bonding laminated thin metal plates under high temperature and high pressure. This technique allows the fabrication of planar hollow waveguide structures with efficiencies up to 80% in the millimeter wave-band.

The lack of medication adherence leads to an incremental risk of diseases which can be a major burden on the individual, healthcare system, and society. Hence, healthcare professionals have a central role and should manage, guide, educate, and make their patient more involved in their treatment and thereby promoting a better medication adherence. Medication adherence is a great challenge for many patients with chronic conditions, elderly patient, or patient prescribed to long-term medication. The rapid development and deployment of mobile phones in the healthcare industry has an important role to play in this area and has led to the development of new phone features and applications that can help both caregivers and patients with managing and monitoring medication intakes. This development and support of mobile phones and applications have created and improved doctor-patient interaction. Today, there is no easy way for healthcare professionals to monitor and help patients with their medication intakes. A solution to this problem is to develop a mobile application that communicates with a smart pillbox via near field communication (NFC) to monitor, manage, and improve patient’s medication intakes in an easy and accessible manner. Using NFC as a communication technology allows data to be wirelessly transferred from phone to pillbox and vice versa. This solution will help healthcare professionals to create better treatment conditions and fewer side effects for their patients. These patients will be more knowledgeable and motivated to take greater responsibility in following doctor’s instructions, thereby improving their treatment process. The application is tested and evaluated during every iteration phase of the development process. These tests have been conducted by allowing healthcare professionals to test the application and provide feedback on their experience when using the app. Conducting these tests have helped with generating new ideas, features, and functionalities, but also helped to improve the user interface to make the application as user-friendly as possible. / Bristen på medicinering följsamhet leder till en ökad risk för sjukdomar som kan vara en stor belastning för individen, vårdsystemet och samhället. Hälsooch sjukvårdspersonal har därför en central roll och bör hantera, vägleda, utbilda och göra patienten mer delaktig i behandlingen och därigenom främja en bättre medicinering följsamhet. Medicinering följsamhet är en stor utmaning för många patienter med kroniska tillstånd, äldre patient eller patient som är ordinerad för långvarig medicinering. Den snabba utvecklingen och användningen av mobiltelefoner inom vårdindustrin har en viktig roll att spela i detta område och har lett till utvecklingen av nya funktioner och applikationer som kan hjälpa både vårdgivare och patienter med att hantera och övervaka medicinsk intag. Denna utveckling och support av mobiltelefoner och applikationer har skapat och förbättrat interaktion mellan läkare och patient. Idag finns det inget enkelt sätt för sjukvårdspersonal att övervaka och hjälpa patienter med sina medicinintag. En lösning på detta problem är att utveckla en mobilapplikation som kommer att kommunicera med en smart pillbox via nära fältkommunikation (eng. Near Field Communication, NFC) för att övervaka, hantera och förbättra patientens medicinintag på ett enkelt och tillgängligt sätt. Med hjälp av NFC som kommunikationsteknik kommer data att överföras trådlöst från telefon till pillerdosa och vice versa. Denna lösning kommer att hjälpa vårdpersonal att skapa bättre behandlingsförhållanden och färre biverkningar för sina patienter. Dessa patienter kommer i sin tur att vara mer kunniga och motiverade att ta större ansvar i efterföljande läkares instruktioner och därigenom förbättra deras behandlingsprocess. Applikationen har testat och utvärderat under varje iteration av utvecklingsprocessen. Dessa tester har utförts genom att låta vårdpersonal testa applikationen och ge feedback på hur dem upplevar applikationen. Dessa tester hjälper till att skapa nya idéer, funktioner och funktioner som bör ingå i den slutliga applikationen, men också bidra till att förbättra användargränssnittet för att göra ansökan så användarvänlig som möjligt.