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Coffee, Popcorn, Soup, and HIV
Chronic food insecurity and achieving strict adherence to antiretroviral therapy (ART) are global challenges that, together, have a deleterious effect on children and pregnant women living with HIV. In Ethiopia, where the child malnutrition rate is one of the highest in the world, side effects of treatment threaten to reduce adherence to drug regimens and contribute to the development of drug-resistant strains of HIV. This case study examines how the Breedlove Project integrates HIV programming (treatment and PMTCT) with nutrition programming to address short-term and long-term needs of families and households in Ethiopia.
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- Introduction
- Coffee Ceremony
- Soup Distribution
- Urban Gardening
- What Worked & Challenges
- Replication and Conclusion
- References
Coffee, Popcorn, Soup, and HIV
By Kara Greenblott
Promoting Food and Nutrition Security for Children and Pregnant Women Living with HIV in Ethiopia
It is 11:00 a.m. at the antiretroviral therapy (ART) unit of Gandhi Hospital in Addis Ababa, Ethiopia. Women have been arriving slowly over the last two hours for their monthly coffee ceremony discussion. The reception area is transformed—condoms and pamphlets swept off the table to make way for a colorful tablecloth and a bowl of flowers. Popcorn is popping, coffee brewing, and the aromas of coffee, popcorn, and incense mingle in the air. Smiles appear on the women's faces as they enter the room and rekindle their monthly friendships.
The coffee ceremony, part of everyday life in Ethiopia, is a key component of the "Food Secure and HIV-Positive in Ethiopia" project managed by Project Concern International (PCI), a San Diego-based nongovernmental organization. The project—an example of integrated HIV and food and nutrition security (FNS) programming—combines distribution of highly nutritious soups, promotion of urban agriculture, and delivery of educational messages (via coffee ceremonies) on issues related to HIV and FNS. All of the women participating are either living with HIV and pregnant or lactating;(1) or, they are caring for children living with HIV who receive life-saving antiretroviral (ARV) drugs at the hospital.
Ethiopia is the second most populous country in Africa, and with an HIV prevalence rate of 2.4 percent, an estimated 1.2 million people are currently living with HIV. In Addis Ababa, the capital and largest city, the HIV prevalence is 9.2 percent, translating to more than 200,000 people living with HIV (Addis Ababa HIV/AIDS Prevention & Control Office 2010).
Every day about 1,000 children under the age of 15 become infected with HIV globally, and in 2007, UNAIDS estimated there were 2 million children living with HIV, almost 90 percent of whom live in Africa. The vast majority of these children acquire HIV before they are born, during pregnancy or delivery, or when they are being breastfed (UNICEF 2007).
Despite the remarkable achievement in the area of HIV treatment in recent years, there is a widely held concern that prevention of mother-to-child transmission (PMTCT) activities have been lagging behind. In Ethiopia, from an estimated 84,189 pregnant women living with HIV in 2009, only 6,466 (eight percent) received antiretroviral prophylaxis (Federal HIV/AIDS Prevention & Control Office 2010).
A total of 13,305 children were ever started on ART at the end of 2009, while 9,992 were currently on ART. ART coverage for children was 48.7 percent (Federal HIV/AIDS Prevention & Control Office 2010).
Chronic food insecurity compounds the problems posed by HIV. Ethiopia has one of the world's highest child malnutrition rates. According to a 2010 study from the National Nutrition Program of Ethiopia, among children 6 to 59 months of age, 38 percent were stunted, with higher levels among rural children. Twelve percent of children 6 to 59 months of age were wasted, and 34 percent of children were underweight (Ethiopian Health and Nutrition Research Institute 2010). Children living with HIV frequently have low birth weight, so high quality nutrition interventions are essential to providing them with the best possible start in life.
Finally, strict adherence to ART for children living with HIV (as well as adults) is a global challenge. Individuals who start ART when malnourished suffer more severe side effects than those who are sufficiently nourished. Side effects, including nausea, taste changes, diarrhea, vomiting, and loss of appetite, threaten to reduce adherence to drug regimens and contribute to the development of drug-resistant strains of HIV. Sadly, of those individuals who are on treatment, the default rate is an alarming 20 to 25 percent (Banteyerga 2007).
As the coffee ceremony participants begin to seat themselves in a large circle, laughter erupts on the far side of the room. Two women share their story with the others.
One woman ran into her neighbor at the hospital this morning and the neighbor asked, "Oh, why are you here?" The first woman did not hesitate to reply that she was visiting a friend who was sick. When she asked her neighbor why she was at the hospital, the neighbor quickly gave the same response. Thirty minutes later, both women found themselves seated at the coffee ceremony. They laughed as they spotted each other from across the circle; one comments that now they will be real friends and not just neighbors! Their story became an ideal introduction to the group's discussion on stigma and the lies people tell, without hesitation, to their own neighbors and family members to avoid the shame and discrimination of living with HIV in Ethiopian society.
Over the next few hours, they drink coffee, listen, and discuss their experiences as a counselor leads them through the agenda. The program does not use a specific facilitator's curriculum, but the counselors from PCI and the hospitals have been trained and develop the topics themselves, setting topics in advance. The topics, as always, cover ART adherence, nutrition, and opportunities for producing food at home. Other topics are added based on current events and issues noticed along the way, as well as a variety of issues raised by the women themselves. Many women linger afterwards, building friendships and sharing stories about how they cope with the challenges of living with HIV.
The Breedlove Project: Integrating HIV and Food and Nutrition Security Programming
Food Secure and HIV-Positive in Ethiopia began in 2006 as a supplementary feeding intervention supported by a small, one-year grant to PCI from the U.S. Agency for International Development's (USAID) International Food Relief Partnership (IFRP). The women and hospital staff call the project "Breedlove," in reference to the lentil and potato blended soups (manufactured by Breedlove Foods Inc.) that are distributed to project participants. The grant has been re-awarded annually since 2006: IFRP provides the food and a cash budget to support administrative costs for distributing the soup, but very little for complementary programming.
Working closely with hospital staff, PCI designed the project to complement the PMTCT, ART, nutrition assessment, education, and counseling services that women and children living with HIV receive during hospital and health facility visits. As the project gathered momentum, PCI deliberately linked the soup distributions to its coffee ceremony and agriculture activities to ensure that nutrition supplementation does not stand alone. Thus, this linkage intentionally integrates HIV programming (ART and PMTCT) with FNS programming in a manner that addresses both short-term and long-term needs of these households.
More specifically, the project is comprised of three components: 1) Distribution of highly nutritious foods to address short-term nutritional needs; 2) Holding coffee ceremony discussions to provide emotional support and education around HIV and FNS; 3) Promoting urban agriculture, including vegetable gardening and poultry raising, to address longer-term nutritional needs. The project's overall aim is to reduce vulnerability to malnutrition and food insecurity among households affected by HIV.
Activities target two groups in Addis Ababa: 1) Pregnant or lactating women living with HIV who are heads of households and attending a PMTCT program in one of the 16 participating health facilities in Addis; 2) Parents and/or caregivers of children who are living with HIV, under the age of 12, and attending a pediatric ART program in one of the five participating hospitals in Addis.
Disclaimer: The author's views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
The Coffee Ceremony: Making Friends, Learning Survival Skills
Group waiting for coffee to be served at Gandhi Hospital
The coffee ceremony is a central part of Ethiopian life and a sign, to those invited, of friendship and respect. In traditional village life, the coffee ceremony is the main social event in the village, a time to discuss current events, politics, and gossip about who did what with whom. It is impolite to retire until you have consumed at least three cups, as the third round is said to bestow a blessing. The Breedlove project's coffee ceremonies build on this tradition of friendship and information-sharing to deliver and reassert a variety of messages related to HIV and FNS.(2)
The idea for the coffee ceremony emerged at the beginning of the project, when staff were delivering the lentil and potato soups to participating health facilities. It became clear that women needed a place to discuss concerns about their HIV status and the status of their children. PCI had used the coffee ceremony successfully in other programs to discuss difficult social issues and saw the ceremony as a platform for advancing nutrition education goals of the Breedlove project.
Twenty to thirty women normally attend the monthly coffee ceremonies (while men are also invited—being caretakers of orphans and vulnerable children—few attend). Every ceremony routinely includes discussions on health, FNS, and their relationship to HIV and AIDS. As with other PCI programs, the familiar setting and ritual of coffee-drinking encourages participants to relax and talk openly about HIV, sex, illness, domestic abuse, rape, birth control, and other taboo topics that are normally difficult to discuss in this extremely traditional society. Given the traditional three-cup minimum, the ceremony provides enough time to delve into a wide array of issues; some ceremonies last up to two or three hours.
Session topics are planned in advance. There are usually four or five, and some are selected by the participants themselves to ensure relevance and a sense of ownership. The facilitators, trained by PCI, keep discussions focused. Often, facilitators launch a topic with the delivery of several key messages. They keep messages clear and succinct, and deliver them slowly and repeatedly, giving women of different education levels time to absorb the concepts. Sometimes, the ceremony will include a guest speaker; alternatively, the facilitator will invite some of the women from within the group to speak about their own experiences.
At the Gandhi Hospital's ART unit, some 20 women, 5 children, 4 volunteer counselors, and 2 PCI staff members sit in chairs around the decorated coffee table. The lead counselor is emphatic about her first discussion point: ART adherence is imperative. "Take your medicines [ARVs] at the same time every day. Make sure you eat when taking the drugs. And stay as healthy as possible through positive living." She reminds them that even if they are traveling, they should take their medicines at the same time and in the same way they would if at home. Following these instructions will help them to maintain high CD4 counts and prevent sickness.
After the women discuss the details of these instructions, the counselor transitions to a discussion on diet. She talks about preparing balanced meals with energy-rich foods: beans and k'ollo (a traditional snack of roasted barley and groundnuts) are high in protein and are affordable to many of the women in the room. She emphasizes that they should buy what is locally available and affordable within their household budget, but aim for as much variety as possible. The women discuss different foods and healthy dishes they have prepared for their families, and briefly discuss recipes for preparing the Breedlove soup they receive each month from PCI.
Next on the agenda is stigma and discrimination. One woman recounts how stigma is so strong in her community that she herself believed that she was a danger to her children. When she was first diagnosed, she was afraid to kiss or even touch her children for fear of transferring the deadly virus to them. Thanks to counseling and the coffee ceremony discussions, she now understands the truth about transmission and is relieved to know that she can be a mother to her children and lead a normal life.
The participants themselves raise the day's most heated discussion: the controversy around taking ARVs with holy water. When someone is sick, it is customary in Ethiopia to spend several days at a natural spring, drinking and bathing in the holy waters. Some priests, however, have said that people living with HIV should abandon their medicines and trust completely in God while at the springs.
The women discuss the recent Ministry of Health campaign countering this dogma. It explains that God has given man the scientific knowledge to develop ARVs, so they are still trusting in God when taking medicines and the holy waters. Some women nod in understanding, but express how difficult it is for them to follow this advice. Because of what some priests have said, they still feel that they are not trusting completely in God. The counselors mention a recent Ethiopian television broadcast with the Patriarch of the Orthodox Church, Muslim Imams, and other religious leaders who explained the importance of medication adherence, with or without holy water.
When the women have finished their discussion about holy water, the urban agriculture officer from PCI is invited to address the group. He starts by describing the possibilities for those in the room to provide healthy food for their families by growing it themselves. He explains the nutritional value of fresh vegetables and eggs, and the importance of vitamins, minerals, and protein to enhance their diet. He emphasizes that if they grow it, it is free! And, if they grow more than their family can consume, their gardens can even earn income.
Finally, he describes PCI's programs for urban garden and poultry production training and asks those who are already involved to contribute their experiences. He informs group members that they are all eligible and takes contact information from those who want to learn more.
The formal discussion then comes to a close, but many of the women stay on for an hour or more, sharing personal stories and strength and hope for their futures as women and mothers living with HIV. One of the participants, Zeritu, who brings her 16-month infant Kaldikane with her to the sessions, describes how the Breedlove coffee ceremony has changed her outlook:
"When I started coming to the coffee ceremony discussions, I saw that there were many other women like me that manage to stay healthy, and would talk about how they do it. I felt empowered and I found hope to keep living. Now I enjoy cooking good quality meals for my family. With my positive way of thinking, eating a balanced diet, staying on my ARVs, and working outside with the chickens, I now know I can provide for my children and live my life."
Breedlove Soup Distribution: Supplementing Daily Food Intake
Breedlove soup warming at a hospital cooking demonstration.
PCI addresses the short-term nutritional needs of HIV-affected households by distributing two fortified, dehydrated soups: the Lentil Blend and the Harvest Pro Vegetable Blend, both containing vegetables, fortified vegetable protein, and spices. The soup is not meant to provide a complete diet, but to supplement a person's existing intake and, importantly, to facilitate improved retention of women receiving PMTCT services and improved adherence for children enrolled in ART. Pregnant women living with HIV receive two kilograms per month and the children receive one kilogram.
PCI implements the Breedlove project in partnership with the Ethiopian Federal HIV/AIDS Prevention & Control Office (F-HAPCO) and Addis Ababa HIV/AIDS Prevention & Control Office (AA-HAPCO). The hospitals and locations that receive the commodity were selected jointly by AA-HAPCO and PCI on the basis of the number of beneficiaries and the facility's ability to keep records and produce reports.
The method of soup distribution depends on the type of recipient. For children living with HIV receiving pediatric ART services, PCI delivers the commodity directly to the hospital staff at the five city hospitals. Mothers or caregivers receive the soup when they bring the child for monthly checkups. During the same visit, either the counselor or home-based care volunteer briefs the caregiver on PCI's urban agriculture program and if they are interested, puts them in contact with the urban agricultural promotion officer. This initiates the transition from short-term assistance (the soup) to more sustainable FNS programming.
"Before the Breedlove support there were beneficiaries who discontinued the ART and PMTCT follow-up but after they heard about the food support they returned. Because of the food support, others who joined after the Breedlove support are also following the PMTCT regularly without dropout. In addition to this I have also observed some dropout when it was discontinued for some time at the end of the first phase."
–Zewditu Ambaw, Nurse at PMTCT Section of Kality Health Center
One-kilogram bag of Harvest Pro Vegetable Blend Soup
For mothers living with HIV attending PMTCT services, the system is slightly different. PCI stores and distributes the soup through AA-HAPCO and the World Food Programme (WFP), making use of their significantly larger food distribution systems. To increase efficiency, PCI delivers the commodities to AA-HAPCO's main warehouse. From there, WFP staff delivers them, along with their own commodities, to 10 subcity stores. Women receiving PMTCT services are scheduled one day each month to pick up the food. While the women are gathered, the storekeepers explain the ingredients of the soup blends, describe various cooking methods—the blends can be prepared as a soup or a main dish—and conduct a cooking demonstration. They also solicit interest in PCI's urban agriculture program.
In the 2009 review of Breedlove distributions conducted at Alert Hospital in Addis, Breedlove participants overwhelmingly found the soup tasty and easy to prepare. While most serve it as soup, some separate out the lentils and prepare them as wot (a spicy stew), then mix the rest of the contents with rice. Others said it was delicious when used with meat. Some of the pregnant women commented that they cannot eat many things during their pregnancies, but the soup is a great meal for them as it tastes good and they can keep it down.
A total of 2,441 children (1,193 boys and 1,248 girls) on ART and 1,915 mothers enrolled in the PMTCT program directly benefited from Breedlove supplementary soup in 2009. The total amount of commodity distributed equaled 74,998 kilograms (PCI 2009).
"Some of the women call it Almi—the nutritious food. We provide both the WFP and Breedlove foods at this warehouse and what I hear from the women is that they prefer cash instead of food for some of the food items, but with the Breedlove and oil they want the food itself."
–Ato Zeru Desale, Storekeeper at Bole Subcity Warehouse
Urban Gardening and Poultry: Sustaining Good Nutrition
"The garden provides a beautiful landscape inside my compound. I have the satisfaction of seeing my garden and eating from it every day. The garden's colors are beautiful and it makes me very happy to see such scenery and know that I have produced this for myself and for my family."
–Zenebech, mother living with HIV—
one of her two children is also living with HIV
PCI staff and the Breedlove participants acknowledge that while food assistance is an important short-term remedy, it is not sustainable in the long-term. Hence the value of the Breedlove project's urban gardening and poultry component, which teaches women to meet their nutritional needs by producing their own food at home. Participants in the urban agriculture program describe the benefits they have reaped: improved access to fresh, nutritious vegetables, eggs, and meat for the entire family; a source of income for those who choose to produce more than they consume; and the therapeutic value of tending the garden and chickens and of watching them grow and produce over time.
The urban garden training is conducted in groups of between 10 and 30 people over the course of one or two days. Most participants already have a basic knowledge of gardening, so the course is meant to strengthen their skills. The training covers such topics as preparing plots, improving the soil, handling seedlings, spacing plants, and intercropping with legumes. Participants also learn about organic pest control—creating a spray from the dodinam plant to control aphids—and making compost from chicken waste, ash, and vegetable scraps. Importantly, the curriculum also includes a nutrition component that reviews the benefits (i.e., vitamins and minerals) of fresh vegetables and their importance in fighting disease. The training stresses cooking vegetables lightly to kill germs, but cautions participants against overcooking, which reduces the nutritional value.
Participants choose one of two options: direct soil gardening or container gardening (using plastic bags, pails, metal drums, and similar containers). They are offered a wide variety of seeds to get started, including kale, Swiss chard, lettuce, cabbage, tomato, green pepper, carrot, and beet. They also receive farming tools: a pick axe, a hoe, and a watering can; those without their own land also receive containers.
The poultry production training likewise takes one to two days. Instruction covers basic poultry care, feeding, and disease management. Each participant receives two roosters, six laying hens, 50 kilograms of feed, and a cage.
To date, more than 200 people have received training, seeds, and tools for home gardening, and about 60 received training and supplies for poultry production. Several participants have produced excess food and specialty crops, such as herbs, which brings in regular income (though this production has not been quantified yet). The vast majority of the participants in the urban agriculture program are mothers or caregivers of children on ART. However, PCI is trying to increase recruitment of women in the PMTCT program as well.
Melkam with her chickens
Melkam lives with her 15-year-old nephew, Girma, on a hillside outside Addis. Both are living with HIV and receive ART from the Alert Hospital. She was referred to the gardening program when she took Girma for his treatment and was waiting at the soup distribution point. She has been gardening for almost a year now; last month, she also received training in poultry production. She grows cabbage, kale, Swiss chard, and lettuce from seeds furnished by PCI, and tends her new poultry flock. "I also plant many other vegetables and herbs on my plot with seeds from neighbors and the market," Melkam says. "I now have onion, potato, gesho (to make t'ella, the local beer), enset (false banana), thyme, and t'ena adam (a medicinal herb). Girma and I consume all of the vegetables, and I sell the gesho, enset, thyme, and t'ena adam."
"Girma and I are eating a lot more now," Melkam says. "Having a garden and working the garden have increased our appetites and we are getting a lot of vitamins from the greens. Since I am HIV-positive, I sometimes feel sick and weak. Sometimes when I'm working in the garden a smell in the air will make me nauseous and I will have to stop working. I was also having problems with birds eating the kale, but I put up sticks with plastic bags (on top) to act as scarecrows and that has solved the problem. My neighbors have inquired about where I received the gardening support, and I told them, 'I am living with the virus. So yes, PCI is helping me with my garden.' Sometimes the neighbors help me with harvesting and preparing the crops for food; today they are helping wash and lay out the barley and millet to dry in my yard."
Preparing for the coffee ceremony at Gandhi Hospital
What Worked Well
Food as an entry point for integrated programming: Linking monthly health care visits to food distribution is an effective strategy for ensuring optimal uptake and retention of HIV and FNS services (i.e., ART, PMTCT, nutrition assessment and counseling, coffee ceremonies, and urban agriculture). A strong referral network between each of the activities described above, along with intentional discussions about the benefits of each of these services during food distributions, is key to ensuring that they are tangibly integrated, and not just connected on paper.
Partnerships for effective programming and cost savings: Partnering with F-HAPCO, AA-HAPCO, WFP, and the health facility staff has been programmatically effective as well as cost-effective. F-HAPCO ensures that the commodity is imported duty-free; AA-HAPCO and WFP manage the bulk of distributions; and health facility staff handle nutrition counseling and education, with technical support and training provided by PCI.
Women speaking to women: When the health staff and PCI team speak at coffee ceremonies, the women listen. But when one of the women participants stands up and tells her story, they really listen. They are engaged and extremely supportive of one another. They often comment on how much they learn from each other's experiences; they remember the stories and the messages that are integrated within them. For this reason, the facilitators frequently invite and encourage the participants to stand and share their experiences on given topics. Some participants have even become PCI peer educators.
Careful timing: PCI learned through trial and error that the timing of ceremonies is critical. Given the frequency of holidays and social events in this culture, and the two- to three-hour duration of a typical ceremony, the date and time need to be carefully selected for optimal turnout.
Skilled facilitation: Facilitation also needs to be effective to guarantee attendance. When certain members dominate the session, other participants are discouraged and may not return. A strong facilitator is therefore crucial to managing the discussion and ensuring that it remains fruitful, inclusive, and relevant to participants' lives.
Reaching families and neighbors: The coffee ceremony is an effective means of reaching the participants' families and neighbors. Participants often share with their family what happens in the coffee ceremony, so the entire family can benefit. Because of the links to the urban agriculture activities, family members often get involved in gardening and poultry production. Some participants have noted that their neighbors will sometimes inquire once they see their success with gardens and chickens. They then use the opportunity to share their new knowledge about nutrition and dietary diversity, sometimes even sharing the information at coffee ceremonies held within their communities.
Using urban agriculture to support durable changes to dietary decision making: As stated in the next section on challenges, dietary recommendations made during coffee ceremonies are often difficult for the participants to implement because of their limited financial means, especially once they graduate from supplementary food support. The gardening and poultry programs facilitate more sustainable dietary changes, though to be effective, the programs would need to be expanded to reach all interested participants. In the 2009 review, participants asked that the urban garden and poultry program be expanded and strengthened so that they could maintain a diverse and healthy diet when the Breedlove project ends. Finally, several participants have been able to produce excess food and specialty crops (such as herbs) that bring in regular income. This income can also enhance participants' ability to purchase items they need to provide healthy, balanced meals.
Widespread poverty: Women participating in the coffee ceremonies said that while they now understand the need for nutritional diversity, they often cannot afford the variety of foods recommended. Vegetables, fruits, milk, and other suggested foods are more expensive than the ingredients for injera (the traditional grain-based bread), so they frequently default to foods they know and can afford. This demonstrates that while behavior change can result from acquiring new knowledge, the change must also be economically accessible.
Long distances: For many clients, traveling to one of the five central hospitals to receive treatment can be inordinately time-consuming and expensive. Hospitals are currently trying to refer them to health centers that are closer to home, but because they fear stigma and discrimination, beneficiaries often prefer to travel long distances so that they will not see neighbors and friends. Participants often cite travel costs as a reason for missing appointments.
Lack of support for monitoring and evaluation (M&E): The limited budget attached to the soup distribution makes it difficult to establish a comprehensive M&E system. A quarterly review meeting takes place, and informal interviews with beneficiaries are held sporadically by M&E staff from other PCI programs (who are "borrowed" by the Breedlove project). Unfortunately, formal monitoring against indicators for the objectives of each project component is not done in a systemic or comprehensive manner. In particular, the project does not review the attendance records of women receiving PMTCT or children's adherence to ART, and so cannot empirically assess whether these adherence objectives have been met. Instead, there is heavy reliance on anecdotal evidence. The project recognizes the need to improve its M&E system and is working to do so.
Overburdened health care staff: Distributing the Breedlove soup became an additional task for already stretched health workers at the distribution sites. The scarcity of qualified health professionals is a systemic problem throughout the country. Those handling the Breedlove commodity complain of being overworked and underpaid. The implications are insufficient communication about the commodity and the intention that it be consumed only by the targeted recipient (the pregnant/lactating mother or child living with HIV). Similarly, the urban agriculture program is not as thoroughly promoted during distributions as it could be.
Ration dilution via intrahousehold sharing: The most common complaint from participants is that the soup ration is not large enough, and that they often exhaust their monthly supply in two weeks or less. Two factors contribute to this problem. First, the soup is intended as a supplementary ration, and not as general ration—the soups are not intended to serve as the main source of nourishment. Second, the commodity and ration size were designed for individual use, but intrahousehold sharing is very common. In many cases, the purpose of the soup ration is not well understood. But even where the principles are understood, participants explain that it is difficult to prioritize one family member when the whole family is hungry. This dilemma is common where household food insecurity is endemic.
Stigma and discrimination: Stigma and discrimination remain significant problems in Ethiopia. In fact, many women who were photographed for this case study did not want their identities known for fear of discrimination within their communities. Stigma affects various aspects of the Breedlove project: women do not want PCI staff visiting them in their homes (to provide technical support or monitoring, for example) for fear that neighbors will suspect their status. Many women intentionally attend health clinics that are far from their homes where they will not see neighbors or be visited by health staff. Stigma exists not only at the societal level, but also within households. Women in coffee ceremonies frequently note that they do not tell their husbands that they are bringing the children for treatment or that they are attending coffee ceremonies at the hospital. Many say that their husbands left them once they discovered their HIV status.
Replicating and Implementing at Scale
The integrated Breedlove project could be replicated in other cultures or contexts, in both urban and rural settings. Implementing at scale would require a significant resource investment at the health facility level, as well as a revision of the urban agriculture strategy. Several enabling factors will help to make it successful:
- The existence of a tradition (like the coffee ceremony) that facilitates social interaction, bonding, and trust.
- A history of working closely with hospital and health facility staff, including familiarity with their systems and constraints.
- Referral networks between components to ensure integrated programming.
- Clarity among beneficiaries that the project is temporary, and that urban agriculture (or other livelihoods programming) can help replace the benefits currently provided through food assistance.
- Home-based care staff or counselors with strong facilitation skills or the ability to learn them.
- Strong willingness on the part of government to collaborate on each of the three components.
- Access to land (or space for containers) and water to plant vegetables and raise chickens.
In addition, there are some considerations for implementing at scale:
- To truly operate at scale, the project would have to focus on expanding and strengthening programming at the health facility level. Coffee ceremonies would need to be conducted both at the hospitals and health care facilities, and promotion of urban agriculture would need to be expanded to the health care facility level as well.
- The urban agriculture program is currently unable to keep up with demand, even though its promotion during the food distributions is limited. The program was originally established to serve participants from PCI's Better Education and Life Opportunities for Vulnerable Children through Networking and Organizational Growth (BELONG)(3) program, a USAID- and U.S. President's Emergency Fund for AIDS Relieffunded program for orphans and vulnerable children, and in 2007 began serving participants from Breedlove as well. To operate at scale, the project would need to consider using a larger infrastructure for training and support. Partnership with the Ministry of Agriculture and use of government extension workers may be one option for enhancing the project's ability to expand and better serve participants at the health facility level.
- With more support to hospital staff, coffee ceremonies could be absorbed into hospital and health facility portfolios of activities (i.e., become their responsibility). The ceremonies are not inordinately expensive; they are very cost-effective, and staff already recognize their value.
- In addition to urban agriculture skills, an option for small business training would make the project more attractive and feasible for a wider range of individuals. Not everyone is suited for (or interested in) gardening and poultry production.
- The referral network between hospital and health facility staff and facilitators for urban agriculture and coffee ceremonies needs to be strengthened. Currently, not all beneficiaries of the Breedlove project are aware of, or have access to, all three services. In some cases, participants at food distributions express interest in the urban agriculture program, but when the promotion officer goes to enroll that person in the program, they cannot locate the person. A formal referral system would improve these problematic linkages.
- The establishment of a formal M&E system would be critical in the event of scale-up and even for moderate expansion. Developing and pilot testing indicators to monitor the progress and success of each component would improve the project's prospects for further funding and expansion, and ensure that it is indeed achieving some of its key objectives (e.g., improved adherence and retention).
Short-term nutritional support has a critical role to play in efforts to improve outcomes of women in PMTCT programs and children on ART. But while providing nutritious foods to PMTCT participants helps offset barriers to retention and helps pediatric ART participants adhere to their drug regimen, it does not address ongoing and long-term household food and nutrition insecurity, which is extremely common among HIV-affected families.
A larger strategy to address food, nutrition, and livelihood insecurity is frequently ignored, leaving these women, their infants, and their families without means to sustain their nutritional status once they graduate from food-supported PMTCT and ART programming.
PCI's Breedlove project is an example of integrated HIV and FNS programming that intentionally links food assistance with activities to address participants' long-term FNS needs. Breedlove soup, the coffee ceremonies, and urban gardening and poultry production combine to offer participants not only an improved quality of life today, but better opportunities for tomorrow. The hope is that the project detailed here, and the lessons that emerged through the development of this case study, will encourage agencies in other countries to experiment with applying the model and exploring the benefits of integrating HIV and FNS programming in their own contexts.
Addis Ababa HIV/AIDS Prevention & Control Office. 2010. AA-HAPCO Website. Available at http://aahapco.org/ (accessed August 2010)
Banteyerga, H. 2007. "System Wide Effects of the Global Fund with Respect to ART Scale-up: Evidence from Ethiopia." PowerPoint presentation given at Health Systems 2020 conference, November 22, Dublin, Ireland.
Central Statistical Agency (Ethiopia) and ORC Macro. 2006. Ethiopia Demographic and Health Survey 2005. Addis Ababa, Ethiopia, and Calverton, MD: Central Statistical Agency and ORC Macro. Available at http://www.measuredhs.com/pubs/pdf/FR179/FR179.pdf (accessed August 2010)
Ethiopian Health and Nutrition Research Institute. 2010. Nutrition Baseline Survey Report for the National Nutrition Program of Ethiopia. Addis Ababa: Ethiopian Health and Nutrition Research Institute.
Federal-HIV/AIDS Prevention & Control Office, Ethiopia. 2010. Report on Progress Towards Implementation of the UN Declaration of Commitment on HIV/AIDS. Available at http://www.unaids.org/en/dataanalysis/monitoringcountryprogress/2010progressreportssubmittedbycountries/ethiopia_2010_country_progress_report_en.pdf (accessed September 2010)
PCI. 2009. Single Year Assistance Plan. Final Results Report to USAID, Fiscal Year 2009.
UNICEF. 2007. UNICEF Website. Available at http://www.unicef.org/aids/index_preventionMTCT.html (accessed September 2010)
This case study was written by Kara Greenblott, with technical input and editing by Kate Greenaway (both of Nzinga International). Field research was conducted on site in Addis Ababa by Rachel Roseberry and Wasihun Eshetu. Specials thanks to Colette Bottini (Technical Advisor, OVC, Office of HIV/AIDS, USAID), Gretchen Bachman (Senior Technical Advisor, PEPFAR OVC Technical Working Group Co-chair, Office of HIV/AIDS, USAID), and the staff at USAID/Ethiopia for their support for the development of this case study.
The authors are grateful to Wasihun Eshetu, Walleligne Beriye, Goshu Seifu, Adisalem Tefaye, and Gwenelyn O'Donnell-Blake of PCI, who generously gave their time and reflections to the development of this case study. And finally, special thanks go to the women, men, and children who participate in PCI's project, and who graciously agreed to share their experiences so that lessons could be disseminated to a wider audience.
Recommended Citation
Greenblott, Kara. 2011. Coffee, Popcorn, Soup, and HIV: Promoting Food and Nutrition Security for Children and Pregnant Women Living with HIV in Ethiopia. Case Study Series. Arlington, VA: USAID's AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1.


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All our volunteer roles are advertised for all seven of our museums at Amgueddfa Cymru. Due to the high demand for volunteering at Amgueddfa Cymru we cannot guarantee your placement, however we do ensure that all applications are treated equally and will be submitted for consideration. Amgueddfa Cymru welcomes volunteers from all parts of the community.
All of our volunteer roles can vary in length, they are usually either long or short term, this will be detailed in the Information Sheet. These volunteer roles will either be advertised with a closing date or be open ended until we have filled the spaces available, so please bear this in mind when considering applying.

subset: commoncrawl


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The Obama administration may regret pushing General James Mattis, the brilliant and blunt-talking Marine who is head of Central Command, into retirement for a variety of reasons—not the least of them being that, with his impending retirement looming, he has felt free to voice undiplomatic truths.
In his testimony before the Senate Armed Services Committee on Tuesday, he was asked whether sanctions and diplomacy were preventing Iran from acquiring nuclear arms. His blunt answer: "No, sir" He followed up by explaining: "That should not be in any way construed as we should not try to negotiate. I still support the direction we're taking. I'm just — I'm paid to take a rather dim view of the Iranians, frankly." Needless to say his "dim view" is a lot closer to reality than the daydreams of political staffers in the White House who imagine that some kind of diplomatic breakthrough with the mullahs is likely.
When he was asked about how many troops the U.S. should leave behind in Afghanistan after 2014, Mattis replied with equal frankness that his recommendation has been to keep 13,600 U.S. troops on the assumption that NATO would provide half as many, for a total international force of 20,000. That is roughly half the figure that the White House has been floating as a possibility. But, again, Mattis's assessment is a lot closer to the mark than the politically driven happy-talk from the White House.
No doubt Mattis caused some consternation in the White House by telling the truth about Iran and Afghanistan—the very definition of a "Washington gaffe"—but it is precisely because of his willingness to speak truth to power that Mattis will be so dearly missed. He is one of the few senior governmental appointees left, after the departure of Clinton, Gates, Panetta, and Petraeus, who can inject some reality into a foreign policy that increasingly seems to be dominated by a handful of like-minded presidential cronies.


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The biography of Langston Hughes. This page has biographical information on Langston Hughes, one of the best poets of all time. We also provides access to the poet's poems, best poetry, quotes, short poems, and more.
Biography |
| Best Poems | Short Poems
| Quotes
An American poet, novelist, playwright, short story writer, and newspaper columnist.. American poet social activist novelist playwright and columnist
Langston Hughes (February 1, 1902 – May 22, 1967) was an American poet, novelist, playwright, short story writer, and newspaper columnist. He is best known for his work during the Harlem Renaissance.
Langston Hughes was born James Mercer Langston Hughes in Joplin, Missouri, the son of Carrie Langston Hughes, a teacher, and her husband, James Nathaniel Hughes. After abandoning his family and the resulting legal dissolution of the marriage later, James Hughes left for Cuba first, then Mexico due to enduring racism in the United States. After the separation of his parents, young Langston was left to be raised mainly by his grandmother, Mary Langston, as his mother sought employment. Through the black American oral tradition of storytelling, she would instill in the young Langston Hughes a sense of indelible racial pride. He spent most of childhood in Lawrence, Kansas. After the death of his grandmother, he went to live with family friends, James and Mary Reed, for two years. His childhood was not an entirely happy one due to an unstable early life, but it was one that heavily influenced the poet he would become. Later, he lived again with his mother in Lincoln, Illinois who had remarried when he was still an adolescent, and eventually in Cleveland, Ohio where he attended high school.
While in grammar school in Lincoln, Illinois, he was designated class poet because of, Hughes said later as an adult, his race, African Americans then being stereotyped as having rhythm.[1] During high school in Cleveland, Ohio, he wrote for the school paper, edited the yearbook, and began to write his first short stories, poetry, and dramatic plays. His first piece of jazz poetry, When Sue Wears Red, was written while he was still in high school. It was during this time that he discovered his love of books. From this early period in his life, Hughes would cite as influences on his poetry the American poets Paul Laurence Dunbar and Carl Sandburg. Hughes spent a brief period of time with his father in Mexico in 1919. The relationship between him and his father was troubled, causing Hughes a degree of dissatisfaction that led him to contemplate suicide at least once. Upon graduating from high school in June of 1920, Hughes returned to live with his father hoping to convince him to provide money to attend Columbia University. Hughes later said that prior to arriving in Mexico again, "I had been thinking about my father and his strange dislike of his own people. I didn't understand it, because I was a Negro, and I liked Negroes very much."[2] Initially, his father hoped for Langston to attend a university anywhere but in the United States and to study for a career in engineering. On these grounds, he was willing to provide financial assistance to his son. James Hughes did not support his son's desire to be a writer. Eventually, Langston and his father came to a compromise. Langston would study engineering so long as he could attend Columbia. His tuition provided, Hughes left his father after more than a year of living with him. While at Columbia in 1921, Hughes managed to maintain a B+ grade average. He left in 1922 because of racial prejudice within the institution and his interests revolved more around the neighborhood of Harlem than his studies, though he continued writing poetry.
Hughes worked various odd jobs before serving a brief tenure as a crewman aboard the S.S. Malone in 1923,spending 6 months traveling to West Africa and Europe.[3]In Europe, Hughes left the S.S. Malone for a temporary stay in Paris. Unlike specific writers of the post-WWI era who became identified as the Lost Generation, writers such as Ernest Hemingway and F. Scott Fitzgerald, Hughes instead spent time in Paris during the early 1920s becoming part of the black expatriate community. In November 1924 Hughes returned to the states to live with his mother in Washington, D.C. Hughes again found work doing various odd jobs before gaining white-collar employment in 1925 as a personal assistant to the scholar Carter G. Woodson within the Association for the Study of African American Life and History. Not satisfied with the demands of the work and time constraints this position with Carter placed on the hours he spent writing, Hughes quit this job for one as a busboy in a hotel. It was while working as a busboy that Hughes would encounter the poet Vachel Lindsay. Impressed with the poems Hughes showed him, Lindsay publicized his discovery of a new black poet though by this time Hughes' earlier work had already been published in magazines and was about to be collected into his first book of poetry.
The following year, Hughes enrolled in and, in 1929, graduated from Lincoln University, PA, a HBCU.[4][5] Hughes received a B.A. degree from this same institution and years later was awarded a Lit.D. in 1943 from it. A second honorary doctorate would be awarded to him in 1963 by Howard University, another HBCU. Barring numerous travels that also included parts of the Caribbean and West Indies, Harlem was Hughes's primary home for the remainder of his life.
In New York City on May 22, 1967, Hughes died from complications after abdominal surgery related to prostate cancer at the age of 65. The ashes of Langston Hughes are interred beneath a floor medallion in the middle of the foyer leading to the auditorium named for him within the Arthur Schomberg Center for Research in Black Culture in Harlem.[6] Many of Langston Hughes' personal papers reside in the Langston Hughes Memorial Library on the campus of Lincoln University as well as at the James Weldon Johnson Collection within the Yale University Beinecke Rare Book and Manuscript Library.
On the issue of the sexual orientation of Hughes, academics and biographers generally agree that Hughes was a homosexual and included homosexual codes into many of his poems similar in manner to Walt Whitman, whose work Hughes would cite as another influence on his poetry, and most patently in the short story Blessed Assurance.[7] [8][9][10][11] Arnold Rampersad, the primary biographer of Hughes, determined that Hughes exhibited a preference for other African American men in his work and life.[12] This love of black men is evidenced in a number of reported unpublished poems to a black male lover.[13]
First debuting in The Crisis in 1921, the prose that would become the signature poem of Hughes appeared in his first book of poetry, The Weary Blues, published in 1926, The Negro Speaks of Rivers.
Hughes' life and work were enormously influential during the Harlem Renaissance of the 1920s alongside those of his contemporaries, Zora Neale Hurston, Wallace Thurman, Claude McKay, Countee Cullen, Richard Bruce Nugent, and Aaron Douglas who collectively would create the short lived magazine Fire!! Devoted to Younger Negro Artists. Hughes and his comptemporaries were often in conflict with the goals and aspirations of the black middle class and the three considered the midwives of the Harlem Renaissance, W.E.B. Du Bois, Jessie Redmon Fauset, and Alain Locke, who they accused of being overly fulsome in accommodating and assimilating eurocentric values and culture for social equality. Of primary conflict were the depictions of the "low-life," that is, the real lives of blacks in the lower social-economic strata and the superficial divisions and prejudices based on skin color within the black community. Hughes wrote what would be considered the manifesto for himself and his comtemporaries published in The Nation in 1926, The Negro Artist and the Racial Mountain:
His poetry and fiction centered generally on insightful views of the working class lives of blacks in America, lives he portrayed as full of struggle, joy, laughter, and music. Permeating his work is pride in the African American identity and its diverse culture. "My seeking has been to explain and illuminate the Negro condition in America and obliquely that of all human kind,"[14] Hughes is quoted as saying. Moreover, Hughes stressed the importance of a racial consciousness and cultural nationalism absent of self-hate that united people of African descent and Africa across the globe and encouraged pride in their own diverse black folk culture and black aesthetic. His African-American race consciousness and cultural nationalism would influence many black writers such as Jacques Roumain, Nicolás Guillén , Léopold Sédar Senghor, and Aimé Césaire.
In 1930, his first novel, Not Without Laughter, won the Harmon Gold Medal for literature.[15]The protagonist of the story is a boy named Sandy whose family must deal with a variety of struggles imposed upon them due to their race and class in society in addition to relating to one another. Hughes first collection of short stories came in 1934 with The Ways of White Folks.[16][17] These stories provided a series of vignettes revealing the humorous and tragic interactions between whites and blacks. He received a Guggenheim Fellowship in 1935. In 1938, Hughes would establish the Harlem Suitcase Theater followed by the New Negro Theater in 1939 in Los Angeles, and the Skyloft Players in Chicago in 1941. The same year Hughes established his threatre troupe in Los Angeles, his ambition to write for the movies materialized when he co-wrote the screenplay for Way Down South. Further hopes by Hughes to write for the lucrative movie trade were thwarted because of racial discrimination within the industry. Through the black publication Chicago Defender, Hughes in 1943 gave creative birth to Jesse B. Semple, often referred to and spelled Simple, the everyday black man in Harlem who offered musings on topical issues of the day. He was offered to teach at a number of colleges, but seldom did. In 1947, Hughes taught a semester at the predominantly black Atlanta University. Hughes, in 1949, spent three months at the integrated Laboratory School of the University of Chicago as a "Visiting Lecturer on Poetry." He wrote novels, short stories, plays, poetry, operas, essays, works for children, and, with the encouragement of his best friend and writer, Arna Bontemps, and patron and friend, Carl Van Vechten, two autobiographies, The Big Sea and I Wonder as I Wander, as well as translating several works of literature into English. Much of his writing was inspired by the rhythms and language of the black church, and, the blues and jazz of that era, the music he believed to be the true expression of the black spirit; an example is "Harlem" (sometimes called "Dream Deferred") from Montage of a Dream Deferred (1951), from which a line was taken for the title of the play A Raisin in the Sun.
During the mid 1950s and 1960s, Hughes popularity among the younger generation of black writers varied as his reputation increased worldwide. With the gradual advancement toward racial integration, many black writers considered his writings of black pride and its corresponding subject matter out of date. They considered him a racial chauvinist.[18] He in turn found a number of writers like James Baldwin lacking in this same pride, over intellectualizing in their work, and occasionally vulgar.[19][20][21] Though he was able to understand the main points of the Black Power movement of the 1960s, he believed that some of the younger black writers who supported it were too angry in their work. Hughes' posthumously published Panther and the Lash in 1967 was intended to show solidarity and understanding with these writers but with more skill and absent of the most virile anger and terse racial chauvinism some showed toward whites.[22][23] Hughes still continued to have admirers among the larger younger generation of black writers who he often helped by offering advice to and introducing to other influential persons in the literature and publishing communities. This latter group, who happened to include Alice Walker who Hughes discovered, looked upon Hughes as a hero and an example to be emulated in degrees and tones within their own work. One of these young black writers observed of Hughes, "Langston set a tone, a standard of brotherhood and friendship and cooperation, for all of us to follow. You never got from him, 'I am the Negro writer,' but only 'I am a Negro writer.' He never stopped thinking about the rest of us."[24]
In 1960, the NAACP awarded Hughes the Spingarn Medal for distinguished achievements by an African American. Hughes was inducted into the National Institute of Arts and Letters in 1961. In 1973, the first Langston Hughes Medal was awarded by the City College of New York.


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Robin Chemers Neustein Postdoctoral Fellowship Recipients
The recipients of the 2015 Robin Chemers Neustein Postdoctoral Fellowship Award are Leticia Tordesillas, PhD and Elizabeth Heller, PhD.
Dr. Tordesillas works in the laboratory of Cecilia Berin, PhD, Associate Professor in the Department of Pediatrics. Dr. Tordesillas' research is focused on how to establish immune tolerance to foods for the treatment of food allergy. In particular, she is studying how regulatory T cells induced by epicutaneous immunotherapy are generated and suppress anaphylaxis.
Dr. Heller works in the laboratory of Eric Nestler, MD, PhD, Professor and Chair of the Fishberg Department of Neuroscience and Director of the Friedman Brain Institute. Dr. Heller's research focuses on epigenetic remodeling - the molecular changes that occur at specific genes – in the context of drugs of abuse and stress. She found that a specific epigenetic remodeling factor delivered to the reward region of the brain is sufficient to reverse the effects of drug and stress exposure, demonstrating the potential therapeutic efficacy of epigenetic regulation in combating neuropsychiatric disease.
In 2014, the Neustein Fellowship was given to both Allyson Friedman, PhD and Sonja Schmid, PhD.
Dr. Friedman works in the laboratory of Ming-Hu Han, PhD, Assistant Professor in the Department of Pharmacology and Systems Therapeutics, and is an alumna of our Graduate School. Dr. Friedman's research has demonstrated that resilience to chronic social stress is achieved through homeostatic mechanisms that stabilize midbrain dopamine activity, an important system in the brain that controls reward and motivation. Promoting these naturally occurring homeostatic mechanisms has antidepressant effects—a conceptually new avenue for exploring depression treatment.
Dr. Schmid works in the laboratory of Benjamin tenOever, PhD, the Irene and Dr. Arthur M. Fishberg Professor of Medicine in the Department of Microbiology. Dr. Schmid's research focuses on the interplay between viruses and their hosts on a molecular level. This includes the characterization of distinct arms of the host antiviral response, as well as the development of novel viral vectors, with a goal to improve current vaccine strategies and generate innovative therapeutics.
In 2013, the Neustein Fellowship was given to Dr. Judith Agudo in Dr. Brian Brown's lab in the Department of Genetics and Genomics Sciences. Judith studies strategies for the induction of tolerance and prevention of type I Diabetes, a topic that has driven her since she was a graduate student. She received a Fulbright fellowship in 2010 to join Dr Brown's lab in order to work on the development of "vaccines" to prevent autoimmune attack in type 1 diabetes. She also received a postdoctoral award from the Juvenile Diabetes Research Foundation to study strategies that can prevent type 1 diabetes.
Publications sponsored by the award:
- Agudo J, Ayuso E, Jimenez V, Casellas A, Mallol C, Salavert A, Tafuro S, Obach M, Ruzo A, Moya M, Pujol A, Bosch F, Vascular Endothelial Growth Factor-mediated islet hypervascularization and inflammation contribute to progressive reduction of beta-cell mass, Diabetes, 61: 2851-2861, 2012.
- Agudo J, Ruzo A, Kitur K, Sachidanandam R, Blander JM, Brown BD, A TLR and non-TLR mediated innate response to lentiviruses restricts hepatocyte entry and can be ameliorated by pharmacological blockade, Molecular Therapy, 20: 2257-67, 2012.
The 2012 Neustein Fellowship was given to Dr. Anne-Claude Bedard, then in Dr. Jefferey Newcorn's lab and now heading her own lab at Mount Sinai in the Department of Psychiatry. AC studies the neural correlates of visual-spatial working memory in children and adolescents with and without ADHD using fMRI to study brain activation.
Publications sponsored by the award:
- Chacko A, Bedard AC, Marks DJ, Feirsen N, Uderman JZ, Chimiklis A, Rajwan E, Cornwell M, Anderson L, Zwilling A, Ramon M. (in press). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: A replication in a diverse sample using a control condition. Journal of Child Psychology and Psychiatry.
- Chacko A, Uderman J, Feirsen N, Bedard AC, Marks D. (2013). Learning and cognitive disorders: multidiscipline treatment approaches. Child Adolesc Psychiatr Clin N Am. Jul;22(3):457-77. Epub 2013 May 17.
- Chacko A, Feirsen N, Bedard AC, Marks D, Uderman JZ, Chimiklis A. (2013). Cogmed Working Memory Training for Youth with ADHD: A Closer Examination of Efficacy Utilizing Evidence-Based Criteria. J Clin Child Adolesc Psychol. May 13. [Epub ahead of print]
- Halperin JM, Bedard ACV, Curchack-Lichtin JT. (2012). Preventive interventions for ADHD: A neurodevelopmental perspective. Neurotherapeutics, 9(3):531-41.
- Halperin JM, Marks DJ, Bedard ACV, Chacko A, Curchack JT, Yoon CA, Healey DM. (in press). Training Executive, Attention and Motor Skills (TEAMS): A Proof-of-Concept Study in Preschool Children with ADHD. Journal of Attention Disorders. Mar 5. [Epub ahead of print]
- Schulz KP, Fan J, Bédard ACV, Clerkin SM, Ivanov I, Tang CY, Halperin JM, Newcorn JH. (2012). Common and Unique Therapeutic Mechanisms of Stimulant and Non-Stimulant Treatments for ADHD. Archives of General Psychiatry, 69(9):952-61.
The 2011 Neustein Fellowship was given to Dr. Marion Sourisseau, in Dr. Matthew Evan's lab in the Department of Microbiology. Marion's project has been on the role of tight junction protein occludin in cell entry pathways of the Hepatitis C Virus. With the help of the fellowship she published three papers and is currently seeking a permanent position where she can continue to produce excellent science in a friendly environment.
Publications sponsored by the award:
- Hepatic Cells Derived from Induced Pluripotent Stem Cells of Pigtail Macaques Support Hepatitis C Virus infection. Sourisseau M, Goldman O, He W, Gori JL, Kiem HP, Gouon-Evans V, Evans MJ. Gastroenterology 145: 966-969, 2013.
- Temporal analysis of hepatitis C virus cell entry with occludin directed blocking antibodies. Sourisseau M, Michta ML, Zony C, Israelow B, Hopcraft SE, Narbus CM, Parra Martín A, Evans MJ. PLoS Pathog. e1003244, 2013.
- KDR identifies a conserved human and murine hepatic progenitor and instructs early liver development. Goldman O, Han S, Sourisseau M, Dziedzic N, Hamou W, Corneo B, D'Souza S, Sato T, Kotton DN, Bissig KD, Kalir T, Jacobs A,Evans T, Evans MJ, Gouon-Evans V. Cell Stem Cell. 12: 748-760, 2013.
The year 2010, the first year of the Neustein Fellowship, honored two awardees, Dr. Ruth Johnson and Dr. Molly Ingersoll. At the time of the award, Dr. Ruth Johnson was in Dr. Ross Cagan's lab in the Department of Developmental and Regenerative Biology. Ruth's work in the Cagan lab aimed to understand how cells that are integrated within a complex tissue layer are capable of re-organizing to generate a functional organ. She is now an Assistant Professor at Wesleyan University where she teaches Introductory Biology, and Principles and Mechanisms of Cell Biology and will be developing an advanced course in Cancer Biology for the Spring 2015 semester. Her own research group is gaining momentum, and she now has her first graduate student.
Dr. Molly Ingersol was in Dr. Gwendalyn Randolph's lab in the Department of Gene and Cell Medicine in 2010, and now is the head of her own lab at the Institut Pasteur in Paris. Molly's work in the Randolph lab was aimed at understanding the pathogenesis of urinary tract infection and host response. In the ~18 months she has been at the Institut Pasteur, she has received a Marie Curie Career Integration Grant as well as co-authored 2 other successful grants to investigate immune responses during bladder infection and bladder cancer. She is now training students of her own and has assembled a team of 5 that is currently collaborating with teams in the US and in Europe to launch 2 Phase III clinical trials to address whether they can improve the efficacy of BCG immunotherapy for patients with early stage bladder cancer.
Publications sponsored by the award:
- The impact of macroautophagy on CD8(+) T-cell-mediated antiviral immunity. Perot BP, Ingersoll MA, Albert ML. Immunol Rev 255: 40-56, 2013
- CD11b⁺, Ly6G⁺ cells produce type I interferon and exhibit tissue protective properties following peripheral virus infection. Fischer MA, Davies ML, Reider IE, Heipertz EL, Epler MR, Sei JJ, Ingersoll MA, Rooijen NV, Randolph GJ, Norbury CC. PLoS Pathog 7: e1002374, 2011
- Niacin inhibits skin dendritic cell mobilization in a GPR109A independent manner but has no impact on monocyte trafficking in atherosclerosis. Ingersoll MA, Potteaux S, Alvarez D, Hutchison SB, van Rooijen N, Randolph GJ. Immunobiology 217: 548-557, 2012.
- Monocyte trafficking in acute and chronic inflammation. Ingersoll MA, Platt AM, Potteaux S, Randolph GJ. Trends Immunol 32:47-477, 2011.
(last updated in June 2013)


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RICHMOND, Va. (WTVR) — On the heels of the news that Richmond Public Schools will shutter three schools, some neighbors are worried that the closures will bring more blight to the community.
Neighbors cite Whitcomb Court Elementary, which closed seven years ago, as an example. The former East End school features boarded up windows, overgrown bushes and weeds. Graffiti also covers much of the building that once touched so many young lives.
"The police sit across the street from there, so I feel safe," said Angel Ortiz, who lives across the street from what he calls the neighborhood eyesore.
Ortiz said he would like to see a store or even another school take the dilapidated structures place.
The old Armstrong High School also sits vacant about a mile away on North 31st Street after it was shut down in 2004.
Several years after the school closed, David Frazier remembers seeing flames shooting from the building when someone set fire to it.
"They actually put steel up around the windows and doors to keep people out," Frazier said. "But instead of doing that, do something with it."
As CBS 6 revisited the location on Tuesday, Richmond police were investigating after someone discovered a body behind the school.
Now that the school board has voted to close Clark Springs Elementary and two other schools Monday night, CBS 6 News asked leaders if those buildings could also wind up sitting vacant for years.
"Our hope is that if we surplus them, there's a plan for them and that they'll move quickly. So, that we can reap some of that financial benefit," said Jeffrey Bourne, chair of the RPS board.
Bourne said the board has a choice to keep the facilities for educational purposes or surplus the properties back to the city. He said then it is up to city council to decide whether to sell the buildings for future development.
However, that has not happened for the two vacant East End schools.
"Some of these schools may not be in the locations that are attracting a lot of buyers," said Bourne. "So, I don't know whether I'm surprised or realistic in the current conditions where some of these schools are located."
But Frazier worries that if something is not done with the old high school that there will be problems.
"You're going to have people going in and out that are homeless. They're going to find somewhere to lay their heads," said Frazier. "I mean until somebody has a heart and tries to do something with some of these things around here it's not going to change."
On the other hand, not every city school is vacant or dilapidated. In fact, one school building has become the Patrick Henry Charter School. Another was renovated and turned into the Lee School Lofts.
As for the two empty schools in Richmond's East End, one school board member told CBS 6 News that the buildings are worth roughly $9 million.
Stay with CBS 6 News and WTVR.com for updates on this story.


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This week the Army, Navy and Marine Corps announced an increase, while the Air Force announced a decrease. The Coast Guard number remained the same. The net collective result is 1,507 more reservists activated than last week.
At any given time, services may activate some units and individuals while deactivating others, making it possible for these figures to either increase or decrease. The total number currently on active duty from the Army National Guard and Army Reserve is 98,491; Navy Reserve, 6,552; Air National Guard and Air Force Reserve, 14,352; Marine Corps Reserve, 7,389; and the Coast Guard Reserve, 665. This brings the total National Guard and Reserve personnel who have been activated to 127,449, including both units and individual augmentees.
A cumulative roster of all National Guard and Reserve personnel who are currently activated can be found at http://www.defenselink.mil/news/Mar2009/d20090324ngr.pdf .


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The National Motor Museum is home to The Caravan Club Collection, which complements and expands the museum's leisure motoring themed collections. Formed in 1907, The Caravan Club is Europe's premier touring organisation, representing over one million caravanners, motor caravanners and trailer tent owners.
Historic material was gathered for many years at The Caravan Club headquarters. In 2006 this Collection was transferred to the National Motor Museum's Collections Centre. Since this time a Curator and a team of volunteers have been working to improve access and preservation. This work has led to numerous displays, exhibitions, publications and educational workshops which have showcased the Collection.
The Caravan Club Collection dates from the birth of leisure touring caravans in 1885 through to its Centenary Celebrations in 2007 and beyond. Material includes a variety of memorabilia, publications, photographs, film footage and sound recordings reflecting the history of its services and members.
The Caravan Club holds a wealth of publications, journals, archives and other resources relating to the history of the caravan. It welcomes professional and amateur researchers to access this material, which is not on public display, at the National Motor Museum Collections Centre.
The Club also answers a range of enquiries regarding its Collection and history.
For further information or to make an appointment please contact the Curator of The Caravan Club Collection.
Learn more about The Club's enquiry service by checking out the Frequently Asked Questions »
Site by Surface Impression


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Drought is forecast to continue for the next few months. In such a context, people should save every drop of water. Canal dredging work is now an urgent task. Farmers should response to measures taken by local authorities to cope with droughts and other natural disasters.
Drought is forecast to last for the next few months, causing certain difficulties for agricultural production.
Sectors, localities and farmers have in recent times implemented many solutions to ensure sufficient water supplies for sowing the winter-spring rice crop.
The power sector has discharged water from the Hoa Binh reservoirs into the Red River to facilitate water-pumping stations' operations for drought prevention.
The prolonged drought is due to water shortages while many ponds and lakes have not been dredged, thus failing to prevent water from running to the sea.
Previously, dyke reinforcement and canal dredge work was implemented by local people. However, there is no denying that despite its limited budget, the State has still allocated a large amount of money to build canals and irrigation projects to serve agricultural production. When canal systems are sufficiently built, local administrations and farmers should engage in dredging work to facilitate irrigation projects. Local Party committees and administrations must be responsible for the issue and consider it an urgent task, which requires the participation of all people for success.
For the long-term, in highland areas, it is essential to plant suitable trees that do not need much water in order to ensure income for farmers. Unless this is implemented, reservoirs will have to continue discharging water to cope with droughts, thus causing electricity shortages during dry seasons. Apart from dealing with droughts, it is necessary to calculate the common economic efficiency of the whole country. Hence, appropriate measures are needed to ensure enough water supplies, while avoiding power shortage. If power shortages occur in the dry season, power plants have to use oil to generate energy, resulting in a high price for electricity. Accordingly, the Government has to provide subsidies for the electricity sector. In such a context, people should save every drop of water.
Vietnamese people have a tradition of developing irrigation networks. If local authorities fail to mobilise the participation of local people, it is impossible to resolve issues relating to water shortages for agricultural production activities. Canal dredging work is now an urgent task that needs people's efforts and contributions, as well as assistance from the Government. Farmers should response to measures taken by local authorities to cope with droughts and other natural disasters.
Phone: 84-4-38255319 / 84-4-39344231
Fax: 84-4-39344230
Email: email@example.com
Online service permit: 1444/GP-BTTTT issued on 05/9/2011


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The Indian Express has reported that when HP's Asia Pacific senior director of consumer PC and media tablets Yam Su Yin was asked if the company has a smartphone in the offing, she replied "The answer is yes but I cannot give a timetable. It would be silly if we say no. HP has to be in the game."
That makes some sense, as for a growing number of people around the world a smartphone is the first and perhaps the only internet-connected device they use.
She went on to say "Being late you have to create a different set of proposition. There are still things that can be done. It's not late. When HP has a smartphone, it will give a differentiated experience."
What seems more probable is that HP will use one of the major mobile OSes overlaid with some combination of its own apps, UI, or cloud services.
It's been a long time since Apple showed any inclination to licence its operating systems to other companies, so it seems safe to rule out iOS.
While Microsoft would like to see more Windows Phones being sold, the consistent UI seems to be one of its selling points. Furthermore, Microsoft seems keen to provide its own cloud infrastructure to Windows Phone users.
Android would seem to be an obvious choice, especially as Samsung has shown how well customers can react to an Android phone with extras delivered by the manufacturer.
But maybe that's too obvious - please read on.


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A slew of flood watches, flood warning, severe thunderstorm warnings, and a few tornado watches hit the air waves and was sent out to smart phones this past Saturday.
Torrential rains impacted Elbert County early Saturday morning and afternoon.
One area hit particularly hard were several of the county's roads.
According to Elbert County Administrator Bob Thomas, a total of eleven roads had to be closed that Saturday.
He also said there were two roads where the drainage pipe had completely been washed out of the road.
Repairs, Thomas said, are going to cost the county a pretty penny.
"The pipe is about three thousand dollars each, and that is going to have to be replaced, and not to mention the aggregate that we are going to have to put down on our dirt roads", said Thomas. "This rain could very well be twenty-five to thirty thousand dollars damage to the county."
Some parts of Elbert County received up to three inches of rainfall this past Saturday.
The Broad River, along with several creeks in the county, approached dangerously high water levels.
If anyone out in Granite Country was able to snag some pictures of some of those creeks or the Broad River you can send them our way at [email protected]


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Jesse Nawrocki '95: Making surgery safer
Jesse Nawrocki '95
Jesse Nawrocki '95, who earned a total of three degrees in
materials science and engineering
from Lehigh, has received the top award given by
Johnson & Johnson
, the worldwide manufacturer of health-care products.
Nawrocki, a senior engineer with Ethicon Inc., received a Johnson Medal for inventing a needle coating technology that enables surgeons to close wounds with greater control, flexibility and comfort. Ethicon, a Johnson & Johnson subsidiary in Somerville, N.J., makes needles, sutures and other surgical devices.
The Johnson Medals are named for Gen. Robert Wood Johnson, founder of Johnson & Johnson, who during World War II resigned as brigadier general in charge of the New York Ordnance District to serve as vice chairman of the War Production Board and as chairman of the Smaller War Plants Corp.
The Medals have been given by Johnson & Johnson since 1960 to scientists whose creativity has helped the company develop and market major new products.
Nawrocki is one of six scientists this year, and 219 since 1960, to receive what Johnson & Johnson calls its "most prestigious award."
"A paradigm-shifting product "
The "MultiPass Needle Coating Technology" that Nawrocki invented is credited by the corporation with generating $100 million in total sales in 2004.
"Jesse's achievement allows superior wound closure performance while preserving the highly valued characteristics of Ethicon's specialty-focused needles," said an article in
The 2005 Johnson Medals
"His invention has afforded surgeons unparalleled control, flexibility and comfort during procedures by allowing far greater numbers of passes through tissue with little diminishment of lubricity.
"Simply put, Jesse's invention is a paradigm-shifting product in the area of wound closure."
Nawrocki developed a polymeric coating of polyolefin wax powders that, when added to the medical grade silicone used in standard needle coatings, "dramatically improves the penetration capability of surgical needles," said the Johnson & Johnson article. This reduces the penetration force required, easing hand fatigue and lowering the likelihood of a needle bending or breaking under pressure.
In short, said the article, "Jesse utilized the combined principles of metallurgy, surface science, and polymer science to solve challenging technical issues and devise a revolutionary coating technology for surgical needles."
Nawrocki, who has three patents pending, earned a B.S. from Lehigh in 1995, an M.S. in 1999, and a Ph.D. in 2001. He received Johnson & Johnson's Philip B. Hofmann Research Award in 2004 for his work in MultiPass Needle Coating.
In 2001, "Stress-Relief Cracking of a Ferritic Alloy Steel," a paper Nawrocki wrote on his Ph.D. research, won the Henry Granjon Award from the International Institute of Welding, one of the top awards given to graduate students in materials science and engineering.
Nawrocki worked with two advisers as a graduate student –
Arnold R. Marder
, the R.D. Stout Distinguished Professor of materials science and engineering, and
John DuPont
, associate professor of materials science and engineering.
Posted on Monday, January 16, 2006
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The Veranda teak end table has a classic look that will provide timeless elegance in any setting. Like all outdoor teak, this teak end table will patina to a rich, silvery color over time, or can be treated to maintain its original luster to match its indoor counterpart. The Veranda teak end table offers an exceptional value since it provides twice the usable surface space in one teak end table.
As you browse through our pages and speak with our knowledgeable customer representatives, you will find there are quite a few reasons why many have returned and recommended others to shop with us over the past 12 years. Here are some that we often hear why many of our customers think we stand out:
Our shipment came and looked great! Once we got our products out and set up we did notice a very small crack in one of the legs of our shelving unit. I called customer service sent a picture and had a resolution unless then 24 hours. Very happy and customer service was very helpful and took care of everything. Nice to order from a company that stands behind their product AND has someone with knowledge that answers the phone to help.
B E, Frankfort, IN
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Assembly is included with this item when this option is selected. With the assembly option selected, orders that are $1500 or over will also include White Glove Service. White Glove Service, in addition to assembly, includes unpacking, placement of furniture as well as removal and disposal of all debris including cartons and wood crating material. In stock cushions and in stock umbrella fabrics will be included with Assembly/White Glove Services. Made to order cushions and made to order umbrella fabrics are shipped separately via UPS and are not included with Assembly/White Glove Services.
Please allow 2-4 weeks for delivery when choosing Assembly/White Glove Services. Standard, non-assembled, delivery is 2-10 days.
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Dancing With The Stars Week 5 The Bangles, Kelly Clarkson, And The Band Perry To Perform
The Bangles, Kelly Clarkson, And The Band Perry will be performing on the Dancing With The Stars Results show Tuesday night according to this tweet from ABC.
Below are more exciting details from the Official Dancing With The Stars site. Being I'm a huge Madonna fan, I am majorly excited!
If you love the '80s, then break out your Ray-Bans and legwarmers, because Week 5 of Dancing with the Stars is just for you!
Each team's dance will feature music straight from the '80s. Get ready for the possibility of bright neon colors, supersized shoulder pads and some sky-high perms. We can't wait! Here's the inside scoop on next week's show:
The pros are doing a Madonna medley to "Like a Virgin" and "Like a Prayer." Sounds, like, totally awesome! There will be a lively Jive to Wham's, "Wake Me Up Before You Go-Go" as well as a slick Samba to Gloria Estefan's "Conga."
Adding: More details revealed at ABCMedia.net.


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"Don't know if you got a man or not/if god put me in ya plans or not/I'm tripping, this drink got me saying a lot…"
It's not the drink that's got Kanye West gabbing – he's always got something to say. This Saturday night, his subject of choice is his rather incredible songs and the tales behind their creation. His latest CD, 808s & Heartbreak, is all about love lost. Expect lots of vivid explanations.
The Kanye West edition of our Storytellers show is one of the most exciting we've ever had. What's the set list include? We'll tell you the show's songs right here. Put hip-hop in your plans on Saturday night at 9/8c.? Come back to VH1.com after the show for some extra, online-exclusive, performances.
Check Storytellers shows by Mary J. Blige, Kid Rock, Jay-Z, Snoop, and others.


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Medals of America is your premier source for Military Medals, Badges, Patches, Challenge Coins, Rank, Rates and Insignia, as well as great military clothing. Our apparel includes military hats, shirts, jackets and more! Most of our clothing products can be Custom Embroidered, so you can make your clothing one-of-a-kind.
We are proud to offer our exclusive Free Custom Builders, including our Ribbon Rack Builder, Military Medals Builder, Custom Display Case Builder and Custom Garment Builders.
Medals of America is Veteran owned and operated for more than 35 years! Our mission is simple - we want every Veteran and Service person to display the Medals our grateful Nation awarded them.
USN Captain Raincoat Size 1 pair
A silver-colored spread eagle, right and left talons of one foot grasping an olive branch, the other, a bundle of arrows. Sold in pairs.
This item is also available to be embroidered on many of our custom embroidered items, printed onto a Custom T-Shirt, or engraved onto a flag case, pint glass. See our Custom Builders section!


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Accessibility on the web has been an issue for over a decade, and it remains a crucial--but often overlooked--element of web design. Instructor Zoe Gillenwater explains the concept of accessibility as it applies to the web, and describes how it affects the audience. She also covers how to set up accessibility testing, and how to apply accessibility principles to new and existing sites using standards-compliant markup and CSS. Exercise files accompany the tutorials.
>> Let's look at how someone using a screen reader would experience a web page that is inaccessible and the improvements that can be made when accessibility features are added. We are at the W3C's web accessibility initiative website at www.w3.org/wai/eo/2005/demo. On this page are a series of links to inaccessible web pages as well as links to the same web pages with accessibility features added.
But for now, I just want you to sit back and get a sense of the experience of having a disability and using a screen reader to access a web page. Let's scroll down the page, and underneath the heading demonstration contents are the listing of pages that we can look at. I'm going to go to the Inaccessible Homepage link. This is a fairly common type of website that you may find. It has a logo on the top left corner identifying the name of the site that we can immediately see. This is also evident in this large heading text in the middle of the page.
We can quickly get a sense of what the sections of the website are by looking in the left-hand column at the four links listed; home, news, tickets and survey. And we can see what the main stories on the website are in this middle column with these three headings: Heat wave link to temperatures, Man gets nine months in violin case, and Lack of brains hinders research. Another thing that we can view on this web page, if we scroll down, is some brief text about each of these stories and a link that says More that we can click on to read the full story.
Now we're going to look at this web page with a screen reader. And I would like you to pay attention to these same parts of the web page that I have pointed out and see how the screen reader reads this and the information that it gives to the user. (Start Screenreader) >> Jaws 40 minute loads dot dot colon colon city lights colon colon colon dot dot dot dash Mozilla Firefox combo box to left's click menu dash dash greater traffic colon construction work on main road to date colon Monday 03 September 2007. Sunny 23 degrees see traffic colon construction work on main road to date colon Monday 03 September 2007.
Sunny 23 degrees see link graphic pics slash nav underline mouse over. Link graphic pics slash NAV underline news on mouse over link graphic pics slash NAV underline fax on those over link graphic pics slash NAV underline survey on mouse over welcome to city lights. City lights is the new portal for visitors and residents. Find out what's on book tickets. Tell us what's good and what's not. Get the latest news. Link heat wave link the temperatures. Link NAV gets nine months in violin case. Link lack of brains hinders research.
After three years of efforts, city scientists now agree that the primary cause of the 2003 heat wave was hot air from our link graphic pics slash on mouse over mayor colon these kinds of crimes need more creative effective punishments. For example, we could require compulsory link graphic pics slash on mouse over brain. >> (End Screenreader). I've stopped the screen reader from finishing to the end of the page now that you've had a chance to hear it. Let's now look at the same version of this page that is more accessible and listen for the differences in how the screen reader reads it.
I scroll to the top. There's a link to the accessible version of this same page, Accessible Homepage. >> Accessible homepage link. Welcome to city lights. Traffic colon construction work on main road to date colon Friday 27 January 2006. Sunny spells 23 degrees. See navigation menu colon. List of four items home link news. Link tickets. Link survey list and ten in level one. Welcome to city lights. City lights is the new portal for visitors and residents. Find out what's on book tickets.
Tell us what's good and what's not. Get the latest news. Head in level two link heat wave link to temperatures graphic man with giant head after three years of efforts, city scientists now agree that the primary cause of the 2003 heat wave was hot air from dot dot dot link heat wave dash. Link full story head in level two. Link man gets nine months in violin case. Traffic A violin case open for inspection complete with violin mayor colon these kinds of crimes need more creative effective punishments. For example, we could require dot dot dot link violin case dash.
Link full story head in level two. Link lack of brains hinders research traffic A brain. >> So as you can see on this web page, it looks almost exactly as it did before, but you heard a number of changes in how the screen reader read the page. First of all, when it read the navigation bar on the left side, it didn't read extra information about each of the images. But instead, said link home link news link tickets link survey. It also announced how many links were about to be read before it began reading them.
Another change that you probably noticed was that it read each of the three headings, then read the caption below the picture. These small changes made the information on the page clearer. And it also took less time for the screen reader to get to the important information. It had less unnecessary characters and images to read through before it could tell the user what the names of the links were, what the names of the stories were and how to get more information on the site. So this is just one example of how small changes on a website can make a big difference in the experience of browsing a website and using it to get information.
Hopefully this shows you the great benefits that can come from accessibility to your users. There's also great benefits from accessibility for you and for your clients. We'll talk about those benefits next.
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Lil' Scrappy may be presently booking club dates solely based off the strength of his work on Love & Hip Hop: Atlanta, but for those of us who knew Scrappy just when he was singing about busting heads and having money in the bank, it's kind of crazy to see the Atlanta rapper turn 30. As in, oh Lord, we're getting old(er). No matter, though, because Scrappy is sailing into the third decade of his life as both a rapper and a big TV star.
But if there's one thing about Scrappy that hasn't changed, it's his love of women. While he's currently dating fellow rapper and reality star Bambi, we've seen Scrappy share his love for many other ladies — including Diamond from Crime Mob, and his fellow Love & Hip Hop: Atlanta co-stars Erica Dixon and Shay Johnson. And of course, you can't forget the other two important women in his life: His mother, Momma Dee, and the cute kid he shares with Erica, Emani.
So inhonor of Lil' Scrappy's 30th birthday, here's a look at all of the women who have helped shape his life. Happy Birthday, Scrappy. Try not to put those paws on anybody. Yes, I had to say that. I'd be wrong not to make that reference.


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Posted at: 12/12/2012 11:20 AM
By: Associated Press
New York's top court has rejected a Henrietta man's plea of guilty to beating and stabbing his elderly father, ruling the judge should have further questioned his mental illness before accepting the manslaughter plea.
The Court of Appeals says Michael Mox of Henrietta raised doubts about his intent to kill, an element of that crime, when telling the judge he was "hearing voices" that 2007 day, was "in a psychotic state" and missed his medications for days.
Mox was charged with murder. Prosecution and defense psychiatrists agreed he had schizoaffective disorder, but differed whether he could appreciate what he did was wrong.
His first attorney told the judge he was willing to forgo an insanity defense and admit manslaughter.
At sentencing, his second lawyer tried to withdraw the plea.