"These are good problems to have ": establishing a collaborative research partnership in East Africa.

In the context of a long-term institutional 'twinning' partnership initiated by Indiana and Moi Universities more than 22 years ago, a vibrant program of research has arisen and grown in size and stature. The history of the AMPATH (Academic Model Providing Access to Healthcare) Research Program is described, with its distinctive attention to Kenyan-North American equity, mutual benefit, policies that support research best practices, peer review within research working groups/cores, contributions to clinical care, use of healthcare informatics, development of research infrastructure and commitment to research workforce capacity. In the development and management of research within our partnership, we describe a number of significant challenges we have encountered that require ongoing attention, many of which are "good problems" occasioned by the program's success and growth. Finally, we assess the special value a partnership program like ours has created and end by affirming the importance of organizational diversity, solidarity of purpose, and resilience in the 'research enterprise.'

Lessons from IAVI-006, a phase I clinical trial to evaluate the safety and immunogenicity of the pTHr.HIVA DNA and MVA.HIVA vaccines in a prime-boost strategy to induce HIV-1 specific T-cell responses in healthy volunteers.

IAVI-006 was the first large randomised, double-blinded, placebo-controlled Phase I clinical trial to systematically investigate the prime-boost strategy for induction of HIV-1 specific CD8+ cytotoxic T-lymphocytes (CTL) in a factorial trial design using (i) priming with 0.5 mg or 2 mg of pTHr.HIVA DNA vaccine, followed by (ii) two booster vaccinations with 5 x 10(7) MVA.HIVA at weeks 8 and 12 (early boost) or weeks 20 and 24 (late boost). This study set the basis for later clinical trials and demonstrated the safety of these candidate HIV vaccines. The safety and immunogenicity results are presented and the lessons derived from this clinical trial are discussed.

What are the results of high ligation followed by sclerotherapy?

In the late 1960's, many surgeons in the United Kingdom became enthusiastic sclerotherapists as a result of the work and publications of Professor George Fegan a few years earlier. This resulted in many centres using compression sclerotherapy alone for all types of varicose veins--some centres virtually abandoned the surgical approach even in the presence of sapheno-femoral and/or sapheno-popliteal reflux. Although initial results seemed remarkable, it gradually became clear that after a few years, recurrent varicose veins were prevalent particularly in those patients who had initially demonstrated reflux. The magnitude of the problem only became fully defined with the publication of the 6 year results of the random trial, "Surgery versus Sclerotherapy" from John Hobbs at St. Mary's Hospital, London. (John Hobbs - The treatment of venous disorders. Edinburgh, R. & R. Clark Ltd, 1977).