A Network-Individual-Resource Model for HIV Prevention

HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual’s relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual’s current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks

Asphalt Crack Treatment FAQs and Technical Resources

Crack treatment is one of the most used pavement preservation practices and although the technique is simple, there are several nuances that make it more of an art than science. The purpose of this document is to provide: \u2022 An overview of crack treatment, \u2022 Guidance on several FAQs, and \u2022 A high-level summary of several technical resources. Crack sealing is an important preventive treatment in a pavement preservation program to extend a pavement\u2019s serviceable life. Many factors go into determining \u201cif\u201d and \u201chow to\u201d best implement a crack treatment program. The following information is a compilation of synthesizing several technical documents and interviews with some local technical/industry representatives. Although much of this information is research based, some is anecdotal and/or advice from experienced practitioners. The intent is to provide an overview so agencies can draw their own conclusions on how to best implement a crack treatment program

Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities

The field of HIV/STI prevention has primarily focused on gay men (or “men who have sex with men” [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention

Introduction to the Special Section on Bisexual Health: Can You See Us Now?

Despite comprising the largest proportion of the “lesbian, gay, and bisexual” population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts

Improving the Health of Cisgender Men Who Identify as Bisexual: What Do They Want from Interventions?

Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors

Development of an Instrument to Assess Athletic Trainers' Attitudes Toward Transgender Patients

Context:  The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities. Objective:  To develop and validate the Attitudes Toward Transgender Patients (ATTP) instrument for ATs. Design:  Cross-sectional study. Setting:  Semistructured interviews, paper-based questionnaire, and electronic questionnaire. Patients or Other Participants:  Six ATs completed semistructured interviews to develop themes regarding transgender patients. Additionally, 39 students in professional and postprofessional athletic training programs answered questionnaires designed to elicit statements regarding transgender patients. For item reduction, a sample of 3000 ATs were e-mailed (response rate = 17%), and for validation, another sample of 3000 ATs were e-mailed (response rate = 13%). Athletic trainers' e-mail addresses were obtained from the National Athletic Trainers' Association. Data Collection and Analysis:  The 3 phases were (1) exploratory interviews, (2) construct validity and item reduction, and (3) criterion validity. Items were created based on interviews and questionnaires. Principal axis factoring was used for item reduction, and Pearson correlations were used for validation. Results:  Thirty-six statements pertaining to transgender patients were developed from the interview and questionnaire data. After item reduction, 10 items remained to form the ATTP (α = .834). For validation, the ATTP and Transphobia Scale were significantly correlated (r = .723; P < .001). Conclusions:  The ability to assess attitudes toward transgender patients will allow clinicians to identify needed areas of focus for training and education. The ATTP assesses affective and cognitive attitudes and behavioral intentions toward transgender patients in common clinical settings

Virtualization And Digital Forensics: A Research And Education Agenda

The application of virtualization software and techniques in information technology research and education has provided a foundational environment to advance the state-of-the-art in research and education in many related areas. Commercial and open source virtualization products are being used by researchers and educators to create a wide variety of virtual environments. These virtual environments facilitate systems design and development and product development as well as the testing and modeling of production and preproduction systems. As the capabilities, functionality, and stability of these products have evolved, the use of virtualization has expanded, necessitating the identification of new research areas to investigate the impacts of virtualization on digital forensics. In February 2007, a group of digital forensics researchers, educators, and practitioners gathered at the National Center for Forensic Science at the University of Central Florida for the 2007 Workshop on Virtualization in Digital Forensics to discuss these issues and develop a research and education agenda for virtualization and digital forensics. This article outlines some of the ideas generated and new research categories and areas identified at this meeting

Exploring the Sexual Development Experiences of Black Bisexual Male Adolescents Over Time

Scant research has sought to explore the development of dimensions of sexual orientation among Black bisexual male adolescents (BBMA). Understanding how sexual attractions, behaviors, and identities evolve among BBMA over time is crucial to understanding the most appropriate support strategies to provide during this developmental period. We sought to understand and describe the sexual orientation development experiences in a sample ofBBMA overthe course of 1 year. We further sought to understand the sociocontextual factors that may play a role during this development process. Fifteen BBMA, aged 15–19 years, were interviewed about sexual debut experiences (baseline) and were re-interviewed three times over a 1-year period about sexual attractions, behaviors, and identity at each follow-up point. A three-person team used inductive open coding to analyze each participant’s data set. The mean Kinsey scale score for the sample was 2.93 (SD = 1.2) most closely translating to“heterosexual/gay-equally.”A case study analysis was used to identify themes related to sexual attractions, behavior, and identity over time, within and across participants. Among the sample of young men, two unique groups were identified based on self-reported sexual identity and experiences of same- and other-sex sexual attractions and behaviors over time. The first group consisted of seven young men who consistently described their sexual identity as bisexual from baseline to the final follow-up. These young men also described similar experiences related to same- and other-sex sexual and romantic attractions and more consistently described same- and other-sex sexual behaviors. The second group consisted of eight young men that described changing sexual identity and same- and other-sex sexual romantic attractions overtime. Participants described sociocontextual factors such as religion, masculinity, and homophobia played during their development. Findings from this study underscore the complexity of sexual orientation development and sociocultural factors and expectations that may influence sexual identity and behavior among BBMA

Medicaid Policy and Liver Transplant for Alcohol‐Associated Liver Disease

Background and aimsIn some states, liver transplantation (LT) for alcohol-associated liver disease (ALD) is covered by Medicaid only with documentation of abstinence and/or alcohol rehabilitation. Different Medicaid policies may affect the distribution of LT for ALD, particularly post-2011, as centers have adopted early (i.e., specific abstinence period not required) LT practices.Approach and resultsWe surveyed Medicaid policies in all states actively performing LT and linked state policies to prospectively collected national registry data on LT recipients from 2002 to 2017 with ALD as the primary listing diagnosis. We categorized Medicaid policies for states as "restrictive" (requiring documentation of a specific abstinence period and/or rehabilitation) versus "unrestrictive" (deferring to center eligibility policies). Difference-of-differences analysis, comparing 2002-2011 versus 2012-2017, evaluated whether restrictive policies were associated with decreased proportion of LTs paid by Medicaid among patients with ALD post-2011. We performed sensitivity analyses to account for any differences by diagnosis of hepatocellular carcinoma, hepatitis C virus, nonalcoholic steatohepatitis, or Medicare insurance. We also performed a sensitivity analysis to account for any difference by prevalence of ALD among restrictive versus unrestrictive states. Of 10,836 LT recipients in 2002-2017, 7,091 were from 24 states in the restrictive group and 3,745 from 14 states in the unrestrictive group. The adjusted proportion (95% confidence interval) of LTs paid by Medicaid among restrictive versus unrestrictive states between 2002 and 2011 was 17.6% (15.4%-19.8%) versus 18.9% (15.4%-22.3%) (P&nbsp;=&nbsp;0.54) and between 2012 and 2017, 17.2% (14.7%-19.7%) versus 23.2% (19.8%-26.6%) (P&nbsp;=&nbsp;0.005). In difference-of-differences analysis, restrictive (versus unrestrictive) policies were associated with a 4.7% (0.8%-8.6%) (P&nbsp;=&nbsp;0.02) absolute lower adjusted proportion of LTs for ALD paid by Medicaid post-2011.ConclusionsRestrictive Medicaid policies are present in most states with active LT centers and are associated with lower proportions of LTs for ALD paid by Medicaid post-2011 compared to states with unrestrictive Medicaid policies. Reevaluation of Medicaid alcohol use policies may be warranted, to align more closely with contemporary center-level practices

HIV Risk and Prevention Outcomes in a Probability-Based Sample of Gay and Bisexual Men in the United States

Background: Although gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States, nearly all evidence on their HIV risk and prevention outcomes derive from nonprobability samples. Setting: A probability-based cohort of GBM (N = 502) from 45 states and Washington, DC. Methods: Cross-sectional survey. Results: Among HIV-negative/unknown/untested GBM, only 6.7% reported using pre-exposure prophylaxis (PrEP) in the past 6 months. Two-thirds (63.3%) of PrEP users reported daily adherence in the past week. Over half (54.2%) of GBM reported not using a condom during anal sex with their most recent male partner; of these men, 93.8% were not on PrEP. Most GBM had been tested for HIV (80.7%) and other sexually transmitted infections (67.1%) in their lifetime, with 45.2% having tested for HIV during the past year. Among those ever tested, 14.1% reported being HIV infected, whereas an additional 8.9% reported testing positive for at least one other sexually transmitted infection after their most recent test. All HIV-positive GBM reported being currently on antiretroviral treatment, and 94.7% reported an undetectable viral load, but nearly one-third (30.4%) reported not taking their medication every day during the past month. A majority of HIV-negative/unknown/untested GBM (64.3%) reported that they had never discussed HIV prevention with their primary health care provider. Conclusions: Our findings present a decidedly mixed picture regarding the success of the US National HIV/AIDS Strategy in meeting its stated goals of addressing HIV risk among the general population of GBM