CHANGES IN SEXUAL BEHAVIORS DUE TO THE UTILIZATION OF PrEP AS A PREVENTIVE METHOD FOR THE TRANSMISSION OF HIV

ABSTRACT According to The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), approximately 33.4 million individuals throughout the world have been affected by HIV/AIDS in the last 30 years or so (Bonacquisti & Geller, 2013). The medication, Truvada, otherwise known as PrEP, has been introduced to serve as a harm reduction technique to combat the spread of HIV infection. PrEP is an antiretroviral drug that lowers the risk of HIV exposure. This is a qualitative study examining the sexual behaviors of gay and bisexual men prescribed PrEP as a preventive method for the transmission of HIV. I conducted 30 semi-structured in-depth interviews of people who had been prescribed PrEP for at least 30 days in three cities: Los Angeles, Philadelphia, and New York City. The results indicate that contextual factors shaped the sexual behaviors of participants on PrEP, leading them to lower risk at times, and elevate it at others. PrEP caused individuals to experience changes within their communication patterns with their medical providers and their sexual partners. The results shed light on the way people on PrEP engage in sexual and health-seeking behaviors, and help to develop a blueprint for the way service providers engage with this community. KEY WORDS: PrEP (Pre-exposure Prophylaxis); HIV /AIDS; Truvada; HIV prevention; harm reduction; risky sexual behaviors; Cognitive Behavioral Therapy (CBT); Relational Cultural Therapy (RCT); qualitative interview

Application of Gravity and Intervening Opportunities Models to Recreational Travel in Kentucky

Weekend outdoor recreational travel has a major impact on the highway network in Kentucky. Data from a previous study (1) indicate that the number of people visiting 42 typical Kentucky outdoor recreation areas on an average summer Sunday in 1970 was approximately 260,000. Most of these 42 areas, by virtue of their outdoor nature, are located in rural settings. Most have access to major arterial highways only by means of narrow, low standard rural roads. Traffic generated by the recreation areas and their associated developments severely strains these secondary access highways and places a significant additional load on the rural arterial network. Construction of man-made lakes often inundates a portion of the highway network. It has been the policy of federal and state agencies to reconstruct these displaced highways to the same standards as the original facilities. However, increased traffic due to development of the area for recreational purposes often renders the old standards inadequate. In addition, development of even non-water-based areas sometimes necessitates construction of new access roads. Too often these roads are constructed to handle an insufficient volume of traffic either because of funding limitations or because of an inadequate assessment of travel demands and characteristics. The purpose of this study was the development of a method for modeling Kentucky\u27s outdoor recreational travel (APPENDIX I contains an outline of the major phases of the study). This information can be used for predicting future travel patterns which allows intelligent planning of highway facilities to accommodate traffic generated by future outdoor recreation developments. As such, this study represents an extension of analyses completed earlier by Pigman (1). It utilizes the same data base but concentrates on the application of gravity and intervening opportunities models to Kentucky\u27s outdoor recreational travel

Wettability of natural root mucilage studied by atomic force microscopy and contact angle: Links between nanoscale and macroscale surface properties

Organic coatings are considered as main cause of soil water repellency (SWR). This phenomenon plays a crucial role in the rhizosphere, at the interface of plant water uptake and soil hydraulics. Still, there is little knowledge about the nanoscale properties of natural soil compounds such as root-mucilage and its mechanistic effect on wettability. In this study, dried films of pure and diluted natural root-mucilage from Sorghum (Sorghum sp., moench) on glass substrates were studied in order to explore experimental and evaluation methods that allow to link between macroscopic wettability and nano-/microscopic surface properties in this model soil system. SWR was assessed by optical contact angle (CA) measurements. The nanostructure of topography and adhesion forces of the mucilage surfaces was characterized by atomic force microscopy (AFM) measurements in ambient air, using PeakForce Quantitative Nanomechanical Mapping (PFQNM). Undiluted mucilage formed hydrophobic films on the substrate with CA > 90° and rather homogeneous nanostructure whereas the contact angles of diluted samples were < 90°. AFM height and adhesion images displayed incomplete mucilage surface coverage for diluted samples. Hole-like structures in the film frequently exhibited increased adhesion forces. The spatial analysis of the AFM data via variograms enabled a numerical description of such ‘adhesion holes’. The use of geostatistical approaches in AFM studies of the complex surface structure of soil compounds was considered meaningful in view of the need of comprehensive analysis of large AFM image data sets that exceed the capability of comparative visual inspection. Furthermore, force curves measured with the AFM showed increased break-free distances and pull-off forces inside the observed ‘adhesion holes’, indicating enhanced capillary forces due to adsorbed water films at hydrophilic domains for ambient RH (40 ± 2 %). This offers the possibility of mapping the nanostructure of water layers on soil surfaces and assessing the consequences for wettability. The collected information on macroscopic wetting properties, nanoscale roughness and adhesion structure of the investigated surfaces in this study are discussed in view of the applicability of the mechanistic wetting models given by Wenzel and Cassie-Baxter

Models of Outdoor Recreational Travel

The purpose of this investigation was to evaluate models of travel flow from population centers throughout the United States to outdoor recreational areas in Kentucky. Data were obtained by means of a license-plate, origin-destination survey at 160 sites within 42 recreational areas and by means of a continuous vehicle counting program at eight of these sites. Attempts to simulate distributed travel flows concentrated on various single-equation models, a cross-classification model, and gravity and intervening opportunities models. The cross-classification model was found to be an acceptable means for simulating and predicting outdoor recreational travel flows and was decidedly superior to the other models. From the cross-classification model, per capita distributed flows were found to (1) decrease at a decreasing rate with increasing population of the origin zone, (2) increase at a variable rate with increasing attraction of tbe recreational area, and (3) decrease at a decreasing rate with increasing distance. The intervening opportunities model was found to be unacceptable as a distribution model since it could not effectively accommodate the widely differing sizes of the 42 recreational areas. The gravity model, on the other hand, was quite effective in distributing actual productions and attractions. Problems associated with tbe gravity model were limited to difficulties in accurately estimating trip productions and attractions in the trip generation phase of analysis

Antiplatelet Therapy Changes for Patients With Myocardial Infarction With Recurrent Ischemic Events: Insights Into Contemporary Practice From the TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) Study

BACKGROUND: Guidelines recommend P2Y12 inhibitor therapy for 1 year after myocardial infarction (MI), yet little guidance is provided on antiplatelet management for patients with recurrent ischemic events during that year. We describe changes in P2Y12 inhibitor type among patients with recurrent ischemic events in the first year after MI. METHODS AND RESULTS: The TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study enrolled 12 365 patients with MI treated with percutaneous coronary intervention. We examined whether P2Y12 inhibitor choice changed among patients with recurrent MI, stent thrombosis, and/or unplanned revascularization during the first year after MI, and modeled factors associated with P2Y12 inhibitor intensification (changing clopidogrel to prasugrel or ticagrelor). In the first year after MI, 1414 patients (11%) had a total of 1740 recurrent ischemic events (771 recurrent MIs, 969 unplanned revascularizations, and 165 stent thromboses). Median time to the first recurrent ischemic event was 154 days (25th-75th percentiles, 55-287 days). Of those with recurrent ischemic events, 101 of 1092 (9.3%) occurring in clopidogrel-treated patients led to P2Y12 inhibitor intensification. Recurrent events involving stent thrombosis or MI were the strongest factors associated with P2Y12 inhibitor intensification, yet only 40% of patients with stent thrombosis and 14% of patients with recurrent MI had P2Y12 inhibitor intensification. Increasing age and longer time from the index MI were associated with lower likelihood for intensification. CONCLUSIONS: Few patients after MI with a recurrent ischemic event who were taking clopidogrel switched to a more potent P2Y12 inhibitor, even after stent thrombosis events. Specific guidance is needed for patients who have recurrent ischemic events, particularly when closely spaced. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503

SAMPI: Protein Identification with Mass Spectra Alignments

BACKGROUND: Mass spectrometry based peptide mass fingerprints (PMFs) offer a fast, efficient, and robust method for protein identification. A protein is digested (usually by trypsin) and its mass spectrum is compared to simulated spectra for protein sequences in a database. However, existing tools for analyzing PMFs often suffer from missing or heuristic analysis of the significance of search results and insufficient handling of missing and additional peaks. RESULTS: We present an unified framework for analyzing Peptide Mass Fingerprints that offers a number of advantages over existing methods: First, comparison of mass spectra is based on a scoring function that can be custom-designed for certain applications and explicitly takes missing and additional peaks into account. The method is able to simulate almost every additive scoring scheme. Second, we present an efficient deterministic method for assessing the significance of a protein hit, independent of the underlying scoring function and sequence database. We prove the applicability of our approach using biological mass spectrometry data and compare our results to the standard software Mascot. CONCLUSION: The proposed framework for analyzing Peptide Mass Fingerprints shows performance comparable to Mascot on small peak lists. Introducing more noise peaks, we are able to keep identification rates at a similar level by using the flexibility introduced by scoring schemes

Magnitude and Characteristics of Patients Who Survived an Acute Myocardial Infarction

BACKGROUND: The purpose of this study was to describe the magnitude and characteristics of patients who did not experience any significant major adverse cardiovascular event early (within 6 weeks) and late (during the first year) after hospital discharge for an acute myocardial infarction (AMI). METHODS AND RESULTS: Data from 12 243 patients discharged after an AMI from 233 sites across the United States in the TRANSLATE-ACS (Treatment With ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study were analyzed. Multivariable adjusted regression analyses modeled factors associated with 6-week and 1-year survivors who did not experience a recurrent AMI, stroke, unplanned coronary revascularization, or rehospitalization for unstable angina/chest pain during these time periods. The average age of this study population was 60.0 years, 72.0% were men, and 87.9% were white. In this population, 92.4% were classified as early low-risk survivors and 76.3% were classified as late low-risk survivors of an AMI. Factors associated with being an early and late postdischarge survivor included being male and having single-vessel coronary artery disease at the patient\u27s index hospitalization. Patients who were not first seen with any chronic health condition, had an index hospital stay of \u3c /=3 days, and had high baseline quality-of-life scores were more likely to be late low-risk survivors. CONCLUSIONS: Identifying low-risk survivors of an AMI may permit healthcare providers to focus more intensive efforts and interventions on those at higher risk of experiencing adverse cardiovascular events during the postdischarge transition period. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503

Bilateral Dorsal Cochlear Nucleus Lesions Prevent Acoustic-Trauma Induced Tinnitus in an Animal Model

Animal experiments suggest that chronic tinnitus (“ringing in the ears”) may result from processes that overcompensate for lost afferent input. Abnormally elevated spontaneous neural activity has been found in the dorsal cochlear nucleus (DCN) of animals with psychophysical evidence of tinnitus. However, it has also been reported that DCN ablation fails to reduce established tinnitus. Since other auditory areas have been implicated in tinnitus, the role of the DCN is unresolved. The apparently conflicting electrophysiological and lesion data can be reconciled if the DCN serves as a necessary trigger zone rather than a chronic generator of tinnitus. The present experiment used lesion procedures identical to those that failed to decrease pre-existing tinnitus. The exception was that lesions were done prior to tinnitus induction. Young adult rats were trained and tested using a psychophysical procedure shown to detect tinnitus. Tinnitus was induced by a single unilateral high-level noise exposure. Consistent with the trigger hypothesis, bilateral dorsal DCN lesions made before high-level noise exposure prevented the development of tinnitus. A protective effect stemming from disruption of the afferent pathway could not explain the outcome because unilateral lesions ipsilateral to the noise exposure did not prevent tinnitus and unilateral lesions contralateral to the noise exposure actually exacerbated the tinnitus. The DCN trigger mechanism may involve plastic circuits that, through loss of inhibition, or upregulation of excitation, increase spontaneous neural output to rostral areas such as the inferior colliculus. The increased drive could produce persistent pathological changes in the rostral areas, such as high-frequency bursting and decreased interspike variance, that comprise the chronic tinnitus signal

Right-Sided Location Not Associated With Missed Colorectal Adenomas in an Individual-Level Reanalysis of Tandem Colonoscopy Studies

Background & Aims Interval cancers occur more frequently in the right colon. One reason could be that right-sided adenomas are frequently missed in colonoscopy examinations. We reanalyzed data from tandem colonoscopies to assess adenoma miss rates in relation to location and other factors. Methods We pooled data from 8 randomized tandem trials comprising 2218 patients who had diagnostic or screening colonoscopies (adenomas detected in 49.8% of patients). We performed a mixed-effects logistic regression with patients as cluster effects with different independent parameters. Factors analyzed included location (left vs right, splenic flexure as cutoff), adenoma size, form, and histologic features. Analyses were controlled for potential confounding factors such as patient sex and age, colonoscopy indication, and bowel cleanliness. Results Right-side location was not an independent risk factor for missed adenomas (odds ratio [OR] compared with the left side, 0.94; 95% CI, 0.75–1.17). However, compared with adenomas ≤5 mm, the OR for missing adenomas of 6–9 mm was 0.62 (95% CI, 0.44–0.87), and the OR for missing adenomas of ≥10 mm was 0.51 (95% CI, 0.33–0.77). Compared with pedunculated adenomas, sessile (OR, 1.82; 95% CI, 1.16–2.85) and flat adenomas (OR, 2.47; 95% CI, 1.49–4.10) were more likely to be missed. Histologic features were not significant risk factors for missed adenomas (OR for adenomas with high-grade intraepithelial neoplasia, 0.68; 95% CI, 0.34–1.37 and OR for sessile serrated adenomas, 0.87; 95% CI, 0.47–1.64 compared with low-grade adenomas). Men had a higher number of adenomas per colonoscopy (1.27; 95% CI, 1.21–1.33) than women (0.86; 95% CI, 0.80–0.93). Men were less likely to have missed adenomas than women (OR for missed adenomas in men, 0.73; 95% CI, 0.57–0.94). Conclusions In an analysis of data from 8 randomized trials, we found that right-side location of an adenoma does not increase its odds for being missed during colonoscopy but that adenoma size and histologic features do increase risk. Further studies are needed to determine why adenomas are more frequently missed during colonoscopies in women than men