A cross-sectional analysis of psychosocial and structural barriers and facilitators associated with PrEP use among a sample of transgender women in Chicago, IL

Abstract Background Expanding pre-exposure prophylaxis (PrEP) among transgender women in the United States is an important strategy to meet national HIV prevention goals, however self-reported use of PrEP is low in this group. Methods This study reports the findings of a cross-sectional analysis of the relationship of barriers as well as facilitators to recent PrEP use among transgender women enrolled in an evaluation of the TransLife Care project (Chicago, Illinois), a structural intervention designed to meet basic needs. We computed multivariable prevalence ratios for barriers, facilitators and recent PrEP use, controlling for demographics. Results Findings suggest that psychosocial and structural barriers, including moderate/high alcohol use, stimulant use, and history of incarceration were all positively associated with recent PrEP use among urban transgender women. In addition, a psychosocial facilitator, gender affirmation, was positively associated with recent PrEP use, while, while collective self-esteem, a was negatively associated with it. Finally, common indications for PrEP have high sensitivity, but low specificity and predictive value for identifying those on PrEP. Conclusion We conclude that despite a large gap in PrEP use among those with indications, individuals experiencing psychosocial and structural barriers are more likely to use PrEP, and facilitators, such as psychological sense of affirmed gender may support its use. Trial registration N/A

A road map for the realization of global-scale thorium breeding fuel cycle by single molten-fluoride flow. Energy Conversion and Management 49

Abstract For global survival, we need to launch a rapid regeneration of the nuclear power industry. The replacement of the present fossil fuel industry requires a doubling time for alternative energy sources of 5-7 years and only nuclear energy has the capability to achieve this. The liquid metal cooled fast breeder reactors (LMFBR) have the best breeding criteria but the doubling time exceeds 20 years. Further, the use of plutonium in these systems has the potential of nuclear proliferation. The Thorium Molten-Salt Nuclear Energy Synergetic System [THORIMS-NES], described here is a symbiotic system, based on the thorium-uranium-233 cycle. The production of trans-uranium elements is essentially absent in Th-U system, which simplifies the issue of nuclear waste management. The use of 233 U contaminated with 232 U as fissile material, instead of plutonium/ 235 U makes this system nuclear proliferation resistant. The energy is produced in molten-salt reactors (FUJI) and fissile 233 U is produced by spallation in Accelerator Molten-Salt Breeders (AMSB). This system uses the multi-functional ''single-phase molten-fluoride" circulation system for all operations. There are no difficulties relating to ''radiation-damage", ''heat-removal" and ''chemical processing" owing to the simple ''idealistic ionic liquid" character of the fuel. FUJI is size-flexible, and can use all kinds of fissile material achieving a nearly fuel self-sustaining condition without continuous chemical processing of fuel salt and without core-graphite replacement for the life of the reactor. The AMSB is based on a single-fluid molten-salt target/blanket concept. Several AMSBs can be accommodated in regional centers for the production of fissile 233 U, with batch chemical processing including radio-waste management. FUJI reactor and the AMSB can also be used for the transmutation of long-lived radioactive elements in the wastes and has a high potential for producing hydrogen-fuel in molten-salt reactors. The development and launching of THORIMS-NES requires the following three programs during the next three decades: 0196-8904/$ -see front matter

Mediterranean outflow: Environmental significance of the Mediterranean Outflow Water and its global implications (Integrated Ocean Drilling Program Expedition 339 Preliminary Report)

During Integrated Ocean Drilling Program Expedition 339, five sites were drilled in the Gulf of Cadiz and two sites were drilled off the West Iberian margin from November 2011 to January 2012. Total length of recovered core is 5447 m, with an average recovery of 86.4%. The Gulf of Cadiz was targeted for drilling as a key location for the investigation of Mediterranean Outflow Water (MOW) through the Strait of Gibraltar gateway and its influence on global circulation and climate. The gulf is also a prime area for understanding the effects of tectonic activity on evolution of the Strait of Gibraltar gateway and margin sedimentation.</p