The Role of Relationship and Other Factors Associated with Condom Use Intention Among Young American Indian Men Ages 18 to 24 Years Old

The purpose of this study was to investigate the heterosexual relationship factors that were associated with condom use intention for STI prevention in a purposive sample of American Indian men. The sample was drawn from the Fort Peck Reservations in northeastern Montana. The sample size included 122 American Indian men ages 18 to 24. The theory of planned behavior and interdependence theory provided the theoretical basis for the study. Seventy- seven percent of the young men reported being in a steady relationship with 60.3% agreeing that they were committed to maintaining their relationship with their current partner. Relationship duration and type and control of condom use was significantly associated with condom use intention for STI prevention. In addition control of condom use and relationship commitment was significantly associated with condom use communication. Regression results suggest that relationship duration, moderate or high participation in condom use decision making and female control of condom use are positively associated with moderately or extremely likely use of condoms in the future. The results from this study suggest that American Indian men are in need of culturally relevant sexual risk prevention efforts that address relationship factors to help reduce STIs in this population

Hastened Death and the Regulation of the Practice of Medicine

We begin with a summary of the controversy over legalized assistance in hastening death and a description of how that controversy led to Gonzales v. Oregon. We then review the Gonzales decision, explaining what it did and did not resolve. Looking to how these issues should be analyzed in the future, we will explain why a fundamental distinction currently embedded in the law is unhelpful in analysis of the legitimacy of assistance in hastening death. We will argue that, correctly understood, assistance in hastening death is properly regarded as a medical practice, or, more broadly stated, that a physician legitimately may assist in various ways in helping to bring about the death of a terminally ill patient who has explicitly and competently requested this assistance from the physician. In making this argument, we suggest how these and other disputes over medicine’s boundaries should be resolved

Somatic Symptom Disorder, Conversion Disorder, and Chronic Pain: Pediatric Clinician Perspectives

Objectives: The appropriateness and relevance of somatic symptom disorder and conversion disorder (American Psychiatric Association, 2013) diagnoses are in question as they relate to pediatric chronic pain. This survey-based study on pediatric chronic pain explores how these psychiatric diagnoses are made and perceived and how treatment of patients is approached by Canadian health care professionals working in pediatric chronic pain clinics. Method: Health care professionals (N = 50) completed the survey, which contained both qualitative and quantitative items. Results: Of participants, 88% reported moderate/advanced training in pain, whereas only 26% reported moderate/advanced training in somatic symptom disorder and conversion disorder. Somatic symptom disorder and conversion disorder were reportedly diagnosed in approximately 17% and 5% of young people with chronic pain, respectively; however, overall, the participants were not confident or only slightly confident when diagnosing these disorders. There were no major differences in the reported interventions used to treat pain, somatic symptom disorder, or conversion disorder. Conclusions: These results highlight the need for standardized training in pain and psychiatric assessment, diagnosis, and treatment; diagnostic guidelines; and how to best provide this training to health care staff who work with young people with chronic pain

Predictors of surgical site skin infection and clinical outcome at caesarean section in the very severely obese : A retrospective cohort study

Introduction The optimal surgical approach for caesarean section is uncertain in women with very severe obesity (body mass index (BMI) >40kg/m2). We aimed to assess maternal and surgical predictors of surgical site skin infection (SSSI) in very severely obese women and to undertake an exploratory evaluation of clinical outcomes in women with a supra-panniculus transverse compared to an infra-panniculus transverse skin incision. Material and methods Using a retrospective cohort design, case-records were reviewed of very severely obese women with a singleton pregnancy delivered by caesarean between August 2011 and December 2015 (n = 453) in two maternity hospitals in Scotland. Logistic regression analysis was used to determine predictors for SSSI. Outcomes were compared between women who had a supra-panniculus transverse compared to infra-panniculus transverse skin incision. Results Lower maternal age was predictive of SSSI, with current smoking status and longer wound open times being marginally significant. Maternal BMI, suture method and material demonstrated univariate associations with SSSI but were not independent predictors. Women with a supra-panniculus transverse skin incision were older (32.9 (4.4), vs. 30.6 (5.7), p = 0.002), had higher BMI (49.2 (7.1), vs. 43.3 (3.3), pPeer reviewe

NAVY EXPEDITIONARY ADDITIVE MANUFACTURING (NEAM) CAPABILITY INTEGRATION

This capstone report analyzes the current and future use of additive manufacturing (AM) technologies within the Department of Defense (DOD). This analysis provided the technical background necessary to develop the Additive Manufacturing Process and Analysis Tool (AMPAT). AMPAT will help stakeholders identify what AM equipment best serves warfighters and their missions in expeditionary environments. Furthermore, the tool can be used by stakeholders to identify the most advantageous dispersions of AM capabilities across the fleet and make decisions on how those capabilities should be integrated into the greater naval mission and larger DOD enterprise. A systems engineering (SE) approach was implemented to gather information on current and prospective AM methods in order to understand and define the AM system operational requirements. Additionally, an SE process was utilized to analyze alternative software options to build the tool, implement agile software development processes to develop the tool, and verify and validate that the tool met the project requirements. The study found that AMPAT successfully outputs a ranked list of AM systems recommendations based upon user-defined input parameters and weighting values. Recommendations for choosing AM equipment and developing dispersion plans for the fleet include using the AMPAT deliverable to conduct customized, iterative analysis with user-defined inputs that are tailored to specific expeditionary environments.Outstanding ThesisCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the ArmyCivilian, Department of the NavyApproved for public release. Distribution is unlimited

Born from pre-eclamptic pregnancies predisposes infants to altered cortisol metabolism in the first postnatal year

Pre-eclampsia leads to disturbed fetal organ development, including metabolic syndrome, attributed to altered pituitary-adrenal feedback loop. We measured cortisol metabolites in infants born from pre-eclamptic and normotensive women and hypothesised that glucocorticoid exposure would be exaggerated in the former. Twenty-four hour urine was collected from infants at months 3 and 12. Cortisol metabolites and apparent enzyme activities were analysed by gas chromatography-mass spectrometry. From 3 to 12 months, excretion of THS, THF and pregnandiol had risen in both groups; THF also rose in the pre-eclamptic group. No difference was observed with respect to timing of the visit or to hypertensive status for THE or total F metabolites (P>0.05). All apparent enzymes activities, except 17α-hydroxylase, were lower in infants at 12 compared to 3 months in the normotensive group. In the pre-eclamptic group, only 11β-HSD activities were lower at 12 months.17α-hydroxylase and 11β-HSD activities of tetrahydro metabolites were higher in the pre-eclamptic group at 3 months (P<0.05). 11β-hydroxylase activity increased in the pre-eclamptic group at 12 months. Cortisol excretion, determined by increased 11β-hydroxylase, compensates for high 11β-HSD-dependent cortisol degradation at 3 months and at 12 months counterbalances the reduced cortisol substrate availability in infants born from pre-eclamptic mothers

Trajectory of Substance Use Disorders and Collegiate Recovery in Emerging Adults

Abstract Collegiate Recovery Programs (CRPs) provide services to support emerging adults achieve academic success, while maintaining substance use disorder recovery. College and university campuses can often be considered abstinence-hostile environments, giving rise to the need of support services for students in recovery. A nationwide survey to understand the efficacy of services provided by CRPs was conducted to assess the demographics and academic profiles of students involved with CRPs. Co-occurring disorders including mental health issues, criminal histories, utilizations of recovery services and 12-step groups, and work histories of students were also assessed. CRPs can provide services and an environment to students that increase recovery capital domains. Recovery capital domains such as spirituality, health and wellness, academics, critical thinking and discernment, personal achievement, and service opportunities may be related to metrics of academic success such as grade point average. However, measuring success for those in substance use disorder recovery through academics metrics alone could present a barrier to improving recovery services. Assessing the effectiveness of CRP programs through the lens of recovery capital offers a strengths-based, wholistic approach to improving services for students in recovery. Future directions include administering comprehensive measurements for recovery success, in addition to academic metrics, for students that are members of CRP. Keywords: Substance Use Recovery; Emerging Adults; Collegiate Recovery Program