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Head-on (HO) collisions between the DNA replication machinery and RNA polymerase over R-loop forming sequences (RLFS) are genotoxic, leading to replication fork blockage and DNA breaks. Current models suggest that HO collisions are avoided through replication initiation site (RIS) positioning upstream of active genes, ensuring co-orientation of replication fork movement and genic transcription. However, this model does not account for pervasive transcription, or intragenic RIS. Moreover, pervasive transcription initiation and CG-rich DNA is a feature of RIS, suggesting that HO transcription units (HO TUs) capable of forming R-loops might occur. Through mining phased GRO-seq data, and developing an informatics strategy to stringently identify RIS, we demonstrate that HO TUs containing RLFS occur at RIS in MCF-7 cells, and are downregulated at the G1/S phase boundary. Our analysis reveals a novel spatiotemporal relationship between transcription and replication, and supports the idea that HO collisions are avoided through transcriptional regulatory mechanisms.

Background Transcendental Meditation (TM) as a stress management technique may offer an adjunctive strategy to improve health and well-being in adults with cardiovascular disease (CVD). Objectives To examine the efficacy of TM to improve aspects of cardiovascular health and psychological functioning in adults with CVD. Method Studies (a) evaluating TM in adults with hypertension or CVD and (b) assessing a physiological or psychological outcome were retrieved and meta-analyzed. Weighted mean effect sizes were computed to assess between- and within-group changes. Results Nine studies met inclusion criteria (N = 851; mean age = 60 ± 8 years; 47% women). Between-group analyses revealed no differences between TM and control groups. However, within-group (i.e., pre- to post-intervention) analyses revealed reductions in systolic (d+ = 0.31) and diastolic (d+ = 0.53) blood pressure (BP) for the TM group. There were no changes in depressive symptoms for TM or control participants. Conclusions TM was associated with within-group (but not between-groups) improvements in BP. Continued research using randomized controlled trials with larger samples, and measuring psychophysiological outcomes at longer follow-up intervals is recommended.

Purpose There is a dearth of research to inform sexual education programs to address sexual health disparities experienced by adolescent males who are interested in sex with males (AMSM). The current study sought to determine where AMSM receive sexual health information, clarify their preferences, and explore relations with sexual behavior. Methods AMSM (N = 207; ages 14–17) in the United States completed an online sexual health survey. Bivariate associations between sexual education exposure/preferences by sexual behavior were assessed using Fisher's exact tests and one-way analyses of variance. Results Eighty-nine (43%) participants reported no sexual contact with male partners, 77 (37%) reported sexual contact without condomless anal sex, and 41 (20%) reported condomless anal sex. Participants received sexual health information from their parents/guardians (n = 122, 59%), formal sources (n = 160, 78%), and the Internet (n = 135, 65%). The most commonly covered topics by parents/guardians and formal sources were how to say no to sex, how to prevent HIV and other sexually transmitted infections, and methods of birth control. The most common online-researched topics were how to safely have anal sex, the types of sex you can have with a male partner, how to use a condom, and how to use lubrication. Participants noted preferring a sexually-explicit online sexual health program that addresses male–male sex. Conclusions Online sexual education programs that explicitly address male–male sex are needed. Tailored programs can help AMSM develop healthy sexual behaviors and decrease their HIV/STI risk.

Background/Purpose Lung cancer is the leading cause of cancer death in the United States. Black Americans have the highest rate of lung cancer mortality, due to being diagnosed at later stage. Lung Cancer Screening (LCS) facilitates earlier detection and has been associated with a reduction in cancer death. We investigated LCS utilization and explored racial disparities (Black vs. non-Black) in LCS among patients for whom LCS is clinically indicated. Methods Using electronic medical records from the Lifespan Medical System, we randomly selected 200 patients who were likely to meet U. S. Preventive Services Taskforce (USPSTF) guidelines for LCS and mailed each patient a survey to assess LCS eligibility and uptake. Results Nearly three-quarters (n = 146, 73%) completed the survey and, of survey respondents, 92% (n = 134) were eligible for the study. Among eligible patients, 35% met criteria for LCS; non-Black patients were 90% more likely to meet criteria for LCS than Black patients (44% vs. 27%). Of the patients meeting USPSTF criteria, only 21% reported being screened; eligible non-Black patients were 2.8 times more likely to have had LCS than eligible Black patients (30% vs. 12%). Conclusions LCS utilization is low despite coverage provided through the Affordable Care Act. Black patients are less likely to qualify for screening and disproportionately less likely to be screened for lung cancer compared with non-Black patients. Targeted intervention strategies are needed to increase referral for and uptake of LCS in patients who are at high risk for developing lung cancer, and for Black patients in particular.

Alcohol use and its consequences have often been associated with depression, particularly among female college students. Interpretation of this association has been challenging due to potential reverse causation. The current study sought to clarify the temporality of these relationships. We examined: (1) the association between alcohol consumption and onset depression among female college students, and (2) the association between drinking consequences and onset depression among drinkers only. We used a prospective longitudinal design. Participants were first-year female college students who completed a baseline survey at study entry, and monthly assessments of alcohol consumption, drinking consequences, and depression symptoms. Cox proportional hazards regression with time-varying covariates were constructed among the full sample (N = 412) and the drinkers only sample (N = 335). Adjusted hazard ratios accounted for known risk factors for depression such as race/ethnicity, academic challenge, not getting along with one's roommate, sexual victimization prior to college, marijuana use, and socioeconomic status. For each additional average drink per week, adjusting for all covariates, there was no (95% CI: -4%, +4%) increased risk of onset depression. For each additional alcohol consequence, adjusting for all covariates, there was a 19% (95% CI: 5%, 34%) increased risk of onset depression. This significant relationship remained after adjusting for quantity of alcohol consumption. Quantity of alcohol consumed did not predict incident depression. However, experiencing alcohol consequences, regardless of consumption, did increase the risk of incident depression. College substance use and mental health interventions should aim to reduce not only alcohol consumption, but also alcohol-related consequences.

Objective Brief motivational interventions (BMIs) reduce problematic drinking for some, but not all, college students. Identifying those students who are less responsive can help to guide intervention refinement. Therefore, we examined demographic, personality, and cognitive factors hypothesized to influence change after a BMI. Method Students mandated for intervention following a campus alcohol violation ( N = 568; 28% female, 38% freshmen) completed a baseline assessment, then received a BMI, and then completed a 1-month follow-up. At both assessments, alcohol use (i.e., drinks per week, typical BAC, binge frequency) and alcohol-related problems were measured. Results Latent change score analyses revealed significant decrease in both alcohol use and problems 1 month after the BMI. In the final model that predicted change in alcohol use , four factors (male sex, a “fun seeking” disposition, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in alcohol use over time. In the final model that predicted change in alcohol-related problems , three factors (stronger beliefs about the centrality of alcohol to college life, more perceived costs and fewer perceived benefits of change) predicted smaller decreases in problems over time. Conclusions Participation in a BMI reduced alcohol use and problems among mandated college students at 1-month follow-up. We identified predictors of these outcomes, which suggest the need to tailor the BMI to improve its efficacy among males and those students expressing motives (pro and cons, and fun seeking) and beliefs about the centrality of drinking in college.

Medication adherence is a complex, multi-determined behavior that is often influenced by system- (e.g., cost), drug- (e.g., regimen complexity), and patient-related (e.g., depression) factors. System-level approaches (e.g., making medications more affordable) are critically important but do not address patient-level factors that can undermine adherence. In this paper, we identify patient-level determinants of non-adherence and discuss whether mindfulness-training approaches that target these determinants can help to improve adherence to medical treatment. We highlight two chronic medical conditions (viz., heart failure and HIV) where poor adherence is a significant concern, and examine the evidence regarding the use of mindfulness interventions to improve medication adherence in these two conditions. We also discuss the theoretical underpinnings of mindfulness training with respect to medication adherence, and conclude by suggesting directions for future research.

Childhood sexual abuse (CSA) is associated with sexual risk behavior in adulthood. Traditional sexual risk reduction interventions do not meet the unique needs of women who have been sexually abused. In the current paper, we describe the four-stage process we followed to develop and refine a targeted sexual risk reduction intervention for this population. First, initial quantitative work revealed that the intervention should address how maladaptive thoughts related to traumatic sexualization, trust, powerlessness, and guilt/shame (traumagenic dynamics constructs) influence current sexual behavior. Second, qualitative interviews with 10 women who reported a history of CSA (M age = 34 years; 90% African American) as well as current sexual risk behavior provided support for targeting maladaptive thoughts associated with these traumagenic dynamics constructs. Third, based on the qualitative and quantitative results, we developed a 5-session, group-delivered intervention to address the maladaptive thoughts that occurred as a result of CSA, as well as the cognitive-behavioral determinants of sexual risk behavior. This intervention drew heavily on cognitive behavioral techniques to address cognitions associated with CSA and the links between these cognitions and current sexual risk behavior. Techniques from trauma-based therapies, as well as motivational techniques, were also incorporated into the intervention. Finally, we refined the intervention with 24 women (M age = 33 years; 79% African American), and assessed feasibility and acceptability. These women reported high levels of satisfaction with the intervention. The resultant intervention is currently being evaluated in a small, randomized controlled trial.

Similarity query processing is becoming increasingly important in many applications such as data cleaning, record linkage, Web search, and document analytics. In this paper we study how to provide end-to-end similarity query support natively in a parallel database system. We discuss how to express a similarity predicate in its query language, how to build indexes, how to answer similarity queries (selections and joins) efficiently in the runtime engine, possibly using indexes, and how to optimize similarity queries. One particular challenge is how to incorporate existing similarity join algorithms, which often require a series of steps to achieve a high efficiency, including collecting token frequencies, finding matching record id pairs, and reassembling result records based on id pairs. We present a novel approach that uses existing runtime operators to implement such complex join algorithms without reinventing the wheel; doing so positions the system to automatically benefit from future improvements to those operators. The approach includes a technique to transform a similarity join plan into an efficient operator-based physical plan during query optimization by using a template expressed largely in the system’s user-level query language; this technique greatly simplifies the specification of such a transformation rule. We use Apache AsterixDB, a parallel Big Data management system, to illustrate and validate our techniques. We conduct an experimental study using several large, real datasets on a parallel computing cluster to assess the similarity query support. We also include experiments involving three other parallel systems and report the efficacy and performance results.

From the *Department of Anesthesiology, University of New Mexico, Albuquerque, NM; †Department of Internal Medicine, Raymond G. Murphy VA Medical Center, Albuquerque, NM; and ‡Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR. Address reprint requests to Neal Stuart Gerstein, MD, Department of Anesthesiology, MSC 10 6000, 2211 Lomas Blvd N.E. University of New Mexico, Albuquerque, NM 87120. E-mail: ngerstein@gmail.com © 2014 Elsevier Inc. All rights reserved. 1053-0770/2601-0031$36.00/0 http://dx.doi.org/10.1053/j.jvca.2013.05.018

Background Depression is severely undertreated in Black men. This is primarily because Black men are less likely to seek traditional psychiatric treatment, have less access and more barriers to treatment, and perceive more stigma associated with treatment. Depression contributes to cardiovascular disease (CVD), and Black men have the highest rate of mortality from CVD. Resistance training (RT) can have beneficial effects on both depression and CVD. This study will be the first randomized controlled trial to test the effects of RT on depression and cardiovascular health in a sample of depressed Black men. Method Fifty Black men with clinically significant symptoms of depression will be randomized to either (a) a 12-week RT or (b) an attention control group. Behavioral Activation techniques will be used to support adherence to home-based RT goals. Both groups will meet on-site twice/week during the 12-week program, and follow-up assessments will occur at the end-of-treatment and 3 months post-treatment. Qualitative interviews will be conducted after the 3-month follow-up. The objectives of this study are (1) to assess the feasibility and acceptability of recruitment, retention, and intervention procedures, (2) to obtain preliminary evidence of efficacy, and (3) to explore potential mediators of the effects of RT on depression. Discussion This study will advance the field of minority men's health by producing new data on the effects of RT for depression, the potential mechanisms of action that may support its use, and its effects on markers of CVD risk in Black men. Trial registration ClinicalTrials.gov (NCT03107039)

Purpose Teenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls. Method Randomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions. Results Relative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months. Conclusions Theory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.

The paralinguistic information in a speech signal includes clues to the geographical and social background of the speaker. This paper is concerned with automatic extraction of this information from a short segment of speech. A state-of-the-art language identification (LID) system is applied to the problems of regional accent recognition for British English, and ethnic group recognition within a particular accent. We compare the results with human performance and, for accent recognition, the 'text dependent' ACCDIST accent recognition measure. For the 14 regional accents of British English in the ABI-1 corpus (good quality read speech), our LID system achieves a recognition accuracy of 89.6%, compared with 95.18% for our best ACCDIST-based system and 58.24% for human listeners. The ''Voices across Birmingham'' corpus contains significant amounts of telephone conversational speech for the two largest ethnic groups in the city of Birmingham (UK), namely the 'Asian' and 'White' communities. Our LID system distinguishes between these two groups with an accuracy of 96.51% compared with 90.24% for human listeners. Although direct comparison is difficult, it seems that our LID system performs much better on the standard 12 class NIST 2003 Language Recognition Evaluation task or the two class ethnic group recognition task than on the 14 class regional accent recognition task. We conclude that automatic accent recognition is a challenging task for speech technology, and speculate that the use of natural conversational speech may be advantageous for these types of paralinguistic task.

Alcohol misuse occurs commonly on college campuses, necessitating prevention programs to help college drinkers reduce consumption and minimize harmful consequences. Computer-delivered interventions (CDIs) have been widely used due to their low cost and ease of dissemination but whether CDIs are efficacious and whether they produce benefits equivalent to face-to-face interventions (FTFIs) remain unclear. Therefore, we identified controlled trials of both CDIs and FTFIs and used meta-analysis (a) to determine the relative efficacy of these two approaches and (b) to test predictors of intervention efficacy. We included studies examining FTFIs (N = 5,237; 56% female; 87% White) and CDIs (N = 32,243; 51% female; 81% White). Independent raters coded participant characteristics, design and methodological features, intervention content, and calculated weighted mean effect sizes using fixed and random-effects models. Analyses indicated that, compared to controls, FTFI participants drank less, drank less frequently, and reported fewer problems at short-term follow-up (d+s = 0.15 – 0.19); they continued to consume lower quantities at intermediate (d+ = 0.23) and long-term (d+ = 0.14) follow-ups. Compared to controls, CDI participants reported lower quantities, frequency, and peak intoxication at short-term follow-up (d+s = 0.13 – 0.29), but these effects were not maintained. Direct comparisons between FTFI and CDIs were infrequent, but these trials favored the FTFIs on both quantity and problems measures (d+s = 0.12–0.20). Moderator analyses identified participant and intervention characteristics that influence intervention efficacy. Overall, we conclude that FTFIs provide the most effective and enduring effects.

Graphics processing units (GPUs) provide substantial processing power for little cost. We explore the application of GPUs to speech pattern processing, using language identification (LID) to demonstrate their benefits. Realization of the full potential of GPUs requires both effective coding of predetermined algorithms, and, if there is a choice, selection of the algorithm or technique for a specific function that is most able to exploit the GPU. We demonstrate these principles using the NIST LRE 2003 standard LID task, a batch processing task which involves the analysis of over 600h of speech. We focus on two parts of the system, namely the acoustic classifier, which is based on a 2048 component Gaussian Mixture Model (GMM), and acoustic feature extraction. In the case of the latter we compare a conventional FFT-based analysis with IIR and FIR filter banks, both in terms of their ability to exploit the GPU architecture and LID performance. With no increase in error rate our GPU based system, with an FIR-based front-end, completes the NIST LRE 2003 task in 16h, compared with 180h for the conventional FFT-based system on a standard CPU (a speed up factor of more than 11). This includes a 61% decrease in front-end processing time. In the GPU implementation, front-end processing accounts for 8% and 10% of the total computing times during training and recognition, respectively. Hence the reduction in front-end processing achieved in the GPU implementation is significant.

This study examined the association between alcohol use and sexual behaviors among South African adults who reported current drinking.Street-intercept surveys were administered to adults residing in neighborhoods in a South African township.Analyses were restricted to participants reporting current drinking (N=1285; mean age=32; 27% women; 98% Black). Most participants (60%) reported heavy episodic drinking (i.e., 5 or more drinks on a single occasion) at least once per week in the past 30 days. Compared to non-heavy episodic drinkers, participants who reported heavy episodic drinking were more likely to drink before sex (79% vs. 66%) and have sex with a partner who had been drinking (59% vs. 44%). Overall, drinking before sex (self or partner) and heavy episodic drinking was associated with multiple sexual partners, discussing condom use with sexual partner(s), and proportion of protected sex. The frequency of condom use varied among participants with steady, casual, or both steady and casual sexual partners.Alcohol use among South African adults is associated with sexual risk behaviors, but this association differs by partner type. Findings suggest the need to strengthen alcohol use components in sexual risk reduction interventions especially for participants with both steady and casual sex partners.

Hookah tobacco smoking has become increasingly prevalent among college students, but little is known about frequency of use or patterns of use over time, including during the transition to college. The goals of this longitudinal cohort study were to assess the: (a) lifetime prevalence, (b) current prevalence, (c) frequency of use, and (d) pattern of initiation of hookah tobacco smoking among female students during the first year of college. First-year female college students (N = 483) at a large private university in upstate New York completed 13 monthly online surveys about their hookah tobacco use from August 2009 to August 2010. Lifetime prevalence of hookah use increased from 29% at college entry to 45% at one-year follow-up. The highest rates of hookah initiation occurred in the first two months of students' first semester of college. Current (past 30 days) hookah use ranged from 5% to 13% during the year after college entry. On average, hookah users reported smoking hookah two days per month. Hookah tobacco use is common among female college students. The transition to college is a vulnerable time for hookah initiation. Preventive efforts should begin in high school and continue through college, with a focus on students' first few months on campus.

Purpose To test the long-term effects of a mass media intervention that used culturally and developmentally appropriate messages to enhance human immunodeficiency virus (HIV)-preventive beliefs and behavior of high-risk African American adolescents. Methods Television and radio messages were delivered for more than 3 years in two cities (Syracuse, NY; and Macon, GA) that were randomly selected within each of the two regionally matched city pairs, with the other cities (Providence, RI; and Columbia, SC) serving as controls. African American adolescents, aged 14–17 years (N = 1,710), recruited in the four cities over a 16-month period, completed audio computer-assisted self-interviews at recruitment and again at 3, 6, 12, and 18-months postrecruitment to assess the long-term effects of the media program. To identify the unique effects of the media intervention, youth who completed at least one follow-up and who did not test positive for any of the three sexually transmitted infections at recruitment or at 6-and 12-month follow-up were retained for analysis (N = 1,346). Results The media intervention reached virtually all the adolescents in the trial and produced a range of effects including improved normative condom-use negotiation expectancies and increased sex refusal self-efficacy. Most importantly, older adolescents (aged 16–17 years) exposed to the media program showed a less risky age trajectory of unprotected sex than those in the nonmedia cities. Conclusion Culturally tailored mass media messages that are delivered consistently over time have the potential to reach a large audience of high-risk adolescents, to support changes in HIV-preventive beliefs, and to reduce HIV-associated risk behaviors among older youth.

Childhood sexual abuse (CSA) is associated with increased sexual risk behavior in adulthood, and this association may be mediated by traumagenic dynamics constructs (i.e., traumatic sexualization, trust, guilt, and powerlessness). However, few studies have investigated whether such relationships hold for women who do not identify as having experienced CSA despite meeting objective criteria that CSA occurred. This study sought to determine whether individuals who met research criteria for CSA and who self-defined as sexually abused differed on traumagenic dynamics constructs and current sexual risk behavior from individuals who met research criteria for CSA and who did not self-define as sexually abused.Participants were 481 women recruited from a publicly funded STD clinic. Participants completed a computerized survey assessing childhood sexual experiences and adult sexual risk behavior.Of the total sample, 206 (43%) met research criteria for CSA. Of the women meeting research criteria for CSA, 142 (69%) self-defined as sexually abused. Women who met research criteria for CSA reported more traumatic sexualization, more trust of a partner, more powerlessness, less sexual guilt, more episodes of unprotected sex, more sex partners, and greater likelihood of sex trading, compared to women who did not meet research criteria for CSA. Among women meeting research criteria, those who self-defined as sexually abused did not differ from those who did not self-define on any of the traumagenic dynamics constructs or on current sexual risk behavior, controlling for CSA characteristics.Individuals who were sexually abused as children by behavioral research criteria are at risk for engaging in sexual risk behavior as adults, regardless of whether or not they perceive the experience to be CSA. Future research is needed to understand how non-definers perceive these childhood sexual experiences.

Objectives Although many factors contribute to racial disparities in human immunodeficiency virus (HIV)/AIDS among young African Americans, knowledge is a particularly modifiable factor. However, little information has been published about the current HIV knowledge of African American teens or to what extent knowledge independently contributes to their sexual behavior and health. This study aimed to describe the level of knowledge among this at-risk population and determine whether knowledge contributes to variance in sexual behavior and health beyond that of sociode-mographic and psychological factors. Methods African American adolescents (n = 1658) were recruited in 2 northeastern and 2 southeastern US cities (74% eligible for free or reduced-price school lunch). Analyses utilized data gathered from adolescents using an audio computer-assisted self-interview program. Results On average, participants answered only 50% of HIV knowledge items correctly and were least accurate concerning effective condom use and HIV testing. Controlling for associated sociodemographic and psychological factors, greater knowledge was associated with sexual experience and, among experienced adolescents, with sexually transmitted infection/HIV testing and—unexpectedly—less condom use. Conclusions HIV knowledge, which is modifiable, is limited among at-risk African American adolescents and is an important contributor to sexual behavior and health. Findings indicate a need for more comprehensive HIV/AIDS education, particularly with regard to condom use and the benefits of routine sexually transmitted infection/HIV testing. Although knowledge might not be sufficiently protective in and of itself, having accurate information about HIV may benefit sexual health by impacting health-promoting attitudes necessary for successful engagement in health care-seeking behavior.

Purpose To examine the effect of a community-based sexually transmitted infection (STI) screening program on sexual risk behavior among African American adolescents. We hypothesized that adolescents testing positive for an STI and receiving post-test counseling would reduce risky sexual practices, whereas STI-negative adolescents would show little or no change in protective sexual behavior after screening. Methods From August 2006 to January 2008, we recruited 636 sexually active African American adolescents (age, 14–17) from community-based organizations in two mid-sized U.S. cities with high STI prevalence. Participants were screened for three STIs (gonorrhea, chlamydia, and trichomoniasis) and completed an audio computer-assisted self-interview. Youth who tested positive for an STI (6.6%) received treatment and counseling. Youth testing negative received no further intervention. Approximately 85% of participants completed 3- and 6-month follow-up assessments. Generalized estimating equations determined the effects of STI screening on adolescents' number of sexual partners and occurrence of unprotected sex. Results Adolescents who tested positive for an STI reduced their number of vaginal and oral sex partners and the probability of unprotected sex. STI-negative adolescents demonstrated no change for numbers of partners or unprotected sex. Conclusions Community-based STI screening can help to reduce sexual risk behavior in youth who test positive for STIs. Alternative approaches will be needed to reduce risk behavior in youth who test negative but who are nevertheless at risk for acquiring an STI.

Objectives High rates of psychosocial and health problems have been identified among patients attending sexually transmitted disease (STD) clinics, who are disproportionately urban, have low income, and are racial/ethnic minorities. This study sought to determine whether these problems co-occurred and whether they indicated the presence of a syndemic. Methods Patients (N = 1557, 46% female, 64% African American) attending an urban STD clinic completed a computerized survey assessing childhood sexual abuse (CSA), depressive symptoms, binge drinking, marijuana use, intimate partner violence (IPV), and sexual risk behavior. Medical records were reviewed to determine incident STD diagnosis. Results The psychosocial and health problems were interrelated. Endorsing more psychosocial problems was associated with a greater likelihood of having multiple sexual partners and STD diagnosis. Interactions between CSA and marijuana use and between CSA and IPV predicted STD diagnosis. Conclusions Numerous psychosocial and health problems co-occur among urban STD clinic patients. There was some evidence of a syngergistic relationship (ie, a syndemic) between these conditions, resulting in worsened sexual health outcomes. Health care needs to be multidisciplinary to address the multiple psychosocial and health problems faced by STD clinic patients. Research needs to identify factors that may underlie these comorbid conditions.

This study evaluates the concurrent validity of an on-line Yes/No test of recognition vocabulary as a placement tool at an Australian English language school. Newly entering students (n = 88) completed a Yes/No test, which measured accuracy and speed of response, and a school placement battery consisting of grammar, writing, speaking and listening measures. Yes/No test accuracy performance approximated that of the listening and grammar placement tests, discriminating between placement levels and correlating with overall placement decisions. Placement level decisions correlated with Yes/No accuracy (r = .6) and the discrete-point placement measures listening (.7) and grammar (.8). Yes/No test accuracy showed a consistently strong correlation (.6) across all test measures, indicating that recognition vocabulary knowledge is a fundamental element in all tests. Response time as an independent measure followed the same pattern as the accuracy results but was less sensitive to differences in placement levels. A hierarchical regression analysis showed that when combined with accuracy, response times account for an additional amount of unique variance in the placement decision. The usefulness the on-line Yes/No test format in placement testing is discussed.

African Americans are disproportionately affected by tobacco smoking and obesity. As weight control expectancies can reinforce smoking maintenance, the purpose of this study was to explore psychosocial factors related to expectancies for weight control among African Americans seeking cessation treatment. African American smokers (N = 117) provided information on demographics, family medical history, personal risk factors, smoking, weight control expectancies and concerns, perceived stress, and acculturation. Multivariate analyses examined hypotheses regarding determinants of weight control expectancies. Fifty-one percent of participants were concerned about gaining weight upon cessation. Positive expectations for weight control through smoking were associated with older age, a family history of heart disease, greater perceived stress, and a lower level of acculturation. In conclusion, many African American smokers are concerned about postcessation weight gain; expectations for weight control through smoking are most evident those with elevated perceived stress, traditional African American cultural values, and a family history of chronic illness. Needed are culturally specific smoking cessation interventions that include weight management strategies as an adjunct to smoking cessation treatments.

Objective The use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature. Method Studies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes. Results Compared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes. Conclusion Computer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.

In preparation for an electronic mail (e-mail) and web-based health promotion intervention across multiple worksites, secure, regulatory-compliant, user-friendly e-mail and Internet applications were used to recruit potential participants across worksites, to enroll participants, and to collect baseline health assessment data. Specific hardware and software information technology environments were required of the 19 participating worksites. Sequential e-mails introduced the study and invited participation. Twenty-four percent of all employees (1106 of approximately 4600) provided consent. E-mail delivered a web link for the baseline study assessment, and reminder e-mails were sent to prompt completion. Of those who consented, 888 (80%) completed baseline health and behavior data surveys. An HTML-native web survey software was more stable across computing environments. Using e-mail and web assessment, this research recruited, enrolled, and collected data from more than 850 participants. Technical and operational challenges emerged at each step. Solutions and recommendations are discussed. Overall, this experience suggests that the use of e-mail and web software can facilitate recruitment, enrollment, and data acquisition through direct contact with study participants. This experience yields a series of lessons learned for using e-mail and the Internet to support multi-site trials.

Chromy CA, Carey MT, Balgaard KG, Iaizzo PA. The potential use of axial spinal unloading in the treatment of adolescent idiopathic scoliosis: a case series. Objective To assess potential benefits of axial spinal unloading (LTX 3000 Lumbar Rehabilitation System) over a brief 3-month period. Design Before-after pilot study. Setting University research laboratory. Participants Five adolescent girls with scoliosis. Interventions Three laboratory sessions: (1) initial baseline, (2) immediately after 3-month treatment period (axial unloading by using LTX 3000 for two 10-minute treatments daily), and (3) 1 month posttreatment. Main Outcome Measures Initial baseline postural data were obtained from 2 sets of radiographs (standing anteroposterior [AP] and lateral, sitting AP and lateral), back range of motion measurements, and numeric pain scales. The following were assessed: static postural changes; potential functional benefits; and therapeutic compliance. Results All subjects elicited reductions in lumbar Cobb angles immediately after 3 months of treatment; initial average scoliotic curves of 13.7° were reduced 42% to 8° (α=.05, P =.004). Additionally, such reductions were evident 1 month posttreatment; average original curves were reduced by 27%. Subjects' range of motion and lumbar lengthening were not significantly altered by this therapeutic protocol. Reported subject compliance was high (95%). Conclusions The LTX 3000 is a potential adjunct therapy for the treatment of adolescent scoliosis. This therapy resulted in curvature reductions and was widely accepted by subjects that were compliant with self-administration.

We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate behavioral HIV-risk reduction interventions targeting people who inject drugs. We included 37 RCTs evaluating 49 independent HIV-risk reduction interventions with 10,190 participants. Compared to controls, intervention participants reduced injection-and non-injection drug use, increased drug treatment entry, increased condom use, and decreased trading sex for drugs. Interventions were more successful at reducing injection drug use when participants were non-Caucasians, when content focused equivalently on drug- and sex-related risk, and when content included interpersonal skills training specific to safer needle use. Condom use outcomes improved when two intervention facilitators were used instead of one. Injection drug use outcomes did not decay, but condom use outcomes did. Behavioral interventions do reduce risk behaviors among people who inject drugs, especially when interventions target both drug- and sexual-risk behavior, and when they include certain behavioral skills components. Implications for future interventions are presented.

Objectives To estimate the lifetime prevalence of four sexually transmitted infections (STIs) and to identify correlates of these infections among patients seeking care for a substance use disorder at a specialized DeAddictions Unit in southern India. Methods Consecutive inpatients ( n = 361; 98% male; M age = 36.7 years) admitted to DeAddictions Unit of the National Institute of Mental Health and Neuro Sciences in Bangalore, India, participated in a structured interview to obtain demographic, psychiatric, sexual behavior, and substance use data; each patient also provided a blood sample for serologic testing for HIV, chlamydia, syphilis, and hepatitis B. Results One-quarter of all patients tested positive for at least one STI. Lifetime seroprevalence rates were 12.9% for syphilis, 10.3% for chlamydia, 3.1% for hepatitis B, and 1.1% for HIV. Analyses did not reveal any consistent pattern of associations between STI status and sociodemographic, psychiatric, and sexual behavioral characteristics. Conclusions All patients should receive a comprehensive sexual assessment during standard care; for those patients who report risky sexual practices, we recommend voluntary counseling and testing for STIs. Although we do not recommend universal testing for STIs at this time, this should be revisited based upon national surveillance data.

Tobacco use among psychiatric patients in developing countries has not been well-investigated. To address this issue, we screened consecutive admissions to a major psychiatric hospital in southern India, and assessed the prevalence and correlates of tobacco use and nicotine dependence. Patients (n = 988) provided information about their use of tobacco products, and participated in an interview that included the Fagerström Test for Nicotine Dependence as well as measures of other substance use. Three hundred and fifty-one patients (36%) reported current tobacco use, with 227 (65% of all users) reporting moderate to severe nicotine dependence. Current tobacco use as well as nicotine dependence were associated with male gender, a diagnosis of bipolar disorder, and risk of other substance use problems. The cultural context of these findings, and the implications for tobacco control among psychiatric patients, are discussed.

To assess the prevalence and frequency of sexual hookups across the first year of college and to compare rates of hookups and romantic relationship sex.We surveyed 483 first-year female college students (mean age, 18.1 years; range, 18-21 years, 64% white) monthly over the first year of college about the frequency of sexual behavior in the context of hookups and romantic relationships.The prevalence of hookups involving oral or vaginal sex was 34% before college and 40% during the first year, compared with 58% and 56%, respectively, with romantic partners. Fewer than one in five participants (7%-18%) had a sexual hookup each month, whereas 25%-38% had sex in the context of relationships each month.Hooking up varies in frequency over the first year in college, but remains less common than sex in the context of relationships.

Background: Persons with co-occurring Axis I mental disorders and substance use disorders often experience multiple negative consequences as a result of their substance use. Because no existing measure adequately assesses these population-specific problems, we developed the Problems Assessment for Substance Using Psychiatric Patients (PASUPP). This paper describes the scale development and factor structure, and provides initial reliability and validity evidence for the PASUPP. Methods: An initial pool of 54 items was assembled by reviewing existing measures for relevant items and generating new items. Then, 239 patients (90% male, 61% White) with documented Axis I psychiatric and current substance use disorders rated the lifetime and last 3-month occurrence of each problem, and completed additional measures of substance use and related functioning. Results: Lifetime endorsements ranged from 31 to 95%, whereas 3-month endorsements ranged from 24 to 78%. Item analyses reduced the set to 50 items. The PASUPP is internally consistent (alpha = 0.97) and unidimensional. Scale validity was suggested by moderate correlation with other measures of substance problem severity. Conclusions: Promising psychometric properties are reported for a population-specific measure of substance use problems. Such a measure could be useful for initial assessments and outcome evaluations with substance using psychiatric patients.

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population.

Auckenthaler, Roland, Carey, Michael, and Lloyd-Thomas, Harvey, Score Normalization for Text-Independent Speaker Verification Systems, Digital Signal Processing10(2000), 42?54.This paper discusses several aspects of score normalization for text-independent speaker verification. The theory of score normalization is explained using Bayes' theorem and detection error trade-off plots. Based on the theory, the world, cohort, and zero normalization techniques are explained. A novel normalization technique, test normalization, is introduced. Experiments showed significant improvements for this new technique compared to the standard techniques. Finally, there is a discussion of the use of additional knowledge to further improve the normalization methods. Here, the test normalization method is extended to use knowledge of the handset type.

We examined the stress-buffering effects of the `sense of coherence' among 116 undergraduates (70 females and 46 males) with a mean age of 18.6 years. Self-reported physical well-being and psychological distress were assessed on two occasions separated by two months. Assessment of the sense of coherence occurred at time-one, whereas assessment of negative life-events for the past year occurred at time-two. Sense of coherence correlated negatively with negative life events and reported psychological symptoms of both occasions, and negative life events correlated positively with both assessments of psychological distress. Negative life events correlated positively with physical ailments reported for both occasions only among students low in sense of coherence; this significant correlation persisted after accounting for the relationship between psychological and physical symptoms. We discuss the possible salubrious effects of a sense of coherence on the health appraisals of young adults experiencing stress.

Women with severe and persistent mental illness (e.g., schizophrenia, bipolar disorder) are at enhanced risk for sexual coercion and several resulting sexual health complications. We examine the prevalence and types of sexual coercion encountered by women with severe and persistent mental illness and provide recommendations for interventions to reduce the prevalence of sexual coercion. Mental health professionals working with this population need to provide increased attention to the problem of sexual coercion and can take measures to intervene safely and effectively.

These experiments on rats evaluated whether recovery of competence in certain motor tests could be enhanced by practice begun soon after traumatic brain injury (TBI). Before TBI, rats were pre-trained to cross a flat and a pegged beam. Anesthetized animals received a right sensorimotor cortex TBI. One group began task-specific testing (flat and pegged beams) on day 1 after injury and repeated 13 times in 35 days by which time functional recovery occurred. Paw preference was evaluated eight times during the 35 day period, beginning the third day after injury. A second group of injured rats remained in their home cage without any testing for 35 days after injury. From day 35 they were tested 13 times over the next 35 days on both beam tests and eight times on the paw preference test. At day 35 those rats that remained in their home cage without testing (task-specific practice) performed as well on the flat beam as the rats that began testing 1 day after injury. By day 37, their third test day, the untested rats performed as well as the tested rats on the pegged beam. Paw preference was the same in both groups of rats. These results were compared to sham-operated controls. Post-injury performance as measured by these tests indicated that most of the recovery occurred without task-specific practice. However, task-specific practice was necessary to achieve optimum performance on both beam tests. This implies that neural reorganization occurred independent of any practice. Task specific practice served to `fine tune' the rat's performance after 35 days.

We summarize the recommendations for research that emerged from a NIMH-sponsored Conference on HIV, AIDS, and Severe Mental Illness. Recommendations are made in four areas, namely, epidemiology of HIV infection, epidemiology of sexual and drug-use risk behaviors, risk reduction and transmission prevention, and treatment of infected persons. This research is urgently needed to adequately respond to the AIDS epidemic among people with severe mental illness.

Traumatic brain injury (TBI) produces learning and memory impairments in humans. This study investigated the effects of TBI on memory and spatial localization strategies in rats. Prior to TBI, separate groups of rats were trained in an 8-arm radial maze with either all 8 arms baited (Expt. 1) or only 4 of the 8 arms baited (Expt. 2). TBI was produced by a controlled pneumatic impactor striking the entire right sensorimotor cortex of the anesthetized rat. Rats used in Expt. 1 were selected because they did not use a stereotypic response strategy (going to adjacent arms) in performing the maze before injury. After TBI the rats were not different from control rats in the number of working memory (WM) errors made. They did, however, display a distinct propensity to go to adjacent arms, i.e., exhibit stereotypic behavior, with a right-handed (ipsiversive) bias (P

Lead impacted media resulting from past waste management practices was detected at a lead casting facility, two mirror manufacturing plants, and a municipal landfill. Leachable lead concentrations prior to treatment ranged from 10 milligrams per liter (mg/l) in a mirror waste pile to 900 mg/l at a lead casting facility. Cement stabilization and the application of a chemical treatment process solution were evaluated as treatment alternatives for each facility based on the cost of treatment and disposal, and time limitations. Cement stabilization was used at two of the facilities and the application of a chemical treatment process solution was used at the other two facilities. The evaluation of treatment alternatives began by characterizing the waste at each facility and performing treatability studies to determine the minimum ratio of cement-to-waste or the minimum concentration of the chemical solution needed to render the lead impacted waste non-hazardous. Cement stabilized wastes were recycled for reuse as fill for the construction of a parking lot at one facility and as the sub-base of a new road at another facility. The use of a chemical process solution permitted on-site treatment and off-site disposal of non-hazardous waste at a RCRA Subtitle D landfill. Following treatment by either cement stabilization or chemical treatment process, leachable lead concentrations were reduced below federal regulatory levels according to the Resource Conservation and Recovery Act (RCRA) maximum allowable concentration limit of 5 mg/l lead (D008) by the toxicity characteristic leaching procedure (TCLP).

Keywords that are characteristic of a topic are ranked by a criterion of usefulness, and a relatively small number (typically 10) of the best keywords are implemented in a hidden Markov model (HMM)-based word-spotting algorithm. Statistical models of counts of occurrences of keywords are used to discriminate topic from non-topic speech. In the simplest model, distinct keywords are treated as independent. Particular combinations of keywords can often improve discrimination, however, and linear-logistic and log-linear models enable higher-order dependencies of the topic on keywords to be detected, leading to enhanced performance. Models involving a small number of parameters can be estimated from modest amounts of training data. Heuristic procedures point the way to good models but assume statistical consistency between training and test data. The approach is tested using a broadcast radio database.

If a missile penetrates a cerebral hemisphere and does not severely disrupt the brain or transit a vital brain structure, it is hypothesized that the indirect effect of ordinary pressure waves set up by the interaction of missile and tissue and that impinge on brain stem respiratory nuclei determines life or death. The likelihood of fatal apnea is a direct function of missile energy of deposit within the brain. With brain wounding, a reduction in CO may also occur, but missile energy required to produce a significant CO decrease is in excess of that required to produce respiratory problems. Unless the individual managed to survive a period of apnea or respiratory resuscitation occurred, the effects of apnea would overshadow any CO decreases. Although transmitted ordinary pressure waves might interfere with the reticular activating system within the brain stem and produce persistent coma, specific long-lasting neurologic defects from a missile wound usually result from direct missile damage to the cerebral cortex or cortical projections. In designing treatments for missile wounds of the brain, two distinct entities must be kept in mind: the brain stem and the cerebral cortex. To decrease the immediate mortality from brain wounding, prompt treatment has to be devised to aid dysfunctional respiratory nuclei and possibly cardiac control nuclei. To decrease long-term neurologic morbidity, drug therapy has to be instituted to help injured cerebral cortical neurons for days to weeks after wounding. Totally different strategies and drugs may be needed to treat the brain stem as opposed to the cerebral cortex. Language: en

This paper presents the results of an experimental evaluation of the performance of three main algorithms for transitive closure: Seminaive, Smart and Blocked Warren. The algorithms have been implemented using a variety of join methods (block nested-loops and hash-join), disk-based and memory-based data structures and buffer replacement strategies. The algorithms were tested on several graphs, ranging from regular trees to random acyclic graphs to random general graphs. Contrary to what several previous studies have found, our experiments indicate that Seminaive is almost always superior to Smart. In most cases, Seminaive exhibited inferior performance to Warren, but surprisingly, there are some types of graphs where Blocked Warren generates more duplicates than Seminaive and is therefore slower. Finally, for the common case where a transitive closure query involves a selection, Seminaive can take advantage of the constants in the selection, whereas Blocked Warren and Smart cannot. Our experiments indicate that the percentage of the graph nodes that need to be selected for Blocked Warren to be superior to Seminaive is rather large (for all graphs tested, it must be greater than 1 3 ). This implies that for the majority of transitive closure queries with selection, Seminaive is the preferred strategy.

Originally, transforming leadership was presented as moral leadership, developmentally raising both leader and follower in a common pursuit of end-values, and compared to transactional leadership, which altered followers' behaviors and attitudes in pursuit of self-interest based in modal-values. Subsequent theoretical development has focused on a change leadership not necessarily related to a change toward higher values. Although the concept of moral leadership must be expanded to include both transformational and transactional factors, this still does not take into account the reality of a leader who effects the retardation or reversal of the developmental process in followers. The premise of this paper is that the leader's orientation toward self and others must be taken into account in order to understand fully the leadership dynamic. A framework for consideration of this orientation is therefore proposed, based upon the concept of a fundamental option, or stable choice, for either self-transcendence or self-embeddedness.