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Consortium-based approaches are a promising avenue toward efficient bioprocessing. However, many complex microbial interactions dictate community dynamics and stability that must be replicated in synthetic systems. The rumen and/or hindguts of large mammalian herbivores harbor complex communities of biomass-degrading fungi and bacteria, as well as archaea and protozoa that work collectively to degrade lignocellulose, yet the microbial interactions responsible for stability, resilience, and activity of the community remain largely uncharacterized. In this work, we demonstrate a "top-down" enrichment-based methodology for selecting a minimal but effective lignocellulose-degrading community that produces methane-rich fermentation gas (biogas). The resulting enrichment consortium produced 0.75-1.9-fold more fermentation gas at 1.4-2.1 times the rate compared to a monoculture of fungi from the enrichment. Metagenomic sequencing of the top-down enriched consortium revealed genomes encoding for functional compartmentalization of the community, spread across an anaerobic fungus (

Botulism is an acute neuroparalytic affliction of the motor and autonomic neurons caused by the toxins produced from Clostridium botulinum and related bacterial strains. The botulinum neurotoxins, or BoNTs, consist of a phylogenetically diverse group of highly potent protein toxins. Current medical interventions for confirmed cases of botulism are limited to immediate administration of antitoxins and respiratory support. There is currently no licensed vaccine against botulism in the United States. The most widely distributed botulism vaccine was a pentavalent BoNT toxoid (PBT) against serotypes A-E administered until 2011 under an investigational new drug license. A binary vaccine composed of the recombinant, non-toxic, receptor binding domains (RBD) of serotypes/A1 and/B1 has completed a phase II clinical trial, but has yet to attain full licensure. We have previously published data demonstrating catalytically inactive, full length botulinum neurotoxin holoproteins (ciBoNT HPs) against serotypes/A1,/B1,/C1,/E1 and/F1 provide equivalent or superior potency against parental and dissimilar subtype toxins as compared the RBD vaccines. Here we describe the consistent potencies of the three independent lots each of ciBoNT/C1,/E1, and/F1 HPs against substantial monovalent challenges of the parental toxins. We also present data that a trivalent formulation of ciBoNT/C1,/E1 and/F1 (triCEF) maintains potency against both monovalent and polyvalent toxin challenges when stored as an adjuvanted vaccine at 4–8 °C for up to 2 years.

Industrial biotechnology has the potential to decrease our reliance on petroleum for fuel and bio-based chemical production and also enable valorization of waste streams. Anaerobic microorganisms thrive in resource-limited environments and offer an array of novel bioactivities in this regard that could revolutionize biomanufacturing. However, they have not been adopted for widespread industrial use owing to their strict growth requirements, limited number of available strains, difficulty in scale-up, and genetic intractability. This review provides an overview of current and future uses for anaerobes in biotechnology and bioprocessing in the postgenomic era. We focus on the recently characterized anaerobic fungi (Neocallimastigomycota) native to the digestive tract of large herbivores, which possess a trove of enzymes, pathways, transporters, and other biomolecules that can be harnessed for numerous biotechnological applications. Resolving current genetic intractability, scale-up, and cultivation challenges will unlock the potential of these lignocellulolytic fungi and other nonmodel micro-organisms to accelerate bio-based production.

Anaerobic gut fungi are biomass degraders that form syntrophic associations with other microbes in their native rumen environment. Here, RNA-Seq was used to track and quantify carbohydrate active enzyme (CAZyme) transcription in a synthetic consortium composed of the anaerobic fungus Anaeromyces robustus with methanogen Methanobacterium bryantii. Approximately 5% of total A. robustus genes were differentially regulated in co-culture with M. bryantii relative to cultivation of A. robustus alone. We found that 105 CAZymes (12% of the total predicted CAZymes of A. robustus) were upregulated while 29 were downregulated. Upregulated genes encode putative proteins with a wide array of cellulolytic, xylanolytic, and carbohydrate transport activities; 75% were fused to fungal dockerin domains, associated with a carbohydrate binding module, or both. Collectively, this analysis suggests that co-culture of A. robustus with M. bryantii remodels the transcriptional landscape of CAZymes and associated metabolic pathways in the fungus to aid in lignocellulose breakdown.

People living with human immunodeficiency virus/AIDS (PLWHA) experience high prevalence of substance use disorders (SUD). HIV care settings represent a unique opportunity to identify possible SUD, to provide SUD interventions, and to improve linkage to SUD treatment. The aims of this paper are to (a) review and critique the extant literature examining substance use screening approaches among PLWHA in HIV care settings and (b) provide recommendations for future clinical practice. Twenty-one peer-reviewed articles that examined substance screening approaches employed in HIV and other primary care settings were included in the review. There was limited literature reporting on the implementation and evaluation of substance use screening practices within HIV care settings, and methodological rigor varied across studies. Further, the use of validated substance use screening measures or incorporation of other substance use screening approaches (e.g., use of urine drug testing) within routine HIV care practice is limited. Strategies to implement routine substance use screening within HIV care and incorporate additional substance use assessment, brief interventions, and referral to specialty substance use treatment are discussed. Use of self-report substance use screening measures using web- or computer-delivered approaches that can be integrated within electronic health record systems is particularly promising. HIV care practices should consider potential models to optimally screen and treat SUD. Co-location of HIV and SUD treatment services may be optimal; when co-located services are not possible, strategies to consistently provide brief intervention approaches and referrals to specialty SUD treatment are needed.

Black females are disproportionately affected by HIV/STIs, though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age= 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factor: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust, and (e) sex-related alcohol expectancies. Results indicated indirect effects of working model of self on: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08 ,95% CI [.02, .17]); any alcohol use prior to sex through peer norms for risky sex (ab = -.06, 95% CI [-.12, -.02]); and alcohol use prior to sex through sex-related alcohol expectancies (ab = -.13, 95% CI [-.21, -.05]). Findings indicated direct associations between working model of self and all the psychosocial HIV/STI risk factors included in the mediation models. Working model of self may help identify Black females elevated risk for HIV/STI through these psychosocial risk factors.

Highlights • An approach to community implementation of evidence-based practices (EBPs) was needed. • The Opioid-overdose Reduction Continuum of Care Approach (ORCCA) was developed. • ORCCA outlines: evidence-based strategies, priority populations, community settings. • ORCCA is a flexible framework for EBP implementation to reduce opioid-overdose deaths., Background The number of opioid-involved overdose deaths in the United States remains a national crisis. The HEALing Communities Study (HCS) will test whether Communities That HEAL (CTH), a community-engaged intervention, can decrease opioid-involved deaths in intervention communities (n = 33), relative to wait-list communities (n = 34), from four states. The CTH intervention seeks to facilitate widespread implementation of three evidence-based practices (EBPs) with the potential to reduce opioid-involved overdose fatalities: overdose education and naloxone distribution (OEND), effective delivery of medication for opioid use disorder (MOUD), and safer opioid analgesic prescribing. A key challenge was delineating an EBP implementation approach useful for all HCS communities. Methods A workgroup composed of EBP experts from HCS research sites used literature reviews and expert consensus to: 1) compile strategies and associated resources for implementing EBPs primarily targeting individuals 18 and older; and 2) determine allowable community flexibility in EBP implementation. The workgroup developed the Opioid-overdose Reduction Continuum of Care Approach (ORCCA) to organize EBP strategies and resources to facilitate EBP implementation. Conclusions The ORCCA includes required and recommended EBP strategies, priority populations, and community settings. Each EBP has a “menu” of strategies from which communities can select and implement with a minimum of five strategies required: one for OEND, three for MOUD, and one for prescription opioid safety. Identification and engagement of high-risk populations in OEND and MOUD is an ORCCArequirement. To ensure CTH has community-wide impact, implementation of at least one EBP strategy is required in healthcare, behavioral health, and criminal justice settings, with communities identifying particular organizations to engage in HCS-facilitated EBP implementation.

Alcohol use is prevalent among young women. Alcohol expectancies for sexual risk-taking and sexual enhancement motives have been associated with decreased condom use. This study investigated whether alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condom use. Young women (N = 287, M age = 20.1) completed a survey assessing alcohol expectancies for sexual risk-taking, sexual enhancement motives, and characteristics of their most recent sexual encounter involving alcohol. Most participants (66.9 %) reported unprotected sex during their last sexual encounter involving alcohol. Higher sexual enhancement motives (OR = 1.35, p = .019) and alcohol expectancies for sexual risk-taking (OR = 1.89, p

Individuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin: AOR: 13.2, 95 % CI 4.9, 35.3, p

There is consistent evidence that impulsivity-like traits relate to problematic alcohol involvement; however, identifying mechanisms that account for this relation remains an important area of research. Drinking refusal self-efficacy (or a person's ability to resist alcohol; DRSE) has been shown to predict alcohol use among college students and may be a relevant mediator of the impulsivity-alcohol relation. The current study examined the indirect effect of various constructs related to impulsivity (i.e., urgency, sensation seeking, and deficits in conscientiousness) via several facets of DRSE (i.e., social pressure, opportunistic, and emotional relief) on alcohol-related problems among a large sample of college students (N=891). Overall, results indicated that certain DRSE facets were significant mediators of the relation between impulsivity-related constructs and alcohol problems. More specifically, emotional-relief DRSE was a mediator for the respective relations between urgency and deficits in conscientiousness and alcohol problems, whereas social-DRSE was a significant mediator of the respective relations between urgency and sensation seeking with alcohol problems. Results from this study suggest particular types of DRSE are important mediators of the relations between specific impulsivity constructs and alcohol-related problems. These findings support prevention and intervention efforts that seek to enhance drinking refusal self-efficacy skills of college students, particularly those high in certain personality features, in order to reduce alcohol-related problems among this population.

BackgroundPatient-generated health data (PGHD) have been largely collected through mobile health (mHealth) apps and wearable devices. PGHD can be especially helpful in mental health, as patients’ illness history and symptom narratives are vital to developing diagnoses and treatment plans. However, the extent to which clinicians use mental health–related PGHD is unknown.ObjectiveA mixed methods study was conducted to understand clinicians’ perspectives on PGHD and current mental health apps. This approach uses information gathered from semistructured interviews, workflow analysis, and user-written mental health app reviews to answer the following research questions: (1) What is the current workflow of mental health practice and how are PGHD integrated into this workflow, (2) what are clinicians’ perspectives on PGHD and how do they choose mobile apps for their patients, (3) and what are the features of current mobile apps in terms of interpreting and sharing PGHD?MethodsThe study consists of semistructured interviews with 12 psychiatrists and clinical psychologists from a large academic hospital. These interviews were thematically and qualitatively analyzed for common themes and workflow elements. User-posted reviews of 56 sleep and mood tracking apps were analyzed to understand app features in comparison with the information gathered from interviews.ResultsThe results showed that PGHD have been part of the workflow, but its integration and use are not optimized. Mental health clinicians supported the use of PGHD but had concerns regarding data reliability and accuracy. They also identified challenges in selecting suitable apps for their patients. From the app review, it was discovered that mHealth apps had limited features to support personalization and collaborative care as well as data interpretation and sharing.ConclusionsThis study investigates clinicians’ perspectives on PGHD use and explored existing app features using the app review data in the mental health setting. A total of 3 design guidelines were generated: (1) improve data interpretation and sharing mechanisms, (2) consider clinical workflow and electronic health record integration, and (3) support personalized and collaborative care. More research is needed to demonstrate the best practices of PGHD use and to evaluate their effectiveness in improving patient outcomes.

We reexamined the psychometric properties of the Momentary Impulsivity Scale (MIS) in two young adult samples using daily diary (N=77) and ecological momentary assessment (N=147). A one-factor between- and within-person structure was supported, though “I felt impatient” loaded poorly within-person. MIS scores consistently related to emotion-driven trait impulsivity; however, MSSDs of MIS scores were unrelated to outcomes after accounting for aggregate MIS scores. We observed positive, within-person correlations with negative, but not positive, affect. Between-person MIS scores correlated with alcohol problems, though within-person MIS-alcohol relations were inconsistent. MIS scores were unrelated to laboratory-based impulsivity tasks. Findings inform the assessment of state-level impulsivity in young adults. Future research should prioritize expanding the MIS to capture the potential multidimensionality of state-level impulsivity.

Critical bacterial pathogens of public health and biodefense concerns were engineered to constitutively express Escherichia coli enzyme thymidine kinase (TK) that allows for noninvasive nuclear imaging via phosphorylation and entrapment of radiolabeled nucleoside analog 1-(2′deoxy-2′-fluoro-β-D-arabinofuranosyl)-5-iodouracil (FIAU). Expression of functional TK was established using a nucleoside analog Zidovudine that impeded the growth of tk-engineered bacteria. Significantly, no observable growth differences were detected for FIAU. High resolution mass spectrometry with Pseudomonas aeruginosa PAO1 and its tk variant (PAO1TK) confirmed FIAU phosphorylation and retention only in PAO1TK. In vitro gamma counting with wild-type PAO1, Acinetobacter baumannii and Burkholderia pseudomallei Bp82 and their tk derivatives with [18F]FIAU further confirmed that tk variants selectively incorporated the radiotracer, albeit with varying efficiencies. In vitro [18F]FIAU labeling coupled with in vivo Positron Emission Tomography/Computed Tomography (PET/CT) imaging of PAO1 and PAO1TK confirmed that only PAO1TK can be imaged in mice at sensitivities ≥107 bacteria per infection site. This was further verified by administering [18F]FIAU to animals infected with PAO1 and PAO1TK. Utility of tk-engineered P. aeruginosa in noninvasive PET/CT imaging for bacterial therapeutic evaluation in animals was demonstrated employing antibiotic ciprofloxacin, underscoring the immediate use of PAO1TK and potentially other engineered pathogens for evaluating experimental therapeutics.

Background Approximately 4–8% of the 1.1 million HIV patients in the United States have or will be diagnosed with HIV encephalopathy or HIV associated dementia (HAD). There are no published studies of the long-term outcomes of HAD treated with potent antiretroviral therapy (ART). We hypothesize that more than 60% of individuals diagnosed with HAD will have persistent neurocognitive impairment despite the successful use of potent ART and fewer than 20% will be employed. Methods This is a cross-sectional prospective and retrospective study of outcomes in individuals previously diagnosed with HAD. We identified all individuals with the diagnosis of dementia and HIV at the UC Infectious Diseases Center (IDC). For those who matched the 1993 CDC HAD definition, we collected medical, neurocognitive, and functional information. We attempted to contact all individuals alive and still in the IDC practice (N = 26) to perform a validated battery of neuropsychological tests. We excluded individuals with HIV-associated neurocognitive disease that developed after treatment with ART. Results We confirmed 39 diagnoses of HAD out of 137 records reviewed. The median CD4 count at the time of diagnosis of HAD was 47 cells/mm3 with a median viral load of 211,475 copies/mL. The median length of follow-up after diagnosis of HAD was 72 months (range 1–166 months). Potent ART was prescribed to all individuals, with 67.5% reaching consistent undetectable viral loads (< 200 copies/mL, occasional blips allowed). Persistent neurologic deficits were noted in 32.5%, while 60% had persistent cognitive deficits. Psychiatric disturbances were present in 72.5%. Only 2.5% reported any employment. To date, 28% have died. Ten participants have undergone formal neurocognitive testing to date (N = 26 available). The median overall summary score (total Z score) was -1.17 (range 0.08, -1.95) and median global deficit (GDS) score was 1.48 (range 0, 2.92). Conclusion HIV-associated dementia results in substantial morbidity and mortality despite potent antiretroviral therapy. Prospective neurocognitive assessment documents significant impairments in most individuals. HIV-associated dementia will require additional strategies to mitigate the profound impact on the quality of life and longevity. Disclosures All authors: No reported disclosures.

When synthetic polyamines, such poly(allylamine hydrochloride) (PAH), are mixed with crosslink-forming multivalent anions, they can undergo complex coacervation. This phenomenon has recently been exploited in various applications, ranging from inorganic material synthesis, to underwater adhesion, to multiple-month release of small, water-soluble molecules. Here, using ibuprofen as a model drug molecule, we show that these coacervates may be especially effective in the long-term release of weakly amphiphilic anionic drugs. Colloidal amphiphile/polyelectrolyte complex dispersions are first prepared by mixing the amphiphilic drug (ibuprofen) with PAH. Pentavalent tripolyphosphate (TPP) ions are then added to these dispersions to form ibuprofen-loaded PAH/TPP coacervates (where the strongly-binding TPP displaces the weaker-bound ibuprofen from the PAH amine groups). The initial ibuprofen/PAH binding leads to extremely high drug loading capacities (LC-values), where the ibuprofen comprises up to roughly 30% of the coacervate mass. Conversely, the dense ionic crosslinking of PAH by TPP results in very slow release rates, where the release of ibuprofen (a small, water-soluble drug) is extended over timescales that exceed 6 months. When ibuprofen is replaced with strong anionic amphiphiles, however (

α-Synuclein (αSyn) histopathology defines several neurodegenerative disorders, including Parkinson's disease, Lewy body dementia, and Alzheimer's disease (AD). However, the functional link between soluble αSyn and disease etiology remains elusive, especially in AD. We, therefore, genetically targeted αSyn in APP transgenic mice modeling AD and mouse primary neurons. Our results demonstrate bidirectional modulation of behavioral deficits and pathophysiology by αSyn. Overexpression of human wild-type αSyn in APP animals markedly reduced amyloid deposition but, counter-intuitively, exacerbated deficits in spatial memory. It also increased extracellular amyloid-β oligomers (AβOs), αSyn oligomers, exacerbated tau conformational and phosphorylation variants associated with AD, and enhanced neuronal cell cycle re-entry (CCR), a frequent prelude to neuron death in AD. Conversely, ablation of the SNCA gene encoding for αSyn in APP mice improved memory retention in spite of increased plaque burden. Reminiscent of the effect of MAPT ablation in APP mice, SNCA deletion prevented premature mortality. Moreover, the absence of αSyn decreased extracellular AβOs, ameliorated CCR, and rescued postsynaptic marker deficits. In summary, this complementary, bidirectional genetic approach implicates αSyn as an essential mediator of key phenotypes in AD and offers new functional insight into αSyn pathophysiology.

Human botulism is most commonly caused by botulinum neurotoxin (BoNT) serotypes A, B, and E. For this work, we sought to develop a human monoclonal antibody (mAb)-based antitoxin capable of binding and neutralizing multiple subtypes of BoNT/E. Libraries of yeast-displayed single chain Fv (scFv) antibodies were created from the heavy and light chain variable region genes of humans immunized with pentavalent-toxoid- and BoNT/E-binding scFv isolated by Fluorescence-Activated Cell Sorting (FACS). A total of 10 scFv were isolated that bound one or more BoNT/E subtypes with nanomolar-level equilibrium dissociation constants (KD). By diversifying the V-regions of the lead mAbs and selecting for cross-reactivity, we generated three scFv that bound all four BoNT/E subtypes tested at three non-overlapping epitopes. The scFvs were converted to IgG that had KD values for the different BoNT/E subtypes ranging from 9.7 nM to 2.28 pM. An equimolar combination of the three mAbs was able to potently neutralize BoNT/E1, BoNT/E3, and BoNT/E4 in a mouse neutralization assay. The mAbs have potential utility as therapeutics and as diagnostics capable of recognizing multiple BoNT/E subtypes. A derivative of the three-antibody combination (NTM-1633) is in pre-clinical development with an investigational new drug (IND) application filing expected in 2018.

Background:Atlanta has been identified as an HIV “hot spot” for Black women and ranks 5th in the US with new infections. Yet little is known about PrEP eligibility or interest among young Black women in Atlanta.Methods:A convenience sample of 1,261 Black women (ages 14-24 years) were recruited from two settings: community venues and sexual health clinics. They provided self-reported sexual behavior data and specimens for laboratory testing for chlamydia (CT) and gonorrhea (GC) infections. For each woman, the number of key self-reported behavioral HIV risk factors was calculated (0-6 factors for the clinic sample, 0-3 factors for the community sample). A single item assessed PrEP interest in the community sample only.Results:Bacterial STI positivity, an indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, 20.1% reported no behavioral risk indicators and 47.2% reported > 2 behavioral indicators. Of the 117 STI positive women from the community sample, 21.4% reported no behavioral risk indicators. 60.7% of the community sample reported they would be likely or very likely to use PrEP if available.Conclusion:Young Black women in Atlanta, whether sampled from community or sexual health settings, are at substantial risk for HIV infection and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.

To inform future psychosocial interventions for HIV-infected women, five focus groups were conducted with 29 HIV-infected women (72% African-American). Sessions were audio-recorded, transcribed, and coded by two raters. HIV-specific stressors included difficulties with serostatus disclosure, HIV medication adherence, and HIV-related discrimination. Stressors not directly linked to HIV were described as more concerning and included mental health or substance use problems, relationship challenges, caretaking for children or grandchildren, and financial difficulties. Participants suggested that interventions provide social support from other HIV-infected women, consistent case management and social work services, and forums to acquire additional information about HIV and treatment options.

This study tested the hypothesis that depressive symptoms would mediate the association of HIV-related stigma to medication adherence. We recruited HIV-infected men who have sex with men (MSM; N = 66; 66 % White, 23 % African-American) from an outpatient infectious disease clinic, and asked them to complete self-report measures. Mediational analyses showed that depressive symptoms fully mediated the association between HIV-related stigma and adherence. That is, stigma-related experiences were positively associated with depressive symptoms and negatively associated with adherence, and, in the final model, depressive symptoms remained a significant correlate of adherence while stigma did not. A test of the indirect effect of stigma on adherence through depressive symptoms was also significant (unstandardized b = -0.19; bootstrap 95 % CI -0.45 to -0.01). These results highlight the importance of treating depressive symptoms in interventions aiming to improve medication adherence among HIV-infected MSM.

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

Purpose Virtually no studies have examined the potential role that chronic stress, particularly the stress associated with socioeconomic status (SES) strain, may play on sexually transmitted infection (STI) risk. This study examined the association between SES-related risk at baseline to STI acquisition and reinfection over 36 months of follow-up. Methods Six hundred twenty-seven African-American female adolescents, ages 14–20 years, recruited from sexual health clinics in Atlanta, GA, participated in a randomized controlled HIV prevention trial and returned for at least one follow-up assessment. Following baseline assessment, six waves of data collection occurred prospectively over 36 months. Chronic SES-related risk was assessed as a sum of yes–no exposure to seven risk indicators. Laboratory-confirmed tests for Chlamydia trachomatis and Neisseria gonorrhoeae were performed at each follow-up. Results In multivariable regression analysis, SES-related risk significantly predicted STI acquisition over 36 months (adjusted odds ratio = 1.22) and STI reinfection (adjusted odds ratio = 1.16) above and beyond other known correlates of STI. Conclusions Findings demonstrate that SES-related risk was predictive of both STI acquisition and reinfection among young African-American females. They are consistent with propositions that some health disparities observed in adulthood may be linked to earlier chronically stress-inducing life experiences, particularly experiences associated with low SES conditions. Although various explanations exist for the observed connection between SES-related risk and subsequent STI acquisition and/or reinfection across 36 months of follow-up, these findings highlight the need for further research to elucidate the exact pathway(s) by which SES-related risk influences later STI acquisition to refine STI prevention interventions for this population.

Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.

OBJECTIVE:To evaluate factors within the social-ecological framework associated with most or moderately effective contraception, condom and dual method use at last coitus among young, HIV-infected women in Atlanta. METHODS:This is a cross-sectional study conducted from November, 2013 until August, 2015 at the Grady Infectious Disease Clinic in Atlanta, Georgia. We recruited perinatally and horizontally HIV-infected women of ages 14-30 years to complete an audio computer-assisted self-interview. We evaluated factors within a social-ecological framework associated with most or moderately effective contraceptive use (hormonal contraception or an IUD), condom use, and dual method use (use of condom and most or moderately effective contraceptive) at last coitus. RESULTS:Of 103 women enrolled, 74 reported a history of sexual activity. The average age was 22.1; 89% were African American, 52% were perinatally infected, 89% received combination antiretroviral therapy, and 63% had undetectable viral loads. At last coitus, 46% reported most or moderately effective contraception, 62% reported condom use and 27% reporting dual-method use. The odds of most or moderately effective contraceptive use was significantly reduced among those with detectable viral loads (versus undetectable viral loads; aOR 0.13 [0.04, 0.38]). Older age (aOR 0.85 [0.74, 0.98] and more frequent coitus (>once/week versus < = once/week; aOR 0.24 [0.08, 0.72]) was significantly associated with reduced condom use. Having a detectable viral load (versus undetectable viral loads; aOR 0.13 [0.03, 0.69]) and more frequent coitus (>once/week versus < = once/week; aOR 0.14 [0.03,0.82]), was associated with reduced dual method use, while being enrolled in school (aOR 5.63 [1.53, 20.71]) was significantly associated with increased dual method use. CONCLUSIONS:Most or moderately effective contraception, condom and dual method use remained inadequate in this cohort of young HIV-infected women. Individual-level interventions are needed to increase the uptake of dual methods with user-independent contraceptives.

Introduction HIV disproportionately impacts African Americans (AAs) in the US. Atlanta has been identified as an HIV ‘hot spot’ for AA women and ranks 8th in the US with new infections. Yet little is known about PrEP eligibility or interest among young AA women in Atlanta. Methods 1261 sexually active young AA women (14–24 years) provided baseline data on self-reported sexual behaviour and laboratory-confirmed STI testing (Chlamydia (CT) and gonorrhoea (GC)) prior to participating in an HIV prevention trial in Atlanta. A convenience sample of women were recruited from 2 settings: community venues (n=560, ages 18–24, 2012–2014) and sexual health clinics (n=701, ages 14–20, 2005–2008) from sexual health clinics. An HIV risk index capturing key HIV risk factors for women was calculated from the self-report data. For the clinic sample the index included recent (past 90 days) condomless vaginal sex, condomless anal sex, sex with partner who has had male partners, sex while high (self), sex while high (partner), and intimate partner violence (IPV) (range: 0–6). For the community sample, the index included condomless sex at last sex, exchanged sex for goods and experienced IPV in past 90 days (range: 0–3). A single item assessed PrEP interest in the community sample only. Results Bacterial STI positivity, a primary indicator for PrEP eligibility, was 20.5% (17.1% CT, 6.3% GC) and 20.9% (18.8% CT, 5.2% GC) for the clinic and community samples, respectively. Of the 144 STI positive women from the clinic sample, HIV risk index scores ranged from 0–4, with 21.5% reporting no other HIV risk indicators, 31% had one, 27.8% two, 16.7% three and 2.8% had 4 additional indicators. Of the 117 STI positive women from the community sample, HIV risk index scores ranged from 0–3, with 51.3% reporting no other indicators, 36.8% one, 10.3% two and 1.7% had all 3 additional indicators. Among STI positive women, the most common HIV risk indicator was condomless vaginal sex, but 23.8% and 13.2% (only reported by those >18 years) of the community and clinic samples, respectively, reported recent IPV. 57.8% of the community sample reported they would be likely or very likely to use PrEP if available. Conclusion Our findings indicate that young AA women in Atlanta, whether sampled from community venues or sexual health clinics, are at substantial risk for HIV and meet several PrEP eligibility criteria. Scaling up PrEP among women in Atlanta could have significant implications for HIV in this high burden region.

Cigarette smoking among people living with HIV/AIDS is associated with significant morbidity and mortality, but findings regarding the association between cigarette smoking and HIV viral load and CD4+ lymphocyte counts have been inconsistent. This study characterized the prevalence of cigarette smoking among HIV-infected Russian women and examined the association between smoking frequency and quantity and HIV viral load and CD4+ lymphocyte counts. HIV-infected Russian women (N = 250; M age = 30.0) in St. Petersburg, Russia, completed an audio computer-assisted self-interview survey assessing cigarette use, antiretroviral medication adherence, and provided blood samples assayed for HIV viral load and CD4+ lymphocyte counts. The majority (60.4%) reported cigarette smoking in the past month; 49.0% of recent smokers were classified as moderate or heavy smokers, defined as smoking ≥10 cigarettes daily. Viral load status did not differ between infrequent smokers and regular smokers. However, moderate/heavy smokers (relative to light smokers) were more likely to have a detectable viral load (AOR = 2.3, 95% CI: 1.1, 5.1). There were no significant differences in CD4+ lymphocyte counts by smoking frequency or quantity of cigarettes smoked. Results highlight the need for additional research to examine the association between cigarette smoking and virologic suppression and markers of HIV disease progression. Adverse health consequences of cigarette smoking coupled with a potential link between heavy smoking and poor virologic suppression highlight the need for assessment of cigarette use and provision of evidence-based smoking-cessation interventions within HIV medical care.

Behavioral HIV prevention interventions designed to improve safer-sex communication skills with sexual partners may enhance engagement in protective behaviors and reduce HIV/STI risk. The current meta-analyses examined the efficacy of individual-based (i.e., not couples-based) HIV prevention interventions with a partner communication skills building component to increase frequency of: (a) safer-sex communication and (b) condom use with sexual partners among HIV at-risk groups (e.g., heterosexual African American females). Studies were retrieved from online bibliographic databases, a database of effective behavioral HIV prevention interventions, and an existing review of effective interventions. Eight manuscripts (k = 10 intervention vs. control comparisons) met inclusion criteria. Results indicated that compared to control conditions, at post-intervention follow-up, participants who were exposed to individual-based HIV prevention interventions with safer-sex communication skills training components had safer sex discussions with partners more frequently [drandom = 0.35 ± 0.10, p

Purpose Although previous studies have elucidated associations between motivations for drinking and sex as they relate to risky health outcomes among female college students, the utility of cross-domain motives (i.e., alcohol motives predicting sex-related outcomes and vice versa) in the prediction of specific alcohol- and sex-related behaviors has yet to be examined. The current study examined relations between drinking and sex motives with multiple risky alcohol- and sex-related outcomes (i.e., alcohol consumption, alcohol-related problems, alcohol consumption prior to sexual intercourse, number of sexual partners [vaginal, oral, anal], and emergency contraception use). Procedures Multiple structural equation models were used to examine univariate and multivariate associations among drinking and sex motives and specific outcomes in a sample of female undergraduates with lifetime histories of alcohol use and sexual activity (N = 436; 77% White, 21% Hispanic). Results Findings indicated differential associations between motives and specific outcomes across univariate versus multivariate analyses. Multivariate models indicated greater endorsement of enhancement and less endorsement of intimacy sex motives were significantly associated with heavy drinking and alcohol-related problems, whereas alcohol motives were less reliably linked to sex-related outcomes. When considered simultaneously, sex motives accounted for more variance in some alcohol outcomes relative to certain drinking motives. Conclusions Cross-domain motives may be useful in predicting risky outcomes among female college students. Research implications include the importance of examining motive-behavior relations in univariate and multivariate contexts. Clinical implications include cross-domain motive assessment and use of emotion regulation strategies to reduce emotionally-motivated maladaptive alcohol- and sex-related behaviors.

A wealth of scientific literature has been devoted to understanding what factors influence parents and their adolescent children to obtain the HPV vaccine. This literature is relatively uniform in its methodological approach of sampling individuals (i.e., either parents or adolescents) and examining the predictors of uptake for that individual. To improve understanding of HPV vaccination uptake, we sampled low-income, African American parent-child dyads with either a female (n = 93) or a male (n = 116) adolescent who had not been vaccinated. Both parents and children completed self-report measures that tapped intent to receive the vaccine and hypothesized predictors of intent (i.e., self-efficacy, beliefs about the vaccine, beliefs about HPV, knowledge of HPV). Using a dyadic analytic approach (i.e., the Actor-Partner Interdependence Model or APIM) [1], we found that parents and their adolescents have different structures of beliefs regarding HPV vaccination (i.e., they are empirically distinguishable). Consistent with prior research, the majority of predictors of an individual’s own intention to vaccinate were individual-level variables; uniquely though, some predictors endorsed by one member of the dyad influenced the intentions held by the other member. Specifically, parents’ reports of HPV severity and their self-efficacy were both associated with adolescents’ intent to obtain the vaccine. Further, adolescents’ beliefs that the vaccine will lead to greater promiscuity or be stigmatizing were associated with parents holding an increased intent to vaccinate. Use APIM improves understanding of HPV vaccination uptake and can be used to guide intervention efforts.

Combination HIV prevention interventions that integrate efficacious behavioral and biomedical strategies offer the potential to reduce new HIV infections. We overview the efficacy data for three biomedical HIV prevention approaches, namely microbicides, pre-exposure prophylaxis (PrEP), and HIV vaccination; review factors associated with differential acceptability and uptake of these methods; and suggest strategies to optimize the effectiveness and dissemination of combination HIV prevention approaches. A narrative review was conducted highlighting key efficacy data for microbicides, PrEP, and an HIV vaccination and summarizing acceptability data for each of the three biomedical HIV prevention approaches. Recommendations for the integration and dissemination of combined behavioral and biomedical HIV prevention approaches are provided. To date, microbicides and an HIV vaccination have demonstrated limited efficacy for the prevention of HIV. However, PrEP has demonstrated efficacy in reducing HIV incident infections. A diverse array of factors influences both hypothetical willingness and actual usage of each biomedical prevention method. Strategies to effectively integrate and evaluate combination HIV prevention interventions are urgently needed.

Empirical evidence linking campaign financing activity to future firm benefits is mixed. However, theory suggests that an important aspect of a successful political strategy is a multi-period investment in cultivating relationships with key policymakers (Snyder 1992). We examine a specific setting and investigate whether firms that invest in relationships with tax policymakers via campaign contributions accrue greater future tax benefits. We find that firms that pursue a more relational approach to corporate political activity have lower future cash and GAAP effective tax rates (ETRs) and less volatile future cash ETRs. Further, we provide evidence of an incremental effect of tax-specific lobbying for firms that develop stronger relationships with tax policymakers via PAC support. Thus, our study links tax-specific PAC support to tax-specific outcomes, providing an economic link for the observed contribution-return relation documented in Cooper, Gulen, and Ovtchinnikov (2010). Data Availability: All data are publicly available from sources as indicated in the text.

The influence of various aspects of life on wellbeing has been extensively researched. However, despite little empirical evidence, participation in leisure activities has been assumed to increase subjective wellbeing. Leisure is important because it is more under personal control than other sources of life satisfaction. This study asked whether people who participate in cultural leisure activities have higher life satisfaction than people who do not, if different types of leisure have the same influence on life satisfaction and if satisfaction is dependent on the frequency of participation or the number of activities undertaken. It used data from UKHLS Survey to establish associations between type, number and frequency of participation in leisure activities and life satisfaction. Results showed an independent and positive association of participation in sport, heritage and active-creative leisure activities and life satisfaction but not for participation in popular entertainment, theatre hobbies and museum/galleries. The association of reading hobbies and sedentary-creative activities and life satisfaction was negative. High life satisfaction was associated with engaging in a number of different activities rather than the frequency of participation in each of them. The results have implications for policy makers and leisure services providers, in particular those associated with heritage recreation. Subjective wellbeing measures, such as life satisfaction, and not economic measures alone should be considered in the evaluation of services. The promotion of leisure activities which are active and promote social interaction should be considered in programmes aimed at improving the quality of life.

I nger (2013) examines the relative valuation of alternative methods of tax avoidance. In particular, she uses hand-collected information from the financial statement footnotes to decompose total tax avoidance into four pieces so she can compare the relative valuation of tax avoidance related to the use of stock options (STOCK AVOID), accelerated depreciation (DEPR AVOID), and the deferral of U.S. tax on foreign earned income (RESIDUAL AVOID). She hypothesizes that different methods of tax avoidance may be valued differently based on characteristics associated with those methods, such as the risk profile and temporary versus permanent nature of the tax savings generated. Her results indicate that tax avoidance resulting from stock options benefits is positively associated with firm value, while avoidance associated with accelerated depreciation is not associated with firm value. Tax avoidance associated with deferral of the residual U.S. tax on foreign earnings is negatively associated with firm value, on average; however, this effect appears limited to firms with a presence in a tax haven and/or instances in which the extent of the residual U.S. tax associated with permanently reinvested earnings is salient to investors. Inger’s research addresses an interesting question and contributes to a growing stream of studies that explore heterogeneity in investor valuation of tax avoidance (Ayers, Laplante, and Schwab 2011; De Simone and Stomberg 2012). Presumably, owners of the firm want managers to make tax-efficient decisions, those where the marginal benefits of the transaction exceed the marginal costs (Hanlon and Heitzman 2010). Because estimating the costs and benefits of alternative tax savings transactions is challenging at best, too often, we lump tax avoidance methods together and treat tax avoidance as one all-encompassing activity. Yet, the marginal costs and benefits of alternative tax reduction methods almost certainly do vary. Inger’s study offers a framework for thinking about the relative costs and benefits of different methods of tax reduction, and the impact those varying costs and benefits might have on firm value. The limited prior

Alcohol use is prevalent among college students and may contribute to sexual risk behavior engagement. A narrative review of the recent empirical literature examining the association between alcohol use and sexual risk behaviors among college student samples was conducted. The purpose of this review was to (a) review studies examining the association between alcohol use and risky sexual behaviors and (b) overview research investigating alcohol expectancies and partner characteristics as factors that may influence the alcohol-risky sex relation among college students. Findings regarding the direct link between alcohol use and sexual risk behaviors were mixed. Results suggest a more nuanced association between alcohol and risky sexual behaviors that is influenced by alcohol expectancies and partner characteristics. Results highlight the importance of considering additional factors that may influence the alcohol-risky sex relation. Future interventions targeting alcohol-related sexual risk behavior engagement among college students are needed.

With growing numbers of Hispanic students enrolling in post-secondary school, there is a need to increase retentionand graduation rates. The purpose of this study was to validate the Spanish adaptation of the Abbreviated MathAnxiety Scale (AMAS). The AMAS was translated and administered to 804 freshman students at a post-secondaryinstitution in Mexico. After data analysis, the measure was found to be valid and reliable. The validated measurecould serve as a predictor for math course grades and retention among Hispanic students at the post-secondary level,and it could allow researchers to study the structure of math anxiety across cultures.

Background Hepatitis C Virus (HCV) risk is elevated for individuals with an opioid use disorder (OUD). Routine HCV testing is recommended for high-risk individuals, including those with an injection drug use history. HCV antibody testing addresses the first step in the HCV treatment care cascade, with uptake and completion of HCV treatment among individuals with chronic HCV as the optimal care cascade endpoint. The aim of this study was to characterize self-reported HCV treatment cascade outcomes among individuals with an OUD in outpatient medication assisted treatment (MAT). Methods Individuals receiving methadone or buprenorphine treatment (N = 202, 67.8% female, M age = 35.0, SD = 8.4) completed a brief, anonymous paper-and-pencil survey examining self-reported history of HCV testing, diagnosis, and treatment. Descriptive statistics characterized HCV treatment cascade outcomes. Results A majority (79.3%) endorsed a lifetime HCV testing history; 34.9% were tested for HCV during the past year. Of those with a lifetime HCV testing history, 42.7% indicated they have been told they have HCV (n = 67/157), with 21% (n = 14/67) of those individuals reporting that they have been told they have chronic HCV, and 71.4% (n = 10/14) of those with chronic HCV reporting receipt of HCV treatment. Discussion Results underscore gaps in the HCV care continuum among individuals with OUD in MAT. Interventions to increase uptake of HCV testing, communication of HCV diagnostic and treatment information by medical providers, linkage to HCV medical care, and uptake and adherence to HCV treatment are urgently needed, particularly among individuals with an OUD in MAT.

* Abbreviations: HIV — : human immunodeficiency virus PSA — : prostate-specific antigen STD — : sexually transmitted disease Yc-PCR — : Y-chromosome polymerase chain reaction Adolescents’ self-reported health behaviors inform medical care and serve as primary intervention outcome measures. Strategies to bolster the validity and reliability of self-report combined with objective biological markers of behavior are urgently needed. We illustrate such strategies within the context of adolescent sexual health research. Research that informs human immunodeficiency virus (HIV) and sexually transmitted disease (STD) prevention efforts and public health policy involves many challenges. One key challenge is the accurate measurement of HIV risk behaviors, particularly sexual behaviors. Adolescent HIV risk reduction intervention trials have relied mainly on outcomes measured via participants’ self-reports of past behavior to evaluate programmatic efficacy. Few trials have complemented participant self-report with biological measures of sexual behaviors (eg, laboratory-confirmed STDs). Indeed, of the 20 US Centers for Disease Control and Prevention evidence-based interventions for adolescents, only 4 have included biological outcomes as trial end points in addition to self-reported measures.1 Although adolescents’ self-reported behaviors have been the most widely measured trial end points, the accuracy of self-report data may be affected by myriad factors, including the cognitive demands of recalling past behaviors and motivational biases that can lead adolescents to misreport behavior.2 Furthermore, inconsistencies between self-reported sexual behaviors and biological end points raise questions about the validity of relying solely on self-report to evaluate the efficacy of HIV risk reduction interventions. Thus, a need exists to both improve the validity of self-report and to integrate biological markers of sexual risk behaviors into future adolescent HIV risk reduction interventions. Motivational biases may result in distortion of self-reported past behaviors to avoid shame or embarrassment or to appear in a more favorable light. … Address correspondence to Jennifer L. Brown, PhD, Department of Psychological Sciences, Texas Tech University, MS 2051, Lubbock, TX 79409-2051. E-mail: jennifer.brown{at}ttu.edu

Greater than 70% of sexually transmitted adolescent human immunodeficiency virus (HIV) infections occur in African American girls; the diagnosis rate in these girls is nearly 23 times greater than that in white adolescents. A number of reviews have demonstrated that behavioral change interve

High levels of antiretroviral therapy (ART) adherence are required to achieve optimal viral suppression. To better understand mechanisms associated with ART adherence, this study characterized demographic and social-cognitive correlates of ART adherence among HIV-infected individuals from a medium-sized northeastern US city (n=116; 42% female; 43% African-American). Participants completed an audio computer-assisted self-interviewing survey assessing demographics, social-cognitive constructs, and ART adherence, and the participants' most recent viral load was obtained from their medical charts. Suboptimal ART adherence (taking less than 95% of prescribed medications during the past month) was reported by 39% of participants and was associated with being female, being a minority, and having a detectable viral load. In a hierarchical logistic regression analysis, greater than 95% ART adherence was associated with higher levels of adherence self-efficacy (AOR =1.1; p=0.015), higher perceived normative beliefs about the importance of ART adherence (AOR=1.3; p=0.03), and lower concern about missing ART doses (AOR=0.63; p=0.002). Adherence did not differ based on ART outcome expectancies, ART attitudes, or the perceived necessity of ART. In fact, most participants endorsed positive attitudes and expectancies regarding the need for and effectiveness of ART. Taken together, results indicate that suboptimal adherence remains high among HIV-infected minority women, a subpopulation that experiences particularly high rates of chronic stress due to both illness-specific stressors and broader environmental stressors. Consistent with social-cognitive theory, adherence problems in our sample were linked with deficits in self-efficacy as well as perceived norms and behavioral intentions that do not support a goal of 100% adherence. We suggest that interventions to improve adherence informed by social-cognitive theory (1) target patients who are at risk for adherence problems, (2) provide a supportive environment that promotes high rates of adherence, and (3) address inaccurate beliefs regarding optimal adherence levels.

Alcohol use disorders are common among HIV-infected individuals and are associated with adverse physiological complications and increased engagement in other health risk behaviors. This paper provides a review and critique of interventions to reduce alcohol use among HIV-infected individuals, including a: (a) synthesis of core intervention components and trial designs; (b) summary of intervention efficacy to reduce alcohol use outcomes; and (c) methodological critique and guidance for future research. We reviewed 14 behavioral interventions that reported on alcohol use outcomes among HIV-infected individuals. Findings were mixed for intervention efficacy to reduce alcohol frequency and quantity. There was limited evidence that interventions reduced binge drinking frequency or alcohol abuse or dependence symptoms. Despite the prevalence of disordered alcohol use among HIV-infected individuals, there is lack of efficacious intervention approaches. Efficacious intervention approaches to reduce alcohol use among HIV-infected individuals are urgently needed.

OBJECTIVES: The aims of this study were to identify partner attributes associated with sexually transmitted infections (STIs) among adolescents and to summarize implications for research and prevention. DESIGN: The design of this study was systematic review. METHODS: We identified peer-reviewed studies published in 1990 through 2010 that assessed 1 or more partner attributes in relation to a biologically confirmed STI among adolescents (15-24 years) by searching MEDLINE and included articles. Studies that included adolescents but more than 50% of the sample or with mean or median age of 25 years or greater were excluded. RESULTS: Sixty-four studies met the eligibility criteria; 61% were conducted in high-income countries; 80% were cross sectional; and 91% enrolled females and 42% enrolled males. There was no standard "partner" definition. Partner attributes assessed most frequently included the following: age, race/ethnicity, multiple sex partners, and STI symptoms. Older partners were associated with prevalent STIs but largely unrelated to incidence. Black race was associated with STIs but not uniformly. Partners with multiple partners and STI symptoms seem to be associated with STIs predominantly among females. Although significant associations were reported, weaker evidence exists for the following: other partner sociodemographics, sexual and other behaviors (sexual concurrency, intimate partner violence, substance use, travel), and STI history. There were no apparent differences by STI. CONCLUSIONS: Partner attributes are independently associated with STIs among male and female adolescents worldwide. These findings reinforce the importance of assessing partner attributes when determining STI risk. Prevention efforts should continue to promote and address barriers to condom use. Increased efforts are needed to screen and treat STIs and reduce risky behavior among men. A standard partner definition would facilitate the interpretation of findings in future studies. Language: en

Given the realistic expectations of HIV-infected adolescents and young adults (AYA) to have children and start families, steps must be taken to ensure that youth are prepared to deal with the challenges associated with their HIV and parenting. Literature reviews were conducted to identify published research and practice guidelines addressing parenting or becoming parents among HIV-infected AYA in the United States. Research articles or practice guidelines on this topic were not identified. Given the paucity of information available on this topic, this article provides a framework for the development of appropriate interventions and guidelines for use in clinical and community-based settings. First, the social, economic, and sexual and reproductive health challenges facing HIV-infected AYA in the United States are summarized. Next, family planning considerations, including age-appropriate disclosure of HIV status to those who are perinatally infected, and contraceptive and preconception counseling are described. The impact of early childbearing on young parents is discussed and considerations are outlined during the preconception, antenatal, and postnatal periods with regard to antiretroviral medications and clinical care guidelines. The importance of transitioning AYA from pediatric or adolescent to adult-centered medical care is highlighted. Finally, a comprehensive approach is suggested that addresses not only medical needs but also emphasizes ways to mitigate the impact of social and economic factors on the health and well-being of these young parents and their children.

Background African American adolescent females are at elevated risk for unintended pregnancy and sexually transmitted infections (STIs). Dual protection (DP) is defined as concurrent prevention of pregnancy and STIs. This can be achieved by abstinence, consistent condom use, or the dual methods of condoms plus an effective non-barrier contraceptive. Previous clinic-based interventions showed short-term effects on increasing dual method use, but evidence of sustained effects on dual method use and decreased incident pregnancies and STIs are lacking. Methods/design This manuscript describes the 2GETHER Project. 2GETHER is a randomized controlled trial of a multi-component intervention to increase dual protection use among sexually active African American females aged 14–19 years not desiring pregnancy at a Title X clinic in Atlanta, GA. The intervention is clinic-based and includes a culturally tailored interactive multimedia component and counseling sessions, both to assist in selection of a DP method and to reinforce use of the DP method. The participants are randomized to the study intervention or the standard of care, and followed for 12 months to evaluate how the intervention influences DP method selection and adherence, pregnancy and STI incidence, and participants' DP knowledge, intentions, and self-efficacy. Discussion The 2GETHER Project is a novel trial to reduce unintended pregnancies and STIs among African American adolescents. The intervention is unique in the comprehensive and complementary nature of its components and its individual tailoring of provider-patient interaction. If the trial interventions are shown to be effective, then it will be reasonable to assess their scalability and applicability in other populations.

Academic researchers and the public have long shared an interest in whether and how corporate political activity is related to taxes and tax policy. In this review, we synthesize 29 empirical studies on tax-related corporate political activity into a conceptual framework to better understand what research has been done and what opportunities for inquiry remain. We also describe the corporate political activity data that is currently available and suggest some standardized terminology. We make three primary recommendations based on our review of the literature: (1) greater attention to institutional detail, (2) further integration of corporate political activity strategies, and (3) methodological improvements. Finally, we provide suggestions for future research, which should be of interest to academics pursuing tax-related corporate political activity research.

Senior student preceptorship is a vital clinical component of many baccalaureate nursing curricula providing a one-on-one partnership with a registered nurse with clinical expertise. Experiential data and literature review support the preceptor's need for guidance with student assessment and evaluation strategies. This article reports on research conducted to assess the perceived increase in a preceptor's knowledge after viewing an author developed instructional CD, Mission Possible CD ROM: Instructional Tool for Preceptors. The results suggest that perceived knowledge increased; however, the lack of time to view the CD was an issue for the majority of the nurse preceptor participants. More research is warranted to build on current literature regarding instructional strategies of benefit to a nurse in the preceptor role.