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The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies (N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS (r = −.16) and a positive correlation between insecure attachment (r = .20), avoidant attachment (r = .20), anxious attachment (r = .32), and disorganized attachment (r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

Objectives Medial patellar luxation (MPL) is the most common developmental cause of hindlimb lameness in cats. The association between femoral and tibial conformation and MPL measured on computed tomography (CT) has not been reported in cats. The aims were to report femoral and tibial conformation in cats with and without MPL and to report normal femoral and tibial angles. Methods Angle of inclination of femoral neck (AI), anatomical lateral distal femoral angle (aLDFA), femoral trochanteric angle (FCT), angle of anteversion of femoral neck (AA), distal and proximal anteversion angle (DAA/PAA), overall tibial valgus (TV), tibial torsion (TT), tibial tuberosity displacement (TTD) and trochlear depth:patellar thickness ratio (T:P) were measured by three observers on CT of cats with and without MPL. Comparisons were made between groups. Inter-observer intraclass correlation coefficient (ICC) was calculated. Results Sixteen cats were recruited: eight control and eight with MPL. The aLDFA, PAA, TT, TTD and T:P were significantly less in cats with high-grade MPL. The AI, FCT, AA, DAA and TV were not significantly different. A high correlation was shown with inter-observer ICC in 33.33% and good correlation in 26.67% when comparing measurements between observers. Clinical Significance This study suggests that cats with high-grade MPL have decreased TT, TTD and T:P and may require tibial tuberosity transposition and femoral trochleoplasty. The PAA, TT and aLDFA were decreased, although clinical significance may vary and these cats may not require correctional osteotomies. Results should be interpreted with caution as high/good levels of inter-observer ICC occurred in less than two-thirds of cases between observers.

Despite the increased uptake of intravascular lithotripsy (IVL) for treating severely calcified coronary lesions, there is limited patient-level data examining the effect of IVL on quality of life, symptomatology, and outcomes beyond 30 days. We sought to assess demographics, procedural characteristics, outcomes, and impact of IVL on patient-reported angina after a minimum of 6 months follow-up.A retrospective single-center study was conducted of patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Technical success and complications were assessed along with clinical outcomes, which included all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and MACE (composite of death, stroke, MI, and TLR). Canadian Cardiovascular Society (CCS) angina classification was assessed at virtual clinical follow-up.Forty-seven consecutive patients were included. At a mean follow-up of 306 ± 74 days, the mean CCS angina score was reduced by 53% post-IVL-assisted PCI (2.9 vs 1.4, p 0.001). Technical and procedural success were high (94% and 92%, respectively). One patient (2%) met the pre-specified criteria for in-hospital MACE and 4 (9%) met pre-specified MACE at follow-up, including 2 deaths and 2 TLR. Procedural complications included coronary dissection (11%) and coronary perforation (6%) and were managed either conservatively or with PCI.Coronary IVL is a safe and effective adjunctive therapy for treating heavily calcified coronary lesions. This cohort shows high procedural success and a significant reduction in CCS angina at follow-up.

OBJECTIVE To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs. ANIMALS 63 client-owned dogs. PROCEDURES Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire. RESULTS 54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified. Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs. Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]). Intraoperative complications occurred in 18 (28.6%) dogs, and 28 (50%) dogs had a postoperative complication. Postoperative complications were minor in 14 of the 28 (50%) dogs. Dehiscence of the esophagotomy occurred in 3 dogs. Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge. Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months). Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication. CLINICAL RELEVANCE Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.

Transcatheter aortic valve implantation and implantation of other transcatheter heart valves, generally requires insertion of a temporary venous pacemaker. Implantation of a temporary venous pacemaker adds complexity, time and risk to the procedure. Guidewire modification to allow pacing is increasingly popular, however it requires technical expertise and provides unipolar pacing resulting in high thresholds and potential capture loss. The Wattson temporary pacing guidewire is a novel device which offers guidewire support for valve delivery and concomitant bipolar pacing. It may offer a safe and effective solution to guidewire pacing for transcatheter aortic valve implantation and other transcatheter heart valve implantations. Herein, we review the literature surrounding left ventricular guidewire pacing along with the features and clinical data of the Wattson wire.Replacing a heart valve, such as in transcatheter aortic valve implantation, requires the use of a pacemaker. This is often inserted through the veins into the opposite side of the heart to the valve being replaced. However, this method adds risk, time and complexity. New technologies have been developed to simplify this process, by using one wire in only one side of the heart to stimulate the heart muscle and support the valve replacement. The Wattson wire is a new device which acts this way and promises to make the transcatheter aortic valve implantation procedure safer and more efficient.

Background Vitamin B12 deficiency is a well described complication post gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia and possible long term neurological symptoms. Treatment can be with standardised replacement regimens or to monitor B12 levels and replace as required. This study assesses patient understanding of and compliance with B12 supplementation guidelines post total and subtotal gastrectomy. Methods 125 patients who underwent gastrectomy between 2010-2020 were available for study (86 total gastrectomies, 39 subtotal gastrectomies). Patient data was collected by review of the hospital electronic records and individual phone calls. Patients were asked standardised questions to elicit knowledge of the importance of B12 supplementation and compliance with supplementation. Results 92% (79/86) of total gastrectomy patients reported compliance in regular parenteral B12 supplementation. Compliance was significantly lower for subtotal gastrectomies for checking and/or replacing their vitamin B12 at 53.8% (21/39) (p Conclusions Regular monitoring and supplementation of vitamin B12 levels is important post gastrectomy. This study demonstrates good compliance in those undergoing total gastrectomy. Patient understanding correlates with compliance, suggesting that patient education and knowledge reinforcement may be key to compliance with vitamin B12 supplementation.

Background Young men who have sex with men (YMSM) are disproportionately impacted by the HIV epidemic in the USA, and a large number of new infections among YMSM occur in the context of main or primary partnerships. At the same time, healthy romantic relationships promote health and wellbeing by improving social support and encouraging healthy behaviors. Thus, we created 2GETHER: a relationship education and HIV prevention program for young male couples. 2GETHER is delivered face-to-face in a university setting and is composed of two group sessions and two individualized skills coaching sessions. We observed strong support of the feasibility, acceptability, and preliminary efficacy of 2GETHER in a pilot trial. Methods We are conducting an attention-matched randomized controlled trial (RCT) to test the efficacy of 2GETHER relative to a control condition based on a well-validated positive affect enhancement program. Enrollment occurred between August 2017 and March 2021 in Chicago and surrounding areas, and we enrolled and randomized 128 dyads (N = 256 individuals). Follow-up is ongoing and we will examine primary and secondary behavioral outcomes at 12 months post-intervention, with interim follow-up at 3, 6, and 9 months post-intervention. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Discussion 2GETHER is innovative in that it places an equal emphasis on relationship skill building and HIV prevention. Thus, the program has the potential to impact numerous health-related outcomes. Despite challenges related to the recruitment of couples and the COVID-19 pandemic, we were able to enroll a robust sample of young male couples with sufficient power to detect effects on study outcomes. Trial registration ClinicalTrials.gov NCT03186534.

Introduction\ud Patient safety within dental education is paramount. Wrong‐site surgery (WSS) tooth extraction is not uncommon and is a significant never event (NE) in dentistry. This study aimed to explore dental schools’ undergraduate experience of NEs, safety interventions implemented and the impact on student experience.\ud \ud Methods\ud All 16 UK dental schools were surveyed via email.\ud \ud Results\ud The response rate was 100%. A modified World Health Organization (WHO) checklist was used within institutions (94%) including pre‐operative briefings and recording teeth on whiteboards (81%, respectively). Students were directly supervised performing extractions (63%) utilising a 1:4 staff: student ratio. WSS by students was reported in 69% of schools, with student experience being impacted by an increased patient safety focus.\ud \ud Discussion\ud This study demonstrated an increased utilisation of an adapted WHO checklist. Modification of practices to ensure patient safety was demonstrated at all schools, irrespective of student WSS occurrences. Institutions experiencing student NEs commonly implemented WHO checklists and recording teeth for extraction on whiteboards. Other strategies included direct staff supervision and pre‐operative briefings.\ud \ud Conclusion\ud UK dental schools have increased the emphasis on patient safety by the implementation of national healthcare models, for example WHO checklists and pre‐operative briefings. These strategies both aim to improve communication and teamwork. Increased levels of staff supervision foster greater quality of teaching; however, this has resulted in reduced student clinical experience. A proposed minimum standard for undergraduate surgery is suggested to ensure safe and competent dental practitioners of the future.

A process has been developed to manufacture a glass diplexer module using conventional laminate circuit board processes that have been adapted to handle glass substrates. Over the past few years we have evaluated both Cu plating and electrically conductive adhesives (ECAs) to produce a through glass via (TGV). From this work, it has been determined that Cu plating is a preferred process to form a robust TGV in a manufacturing environment. A Cu plated TGV nicely compliments our semi-additive plating (SAP) processes to produce fine line Cu circuitry on both sides of a glass substrate. In addition, we have successfully laminated an Ajinomoto Buildup Film (ABF) to both sides of a glass substrate having TGVs. The ABF completely filled the vias and also maintained uniform flatness on both sides. The resulting interposer was very flat and suitable for the next level of Cu plating using SAP. The ABF material was able to form high quality blind vias using laser drilling. A more comprehensive characterization of the glass diplexer modules will be presented, which will include X-sections of a double-sided Cu circuitry and Cu MIM (metal-insulator-metal) capacitors and inductors. In addition, the first set of electrical test data will be presented and compared with the modeling work done to date.

Background: Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. Purpose/Hypothesis: The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. Results: A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. Conclusion: PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

For the next generation of 3D-IC applications, glass offers many desirable properties that make it an ideal interposer. In order to realize these applications, it becomes necessary to be able to deposit a Cu layer on both surfaces as well as in the glass via. In this paper we will present results of interposers that have fine line circuitry on both sides of the glass and have through glass vias (TGVs). One major challenge is how to create a TGV using either electrically conductive adhesives (ECAs) or Cu plating methods to achieve a high conductivity and reliable via connection. Most work to date uses ECA materials to fill the TGV, however, many of these ECA materials have limitations in that they cannot withstand temperatures in excess of 400°C, are not hermetic and do not have the electrical properties of bulk Cu. In the first phase of our work, we have evaluated different commercially available ECA materials to fill the glass vias. A major challenge in using these materials is how to effectively fill the vias. Our test vehicle has a TGV with dimensions of 50um diameter and a 300um thickness on 2″ × 2″ glass substrate. A positive pressure screen printing process was used to fill the vias. These ECA materials exhibited a very high viscosity, due to the high Cu metal filler content, which made them very difficult to fill. Different pressures, squeegee speeds, and standoff conditions were evaluated to arrive at an optimized process to effectively fill the glass vias. A tilted X-ray inspection approach was used to characterize the yield for ECA hole fill. A DOE of different sintering conditions was conducted to determine how to maximize the electrically conductivity of the paste. From this work we will show the impact of sintering conditions on electrical conductivity and hermeticity. In parallel, we have developed a process to Cu plate a TGV. In this approach, a dry deposition process was used to produce a conductive seed layer in the via having a diameter of 100um and a total substrate thickness of 300um. We proceeded to use a Cu electroplating process to plate up a conformal Cu layer in the glass via. In this work we have pattern plated circuitry on both surfaces along with the via to produce a glass interposer. In addition, we were able to deposit a very thin layer of Si3N4 between two thick Cu metal layers on the topside of a glass interposer to produce a capacitor. The success of plating a TGV also enables the formation of inductors in a glass substrate. An organic dielectric layer using an Ajinomoto Buildup Film (ABF) was used to create a single buildup layer on the glass interposer. The combination of these individual technologies allows the capability to manufacture a glass interposer for advanced packaging applications. A discussion of the challenges associated in building glass interposers will be presented, which will include examples of recent builds of a double-sided Cu circuitry glass interposer and a diplexer module having Cu MIM (metal-insulator-metal) capacitors and inductors for RF applications.

Aortic insufficiency resulting from radiofrequency (RF) ablation of the left ventricular outflow tract (LVOT) is a rarely reported complication. We describe a 56-year-old man with a significant burden of premature ventricular contractions (PVCs) who underwent unsuccessful LVOT RF ablation and suffered iatrogenic aortic valve injury producing severe aortic insufficiency. He required aortic valve replacement in the setting of a redo sternotomy and ischemic cardiomyopathy. Intraoperative transesophageal echocardiography demonstrated diastolic prolapse of a coronary leaflet and a defect in the right coronary leaflet base. Physical inspection of the valve confirmed the echocardiography findings and revealed extensive damage to the noncoronary and right coronary leaflets. These findings suggest that the trauma of extensive RF ablation was the culprit responsible for the iatrogenic aortic valve damage and not a mechanical, catheter-induced injury.

Polyploidy, or whole genome duplication, is rampant among both extant and ancient flowering plant species. Whole genome duplications create simultaneous copies of all genes contained within a genome as well as associated regulatory sequences. These duplication and the subsequent deletions of redundant coding and noncoding sequence both shape the natural evolution of plant genomes and provide a unique opportunity for researchers to characterize the regulatory sequences which determine when, in which cells and in what quantities the mRNA encoded for by particular genes will be produced. This dissertation describes a model for explaining both bias in gene loss between parental subgenomes and the escape from preferential retention of duplicated genes between sequential whole genome duplications. Bias in gene deletion between individual duplicated segments had been previously observed by the publication of the sorghum and maize genomes provided an opportunity to demonstrate this bias was a consistent mark distinguishing whole pairs of ancestral chromosomes, and that ongoing gene loss remains consistently biased between high and low gene loss subgenomes millions of generations after a whole genome duplication. Bias in both ancestral and ongoing gene loss is shown to be correlated with biased gene expression between parental subgenomes with genes on the low gene loss subgenome tending to show higher expression levels than duplicate copies of the same genes on the high gene loss subgenome. This phenomena, originally referred to as genome dominance, although the literature has since become somewhat confused, provides an explanation both for biased gene loss between parental subgenomes and for the escape of deletion-resistant genes from the ratchet of ever increasing copy numbers through continued whole genome duplications. This dissertation also demonstrates the use of polyploid lineage - in this case maize - as a deletion machine to rapidly characterize the function of regulatory sequences shared by orthologous genes within a clade. It was possible to develop testable hypothesis about the specific function of individual regulatory sequences by combining conserved noncoding sequence sequence datasets, noncoding sequence deletions identified using comparative genomics with analysis and visualization of gene expression data from diverse organs, tissues, and cell types. As a test of the accuracy of this method, a putative pollen specific enhancer of expression identified using expression data from maize was cloned from the orthologous sorghum gene and used to drive the expression of a reporter construct in Brachypodium distachyon. Polyploid deletion machines have the potential to radically accelerate the characterization of noncoding regulatory sequences, an area of genetics previously largely untouched by advances next generation sequencing technologies.

BACKGROUND Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. OBJECTIVE The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. METHODS This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. RESULTS As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. CONCLUSIONS 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. CLINICALTRIAL ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15883

A kitten presented with acute kidney injury, bilateral hydronephrosis and proximal hydroureter, three days following bilateral ureteral ligation, during a complicated ovariohysterectomy procedure. Clinical signs were anorexia, lethargy, weakness, hypothermia, nausea, pain and anuria, associated with marked azotaemia, hyperkalaemia and metabolic acidosis. Insufficient response to medical management alone led to emergency surgical placement of bilateral subcutaneous ureteral bypass (SUB) systems, resulting in dramatic improvement in azotaemia and acidosis and resolution of hyperkalaemia. Elective bilateral neoureterocystostomy was performed the next day. The cat was clinically well for three months until the left SUB cystostomy catheter migrated out of the bladder resulting in uroabdomen. At this time, fluoroscopy demonstrated normal ureteral function bilaterally, so both SUBs were removed. Following recovery from surgery the cat has remained clinically normal. This report highlights the possibility of temporary SUB placement as a bridge to definitive ureteral repair in cases of accidental ureteral ligation.

After extensive inquiry and backlash against the historic recommendation-based clinical practice guidelines, the Institute of Medicine, and others, called for a revision of the recommendation-based clinical practice guidelines. The new guidelines were to be evidence-based. A rigorous rubric was created to standardize the development process of future clinical practice guidelines. These evidence-based clinical practice guidelines are designed to stand certain scrutiny their recommendation-based predecessors could not, improve the quality of health care, decrease inefficiencies, and reduce practice variation. Through the extensive and deliberate analysis of high-quality medical literature, clinical practice guidelines provide evidence-supported health-care plans for physicians and patients alike. As clinical practice guidelines serve as a summary of scientific evidence available, those areas which lack adequate clinical research may become research priority.

Background Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID) DERR1-10.2196/15883

Carey argues that Socrates’ injunction to follow the logos has two distinct, though related implications. The first is well-known: we should subject what is sub-rational in the soul to the rule of reason. The second implication is less well-known, though it becomes obvious on reflection: we can follow the logos only if the logos is, of its own nature, headed somewhere, or at least pointing somewhere. What human reason is headed toward or pointing to is its natural end. Reason is intrinsically teleological. Carey explores the Socratic conception of reason, which is generally the pre-modern conception, as something more than an instrument to be employed solely for the sake of attaining ends, such as longevity and pleasure, that are not specifically rational.