Cognitive Behavioral Therapy for Trauma and Self-Care (CBT-TSC) in Men Who have Sex with Men with a History of Childhood Sexual Abuse: A Randomized Controlled Trial.

To address childhood sexual abuse (CSA) related distress and HIV risk in men who have sex with men (MSM) using cognitive-behavioral therapy for trauma and self-care (CBT-TSC), which is a novel intervention integrating HIV risk reduction with modified cognitive and behavioral therapy strategies for post-traumatic stress. We compared CBT-TSC to HIV voluntary counseling and testing (VCT)-only in an initial 2-arm RCT in 43 HIV-negative MSM at with a history of CSA and HIV risk. Serodiscordant condomless anal/vaginal sex (CAS; CAS with HIV-postive or HIV unknown status partners) and posttraumatic stress disorder (PTSD) symptoms (Davidson Trauma Scale: total score and avoidance, intrusions, hyperarousal subscales) were outcomes immediately post-treatment, and at 6- and 9-month follow-up. At post-treatment, CBT-TSC had decreased odds (approximately 60%) of any CAS and greater reductions in CAS compared to VCT-only. Additionally, the CBT-TSC condition experienced greater reductions in total PTSD and avoidance symptoms. At the follow-up visits, CBT-TSC condition had significant reductions in the odds of any CAS and reductions in CAS. However, for PTSD symptoms, only the avoidance subscale remained significantly different compared to VCT-only. CBT-TSC is a potentially efficacious approach to address HIV risk in MSM with a CSA history, with replication and extension in a larger trial needed. This proof-of-concept trial is the first to integrate the treatment of a commonly occurring mental-health syndemic problem in MSM with a health psychology approach to self-care in MSM.Trial Registration Clinicaltrials.gov NCT01266122.

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men.

Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants' clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45-4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.

Evaluating a novel intervention to reduce trauma symptoms and sexual risk taking: qualitative exit interviews with sexual minority men with childhood sexual abuse.

Childhood sexual abuse (CSA) continues to affect sexual minority men (SMM) at disproportionate levels and contributes to multiple negative health outcomes, including sexual-risk taking and HIV acquisition. This paper presents qualitative evaluative feedback from SMM (N = 9) who participated in a 10-session Cognitive Behavioral Therapy-Trauma and Sexual Health (CBT-TSH) intervention to reduce CSA-related posttraumatic stress reaction and distress. The treatment was designed to increase accurate sexual risk appraisals and to improve self-care health behaviors related to HIV/STI acquisition. The researchers identified four emerging themes: (1) motivation to participate, (2) response to cognitive therapy, (3) process of change, and (4) considerations for intervention improvement. These qualitative findings provide useful feedback on the acceptability of an innovative program that integrates CBT for trauma related to CSA with sexual risk-reduction counseling.

Individualized Closed-Loop Acoustic Stimulation Suggests an Alpha Phase Dependence of Sound Evoked and Induced Brain Activity Measured with EEG Recordings.

Following repetitive visual stimulation, post hoc phase analysis finds that visually evoked response magnitudes vary with the cortical alpha oscillation phase that temporally coincides with sensory stimulus. This approach has not successfully revealed an alpha phase dependence for auditory evoked or induced responses. Here, we test the feasibility of tracking alpha with scalp electroencephalogram (EEG) recordings and play sounds phase-locked to individualized alpha phases in real-time using a novel end-point corrected Hilbert transform (ecHT) algorithm implemented on a research device. Based on prior work, we hypothesize that sound-evoked and induced responses vary with the alpha phase at sound onset and the alpha phase that coincides with the early sound-evoked response potential (ERP) measured with EEG. Thus, we use each subject's individualized alpha frequency (IAF) and individual auditory ERP latency to define target trough and peak alpha phases that allow an early component of the auditory ERP to align to the estimated poststimulus peak and trough phases, respectively. With this closed-loop and individualized approach, we find opposing alpha phase-dependent effects on the auditory ERP and alpha oscillations that follow stimulus onset. Trough and peak phase-locked sounds result in distinct evoked and induced post-stimulus alpha level and frequency modulations. Though additional studies are needed to localize the sources underlying these phase-dependent effects, these results suggest a general principle for alpha phase-dependence of sensory processing that includes the auditory system. Moreover, this study demonstrates the feasibility of using individualized neurophysiological indices to deliver automated, closed-loop, phase-locked auditory stimulation.

Condom use philosophy and behaviors among young men who have sex with men: Variations among HIV pre-exposure prophylaxis users and nonusers.

BACKGROUND: In the United States, sexually transmitted infections, particularly HIV, occur at disproportionally high rates among young men who have sex with men (YMSM). Oral pre-exposure prophylaxis (PrEP) is a highly effective in reducing HIV acquisition. Reduction of condom use has been noted among adult populations of MSM using PrEP. However, less is known about PrEP and condom use among YMSM. PURPOSE: Our objective was to understand condom attitudes/beliefs and behaviors among YMSM in the context of PrEP use and nonuse. METHODOLOGICAL ORIENTATION: We conducted qualitative interviews between May and November, 2017 in Boston, MA. All YMSM were HIV-negative by self-report. We purposively sampled youth who used PrEP and those who did not use PrEP. Data were analyzed using content analysis. SAMPLE: The sample consisted of 31 YMSM aged 17-24 years (mean = 21.5 years). CONCLUSIONS: Young men who have sex with men provided rich descriptions of their condom-use philosophies and behaviors. Three themes emerged: 1) Different condom philosophies between youth who used PrEP and youth who do not, 2) Inconsistent or absent condom use by PrEP users, and 3) Similar condom behaviors regardless of PrEP use with certain partner types, if low self-efficacy was reported, and when sex occurred during periods of substance use and/or intoxication. IMPLICATIONS FOR PRACTICE: This study provides understanding of YMSM condom decision-making process in the context of PrEP use or nonuse. Findings are useful to inform development and testing of individually tailored interventions for YMSM based on their personal condom-use philosophies and behaviors to improve risk reduction decision making, use of condoms, and PrEP.

Extreme thermodynamics with polymer gel tori: Harnessing thermodynamic instabilities to induce large-scale deformations.

When a swollen, thermoresponsive polymer gel is heated in a solvent bath, it expels solvent and deswells. When this heating is slow, deswelling proceeds homogeneously, as observed in a toroid-shaped gel that changes volume while maintaining its toroidal shape. By contrast, if the gel is heated quickly, an impermeable layer of collapsed polymer forms and traps solvent within the gel, arresting the volume change. The ensuing evolution of the gel then happens at fixed volume, leading to phase separation and the development of inhomogeneous stress that deforms the toroidal shape. We observe that this stress can cause the torus to buckle out of the plane, via a mechanism analogous to the bending of bimetallic strips upon heating. Our results demonstrate that thermodynamic instabilities, i.e., phase transitions, can be used to actuate mechanical deformation in an extreme thermodynamics of materials.

Disparities in Exposure to Intimate Partner Violence Among Transgender/Gender Nonconforming and Sexual Minority Primary Care Patients.

PURPOSE: We investigated the odds of intimate partner violence (IPV) among primary care patients across subgroups of transgender and gender nonconforming (TGNC) individuals relative to cisgender women, and cisgender sexual minority men and women relative to cisgender heterosexual men and women. METHODS: Participants completed an IPV screener as part of routine primary care visits at an urban community health center (N = 7572). Electronic medical record data were pooled for all patients who received the IPV screener January 1 to December 31, 2014. RESULTS: Overall, 3.6% of the sample reported experiencing physical or sexual IPV in the past year. Compared to cisgender women (past-year prevalence 2.7%), all TGNC subgroups reported elevated odds of physical or sexual IPV, including transgender women (past-year prevalence 12.1%; adjusted odds ratio [AOR] = 5.0, 95% confidence interval [CI] = 2.9-8.6), transgender men (6.6%; AOR = 2.4, 95% CI: 1.2-4.6), gender non-binary individuals (8.2%, AOR = 3.1, 95% CI = 1.7-5.4), and TGNC individuals who did not report their gender identity (9.1%; AOR = 3.7, 95% CI = 2.2-6.3). The prevalence of isolation-related IPV and controlling behaviors was also high in some TGNC groups. CONCLUSION: Our findings support that IPV is prevalent across genders and sexual orientations. Clinical guidelines for IPV screening should be expanded to include TGNC individuals and not just cisgender women. Future research could explore the complex patterns by which individuals of different genders are at increased risk for different types of IPV, and investigate the best ways to screen TGNC patients and support TGNC survivors.

Uniform yeast cell assembly via microfluidics.

This paper reports the use of microfluidic approaches for the fabrication of yeastosomes (yeast-celloidosomes) based on self-assembly of yeast cells onto liquid-solid or liquid-gas interfaces. Precise control over fluidic flows in droplet- and bubble-forming microfluidic devices allows production of monodispersed, size-selected templates. The general strategy to organize and assemble living cells is to tune electrostatic attractions between the template (gel or gas core) and the cells via surface charging. Layer-by-Layer (LbL) polyelectrolyte deposition was employed to invert or enhance charges of solid surfaces. We demonstrated the ability to produce high-quality, monolayer-shelled yeastosome structures under proper conditions when sufficient electrostatic driving forces are present. The combination of microfluidic fabrication with cell self-assembly enables a versatile platform for designing synthetic hierarchy bio-structures.