Egocentric network characteristics of people who inject drugs in the Chicago metro area and associations with hepatitis C virus and injection risk behavior.

BACKGROUND: Hepatitis C (HCV) infection has been rising in the suburban and rural USA, mainly via injection-based transmission. Injection and sexual networks are recognized as an important element in fostering and preventing risky behavior; however, the role of social support networks has received somewhat less attention. METHODS: Using baseline data from an ongoing longitudinal study, we examined the composition and structure of injection drug use (IDU), sex, and social support networks of young people who inject drugs (aged 18-30) and their injection network members. Lasso logistic regression was used to select a subset of network characteristics that were potentially important predictors of injection risk behaviors and HCV exposure. RESULTS: Several measures of IDU, sexual, and support network structure and composition were found to be associated with HCV exposure, receptive syringe sharing (RSS), and ancillary equipment sharing. Gender and sexual relationships were important factors for all risk behaviors. Support network characteristics were also important, notably including a protective effect of majority Hispanic support networks for RSS and HCV exposure. Both IDU network residence heterogeneity and support network geography were associated with injection equipment sharing. CONCLUSIONS: The associations of IDU and support network geography with equipment sharing highlight the need to extend harm reduction efforts beyond urban areas. Greater understanding of support network influences on risk behavior may provide important insights to strengthen the benefits of harm reduction. In considering the probability of HCV transmission, it is important to consider setting and network structures that promote propagation of risk.

The Relationship Between Clinical and Indocyanine Green Staging in Lymphedema.

Background: Multiple staging systems for classifying the severity of lymphedema exist. The International Society of Lymphology (ISL) stage is considered standard for clinical reporting, but the relationship between clinical and functional/imaging stage remains poorly defined. Materials and Methods: We reviewed the prospectively collected data of all patients who underwent physiologic lymphedema surgery for a 3-year period by the senior author. Patients who underwent preoperative clinical staging with limb volume calculations and intraoperative indocyanine green (ICG) staging were included. Correlations were examined between ISL stage, ICG stage, and preoperative volume difference. Results: A total of 212 patients met inclusion criteria. ISL stage and preoperative volume difference had a Pearson correlation coefficient of 0.579 [p < 0.001, 95% confidence intervals, CIs (0.479-0.664)]; ICG stage and preoperative volume difference had a Pearson correlation coefficient of 0.338 [p < 0.001, 95% CIs (0.204-0.460)]; and ISL stage and ICG stage had a Pearson correlation coefficient of 0.254 [p < 0.001, 95% CIs (0.114-0.383)]. Conclusion: Clinical ISL stage does not correlate well with ICG stage in patients undergoing physiologic lymphedema surgery.

Production and Comprehension of Prosodic Markers in Sign Language Imperatives.

In signed and spoken language sentences, imperative mood and the corresponding speech acts such as for instance, command, permission or advice, can be distinguished by morphosyntactic structures, but also solely by prosodic cues, which are the focus of this paper. These cues can express paralinguistic mental states or grammatical meaning, and we show that in American Sign Language (ASL), they also exhibit the function, scope, and alignment of prosodic, linguistic elements of sign languages. The production and comprehension of prosodic facial expressions and temporal patterns therefore can shed light on how cues are grammaticalized in sign languages. They can also be informative about the formal semantic and pragmatic properties of imperative types not only in ASL, but also more broadly. This paper includes three studies: one of production (Study 1) and two of comprehension (Studies 2 and 3). In Study 1, six prosodic cues are analyzed in production: temporal cues of sign and hold duration, and non-manual cues including tilts of the head, head nods, widening of the eyes, and presence of mouthings. Results of Study 1 show that neutral sentences and commands are well distinguished from each other and from other imperative speech acts via these prosodic cues alone; there is more limited differentiation among explanation, permission, and advice. The comprehension of these five speech acts is investigated in Deaf ASL signers in Study 2, and in three additional groups in Study 3: Deaf signers of German Sign Language (DGS), hearing non-signers from the United States, and hearing non-signers from Germany. Results of Studies 2 and 3 show that the ASL group performs significantly better than the other 3 groups and that all groups perform above chance for all meaning types in comprehension. Language-specific knowledge, therefore, has a significant effect on identifying imperatives based on targeted cues. Command has the most cues associated with it and is the most accurately identified imperative type across groups-indicating, we suggest, its special status as the strongest imperative in terms of addressing the speaker's goals. Our findings support the view that the cues are accessible in their content across groups, but that their language-particular combinatorial possibilities and distribution within sentences provide an advantage to ASL signers in comprehension and attest to their prosodic status.