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1.
J Adolesc Health ; 66(3): 268-274, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31672523

RESUMO

PURPOSE: The aim of the study was to characterize perceived social support for young men and transgender women who have sex with men (YM/TWSM) taking HIV pre-exposure prophylaxis (PrEP). METHODS: Mixed-methods study of HIV-negative YM/TWSM of color prescribed oral PrEP. Participants completed egocentric network inventories characterizing their social support networks and identifying PrEP adherence support figures. A subset (n = 31) completed semistructured interviews exploring adherence support and qualities of PrEP support figures. We calculated proportions of role types (e.g., family), individuals disclosed to regarding PrEP use, and PrEP-supportive individuals within each participant network. Interviews were analyzed using an inductive approach. RESULTS: Participants (n = 50) were predominately African American men who have sex with men. Median age was 22 years (interquartile range: 20-23). Biologic family were the most common support figures, reported by 75% of participants (mean family proportion .37 [standard deviation (SD): .31]), followed by 67% reporting friends (mean friend proportion .38 [SD: .36]). Most network members were aware (mean disclosed proportion .74 [SD: .31]) and supportive (mean supportive proportion .87 [SD: .28]) of the participants' PrEP use. Nearly all (98%) participants identified ≥1 figure who provided adherence support; more often friends (48%) than family (36%). Participants characterized support as instrumental (e.g., transportation); emotional (e.g., affection); and social interaction (e.g., taking medication together). Key characteristics of PrEP support figures included closeness, dependability, and homophily (alikeness) with respect to sexual orientation. CONCLUSIONS: Although most YM/TWSM identified family in their support networks, friends were most often cited as PrEP adherence support figures. Interventions to increase PrEP adherence should consider integrated social network and family-based approaches.

3.
Medicina (Kaunas) ; 55(8)2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31390821

RESUMO

Background and Objective: The objective of this study was to evaluate the potential independent and interactive effects of handedness and grip strength on episodic memory function, and whether biological sex moderated these relationships. Materials and Methods: 162 young adults (Mage = 20.7 years) completed a series of memory assessments including a subjective memory complaint evaluation and several objective measures of memory. Handedness (i.e., left-hand dominant, inconsistent handedness (ICH), and right-hand dominant) was evaluated using the Edinburgh Handedness Inventory. Handgrip strength was determined from a handgrip dynamometer. Results: When compared to ICH individuals, retrospective memory scores were statistically significantly worse for left-handed (p = 0.02) and right-handed (p = 0.03) individuals. Higher grip strength was statistically significantly associated with fewer retrospective memory complaints (b = 0.10, 95% CI: 0.01, 0.19, p = 0.04). Conclusions: The present study provides some suggestive evidence that ICH (inconsistent handedness) and greater grip strength are associated with fewer retrospective memory complaints. However, we did not observe any evidence of an interaction effect of handedness and grip strength on memory, and similarly, biological sex did not interact with these parameters to influence memory.


Assuntos
Lateralidade Funcional/fisiologia , Força da Mão/fisiologia , Memória/fisiologia , Fatores Sexuais , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Mississippi , Inquéritos e Questionários , Adulto Jovem
4.
Artif Life ; 25(3): 250-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31397601

RESUMO

Populations exposed to a high mutation rate harbor abundant deleterious genetic variation, leading to depressed mean fitness. This reduction in mean fitness presents an opportunity for selection to restore fitness through the evolution of mutational robustness. In extreme cases, selection for mutational robustness can lead to flat genotypes (with low fitness but high robustness) outcompeting fit genotypes (with high fitness but low robustness)-a phenomenon known as survival of the flattest. While this effect was previously explored using the digital evolution system Avida, a complete analysis of the local fitness landscapes of fit and flat genotypes has been lacking, leading to uncertainty about the genetic basis of the survival-of-the-flattest effect. Here, we repeated the survival-of-the-flattest study and analyzed the mutational neighborhoods of fit and flat genotypes. We found that the flat genotypes, compared to the fit genotypes, had a reduced likelihood of deleterious mutations as well as an increased likelihood of neutral and, surprisingly, of lethal mutations. This trend holds for mutants one to four substitutions away from the wild-type sequence. We also found that flat genotypes have, on average, no epistasis between mutations, while fit genotypes have, on average, positive epistasis. Our results demonstrate that the genetic causes of mutational robustness on complex fitness landscapes are multifaceted. While the traditional idea of the survival of the flattest emphasized the evolution of increased neutrality, others have argued for increased mutational sensitivity in response to strong mutational loads. Our results show that both increased neutrality and increased lethality can lead to the evolution of mutational robustness. Furthermore, strong negative epistasis is not required for mutational sensitivity to lead to mutational robustness. Overall, these results suggest that mutational robustness is achieved by minimizing heritable deleterious variation.

5.
AIDS Behav ; 23(10): 2719-2729, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30993479

RESUMO

We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.


Assuntos
Afro-Americanos/psicologia , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Homossexualidade Masculina/psicologia , Adesão à Medicação/etnologia , Profilaxia Pré-Exposição/métodos , Pessoas Transgênero/psicologia , Afro-Americanos/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Adesão à Medicação/psicologia , Philadelphia , Pesquisa Qualitativa , Assunção de Riscos , Minorias Sexuais e de Gênero , Estigma Social , Apoio Social , Tenofovir/administração & dosagem , Tenofovir/uso terapêutico , Pessoas Transgênero/estatística & dados numéricos , Adulto Jovem
6.
Transgend Health ; 2(1): 81-90, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28861551

RESUMO

Purpose: (1) To describe psychosocial, medical, and mental health outcomes of young transgender women (YTW) living with or at risk for HIV infection and (2) to explore barriers and facilitators to medical and mental health services across the HIV care continuum. Methods: We conducted a cross-sectional observational study of YTW aged 16-24 years who were at risk for contracting or living with HIV. Participants were recruited from an adolescent HIV clinic and local community-based organizations that serve YTW. The single study visit included: a computer-assisted self-interview of demographics, medical and mental health measures, a qualitative semi-structured interview, optional rapid HIV testing for HIV-negative/status-unknown participants, and a chart review to determine rates of antiretroviral therapy (ART) prescription and viral suppression among HIV+ participants. Descriptive statistics were used for quantitative data, and a modified-grounded theory approach was used for qualitative analysis. Results: Participants (n=25) had a mean age of 21.2 years; the majority were non-white (76%), had less than a college education (76%), were unemployed (52%), and had an income <$12,000/year (80%). More than one-third were unstably housed (36%) and uninsured (36%), and 28% reported having transactional sex. A majority had taken gender-affirming hormones (72%), but 17% obtained them from a source other than their doctor. Among HIV+ participants (n=8), 50% were prescribed ART and all four participants achieved viral suppression. Qualitative themes included lack of respect for or misunderstanding of gender identity, mismatch of mental health needs with available provider skills, challenges in finding HIV prevention services during adolescence or when transitioning to adult care, and importance of workforce diversity, including representation of transgender women in care teams. Conclusion: This study identified significant unmet mental health needs and several barriers and facilitators to engaging in healthcare for YTW across the HIV care continuum. Our data suggest an urgent need for provider competency training in gender-affirming care and integration of appropriate mental health and gender-affirming treatment with HIV prevention and treatment services for this population.

7.
J Biomed Inform ; 44 Suppl 1: S103-8, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21651992

RESUMO

Amid researchers' growing need for study data management, the CTSA-funded Institute for Translational Health Sciences developed an approach to combine technical and scientific resources with small-scale clinical trials researchers in order to make Electronic Data Capture more efficient. In a 2-year qualitative evaluation we found that the importance of ease of use and training materials outweighed number of features and functionality. EDC systems we evaluated were Catalyst Web Tools, OpenClinica and REDCap. We also found that two other systems, Caisis and LabKey, did not meet the specific user needs of the study group.


Assuntos
Ensaios Clínicos como Assunto , Informática Médica/métodos , Coleta de Dados , Humanos , Internet
8.
Front Neuroinform ; 3: 2, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19198662

RESUMO

This paper addresses the need for relatively small groups of collaborating investigators to integrate distributed and heterogeneous data about the brain. Although various national efforts facilitate large-scale data sharing, these approaches are generally too "heavyweight" for individual or small groups of investigators, with the result that most data sharing among collaborators continues to be ad hoc. Our approach to this problem is to create a "lightweight" distributed query architecture, in which data sources are accessible via web services that accept arbitrary query languages but return XML results. A Distributed XQuery Processor (DXQP) accepts distributed XQueries in which subqueries are shipped to the remote data sources to be executed, with the resulting XML integrated by DXQP. A web-based application called DXBrain accesses DXQP, allowing a user to create, save and execute distributed XQueries, and to view the results in various formats including a 3-D brain visualization. Example results are presented using distributed brain mapping data sources obtained in studies of language organization in the brain, but any other XML source could be included. The advantage of this approach is that it is very easy to add and query a new source, the tradeoff being that the user needs to understand XQuery and the schemata of the underlying sources. For small numbers of known sources this burden is not onerous for a knowledgeable user, leading to the conclusion that the system helps to fill the gap between ad hoc local methods and large scale but complex national data sharing efforts.

9.
AMIA Annu Symp Proc ; : 946, 2008 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-18998840

RESUMO

Recent advances in semantic web technologies now provide the methodology for efficient and adaptable deployment of ontology support to biomedical applications for data annotation and integration.


Assuntos
Sistemas de Gerenciamento de Base de Dados , Dicionários Médicos como Assunto , Armazenamento e Recuperação da Informação/métodos , Internet , Semântica , Interface Usuário-Computador , Processamento de Linguagem Natural , Integração de Sistemas , Estados Unidos
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