New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection.

Large-scale structural interventions and "Big Events" like revolutions, wars and major disasters can affect HIV transmission by changing the sizes of at-risk populations, making high-risk behaviors more or less likely, or changing contexts in which risk occurs. This paper describes new measures to investigate hypothesized pathways that could connect macro-social changes to subsequent HIV transmission. We developed a "menu" of novel scales and indexes on topics including norms about sex and drug injecting under different conditions, experiencing denial of dignity, agreement with cultural themes about what actions are needed for survival or resistance, solidarity and other issues. We interviewed 298 at-risk heterosexuals and 256 men who have sex with men in New York City about these measures and possible validators for them. Most measures showed evidence of criterion validity (absolute magnitude of Pearson's r ≥ 0.20) and reliability (Cronbach's alpha ≥ 0.70). These measures can be (cautiously) used to understand how macro-changes affect HIV and other risk. Many can also be used to understand risk contexts and dynamics in more normal situations. Additional efforts to improve and to replicate the validation of these measures should be conducted.

Women's health research: public policy and sociology.

In the space of just a few years, the amount and nature of scientific research on women's health has emerged as a major policy issue being addressed at the highest levels of the federal government and in the mainstream media. This debate has engaged members of Congress, the National Institutes of Health, and other federal agencies, and medical, scientific, health, and women's organizations. Sociologists have made significant contributions to both the process by which the women's health research issue has ascended to public awareness and the content of its agenda. Many of these contributions go unrecognized and other potential contributions by medical sociologists remain unrealized. In order to advance both science and practice in women's health--by ensuring the inclusion of the sociological perspective--we encourage sociologists to participate more directly in the policy debates.

The role of behavioral research in HIV/AIDS prevention.

Behavioral and social research has been at the core of HIV/AIDS prevention efforts, by identifying the factors that contribute to the risk of transmission and by developing effective behavioral interventions to modify that risk. The historical focus of behavior-change strategies on decision-making processes within the individual has evolved to include more attention to the dynamics of interpersonal relationships and the sociocultural contexts in which HIV-related risk behaviors occur.

HIV prevention research: accomplishments and challenges for the third decade of AIDS.

The past 2 decades have taught us that HIV prevention can work. We now have evidence from places as diverse as Senegal, Thailand, Uganda, and Australia that concerted HIV prevention efforts at the national level have resulted in the maintenance of low seroprevalence rates where they otherwise would have been expected to rise. We are beginning to observe declining rates of HIV prevalence and incidence in places and populations with historically high rates--for example, injection drug users in New York City. This trend points to the long-term impact of prevention efforts in those communities. The best of these efforts have been based on sound scientific research. As we move into the third decade of the AIDS epidemic, it is important to restate principles, acknowledge advances, and identify challenges and future directions in HIV prevention research.

Latissimus dorsi tendon transfer for massive rotator cuff tears: a cadaveric study.

Certain massive defects of the rotator cuff tendinous insertion cannot be repaired primarily to the greater tuberosity. If restoration of strength is an important treatment goal to the patient, then a tendon transfer may be considered. Ten cadaver shoulders were dissected to define the anatomy of the latissimus dorsi tendon (LDT) and its distance relationship to the axillary and radial nerves with the arm in various positions. The axillary nerve lies superior to the LDT insertion, and the radial nerve passes medial and inferior to the LDT insertion. With the arm internally rotated and the shoulder flexed, the distances from the axillary and radial nerves to the LDT insertion were 2.3 cm and 2.8 cm, respectively. With the arm internally rotated and the shoulder abducted, the distances from the axillary and radial nerves to the LDT insertion were 1.8 cm and 2.0 cm, respectively. Understanding specific anatomic relationships is one of the factors contributing to the safety of the LDT transfer procedure with respect to nerve injury.