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PURPOSE: Approximately 1.6% of adult Americans identify as transgender (TG) or nonbinary (NB) and many take gender-affirming hormone therapy (GAHT). Little data exist to inform breast and cervical cancer risks, gender-specific screening guidelines, and inclusive cancer treatment algorithms that consider GAHT. We aimed to assess TGNB persons' perceptions on breast and cervical cancer development, screening knowledge and practices, and attitude toward GAHT in the setting of a hormone receptor–positive breast cancer diagnosis. METHODS: This single-institution survey study was conducted through an LGBTQ+ focused clinic from 2021 to 2022. Noncisgender patients age ≥ 18 years who were English speaking were eligible to participate. A 5-point Likert scale was used to assess concern of developing breast (all participants) and cervical cancer (those assigned female sex at birth). Demographic and quantitative variables were examined in comparison with responses via chi-squared tests. RESULTS: Eighty-six participants completed the survey: 43% TG men, 24% TG women, and 20% NB persons. Most (84.9%) were age < 40 years, and 86% were non-Hispanic White. The majority were unaware of breast (77%) or cervical (60%) cancer screening recommendations for their sex assigned at birth or their gender. Approximately 35% reported concern regarding breast cancer development and of those age > 40 years; only 50% had undergone screening mammography. Of those assigned female sex at birth with an intact cervix, 47% were concerned about cervical cancer development and 46.6% had a Papanicolaou smear within the past 5 years. Nearly all (87.2%) were on GAHT, and 35.1% reported they would not consider stopping GAHT if diagnosed with a hormone receptor–positive breast cancer. CONCLUSION: The findings support the need for patient and provider education on screening options and large prospective cohort data to elucidate optimal gender-specific screening guidelines and treatment algorithms. [Media: see text]

No processo de compra existem diversos aspectos que influenciam o consumidor, desde racionais até emocionais. Um destes aspectos é a valorização dada à obtenção de posses, que caracteriza o materialismo. A religião e a religiosidade estão também relacionadas ao bem estar psicológico, social e emocional do indivíduo. Considerando que a maior parte da população brasileira se declara pertencente à religião católica, o presente artigo tem como objetivo analisar o impacto da religião no materialismo entre os fiéis católicos residentes em Santa Catarina. Para a realização do estudo foram coletados 272 questionários aplicados via online e que continham duas escalas: a Escala Brasileira de Valores Materiais e a Escala de Religiosidade de Duke. Encontrou-se que não houve correlação significativa entre gênero, idade e renda com materialismo; porém, os católicos que possuem alta religiosidade intrínseca - aquelas ligadas a fatores psicológicos e convicções pessoais - possuem um menor grau de materialismo do que aquelas que possuem baixa religiosidade intrínseca. Conclui-se, portanto, que o grau materialismo pode ser influenciado pelas crenças pessoais quando vividas de forma intrínseca, porém os dados não podem ser generalizados. Sugere-se ainda pesquisas que contenham respondentes com baixa religiosidade ou sem religião para comparar ao grupo do estudo.

Rural older people living with HIV (PLH) in the United States are a population of growing size and significance. A better understanding of factors associated with quality of life (QOL), depressive symptoms, and stress in this population-especially modifiable factors-could inform future interventions.Online or on paper, we surveyed 446 PLH aged 50+ residing in rural counties across the United States (MControlling for demographics, greater social support was associated with better QOL, fewer depressive symptoms, and less stress. Greater HIV stigma was associated with more depressive symptoms and stress. Satisfaction with care was associated with better QOL and less stress. Discrimination in medical settings was associated with lower QOL and more depressive symptoms and stress. Finally, experiencing more structural barriers was associated with lower QOL and more depressive symptoms and stress.In addition to engagement in care and viral suppression, QOL and mental health are also critical considerations for rural older PLH. Increasing social support, reducing or providing skills to cope with HIV stigma, improving quality of care, reducing discrimination and stigma in medical settings, and reducing or mitigating the impact of structural barriers present potential targets for interventions aiming to improve the well-being of older rural PLH.

PurposeThis study investigates impulse buying as a consumer behaviour outcome in omnichannel retail through the stimulus-organism-response (S-O-R) theory. For such, the authors addressed convenience and channel integration as the stimuli, the relationship among consumer empowerment, trust, satisfaction, and perceived value as the organism, and impulse buying as the response.Design/methodology/approachAn online survey was conducted with 229 customers of a Brazilian retailer that adopts the omnichannel strategy. Data were analysed by partial least squares structural equation modelling (PLS-SEM).FindingsChannel integration and convenience had a positive influence on consumer empowerment which, in turn, influenced customer satisfaction and trust, producing direct and indirect effects on their perception of value relative to the retailer. In addition, impulsive buying was significantly influenced by perceived value.Practical implicationsThe results indicate that retailers that use the omnichannel strategy need to be alert to the factors mentioned above. The study empirically demonstrates that investing in channel integration increases customer empowerment, which will significantly improve customer trust and satisfaction and, eventually, customer impulse buying from the retailer.Originality/valueThis work contributes to the literature on marketing and consumer behaviour by identifying factors that influence consumers' impulse buying behaviour in the context of omnichannel retail. It suggests that impulse buying may be a relevant variable to understand the reaction of consumers empowered by the integration of the marketing channels and the convenience offered to them in an omnichannel retail environment.

HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.

Intramuscular cabotegravir for long-acting injectable HIV pre-exposure prophylaxis (i.e., LAI-PrEP) was approved by the U.S. FDA in 2021. We sought to explore LAI-PrEP decision-making among a nationwide sample of young sexual minority men (YSMM) 17–24 years old. In 2020, HIV-negative/unknown YSMM (n = 41) who met CDC criteria for PrEP were recruited online to participate in synchronous online focus groups eliciting preferences and opinions about LAI-PrEP, as well as the impact of a potential self-administered option. Data were analyzed using inductive and deductive thematic analysis with constant comparison. Preferences and decision-making about LAI-PrEP varied widely among YSMM, with participants frequently comparing LAI-PrEP to oral PrEP regimens. We identified five key themes related to LAI-PrEP decision-making including concerns about adherence to PrEP dosing and clinic appointments, awareness and knowledge of PrEP safety and efficacy data, comfort with needles, minimizing PrEP stigma, and considerations of self-administration. YSMM acknowledged more PrEP options as beneficial to supporting uptake and persistence.

Hydrogen is a clean alternative to fossil fuels. It has applications for electricity generation and transportation and is used for the manufacturing of ammonia and steel. However, today, H

The goal of this study was to evaluate the temporal and spatial pattern of wound healing following UV corneal cross-linking (CXL) using 3-dimensional (3-D) confocal imaging in vivo. Using a modified Heidelberg Retinal Tomograph with Rostock Corneal Module confocal microscope, we performed 3-D scans on two patients at multiple time points after CXL. Patient 1 showed a normal post-CXL wound healing response, with initial subbasal nerve loss and keratocyte apoptosis in the anterior stroma, followed by partial restoration of both the nerve plexus and stromal keratocytes by 6 months. In patient 2, in addition to anterior corneal damage, pyknotic nuclei were observed in the posterior stroma 7 days after CXL. Acellular areas were present in the posterior stroma at 3 months, with only partial keratocyte repopulation at 6 months. Regeneration of the subbasal nerve plexus was also delayed. Three-dimensional confocal imaging allowed these unusual wound healing responses to be identified in the absence of any corresponding clinical observations.

Objetivo: Demonstrar que a animação elimina o efeito que a posição do banner na tela (direita vs. esquerda) exerce sobre a atitude do consumidor em relação à marca anunciada.Método: Foram realizados dois experimentos com estudantes universitários como participantes.Originalidade/Relevância: Com base no Modelo de Processamento Hemisférico (MPH), anúncios localizados à esquerda (vs. direita) do observador serão avaliados mais positivamente. Neste estudo, foi demonstrado que a animação é capaz de interferir no efeito que a posição do estímulo exerce sobre a avaliação do observador. Especificamente, quando um banner está animado, a sua posição (esquerda vs. direita) não mais exerce influência sobre a atitude do consumidor em relação à marca anunciada.Resultados: Marcas anunciadas em banners estáticos localizados à esquerda (vs. direita) do espectador foram avaliadas mais positivamente, em conformidade com o MPH. Contudo, quando o banner estava animado, a sua posição (esquerda vs. direita) não mais exerceu influência sobre a atitude em relação à marca anunciada. Assim, a animação eliminou o efeito da posição do banner na tela sobre a atitude em relação à marca anunciada.Contribuições teóricas/metodológicas: O resultado obtido contribui para os estudos na área de marketing e publicidade que se baseiam no MPH ao demonstrar que a animação interfere no efeito defendido pelo MPH de que estímulos localizados à esquerda (vs. direita) do observador serão avaliados mais positivamente.Contribuições sociais / para a gestão: O resultado obtido oferece insights para publicitários quanto à melhor combinação de variáveis para otimizar a capacidade de persuasão dos banners inseridos em programas de televisão ou páginas da internet.

The filamentous and unicellular algae of the class Zygnematophyceae are the closest algal relatives of land plants. Inferring the properties of the last common ancestor shared by these algae and land plants allows us to identify decisive traits that enabled the conquest of land by plants. We sequenced four genomes of filamentous Zygnematophyceae (three strains ofZygnema circumcarinatumand one strain ofZ. cylindricum) and generated chromosome-scale assemblies for all strains of the emerging model systemZ. circumcarinatum. Comparative genomic analyses reveal expanded genes for signaling cascades, environmental response, and intracellular trafficking that we associate with multicellularity. Gene family analyses suggest that Zygnematophyceae share all the major enzymes with land plants for cell wall polysaccharide synthesis, degradation, and modifications; most of the enzymes for cell wall innovations, especially for polysaccharide backbone synthesis, were gained more than 700 million years ago. In Zygnematophyceae, these enzyme families expanded, forming co-expressed modules. Transcriptomic profiling of over 19 growth conditions combined with co-expression network analyses uncover cohorts of genes that unite environmental signaling with multicellular developmental programs. Our data shed light on a molecular chassis that balances environmental response and growth modulation across more than 600 million years of streptophyte evolution.HIGHLIGHTSGenomes of four filamentous algae (Zygnema) sisters to land plantsZygnemaare rich in genes for multicellular growth and environmental acclimation: signaling, lipid modification, and transportCell wall innovations: diversification of hexameric rosette cellulose synthase in ZygnematophyceaeCo-expression networks reveal conserved modules for balancing growth and acclimation

Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50.We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement.Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care.Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.

The COVID-19 pandemic has caused disruptions to health care access for sexual and gender minorities in the U.S. We sought to explore the impact of COVID-19 on HIV pre-exposure prophylaxis (PrEP) use and sexual health services by assessing PrEP eligibility and use, changes in sexual behaviors, and HIV/STI testing during the COVID-19 pandemic. We surveyed 239 young sexual minority men (YSMM) 17-24 years old between April and September 2020 in the U.S. One-in-seven YSMM PrEP users discontinued use during the pandemic, and all those who discontinued PrEP reported a decrease in sexual activity. Twenty percent reported difficulty getting prescriptions and medications from their doctors or pharmacies, and more than 10% reported challenges accessing HIV/STI testing. Among those who met Centers for Disease Control and Prevention criteria for PrEP (n = 104), 86.5% were not currently using PrEP. Among those surveyed 3 months or later after the start of major COVID-19 stay-at-home measures (n = 165), 35.8% reported CAS with a causal partner within the past 3 months during the COVID-19 pandemic. Seeking HIV testing was associated with reporting condomless anal sex in the previous 3 months, indicating the necessity for ensuring continuity of basic sexual health services for YSMM. Failure to adequately adjust HIV prevention services and intervention in the face of pandemic-related adversity undermines efforts to end the HIV epidemic in the U.S.La pandemia de COVID-19 ha causado interrupciones en el acceso a la atención médica para las minorías sexuales y de género en los EE. UU. Buscamos explorar el impacto de COVID-19 en el uso de la profilaxis de preexposición al VIH (PrEP) y los servicios de salud sexual mediante la evaluación de la elegibilidad y el uso de PrEP, los cambios en los comportamientos sexuales y las pruebas de VIH/ITS durante la pandemia de COVID-19. Encuestamos a 239 hombres jóvenes de minorías sexuales (YSMM) de 17 a 24 años entre abril y septiembre de 2020 en los EE. UU. Uno de cada siete usuarios de PrEP YSMM interrumpió su uso durante la pandemia, y todos los que interrumpieron la PrEP informaron una disminución en la actividad sexual. El veinte por ciento informó tener dificultades para obtener recetas y medicamentos de sus médicos o farmacias, y más del 10% informó tener dificultades para acceder a las pruebas de VIH/ITS. Entre los que cumplieron con los criterios de los Centros para el Control y la Prevención de Enfermedades para la PrEP (n = 104), el 86,5% no estaba usando PrEP actualmente. Entre los encuestados 3 meses o más después del inicio de las principales medidas de COVID-19 para quedarse en casa (n = 165), el 35,8% informó CAS con una pareja causal en los últimos 3 meses durante la pandemia de COVID-19. La búsqueda de la prueba del VIH se asoció con la notificación de sexo anal sin condón en los 3 meses anteriores, lo que indica la necesidad de garantizar la continuidad de los servicios básicos de salud sexual para YSMM. No ajustar adecuadamente los servicios de prevención del VIH y la intervención frente a la adversidad relacionada con la pandemia socava los esfuerzos para poner fin a la epidemia del VIH en los EE. UU.

Corneal crosslinking is a U.S. Food and Drug Administration--approved therapy to stiffen the cornea and prevent progression of corneal ectasia in patients with keratoconus. The standard procedure involves removal of the corneal epithelium (epithelial-off) prior to treatment. Variations to the standard procedure include accelerated crosslinking and transepithelial procedures. This study reviewed what is known regarding the risk for infection after epithelial-off crosslinking, the spectrum of pathogens, and clinical outcomes. 26 publications were identified. All eyes were fit with a bandage contact lens postoperatively. Available data indicate that the overall frequency of infectious keratitis after epithelium-off crosslinking is low. Bacterial infections are the most common, with a mean time of presentation of 4.8 days postoperatively. The use of steroids and bandage contact lenses in the immediate postoperative period and/or a history of atopic or herpetic disease were associated with infection. These patients require intense postoperative care with prophylactic antiviral therapy when appropriate.

Commercially available metal Laser Powder Bed Fusion (L-PBF) systems are steadily evolving. Thus, design limitations narrow and the diversity of achievable geometries widens. This progress leads researchers to create innovative benchmarks to understand the new system capabilities. Thereby, designers can update their knowledge base in design for additive manufacturing (DfAM). To date, there are plenty of geometrical benchmarks that seek to develop generic test artefacts. Still, they are often complex to measure, and the information they deliver may not be relevant to some designers. This article proposes a geometrical benchmarking approach for metal L-PBF systems based on the designer needs. Furthermore, Geometric Dimensioning and Tolerancing (GD&T) characteristics enhance the approach. A practical use-case is presented, consisting of developing, manufacturing, and measuring a meaningful and straightforward geometric test artefact. Moreover, optical measuring systems are used to create a tailored uncertainty map for benchmarking two different L-PBF systems.

Summary Background In DISCOVER, a multinational, randomised controlled trial, emtricitabine and tenofovir alafenamide compared with emtricitabine and tenofovir disoproxil fumarate showed non-inferior efficacy for HIV prevention and improved bone mineral density and renal safety biomarkers at week 48. We report outcomes analysed after all participants had completed 96 weeks of follow-up. Methods This study is an ongoing, randomised, double-blind, multicentre, active-controlled, phase 3, non-inferiority trial done at 94 community, public health, and hospital-associated clinics located in Europe and North America. Adult cisgender men and transgender women who have sex with men, both with a high risk of acquiring HIV as determined by self-reported sexual behaviour or recent sexually transmitted infections, were randomly assigned (1:1) to receive either emtricitabine and tenofovir alafenamide (200/25 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir alafenamide group), or emtricitabine and tenofovir disoproxil fumarate (200/300 mg) tablets daily, with matched placebo tablets (emtricitabine and tenofovir disoproxil fumarate group). The primary efficacy outcome was incident HIV infection. Incidence of HIV-1 infection per 100 person-years was assessed when the last participant had completed 96 weeks of follow-up. This trial is registered with ClinicalTrials.gov , number NCT02842086 . Findings Between Sept 13, 2016, and June 30, 2017, 5387 participants were randomly assigned to receive emtricitabine and tenofovir alafenamide (n=2694) or emtricitabine and tenofovir disoproxil fumarate (n=2693), contributing 10 081 person-years of follow-up. At 96 weeks of follow-up, there were eight HIV infections in participants who had received emtricitabine and tenofovir alafenamide (0·16 infections per 100 person-years [95% CI 0·07–0·31]) and 15 in participants who had received emtricitabine and tenofovir disoproxil fumarate (0·30 infections per 100 person-years [0·17–0·49]). Emtricitabine and tenofovir alafenamide maintained its non-inferiority to emtricitabine and tenofovir disoproxil fumarate for HIV prevention (IRR 0·54 [95% CI 0·23–1·26]). Approximately 78–82% of participants reported taking study medication more than 95% of the time across all study visits. Rates of sexually transmitted infections remained high and similar across groups (21 cases per 100 person-years for rectal gonorrhoea and 28 cases per 100 person-years for rectal chlamydia). Emtricitabine and tenofovir alafenamide continued to show superiority over emtricitabine and tenofovir disoproxil fumarate in all but one of the six prespecified bone mineral density and renal biomarkers. There was more weight gain among participants who had received emtricitabine and tenofovir alafenamide (median weight gain 1·7 kg vs 0·5 kg, p Interpretation Emtricitabine and tenofovir alafenamide is safe and effective for longer-term pre-exposure prophylaxis in cisgender men and transgender women who have sex with men. Funding Gilead Sciences.

During corneal wound healing, corneal keratocytes are exposed to both biophysical and soluble cues that cause them to transform from a quiescent state to a repair phenotype. How keratocytes integrate these multiple cues simultaneously is not well understood. To investigate this process, primary rabbit corneal keratocytes were cultured on substrates patterned with aligned collagen fibrils and coated with adsorbed fibronectin. After 2 or 5 days of culture, keratocytes were fixed and stained to assess changes in cell morphology and markers of myofibroblastic activation by fluorescence microscopy. Initially, adsorbed fibronectin had an activating effect on the keratocytes as evidenced by changes in cell shape, stress fiber formation, and expression of alpha-smooth muscle actin (α-SMA). The magnitude of these effects depended upon substrate topography (i.e., flat substrate vs aligned collagen fibrils) and decreased with culture time. When keratocytes were simultaneously exposed to adsorbed fibronectin and soluble platelet-derived growth factor-BB (PDGF-BB), the cells elongated and had reduced expression of stress fibers and α-SMA. In the presence of PDGF-BB, keratocytes plated on the aligned collagen fibrils elongated in the direction of the fibrils. These results provide new information on how keratocytes respond to multiple simultaneous cues and how the anisotropic topography of aligned collagen fibrils influences keratocyte behavior.

There are over 1.4 million individuals who identify as transgender in the USA, and these individuals are frequently treated with cross-sex hormonal therapy (CSH) to acquire their desired phenotype. Simultaneously, breast cancer is one of the most common cancers in the USA, and there are mixed data on how CSH may influence breast cancer development in transgender individuals. Here, we review the barriers that exist to health access in this population, the current evidence of breast cancer risk in transgender individuals, and breast cancer screening guidelines for both transgender women and men. A large portion of the transgender population report barriers that exist to accessing appropriate healthcare, some of which are directly related to poor interactions with healthcare providers. From both systemic reviews and large retrospective studies, it appears that while transgender females have a lower rate of breast cancer development compared to cis-gender females, transgender males have a higher rate of breast cancer development compared to cis-gender males. While several organizations have released screening guidelines for transgender persons, there is a lack of consensus on optimal screening regimens. In addition, there are no formal recommendations by the American Cancer Society or the United States Preventative Task Force for breast cancer screening in transgender persons. The risk of breast cancer development in transgender individuals is different compared to that of the cis-gender population. Further prospective data are needed to appropriately quantify these risks and to assess what is the appropriate breast cancer screening recommendations for this population.

Following injury and refractive surgery, corneal wound healing can initiate a protracted fibrotic response that interferes with ocular function. This fibrosis is related, in part, to the myofibroblast differentiation of corneal keratocytes in response to transforming growth factor beta 1 (TGF-β1). Previous studies have shown that changes in the mechanical properties of the extracellular matrix (ECM) can regulate this process, but the mechanotransductive pathways that govern stiffness-dependent changes in keratocyte differentiation remain unclear. Here, we used a polyacrylamide (PA) gel system to investigate how mechanosensing via focal adhesions (FAs) regulates the stiffness-dependent myofibroblast differentiation of primary corneal keratocytes treated with TGF-β1. Soft (1 kPa) and stiff (10 kPa) PA substrata were fabricated on glass coverslips, plated with corneal keratocytes, and cultured in defined serum free media with or without exogenous TGF-β1. In some experiments, an inhibitor of focal adhesion kinase (FAK) activation was also added to the media. Cells were fixed and stained for F-actin, as well as markers for myofibroblast differentiation (α-SMA), actomyosin contractility phosphorylated myosin light chain (pMLC), focal adhesions (vinculin), or Smad activity (pSmad3). We also used traction force microscopy (TFM) to quantify cellular traction stresses. Treatment with TGF-β1 elicited stiffness-dependent differences in the number, size, and subcellular distribution of FAs, but not in the nuclear localization of pSmad3. On stiff substrata, cells exhibited large FAs distributed throughout the entire cell body, while on soft gels, the FAs were smaller, fewer in number, and localized primarily to the distal tips of thin cellular extensions. Larger and increased numbers of FAs correlated with elevated traction stresses, increased levels of α-SMA immunofluorescence, and more prominent and broadly distributed pMLC staining. Inhibition of FAK disrupted stiffness-dependent differences in keratocyte contractility, FA patterning, and myofibroblast differentiation in the presence of TGF-β1. Taken together, these data suggest that signaling downstream of FAs has important implications for the stiffness-dependent myofibroblast differentiation of corneal keratocytes.

Seventy percent of Fuchs' endothelial corneal dystrophy (FECD) cases are caused by an intronic trinucleotide repeat expansion in the transcription factor 4 gene (Cross-sectional, single-center study.Fifty-two eyes of 29 subjects with a modified Krachmer grade of FECD severity from 1 to 6 were included in the study. Fifteen of the 29 subjects carried an expandedIn vivo confocal microscopy assessments of corneal nerve fiber length (CNFL), corneal nerve branch density, corneal nerve fiber density (CNFD), and anterior corneal stromal backscatter (haze); Scheimpflug tomography densitometry measurements of haze in anterior, central, and posterior corneal layers.Using confocal microscopy, we detected a negative correlation between FECD severity and both CNFL and CNFD in the eyes of RE+ subjects (Spearman ρ = -0.45,Loss of corneal nerves in FECD supports the classification of the

BACKGROUND Health care provider assessment of patient sexual behavior and substance use is essential for determining appropriate prevention interventions-including HIV pre-exposure prophylaxis (PrEP)-for sexual minority men (SMM). We sought to explore acceptability and utility of using electronic surveys to conduct health behavior assessments in clinical settings among SMM. METHODS Among a US nationwide sample of SMM (n = 4187; mean age = 38.3 years; 60% white; 82% HIV-negative), we examined associations of demographics, recruitment venue, sexual behavior characteristics, and recent substance use with participants' comfort communicating verbally and through electronic survey with a health care provider about sexual and substance use behavior. RESULTS On average, SMM had greater comfort communicating through electronic survey vs. verbally. In our fully adjusted analysis, preference favoring electronic surveys more strongly than verbal communication differed by age (β = -0.07, P ≤ 0.001). SMM with a bachelor's degree or more (β = 0.04, P < 0.05), those recruited from nonclinical settings (β = 0.06, P ≤ 0.001), and those without primary care providers (β = 0.04, P < 0.05) favored electronic surveys more strongly in the fully adjusted multivariable model. SMM who reported any recent casual sex partners (β = 0.05, P < 0.01), those never tested for HIV (β = 0.03, P < 0.05), and HIV-negative/unknown men not on PrEP (compared with PrEP users; β = 0.09, P ≤ 0.001) also favored electronic surveys in the fully adjusted model. CONCLUSIONS Reducing communication barriers by incorporating electronic surveys into patient assessments could help identify HIV testing and PrEP needs for SMM most susceptible to HIV acquisition. Nonetheless, no one screening strategy is likely to work for most SMM, and multiple approaches are needed.

Fibulin-3 (F3) is an extracellular matrix glycoprotein found in basement membranes across the body. An autosomal dominant R345W mutation in F3 causes a macular dystrophy resembling dry age-related macular degeneration (AMD), whereas genetic removal of wild-type (WT) F3 protects mice from sub-retinal pigment epithelium (RPE) deposit formation. These observations suggest that F3 is a protein which can regulate pathogenic sub-RPE deposit formation in the eye. Yet the precise role of WT F3 within the eye is still largely unknown. We found that F3 is expressed throughout the mouse eye (cornea, trabecular meshwork (TM) ring, neural retina, RPE/choroid, and optic nerve). We next performed a thorough structural and functional characterization of each of these tissues in WT and homozygous (F3−/−) knockout mice. The corneal stroma in F3−/− mice progressively thins beginning at 2 months, and the development of corneal opacity and vascularization starts at 9 months, which worsens with age. However, in all other tissues (TM, neural retina, RPE, and optic nerve), gross structural anatomy and functionality were similar across WT and F3−/− mice when evaluated using SD-OCT, histological analyses, electron microscopy, scotopic electroretinogram, optokinetic response, and axonal anterograde transport. The lack of noticeable retinal abnormalities in F3−/− mice was confirmed in a human patient with biallelic loss-of-function mutations in F3. These data suggest that (i) F3 is important for maintaining the structural integrity of the cornea, (ii) absence of F3 does not affect the structure or function of any other ocular tissue in which it is expressed, and (iii) targeted silencing of F3 in the retina and/or RPE will likely be well-tolerated, serving as a safe therapeutic strategy for reducing sub-RPE deposit formation in disease. • Fibulins are expressed throughout the body at varying levels. • Fibulin-3 has a tissue-specific pattern of expression within the eye. • Lack of fibulin-3 leads to structural deformities in the cornea. • The retina and RPE remain structurally and functionally healthy in the absence of fibulin-3 in both mice and humans.

Dados de mercado revelam crescimento no acesso à internet e na conectividade de pessoas e empresas. Neste contexto, o marketing digital tem sido incorporado nas estratégias de diversas empresas. Em face da importância do tema, buscou-se, neste estudo, através de uma pesquisa bibliométrica seguida de uma revisão sistemática integrativa, mapear a compreensão da influência do marketing digital no comportamento de compra dos consumidores e propor uma agenda de pesquisa acerca do tema. Para isto, foram avaliados artigos publicados nas bases de dados: Ebsco, Periódicos Capes, Scopus, Spell e Web of Science entre os anos de 2000 a 2019. Os resultados apontaram que mais de 60% das publicações foram realizadas entre os anos de 2016 e 2019 e que temas emergentes como “IOT”, “economia compartilhada” e “marketing sensorial digital” são passiveis de melhor investigação. Estudos transculturais e longitudinais de temas como “influenciadores digitais” e “marketing boca a boca on-line” figuraram entre importantes gaps teóricos. Sugere-se estudos transculturais que permitam evidenciar características e gatilhos na utilização do marketing boca a boca digital, opção por modalidade de compra em grupo, opções por empresas com iniciativas sustentáveis e envolvendo a compra por impulso.

From a theoretical reference on consumer behavior in traditional retail, this article explores the role of window display as a predictor of store entry and purchase decision. The study carried out in a Brazilian capital is a replication of Sen, Block and Chandran’s (2002) seminal research and had 364 participants. Data were analyzed by structural equation modeling. Results indicate fashion trend, price and sale information as the main drivers of the decision to enter the store, which is the most relevant factor for consumers when deciding to buy a product. These findings confirm not only the relationship between window display and decision making, but they reveal window display as an antecedent of consumer decision making in traditional retail. Additionally, our findings show the sensitivity of Brazilian consumer to novelty and fashion trends, as well as their predisposition to enter stores and purchase products when they are on sale or when payment alternatives are announced. Regarding academic contributions, this is a first step in understanding retail shopping experience, being window display the staring point. Thus, studies on store atmosphere, visual identity construction as well as price strategies can benefit from this content. Considering also the growth of e-commerce and the need to attract consumers to the physical stores, these results contribute to the studies on retail business strategies, suggesting the relationship between the effect provoked by window displays and business performance.

Assessment of donor suitability and criteria development for tissue donation evaluation which appropriately addresses the risk factors for disease transmission, especially high risk for Hepatitis B or C, HIV or other transmissible diseases as defined by the Food and Drug Administration, FDA, is a continuing concern for tissue banks. The relationship of drug use, especially IV drugs, has been determined to be associated with an increased possibility of reactive serology (Centers for Disease Control and Prevention (USCDC) in Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Hepatitis C questions and answers for health professionals. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm; Centers for Disease Control and Prevention (USCDC) in infectious diseases, opioids and injection drug use, 2018. https://www.cdc.gov/pwid/opioid-use.html; HIH National Institute on Drug Abuse in Health Consequences of Drug Misuse, 2017. https://www.drugabuse.gov/related-topics/health-consequences-drug-misuse). Therefore, prior drug use determined by medical social history screening frequently results in deferral of a potential donor even when the route of drug administration has not been determined to be intravenous. Because of the association of drug use in numerous cases, which come under Medical Examiner jurisdiction, a possible rule out of a number of otherwise suitable medical examiner cases could occur. This retrospective review of medical examiner cases, tissue bank referrals and tissue donors in a 3-year period examines the relationship, if any, between reactive serology and positive toxicology results. These results would appear to indicate assessment of donor medical social history screening is effective in reducing recovery of high-risk donors.

In the United States, HIV incidence is highest among Black men who have sex with men (MSM), but their PrEP uptake is low, especially outside the country’s largest cities and in part due to lack of normative support for using PrEP. This research pilot tested a social network-level intervention designed to increase PrEP awareness, benefit perception, and norms among Black MSM in Milwaukee, a Midwestern U.S. city with large racial disparities and low PrEP uptake. Five social networks (n=40 participants) of racial minority MSM were recruited in the community and assessed at baseline with measures of PrEP knowledge, interest, attitudes, and action taking. Persons most socially interconnected with others in each network were identified as leaders, and they attended a 7-session intervention that provided training to increase knowledge about PrEP and its benefits, address misconceptions and concerns about PrEP, endorse PrEP use as a symbol of pride and health, and deliver these messages to others in their social networks between sessions. At 3-month followup, all network members were re-administered assessment measures, and changes between baseline and followup were statistically analyzed. Significant increases over time were found in network members’ knowledge about PrEP together with improved PrEP attitudes, descriptive and subjective peer norms for PrEP, PrEP use self-efficacy, and willingness to use PrEP. Participants increased in frequency of conversations with friends about HIV and reported more discussions with health care providers about PrEP. The percentage of participants who reported using PrEP increased from 3% at baseline to 11% at followup. Larger-scale evaluations of this intervention are needed in populations with high HIV incidence but low PrEP use.

Increasing prescription of pre-exposure prophylaxis (PrEP) is imperative to ending the HIV epidemic in the United States. The objective of this review was to identify health care provider barriers to PrEP implementation. A systematic review was conducted in February 2019 using PubMed to identify barriers to PrEP prescribing practices in the United States. Targeted search terms surrounding PrEP and providers resulted in 222 original studies, 28 of which were ultimately included in our review, with data collected between 2011 and 2018. Six themes were identified across reviewed studies: (i) a lack of PrEP knowledge, (ii) the presence of the Purview Paradox, which refers to discordance in beliefs between HIV specialists and primary care providers on who should prescribe PrEP, (iii) concerns about PrEP costs, (iv) concerns about behavioral and health consequences, (v) interpersonal stigma, and (vi) concerns about patient adherence. A majority of providers were lacking knowledge regarding PrEP, resulting in discomfort in prescribing PrEP, or limited awareness and understanding of PrEP clinical guidelines. Discrepant opinions were identified regarding whether PrEP was best managed within primary care or specialty clinics. Other barriers included concerns about cost, patient adherence, and follow-up maintenance care. Finally, concerns about risk compensation and discomfort discussing sexual activities with patients who would benefit most from PrEP were apparent. Additional work is needed to prepare providers to prescribe and manage patients on PrEP, optimize PrEP delivery, and reduce provider bias. Future research is needed to identify providers’ attitudes and beliefs regarding innovations in PrEP dosing, task shifting, and novel strategies for PrEP care.

Following injury and refractive surgery, corneal wound healing can initiate a protracted fibrotic response that interferes with ocular function. This fibrosis is related, in part, to the myofibroblast differentiation of corneal keratocytes in response to transforming growth factor beta 1 (TGF

Cell-free biocatalysis with a number of enzymes is a fast growing and potentially high impact field in synthetic biology for the bio-manufacture of existing and novel fine or platform chemicals and biofuels. The assembly of multiple different enzymes to form synthetic pathways is a relatively new development in contrast to the single enzyme systems that have been used for decades. The cell-free approach employs enzymes outside of the cell, allowing for controllable reaction conditions and avoids metabolic repression. It prevents the diversion and loss of pathway intermediates or end-products into the cell's own metabolism. Multi-enzyme systems in a cell-free context are particularly attractive for the 'green' synthesis of high value compounds from inexpensive, simple and renewable substrates. These systems offer great versatility, allowing the investigator to 'pick, mix and test' without the need for genetic modification of the host organism and without interference from intracellular processes.Therefore, substrate conversion yields by cell-free biocatalysis can reach 100% of the theoretical value. However, major challenges for the industrial implementation of this approach includes costly enzyme preparation, enzyme stability and the dependency on expensive cofactors. Glucaric acid (GlucA) is one of the top 12 bio-based chemicals recognised worldwide for its potential impact and application in the synthesis of greener products. GlucA can be used in the production of (biodegradable) polymers, including (hydyroxylated) nylons and polyesters, offering a more sustainable and environmentally-friendly alternative to fossil fuel-derived products. The production of GlucA has been attempted mainly by chemical and microbial synthesis. This research describes a novel cell-free and multi-enzyme biocatalytic system developed for the synthesis of GlucA. The system is composed of a synthetic six enzyme pathway designed to facilitate the synthesis of GlucA from glucose-1-phosphate (G1P) which can be derived enzymatically from various natural polymers, such as cellulose or starch, and thus represents a promising approach to utilise crude biomass for GlucA production. An integrative framework was established to achieve an economical and efficient biocatalytic process which included; i)metabolic flux analysis for system optimisation, ii) the use of thermostable enzymes for improved stability and robustness of the system, iii) immobilisation and recycling of enzymes for reduced costs and iv) a cofactor regenerating tool to reduce cofactor requirements. To accomplish this framework, a novel analytical method was developed to engineer the GlucA production towards high titres and to monitor the pathway flux rapidly. It was based on ultrahigh performance liquid chromatography (UHPLC) and refractive index detection (RID) which enabled the simultaneous analysis of GlucA and its intermediates. All selected enzymes (mostly thermostable) were fused genetically to a synthetic peptide (referred to as the "linker") which displayed high affinity towards silica-based materials. Due to the non-invasive binding mechanism of the linker, the enzymes were co-immobilised successfully onto zeolite, a low costand commercially-available silica-based material. All the immobilised enzymes except the labile mouse myo-inositol oxygenase remained active, implying their suitability for application in a high temperature bioprocess, and allowed for their repeated use and recycling. Finally, an additional cofactor regenerating enzyme was integrated effectively into the cell-free process which maintained high cofactor levels while reducing the cofactor requirements of the pathway. In summary, this work presents the first cell-free production of GlucA and describes a powerful framework for viable cell-free biocatalysis based on an immobilised multi-enzyme synthetic pathway. Further work on the cell-free GlucA production is anticipated to extend the synthesis of GlucA from biomass such as cellulose and starch, and to allow increases in the overall efficiency of the system.

Inadequate management of household and industrial wastes poses major challenges to human and environmental health. Advances in synthetic biology may help address these challenges by engineering biological systems to perform new functions such as biomanufacturing of high-value compounds from low-value waste streams and bioremediation of industrial pollutants. The current emphasis on microbial systems for biomanufacturing, which often requires highly preprocessed inputs and sophisticated infrastructure, is not feasible for many waste streams. Furthermore, concerns about transgene biocontainment have limited the release of engineered microbes or plants for bioremediation. Engineering of animals may provide opportunities for utilizing various waste streams that are not suitable for microbial biomanufacturing while effective transgene biocontainment options should enable

People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.

Objective: The study aimed to analyze the effect of the day of the week on the engagement of users on Twitter. Method: This is a quantitative, conclusive, descriptive research, with data collection by observation and analysis via descriptive statistics and T-test. A total of 51,967 posts were analyzed by 45 of the professional profiles with the highest number of followers from five countries (Argentina, Brazil, Canada, USA, and Mexico) in a period of 24 months. Originality/Relevance: The study seeks to deepen the engagement in social media, especially Twitter. The results were found to indicate the existence of the effects of the day of posting and the country of the profile on the engagement of users on Twitter. Results: The results revealed that Saturday and Sunday have a lower average of posts; however, they have a higher average in the two engagement variables. There was a statistically significant and positive difference in the retweet variable in posts on the weekend. The favorite variable did not show a statistical difference. The results show differences in user behavior in the five countries regarding engagement. Theoretical/methodological contributions: The study advances the literature on the influence of the day of the week on engagement and cultural differences between countries on engagement. Social/management contributions: Managerial, the study provides input for marketing professionals to plan posts for greater engagement in a social media platform focused on texts, according to the day and country in which the content is made available.

Transmedia narratives became an entertainment experience in which visual elements, characters, and objects create an imaginary world, conquering large audiences in a sequence of movies. From toy lines to Hollywood blockbusters, the Transformers movies franchise has turned into an opportunity for brands to reach consumers in a world where technological devices have changed how they absorb advertisements. In this context, we propose a longitudinal analysis of brand placements in the five movies launched under the Transformers label from 2007 to 2017. A 65-hours passive observation of the movies’ content identified several insertions, most frequent brands, and most frequent product categories in each film, classifying data according to placement type, prominence, congruency, and product category criteria. A longitudinal analysis of the five films revealed that brand placement constitutes an effective strategy once its use showed to be consistent over the years. Congruency was the most relevant factor in brand communication and the movies over time, helping consumers familiarize themselves with brands, associate brands to the story, and enhance brand recall. This analysis indicates a successful integration of brand and film components, resulting in adequate placement insertions, promoting benefits for companies, brands, and the cinematographic industry.

BACKGROUND HIV disproportionately affects sexual minority men (SMM) in the U.S. OBJECTIVE We sought to determine past HIV post-exposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among an online sample of cisgender and transgender men who have sex with men. METHODS In 2019, HIV-negative and unknown status SMM (n = 63,015) were recruited via geosocial networking apps, social media, and other online venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, recent club drug use, and PrEP status on past PEP use using fully-adjusted logistic regression. RESULTS Prior PEP use was relatively uncommon (11.3%), with 2.66 times more men reporting current or prior PrEP use (30.1%). Most (85.9%) past PEP users were current or prior PrEP users, representing 23.6% and 55.4% of all current and prior PrEP users, respectively. In multivariable analysis, current and prior PrEP users had 12.4 (99.9% CI: 10.9-14.3) and 49.3 (99.9% CI: 42.6-57.1) times higher odds of past PEP use compared to non-PrEP users, respectively. Other factors significantly (p < 0.001) associated with past PEP use but with smaller effect sizes included: older age groups (25-34 and 35-44 years old) compared to younger age (< 25 years old; AORs: 1.27-1.34); bisexual identity compared to gay (AOR=0.81); and Asian or Pacific Islander, non-Hispanic Black, Latinx, and multiracial or another race/ethnicity compared to non-Hispanic white, individually (AORs=1.33-1.51). Men who lived in the Midwest, South, and West had significantly lower odds of past PEP use compared to men residing in the Northeast (AORs=0.75-0.86). No significant effects at alpha=0.001 were found by gender, health insurance status, socio-economic status, or recent club drug use in multivariable analysis. CONCLUSIONS Prior PEP use was relatively uncommon in our online sample of SMM, but our findings indicate PEP is likely a gateway to PrEP and used in combination during gaps in PrEP use. Advertising and prescribing PEP could support efforts to increase PrEP and sustain HIV prevention during breaks or interruptions in daily or intermittent PrEP use. CLINICALTRIAL

Background HIV disproportionately affects sexual minority men (SMM) in the United States. Objective We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. Methods In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P Results Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. Conclusions PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research.

Purpose The purpose of this paper is to investigate the influence of store atmosphere on consumers’ positive emotional responses and impulsive purchase behaviour. In addition, it analyses the moderating role of culture characteristics and situational variables on this influence. Design/methodology/approach The study carried out a quantitative face-to-face on-site survey of a retail fashion brand in two countries, Brazil and Germany. This paper extended the original model of Jung Chang et al. (2014) based on environment, design and social features (staff) by adding store atmosphere factors such as layout, music and lighting (Mohan et al., 2013), thereby defining store atmosphere as the way customers perceive and experience the combination of all those factors. Findings Data analysis from 313 consumers by structural equation modelling (PLS–SEM) showed that most factors influence consumers’ positive emotional responses, but no significant difference between countries. However, the effect of emotions on impulse purchase behaviour is stronger among collectivist consumers (Brazil) than among individualists (Germany). Originality/value This study sheds light on the links between store atmosphere and retail market in Brazil and Germany, framing its conclusions in the context of a comparison between cultures. The paper extends the growing research in the area by exploring the moderating role of the individualism–collectivism dimension of national culture in consumer buying behaviour by comparing the strength of various relationships across shoppers from individualistic vs collectivistic cultures.

Glucaric acid (GlucA) has been identified as one of the top 10 potential bio-based chemicals for replacement of oil-based chemicals. Several synthetic enzyme pathways have been engineered in bacteria and yeast to produce GlucA from glucose and myo-inositol. However, the yields and titres achieved with these systems remain too low for the requirements of a bio-based GlucA industry. A major limitation for the optimisation of GlucA production via synthetic enzymatic pathways are the laborious analytical procedures required to detect the final product (GlucA) and pathway intermediates. We have developed a novel method for the simple and simultaneous analysis of GlucA and pathway intermediates to address this limitation using mixed mode (MM) HILIC and weak anion exchange chromatography (WAX), referred to as MM HILIC/WAX, coupled with RID. Isocratic mobile phase conditions and the sample solvent were optimised for the separation of GlucA, glucose-1-phosphate (G1P), glucose-6-phosphate (G6P), inositol-1-phosphate (I1P), myo-inositol and glucuronic acid (GA). The method showed good repeatability, precision and excellent accuracy with detection and quantitation limits (LOD and LOQ) of 1.5–2 and 577 mM, respectively. The method developed was used for monitoring the enzymatic synthesis of the final step in the GlucA pathway, and showed that GlucA was produced from GA with near 100% conversion and a titre of 9.2 g L−1.

There is a growing population of ageing individuals living with the human immunodeficiency virus (HIV). Older adults living with HIV often contend with intersecting stigmas including HIV stigma, ageism and, for some, homonegativity and/or racism. Although the HIV stigma literature is quite robust, research on the relationship between HIV stigma, social support and mental wellbeing among older adults living with HIV is limited. This study begins to address this gap by examining how intersectional stigma affects social support and mental wellbeing among rural-dwelling older adults living with HIV. Qualitative interviews were conducted by phone with 29 older adults living with HIV, over the age of 50, living in rural areas of the United States of America. Interviews were transcribed verbatim and analysed using thematic content analysis in MAXQDA qualitative analysis software. Analysis revealed three primary themes. The first had to do with gossip and non-disclosure of HIV status, which intersected with ageism and homonegativity to exacerbate experiences that fell within the remaining themes of experiences of physical and psychological isolation and loneliness, and shame and silence surrounding depression. The prevalence of social isolation and the effects of limited social support among older adults living with HIV are prominent and indicate a need for tailored interventions within the HIV care continuum for older adults living with HIV.

e18500 Background: Approximately 1.4 million adult Americans identify as transgender (TG) or non-binary (NB), a number that has steadily increased over time. In this population, cancer risk is unclear, and screening and treatment guidelines are lacking. We sought to assess TG and NB persons’ perceptions towards breast and cervical cancer screening, risk of cancer development, and thoughts towards gender-affirming hormone therapy in the setting of a hormone-receptor positive breast cancer. Methods: A single-institution online survey was administered from October 2021-January 2022 at our comprehensive LGBTQ+ Inclusion Health Clinic. Participants with female sex at birth were asked about breast and cervical cancer, while those assigned male sex at birth were exclusively asked about breast cancer. A 5-point Likert scale was used to assess attitudes toward cancer screening and concerns regarding cancer development. Results: 40 patient responses were collected: 13% were TG women, 45% TG men, 23% NB, and 20% identified as other (i.e., agender, genderqueer, etc). 71% were assigned female sex at birth (59% of whom had chest masculinization surgery), 27% were assigned male sex at birth, and one individual was intersex at birth. 52.5% were age < 30, 84% were Caucasian, 65% had at least a bachelor’s degree, and all but one respondent had health insurance. The majority reported they were not familiar with breast (77%) or cervical (60%) cancer screening recommendations for their sex-assigned at birth or current gender identity. 23% reported concern regarding breast cancer development and cited family history as the primary reason. In patients age > 40, 50% had a mammogram (MMG) in the past 10 years. When presented with information regarding screening MMG and automated breast ultrasonography (ABUS), 78% reported they would prefer ABUS over MMG for breast cancer screening. 84% of respondents were currently using or had previously used gender-affirming hormone therapy, and of these, 61% reported they would stop therapy in the event they developed a hormone-receptor positive breast cancer. In patients assigned female sex at birth, 25% had a hysterectomy and, in those who still had a cervix, 50% reported having a Pap smear in the past 5 years and 38% were concerned about cervical cancer development. Conclusions: This survey identified that > 60% of TG and NB individuals are unaware of breast and cervical cancer screening guidelines, > 20% are concerned about breast and cervical cancer development, and < 50% of patients eligible for breast and cervical cancer screening had undergone screening in recent years. Additionally, in the setting of a hormone-receptor positive breast cancer, only 61% would consider stopping gender-affirming hormone therapy. Further data on the risk of breast and cervical cancer development and incidence in TG and NB persons is needed to inform optimal screening and treatment guidelines.

Red algae (Rhodophyta) belong to the superphylum Archaeplastida, and are a species-rich group exhibiting diverse morphologies. Theory has it that the unicellular red algal ancestor went through a phase of genome contraction caused by adaptation to extreme environments. More recently, the classes Porphyridiophyceae, Bangiophyceae, and Florideophyceae experienced genome expansions, coinciding with an increase in morphological complexity. Transcription-associated proteins (TAPs) regulate transcription, show lineage-specific patterns, and are related to organismal complexity. To better understand red algal TAP complexity and evolution, we investigated the TAP family complement of uni- and multi-cellular red algae. We found that the TAP family complement correlates with gain of morphological complexity in the multicellular Bangiophyceae and Florideophyceae, and that abundance of the C2H2 zinc finger transcription factor family may be associated with the acquisition of morphological complexity. An expansion of heat shock transcription factors (HSF) occurred within the unicellular Cyanidiales, potentially as an adaption to extreme environmental conditions.

Inadequate management of household and industrial wastes pose major challenges to human and environmental health. Advances in synthetic biology may help address these challenges by engineering biological systems to perform new functions such as biomanufacturing of high-value compounds from low-value waste streams and bioremediation of industrial pollutants. The current emphasis on microbial systems for biomanufacturing, which often require highly pre-processed inputs and sophisticated infrastructure, is not feasible for many waste streams. Concerns about transgene biocontainment have limited the release of engineered microbes or plants for bioremediation. Engineering animals may provide opportunities for utilizing various waste streams that are not suitable for microbial biomanufacturing while effective transgene biocontainment options should enable in situ bioremediation. Here, we engineer the model insect Drosophila melanogaster to express a functional laccase from the fungus Trametes trogii. Laccase expressing flies reduced concentrations of the endocrine disruptor bisphenol A by more than 50% when present in their growth media. A lyophilized powder made from engineered adult flies retained substantial enzymatic activity, degrading more than 90% of bisphenol A and the textile dye indigo carmine in aqueous solutions. Our results demonstrate that transgenic animals may be used to bioremediate environmental contaminants in vivo and serve as novel production platforms for industrial enzymes. These results support further development of insects, and possibly other animals, as bioproduction platforms and their potential use in bioremediation.

Family/systemic constellation therapy is a short-term group intervention aiming to help clients better understand and then change their conflictive experiences within a social system (e.g., family). The aim of the present systematic review was to synthetize the empirical evidence on the tolerability and effectiveness of this intervention in improving mental health. The PsycINFO, Embase, MEDLINE, ISI Web of Science, Psyndex, PsycEXTRA, ProQuest DissertationsTheses, The Cochrane Library, Google Scholar, and an intervention-specific organization's databases were searched for quantitative, prospective studies published in English, German, Spanish, French, Dutch or Hungarian up until April 2020. Out of 4,197 identified records, 67 were assessed for eligibility, with 12 studies fulfilling inclusion criteria (10 independent samples; altogether 568 participants). Outcome variables were diverse ranging from positive self-image through psychopathology to perceived quality of family relationships. Out of the 12 studies, nine showed statistically significant improvement postintervention. The studies showing no significant treatment benefit were of lower methodological quality. The random-effect meta-analysis-conducted on five studies in relation to general psychopathology-indicated a moderate effect (Hedges' g of 0.531, CI: 0.387-0.676). Authors of seven studies also investigated potential iatrogenic effects and four studies reported minor or moderate negative effects in a small proportion (5-8%) of participants that potentially could have been linked to the intervention. The data accumulated to date point into the direction that family constellation therapy is an effective intervention with significant mental health benefits in the general population; however, the quantity and overall quality of the evidence is low.La terapia de constelación sistémica/familiar es una intervención grupal a corto plazo orientada a ayudar a los pacientes a comprender mejor y a cambiar sus experiencias conflictivas dentro de un sistema social (p. ej.: la familia). El objetivo del presente análisis sistemático fue sintetizar las pruebas empíricas sobre la tolerabilidad y la eficacia de esta intervención en la mejora de la salud mental. Se buscó en PsycINFO, Embase, MEDLINE, ISI Web of Science, Psyndex, PsycEXTRA, ProQuest DissertationsTheses, The Cochrane Library, Google Scholar y en bases de datos de una organización dedicada a las intervenciones para obtener estudios cuantitativos y prospectivos publicados en inglés, alemán, español, francés, holandés o húngaro hasta abril de 2020. Se identificaron 4197 documentos y se evaluó la elegibilidad de 67. Finalmente se determinó que 12 cumplían con los criterios de inclusión (10 muestras independientes; en total, 568 participantes). Los criterios de valoración fueron diversos y abarcaron desde una autoimagen positiva hasta la psicopatología y la calidad percibida de las relaciones familiares. De los 12 estudios, 9 demostraron mejoras estadísticamente significativas después de la intervención. Los estudios que no demostraron ningún beneficio significativo del tratamiento fueron de menor calidad metodológica. El metaanálisis de efectos aleatorios -realizado en 5 estudios en relación con la psicopatología general- indicaron un efecto moderado (g de Hedges de 0.531, CI: 0.387-0.676). Los autores de 7 estudios también investigaron los posibles efectos iatrogénicos, y en 4 estudios se informaron efectos negativos moderados o leves en una pequeña proporción (5-8%) de participantes que podrían haber estado ligados a la intervención. Los datos acumulados hasta la fecha señalan que la terapia de constelación familiar es una intervención eficaz con beneficios considerables para la salud mental en la población en general; sin embargo, la cantidad y la calidad general de las pruebas es baja.家庭/系统星座疗法是一种短期的团体干预措施, 旨在帮助来访者更好地理解, 然后改变他们在社会系统 (如家庭) 中的冲突体验。本文是一个系统性综述, 旨在综合该干预措施在改善心理健康方面的耐受性和有效性的经验证据。笔者检索了PsycINFO、Embase、MEDLINE、ISI Web of Science、Psyndex、PsycEXTRA、ProQuest DissertationsTheses、The Cochrane Library、Google Scholar和一个特定干预组织的数据库, 寻找截至2020年4月以英语、德语、西班牙语、法语、荷兰语或匈牙利语发表的定量、前瞻性研究。在4197条已识别的记录中, 67条被评估为合格, 12项研究符合纳入标准 (10个独立样本; 共568名参与者) 。结果变量多种多样, 从积极的自我形象到精神病理学, 再到对家庭关系质量的感知。在12项研究中, 有9项研究显示在干预后有统计学上的显著改善。没有显示出显著治疗效果的研究是研究方法质量较低的研究。对5项与一般精神病理学有关的研究进行的随机效果荟萃分析显示出中等效果 (Hedges'g为0.531, CI: 0.387-0.676) 。7项研究的作者还调查了潜在的医源性影响, 4项研究报告了一小部分参与者 (5-8%) 的轻微或中度的负面影响, 这些影响可能与干预措施有关。迄今为止积累的数据表明, 家庭星座疗法是一种有效的干预措施, 对普通人群的心理健康有显著的益处; 但是, 证据的数量少, 总体质量也很低。.

The design freedom and functional integration of additive manufacturing is increasingly being implemented in existing products. One of the biggest challenges are competing optimization goals and functions. This leads to multidisciplinary optimization problems which needs to be solved in parallel. To solve this problem, the authors require a synthetic data set to train a deep learning metamodel. The research presented shows how to create a data set with the right quality and quantity. It is discussed what are the requirements for solving an MDO problem with a metamodel taking into account functional and production-specific boundary conditions. A data set of generic designs is then generated and validated. The generation of the generic design proposals is accompanied by a specific product development example of a drone combustion engine.

Interventions are needed to expand HIV pre-exposure prophylaxis (PrEP) prescribing practices among healthcare providers, but research classifying providers to determine tailored intervention needs is lacking. Providers reported demographics, factors related to HIV treatment and prevention experience, and PrEP-related factors such as knowledge and community protection beliefs via online survey. Latent class analysis grouped providers with similar patterns of HIV prevention- and treatment-related care and tested for associations with demographics and PrEP-related factors. Three distinct classes of providers emerged: (1) PrEP naïve, (2) PrEP aware, and (3) PrEP prescribers. Providers with lower community protection beliefs and staff capacity were more likely to be classified as PrEP naïve compared to aware (ps 0.05). Providers with concerns about PrEP-related tasks and staff capacity were more likely to be classified as PrEP aware compared to prescribers (ps 0.05). PrEP-naïve providers could benefit from continuing education, whereas PrEP-aware providers might benefit from capacity building and prescribing optimization interventions.Se necesitan intervenciones para expandir los hábitos de prescripción de la profilaxis de pre-exposición al VIH (PrEP) entre los proveedores de atención médica, pero faltan investigaciones que categoricen a los proveedores para identificar necesidades que requieran intervención personalizada. A través de una encuesta en línea, proveedores de salud reportaron sus datos demográficos, los factores relacionados con la experiencia en el tratamiento y la prevención del VIH y los factores relacionados con la PrEP, como el conocimiento y las creencias de protección de la comunidad. Se aplicó un análisis de clases latentes para agrupar a los proveedores con patrones similares de atención de la prevención y el tratamiento del VIH y se evaluó la asociación de estos con factores demográficos y factores relacionados con la PrEP. Surgieron tres clases de proveedores: (1) ingenuos de la PrEP, (2) conscientes de la PrEP y (3) prescriptores de la PrEP. Los proveedores con creencias de protección de la comunidad y capacidad del personal más bajos tuvieron más probabilidad de ser clasificados como ingenuos de la PrEP en comparación con los proveedores conscientes de la PrEP (ps0.05). Los proveedores con preocupaciones sobre las tareas relacionadas con la PrEP y la capacidad del personal tuvieron mas probabilidad de ser clasificados como conscientes de la PrEP en comparación con los prescriptores de la PrEP (ps0.05). Los proveedores ingenuos de la PrEP podrían beneficiarse de la educación continua, mientras que los proveedores conscientes de la PrEP podrían beneficiarse de intervenciones para el desarrollo de capacidades y optimización de los hábitos de prescripción.