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The time of spread of HIV-1 to non-lymphoid tissue was investigated by sequence comparisons of variants infecting a range of tissues from three individuals with AIDS in the p 17_gag gene, and flanking regions of V1/V2. Phylogenetic analysis revealed several lineages in each individual that contained sequences from lymphoid and nonlymphoid tissue, such as brain, in both regions. This observation contrasts strongly with the previously described organ-specific sequences in the V3 region in this study population and other investigations. By estimating mean synonymous pairwise distances in the p 17_gag region, we were able to calculate the time of divergence of variants infecting lymphoid and non-lymphoid tissues, such as brain. In lymphoid tissue the mean diversity of gag sequences implied an approximate population age of 2.65 to 5.6 years, while those infecting brain were significantly more variable, suggesting an even earlier time of diversification (4.1 to 6.2 years). In two of the three individuals, these times of divergence indicate that infection of the brain may have occurred as an early event in the progression to disease, preceding the onset of AIDS by several years. This is the first report where it has been possible to estimate times of diversification in different tissues in vivo and is of importance in understanding the dynamics of the spread of HIV-1 into non-lymphoid tissue, and its possible adaptation for replication in different cell types. In summary, both analysis of the P17_gag and V1/V2 regions revealed high levels of heterogeneity of HIV-1 in tissue such as brain producing multiple lineages upon phylogenetic analysis. We have therefore found no evidence for specifically neurotropic variants of HIV-1 and question the idea that spread into the central nervous system or other non-lymphoid tissues requires specific adaptation.

Extant research on African-American women’s sexuality is typically couched within the public health literature. Evidence of African-American women’s high rates of sexually transmitted diseases, HIV/AIDS, and unwanted pregnancies is used to socially regulate and punish women of color, such as through forced sterilization. The construction of African-American women’s sexuality continues to serve as a linchpin of racial difference in a supposedly “post-racial” era. Challenging this line of research, Black feminist scholars have called for more critical research that acknowledges how race, gender, and class profoundly shape matters of sexuality. Past research has tended to focus on African-American women’s sexual attitudes and socialization by family, peers, and media. However, relatively little attention has focused on how intersecting social inequalities shape intimate experiences and more specifically, the social conditions that lead to increased sexual subjectivity for women of color. This study builds on the trailblazing work of Black feminists by identifying social-structural factors that shape Black women’s sexual experiences. Chapter 4 explores women’s conceptualizations of sexual pleasure. Given the taboo of women’s pleasure in society, particularly for racially marginalized women, little research has examined how sexual pleasure factors into women’s sexual lives. Women conceptualize sexual pleasure as partner, purpose, or process. This contributes to the literature by underscoring the variations in Black women’s beliefs about sexual pleasure and challenging the predominant assumptions of Black women’s sexuality as dangerous, risky, or immoral. Chapter 5 examines the cultural stereotypes surrounding Black women’s sexuality and how women manage the stigma of Black women’s deviant sexuality. I find that women contend with cultural beliefs of Black women’s asexuality or hypersexuality, which both construct Black women as not ideal sexual partners. Women draw on one of two techniques to manage negative stereotypes: by minimizing the stereotypes as salient in their sexual lives or by challenging them and subscribing to gendered arrangements in relationships. However, women must perform labor to shed this stigma and decrease their sexual agency. Chapter 6 focuses on Black women’s sexual body image. I argue that Black women contend with the “thick imperative,” or expectations to possess a curvier body. However, the “thick imperative” conflicts with the dominant ideal of thinness, which many voiced as a perennial concern in their lives. Therefore, I highlight how Black women must navigate two opposing ideals, which ultimately leads to increased frustration and body anxieties in their lives.

A growing body of research supports instructional strategies, such as concrete-representational-abstract (CRA) sequence, to teach mathematics to students at risk of failure, including those with disabilities. This study extends the current body of CRA research by analyzing the effects of CRA sequence of instruction on student achievement, and retention, and self-efficacy of performance on computations of fractions. Thirty-five students participated in this study. A series of repeated measures ANOVAs were performed to assess main effects and interaction effects for performance and self-efficacy of students in a control group who received traditional fractions instruction and a treatment group who received CRA sequenced instruction. Results revealed significant differences between the control and treatment groups on delayed-post measures of fractions computations. Students in the CRA group outperformed peers in the control group on the delayed-post assessment. No significant differences were detected on self-efficacy measures, with the exception of sources of self-efficacy. Vicarious experiences as a source of self-efficacy significantly decreased on delayed-post measures. Students in the CRA group scored significantly higher than peer in the control group on the construct of negative psychological state (e.g., anxiety) as a source of self-efficacy on the presurvey, but not on the post- or delayed-post surveys, as a result of decrease in scores of negative psychological state.

This study investigated the extent to and ways in which attention to students' mathematical thinking was evident in the written lesson plans or lesson planning process of ten pre-service secondary mathematics teachers at various points during their teacher education program: prior to and immediately after participation in a course (the Teaching Lab) that emphasized students' mathematical thinking as a key element of planning, during teachers' first semester of their field experience as they planned lessons in their actual practice of teaching, and near the end of the first semester of their field experience as they planned lessons on demand and for university assignments. With respect to learning from the Teaching Lab, the study shows that the teachers demonstrated significant growth on pre to post course measures in their ability to attend to students' thinking when planning a lesson on demand and for a university assignment. Furthermore, teachers continued to be able to apply these ideas when planning on demand and for university assignments several months later. When investigating whether or not teachers would apply the ideas they had learned when planning in their own practice, the study suggests three findings. First, teachers' attention to students' thinking when planning lessons that used tasks with a high level of cognitive demand was not significantly different from their planning for a lesson on demand or the lesson plan they produced for the Teaching Lab assignment. Furthermore, teachers were more likely to attend to students' thinking when planning a lesson that used a high-level task compared to a lesson that used a low-level task. Second, for some teachers, written lesson plans significantly under-represented their attention to students' thinking in their planning process. Finally, the study suggests that support from the mentor teacher and/or university supervisor may be an important factor in determining whether or not the teacher applies their knowledge of attention to student's thinking to their planning in practice.

Background: People with severe mental illness (SMI) experience significant inequalities in physical health and die on average 15-20 years earlier than the general population. To address this, physical health is now higher on the health policy and practice agenda. However, sexual health is significantly neglected within current UK health policy, and there is a paucity of research within the UK despite the international literature suggesting the sexual health of people with SMI is poor. Methods: A range of methods were employed to explore the intersection of SMI and sexual health in the UK. A systematic review was undertaken to examine whether adults with SMI are more likely to engage in behaviours associated with increased risk of blood borne viruses/sexually transmitted infections compared to those with no history of SMI. A feasibility study examined recruitment processes and, explored participant feedback on the acceptability of a sexual health interview. Qualitative interviews explored mental health professional’s (MHPs) views in relation to the sexual health and relationship needs of people with SMI. Lastly, secondary data analysis of survey data examined the acceptability and experiences of people with SMI in the UK who participated in the RESPECT study. Results: Within the UK context, this thesis provides evidence that it is acceptable to speak to the SMI population about their sexual health and behaviour as well as preliminary evidence that it is feasible to recruit people with SMI to research in this area. Priorities for policy include bringing the sexual health and relationship needs to the forefront of guidance to ensure MHPs are aware of the legitimacy of supporting their service users with this aspect of their physical health. Conclusions: The research within this thesis provides important evidence that it is acceptable to undertake sexual health and behaviour research in people with SMI in the UK.

Background: People with substance use disorders (SUDs) often have co-existing physical and/or mental health conditions and are prescribed a large number of medications which may or may not be justified. Among this population, psychiatric medications and opioids are often involved in adverse events. There is, however, a lack of research on the quality of prescribing of these medications. In this thesis, the appropriateness of these medications is explored, as well as the response of prescribers in a specialist addiction service (SAS) to their inappropriate prescribing. Methods: A mixed methods design was utilised. A descriptive quantitative study using routinely available data was conducted to describe the scale of prescribing for service users. A second quantitative component involving questionnaires was carried out to assess the appropriateness of psychiatric medications and opioids in a sample of service users by SAS prescribers. Qualitative interviews were conducted with service users to explore their perspectives on the appropriateness of these medications while prescriber interviews explored how they responded to inappropriate prescribing. Results: The descriptive study showed that 27% of service users were prescribed four or more medications with almost half of them receiving antidepressants. The second study showed that nearly half of service users had at least one inappropriate psychiatric medication or opioid. Interviews with service users revealed that most of them benefited from these medications but that their use often involved making a compromise between risks and benefits. Benefits/risks of medications, prescriber expertise, nature of addiction and communication with service users and prescribers were considered by SAS prescribers before responding to inappropriate prescribing. It appears the need to maintain service users’ stability and well-being may lead to a greater focus on these issues when assessing the appropriateness of prescribing decisions. Conclusion: The quality of prescribing of opioids and psychiatric medications to service users referred to this SAS appeared to present room for improvement. Further research is required with the availability of a more mixed economy of service providers in the alcohol and drug treatment sector to establish if these findings are applicable.