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Objective: We sought to evaluate the impact of the 1997 American Diabetes Association gestational diabetes mellitus screening guidelines applied to a universally screened population.Study Design: A retrospective analysis of 18,504 women universally screened for gestational diabetes mellitus at Mayo Clinic, Rochester, between January 1, 1986, and December 31, 1997, was performed. Diabetic screening consisted of plasma glucose determination 1 hour after a 50-g oral glucose challenge. Diagnosis of gestational diabetes mellitus was based on National Diabetes Data Group criteria.Results: Of 564 cases of gestational diabetes mellitus diagnosed during the study period, 17 (3.0%) would have been missed under the 1997 American Diabetes Association selective screening guidelines while exempting only 10% of this predominantly white population from screening. Screening only women >/=25 years old would have detected 90.4% of gestational diabetes mellitus cases, whereas the addition of the remaining 3 screening criteria combined would have detected only an additional 6.6% of cases.Conclusions: The proportion of patients with gestational diabetes mellitus that would remain undiagnosed under the 1997 American Diabetes Association screening guidelines would be relatively small in our population. However, implementation of these guidelines would decrease the number of screens by only 10% while adding significant complexity to the screening process. Youth appears to be the most significant protective factor for gestational diabetes mellitus in our population. [ABSTRACT FROM AUTHOR]

This study describes the results of an online social support intervention, called 'Thrive with Me' (TWM), to improve antiretroviral therapy (ART) adherence. HIV-positive gay or bisexually-identified men self-reporting imperfect ART adherence in the past month were randomized to receive usual care ( n = 57) or the eight-week TWM intervention ( n = 67). Self-reported ART outcome measures (0-100 % in the past month) were collected at baseline, post-intervention, and 1-month follow-up. Follow-up assessment completion rate was 90 %. Participants rated (1-7 scale) the intervention high in information and system quality and overall satisfaction (Means ≥ 5.0). The intervention showed modest effects for the overall sample. However, among current drug-using participants, the TWM (vs. Control) group reported significantly higher overall ART adherence (90.1 vs. 57.5 % at follow-up; difference = 31.1, p = 0.02) and ART taken correctly with food (81.6 vs. 55.7 % at follow-up; difference = 47.9, p = 0.01). The TWM intervention appeared feasible to implement, acceptable to users, and demonstrated greatest benefits for current drug users. [ABSTRACT FROM AUTHOR]

The Men's INTernet Study II included a randomized controlled trial to develop and test an Internet-based HIV prevention intervention for U.S men who use the Internet to seek sex with men. In 2008, participants ( n = 560) were randomized to an online, interactive, sexual risk-reduction intervention or to a wait list null control. After 3 months, participants in both conditions reported varying degrees of change in sexual beliefs or behaviors. Using content analysis and logistic regression, this mixed-methods study sought to understand why these changes occurred. Level of critical self-reflection of assumptions appeared to facilitate the labeling of sexual beliefs and behaviors as risky, which in turn encouraged men to commit to and enact change. New HIV prevention interventions should include activities in their curriculum that foster critical self-reflection on assumptions. [ABSTRACT FROM AUTHOR]

This study documents our experience in designing, testing, and refining human subjects' consent protocol in 3 of the first NIH-funded online studies of HIV/STI sexual risk behavior in the USA. We considered 4 challenges primary: a) designing recruitment and enrollment procedures to ensure adequate attention to subject considerations; b) obtaining and documenting subjects' consent; c) establishing investigator credibility through investigator-participant interactions; d) enhancing confidentiality during all aspects of the study. Human consent in online studies appears more relative, continuous, inherent, tenuous, and diverse than in offline studies. Reasons for declining consent appear related to pragmatic concerns not human subjects' risks. Reordering the consent process, and short, chunked, stepwise, tailored consent procedures may enhance communicating information and documenting consent. [ABSTRACT FROM AUTHOR]

Discusses the use of activity based costing (ABC) by information centers in the United States to provide better cost information. When to use ABC; Product definition for services; Cost drivers; Benefits and implications of the use of ABC for information centers.