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Previous research suggests that spontaneous evaluative responses to a stimulus depend on how that stimulus is categorised. The present research indicates that such categorisation effects depend on task-specific aspects of the measure, thereby concealing or overriding effects of unattended category cues. Results showed that affective priming effects in a paradigm based on response interference depended on participants' attention to the category membership of the primes. These effects were reflected in: (a) reduced effect sizes; (b) reduced internal consistencies; and (c) reduced correlations to corresponding self-reports when attention was directed toward alternative categories. Such attention-related decrements were not obtained for a priming paradigm based on affect misattribution, which showed reliable priming effects irrespective of participants' attention to the relevant categories. These results challenge the ubiquity of categorisation effects on spontaneous evaluations, suggesting that the impact of...

Public Health Critical Race Praxis (PHCRP) contributes three functional elements to health equity studies: a race conscious orientation; an antiracism lexicon based on Critical Race Theory (CRT); and an integrat­ed, reflexive approach. Few big data studies employ all three functional elements. There­fore, this article describes the application of PHCRP to the Human Immunodeficiency Virus Testing, Linkage and Retention in care (HIV TLR) study (N=3,476,741), which con­nects multiple large datasets to electronic medical records to examine contextual de­terminants of racial/ethnic disparities in HIV care continuum outcomes in southern Cali­fornia. As HIV TLR demonstrates, PHCRP’s innovative tools and strategies help big data research maintain fidelity to CRT. Ethn Dis. 2018; 28 (Suppl 1):261-266; doi:10.18865/ed.28.S1.261

Importance Diagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release. Objective To test the effect on viral suppression in released inmates of the manualized LINK LA (Linking Inmates to Care in Los Angeles) peer navigation intervention compared with standard transitional case management controls. Design, Setting, and Participants Randomized clinical trial conducted from December 2012 through October 2016 with people living with HIV being released from Los Angeles (LA) County Jail. All participants were (1) 18 years or older; (2) either men or transgender women diagnosed with HIV; (3) English speaking; (4) selected for the transitional case management program prior to enrollment; (5) residing in LA County; and (6) eligible for antiretroviral therapy. Main Outcomes and Measures Change in HIV viral suppression ( Interventions During the 12-session, 24-week LINK LA Peer Navigation intervention, trained peer navigators counseled participants on goal setting and problem solving around barriers to HIV care and adherence, starting while the participants were still in jail. After their release, they continued counseling while they accompanied participants to 2 HIV care visits, then facilitated communication with clinicians during visits. Results Of 356 participants randomized, 151 (42%) were black; 110 (31%) were Latino; 303 (85%) were men; 53 (15%) were transgender women; and the mean (SD) age was 39.5 (10.4) years. At 12 months, viral suppression was achieved by 62 (49.6%) of 125 participants in the peer navigation (intervention) arm compared with 45 (36.0%) of 125 in the transitional case management (control) arm, for an unadjusted treatment difference of 13.6% (95% CI, 1.34%-25.9%; P = .03). In the repeated measures, random effects, logistic model the adjusted probability of viral suppression declined from 52% at baseline to 30% among controls, while those in the peer navigation arm maintained viral suppression at 49% from baseline to 12 months, for a difference-in-difference of 22% (95% CI, 0.03-0.41; P = .02). Conclusions and Relevance The LINK LA peer navigation intervention was successful at preventing declines in viral suppression, typically seen after release from incarceration, compared with standard transitional case management. Future research should examine ways to strengthen the intervention to increase viral suppression above baseline levels. Trial Registration clinicaltrials.gov Identifier:NCT01406626

INTRODUCTION The forward placement of inventory in the supply chain in order to save time and cost in "anticipation" of future demand is a strategic decision, which can save delivery time, and also cut transportation costs. *, ** Similarly, the consolidation of inventory creates pooling effects, improves standardization, and can increase control and visibility of key stocks. But how should this type of consolidation be made in an existing logistics network and what sort of metric should be used to measure the efficiency of such a consolidation of strategic inventory? These are questions which managers must understand as they consider forward positioning strategic inventory in the supply chain, especially in the face of uncertain demand with extremely high stockout costs, as exist in wartime, humanitarian aid operations, and other emergency response environments. This decision to forward position inventory in the supply chain may also help support critical maintenance activities necessary to sustain geographically isolated operations or to protect valuable personnel and resources when the unavailability of such inventory poses significant risk and costs. The U.S. military faces the problem of deciding how and where to pre-position such anticipation inventory in the face of uncertain demand and is also highly sensitive to shipping time and stockout costs. In one particular problem, the U.S. Air Force at Randolph Air Force Base Texas is responsible for the management of a variety of Security Force's' War Readiness Material (WRM) equipment packages that are shipped overseas for conflicts. This equipment is divided into several different Unit Tasking Codes (UTCs) and the packages are positioned at twelve Air Force bases in the U.S. As a result of this decentralized storage, inconsistencies in management of the assets often exist and the timeliness of their deployment to overseas locations is often lacking. How and where to best manage this inventory prior to shipment overseas is a question whose answer may provide efficiencies and increased savings for the military. Additionally, the methods used in this study and the similar forward positioning of strategic inventories in the supply chain may hold similar advantages and savings in other logistics operations where delivery time is critical. LITERATURE REVIEW Although the elimination of inventory has the potential to achieve significant cost savings, the need for strategic inventory buffers is still an accepted practice to account for variability in demand, even in "lean" supply chains (Womack and Jones, 1996; Christopher and Towill, 2000). The concept of advanced placement of inventory in the supply chain has been considered in a handful of previous studies (Sampson et al., 1985; Teulings and van der Vlist, 2001). More recently, the advanced or forward placement or prepositioning of such inventories referred to as "floating stock" has been studied by Dekker et al. (2009). They showed that using intermodal rail terminals as pre-positioning points in the supply chain can result in lower inventory costs as well as shorter customer lead times. These results are similarly consistent with expected results of the forward placement or "logistics speculation" of inventory in the supply chain, as discussed by Pagh and Cooper (1998). Related research has also shown that inventory consolidation may create efficiencies and pooling effects (Zinn, Levy and Bowersox, 1989; Evers and Beier, 1998) leading to decreased logistics costs for transshipments (Evers, 1999, and Minner 2003) and as achieved by the square-root rule (Croxton and Zinn, 2005 and Shapiro& Wagner, 2009). These studies all examine the efficiencies and inventory cost savings associated with pooling and consolidation. This study, however, contains more of a supply chain focus that looks at the impact of transportation, inventory and other relevant costs when making decisions about where to preposition inventory in the supply chain (Vanteddu et al, 2007, and Dekker et al, 2009). …

We take a social neuroscience approach to self and social categorisation in which the current self-categorisation(s) is constructed from relatively stable identity representations stored in memory (such as the significance of one's social identity) through iterative and interactive perceptual and evaluative processing. This approach describes these processes across multiple levels of analysis, linking the effects of self-categorisation and social identity on perception and evaluation to brain function. We review several studies showing that self-categorisation with an arbitrary group can override the effects of more visually salient, cross-cutting social categories on social perception and evaluation. The top-down influence of self-categorisation represents a powerful antecedent-focused strategy for suppressing racial bias without many of the limitations of a more response-focused strategy. Finally we discuss the implications of this approach for our understanding of social perception and evaluation and t...

Effective self-regulation requires the ability to consider alternate goal states in order to adapt to shifting circumstances. Previous research on goal reflection has identified goal-type dissociations in brain regions broadly associated with self-projection. Importantly, however, there is a need to distinguish activation differences due to recruitment of distinct processes from activations that reflect common processes with varying levels of recruitment. The fact that different types of goals tend to covary naturally with time allowed us to vary the difficulty of goal reflection across content domains. Participants in an fMRI study thought about promotion or prevention goals at three time points. Goals that varied in terms of content, time-frame, valence, and abstractness but were difficult to construct (relative to other goals) activated an area of dorsal medial PFC, suggesting that this region may support general-purpose projective processes. In contrast, goals that were easy to construct activated a region of dorsolateral PFC involved in domain-general memory retrieval. Importantly, we also observed domain-specific effects of goal type and temporal distance; promotion goals were associated with heightened activity in medial PFC, short-term goals activated precuneus and anterior cingulate cortex, and longer-term goals activated frontal areas, including ventrolateral PFC and orbitofrontal cortex.

Background The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care. Objectives To estimate the association between HIV stigma and: self-reported access to care, regular source of HIV care, and antiretroviral therapy adherence; and to test whether mental health mediates these associations. Design Cross-sectional study. Participants 202 PLHA living in Los Angeles County in 2007. Measurements Participants completed an anonymous survey, assessing internalized HIV stigma (28-items, alpha = 0.93), self-reported access to medical care (six items, alpha = 0.75), regular source of HIV care, and antiretroviral therapy (ART) adherence. Results One-third of participants reported high levels of stigma; 77% reported poor access to care; 42.5% reported suboptimal ART adherence; and 10.5% reported no regular source of HIV care. In unadjusted analysis, those reporting a high level of stigma were more likely to report poor access to care (OR = 4.97, 95% CI 2.54–9.72), regular source of HIV care (OR = 2.48, 95% CI 1.00–6.19), and ART adherence (OR = 2.45, 95% CI 1.23–4.91). In adjusted analyses, stigma was significantly associated with poor access to care (OR = 4.42, 95% CI 1.88–10.37), but not regular source of HIV care or ART adherence. Mental health mediated the relationship between stigma and ART adherence, but not poor access to care or regular source of HIV care. Conclusions The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and it′s mediators.

Developing and disseminating a preventive HIV vaccine is a primary scientific and public health objective. However, little is known about HIV vaccine acceptability in the high-prevalence setting of South Africa— where young adults are likely to be targeted in early dissemination efforts. This study reports on six focus groups ( n = 42) conducted in 2007 with South Africans aged 18 to 24 years. A deductive framework approach is used to identify key motivators and barriers to future HIV vaccine uptake. Participants identify HIV testing, HIV stigma, mistrust of the health care system, and concerns about sexual disinhibition as barriers to vaccine uptake. For women, family members and friends are strong motivators for vaccine uptake, whereas men are more likely to see vaccines as an opportunity to stop using HIV prevention strategies such as condoms and partner reduction. Implications of these findings for developing HIV vaccine dissemination strategies and policy in South Africa are discussed.

Despite high documented HIV prevalence, few jail systems offer universal HIV screening, nor is this always feasible. The authors evaluated undiagnosed HIV infection and HIV risk history by arrest charge among 1,322 new arrestees to examine whether specific charges may help prioritize jail-based screening. Undiagnosed HIV prevalence was 2.7% and 1.0% among males and females, with 32% and 45% reporting recent STD diagnoses or high-risk behaviors for HIV. HIV risk history distinguished HIV-infected males but not females. Males with parole violation, sex, or theft charges had high undiagnosed HIV infection rates relative to other males. A weaker trend was observed for females with parole violation, drug, or violent charges. These charges represented 30% and 66% of males and females studied and 56% and 100% of their undiagnosed HIV infections, respectively. Using arrest charge to target screening may efficiently increase HIV diagnosis in jail inmates where universal HIV screening is not possible.

Introduction . HIV/AIDS disproportionately affects Hispanics in the United States, a diverse and heterogeneous population. The purpose of this study was to evaluate the relation- ship of acculturation with HIV and hepatitis C testing, and access to care among Hispanics at risk for HIV. Methods. We recruited 600 Hispanics from STD clinics, community-based organizations, and needle exchange programs in Los Angeles County. Results. Low levels of acculturation were significantly associated with having fewer HIV tests (OR 1.98, 95% CI 1.24, 3.15), no hepatitis C tests (OR 2.61, 95% CI 1.77, 3.84), testing positive for HIV (OR 2.67, 95% CI 1.04, 6.83), and low levels of access to care (β50.06; p,.05). Conclusions. Low levels of acculturation are an important barrier to the use of HIV-related health care services. Our findings may inform the development of effective interventions that address the cultural and behavioral differences among Hispanic subgroups.

Growing criticism of existing educational leadership preparation programs seems to focus on a lack of contextual relevancy and instructional leadership. Universities and school districts need to develop more formal, collaborative, long-term relationships focused on the nature of principal preparation, moving beyond acculturation to district norms and irrelevancy to building future leaders' capacity for continuous educational improvement. Educational administration as an applied field demands that we answer key questions regarding the development of effective practitioners.

CD4 cell count and viral load are the most widely used markers of Human Immunodeficiency Virus (HIV). Obtaining accurate measures of these laboratory markers can be challenging. The purpose of this study was to assess the reliability and validity of self-reported and abstracted paper medical record CD4 counts, viral load, and outpatient visits using electronic data as the gold standard. We sampled a subgroup of 114 HIV-infected individuals in Los Angeles from a larger multi-site study for whom we could confirm outpatient visits and CD4 count and viral load data through electronic data. Agreement between electronic and paper record abstractions was approximately 90% for CD4 count (kappa = 0.85; P < 0.001), 78% for viral load (kappa = 0.56; P < 0.001), and 62% for visits (kappa = 0.02; P = 0.36). Agreement between electronic and self-reported measures was 80% for CD4 count (kappa = 0.71; P < 0.001), 77% for viral load (kappa = 0.54; P < 0.001), and 62% for visits (kappa = 0.13; P < 0.05). Using electronic data as the gold standard, we found that the accuracy of self-report was as good as paper record abstraction regarding viral load levels and visits, and only slightly lower for CD4 count. Despite limited generalizability, these findings are important because they suggest that the accuracy of clinical information collected by self-report and paper medical records are similar and raise questions about whether conducting abstractions of paper medical records is worthwhile, especially if it increases the costs of data collection.

Transportable radioanalytical systems were assembled and tested for quantitative determination of γ-emitting radionuclides and screening of β-emitting radionuclides. Standard operating procedures (SOPs), including instructions for assembly, disassembly, operation, sample collection and analysis, and all other procedures needed, were developed. Foods, as well as National Institute of Standards and Technology, International Atomic Energy Agency, and in-house Reference Materials were analyzed. An SOP for γ-emitting radionuclides was successfully tested at 3 locations.

Although early research implicated the amygdala in automatic processing of negative information, more recent research suggests that it plays a more general role in processing the motivational relevance of various stimuli, suggesting that the relation between valence and amygdala activation may depend on contextual goals. This study provides experimental evidence that the relation between valence and amygdala activity is dynamically modulated by evaluative goals. During functional magnetic resonance imaging, participants evaluated the positive, negative, or overall (positive plus negative) aspects of famous people. When participants were providing overall evaluations, both positive and negative names were associated with amygdala activation. When they were evaluating positivity, positive names were associated with amygdala activity, and when they were evaluating negativity, negative names were associated with amygdala activity. Evidence for a negativity bias was found; modulation was more pronounced for positive than for negative information. These data suggest that the amygdala flexibly processes motivationally relevant evaluative information in accordance with current processing goals, but processes negative information less flexibly than positive information.

Two cryogenic homogenization procedures, Teflon disk milling and stainless-steel impact milling, were studied for preparing food and dietary supplements for element analysis. The functionality of the disk mill was demonstrated for a fruit/nut/oatmeal granola. Improvement over a rotary cutter blending procedure was shown for three fast-food type foods—hamburger, fried chicken, and egg/ham/cheese English muffin. The capabilities of the two procedures to process mixtures comprised of very dissimilar components were compared. The mixtures included a commercial hard candy having a chili powder coating and a 50:50 (by mass) combination of choline tablets and echinacea root capsules. Nonhomogeneities were found by calculating relative standard deviations (RSDs) for replicate analyses (n=5) and comparing them with the random uncertainties associated with the measurements. Analytical portion masses ranged between 1 g and 45 mg. Element mass fractions were determined using instrumental neutron activation analysis.

Purpose . This study compared African American/Black and White Medicare enrollees' perceptions of care. Design and methods . Analyses of the 2002 Consumer Assess- ment of Healthcare Providers and Systems (CAHPS®) 3.0 survey of 101,189 (White) and 8,791 (Black) Medicare enrollees (82% response rate) randomly sampled from 321 health plans, with data collected via mail (84%) and telephone (16%). Multivariate linear regres- sion models were conducted with the CAHPS® composites and global ratings as dependent variables, controlling for case-mix variables. Results . Blacks reported significantly (p #.0001, p#.05) worse experiences with getting care quickly, office staff helpfulness, getting needed care, health plan customer service, rating of specialist care, and rating of the health plan (effect sizes ranging from 0.02 to 0.21). However, they reported better provider communi - cation and rated their personal doctors/nurses and health care more positively (effect sizes ranging from 0.02 to 0.09).

Fear of violent crime is common among adolescents in urban settings; however, little is known about individual- and neighborhood-level determinants of fear. A generalized ordered logit model was used to analyze individual- and neighborhood-level variables among 2474 adolescents. Seeing violence significantly reduced the probability of feeling unafraid, as did higher levels of social disorder. The more block faces where police were visible, the higher the probability of feeling unafraid and lower the probability of feeling very afraid. Reducing fear could affect more people than just reducing crime. Fear-reduction strategies should target those most at risk of becoming fearful.

We study the single site lattice gauge theory of SU(N) coupled to one Dirac flavor of fermion in the adjoint representation. We utilize M\"obius fermions for this study, and accelerate the calculation with graphics processing units (GPUs). Our Monte Carlo simulations indicate that for sufficiently large inverse 't Hooft coupling b = 1/g^2 N, and for N \leq 10 the distribution of traced Polyakov loops has "fingers" that extend from the origin. However, in the massless case the distribution of eigenvalues of the untraced Polyakov loop becomes uniform at large N, indicating preservation of center symmetry in the thermodynamic limit. By contrast, for a large mass and large b, the distribution is highly nonuniform in the same limit, indicating spontaneous center symmetry breaking. These conclusions are confirmed by comparing to the quenched case, as well as by examining another observable based on the average value of the modulus of the traced Polyakov loop. The result of this investigation is that with massless adjoint fermions center symmetry is stabilized and the Eguchi-Kawai reduction should be successful; this is in agreement with most other studies., Comment: 28 pages, 18 figures, v2 new method based on eigenvalue distribution allowed us to extrapolate to the large N limit, changing our conclusions, v3 additional observable considered, quenched studies included for comparison

Background: Effective interventions to improve stroke preventative care in vulnerable populations have not been reported. Methods: We tested the impact of a chronic care model-based intervention program among 407 subjects with a recent stroke or transient ischemic attack at four Los Angeles County public hospitals. All subjects had a baseline systolic blood pressure (SBP) of at least 120 mm Hg and were randomized after baseline assessment in a 1:1 ratio to usual care or intervention, stratified by hospital and by English/Spanish language. The care management intervention was led by bilingual nurse practitioners or physician assistants, and it consisted of group clinics, self-management support, report cards, decision support, and coordination of ongoing care. Intention-to-treat analyses were conducted using repeated-measures mixed-effects models. The primary outcome was change in SBP. Secondary outcomes were other measures of SBP, low-density lipoprotein (LDL), ACC/AHA 10-year cardiovascular risk, adherence to antihypertensive and to antithrombotic medications, and physical activity. Results: Mean age was 57 years, 60% were male, 18% were African-American race, and 69% were Hispanic ethnicity. 48% had not graduated from high school. Baseline SBP was 150 mm Hg in the usual care arm and 149 mm Hg in the intervention arm. 12 month data were obtained in 333 participants (82%). There were substantial declines in SBP in both the usual care and intervention arms (Table). However, there were no significant differences between the two arms in either improvement of SBP from baseline or other measures of stroke risk factor control. Subgroup analyses did not reveal a differential impact of the intervention by race/ethnicity. Conclusion: Our care management intervention did not improve stroke risk factor control beyond what was attained in usual care. Further analyses are ongoing, and those findings will be used to guide modification of the intervention for future testing.

If Form C is the Swiss Army knife of disclosure documents, Form 1-A is a machete. The stakes are higher. You can solicit up to $50 million from anyone, not just accredited investors. (Certain investors are limited to investing only a certain percentage of their income, however.) While you have more freedom to talk about your offering on social media and via advertising, the overall audience is going to be more knowledgeable.

As I noted in this book, it makes sense to have a cogent, easy-to-share summary of your crowdfunding approach, no matter what you are trying to do. This chapter facilitates that by presenting sample slides. These slides (available free online at www.creativeinvest/crowdfundingslides/) provide a framework you can use in your own crowdfunding efforts.

Under the final rules for crowdfunding, the SEC (the commission) has developed detailed cost estimates for Title III JOBS Act issuers. These estimates cover the cost of each requirement imposed on issuers. This chapter describes these estimates and offers my perspective. As an initial cost guide, I think these estimates will be of interest to those considering JOBS Act crowdfunding under Title III.

Compton suppression spectrometry was used to analyze foods for elements with short-lived neutron activation products (half-lives of about 2 minutes to 1.5 days). Analysis conditions were optimized to provide quality assurance analyses for iodine in FDA’s Total Diet Study. Iodine mass fractions (0.075 to 2.03 mg/kg) were measured in 19 of 42 foods analyzed, with limits of detection (LODs) ranging from 0.03 to 1.4 mg/kg, mostly depending on NaCl content. LODs were lowered by up to a factor of 2 for 16 elements. Suppression factors ranged from about 2 to 8 over the energy range 400 to 3200 keV.

Dual–process models of attitudes highlight the fact that evaluative processes are complex and multifaceted. Nevertheless, many of these models typically neglect important interactions among processes that can contribute to an evaluation. In this article, we propose a multilevel model informed by neuroscience in which current evaluations are constructed from relatively stable attitude representations through the iterative reprocessing of information. Whereas initial iterations provide relatively quick and dirty evaluations, additional iterations accompanied by reflective processes yield more nuanced evaluations and allow for phenomena such as ambivalence. Importantly, this model predicts that the processes underlying relatively automatic evaluations continue to be engaged across multiple iterations, and that they influence andare influenced by more reflective processes. We describe the Iterative Reprocessing Model at the computational, algorithmic, and implementational levels of analysis (Marr, 1982) to mo...

Perceived stigma in clinical settings may discourage HIV-infected individuals from accessing needed health care services. Having good access to care is imperative for maintaining the health, well being, and quality of life of persons living with HIV/AIDS (PLWHAs). The purpose of this prospective study, which took place from January 2004 through June 2006, was to evaluate the relationship between perceived stigma from a health care provider and access to care among 223 low income, HIV-infected individuals in Los Angeles County. Approximately one fourth of the sample reported perceived stigma from a health care provider at baseline, and about one fifth reported provider stigma at follow up. We also found that access to care among this population was low, as more than half of the respondents reported difficulty accessing care at baseline and follow up. Perceived stigma was found to be associated with low access to care both at baseline (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.55, 7.01) and 6-month follow up (2.85; 95% CI = 1.06, 7.65), even after controlling for sociodemographic characteristics and most recent CD4 count. These findings are of particular importance because lack of access or delayed access to care may result in clinical presentation at more advanced stages of HIV disease. Interventions are needed to reduce perceived stigma in the health care setting. Educational programs and modeling of nonstigmatizing behavior can teach health care providers to provide unbiased care.

Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown.To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status.Prospective cohort study.Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations.Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos.Cronbach's alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20-4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status.We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.

This cross-sectional study examined factors associated with the receipt of HIV medical care among people who know their HIV status and are not newly diagnosed with HIV. Interviews were conducted with 1133 HIV-positive individuals between October 2003 and July 2005 who enrolled in 1 of 10 outreach programs across the country. The sample was predominantly non-white (86%), male (59%), and unstably housed (61%), with a past history of cocaine use (68%). Twelve percent had received no HIV medical care in the 6 months prior to the interview. Those with no care were similar to those who received some HIV care in sociodemographic characteristics, but in multivariate analysis were less likely to have a case manager (p < 0.001) or use mental health services (p < .001), had lower mental health status scores (p < 0.05), were more likely to be active drug users (p < 0.01), had greater unmet support service needs (p < 0.05) and reported that health beliefs were a barrier to care (p < 0.001). Interventions to engage people in HIV medical care need to address barriers to care through linkages with mental health, substance abuse treatment and support services, and address the health beliefs that deter people from seeking care.

We investigated self-regulatory focus (Higgins, 1997, 1998) as one source of variation in encoding of, and memory for, emotional words. Participants wrote about their hopes and aspirations (promotion focus) or duties and obligations (prevention focus). In a subsequent incidental encoding task during functional magnetic resonance imaging (fMRI), participants evaluated emotional (positive and negative) and neutral words as either good or bad. A surprise memory test followed, outside the scanner. We observed a dissociation in posterior cingulate cortex (PCC), where activity during the evaluation task was greater when words were focus-consistent (positive for the promotion focus group, negative for the prevention focus group). Similarly, activity in a parahippocampal region was related to subsequent memory, but only for focus-consistent words. Given the role of the PCC in self-referential processing and episodic retrieval, and the parahippocampus in memory-related processing, these data suggest that regulatory focus influences which items are preferentially associated with self-referential information in memory. Such preferential processing may help explain why events are remembered differently by different individuals, which subsequently may influence interpersonal interactions.

Recent evidence suggests that postpartum depression is associated with reduced amygdala (AMY) response to negative stimuli. However, given the anhedonic features of PPD, it is important to consider mothers' brain response specifically to positive infant and to other positive stimuli. Mothers with (n = 28) and without (n = 17) clinically determined PPD (n = 28) viewed smiling pictures of infants (Own and Other), and positive non-infant stimuli (Non-Infant). First, we examined group differences in AMY response across conditions. Next, psychophysiological interaction was used to examine group differences in AMY connectivity across conditions. Connectivity estimates were then correlated with measures of maternal mood and anxiety. PPD mothers, compared to non-PPD mothers, showed overall increased AMY response across conditions in the right AMY. Despite this, PPD mothers demonstrated decreased bilateral AMY-right insular cortex (IC) connectivity as compared to non-PPD mothers when they view Own-Other infants. Furthermore, decreasing AMY-IC connectivity was associated with increasing symptoms of depression and anxiety. These differences were evident only for infant stimuli and did not apply to all positively valenced stimuli. Thus, PPD mothers show altered brain response and connectivity in regions strongly implicated in the processing of socially and emotionally relevant stimuli, as well as interoception and the evaluation of subjective emotional experience.

HIV/AIDS-related stigma is a key factor impeding patient utilization of HIV testing services. To destigmatize HIV testing, the Centers for Disease Control and Prevention recommended an 'opt-out' screening strategy aimed at all patients in all clinical settings, regardless of HIV risk. This study assessed whether opt-out screening as compared to opt-in screening was associated with increased uptake of HIV testing among patients with HIV/AIDS-related stigma concerns. This study included 374 patients attending two Los Angeles ambulatory care clinics. Stigma items were grouped into three constructs: Blame/isolation, abandonment, and contagion. Individuals endorsing the blame/isolation subscale (AOR = 0.52; 95 % CI 0.29-0.92; p\0.05) and abandonment subscale (AOR = 0.27; 95 % CI 0.13-0.59; p\0.01) were significantly less likely to accept an HIV test. Additionally, the opt-out model did not counter the negative effects of stigma on HIV test acceptance. These findings indicate that stigma remains a barrier to HIV testing, regardless of the opt-out screening approach.

Bipolar disorder (BD) is associated with increased reactivity to rewards and heightened positive affectivity. It is less clear to what extent this heightened reward sensitivity is evident across contexts and what the associated neural mechanisms might be. The present investigation employed both a monetary and social incentive delay task among adults with remitted BD type I (N=24) and a healthy non-psychiatric control group (HC; N=25) using fMRI. Both whole-brain and region-of-interest analyses revealed elevated ventral and dorsal striatal reactivity across monetary and social reward receipt, but not anticipation, in the BD group. Post-hoc analyses further suggested that greater striatal reactivity to reward receipt across monetary and social reward tasks predicted decreased self-reported positive affect when anticipating subsequent rewards in the HC, but not BD, group. Results point toward elevated striatal reactivity to reward receipt as a potential neural mechanism of reward reactivity.

Research on affect and emotion has recently been informed by novel methods and theories in cognitive neuroscience. This perspective, known as affective neuroscience, has the potential to dramatically improve our understanding of fundamental processes of emotion. In this article, we review the major neural systems involved in emotion and consider the computational properties of these regions. Specifically, we consider affect systems associated with the representation of predicted and experienced affective states, the cortical re-representation of body states, and the role of reflection in generating and maintaining emotional episodes. WIREs Cogni Sci 2011 2 656-665 DOI: 10.1002/wcs.145 For further resources related to this article, please visit the WIREs website.

Antiaccess / area-denial (A2AD) tactics are elements of warfare with long histories of use. Understanding the magnitude of the modern A2AD threat requires knowledge of the evolution of A2AD effects. Since WWII, a modern concept of A2AD has evolved along lines of speed, range, and lethality. Case studies of the Maginot Line in WWII, the 1973 Israeli-Egyptian October War, and a hypothetical conflict involving modern-day China and the United States illustrate the evolution of A2AD actions and show the impact of A2AD effects on the overall character of campaigns. Concepts of operational reach, intelligence, and battlespace are critical to informing A2AD and counter-A2AD approaches. Although A2AD is not a revolution in military affairs, it does inform the expected evolution of warfare's character: where feasible, conventional warfare will include A2AD approaches. Without a deeper shared understanding of the A2AD concept, the military faces significant difficulty overcoming the threat it poses.

English proficiency may be important in explaining disparities in health and health care access among older adults.Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey.We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health).Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers.Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

Objectives. We examined correlates of deliberate sexual abstinence among gay/bisexual men, heterosexual men, and women in a national probability sample of adults with HIV. Methods. Participants in the HIV Cost and Services Utilization Study (HCSUS; n=1339) answered questions about oral, anal, or vaginal sexual intercourse in the past 6 months; those who reported none of these behaviors (n=415) were asked about their reasons for abstinence. Of these, 201 participants (11% of gay/bisexual men, 18% of women, 18% of heterosexual men) indicated that their abstinence was deliberate. Multivariate models were used to predict deliberate abstinence. Results. In multivariate analyses, not having a primary relationship partner/spouse was a significant correlate of deliberate abstinence for all 3 groups. Higher perceived responsibility for limiting disease transmission and nondrinking status were related to deliberate abstinence only among gay/bisexual men. Worse health was associated with deliberate abstinence only among heterosexual men. Conclusions. Perhaps because HIV is more common in gay communities, abstinence choices may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity.

HIV vaccines offer the best long-term hope of controlling the AIDS pandemic; yet, the advent of HIV vaccines will not ensure their acceptability. We conducted a cross-sectional survey (n = 143), incorporating conjoint analysis, to assess HIV vaccine acceptability among participants recruited using multi-site (n = 9), venue-based sampling in Los Angeles. We used a fractional factorial experimental design to construct eight hypothetical HIV vaccines, each with seven dichotomous attributes. The acceptability of each vaccine was assessed individually and then averaged across participants. Next, the impact of each attribute on vaccine acceptability was estimated for each participant using ANOVA and then analyzed across participants. Acceptability of the eight hypothetical HIV vaccines ranged from 33.2 (S.D. 34.9) to 82.2 (S.D. 31.3) on a 0–100 scale; mean = 60.0 (S.D. 21.9). Efficacy had the greatest impact on acceptability (22.7; CI: 18.5–27.1; p < 0.0001), followed by cross-clade protection (12.5; CI: 8.7–16.3, p < 0.0001), side effects (11.5; CI: 7.4–15.5; p < 0.0001), and duration of protection (6.1; CI: 3.2–9.0; p < .0001). Route of administration, number of doses and cost were not significant. Low acceptability of “partial efficacy” vaccines may present obstacles to future HIV vaccine dissemination. Educational and social marketing interventions may be necessary to ensure broad HIV vaccine uptake.

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare.

Using fMRI, we investigated the functional organization of prefrontal cortex (PFC) as participants briefly thought of a single just-experienced item (i.e., refreshed an active representation). The results of six studies, and a meta-analysis including previous studies, identified regions in left dorsolateral, anterior, and ventrolateral PFC associated in varying degrees with refreshing different types of information (visual and auditory words, drawings, patterns, people, places, or locations). In addition, activity increased in anterior cingulate with selection demands and in orbitofrontal cortex when a nonselected item was emotionally salient, consistent with a role for these areas in cognitive control (e.g., overcoming “mental rubbernecking”). We also found evidence that presenting emotional information disrupted an anterior component of the refresh circuit. We suggest that refreshing accounts for some neural activity observed in more complex tasks, such as working memory, long-term memory, and problem solving, and that its disruption (e.g., from aging or emotion) could have a broad impact.

BACKGROUND: Perceived discrimination in clinical settings could discourage HIV-infected people from seeking health care, adhering to treatment regimens, or returning for follow-up. OBJECTIVES: This study aims to determine whether HIV-infected people perceive that physicians and other health care providers have discriminated against them. DESIGN, PARTICIPANTS: Cross-sectional data (1996 to 1997) from the HIV Cost and Services Utilization Study (HCSUS), which conducted in-person interviews with a nationally representative probability sample of 2,466 HIV-infected adults receiving health care within the contiguous U.S. MEASUREMENTS: Reports of whether health care providers have been uncomfortable with the respondent, treated the respondent as an inferior, preferred to avoid the respondent, or refused the respondent service. Questions also covered the types of providers who engaged in these behaviors. RESULTS: Twenty-six percent of HIV-infected adults receiving health care reported experiencing at least 1 of 4 types of perceived discrimination by a health care provider since becoming infected with HIV, including 8% who had been refused service. White respondents (32%) were more likely than others (27%) and Latinos (21%) and nearly twice as likely as African Americans (17%) to report perceived discrimination (P

Prior studies have found that partner abuse is related to risky sexual behavior. However, few studies have explored gender, sexual orientation, or substance use differences in this association, especially among people with HIV. We examined data from the Risk and Prevention survey from the HIV Cost and Services Utilization Study (HCSUS) sample on 726 sexually-active individuals in three gender/orientation groups (286 women, 148 heterosexual men, and 292 gay/bisexual men). The study assessed whether individuals with HIV who experienced or perpetrated abuse within a close relationship were likely to engage in unprotected intercourse with that same partner. Both abuse perpetration and victimization were significantly associated with having any unprotected intercourse. In multivariate tests, gender/orientation and substance use during sex moderated the perpetration effects. Secondary HIV prevention interventions need to take into account potentially abusive contexts in which sexual activity may occur for both men and women.

Synthetic and kinetic studies on the 1,3-dipolar cycloaddition reactions of dicyano(phthalazin-2-ium-2-yl)methanide (1) with some substituted styrenes and ‘benzylidene acetones’ in MeCN and H2O containing 10 mol-% of MeCN are reported. The kinetic data were supported by theoretical calculations. The major products from styrenes were exo-2-aryl-1,2,3,10b-tetrahydropyrrolo[2,1-a]phthalazine-3,3-dicarbonitriles 3, and, from ‘benzylidene acetones’, 1-endo,2-exo-2-acetyl-1-aryl-1,2,3,10b-tetrahydropyrrolo[2,1-a]phthalazine-3,3-dicarbonitriles 7. There was no indication that the cycloadditon transition states were more polar in the aqueous environment than in MeCN.

Foods collected for radionuclide analysis under the Food and Drug Administration's (FDA's) Total Diet Study (TDS) Program were analyzed by the Center for Food Safety and Applied Nutrition (CFSAN) as quality assurance (QA) for analyses performed at FDA's Winchester Engineering and Analytical Center (WEAC). 200-ml QA portions were analyzed for gamma-ray emitting fission products and naturally occurring radionuclides. Efficiency, pileup correction, absorption effects, and accuracy were determined by analyzing a variety of certified reference materials and KNO3 and KCl solutions. 40K results agreed well with those from WEAC and with total K results from other techniques. Count times as low as 2 minutes were sufficient to confirm that radioactivity concentrations were below regulatory limits.

OBJECTIVE: Professional medical associations recommend that physicians who treat patients with human immunodeficiency virus (HIV) have a measurable form of disease-specific expertise, such as high HIV patient volume or infectious diseases certification. Although it is known that racial/ethnic minorities generally have worse access to care than do whites, previous work has not examined disparities in the use of physicians with HIV-related expertise.

Objective While gel-formulated rectal microbicides (RM) are the first to enter clinical trials, rectal douching in preparation for anal intercourse is a common practice; thus RMs formulated as douches may be a convenient alternative to gels. Nonetheless, little is known about potential users’ thoughts regarding douche-formulated RMs or rectal douching practices, data that is needed to inform the advancement of douche-based RMs. This qualitative study examined thoughts regarding douches, their use as an RM and current douching practices among men who have sex with men and transgender women. Methods 12 focus groups and 36 in-depth interviews were conducted (N=140) to examine the overall acceptability of RM, of which one component focused on rectal douching. Focus groups and interviews were recorded, transcribed verbatim and coded; text relating to rectal douching was extracted and analysed. Sociodemographic information was collected using a self-administered questionnaire. Results Support for a douche-formulated RM centred on the possibility of combined precoital hygiene and HIV protection, and it was believed that a deeply penetrating liquid douche would confer greater HIV protection than a gel. Drawbacks included rectal dryness, impracticality and portability issues, and potential side effects. Non-commercial douching apparatus use was common and liquids used included detergents, vinegar, bleach, lemon juice and alcohol. Conclusions A douche-formulated RM, while desirable and perceived as more effective than a gel-formulated RM, also generated questions regarding practicality and side effects. Of immediate concern were the non-commercial liquids already being used that likely damage rectal epithelia, potentially increasing HIV infection risk. Precoital rectal douching is common and an RM formulated as such is desirable, but education on rectal douching practices is needed now.