Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study.

Internalized homophobia, or the internalization of negative attitudes toward one's sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort Study.

We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18-22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development-the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.

Social support network characteristics and sexual risk taking among a racially/ethnically diverse sample of young, urban men who have sex with men.

Associations between social support network characteristics and sexual risk among racially/ethnically diverse young men who have sex with men (YMSM) were examined using egocentric network data from a prospective cohort study of YMSM (n = 501) recruited in New York City. Bivariate and multivariable logistic regression analyses examined associations between social support network characteristics and sexual risk taking behaviors in Black, Hispanic/Latino, and White YMSM. Bivariate analyses indicated key differences in network size, composition, communication frequency and average relationship duration by race/ethnicity. In multivariable analyses, controlling for individual level sociodemographic, psychosocial and relationship factors, having a sexual partner in one's social support network was associated with unprotected sexual behavior for both Hispanic/Latino (AOR = 3.90) and White YMSM (AOR = 4.93). Further examination of key network characteristics across racial/ethnic groups are warranted in order to better understand the extant mechanisms for provision of HIV prevention programming to racially/ethnically diverse YMSM at risk for HIV.

Evaluation of various laboratory assays in detection of heparin-induced thrombocytopenia in an adult general ICU.

INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. Our objective was (i) to compare various laboratory assays for HIT against clinical probability (4-T score) and (14) C-serotonin release assay (SRA), which was the composite gold standard and (ii) to determine the incidence of HIT in the ICU. METHODS: The study group (n = 217) consisted of consecutive ICU patients with heparin exposure followed by thrombocytopenia. The clinical probability (4-T score) was applied to the study group. Enzyme-linked immunosorbent assay (ELISA), particle gel immunoassay (PGIA), SRA, and platelet aggregation assay (PAA) were performed. RESULTS: The 4-T score showed that 1/217 patients had high probability, 48 had intermediate probability, and 168 had low probability for HIT. One patient was positive by SRA, three by PGIA, and 33 by ELISA. The incidence based on a combination of clinical features and laboratory findings was 1.8%. CONCLUSIONS: A greater number of false positives were observed by ELISA than by PGIA when compared to a composite gold standard of SRA and clinical probability. The incidence of SRA-positive HIT was 0.46% (1/217).

Standardization of fungal polymerase chain reaction for the early diagnosis of invasive fungal infection.

BACKGROUND: An early initiation of antifungal therapy in invasive fungal infections (IFIs) is critical in reducing the high mortality rate. Current diagnosis of fungal infection relies on microscopy, culture, antigen, antibody specific tests and histological diagnosis. However, these tests either lack sensitivity or specificity. There is thus the need for a rapid, specific and accurate diagnostic method. OBJECTIVE: The aim of our study was to establish PCR for the rapid detection of Candida and Aspergillus species in clinical specimens with improved sensitivity and specificity. MATERIALS AND METHODS: A total of 71 proven cases of IFI (confirmed by culture) were collected. A total of 15 healthy, 15 patients suffering from bacterial sepsis and 15 patients with HIV, HBV viral infections were included as controls. Clinical specimens were subjected to a standardized nested amplification to produce Round I (504 bp) and Round II (150 bp) amplicons. Restriction digestion was performed on these products for further identification. RESULTS: Analytical sensitivity was determined using 106-10 CFU/ml of cell suspension. The lower detection limit of the assay was 10 CFU/ml of blood. This test was 100% sensitive and specific with a positive predictive value of 100% and a negative predictive value of 96.7%. CONCLUSION: The assay was found to be effective for the rapid detection of Candida and Aspergillus in clinical specimens.

Longitudinal determinants of consistent condom use by partner type among young injection drug users: the role of personal and partner characteristics.

We investigated the longitudinal influence of individual-, relationship- and social-level factors on condom use by partner type among young injections drug users (IDUs) enrolled in the Collaborative Injection Drug Users Study-III/Drug Users Intervention Trial (CIDUS-III/DUIT) from 2002 to 2004. Based on longitudinal analysis using generalized estimating equations (GEE), consistent condom use with main partners was more commonly reported among males and those with greater self-efficacy for condom use; main partner's desire for pregnancy and needle sharing were negatively associated with consistent condom use. Among those with casual partners, having fewer sex partners was associated with consistent condom use. Positive attitudes toward condom use and partner norms supporting condom use were associated with greater consistent condom use with both partner types. These findings suggest that intervention strategies targeting individual- and partner-level factors may provide avenues for intervening upon sexual risks among young IDUs.

Correlates of consistent condom use with main partners by partnership patterns among young adult male injection drug users from five US cities.

This paper examined correlates of consistent condom use with a main partner among heterosexual male injection drug users (IDUs). Using data from a multi-site sample of young IDUs, we identified 1770 sexually active men of whom 24% (429/1770) reported an exclusive main female sex partner and 49% (862/1770) reported both main and casual female sex partners. Consistent condom use with a main partner was low among men with an exclusive main partner and those with multiple partners (12% and 17%, respectively). In multivariate analysis, consistent condom use with a main partner across partnership patterns was directly associated with anticipating a positive response to requests for condom use and by partner support of condom use; consistent condom use was inversely associated with a main partner's pregnancy desires. Among men with an exclusive main partner, consistent condom use was also inversely associated with needle sharing with a main partner. Among men with multiple partners, consistent condom use with a main partner was inversely associated with injecting with a used needle and intimate partner violence. The low prevalence of consistent condom use with main female partners among heterosexually active male IDUs indicates an increased risk for HIV transmission between men and their primary sex partners. Interventions for heterosexual males that are geared toward increasing condom use in primary relationships are warranted.

Treatment of acute infectious purpura fulminans with activated protein C.

Infectious purpura fulminans is associated with high mortality and morbidity despite standard antimicrobial therapy. We report satisfactory clinical outcome in two children with sepsis associated purpura fulminans who were treated with activated protein C (APC). There is need for proper evaluation of the efficacy of this extremely expensive therapeutic modality by randomized controlled trials before it is made standard of care in childhood infectious purpura fulminans.

Factors associated with interest in initiating treatment for hepatitis C Virus (HCV) infection among young HCV-infected injection drug users.

OBJECTIVE: We sought to identify factors associated with interest in receiving therapy for hepatitis C virus (HCV) infection among HCV-infected injection drug users (IDUs) in 3 United States cities. METHODS: IDUs aged 18-35 years who were HCV-infected and seronegative for human immunodeficiency virus underwent surveys on behaviors, experience, and interest in treatment for HCV infection and readiness to quit drug use. RESULTS: Among treatment-naive IDUs (n=216), 81.5% were interested in treatment for HCV infection, but only 27.3% had seen a health-care provider since receiving a diagnosis of HCV infection. Interest in treatment for HCV infection was greater among IDUs with a high perceived threat of progressive liver disease, those with a usual source of care, those without evidence of alcohol dependence, and those with higher readiness scores for quitting drug use. Interest in treatment for HCV infection was 7-fold higher among IDUs who were told by their health-care provider that they were at risk for cirrhosis or liver cancer. CONCLUSIONS: Improving provider-patient communication and integrating treatments for substance abuse and HCV may increase the proportion of IDUs who initiate treatment for HCV infection.

Low response rate schools in surveys of adolescent risk taking behaviours: possible biases, possible solutions.

STUDY OBJECTIVE: To examine the potential biases introduced when students in low response rate schools are dropped from classroom based surveys of adolescent risk taking behaviour. DESIGN: Self administered confidential surveys were conducted in classrooms, with follow up visits to each school to survey students absent during the initial survey administration. Data on students in schools that achieved a 70% response rate are compared with data on students in schools that did not achieve this level of response. SETTING: New York City, United States. PARTICIPANTS: 1854 10th graders in 13 public (state supported) high schools. MAIN RESULTS: Students in schools with low response rates resulting from high rates of absenteeism have different demographic characteristics and engage in more risk behaviours than students in schools with low absenteeism and high response rates. Excluding schools with low rates of response can have an effect on estimates of risk behaviour, even after data are weighted for individual absences. The potential for bias is greatest when, in sampling schools, the proportion of schools with low response rates is large, and when such schools represent a large share of the students in the area under study. CONCLUSIONS: Excluding schools with poor response rates from survey samples using a classroom based approach does not improve, and may, under some circumstances, underestimate risky behaviour among adolescent populations.

Changing patterns of airway accidents in intubated ICU patients.

OBJECTIVE: To document the changes in patterns of airway accidents in intubated patients. DESIGN: Prospective recording of all airway accidents over two periods: 1994-1997 and 1998-1999. PATIENTS: Ventilated patients (5,046) intubated for 9,289 days over 4 years (1994-1997) and 2,932 ventilated patients intubated for 6,339 days over 2 years (1998-1999). MEASUREMENTS: The incidence and pattern of airway accidents over a 2-year period were compared to an earlier similar analysis done in the previous 4 years. RESULTS: The total accident rate in the 1994-1997 period was 36 in 5,046 patients over 9,289 intubated-patient days. The total accident rate in the period 1998-1999 was 20 in 2,932 patients over 6,339 intubated-patient days. The frequency of blocked tracheal tube increased to equal that of unplanned extubation (UE) of endotracheal tube (ETT) as the commonest airway accident. There were nine episodes of blocked tracheal tube in the two current years compared to four in the previous 4 years and there were nine episodes of UE in the two current years compared to 15 in the previous 4 years. There were a total of 18 ETT accidents in 2,930 patients over 5,309 ETT days compared to a total of two tracheostomy accidents in 67 patients over 1,030 tracheostomy days. CONCLUSIONS: We noted a change of the pattern of airway accidents. We noted an increasing trend in the incidence of blocked tracheal tubes, associated with an increased duration of heat and moisture exchanger-filters use. We also noted that the incidence of tracheostomy tube accidents was similar to that of ETT accidents in the current study, unlike the earlier study where tracheostomy tube accidents were more frequent than ETT accidents. This was due to the elimination of tracheostomy tube displacements during the later study period. We associated this with the use of adjustable tracheostomy length tubes.

Airway accidents in intubated intensive care unit patients: an epidemiological study.

OBJECTIVE: To assess the rate of occurrence and nature of airway accidents in intubated patients. DESIGN: Prospective recording of all airway accidents in a 16-bed multidisciplinary intensive care unit. PATIENTS: A total of 5,046 ventilated patients intubated for 9,289 days during 4 yrs. MEASUREMENTS AND MAIN RESULTS: We determined the number and diagnoses of intubated and ventilated patients, the number and timing of airway accidents, the type of tracheal tube used and duration for which the tube was in situ, the description of the type of accident, the severity of the accident, and its impact on the course of the patient's illness, whether the patient needed reintubation, and whether the accident was preventable. The total accident rate was 36 of 5,046 patients during 9,289 intubated patient days; 26 occurred in 5,043 endotracheally intubated patients during 8,446 patient endotracheal tube days. There were 10 tracheostomy-related accidents from a total of 79 patients with tracheostomies during 843 tracheostomy patient days. Six had severe consequences and one resulted in death. Eleven were completely preventable, 17 partly preventable, and 8 were considered unpreventable. Self-extubation was the most common accident. Seven of 13 self extubations occurred in patients due for elective extubation in the next few hours. Twelve of 15 patients with self- or accidental extubation of an endotracheal tube accidents did not require reintubation. CONCLUSIONS: Airway accidents occurred at low levels with even lower rates of resultant morbidity and mortality. Tracheostomy accidents are more common than those with an endotracheal tube.

Mechanical ventilation: simplifying the terminology.

There is presently considerable ambiguity and confusion relating to ventilator terminology. This can be eliminated using a simple approach, visualising mechanical ventilation as an inspiratory pump, and defining trigger, limit, and cycling in this context. The trigger is the signal that starts a breath by opening the inspiratory valve, the limit is the factor which controls the way gas flows into the lung, and the cycle is the signal that stops the breath by closing the inspiratory valve and opening the expiratory valve. By identifying these three basic parameters, one can precisely dissect and interpret any of the vast ventilatory terminology.