Correlates of PrEP Uptake Among Young Sexual Minority Men and Transgender Women in New York City: The Need to Reframe "Risk" Messaging and Normalize Preventative Health.

Pre-exposure prophylaxis (PrEP) is an effective form of HIV prevention, but young sexual minority men face myriad barriers to PrEP uptake. Participants (n = 202) completed a survey on healthcare experiences and beliefs about HIV and PrEP. While 98% of the sample knew about PrEP, only 23.2% reported currently taking PrEP. Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV "risk", highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.

An "appropriate technology" trans-femoral prosthesis, using materials available in Nepal.

The use of western components and materials for prostheses is prohibitively expensive in most developing countries. In addition, local customs and conditions vary considerably from those for which the prostheses were designed. For these reasons, a trans-femoral prosthesis has been developed in Pokhara, Nepal, using entirely locally available materials, and with a view to fulfilling local requirements as far as possible. This paper describes the materials and fabrication technique for the component parts of the prosthesis, the local conditions for which it was developed, and a three year follow-up of the first prosthesis issued. Only one serious design fault was discovered during this period, and a modification to the fabrication procedure introduced. The authors believe that if this trend continues, this style of prosthesis may be useful in the future for Nepali amputees and perhaps also in other countries, particularly where mass production of components is not practical.

Different approaches and cultural considerations in third world prosthetics.

The major objective of prosthetics the world over is the same, i.e. to restore the amputee to as functional a capacity as possible in his cultural environment, whilst attaining as good a cosmetic result as can be achieved. At first glance it would seem that this would mean there would be very little difference in approach to the subject in western and in third world countries. Availability of materials, resources and skilled personnel, together with a variety of cultural differences, however, make third world prosthetics a subject in itself. This paper reviews the literature available on the subject, examines some different approaches to prosthetics in the third world, gives an overview of some materials and designs used and considers adaptations for cultural differences. It concludes that, whilst direct transfer of western prosthetics technology is useful in the short term, for long term benefit to the poorer amputees in the third world, culture-specific designs and materials are more appropriate.

Rehabilitation engineering and leprosy in Nepal: a personal view.

Green Pastures Hospital is a specialist leprosy hospital in Pokhara, Nepal. As part of its service it offers a range of appliances aimed to assist in the rehabilitation of patients. This paper outlines the different orthoses and prostheses made at the Orthopaedic Appliances Centre in the hospital, their various indications and some of the benefits and problems associated with their use. Specific reference is made to the requirements related to local conditions and customs. The terrain, communications, facilities and materials available in Nepal make the work of the few rehabilitation engineers in the country somewhat different from that of those in the West. Some of these differences are described, drawing out contrasts in technical requirements of appliances and in organizational structures in the field of rehabilitation in the UK and Nepal.

The development of a prototype patella tendon bearing prosthesis using high-density polyethylene piping (the drainpipe leg).

In Nepal, the few centres that offer a lower limb prosthetics service generally use a laminate of polyester resin with cotton stockinette in the manufacture of the hard socket and cosmesis. Until 1989 this was also the only process used at Green Pastures Hospital in Pokhara. In response to a materials shortage brought about by a local international trading dispute, however, a prototype patella tendon bearing prosthesis was developed using high-density polyethylene piping. The terrain of Nepal, local walking habits, and therefore expectations of a prosthesis, differ considerably from those in the United Kingdom; hence some unusual design requirements are needed to be taken into consideration. This paper describes the progress of the design over several months and the constraints under which the work was carried out. Feedback was sought at the meeting at which the paper was presented, and would also be valued in response to this written account of the work.

A study of the uniaxial mechanical properties of human dura mater preserved in glycerol.

Heart valve replacements have now been made for some years from human dura mater. While the clinical results have been encouraging there is a considerable lack of information on the mechanical properties of the dura mater and the effects of the glycerol treatment employed. This study revealed that glycerol provided an adequate preserving medium for periods of up to 12 days, with no significant changes in the mechanical properties of dura mater. A wide range in mechanical properties was observed with, for example, the tensile strength varying from 3.28 N/mm2 to 7.86 N/mm2. Although no age-related deterioration in human dura mater could be shown, the results do suggest that dura mater in excess of fifty years of age should be avoided in order to prevent the selection of poor quality material.