This study tests whether musculoskeletal markers are attributable to occupational categories. It is hypothesized that individuals over the age of 30 years with a lifetime occupation as a laborer will demonstrate a significantly different pattern of activity markers from individuals in the white collar classifications. A sample of n=69 from the Maxwell Museum's Documented Skeletal Collection are investigated. Upper and lower extremities were scored for MSM type (robusticity, stress lesions, and ossification exostoses) and severity (grades 0 - 3) following Hawkey and Merbs (1995) visual reference system. To evaluate methodological approaches to MSM scoring, ossification exostoses and stress lesions were also scored using the Mariotti et al. (2004) proposed methods. Upper limb muscle insertion sites on the humerus, radius, and ulna and lower limb insertion sites on the femur, fibula, patella, calcaneus, and tibia were studied. The Kruskal Wallis test was used to predict occupational class according to an individual's aggregate MSM z-score. The Mann-Whitney test was used for comparison of aggregate MSM z-scores between the two occupational categories and for comparison of aggregate MSM z-scores between males and females. The Spearman correlation was used for non-parametric correlation analysis of aggregate MSM z-scores and the occupational categories of white collar and labor. The data were analyzed using the statistical software program SPSS (version 17.0). Results of this study show that musculoskeletal markers cannot statistically predict, nor can they be used to distinguish between, occupational categories of white collar and labor. Comparison of MSM shows no significant difference in the overall patterns of enthesopathies between individuals who report an occupation of white collar or those who report an occupation of laborer as defined by the U.S. Office of Personnel. Comparison of MSM in this population shows no significant difference between males and females, regardless of occupational category, a finding which runs counter to many earlier studies. Using dichotomous data it is revealed that laborers develop MSM symmetrically, evidence of whole-body activity. Further, white collar MSM can be associated with sitting and elevating the arm. Laborer's MSM are associated with lifting, twisting, pushing, squatting, walking, running and standing. Recommendations on methodology are provided.

BACKGROUND: Although the total number of new documented HIV diagnoses annually decreased from 2008-2018, the rate of decrease started to slow in 2013, and substantial variation exists across at-risk groups. People who inject drugs (PWID) account for 9% of new diagnoses annually, with increasing incidence in this population starting in 2015. Among PWID, 34% of new HIV diagnoses occurred in individuals who were also classified as men who have sex with men (MSM), indicating that MSM-PWID have elevated HIV risk. Data on MSM-PWID are scarce, and programmatic and advocacy efforts in HIV prevention do not specifically target MSM-PWID, with no CDC-recommended interventions existing for this population. OBJECTIVE: We sought to characterize the complex, intersecting and unique HIV risks faced by MSM-PWID, including perceptions of HIV risk and attitudes toward antiretroviral pre-exposure prophylaxis (PrEP) among MSM-PWID in urban and non-urban areas of Massachusetts and Rhode Island. METHODS: We recruited PWID through community-based organizations (CBOs; e.g. syringe service programs) in 18 urban centers and smaller cities and towns across Massachusetts and Rhode Island. Participants completed semi-structured interviews exploring substance use behaviors and HIV prevention needs. This in-depth analysis focused on describing the experiences and HIV prevention needs and attitudes of nine participants in the sample who reported a sexual orientation other than “heterosexual.” RESULTS: Most participants identified as cisgender, bisexual men. However, the context of their sexual behaviors varied, with some participants only engaging in same-sex behavior during sex work. The relationship between identity and behavior is explored in the context of reported risk behavior. All participants engaged in at least one behavior that increased risk of HIV acquisition, including syringe sharing, inconsistent condom use, and sex work. Participants also described heightened risk when these behaviors overlapped, particularly within contexts of “sex parties” that some individuals described. At the same time, experiences of isolation and exclusion were common in the sample, indicating a potential vulnerability in this population. HIV risk perception varied among participants, but was not consistently aligned with the behaviors described. Many participants did not perceive needing HIV prevention services “yet,” indicating that they did not view their risk to be high enough to warrant prevention services. Alternatively, some described needing to prioritize daily survival and mental health over HIV prevention efforts. Although knowledge of PrEP was low, acceptability of PrEP was high in this sample, and several participants provided specific suggestions for improving the feasibility of PrEP. CONCLUSION: Data from this study illustrate the HIV risks and prevention needs of this at-risk population and highlight mechanisms to engage them in preventative care. Our main findings are (1) participants had low knowledge of PrEP, but were largely enthusiastic after learning about it from interviewers, (2) varying identity related to same-sex behavior among men who have sex with men and inject drugs may play a role in shaping HIV risk and prevention needs, (3) specific healthcare and prevention service needs of this population emerged, including reducing risk at sex parties and improving access to non-stigmatizing mental health services. An in-depth understanding of the ways in which sexual orientation and gender identity shape HIV risk and prevention needs remains crucial in providing treatment and prevention services to MSM-PWID.

The incidence rate of HIV among Black males having sex with Black males (BMSM) is high compared to that of other racial groups. Researchers have established the association between inappropriate sexual practices, age, income, and environmental determinants and HIV positive status among BMSM. Guided by resilience theory, the purpose of this study was to examine the relationship between HIV risk behavior and resiliency with the goal of identifying a new intervention to mitigate the HIV infection rate in the BMSM community. The theoretical framework used for this study was the resilience theory. This theory is concern with the phenomenon of why some people thrive after period of catastrophic adversity while others do not. A quantitative research design was used to test for a correlation between psychosocial resilience and HIV risk behavior. Fifty seven respondents were included in the study, 28 who were HIV positive, and 29 who were HIV negative. The Risky Behavior Questionnaire and the Resilience Survey were used to collect study data. The main study finding was a significant correlation between resilience and sex-related HIV risk behaviors, including unprotected sex, a lack of awareness of HIV status, multiple male sexual partners, and alcohol and drug use during sex. According to study findings, BMSM with higher resilience might be less likely to engage in sex-related HIV risk behaviors than those with low resilience. Strategies to mitigate HIV transmission could include resilience training. The benefit to the society would be reduced HIV infections transmission due to reduced risky HIV behaviors. The population social change would be the importance of the resiliency practice among BMSM in an effort to dispel the fear about the disease.

Efforts to reduce the spread of human immunodeficiency virus (HIV) and find innovative alternatives to condom use are important public health challenges. While the incidence of HIV is leveling off among some populations, it is escalating in other populations such as young African American men who have sex with men (MSM). Guided by the health belief model (HBM) and the AIDS risk reduction model (ARRM), this quantitative, cross-sectional study sought to use multiple linear regression, binary logistic regression, and Fisher's exact test to determine how perceived susceptibility, as measured by the AIDS Health Belief Scale (AHBS), and labeling of unprotected receptive anal intercourse (URAI) risk predicted the preference for prevention products and the number of self-reported sexual activities among MSM who seek sexual partners on the Internet. This study also sought to determine any ethnic differences in the preference for prevention products among these men. Due to the limited sample size (N = 19), there were no significant relationships between the independent variables (i.e., AHBS Score, URAI Risk, or ethnicity) and dependent variables (i.e., product preference or sexual activity). Moreover, covariates of age and alcohol/drug use were not significant in this study. The implications of positive social change include new insights into designing culturally-sensitive, Internet-based, HIV interventions for hard-to-reach and hidden populations that protect their privacy.

HIV incidence among Black men who have sex with men (BMSM) is extremely high in contrast to their estimated population size and compared to other racial groups. Researchers have established that a significant proportion of these new cases annually originate from HIV transmission by BMSM who are unaware of their HIV status. The purpose of the study was to assess the relationship between age, sexual behavior, social support, substance use, internalized homophobia, depression, and HIV test history in BMSM. Guided by the social ecological model (SEM) as the conceptual framework, a quantitative cross-sectional study was designed to analyze secondary data from the HIV Prevention Trials Network Study 061. Bivariate and multivariate logistic regression was used to estimate the association. The research goal was to identify strategies to engage BMSM with infrequent/nonexistent HIV testing history into testing services. While there was very little difference between the bivariate and multivariate models, the results indicated that BMSM who were younger in age, had lower levels of internalized homophobia, and were recruited at a particular study site were more likely to have tested for HIV in the past 12 months. The other variables did not show a significant relationship to HIV testing history. Implications for positive social change included informing HIV prevention and testing messages and strategies that will result in an increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories. This increase in HIV testing among BMSM with infrequent/nonexistent HIV testing histories will reduce the number of BMSM who are unaware of their HIV status and who may subsequently transmit HIV to their sexual partners unknowingly.

ABSTRACT Health Service Utilization and Stigma among HIV-Positive Men-Who-Have-Sex-With-Men (MSM) in Rural Appalachia by Roger Lee Blackwell The world has now entered the third decade of the AIDS epidemic. Men-who-have-sex-with-men continue to be disproportionately affected by HIV/AIDS. The United States still struggles in its response to this ongoing crisis in many areas: disease prevention, treatment, and HIV related stigma, prejudice and discrimination. Much of the information reported on MSM living with HIV has come from urban population centers, but only a few studies have focused on HIV positive MSM living in rural areas. Therefore, the overall aim of this dissertation was to explore the lived experiences of MSM living with HIV/AIDS, in particular the intersection of HIV related stigma with social, behavioral and health outcomes in rural, South Central Appalachia. For this dissertation, data were collected via semi-structured, face-to-face interviews with 23 HIV-positive MSM living in South Central Appalachia. Using a descriptive narrative approach, the researcher sought to address the influence of HIV/AIDS related stigma in the lives of these men and provide a forum for their voices. Qualitative data were sorted into various categories from which emergent themes and topics were generated using Nvivo software for data management and manipulation. In addition to qualitative interviews, demographic data were gathered and analyzed to produce basic, descriptive statistics. Results indicated that MSM participating in this study accessed health services through various agencies. MSM also experienced stigma in multiple and overlapping ways; MSM described stigmatizing experiences stemming from religious sources, communities, family and friends, and from the medical establishment. Moreover, it was revealed that homophobia and HIV-related stigma were related; participants did not differentiate between the two. Homophobia and HIV related stigma were specifically contextualized in relation to rurality and religiosity. The use of health related services was not mediated by stigma. The results within this dissertation are intended to inform health professionals in the planning and implementation of interventions and treatments for this hidden population in Appalachia. This exploratory dissertation provides insight and contextual information for a highly stigmatized population. Lastly, this project provided rural MSM with a voice.

Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population.

No description available.

Este trabalho visa o projeto, modelagem e fabricação de estruturas multicamadas baseadas em polímeros para aplicações como sensores ópticos integrados. A grande motivação para este trabalho está no fato de que estas estruturas, diferente da geometria Mach-Zehnder, dispensam o uso de litografia pois são completamente planares. Isto permite uma diminuição no custo de fabricação dos dispositivos além de permitir que estruturas mais curtas sejam utilizadas. Em se tratando de óptica integrada, as dimensões reduzidas da estrutura impõem severas penalidades no processo de lançamento de potência óptica na mesma. Por isso, será considerada neste estudo a utilização de prismas para o acoplamento de entrada do acoplador. Esta técnica, além de reduzir drasticamente os problemas de alinhamento decorrentes de acoplamento convencional do tipo \"End Fire\", permite uma transferência de potência óptica superior a 80% entre a fibra e o guia retangular. As variações na transferência de potência entre os guias de ondas da estrutura multicamada serão medidas através de um fotodetetor MSM integrado ao sensor. Este detetor, além de sua extrema facilidade de fabricação e baixos custos, torna o conjunto sensor mais robusto. Em se tratando de uma proposta de plataforma para sensores, serão também investigadas possíveis aplicações para esta estrutura, como por exemplo: refratômetro integrado, sensor de glicose, sensor de adulteração de combustível, etc. A análise das estruturas será efetuada por meio de técnicas de modelagem analíticas (Técnica da Matriz de Transferência - TMT e Teoria de Modos Acoplados - TMA), e numéricas (Método da Propagação de Feixe de Ângulo Largo formulado em Diferenças Finitas - WA-FD-BPM). Esta última permite que a estrutura do fotodetetor seja levada em consideração simultaneamente nas simulações. / This work concerns with design, modeling and fabrication of polymer based planar multilayer structures for integrated optic sensor applications. The motivation for this work is that planar multilayer structures, differently from the Mach-Zehnder geometry, do not require a lithographic process. As a consequence, significantly cheaper and shorter structures can be realized. The reduced dimensions of the structure, by its turn, pose a severe penalty in terms of optical power coupling. Therefore, this investigation will focus primarily on input (and output) prism coupling configuration. This technique, besides reducing the alignment requirements observed for conventional end-fire coupling, allows optical power coupling efficiency as high as 80% from fiber to rectangular waveguide. Any optical power transfer between the waveguides of the multilayer structure will be detected by an MSM photodetector integrated with the sensor. This low cost photodetector, besides improving the structure robustness, is quite ease to fabricate. Since the idea of this work is to develop a platform for integrated optic sensors, it will also be investigated possible applications for this structure, such as: integrated optic refractometer, glucose sensor and fuel adulteration sensor. The analysis of such structures will be carried out by means of analythical (Transfer Matrix Technique-TMT and Coupled Mode Theory-CMT) and numerical (Wide-Angle Finite Difference Beam Propagation Method-WA-FD-BPM) modeling techniques. The WA-FD-BPM technique allows one to simulate the multilayer waveguide and the MSM photodetector simultaneously.

Este trabalho visa o projeto, modelagem e fabricação de estruturas multicamadas baseadas em polímeros para aplicações como sensores ópticos integrados. A grande motivação para este trabalho está no fato de que estas estruturas, diferente da geometria Mach-Zehnder, dispensam o uso de litografia pois são completamente planares. Isto permite uma diminuição no custo de fabricação dos dispositivos além de permitir que estruturas mais curtas sejam utilizadas. Em se tratando de óptica integrada, as dimensões reduzidas da estrutura impõem severas penalidades no processo de lançamento de potência óptica na mesma. Por isso, será considerada neste estudo a utilização de prismas para o acoplamento de entrada do acoplador. Esta técnica, além de reduzir drasticamente os problemas de alinhamento decorrentes de acoplamento convencional do tipo \"End Fire\", permite uma transferência de potência óptica superior a 80% entre a fibra e o guia retangular. As variações na transferência de potência entre os guias de ondas da estrutura multicamada serão medidas através de um fotodetetor MSM integrado ao sensor. Este detetor, além de sua extrema facilidade de fabricação e baixos custos, torna o conjunto sensor mais robusto. Em se tratando de uma proposta de plataforma para sensores, serão também investigadas possíveis aplicações para esta estrutura, como por exemplo: refratômetro integrado, sensor de glicose, sensor de adulteração de combustível, etc. A análise das estruturas será efetuada por meio de técnicas de modelagem analíticas (Técnica da Matriz de Transferência - TMT e Teoria de Modos Acoplados - TMA), e numéricas (Método da Propagação de Feixe de Ângulo Largo formulado em Diferenças Finitas - WA-FD-BPM). Esta última permite que a estrutura do fotodetetor seja levada em consideração simultaneamente nas simulações. / This work concerns with design, modeling and fabrication of polymer based planar multilayer structures for integrated optic sensor applications. The motivation for this work is that planar multilayer structures, differently from the Mach-Zehnder geometry, do not require a lithographic process. As a consequence, significantly cheaper and shorter structures can be realized. The reduced dimensions of the structure, by its turn, pose a severe penalty in terms of optical power coupling. Therefore, this investigation will focus primarily on input (and output) prism coupling configuration. This technique, besides reducing the alignment requirements observed for conventional end-fire coupling, allows optical power coupling efficiency as high as 80% from fiber to rectangular waveguide. Any optical power transfer between the waveguides of the multilayer structure will be detected by an MSM photodetector integrated with the sensor. This low cost photodetector, besides improving the structure robustness, is quite ease to fabricate. Since the idea of this work is to develop a platform for integrated optic sensors, it will also be investigated possible applications for this structure, such as: integrated optic refractometer, glucose sensor and fuel adulteration sensor. The analysis of such structures will be carried out by means of analythical (Transfer Matrix Technique-TMT and Coupled Mode Theory-CMT) and numerical (Wide-Angle Finite Difference Beam Propagation Method-WA-FD-BPM) modeling techniques. The WA-FD-BPM technique allows one to simulate the multilayer waveguide and the MSM photodetector simultaneously.