Os transtornos alimentares (TA) são doenças psiquiátricas graves que apresentam quadro complexo e de mau prognóstico. Acometem principalmente adultos jovens que não raramente abandonam o tratamento. O objetivo deste trabalho foi traçar o perfil da não adesão do tratamento de pacientes com TA de um serviço especializado e investigar os fatores associados. Trata-se de estudo transversal de caráter descritivo exploratório com delineamento do tipo caso-controle e quali-quantitativo, cuja coleta de dados se deu em duas etapas. Na primeira, os prontuários de todos os pacientes atendidos pelo serviço foram revisados para coletar dados sociodemográficos, clínicos e desfecho do tratamento. Na segunda etapa, seis participantes do sexo feminino que abandonaram o tratamento foram entrevistadas para coleta de dados antropométricos, alimentares (EAT-26), de imagem corporal (Escala de Figuras de Silhuetas) e investigar os motivos da não adesão. Os dados foram analisados pelo programa SPSS e foram utilizados os testes qui-quadrado, teste exato de Fisher, teste não paramétrico de Mann-Whitney e análise de regressão logística, além da análise de conteúdo temático. Como resultados, 156 (66,7%) pacientes abandonaram o tratamento (Grupo Abandono-GA) e 78 (33,3%) tiveram outros desfechos (Grupo Não Abandono-GNA): alta (n=55; 70,5%), óbito (n=02; 2,6%) ou estavam em seguimento no momento da coleta de dados (n=21; 26,9%). No GA, a maioria era do sexo feminino (n=140; 89,7%), de Ribeirão Preto e região (n=120; 76,9%), estudantes (n=86; 55,1%), solteiros (n=122; 78,2%) com escolaridade mínima do nível fundamental (n=45; 28,8%) e proporcionalmente com diagnóstico de bulimia nervosa (n=41; 80,4%). Foi encontrada diferença significativa entre os grupos na Hipótese Diagnóstica, Comorbidades Psiquiátricas, Depressão, Transtornos de Personalidade, Comorbidades Clínicas e Osteopenia. No GA, o primeiro (n=85; 54,5%) e o último atendimento (n=89; 57,05%) foram nos anos 2000, o estado nutricional foi de eutrofia tanto no primeiro (n=85; 54,5%) quanto no último atendimento (n=104; 66,7%) e ausência de amenorreia no momento inicial e final do seguimento. O estado nutricional apresentou significância estatística em relação ao desfecho do tratamento e a presença de comorbidade clínica atuou como fator protetor para o abandono. No momento atual, a maioria das participantes apresenta atitudes alimentares típicas dos TA, inacurácia da percepção corporal e insatisfação com a autoimagem. Os motivos para o abandono do tratamento foram multifatoriais envolvendo aspectos relacionados à equipe, ao protocolo de tratamento e à própria paciente. Como conclusão, a taxa de abandono do serviço é alta e a presença de comorbidade clínica atuou como fator protetor para o abandono. Pacientes com estado nutricional adequado e sem complicações clínicas são mais vulneráveis ao abandono e podem, a longo prazo, permanecer com os sintomas típicos dos TA. Pelo fato do abandono envolver questões multifatoriais, sugere-se capacitação dos profissionais da equipe, revisão e aprimoramento de protocolos de atendimento para melhor acolhimento, adesão e identificação prévia dos grupos de risco. Estudos prospectivos e baseados em evidências poderão contribuir para as pesquisas dirigidas especificamente à resistência ao tratamento e consequente não adesão de pacientes com TA, buscando uma melhor compreensão desses transtornos e seu tratamento / Eating Disorders (ED) are serious psychiatric illness which present a complex set of symptoms and signs and bad prognosis. ED affect mainly young adults who not infrequently dropout of treatment. This paper aims at outlining the profile of non-adherent patients from a specialized service suffering from ED and investigating associated factors. This is a cross- sectional study, of exploratory descriptive nature, with case-control and quali-quantitative approach, whose data collection occurred in two stages. In the first stage, medical records of all patients being treated by the service have been reviewed in order to collect social and demographic data, as well as clinical data and data related to the outcome of the treatment. In the second stage, six female participants who have dropped out of treatment have been interviewed for the purposes of collecting anthropometric, eating (EAT-26), body image (Silhouettes Scales) data and investigating the reason for their non-adherence. Data has been analyzed by SPSS program and the following tests have been used: chi-square, Fisher\'s exact test, Mann-Whitney U test and logistic regression analysis, besides theme-based content analysis. As a result, 156 (66.7%) patients dropped out of treatment (Dropout Group-DG) and 78 (33.3%) had different outcomes (Persisters Group-PG): medical discharge (n=55; 70.5%), death (n=02; 2.6%) or were still under treatment at the time of data collection (n=21; 26.9%). Among DG, most were female (n=140; 89.7%), from Ribeirão Preto and surroundings (n=120; 76.9%), students (n=86; 55.1%), single (n=122; 78.2%) at least with Junior and Elementary High School (n=45; 28.8%) and proportionally with a diagnosis of bulimia nervosa (n=41; 80.4%). A significant difference was found between the groups in terms of Diagnostic Hypothesis, Psychiatric Comorbidities, Depression, Personality Disorder, Clinical Comorbidities and Osteopenia. Among DG, the first (n=85; 54.5%) and last visits (n=89; 57.05%) were paid in the 2000\'s, nutritional status was eutrophia both in the first (n=85; 54.5%) and last visits (n=104; 66.7%) and absence of amenorrhea on the first and final moments of their treatment. Nutritional status has proved to be statistically significant regarding the outcome of the treatment and existence of clinical comorbidity has worked as a protective factor to prevent dropout. Currently, most participants assume eating attitudes typical of ED: inaccurate body perception and dissatisfaction with their self-image. Reasons for their dropping out treatment were due to many factors, involving aspects related to the team, to the treatment protocol and to patients themselves. As a conclusion, the dropping out rate of service is high and the existence of clinical comorbidity has worked as a protective factor to prevent dropout. Patients with an appropriate nutritional status and without clinical complications are more likely to dropout of treatment and may, on a long term, remain with symptoms typical of ED. As dropouts occur for multiple reasons, it is suggested: to qualify and train the team of professionals, review and improve service protocols in order to enhance receptiveness, adhesion and prior identification of risk groups. Prospective evidence-based studies could contribute to researches specifically driven to treatment resistance and consequent non-adherence of patients with ED, which could seek a better understanding of these disorders and their treatment

A síndrome mielodisplásica primária (SMD) compreende um grupo de doenças hematopoéticas clonal de célula tronco pluripotente cacacterizada por vários graus de pancitopenia e alterações morfológica das células hematopoeticas e risco aumentado de transformação para leucemia mielóide aguda. A citogenética e a morfologia da medula óssea desempenham um papel fundamental para o diagnóstico e o prognóstico desses pacientes. Alterações cromossômicas são encontradas em aproximadamente 30-50% dos casos. Devido à importância da análise desses fatores para escolha terapêutica, torna-se necessário definir as alterações morfológicas e citogenéticas que possam contribuir para o prognóstico. Esse trabalho visa correlacionar as características morfológicas e citogenéticas da medula óssea em pacientes com SMD primária com as classificações OMS e FAB e com o IPSS. Foram estudados 32 pacientes com SMD primária diagnosticados entre 2000 e 2009 no HUPE-UERJ. As características clínicas foram analisadas através do levantamento de prontuários. A análise citogenética foi feita pela técnica de bandeamento GTG em células da medula ossea. A análise morfológica da biópsia de medula óssea e do mielograma foram realizadas através da revisão de lâminas. Vinte e três pacientes foram classificados em estágios iniciais da doença (22 AR, 1 ARSA) e 9 em estágio avançado AREB de acordo com a FAB. Alterações cromossômicas foram detectadas em 16 pacientes (50%). As mais frequentes foram: del(11)(q23) e del(17p). Dos pacientes com doença avançada, seis (66%) apresentaram aumento significativo da relação M:E (p=0,003) e sete (77%) possuíam alterações arquiteturais acentuadas (p<0,001) em comparação ao grupo de doença inicial. Pacientes classificados como intermediário 2 e alto risco pelo IPSS tiveram importante perda arquitetural (p<0,001), número significativamente maior de micromegacariócitos (p=0,017) e seis (85%) sofreram transformação leucêmica (p=0,006). ALIP foi significantemente aumentada nos pacientes de pior prognóstico (p=0,0 1) e naqueles com doença avançada (p=0,001). Nossos resultados apresentaram implicações potenciais para o diagnóstico e o prognóstico da SMD primária. As alterações morfológicas foram associadas com as classificações FAB, OMS e com os grupos de risco segundo o IPSS. / The primary myelodysplastic syndrome (MDS) comprises a heterogeneous group of clonal bone marrow disorders characterized by varying degrees of pancytopenia and morphological abnormalities of hematopoietic cells, and an increased risk of transformation into acute myeloid leukemia. The morphology and the cytogenetic of bone marrow play a key role in the diagnosis and the prognosis. Chromosomal abnormalities are found in 30-50% of cases. Due to the importance of analyzing these factors for therapeutic choice, it becomes necessary to define the morphological and the cytogenetic changes which could contribute to the prognosis.The aim of this study was to analyze the morphological and cytogenetic features of bone marrow and their correlations with FAB and WHO clasification and IPSS. We studied 32 patients with primary MDS between 2000 - 2009. The clinical data was recovered from medical records. Morphological characteristics were analyzed through a review of bone marrow biopsies and mielogram slides. Cytogenetic analysis was performed by GTG banding from bone marrow cells. The patients were classified according to FAB in initial stages: RA (22 patients) and RARS (1 patient) and nine in advanced stages - RAEB. Chromosomal abnormalities were detected in 16 patients (50%). The most frequent abnormalities were: del(11)(q23) and del(17p). Patients with advanced disease, six (66%) had significant increased M:E ratio (p=0.003) and seven patients (77%) had increased architectural changes (p<0.001). Patients classified as intermediary 2 and high risk according IPSS had important architectural loss (p<0.001), presence of micromegakaryocyte was considered significant higher (p=0.017) and six patients (85%) underwent leukemia transformation (p=0.006). ALIP was significant higher in the patients with a worse prognosis (p=0.021) and advanced stage of disease (p=0.001). Our results showed potential implications for diagnosis and prognosis of MDS. The morphological findings in this study were associated with FAB and WHO groups and prognostic risk (IPSS).

During my time spent as a practitioner teacher I experienced that students lack of interest for the studies of religion. Nonetheless, students tend to have questions regarding their identity and existential health, questions that, arguably, could be discussed in the scholar of religion. I wished to see if one could increase the interest in religious studies by understanding the students’s health issues and their ideas of existential health. The psychology of religion aims to answer and reflect upon questions regarding health and the well-being of humans. The aim of current study was to explore how adolescents describe their identity in relationship to existential questions. The following research questions were posed:   How do young people express aspects that relate to existential health and identity on the BRIS homepage chat forum? How can these descriptions be interpreted based on Melder's theory of existential health and Erikson's theory of self-development? Can the above analysis contribute to increasing the conditions for pupils' perceived relevance and interest in the teaching of religion in high school?   The method used to answer these was qualitatively targeted content analysis. The qualitative data was generated from the adolescents different expressions, coded with Open Code 4.03. Data were gathered from a Swedish children’s rights organization, BRIS (Barnens rätt i samhället)chat forum and included posts from adolescents between 12 and 18 years old. The material is posted over 2 months, September-October, 2018. The phenomenon was investigated with the help of Erik H Erikson and Cecilia Melder’s theories. Erikson's theory is used based on his theories on the development of young people and its stages. By applying Melder’s theory I was able to search for aspects and parts of the material that could be understood and explained by some or more of the eight existential aspects that, according to the theory, affect the overall self-valued health a person experiences. The result of this study shows that with the help of Erikson’s theory, we can receive knowledge on how young people develop. With Melder's theory we can show the eight existential aspects of the material to reach a deeper understanding of the health of young people. In conclusion, the study also contributes to a further comprehension in how religious studies can be conducive when trying to understand existential health and ideas of identity among adolescents.

Individuals who sell drugs are often mandated by legal forces to substance abuse treatment because of their criminal offenses and the belief they may have a drug problem. Previous researchers have noted this population may be disruptive in the treatment process, but it has not been explored in depth. The purpose of this phenomenological study was to learn the lived experiences of counselors who work with individuals who report a primary problem of selling drugs, not substance abuse, who are mandated to a substance abuse treatment program. Thirteen semi structured interviews were conducted with counselors who have worked with individuals who sell drugs that were mandated to participate in a correctional-based therapeutic community substance abuse treatment program. Interviews were transcribed and analyzed with the assistance of NVivo for meaning and themes. Data were examined through the theoretical lens of the social learning theory (SLT). The results of the study indicated counselors were prepared for their jobs through education and training to have longevity in working in a correctional environment and provided treatment services. The counselors found that individuals who sell drugs had a history substance use, which the individuals minimized. During treatment, counselors sought to challenge individuals who sell drugs to think and explore the effects of their behaviors. Counselors found individuals who sell drugs were able to engage in treatment to avoid negative consequences. The results of this research can encourage positive social change by initiating a discussion about assessments prior to drug treatment, characteristics of drug treatment program participants, and counselor training to improve quality of drug treatment services provided.

Hearing loss affects millions of Americans each year, especially targeting older Americans. Elders aged 65-75 years are affected as much as 38% and those numbers rapidly rise to over 42% affected by the time a person is 75 years of age. The rise in the numbers of older persons in the United States makes hearing loss the third most common chronic illness in the US today. Of these persons approximately 30% chose to purchase hearing aids, but an astounding 47.2% of these individuals are able to adjust to the hearing aids in order to wear them daily. Ambient sounds and physical discomfort, from the presence of the device in the ear cause individuals either to never wear the devices or stop wearing them after a short time. This dissertation focused on an intervention to assist those older persons who have purchased hearing aids, but are not wearing them, in adjusting to those aids; in order to improve hearing aid satisfaction and hours of hearing aid use. A one group pre/posttest design was implemented on a group of individuals who had previously failed to adjust to hearing aids between the ages of 65-75 years of age. The Glasgow Hearing Aid Benefit Profile (GHABP) and hours of hearing aid use time were the primary outcome variables. This intervention study occurred over a four week period of time, with weekly face-to-face meetings with participants. Findings demonstrated that the intervention was feasible to administer in a group of community dwelling older persons (aged 65-75 years). All 15 participants completed the entire intervention, meeting each of 4 times with the researcher over a four week period. 40% of volunteers later declined to participate and 48% were turned away due to the small sample size of this study. An overall increase of hearing aid use time was between 1-9 hours per day. A Wilcoxin signed rank test was performed with a result of 60 (p=<0.0001). Participants who increased their hearing aid use time >4 hours equaled 53% while 46.7% increase their hearing aid use time <4 hours. Hearing aid satisfaction as measured by the GHABP improved between 1-5 with a median of 4. The Wilcoxin signed rank test result was 22.5 with a p value of 0.0039. These results deem the intervention not only feasible, but statistically significant in improving both hearing aid use time and hearing aid satisfaction. Future studies should be aimed at advanced statistical analysis, randomized clinical trial with larger numbers to improve power, and expanding the age criteria for study inclusion. Implications for future research are great, improving communication in older persons, but also perhaps impacting third party reimbursement of hearing aids, as well as decreasing the biopsychosocial effects hearing loss has on the population as a whole.

Science fiction films may be viewed as existing as threads within a web, and at the same time constituting the web. The metaphor is apt: texts and contexts and their relationship have a difficult accommodation with each other, an interdependent and dynamic relationship. The text is a thread in the web, as are elements of context, yet the threads are in a symbiotic and constantly changing relationship with each other, as the web is constantly in a state of renewal and change. At the same time, the text itself is a web, as are the various contexts. The threads are both ephemeral and fleeting, while incredibly strong. This thesis is about the polysemy of science fiction film: its subject is the films of the fifties that belong to the genre of science fiction. But the area of study began as an investigation of the science in science fiction films; the way in which films construct that science, the end result of that construction and the totality of the discourse of science in relation to other discourses of power and influence. The investigation of those issues involves a multi-layered investigation into science fiction, in a similar way to Tulloch and Alvarado's approach to the Dr Who television series.1 Approaching science fiction films from a perspective of genre, as in chapter one, uncovers a set of arguments about the science in science fiction, as well as establishing the global nature of some science fiction. These concerns lead into the discussion in chapter two of the social and historical context of the fifties, specifically in the US. Science plays a major role in these contexts, in the sense of the importance of science in creating these contexts (from this perspective) as well as the effects of the application of this science. But the historical and cultural contexts tend to suggest that science fiction films are in large part both a response to the social and historical context, and also create that context. This would not be quite accurate: the production of many science fiction films mobilise other arguments, arguments relating to the industry of Hollywood, and the specific industrial context that gave rise to some very financially successful science fiction films, as well as some films where the budget was good for a few days filming. Science and technology are sometimes important elements in this industrial context as well. Part II traces the nature of science in these films, using the contexts in Part I to anchor the science and its implications and effects. Foregrounded is the debate in which science is both key player and, in many cases, antagonist. The debate is traced and the various representations of science and its nature are tracked and highlighted. Science can cause change, by virtue of its nature of uncovering superstition, but the worth or desirability of that change is open to question. The control of science is a related issue. The thesis examines science at a period that saw the efflorescence of science fiction films. The examination of those films tells us a great deal about the concerns of the time, as well as the science that figures so powerfully in the webs of culture of the fifties.

Men who have sex with men (MSM) are disproportionately affected by HIV infection and account for more than half of all new HIV infections diagnosed in the U. S. The purpose of this study was to explore factors that influence sexual behavior among sexually active HIV positive MSM using constructs from the health belief model (HBM). A cross-sectional, correlational study was conducted with a non-randomized sample of 216 HIV positive MSM. Participants were predominantly Black/African American (85.6%). The mean age of the sample was 43.02 years (SD = 9.74) and ages ranged from 19 to 66. More than 90% reported a high school educational level or greater; and nearly half (47.2%) had been diagnosed with HIV for more than 10 years. The overall model predicted that participants who had perceived less severity of living with HIV and who had a positive attitude toward condom use were more likely to practice safer sex, accounting for 24% of the variance in sexual behavior (p < .001). When controlling for demographic characteristics (age, number of years diagnosed as HIV positive, number of recent sexual partners, and current antiretroviral medication use), the overall model accounted for 41% of the variance (p < .001). Participants who had a fewer number of recent sex partners and who had a positive attitude toward condom use were more likely to practice safer sex. Additionally, those who practiced safer sex (n = 58, 27%) reported significantly higher levels of perceived severity of living with HIV (p = .037), perceived benefits of safe sex (p = .018), perceived barriers to safe sex (p < .001), and self-efficacy for negotiating safe sex (p = .013) compared to those who did not practice safer sex (n = 157, 73%). Results from the study indicated there was a high prevalence of unsafe sexual practices among the participants. These findings support the need for additional research to explore factors that influence sexual behavior among HIV positive MSM with an emphasis on testing interventions that support safe sex practices.

Användandet av obehandlat avloppsvatten inom jordbruket är en växande företeelse i många delar av världen. Speciellt i vattenfattiga områden där avloppsvattnet ses som en värdefull och pålitlig resurs. Det höga näringsinnehållet minskar behovet av konstgödsel och detta ökar böndernas inkomster. Men med användandet av avloppsvattnet följer vissa hälsorisker. Bland annat har man sett en högre förekomst av inälvsmaskar hos bönder som använder orenat avloppsvatten jämfört med de som använder rent vatten. Den här vattenkvalitetstudien har utförts längs floden Musi i Andhra Pradesh, Indien. Musi rinner igenom staden Hyderabad och mycket av stadens avloppsvatten dumpas i floden. Nedströms Hyderabad används detta vatten för bevattning. Längs med floden är dammar byggda, för att avleda vattnet i bevattningskanaler. Reservoirer bildas då flödeshastigheten minskar. Studieområdet sträcker sig från Hyderabad och 28.7 km nedströms. Hypotesen var att reservoirerna fungerar som biodammar och syftet var att kvantifiera dammarnas inverkan på vattenkvaliteten och utvärdera dess lämplighet utifrån ett hälso- och jordbruksperspektiv. Inom studieområdet är reningen med avseende på BOD, Nematoder och E coli 86,9%, 99,9% respektive 99,9%. Trots att reningen är så hög överstiger Nematod- och E coli-koncentrationerna Världshälsoorganisationens riktlinjer och utgör en hälsorisk för bönder och konsumenter. Syre- och salthalt ökar nedströms och den höga salthalten kan ha negativ inverkan på jordbrukets avkastning. Genom att titta på reningsmönster och förändring av olika vattenkvalitetsparametrar är en av slutsatserna av detta arbete att reningen i dammarna motsvarar den rening som sker i de anaeroba bassängerna i ett biodammsystem. / The use of untreated domestic sewage in agriculture is a growing practice in many parts of the world. It is being looked upon as a valuable and reliable resource in water scarce communities. Wastewater is usually rich in nutrients and the use results in high yields without the need for artificial fertilisers. But with the use of untreated wastewater follows a number of associated health risks, e.g. a higher prevalence of helminth infections has been seen among wastewater users compared to non-users. This water quality study was performed along the River Musi in Andhra Pradesh, India. The Musi River flows through the city of Hyderabad carrying the most of the town’s wastewater. Downstream of Hyderabad the wastewater is used by farmers for irrigation. Along the river weirs are constructed which diverts the irrigation water into canals and reservoirs are formed where the flow velocity slows down. The study area stretches from Hyderabad and 28.7 km downstream. The hypothesis was that the existing irrigation infrastructure acts like Wastewater Stabilisation Ponds and the aim was to quantify the impact of the weirs on water quality and to evaluate the irrigation water quality in reference to associated health risks and agricultural suitability. Within the study area the BOD, E coli and Nematode removals were 86.9%, 99.9% and 99.9% respectively. Despite the high removal the E coli and Nematodes, the concentrations exceed WHO guidelines for unrestricted and restricted irrigation, and there exists an excess risk of intestinal nematode- and enteric infections for farmers. Dissolved oxygen and salinity increases downstream and due to the high salinity farmers could experience reduced crop yields. By looking at removal patterns, and the change in water quality parameters, the conclusion can be made that the reservoirs act like anaerobic ponds in a Wastewater Stabilisation Pond system.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety. Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist. Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden. Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower. Team member introductions, patient ID, planned surgery and antibiotic prophylaxis had highest compliance. Theatre nurse responsibilities in Timeout, particularly sterility and positioning of the patient had low compliance. During Sign In the majority of theatre nurses greeted the patient in the operating room and everyone performed skin control. One theatre nurse asked the patient about allergies/intolerance. The theatre nurses participated rarely in Sign Out. Conclusions: The study showed that there are large differences in compliance between items of the checklist. Theatre nurses can increase their participation by being more involved in the surgical team communication and thus clearly demonstrate her responsibilities in the perioperative nursing. Revisited routines and continuous monitoring may be needed for increased checklist compliance

Objective: The rectal mucosa is highly susceptible to HIV infection. Mucosal fluid contains soluble immune proteins that influence HIV infection, and previous studies have shown unique mucosal protein expression in HIV-exposed seronegative (HESN) populations, which may contribute to reduced HIV susceptibility. However, the key correlates of susceptibility at the rectal mucosa have not been well defined, which is a critical knowledge gap for our understanding of HIV pathogenesis. Methods: Rectal lavage from low risk men was screened for HIV-neutralizing activity in a TZM-bl reporter cell line against an R5-tropic HIV virus. Label-free tandem mass spectrometry was used to characterize soluble proteins within rectal lavage samples from a low-risk cohort of men (n=15), and HESN men who have sex with men (MSM; n=25). Protein expression between populations was compared using adjusted t tests (p<0.05), and was interpreted using hierarchical clustering and DAVID biofunctional analysis. Protein expression was further analyzed using survey data on sexual behaviours. Proteins associated with the HESN population were screened for antiviral activity in TZM-bl and PBMC culture against an R5- and X4-tropic virus. Major Results: Rectal mucosal fluid was able to inhibit HIV infection in vitro by 40% (p<0.05). Mass spectrometry identified 30/341 (9%) proteins deferentially expressed (DE) in HESN MSM. DE proteins held functions in immunity (p=6.68x10-6, p=0.001) and epithelial barrier development (p=1.81x10-4; p=0.01); notably, specific antiproteases were elevated in HESN secretions, two of which were screened for antiviral activity. Serpin B4 (+2.52 L2FD; p=1.09x10-5), showed significant inhibition of HIV in TZM-bl (45% BaL, 34% IIIB; p<0.05) and PBMC culture (37% BaL, 49% IIIB; p<0.05); cystatin A (+1.52 L2FD; p=1.40x10-3) showed no inhibitory effects. Serpin B4 expression was not associated with frequency of oral intercourse (p=0.32), partner viral load (r=0.16; p=0.29) or presence of HIV neutralizing IgA in secretions (p=0.52). Conclusions: This thesis reports the use of proteomics to understand HIV-susceptibility at the rectal mucosa, and identified serpin B4 as a novel antiviral immune correlate in a population of HESN MSM. These results may help guide future studies of prevention technologies, such as microbicides or vaccines, which would ultimately help limit the spread of HIV. / February 2016