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Latinos in the United States have been disproportionately affected by the HIV epidemic. The purpose of this study was to identify potential themes for inclusion in effective HIV prevention interventions for Mexican American men who have sex with men (MSM). The authors used a phenomenological design to explore the lived experiences of Mexican American MSM who had grown up in Dallas, Texas, regarding protective factors for HIV infection. A total of 20 30- to 60-year-old Mexican American MSM participated in semistructured interviews. During data analysis, the following themes concerning protective behaviors for HIV emerged: (a) accepting one's sexuality; (b) machismo; (c) being in love; (d) respect for family, self, and life; and (e) having HIV-living now. Strategies for potential inclusion in HIV prevention interventions geared toward Mexican American MSM were identified based on these themes. The recommendations encompass modification of behavioral interventions and related social policies.

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BACKGROUND: Hospitals use time-motion studies to monitor process effectiveness and patient waiting. Manual tracking is labor-intensive and potentially influences system performance. New technology known as indoor positioning systems (IPS) may allow automatic monitoring of patient waiting and progress. The authors tested whether an IPS can track patients through a multistep preoperative process. METHODS: The authors used an IPS between October 14, 2005, and June 13, 2006, to track patients in a multistep ambulatory preoperative process: needle localization and excisional biopsy of a breast lesion. The process was distributed across the ambulatory surgery and radiology departments of a large academic hospital. Direct observation of the process was used to develop a workflow template. The authors then developed software to convert the IPS data into usable time-motion data suitable for monitoring process efficiency over time. RESULTS: The authors assigned tags to 306 patients during the study period. Eighty patients never underwent the procedure or never had their tag affixed. One hundred seventy-seven (78%) of the remaining 226 patients successfully matched the workflow template. Process time stamps were automatically extracted from the successful matches, measuring time before radiology (mean +/- SD, 77 +/- 35 min), time in radiology (105 +/- 35 min), and time between radiology and operating room (80 +/- 60 min), which summed to total preoperative time (261 +/- 67 min). CONCLUSIONS: The authors have demonstrated that it is possible to use a combination of IPS technology and sequence alignment pattern matching software to automate the time-motion study of patients in a multidepartment, multistep process with the only day-of-surgery intervention being the application of a tag when the patient arrives.

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STUDY DESIGN: Clinical literature consistently identifies women as more susceptible to trauma-related neck pain, commonly resulting from soft tissue cervical spine injury. Structural gender differences may explain altered response to dynamic loading in women leading to increased soft tissue distortion and greater injury susceptibility. OBJECTIVE: Identify anatomic gender differences in cervical spinal geometry that contribute to decreased column stability in women. SUMMARY OF BACKGROUND DATA: Previous studies investigating male and female vertebral and vertebral body geometry demonstrated female vertebral dimensions were smaller. However, populations were not size matched and parameters related to biomechanical stability were not reported. METHODS: Computed tomography scans of the cervical spine were obtained from size-matched young healthy volunteers. Geometrical dimensions were obtained at the C4 level and analysis of variance determined significant gender differences. RESULTS: Two volunteer subsets were size matched based on sitting height and head circumference. All geometrical measures were greater in men for both subsets. Vertebral width and disc-facet depth were significantly greater in men. Additionally, segmental support area, combining interfacet width and disc-facet depth, was greater in men, indicating more stable intervertebral coupling. CONCLUSION: Present results of decreased linear and areal cervical dimensions leading to decreased column stability may partially explain increased traumatic injury rates in women.

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BACKGROUND: Latinos have been disproportionately affected by HIV, placing young Latino men who have sex with men (MSM) at increased risk within this ethnic community. OBJECTIVES: The study explored the lived experience of growing up as a young Latino MSM and motivators to HIV risk behaviors. DESIGN: Five young Latino MSM ages 18 to 25 years were enrolled in a qualitative, phenomenological study using semistructured interviews followed by a HIV risk-taking behavior survey. RESULTS: A relationship was identified between patterns of belonging and self-acceptance of sexual orientation and motivators of HIV sexual risk-taking behavior. La familia, machismo, hiding, and guilt were themes related to belonging and self-acceptance. CONCLUSIONS: The need to belong and be accepted by the family and self-acceptance of sexual orientation are related to the HIV sexual risk-taking behavior of young Latino MSM. J Am Psychiatr Nurses Assoc, 2008; 14(4), 310-316. DOI: 10.1177/1078390308321926.

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BACKGROUND: Capacity constraints necessitate improving hospital efficiency. An integrated real time system facilitating patient flow between the post-anesthesia care unit (PACU) and surgical ward would ease PACU workload by reducing the effort of discharging patients. METHODS: We developed INCOMING!, a web-based platform that monitors patient progress from the operating room to the PACU. INCOMING! integrates available data, automatically determining when a patient enters the PACU. An automated paging system alerts clinical unit managers to 'pull' their patients from the PACU after a set recovery period. General surgery patients were included in the INCOMING! system in late 2004 with paging added in mid-March 2005. Mean PACU length of stay was calculated for the intervention group (general surgery patients with INCOMING!) and compared to a control group (general surgery patients without INCOMING!) and an orthopedic surgery group before and after paging. RESULTS: The system successfully gathers data and generates automated pages when events occur. After paging, there was a significant difference between the orthopedic surgery control group and the general surgery intervention group (235 min versus 185 min, P = 0.001). The mean PACU LOS decreased in the INCOMING! intervention group by 26 min while the mean LOS increased by 28 min in the general surgery control group (P = 0.27). CONCLUSION: Pilot implementation demonstrates that INCOMING! performs the desired integration and automatic notification. Given the minimal cost and potential large gains from a wider deployment, we plan to implement the system for all PACU patients and all post-PACU care units.

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