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OBJECTIVE: Effectiveness of evidence-based psychotherapy (EBP) for PTSD can vary based on gender and trauma type, with poorer outcomes for men and sexual traumas. Among veterans receiving EBPs for PTSD, the effects of the interaction between gender and military sexual trauma (MST) on treatment outcome are unclear. This study examined how gender and MST impact PTSD symptoms following cognitive processing therapy (CPT) and prolonged exposure (PE). METHOD: We conducted a national, retrospective cohort study of all post 9/11 veterans who had a PTSD diagnosis from 10/2001-9/2017 at VHA facilities and >1 psychotherapy visit. Inclusion criteria included completion of ≥8 CPT/PE sessions and pre- and post-treatment PCL (N = 9711). Mixed-effects linear regression models were conducted, separately by treatment, to examine associations between changes in PTSD symptoms and gender, MST, and their interactions with time. RESULTS: For both treatments, there were no significant differences in pre-treatment PCL by gender or MST, and PCL decreased significantly over time. In adjusted models, only the gender by time interaction on pre-to-post-CPT change was significant (p < .001); the decrease in women's PCL was 2.67 points greater, compared to men. CONCLUSIONS: Women veterans demonstrated greater reductions in PTSD symptoms from CPT. There were no differences by gender for PE, suggesting men and women veterans benefit similarly. Results suggest outcomes may be impacted by gender socialization when utilizing certain cognitive behavioral techniques. MST, regardless of gender, did not impact PTSD outcomes for either treatment. Both CPT and PE may thus be effective for veterans irrespective of MST history.

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Harnessing electrical bias-induced mechanical motion on the nanometer and molecular scale is a critical step toward understanding the fundamental mechanisms of redox processes and implementation of molecular electromechanical machines. Probing these phenomena in biomolecular systems requires electromechanical measurements be performed in liquid environments. Here we demonstrate the use of band excitation piezoresponse force microscopy for probing electromechanical coupling in amyloid fibrils. The approaches for separating the elastic and electromechanical contributions based on functional fits and multivariate statistical analysis are presented. We demonstrate that in the bulk of the fibril the electromechanical response is dominated by double-layer effects (consistent with shear piezoelectricity of biomolecules), while a number of electromechanically active hot spots possibly related to structural defects are observed.

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The mesoscopic reversible and irreversible polarization dynamics in polycrystalline PZT thin film capacitors are studied using local spectroscopic mapping and macroscopic first-order reversal curve measurements. The transition from a regime of short range domain wall motion to the formation of mesoscopic clusters to complete switching is observed. The fractal dimension of the clusters is consistent with the random-bond disorder model. The combination of macroscopic and local measurements allows the characteristics length scales corresponding to the transition from Rayleigh to Preisach behaviors and onset of macroscopic averaging to be determined.

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Near-field intensity statistics in semicontinuous silver films over a wide range of surface coverage are investigated using near-field scanning optical microscopy. The variance of intensity fluctuations and the high-order moments of intensity enhancement exhibit local minima at the percolation threshold. This reduction in local field fluctuations results from resonant excitation of delocalized surface plasmon modes. By probing the modification of the critical indices for high-order moments of intensity enhancement caused by the delocalized states, we provide the first experimental evidence for the coexistence of localized and delocalized surface plasmon modes in percolating metal films.

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Spatial intensity correlation functions are obtained from near-field scanning optical microscope measurements of semicontinuous metal-dielectric films. The concentration of metal particles on a dielectric surface is varied over a wide range to control the scattering strength. At low and high metal coverages where scattering is weak, the intensity correlation functions exhibit oscillations in the direction of incident light due to excitation of propagating surface waves. In the intermediate regime of metal concentration, the oscillatory behavior is replaced by a monotonic decay as a result of strong scattering and anomalous absorption. Significant differences in the near-field intensity correlations between metallic and dielectric random systems are demonstrated.

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OBJECTIVES: To determine trends in HIV infection and risk behaviors among street-recruited self-identified gay and bisexual male injection drug users (IDUs) in San Francisco. METHODS: Trends in HIV infection and risk behaviors were calculated for gay/bisexual ( n = 1594 interviews) IDUs in 26 semiannual cross sections from 1988 to 2000. RESULTS: HIV seroprevalence among gay/bisexual IDUs decreased from the range of 35% to 45% in 1988/1989 to 25% in 1996 and then began to increase, reaching 42% in 2000. In contrast, HIV prevalence among heterosexual male IDUs remained stable during the study period. For gay/bisexual IDUs, injection and sex-related HIV risk behaviors declined modestly throughout the study period. As of the last cross section (July 2000), however, over a third of respondents reported recent syringe sharing or unprotected anal sex. CONCLUSIONS: Gay/bisexual men who inject drugs continue to be at elevated risk for HIV, suggesting that interventions such as amphetamine drug treatment and sexual risk reduction programs targeted at this population are needed.

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OBJECTIVES: This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. METHODS: From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. RESULTS: Of the 1427 participants, 684 (48%) had had an overdose, 466 (33%) had experienced 2 or more overdose events, and 182 (13%) had had a recent overdose. In multiple logistic regression, being younger (adjusted odds ratio [OR] for each year of increasing age = 0.95; 95% confidence interval [CI] = 0.94, 0.97), having been arrested 3 or more times in the past year (adjusted OR = 2.50; 95% CI = 1.61, 3.87), drinking 4 or more alcoholic drinks per day (adjusted OR = 2.05; 95% CI = 1.37, 3.05), and having participated in methadone detoxification during the past year (adjusted OR = 1.47; 95% CI = 1.03, 2.09) were independently associated with recent overdose. Being homeless; identifying as gay, lesbian, bisexual, or transgender; having spent 5 or more years in prison or jail; and having engaged in sex work also were associated with recent overdose. CONCLUSIONS: Targeted interventions that decrease risk for overdose are urgently needed.

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Heroin overdoses increased sharply in the US in the 1990s, but few studies have addressed overdose risk. We examined overdosing and injection-related risk behavior in young injection drug users (IDUs). We interviewed all consenting injectors under age 30 at needle exchanges and youth outreach sites in San Francisco. Their median age was 22, and their median number of years of injecting was 4. About 48% reported at least one overdose, with a median of two overdoses reported. Overdosing was associated with injecting "speedballs" (i.e. mixtures of heroin and cocaine), with borrowing syringes, and (with P-values of borderline statistical significance) with heroin injection and with gay or bisexual behavior. It was not associated with age, sex, years of injecting, or frequency of injecting. In multivariate analysis, only borrowing syringes and gay or bisexual behavior were independent statistically significant predictors, probably because gay and bisexual subjects were more likely to be heroin or "speedball" injectors. Most subjects (65%) reported that they had not received medical attention at time of last overdose. Risk of overdose in young injectors is acute and closely associated with HIV risk. HIV interventions should include overdose prevention. Emergency response protocols should minimize risk of arrest. Injectors and providers should be trained in overdose prevention, and developing overdose interventions should be a priority among drug educators.

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OBJECTIVE: To compare the demographic characteristics and risk behaviors for hepatitis B infection among injection drug users younger than 30 years with those aged 30 or older and to evaluate participants' knowledge, attitudes, and experiences of infection, screening, and vaccination against hepatitis B virus. DESIGN: A systematic sample of injection drug users not currently in a treatment program were recruited and interviewed at needle exchange programs and community sites. PARTICIPANTS: 135 injection drug users younger than 30 years and 96 injection drug users aged 30 or older. RESULTS: Injection drug users younger than 30 were twice as likely as drug users aged 30 or older to report having shared needles in the past 30 days (36/135 [27%] vs 12/96 [13%]). Injection drug users younger than 30 were also twice as likely to report having had more than two sexual partners in the past 6 months (80/135 [59%] vs 29/96 [30%]). Although 88 of 135 (68%) young injection drug users reported having had contact with medical providers within the past 6 months only 13 of 135 (10%) had completed the hepatitis B vaccine series and only 16 of (13%) perceived themselves as being at high risk of becoming infected with the virus. CONCLUSION: Few young injection drug users have been immunized even though they have more frequent contact with medical providers and are at a higher risk for new hepatitis B infection than older drug users. Clinicians caring for young injection drug users and others at high risk of infection should provide education, screening, and vaccination to reduce an important source of hepatitis B infection.

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The mechanism of adaptation of bacteria to survive at elevated temperature in the human host and the expression of heat-shock proteins in response to stress was examined by labelling with [35S]methionine. An increase in culture temperature from 26 degrees C to 37 degrees C induced expression of certain bacterial proteins (70 and 60 kDa). Heat shock at 40 degrees C, cold shock (10 degrees C), ethanol treatment or arsenite treatment also led to an increased expression of heat shock proteins of 70 and 60 kDa. Actinomycin D completely blocked the induction, indicating that transcription is required for the overexpression of stress proteins in Leuconostoc mesenteroides. N-terminal sequence analysis showed that these proteins were homologous to the highly conserved chaperone proteins DnaK and GroEL of Escherichia coli, respectively.

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This study reports the various steps involved in the design of a simplified information system for leprosy (OMSLEP), developed in cooperation between the Unit of Epidemiology, University of Louvain, Belgium, and WHO. The objective of the system is to permit the evaluation of a) the efficiency of programs within the context of established strategies and norms; b) the effectiveness of leprosy control methods from an epidemiological point of view; c) the efficacy and productivity of certain program components. Prior to designing the system, the relevant epidemiological and operational indices have been reviewed. A survey was also made of the forms used by some 78 leprosy control schemes throughout the world in order to analyze the current information now being collected. The proposed system is described. It includes individual record form to be filled at registration and once yearly in subsequent years of follow-up, a detection form, and an annual statistics form for the tabulation of total patients. The system is presently being tested in some 15 countries.

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PIP: A lineral programming model is used to determine the contraceptive mix necessary to achieve birthrate targets set forth in India's Fifth Plan, with cost the major componenet. To achieve the target within the budget of Rs. 5160 million more emphasis must be put on conventional contraceptives and IUDs. To achieve birthrates of 25/1000 by 1983-1984 as set forth in the Sixth Plan, 3 times as many sterilizations (to 4.5 million). 11 times as many IUD users (5.5 million) and 6 times as many users of conventional contraceptives (18.5 million) will be needed. Sterilizations will have greater long-term benefits.^ieng

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PIP: An evaluation pertaining to the achievement of the objectives of India's family planning program is presented. The general conclusion is that very limited success has been achieved in curbing the birthrate and in creating an awareness of the population problem and of family planning methods among the masses. A gap between knowledge of contraceptive methods and the practice of such methods exists. About 15% of reproductive couples use contraceptive methods, and the birthrate has declined by about 10% from its level of 41.7 per 1000 in 1961. The impact of the family planning program has been much less in rural than in urban areas. There has been an upward trend of age at marriage for women. Immunization and nutrition programs have been undertaken in family welfare planning centers, and treatment for sterile couples and recanalization of sterilized cases have also been given attention in order to emphasize that family planning is meant for family welfare. Equal status for men and women has been pursued so that couples will be content with a small family, regardless of the sex of the children.^ieng

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